儿童深颈部烧伤早期手术治疗的优点

封面

如何引用文章

全文:

详细

论证：儿童深颈部烧伤比深面部烧伤的发生率多4倍。目前，深颈部烧伤的外科治疗方法尚无统一
意见，仍采用自体打孔皮片移植。

目的是从受伤的那一刻起的第3-5天评估早期外科手术治疗儿童深颈部烧伤的优势。

材料与方法。研究是病例对照。对81例深颈部烧伤患儿进行了手术治疗。主要组（早期手术治疗组）为46例患儿，其伤后第3.37 ± 0.14天进行了手术治疗。对照组为35例患儿，其进行行分期治疗，
并于27.17 ± 0.18天再次自皮成形术。根据敷料的数量、皮肤修复的时间、移植物愈合面积等指标可以评价治疗效果。在长期，进行功能和美容治疗结果的分析。

结果。主要组需要7.93 ± 0.45绷带可以完成治疗，而对照组为18.75 ± 0.61（p < 0.001）。主要组和对照组分别在16.54 ± 0.68天和36.94 ± 0.89天恢复皮肤（p < 0.001）。主要组的移植物愈合面积为99.50 ± 0.13，对照组为93.91 ± 2.68%（p < 0.001）。在分期的手术治疗过程中，有一位病人观察到90%的移植物分解，因此进行了再次的自皮成形术。治疗期间无发生其他并发症。在温哥华瘢痕评定量表上评价长期美容效果时，主要组平均分为4.0 ± 0.26分，对照组平均分为7.0 ± 0.28分（p < 0.001）。烧伤后瘢痕挛缩在主要组发现于12例（26%）患儿。对照组中，对于20例（57%）患者接受了烧伤后畸形的手术切除。

结论。儿童深颈部烧伤的早期外科治疗（从受伤开始的第3-5天）不仅可以加快皮肤修复的进程，
而且可以改善美容和功能效果。

作者简介

Pavel Gnipov

Saint Petersburg Children State Hospital No. 1

编辑信件的主要联系方式.
Email: elect86@mail.com
ORCID iD: 0000-0002-1906-9943

MD, Orthopedic and Trauma Surgeon of Burn Department

俄罗斯联邦, 198205, Saint-Petersburg, Avanguardnaya street 14

Alexey Baindurashvili

H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: turner01@mail.ru
ORCID iD: 0000-0001-8123-6944
SPIN 代码: 2153-9050

MD, PhD, D.Sc., Professor, Member of RAS, Honored Doctor of the Russian Federation, Director

俄罗斯联邦, 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Marina Brazol

Saint Petersburg Children State Hospital No. 1; H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: mbrazol@mail.ru
ORCID iD: 0000-0002-2678-5729

MD, PhD, Deputy Chief for Surgery, Head of the Burn Department; Senior Researcher of the Department of Trauma Sequalae and Rheumatoid Arthritis 

俄罗斯联邦, 198205, Saint-Petersburg, Avanguardnaya street 14; 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Ekaterina Mitrofanova

Saint Petersburg Children State Hospital No. 1; H. Turner National Medical Research Center for Сhildren’s Orthopedics and Trauma Surgery

Email: elect86@mail.com
ORCID iD: 0000-0001-5959-5086

MD, Orthopedic and Trauma Surgeon of the Burn Department; Researcher of the Department of Trauma Sequalae and Rheumatoid Arthritis 

俄罗斯联邦, 198205, Saint-Petersburg, Avanguardnaya street 14; 64, Parkovaya str., Saint-Petersburg, Pushkin, 196603

