CN103961747A - Method for transplanting body skin particles in granulation wounds so as to treat burns and various refractory wounds - Google Patents
Method for transplanting body skin particles in granulation wounds so as to treat burns and various refractory wounds Download PDFInfo
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- CN103961747A CN103961747A CN201410206437.0A CN201410206437A CN103961747A CN 103961747 A CN103961747 A CN 103961747A CN 201410206437 A CN201410206437 A CN 201410206437A CN 103961747 A CN103961747 A CN 103961747A
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Abstract
The invention discloses a method for implanting body skin particles in granulation wounds so as to treat burns and various refractory wounds, and belongs to the technical field of medical treatment. The method comprises the following steps: (1) forming a granulation wound; (2) transplanting body skin particles; (3) performing post-operation nursing. The method for implanting the body skin particles in the granulation wounds so as to treat deep burns and chronic refractory wounds has the advantages that 1, general anesthesia is not needed in the technology, only tumescent anesthesia is performed on a skin grafting site, and anesthesia is not needed in a recipient site; 2, the wound is not subjected to cutting, peeling, scraping and other treatments, a fresh granulation wound is directly subjected to skin particle transplanting, and is covered and banded by a moisturizing dressing; 3, allogenic skin or xenograft skin is not needed to serve as coverage to guide a material in a skin particle transplanting site. According to the method, the operation wound is small with less blood loss, and the risk is small since general anesthesia is not needed, and allogenic skin or xenograft skin is not needed to serve as coverage to guide a material in the skin particle transplanting site, so that possibilities of rejection reactions and infectious diseases can be avoided, the technical difficulty is low, the operation is simple, and the treatment cost is greatly reduced.
Description
Technical field
The present invention relates to field of medical technology, relate in particular to autologous microparticle skin and be implanted in granulation wound treatment burn and various wound surface in refractory to treatment method.
Background technology
Special severe burn patients is because self skin injury is large, gradient of infection is serious, complication is more, therefore sealing burn wound is the key of successfully treating, Chinese scholar adopts the autologous microparticle skin of the floating method row of microparticle skin to transplant more, has saved autologous skin consumption, can make divergence ratio reach 10: 1, reduce operation number of times, accelerated wound healing.The employing latexes such as Sun Yonghua are transplanted and have also been obtained good clinical effectiveness.These traditional extensive deep burn wound surface application Micro-skin autografts have been applied 28 years, its topmost advantage is the microparticle skin after transplanting, the main migration that relies on microparticle skin edge epidermis cell, expand as far as possible wound repairing area, be best suited for the treatment of especially big deep burn, be at home and abroad widely used at present.But traditional extensive deep burn wound surface is applied in autologous microparticle skin transplant operation, emphasize to cut completely, eliminate or strike off burn wound's total necrosis eschar or established granulation tissue after anesthesia, by cutting, cut, scrape operation, burn wound is changed into after new wound and wound surface, just can carry out autologous microparticle skin transplanting, when the microparticle skin of being expert at is transplanted, must apply a large allograft skin or xenogenesis skin and make guiding cladding material, institute's autologous transplanting microparticle skin could be survived.
Traditional extensive deep burn wound surface is applied autologous microparticle skin transplant operation, emphasize to cut completely, eliminate or strike off burn wound's total necrosis eschar or established granulation tissue under narcotism, change into after new wound and wound surface by cutting, cut, scrape operation, just can carry out autologous microparticle skin transplanting, and when the microparticle skin of being expert at is transplanted, must apply a large allograft skin or xenogenesis skin and cover, institute's autologous transplanting microparticle skin could be survived.Allograft skin skin source is in short supply, expensive at present, has become a very large expenditure in medical expense.
And the autologous microparticle skin of traditional approach is transplanted and covered with a large allograft skin or xenogenesis skin, it there will be rejection when 7d-14d after surgery, repels in solution-off process at allograft skin or xenogenesis skin, and skin-grafting area wound surface easily infects.Affect that microparticle skin survives and wound surface is exposed again, need again again to make skin graft.
Summary of the invention
In order to solve the deficiencies in the prior art, the object of the invention is to provide autologous microparticle skin to be implanted in granulation wound treatment burn and various wound surface in refractory to treatment method.
