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Title: [Application of high-frequency ultrasound in dermabrasion of patients with deep partial-thickness burns].
Author: Zang CY, Cao YQ, Xue WJ, Zhao R, Zhang M, Zhang YH, Feng Z, Wang YB.
Journal: Zhonghua Shao Shang Za Zhi; 2017 Feb 20; 33(2):97-102. PubMed ID: 28219142.
Abstract:
Objective: To investigate the application of high-frequency ultrasound in dermabrasion of patients with deep partial-thickness burns. Methods: Twenty-six patients with deep partial-thickness burns conforming to the study criteria were hospitalized in our unit from March 2015 to March 2016. Patients were all performed with dermabrasion. The structure of skin tissue and blood flow signals of uninjured side and wounds before dermabrasion, and those of wounds immediately post dermabrasion and on post dermabrasion day (PDD) 1, 3, 5, 7, 10, 14, and 21 were detected with high-frequency ultrasound, and the percentage of blood flow signals was calculated. According to the results of comparison between percentage of blood flow signals of wounds and that of normal skin before dermabrasion, patients were divided into no significant decrease group (NSD, n=19) and significant decrease group (SD, n=7). Wound healing time of patients in two groups was recorded. Data were processed with analysis of variance of repeated measurement, LSD test, t test and Chi-square test. The correlation between the percentage of blood flow signals of wounds before dermabrasion and wound healing time of 26 patients were analyzed by Spearman correlation analysis. Results: (1) Epidermis of normal skin of patients in two groups before dermabrasion showed continuous smooth linear hyperecho, which was stronger than that of dermis, and boundary of dermis and subcutaneous tissue showed stronger discontinuous linear echo than that of dermis, which gradually transited to subcutaneous tissue. In group NSD, epidermis of wound of patients before dermabrasion showed intermittent rough linear echo, which was weaker than that of normal skin epidermis, and there was no obvious abnormity of boundary between dermis and subcutaneous tissue. Immediately post dermabrasion and on PDD 1, no linear hyperecho of epidermis was observed, showing complete attrition of epidermis, and the echo of dermis and subcutaneous tissue had no obvious change as compared with that before dermabrasion, with flat surface of dermis and partly abraded superficial-dermis but relatively well preserved dermal tissue in whole. The epidermis showed discontinuous linear hyperecho, and epidermis was discontinuously regenerated on PDD 3 and 5. Partial continuous linear hyperecho was detected in the epidermis, showing partial continuous regeneration of epidermis on PDD 7 and 10. The regenerated epidermis was thicker than normal skin epidermis and showed rough linear hyperecho with non-uniform thickness on PDD 14. The regenerated epidermis was thicker than normal skin epidermis and showed rather smooth linear hyperecho with uniform thickness on PDD 21. In group SD, the structure of epidermis and dermis of wound of patients before dermabrasion, immediately post dermabrasion, and on PDD 1 was similar to that in group NSD, but the echo of boundary of dermis and subcutaneous tissue was weakened in different degrees. There was no linear hyperecho of epidermis, showing no epidermis