人工真皮联合自体刃厚皮移植治疗严重烧伤后瘢痕挛缩的疗效及其感染相关因素分析OA

Objective To explore the efficacy of artificial dermis combined with autologous split-thickness skin transplantation in the treatment of severe burn scar contracture and to analyze the factors related to infection.Methods From January 2022 to February 2025,120 patients with severe post-burn scar contracture treated in Burn Department of our hospital were enrolled.They were randomly divided into a control group(treated with autologous split-thickness skin grafting)and an observation group(treated with artificial dermis combined with autologous split-thickness skin grafting).Outcomes including skin graft survival rate,wound healing rate,adverse events,activities of daily living,scar status,and quality of life were compared between the two groups.Based on the occurrence of postoperative infection,patients were further classified into an infection group(n=13)and a non-infection group(n=107),and the distribution characteristics of pathogenic microorganisms were analyzed.Baseline data were collected and compared between the two groups.Logistic regression was used to identify risk factors for postoperative infection in severely burned patients,and a nomogram prediction model was constructed based on the results.The discrimination,calibration,and clinical utility of the model were evaluated using ROC curve,calibration curve,and decision curve analyses,respectively,to comprehensively assess its predictive performance.Results The observation group demonstrated superior outcomes compared to the control group in terms of skin graft survival rate,wound healing rate,ADL scores,VSS scores and BSHS-B scores,along with a lower incidence of adverse events(P<0.05).The postoperative infection rate was 10.83%,with Gram-negative bacteria being predominant(53.84%).Logistic regression analysis identified age,length of hospital stay,and preoperative WBC count as independent risk factors for postoperative infection in severe burn patients.The nomogram prediction model showed an AUC of 0.883(95%CI:0.767-0.999)on ROC analysis,with a sensitivity of 0.872 and specificity of 0.620.The Hosmer-Lemeshow goodness-of-fit test yielded χ²=12.95,P=0.114.Conclusion The combination of artificial dermis with autologous split-thickness skin grafting promotes wound healing and improves functional and quality-of-life outcomes.Age,length of hospital stay,and preoperative WBC count are independent risk factors for postoperative infection.The nomogram model constructed based on these factors provides a quantitative tool for clinical risk assessment and intervention planning.