目的 探讨应用负压辅助愈合治疗系统（V.A.C. Therapy）在胸、腹、背部断层皮片游离移植术后加压固定的有效性。 方法 2010年10月－2011年10月，应用V.A.C. Therapy加压固定游离断层皮片修复21例胸、腹、背部皮肤软组织缺损患者。男15例，女6例；年龄21～63岁，平均43岁。其中瘢痕切除后创面13例，皮瓣切取后供瓣区形成的创面8例。创面位于胸部7例，腹部9例，背部5例。皮肤及软组织缺损范围12 cm×10 cm～18 cm×15 cm。游离移植的断层皮片厚度为0.6 mm，在缺损部位移植断层皮片后，使用V.A.C. Therapy固定皮片，压力范围100～125 mm Hg （1 mm Hg=0.133 kPa）。 结果 住院时间19～32 d，平均24 d。21例植皮均成活，受区创面Ⅰ期愈合；供皮区创面Ⅰ期愈合。随访时间6～12个月，平均8个月。游离移植皮肤色泽与周围皮肤色泽相似，无破溃，无明显凹陷。 结论 应用V.A.C. Therapy加压固定的游离断层皮片，成活率高，效果可靠，是一种安全实用的固定方法。
ObjectiveTo investigate the feasibil ity and effectiveness of using scar spl it thickness skin grafts combined with acellular allogeneic dermis in the treatment of large deep Ⅱ degree burn scar. MethodsBetween January 2013 and December 2013, 20 cases of large deep Ⅱ degree burn scar undergoing plastic operation were enrolled. There were 14 males and 6 females, aged 4 to 60 years (mean, 40 years). Burn reasons included hydrothermal burns in 10 cases, flame burns in 9 cases, and lime burns in 1 case. The burn area accounted for 70% to 96% total body surface area (TBSA) with an average of 79% TBSA. The time from wound healing to scar repair was 3 months to 2 years (mean, 7 months). Based on self-control, 0.7 mm scar spl it thickness skin graft was used to repair the wound at the right side of joints after scar resection (control group, n=35), 0.5 mm scar spl it thickness skin graft combined with acellular allogeneic dermis at the left side of joints (trial group, n=30). Difference was not statistically significant in the scar sites between 2 groups (Z=-1.152, P=0.249). After grafting, negative pressure drainage was given for 10 days; plaster was used for immobilization till wound heal ing; and all patients underwent regular rehabil itation exercises. ResultsNo significant difference was found in wound heal ing, infection, and healing time between 2 groups (P>0.05). All patients were followed up for 6 months. According to the Vancouver Scar Scale (VSS), the score was 5.23±1.41 in trial group and was 10.17±2.26 in control group, showing significant difference (t=8.925, P=0.000). Referring to Activities of Daily Living (ADL) grading standards to assess joint function, the results were excellent in 8 cases, good in 20 cases, fair in 1 case, and poor in 1 case in trial group; the results were excellent in 3 cases, good in 5 cases, fair in 22 cases, and poor in 5 cases in control group; and difference was statistically significant (Z=-4.894, P=0.000). ConclusionA combination of scar spl it thickness skin graft and acellular allogeneic dermis in the treatment of large deep Ⅱ degree burn scar is feasible and can become one of solution to the problem of skin source tension.