瘢痕松解一期植皮与负压封闭二期植皮的疗效对比研究

The comparative study on the effect of one-stage skin graft and VSD treatment of second-stage sugery after scar release

目的研究负压封闭引流（VSD）技术对瘢痕松解一期植皮与二期植皮疗效的差异。方法将42例欲行瘢痕松解植皮手术的患者随机分为对照组和负压组，每组21例。对照组实施瘢痕松解后一期皮肤移植，负压组实施瘢痕松解后VSD治疗创面3d再行二期皮肤移植，观察植皮术后7d皮下淤血率和植皮成活率以及术后半年移植皮肤挛缩增生情况。结果术后7d负压组皮下淤血发生率明显低于对照组（P〈0．05），植皮成活率显著高于对照组（P〈0．05）；术后半年负压组移植皮肤温哥华瘢痕评分显著低于对照组（P〈0．05）。结论瘢痕松解负压治疗二期植皮较一期植皮可降低皮下淤血发生，促进植皮成活，减轻术后移植皮片挛缩，改善患者预后。

Objective To investigate the difference of vacuum sealing drainage （VSD） on the effect of one-stage skin graft and second-stage sugery after scar release. Methods A total of 42 patients who wanted to undergo scar release and skin graft was randomly divided to control group （ n = 21 ） and VSD treatment group （ n = 21 ）. The control group implemented skin graft immdiately after scar release while VSD treatment group were treated with VSD for 3 days after scar release and then implemented skin graft. The rate of subcutaneous blood stasis and the survival rate of skin graft were observed at 7 days after skin graft. The condition of grafted skin contraeture and hyperplasia after half a year was also observed. Results The incidence of subcutaneous blood stasis was significantly lower in the VSD group than that in the control group （P 〈 0. 05）. The survival rate of skin grafts was significantly higher in the VSD group than that of the control group （ P 〈 0. 05 ）. The score of Vancouver scar was significantly lower in the VSD group than that in the control group （P 〈 0. 05）. Conclusions VSD treatment of second-stage sugery after scar release can reduce the occurrence of subcutaneous blood stasis, promote skin graft survival, reduce postoperative skin graft contracture and improve the prognosis of patients compared to one-stage skin graft.