Autologous scalp repair of wounds in the medium-thickness skin donor area: safety and effectiveness

doi:10.12307/2025.664

Abstract

Abstract: BACKGROUND: Large deep burn wounds are often accompanied by scar hyperplasia after healing, requiring transplantation of medium-thickness skin for repair, and the medium-thickness skin slices taken generally reach below the papillary layer of the dermis. If not handled correctly, complications such as delayed healing, ulceration, and post-healing pain and itching in the donor area can easily occur. Therefore, the repair of wounds in the donor area should be emphasized.
OBJECTIVE: To observe the safety and practicability of autologous scalp repair of skin donor area in patients with deep burns and scarring.
METHODS: Sixty patients with deep burn and scar hyperplasia admitted to the Burn Department of Zhengzhou First People’s Hospital from January 2021 to September 2023 were selected as the study subjects. They all needed medium-thickness skin transplantation and repair, and were divided into study group (n=30) and control group (n=30) according to random systematic sampling method. The skin was taken from the patient's own medium-thickness skin on the leg or back. In the study group, the skin donor area was repaired with self-blade thick scalp replantation, and in the control group, the skin donor area was repaired with absorbent dressing. The wound healing rate and the time to complete epithelialization of the wound were observed and compared in the two groups 6 days after surgery. The pain of dressing change at 3 and 6 days after surgery and scar hyperplasia in the skin donor area at 6 months after surgery were compared between two groups.
RESULTS AND CONCLUSION: Compared with the control group, the time to complete epithelialization of the wound was significantly lower in the study group (P < 0.05), and the wound healing rate was significantly higher in the study group (P < 0.05), the pain score for dressing change at 3 and 6 days after surgery was significantly lower in the study group (P < 0.05), and the scar hyperplasia rate, scar score and itch score were also significantly lower in the study group (P < 0.05) at 6 months after surgery. In conclusion, autologous scalp repair of the medium-thickness skin donor area can accelerate wound healing and reduce scar hyperplasia.

中国组织工程研究杂志出版内容重点：组织构建；骨细胞；软骨细胞；细胞培养；成纤维细胞；血管内皮细胞；骨质疏松；组织工程

Key words: autologous scalp, skin donor area, wound healing, scar, skin transplantation, absorbent dressing, engineered materials

CLC Number:

Cao Dayong, Zheng Junjie, Wang Lei, Yang Yang, Guo Haina, Xing Peipeng, Xia Chengde, Di Haiping. Autologous scalp repair of wounds in the medium-thickness skin donor area: safety and effectiveness[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(18): 3804-3810.

Figures/Tables 7

2.7 典型病例 37岁男性患者，全身多处火焰烧伤，烧伤总面积达32%，Ⅲ度伤18%，深Ⅱ度伤14%，外院治疗后转入郑州市第一人民医院，查体：未愈创面主要位于颈部、前躯，面积约8%，Ⅲ度肉芽创面，入院诊断：重度烧伤，火焰烧伤后颈部、前躯肉芽创面。完善术前准备，手术室全麻下行颈部、前躯扩创植皮，后躯、右大腿取中厚皮，头部取皮回植后躯供皮区。术后8 d后躯供皮区创面完全愈合，头部供皮区5 d愈合，不影响毛发生长，植皮区10 d愈合，植皮区及后躯供皮区创面愈合后给予压力衣、功能锻炼等综合康复治疗。术后随访6个月，颈部、前躯植皮区外观、功能良好，无明显瘢痕增生挛缩畸形，后躯头皮移植区皮片接缝处有轻微瘢痕形成，余无明显瘢痕增生，无明显瘙痒等不适症状，头部供皮区毛发生长正常，无色素瘢痕遗留。该患者治疗前后的资料图片，见图3。 41岁男患者，全身多处火焰烧伤后瘢痕增生伴溃疡创面2年余，查体：全身多处烧伤后瘢痕增生，以双手为重，双手背瘢痕增生致屈曲功能受限，呈爪形手，右手背侧可见2个约1 cm×2 cm大小溃疡创面，双手外观及功能受限，生活无法自理。入院诊断：全身多处瘢痕，双手瘢痕增生挛缩畸形伴溃疡创面。完善相关术前准备，手术室全麻下行双手瘢痕及溃疡创面切除松解、后躯取中厚皮，头部取皮回植后躯供皮区。后躯供皮区和双手植皮区打包加压固定，双手植皮区术后7 d拆包换药发现皮片成活良好，后间断换药约15 d植皮区完全愈合。头部供皮区6 d愈合，不影响毛发生长，无色素瘢痕形成，术后7 d后躯供皮区创面完全愈合，双手植皮区小指拔除克氏针后给予压力衣、功能锻炼等综合康复治疗。术后随访6个月，双手植皮区外观及活动良好，无明显瘢痕增生挛缩畸形，生活可自理，后躯中厚取皮区无明显瘢痕增生、瘙痒等不适症状。该患者治疗前后的资料图片，见图4。"