Maxim Melnikov

Saint Petersburg Children State Hospital No. 1

Email: elect86@mail.com
ORCID iD: 0000-0002-2173-5693

MD, Orthopedic and Trauma Surgeon of Burn Department

俄罗斯联邦, 198205, Saint-Petersburg, Avanguardnaya street 14

Gleb Mashevskiy

Saint Petersburg Electrotechnical University LETI

Email: aniket@list.ru
ORCID iD: 0000-0001-9380-9543

PhD, Associate Professor. Department of Biotechnical Systems

俄罗斯联邦, 5, Professor Popov street, Saint-Petersburg, 197376

参考

  1. Akita S, Hayashida K, Takaki S, et al. The neck burn scar contracture: a concept of effective treatment. Burns Trauma. 2017;5(1). https://doi.org/10.1186/s41038-017-0086-8.
  2. Hamilton TJ, Patterson J, Williams RY, et al. Management of head and neck burns — a 15-year review. J Oral Maxillofac Surg. 2018;76(2):375-379. https://doi.org/10.1016/j.joms.2017.09.001.
  3. Hoogewerf CJ, van Baar ME, Hop MJ, et al. Burns to the head and neck: epidemiology and predictors of surgery. Burns. 2013;39(6):1184-1192. https://doi.org/10.1016/j.burns.2013.03.006.
  4. Xin W, Yin Z, Qin Z, et al. Characteristics of 1494 pediatric burn patients in Shanghai. Burns. 2006;32(5):613-618. https://doi.org/10.1016/j.burns.2005.12.012.
  5. Mody NB. Post burn contracture neck: clinical profile and management. J Clin Diagn Res. 2014;8(10):NC12-17. https://doi.org/10.7860/jcdr/2014/10187.5004.
  6. Dalal PK, Saha R, Agarwal M. Psychiatric aspects of burn. Indian J Plast Surg. 2010;43(3):136. https://doi.org/10.4103/0970-0358.70731.
  7. Grishkevich VM, Grishkevich M, Menzul V. Postburn neck anterior contracture treatment in children with scar-fascial local trapezoid flaps. Indian J Plast Surg. 2015;36(3):e112-e119. https://doi.org/10.1097/bcr.0000000000000118.
  8. Афоничев К.А., Баиндурашвили А.Г., Цветаев Е.В., и др. Оптимизация результатов и сроков лечения ожогов IIIA степени у детей // Травматология и ортопедия России. – 2007. – № 3. – С. 45–47. [Afonichev KA, Baindurashvili AG, Tsvetaev EV. The optimization of the results and period of the treatment of third A-degree burns in children. Travmatologiia i ortopediia Rossii. 2007;(3):45-47. (In Russ.)]
  9. Афоничев К.А., Филиппова О.В., Цветаев Е.В. Оптимизация результатов и сроков лечения глубоких дермальных ожогов у детей // Ортопедия, травматология и восстановительная хирургия детского возраста. – 2014. – Т. 2. – № 2. – С. 9–11. [Afonichev KA, Filippova OV, Tsvetaev EV. Optimization of results and treatment timing of deep dermal burns in children. Pediatric traumatology, orthopaedics and reconstructive surgery. 2014;(2):9-11. (In Russ.)]. https://doi.org/10.17816/PTORS229-11.
  10. Belba G, Gedeshi I, Isaraj S. et al. Head and neck burns: acute and late reconstruction data of burn injury management in 2007. Ann Burns Fire Disasters. 2008;21(4):203-205.
  11. Cole JK, Engrav LH, Heimbach DM, et al. Early excision and grafting of face and neck burns in patients over 20 years. Plast Reconstr Surg. 2002;109(4):1266-1273. https://doi.org/10.1097/00006534-200204010-00009.
  12. Патент РФ на изобретение № 2564075/01.07.2014. Порханов В.А., Богданов С.Б., Поляков А.В., и др. Способ лечения ингаляционной травмы в сочетании с ожогами шеи. [Patent RUS 2564075/01.07.2014. Porhanov VA, Bogdanov SB, Poljakov AV, et al. Sposob lecheniya ingalyatsionnoy travmy v sochetanii s ozhogami shei. (In Russ.)]
  13. Порханов В.А., Вагнер Д.О., Богданов С.Б., и др. Подходы к трахеостомии у пациентов с глубокими ожогами шеи и ингаляционной травмой // Вестник хирургии им. И.И. Грекова. – 2018. – Т. 177. – № 4. – С. 52–55. [Porhanov VA, Vagner DO, Bogdanov SO, et al. Approaches to tracheostomy in patients with deep neck burns and inhalation injury. Grekov’s Bulletin of Surgery. 2018;177(4):52-55. (In Russ.)]. https://doi.org/10.24884/0042-4625-2018-177-4-52-55.
  14. Burd A. Burns: treatment and outcomes. Semin Plast Surg. 2010;24(03):262-280. https://doi.org/ 10.1055/s-0030-1263068.
  15. Jonsson CE, Dalsgaard CJ. Early excision and skin grafting of selected burns of the face and neck. Plast Reconstr Surg. 1991;88(1):83-92.
  16. Sharp PA, Dougherty ME, Kagan RJ. The effect of positioning devices and pressure therapy on outcome after full-thickness burns of the neck. J Burn Care Res. 2007;28(3):451-459. https://doi.org/10.1097/bcr.0b013e318053d35b.
  17. Voinchet V, Bardot J, Echinard C, et al. Advantages of early burn excision and grafting in the treatment of burn injuries of the anterior cervical region. Burns. 1995;21(2):143-146. https://doi.org/10.1016/0305-4179(95)92141-x.
  18. Gaviria JL, Gómez-Ortega V. One-stage reconstruction of neck burns with single-layer dermal matrix. Plast Aesthet Res. 2018;5(9):35. https://doi.org/10.20517/2347-9264.2018.38.

补充文件

附件文件
动作
1. JATS XML
下载

版权所有 © Gnipov P., Baindurashvili A., Brazol M., Mitrofanova E., Melnikov M., Mashevskiy G., 2020

Creative Commons License
此作品已接受知识共享署名 4.0国际许可协议的许可
 


Согласие на обработку персональных данных

 

Используя сайт https://journals.rcsi.science, я (далее – «Пользователь» или «Субъект персональных данных») даю согласие на обработку персональных данных на этом сайте (текст Согласия) и на обработку персональных данных с помощью сервиса «Яндекс.Метрика» (текст Согласия).