The technical scheme that the present invention takes is:
The concrete steps that autologous microparticle skin of the present invention is implanted in granulation wound treatment burn and various wound surface in refractory to treatment methods are as follows:
(1) granulation wound forms:
To deep burn wound, in adjusting patient's homeostasis and prevention and control wound surface and systemic infection, burn wound's application moisture-preserving dressing covers, make as far as possible wound surface slough form soft eschar, but not liquefacttus, after wound in 2-3d, patient does not need anesthesia can start gradation to implement burn wound slough skiving slough is in layer eliminated, after slough skiving, continuing application moisture-preserving dressing covers, guarantee that patient feels not bitterly, wound surface not hemorrhage or even have oozing of blood till, skiving processing can be carried out at every turn in the time changing dressings, until burn wound's slough is removed totally substantially, continue application moisture-preserving dressing flap coverage, treat that remaining slough dissolves and easily removes, change subsequently moisture-preserving dressing every day, after 10d-30d, can be completed into cherry granulation wound,
To avulsion injury of skin, pressure ulcer, diabetic foot ulcer and other chronic ulcers, first treat systemic disease, nutritional support, anemia and hypoproteinemia, diabetics control blood glucose is below 10mmol/L, complication and control wound surface and systemic infection are simultaneously, strengthen wound surface debridement, remove slough, impel wound surface granulation to form;
(2) autologous microparticle skin is transplanted:
After granulation wound forms, can carry out autologous microparticle skin transplanting, first according to being subject to dermatotome granulation wound area and condition, determine and be subject to dermatotome and skin donor site ratio, to determine bark fetching area, skin donor site Haemodynamics, get razor graft, and shred to 0.5-1mm with eye scissors
3microgranular for subsequent use, skin donor site moisture-preserving dressing covers pressure dressing, microparticle skin for subsequent use is applied on granulation wound with the Direct Uniform such as ophthalmic tweezers and blade holder, operation is soft, with granulation wound not oozing of blood be as the criterion, cover and transplant microparticle skin wound surface pressure dressing with moisture-preserving dressing again, the fixing braking in limbs skin-grafting position;
(3) postoperative care:
After transplanting completes, by skin grafting conventional treatment and observation, use anti-gram negative bacilli antibiotics 3-5 day or select responsive antibiotics according to preoperative wound surface antibacterial culturing susceptibility, strengthen whole body support, postoperative 3-6d skin-grafting area change dressings first, oozes out how many according to microparticle skin at wound surface survival condition, wound surface, determines and changes the Dressing Room interval, cover pressure dressing with moisture retention dressing, until skin grafted wounds heals completely.
In step (2), skin donor site Haemodynamics adopts lignocaine and the adrenalin hydrochloride of 0.1-0.2% to anaesthetize.
In step (2), the thickness of getting razor graft is 0.15-0.30mm.
In step (3), change the Dressing Room interval and be that more change dressings is once every 1d or 2d.
Autologous microparticle skin of the present invention is implanted in granulation wound treatment burn and various wound surface in refractory to treatment method is intended to the directly autologous microparticle skin transplanting of row on granulation wound, after transplanting, moisture-preserving dressing covers, there is good safety and effectiveness, operation wound is little, risk is little, technical difficulty is low, simple to operate, significantly reduce medical expense, be a kind of alternative effective ways for burn patient and the multiple chronic wound patient of developing country.This method is more suitable for the poor hospitalize of primary care condition.
Good effect of the present invention is as follows:
Autologous microparticle skin of the present invention is implanted in granulation wound treatment burn and various wound surface in refractory to treatment method without general anesthesia, bark fetching district is row swelling anaesthesia only, be subject to dermatotome wound surface not need anesthesia, processing such as not cutting, cut, scrape, operation wound is little, lose blood few,, microparticle skin graft area little without general anesthesia risk be without doing covering guiding material with allograft skin or xenogenesis skin, and technical difficulty is low, simple to operate, significantly reduce medical expense.Be more suitable for elderly patient, infant patient and merge many internal organs severe complication, and can not tolerate the patient of the poor and financial difficulties of general anesthesia and massive blood loss and systemic conditions, realize burn wound's skin-grafting with minimum wound and repair.This technology is more suitable for the relatively poor basic medical unit of medical condition.
Autologous microparticle skin of the present invention is implanted in granulation wound treatment burn and various wound surface in refractory to treatment method has the following advantages:
1. this technology is without general anesthesia, and bark fetching district is row swelling anaesthesia only, is subject to dermatotome wound surface not need anesthesia.
2. wound surface such as does not cut, cuts, scrapes at the processing, and on fresh granulation wound, directly row microparticle skin is transplanted, and moisture-preserving dressing covers wrapping.
3. microparticle skin graft area is without doing covering guiding material with allograft skin or xenogenesis skin.
