Clinical Study On Artificial Dermis In The Role Offunction Reconstruction After Extra Severe Burn

Objective:To observe the effects of artificial dermis combined with autologous razor thin skin graft in the role of function reconstruction after extra severe burn.Methods:The clinical data of 40 patients with limited function activities after extra severe burn,hospitalized in our unit from June 2015 to June 2016,were enrolled in the study.All patients were divided into the artificial dermis group(n=20)and the control group(n=20).In experimental group,after release and resection of cicatrices artificial dermis was directly grafted to the wonds in the one-stage operation.And wonds were repaired with razor thin skin grafts in the second-stage operation.In control group,after release and resection of cicatrices,autologous split-thickness skin grafts were directly grafted on the wonds.5 days after surgery,the survival rate and the infection situation of autologous skin graft were calculated;3,6 and 10 months after surgery,the scar score of skin graft area was assessed.After 10 months follow-up visit,the situation of functional parts in grafted area was assessed.Furthermore the healing time of skin graft area was assessed.Also the healing time of the donor site was evaluated and the cicatrices scar of the donor site was calculated after 10 months.All the data were processed with SPSS23.0 software.Results:5 days after surgery,the survival rate of autologous skin grafts in the artificial dermis group was(94.65±3.01)%,which is closed to the control group(93.45 5±3.00)%(t=1.532,P=0.142>0.05);And 2 cases of patient with skin graft infection occurred in the artificial dermis group,1 case occurred in the control group(P=1.000>0.05).3 months after surgery,the scar score in the artificial dermis group was(3.70±1.17),significantly lower than that of control group(5.15±0.88)(t=5.445,P<0.0001).6 and 10 months after surgery,thescarscoresinartificialdermisgroupwere(4.80±1.24)and(5.30±1.42)respectively,with control group(7.05±1.28),(8.50±1.54)obviously on the higher side.(t value were 6.485,7.847respectively,P<0.0001).After a follow-up of 10months visit,in artificial dermis group there were 4"good"cases,15“inferior”cases and1“poor”case in function parts.While in control group there were 5"good"cases,8“inferior”cases and 7“poor”cases.The function recovery of artificial dermis group was better than that of control group(?~2=6.742,P=0.034).The healing time of artificial group in grafted area was(12.30±2.54)days,which had no statistical difference with that of control group(12.70±1.98,p=0.898>0.05).And the healing time of artificial group in donor site was(11.2±0.89)days,which was better than that of control group(16.1±1.52days,P<0.0001).And 10 months after surgery the scar score of artificial dermis group in donor site was(7.70±1.26),which was significantly lower than that of control group(13.55±0.89,P<0.0001).Conclusions:Compared with autologous split-thickness skin graft,artificial dermis combined with autologous razor thin skin graft does not affect the early flap survival and can also effectively improve the function recovery in grafted area.It can also reduce the scar of the donor site and shorten the healing time of the donor site.