References

[1] QI Y, DONG Z, CHU H, et al. Denatured acellular dermal matrix seeded with bone marrow mesenchymal stem cells for wound healing in mice. Burns. 2019;45(7):1685-1694.
[2] 付全有,邢福席,李林,等.人工真皮联合自体瘢痕表皮移植修复大面积烧伤后期关节部位瘢痕畸形[J].中国组织工程研究, 2024,28(10):1533-1539.
[3] HENDRIKS T, BOTMAN M, DE HAAS L, et al. Burn scar contracture release surgery effectively improves functional range of motion, disability and quality of life: A pre/post cohort study with longterm follow-up in a Low- and Middle-Income Country. Burns. 2021;47(6): 1285-1294.
[4] 高磊,秦新愿,李天博,等.脱细胞同种异体真皮与自体刃厚皮联合移植修复糖尿病足创面[J].中国组织工程研究,2022,26(14): 2138-2143.
[5] CHI Z, LIN D, CHEN Y, et al.Routine closure of the donor site with a second dorsal metacarpal artery flap to avoid the use of a skin graft after harvest of a first dorsal melacarpal artery flap. J Plast Reconstr Aesthet Surg. 2018;71(6):870-875.
[6] XIAO H, LIU R, LIU X, et al. Reconstruction of Severe Neck Scar Contracture After Electrical Injury. J Craniofac Surg. 2022;33(1): 203-205.
[7] XIA Y, WANG Y, SHAN M, et al. Decoding the molecular landscape of keloids: new insights from single-cell transcriptomics. Burns Trauma. 2023;11:tkad017.
[8] LI K, NICOLI F, XI WJ, et al. The 1470 nm diode laser with an intralesional fiber device: a proposed solution for the treatment of inflamed and infected keloids. Burns Trauma. 2019;7:5.
[9] ASUKU M, YU TC, YAN Q, et al. Split-thickness skin graft donor-site morbidity: a systematic literature review. Burns. 2021;47(7):1525-1546.
[10] 中华医学会烧伤外科学分会, 海峡两岸医药卫生交流协会暨烧创伤组织修复专委会. Ⅱ度烧伤创面治疗专家共识(2024版)Ⅱ:手术治疗和感染防治[J].中华烧伤与创面修复杂志,2024,40(2):101-118.
[11] SCHULZ A, ROTHERMUND I, LEFERING R, et al. Long-term scar quality after treatment of standardized partial-thick-ness skin graft donor sites. Adv Skin Wound Care.2018;31(3):109-117.
[12] DUANE TM, HUSTON JM, COLLOM M, et al. Surgical Infection Society 2020 updated guidelines on the management of complicated skin and soft tissue infections. Surg Infect (Larchmt). 2021;22(4):383-399.
[13] 刘继松,宋德恒,赵刚宏,等.新型生物敷料Ⅱ型在二度烧伤创面中的应用[J].中华全科医学,2018,16(5):740-743.
[14] HALGAS B, BAY C, FOSTER K. A comparison of injury scoring systems in predicting burn mortality. Ann Burns Fire Disasters. 2018;31(2):89-93.
[15] BARYZA MJ, BARYZA GA. The Vancouver Scar Scale: an administration tool and its interrater reliability. J Burn Care Rehabil. 1995;16(5): 535-538.
[16] LV K, LIU H, XU H, et al. Ablative fractional CO2 laser surgery improving sleep quality, pain and pruritus in adult hypertrophic scar patients: a prospective cohort study. Burns Trauma. 2021;9:tkab023.