Detailed description of the invention
The following examples are to describe in further detail of the present invention.
Embodiment 1
After patients with deep burn is seen and treated patients, when adjusting patient's homeostasis and prevention and control wound surface and systemic infection, burn wound's application moisture-preserving dressing covers, make as far as possible wound surface slough form soft eschar, but not liquefacttus, after wound in 2-3d, patient does not need anesthesia can start gradation to implement burn wound's slough skiving slough is in layer eliminated, after slough skiving, continue application moisture-preserving dressing and cover.Guarantee that patient feels not bitterly; wound surface not hemorrhage or even have oozing of blood till; skiving processing can be carried out at every turn in the time changing dressings; until burn wound's slough is removed totally substantially; continue application moisture-preserving dressing flap coverage; treat that remaining slough dissolves and easily removes, change subsequently moisture-preserving dressing every day, after 10d-30d, can be completed into cherry granulation wound.Be that feasible autologous microparticle skin is transplanted.
According to being subject to dermatotome granulation wound area and condition, determine dermatotome and the skin donor site ratio of being subject to, to determine bark fetching area, skin donor site Haemodynamics (0.1%-0.2% lignocaine+adrenalin hydrochloride), get razor graft (0.15-0.30mm), and shred to 0.5-1mm with eye scissors
3microgranular for subsequent use, skin donor site moisture-preserving dressing covers pressure dressing, microparticle skin for subsequent use is applied on granulation wound with the Direct Uniform such as ophthalmic tweezers and blade holder, operation is soft, with granulation wound not oozing of blood be as the criterion, cover and transplant microparticle skin wound surface pressure dressing with moisture-preserving dressing again, the fixing braking in limbs skin-grafting position.By skin grafting conventional treatment and observation, routine is used anti-gram negative bacilli antibiotics 3-5 day or selects responsive antibiotics according to preoperative wound surface antibacterial culturing susceptibility, strengthen whole body support, postoperative 3-6d skin-grafting area change dressings first, ooze out how many according to microparticle skin at wound surface survival condition, wound surface, determine and change the Dressing Room interval, generally every 1d or 2d, more change dressings is once, all cover pressure dressing with moisture retention dressing, until skin grafted wounds heals completely.
Embodiment 2
To avulsion injury of skin, pressure ulcer, diabetic foot ulcer and other chronic wounds, active treatment systemic disease, nutritional support after seeing and treating patients, anemia and hypoproteinemia, diabetics control blood glucose is below 10mmol/L, complication and control wound surface and systemic infection are simultaneously, strengthen wound surface debridement, remove slough, impel wound surface granulation to form.Be that feasible autologous microparticle skin is transplanted.
According to being subject to dermatotome granulation wound area and condition, determine dermatotome and the skin donor site ratio of being subject to, to determine bark fetching area, skin donor site Haemodynamics (0.1%-0.2% lignocaine+adrenalin hydrochloride), get razor graft (0.15-0.30mm), and shred to 0.5-1mm with eye scissors
3microgranular for subsequent use, skin donor site moisture-preserving dressing covers pressure dressing, microparticle skin for subsequent use is applied on granulation wound with the Direct Uniform such as ophthalmic tweezers and blade holder, operation is soft, with granulation wound not oozing of blood be as the criterion, cover and transplant microparticle skin wound surface pressure dressing with moisture-preserving dressing again, the fixing braking in limbs skin-grafting position.By skin grafting conventional treatment and observation, routine is used anti-gram negative bacilli antibiotics 3-5 day or selects responsive antibiotics according to preoperative wound surface antibacterial culturing susceptibility, strengthen whole body support, postoperative 3-6d skin-grafting area change dressings first, ooze out how many according to microparticle skin at wound surface survival condition, wound surface, determine and change the Dressing Room interval, generally every 1d or 2d, more change dressings is once, all cover pressure dressing with moisture retention dressing, until skin grafted wounds heals completely.
Although illustrated and described embodiments of the invention, for the ordinary skill in the art, be appreciated that without departing from the principles and spirit of the present invention and can carry out multiple variation, amendment, replacement and modification to these embodiment, scope of the present invention is limited by claims and equivalent thereof.