was regenerated on PDD 3 and 5. Intermittent regeneration of epidermis appeared on PDD 7 and 10 with intermittent linear hyperecho. Partial continuous linear hyperecho was detected in the epidermis, showing partial continuous regeneration of epidermis on PDD 14 and 21. (2) The percentages of blood flow signals of wounds of patients in group NSD before dermabrasion, immediately post dermabrasion, and on PDD 1 were (3.1±1.3)%, (6.5±2.0)%, and (5.3±1.9)% respectively, higher than those in group SD [(0.9±1.1)%, (3.5±1.3)%, and (3.6±0.9)% respectively, P<0.05 or P<0.01]. The percentages of blood flow signals of wounds of patients in two groups were similar at the other time points (with P values above 0.05). Compared with the percentage of normal skin in the same group [(3.2±0.7)%], the percentages of blood flow signals of wounds of patients in group NSD were significantly increased immediately post dermabrasion and on PDD 1 (with P values below 0.01) but had no significant change at the other time points (with P values above 0.05). The percentage of blood flow signals of wounds of patients before dermabrasion in group SD was significantly lower than that of normal skin in the same group [(2.8±0.6)%, P<0.01]. The percentage of blood flow signals of wounds of patients in group SD was close to that of normal skin in the same group at each time point post dermabrasion (with P values above 0.05). (3) The wound healing time of patients in group NSD was (16.2±2.5) d, lower than that in group SD [(30.9±2.9) d, t=12.67, P<0.01]. There was obvious negative correlation between the percentage of blood flow signals of wounds before dermabrasion and wound healing time of 26 patients (r=-0.77, P<0.01). Conclusions: High-frequency ultrasound is a good way to observe the imaging features of wounds in patients with deep partial-thickness burns before and after dermabrasion, and it can provide objective imaging evidence for the performance of dermabrasion in patients with deep partial-thickness burns. 目的：探讨高频超声在深Ⅱ度烧伤患者磨痂术中的应用。 方法： 2015年3月—2016年3月，笔者单位收治符合入选标准的深Ⅱ度烧伤患者26例，均行磨痂术。采用高频超声检测患者磨痂术前健侧正常皮肤、创面，以及术后即刻与术后1、3、5、7、10、14、21 d创面皮肤组织结构和血流信号，计算血流信号百分比。根据术前创面血流信号百分比与正常皮肤血流信号百分比的对比结果，将患者分为无明显降低组19例和明显降低组7例。记录2组患者创面愈合时间。对数据行重复测量方差分析、LSD检验、t检验和χ(2)检验，对26例患者术前创面血流信号百分比和创面愈合时间行Spearman相关分析。 结果： (1)2组患者术前正常皮肤表皮层呈连续平滑线状强回声，真皮层回声弱于表皮层，真皮-皮下组织分界呈较真皮层强的不连续线状回声，逐渐过渡到皮下组织。无明显降低组患者术前创面表皮层呈不连续的不光滑线状回声，回声弱于正常皮肤表皮层；真皮-皮下组织分界未见明显异常。术后即刻及术后1 d，未见表皮层线状强回声，表皮层完全脱失；真皮层及皮下组织回声较术前未见明显改变，真皮层表面平整伴有真皮浅层部分磨失，但真皮组织总体保存较完好。术后3、5 d可见表皮层呈不连续线状强回声，不连续表皮层再生。术后7、10 d可见表皮层呈部分连续线状强回声，部分连续表皮层再生。术后14 d，再生的表皮层厚于正常皮肤表皮层且呈不光滑线状强回声，厚度不均匀。术后21 d，再生的表皮层厚于正常皮肤表皮层，呈较光滑线状强回声，厚度较均匀。明显降低组患者术前、术后即刻及术后1 d，创面表皮层和真皮层组织结构与无明显降低组大体相似，但真皮-皮下组织分界回声呈不同程度减弱；术后3、5 d未见表皮层线状强回声，未见表皮层再生；术后7、10 d可见不连续表皮层再生，呈不连续线状强回声；术后14、21 d可见表皮层呈部分连续线状强回声，部分连续表皮层再生。(2)无明显降低组患者术前、术后即刻、术后1 d创面血流信号百分比分别为(3.1±1.3)%、(6.5±2.0)%、(5.3±1.9)%，明显高于明显降低组的(0.9±1.1)%、(3.5±1.3)%、(3.6±0.9)%(P<0.05或P<0.01)；2组患者其余时相点创面血流信号百分比相近(P值均大于0.05)。与组内正常皮肤的(3.2±0.7)%比较，无明显降低组患者术后即刻、术后1 d创面血流信号百分比明显升高(P值均小于0.01)，其余时相点创面血流信号百分比无明显变化(P值均大于0.05)。明显降低组患者术前创面血流信号百分比明显低于组内正常皮肤的(2.8±0.6)%(P<0.01)，术后各时相点创面血流信号百分比与组内正常皮肤相近(P值均大于0.05)。(3)无明显降低组患者创面愈合时间为(16.2±2.5)d，短于明显降低组的(30.9±2.9)d(t＝12.67，P<0.01)。26例患者术前创面血流信号百分比与创面愈合时间呈明显负相关(r＝-0.77，P<0.01)。 结论：高频超声可较好地观察深Ⅱ度烧伤患者磨痂术前后创面影像学特点，为深Ⅱ度烧伤患者行磨痂术提供客观的影像学依据。.

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