The Clinicial Study Of Treat-Ment For Pediatric Depth Second-Degree Burn Wound With Preserving Denatured Dermis

Objective:To evaluate the effectiveness of a new method of tangential excision of eschar, reserved partial denatured dermis and covered with a cell free heterogonous dermis (biological dressing) to treat pediatric depthⅡdegree burn wound.Methods:24 cases of pediatric depth II degree burn treated by eschar shaving were divided into group A and B. Group A was treated by tangential excision of eschar, retained denatured dermis and covered with a biological dressing. Group B was treated by traditional method of tangential excision of escher, thoroughly cleaning the necrotic or degenerative tissues, transplanting antilogous skin and covering biological dressing on the wound. Two groups of wound healing time, changes in children with high fever and duration, intra-operative bleeding, bacterial clearance in the wound and the severity of scar hyperplasia after wound healing were observed. At the same time, tissue biopsies before and after tangential excision of eschar in Group A were taken respectively to confirm how much the denatured dermis retained and the thickness of the degenerative dermis.Results:The completely healing time of wound in Group A was (22.33±11.98)d, and approximately 11d shorter than Group B, and there was statistically significant (P<0.05). In Group A, the highest average temperature of pre-operation 4 days was (39.01±0.83)℃, the highest average temperature of post-operation 1st day was (37.99±0.79)℃, post-operation 2nd day was (37.97±0.79)℃, post-operation 3rd day was (37.95±0.86)℃, The differences between pre-operation 4 days and post-operation 1st day,2nd day,3rd day were statistically significant (P<0.05). In Group B, the highest average temperature of pre-operation 4 days was (39.05±0.90)℃, the highest average temperature of post-operation 1st day was (38.41±0.66)℃, post-operation 2nd day was (38.31±0.67)℃, post-operation 3rd day was (38.17±1.03)℃, The differences between pre-operation 4 days and post-operation 1st day there was no statistically significant (P>0.05), pre-operation 4 days and post-operation 2nd day,post-operation 3rd day, there were statistically significant (P<0.05). Intra-operative bleeding in Group A was approximately (55.16±36.21) ml, and blood transfusion was not need. Intra-operative bleeding in Group B was approximately (250.83±62.00) ml. The differences was statistically significant (P<0.01). The HE and the Masson's dyeing in group A:the majority of necrosis tissue of the wound was cut away, retained majority of denaturated the dermis; and vitreous degeneration was observed in the preserved denatured dermis.The healing wound in Group A was relatively flat, no obvious tendency of scar hyperplasia, but in Group B was slightly uneven due to stamp skin grafting and reddish. The bacterial clearance rate between the two groups was not significant.Conclusion:The new therapy to treat pediatric depthⅡdegree burn by tangential excision of eschar retained partial denatured dermis is benefit of shortening the time of operation, lessening intra-operative damage and bleeding, no needing intra-operative blood transfusion, fastening wound healing, flatter after wound healing, and may be can reduce the scar hyperplasia. However, excellent instruments and surgical technique are required.