[17] ABAZARI M, GHAFFARI A, RASHIDZADEH H, et al. A systematic review on classification, identification, and healing process of burn wound healing. Int J Low Extrem Wounds. 2022;21(1):18-30.
[18] ZUBAIR M, AHMAD J. Role of growth factors and cytokines in diabetic foot ulcer healing: A detailed review. Rev Endocr Metab Disord. 2019;20(2):207-217.
[19] ABAZARI M, GHAFFARI A, RASHIDZADEH H, et al. A systematic review on classification, identification, and healing process of burn wound healing. Int J Low Extrem Wounds. 2022;21(1):18-30.
[20] HABIBI S, MOHAMMADI T, HMTSHIRAZI R, et al. A bilayer mupirocin/bupivacaine-loaded wound dressing based on chitosan/poly (vinyl alcohol) nanofibrous mat: preparation, characterization, and controlled drug release. Int J Biol Macromol. 2023;240:124399.
[21] HENRY S, MAPULA S, GREVIOUS M, et al. Maximizing wound coverage in full-thickness skin defects: a randomized-controlled trial of autologous skin cell suspension and widely meshed autograft versus standard autografting. J Trauma Acute Care Surg. 2024;96(1):85-93.
[22] CHANG LS, KIM YH, KIM SW. Reconstruction of burn scar contracture deformity of the extremities using thin thoracodorsal artery perforator free flaps. ANZ J Surg. 2021;91(9):E578-E583.
[23] 高仪轩,周彪,巴特,等.新型敷料在创面修复中的应用与进展[J].中华损伤与修复杂志(电子版),2022,17(1):68-71．
[24] 马少君,栾文康,刘圣洁,等.银离子敷料覆盖联合负压吸引在慢性难愈性创面修复中的应用效果[J].中国美容医学,2022,31(1):23-26.
[25] CHAN RK, ROSE LF, WU JC, et al. Autologous graft thickness affects scar contraction and quality in a porcine excisional wound model. Plast Reconstr Surg Glob Open. 2015;3(7):e468.
[26] YANG J, HUANG Z, TAN J, et al. Copper ion/gallic acid MOFs-laden adhesive pomelo peel sponge effectively treats biofilm-infected skin wounds and improves healing quality. Bioact Mater. 2023;32:260-276.
[27] 李顺堂,林源,欧斌贤,等.综合治疗医源性库欣综合征患者感染性创面的效果[J].中华烧伤与创面修复杂志,2022,38(6):512-519.
[28] YAMMINE K, ASSI C. A meta-analysis of the outcomes of split-thickness skin graft on diabetic leg and foot ulcers. Int J Low Extrem Wounds. 2019;18(1):23-30.
[29] 王振君,潘孙峰,方高丰,等.老年中厚皮供皮区回植自体刃厚皮疗效观察[J].中华全科医学,2022,20(5):773-776.
[30] 李智明,黄远发,方云德,等.背部供皮区在大面积烧伤后期整复中的应用[J].组织工程与重建外科杂志,2012,8(6):336-337.
[31] 孟艳斌,雷晋,张海瑞,等.原位保留打孔断层瘢痕基质联合头皮移植与负压封闭引流治疗烧伤后非功能部位增生性瘢痕的临床效果[J].中华烧伤与创面修复杂志,2022,38(3):251-255.
[32] KHALID FA, AHMED OA, JIBRAN RABBANI M, et al. An algorithm for reconstruction of electrical injuries of the scalp. Plast Reconstr Surg. 2022;150(3):630e-638e.