Claims (5)
1. autologous microparticle skin is implanted in granulation wound treatment burn and various wound surface in refractory to treatment method, it is characterized in that: the concrete steps of described method are as follows:
(1) granulation wound forms:
To deep burn wound, in adjusting patient's homeostasis and prevention and control wound surface and systemic infection, burn wound's application moisture-preserving dressing covers, make as far as possible wound surface slough form soft eschar, but not liquefacttus, after wound in 2-3d, patient does not need anesthesia can start gradation to implement burn wound slough skiving slough is in layer eliminated, after slough skiving, continuing application moisture-preserving dressing covers, guarantee that patient feels not bitterly, wound surface not hemorrhage or even have oozing of blood till, skiving processing can be carried out at every turn in the time changing dressings, until burn wound's slough is removed totally substantially, continue application moisture-preserving dressing flap coverage, treat that remaining slough dissolves and easily removes, change subsequently moisture-preserving dressing every day, after 10d-30d, can be completed into cherry granulation wound,
To avulsion injury of skin, pressure ulcer, diabetic foot ulcer and other chronic ulcers, first treat systemic disease, nutritional support, anemia and hypoproteinemia, diabetics control blood glucose is below 10mmol/L, complication and control wound surface and systemic infection are simultaneously, strengthen wound surface debridement, remove slough, impel wound surface granulation to form;
(2) autologous microparticle skin is transplanted:
After granulation wound forms, can carry out autologous microparticle skin transplanting, first according to being subject to dermatotome granulation wound area and condition, determine and be subject to dermatotome and skin donor site ratio, to determine bark fetching area, to extensive deep burn granulation wound Qi Shou district, confession district ratio be conventionally: 10: 1-6: 1, in, there is not the not enough problem in skin source in small size deep burn granulation wound, be subject to district, can be 7 for district's ratio: 1-4: 1, for difficult acute wound, be subject to district, can be 3 for district's ratio; 1-2: 1, skin donor site Haemodynamics, gets razor graft, and shreds to 0.5-1mm with eye scissors
3microgranular for subsequent use, skin donor site moisture-preserving dressing covers pressure dressing, microparticle skin for subsequent use is applied on granulation wound with the Direct Uniform such as ophthalmic tweezers and blade holder, operation is soft, with granulation wound not oozing of blood be as the criterion, cover and transplant microparticle skin wound surface pressure dressing with moisture-preserving dressing again, the fixing braking in limbs skin-grafting position;
(3) postoperative care:
After transplanting completes, by skin grafting conventional treatment and observation, use anti-gram negative bacilli antibiotics 3-5 day or select responsive antibiotics according to preoperative wound surface antibacterial culturing susceptibility, strengthen whole body support, postoperative 3-6d skin-grafting area change dressings first, oozes out how many according to microparticle skin at wound surface survival condition, wound surface, determines and changes the Dressing Room interval, cover pressure dressing with moisture retention dressing, until skin grafted wounds heals completely.
2. autologous microparticle skin as claimed in claim 1 is implanted in granulation wound treatment burn and various wound surface in refractory to treatment method, it is characterized in that: in step (2), skin donor site Haemodynamics adopts lignocaine and the adrenalin hydrochloride of 0.1-0.2% to anaesthetize.
3. autologous microparticle skin as claimed in claim 1 is implanted in granulation wound treatment burn and various wound surface in refractory to treatment method, it is characterized in that: in step (2), the thickness of getting razor graft is 0.15-0.30mm.
4. autologous microparticle skin as claimed in claim 1 is implanted in granulation wound treatment burn and various wound surface in refractory to treatment method, it is characterized in that: in step 2, be 10 to extensive deep burn granulation wound Qi Shou district, confession district ratio conventionally: 1-6: 1, in, there is not the not enough problem in skin source in small size deep burn granulation wound, be subject to district, can be 7 for district's ratio: 1-4: 1, for difficult acute wound, be subject to district, can be 3 for district's ratio; 1-2: 1.
5. autologous microparticle skin as claimed in claim 1 is implanted in granulation wound treatment burn and various wound surface in refractory to treatment method, it is characterized in that: in step (3), the postoperative time of changing dressings is first 3---6 days, change the Dressing Room interval and be that more change dressings is once every 1d or 2d.
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| Application Number | Priority Date | Filing Date | Title |
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| CN201410206437.0A CN103961747A (en) | 2014-05-16 | 2014-05-16 | Method for transplanting body skin particles in granulation wounds so as to treat burns and various refractory wounds |
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| Application Number | Priority Date | Filing Date | Title |
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| CN201410206437.0A CN103961747A (en) | 2014-05-16 | 2014-05-16 | Method for transplanting body skin particles in granulation wounds so as to treat burns and various refractory wounds |
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Application publication date: 20140806 |