分阶段生物降解临时基质和Meek Microcrafting作为大面积烧伤的供体储备策略

摘要(中文译文)

对于大面积烧伤的确定性封闭，供区可用性仍然构成限制，尤其是烧伤面积达50%全身体表面积（TBSA）或以上的患者。可生物降解临时基质（BTM）可在供区恢复期间稳定切削创面，而Meek微移植允许有限自体皮肤的控制性扩展。我们回顾性分析了2022年5月至2025年5月期间收治的烧伤面积达50% TBSA或以上、接受BTM应用后行Meek微移植作为确定性创面封闭管理一部分的成年患者。人口学、损伤、手术和结局变量从电子病历、手术记录、麻醉记录、创面护理文书以及可获得的临床照片中收集。共纳入12例患者。平均年龄41.5岁，平均烧伤面积63.1% TBSA，平均Baux评分104.6。所有患者均有吸入性损伤并需要气管切开。BTM平均在入院后13.3天应用，Meek微移植平均在42.2天进行。Meek微移植覆盖的平均TBSA为32.5%，占烧伤面积的50.6%。研究期间手术效率从每覆盖1% TBSA 15.2分钟提高至约10.8分钟。在可评估病例中，临床记录的Meek移植成活率超过90%，无患者需要对Meek移植的BTM区域进行二次自体移植，12例中有11例存活至出院或住院康复。分期BTM后行Meek微移植是一种可行的节省供区的广泛烧伤封闭策略，允许特殊区域优先处理、供区恢复以及对大范围准备后创面进行高效的确定性覆盖。

Abstract

Definitive closure of extensive burns remains constrained by donor-site availability, particularly in patients with burns of 50% total body surface area (TBSA) or greater. Biodegradable Temporizing Matrix (BTM) can stabilize excised wounds while donor sites recover, whereas Meek micrografting permits controlled expansion of limited autologous skin. We retrospectively reviewed adult patients admitted between May 2022 and May 2025 with burns of 50% TBSA or greater who underwent BTM application followed by Meek micrografting as part of definitive wound-closure management. Demographic, injury, operative, and outcome variables were collected from electronic medical records, operative reports, anesthesia records, wound-care documentation, and clinical photography when available. Twelve patients were included. Mean age was 41.5 years, mean burn size was 63.1% TBSA, and mean Baux score was 104.6. All patients had inhalation injury and required tracheostomy. BTM was applied at a mean of 13.3 days after admission, and Meek micrografting was performed at a mean of 42.2 days. Mean TBSA covered by Meek micrografting was 32.5%, representing 50.6% of the burn surface. Operative efficiency improved from 15.2 to approximately 10.8 minutes per 1% TBSA covered over the study period. Clinically documented Meek graft take exceeded 90% in evaluable cases, no patient required secondary autografting of Meek-grafted BTM areas, and 11 of 12 survived to discharge or inpatient rehabilitation. Staged BTM followed by Meek micrografting is a feasible donor-sparing strategy for extensive burn closure that permits special-area prioritization, donor-site recovery, and efficient definitive coverage of large prepared wound surfaces.

如何引用

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