双层人工真皮联合自体瘢痕表皮移植修复手足烧伤后瘢痕挛缩疗效观察OA

Objective To explore the effect of double-layer artificial dermis combined with autologous scar epidermal transplantation on the repair effect of scar contracture after burns on hands and feet.Methods From June 2021 to June 2023,108 patients with scar contracture after burns in our hospital were selected as the research objects.According to the wishes of the patients,they were divided into the observation group and the control group according to the random number table method,with 54 cases in each group.The observation group used double-layer artificial dermis combined with autologous scar epidermal transplantation,while the control group used autologous medium-thickness skin transplantation.The postoperative skin graft survival rate,wound infection rate,wound healing time,VSS score,and levels of wound inflammatory factors[γ Interferon(IFN-γ),Tumor Necrosis Factor-α(TNF-α),Interleukin-1(IL-1)]and growth factors[Vascular Endothelial Growth Factor(VFGF),Transforming Growth Factor β1(TGF-β1)]were statistically compared between the two groups.Results There was no significant difference in skin graft survival rate between the two groups(P＞0.05).The wound infection rate in the observation group was 3.70%,which was lower than 16.67%in the control group(P＜0.05).The complete healing time of the recipient site in the observation group was significantly longer than that in the control group(P＜0.05),but the healing time of the donor site in the observation group was significantly shorter than that in the control group(P＜0.05).At 6 and 12 months after operation,the VSS scores of the skin recipient site in the observation group were higher than those in the control group(P＜0.05),but the VSS scores of the skin donor site in the observation group were lower than those in the control group(P＜0.05).On the 7th day after operation,there was no significant difference in the levels of inflammatory factors between the two groups(P＞0.05),but the levels of VFGF and TGF-β1 in the observation group were higher than those in the control group(P＜0.05).Conclusion The use of double-layer artificial dermis combined with autologous scar epidermal transplantation shows a survival rate similar to that of medium-thickness skin grafting and a lower wound infection rate in the surgical area.It can increase the expression of growth factors such as VFGF and TGF-β1 after surgery,not only it has a good effect on improving scar contracture in patients with burns on hands and feet,it can also shorten the wound healing time and reduce scar formation in the donor area.