不同皮肤牵张闭合器治疗皮肤软组织缺损的临床研究

Different skin-stretching devices for the treatment of skin and soft tissue defects

目的:比较托氏皮肤牵张闭合器(tension-relief system,TRS)和自制简易式皮肤牵张带治疗创伤所致皮肤软组织缺损的临床疗效.方法:回顾性分析2015年6月至2016年10月创伤所致皮肤软组织缺损并行皮肤牵张器治疗的41例患者,男28例,女13例,年龄22~64(43.2±10.4)岁.根据治疗方法不同分为两组,其中采用托氏皮肤牵张闭合器治疗18例,男11例,女7例;年龄22~61 (41.7±9.5)岁;缺损部位,上肢5例,下肢11例,背部2例;缺损面积42~160(78.6±17.4) cm2.自制皮肤牵张器治疗23例,男17例,女6例;年龄25~64 (44.4±12.7)岁;缺损部位,上肢6例,下肢13例,背部4例;缺损面积54~175(75.2±14.3) cm2.比较两组患者创面Ⅰ期闭合情况、术中出血量、手术时间、创面愈合时间、手术并发症等情况,并采用视觉模拟评分法(visual analogue scale,VAS)评估疼痛缓解程度,采用温哥华瘢痕量表(vancouver scar scale,VSS)评定术后瘢痕恢复情况.结果:41例患者均得到随访,时间3~12(6.2±3.7)个月.两组患者术中出血量、手术时间比较差异无统计学意义(P>0.05).TRS组Ⅰ期直接闭合16例,创面愈合时间≤3周16例,VAS评分(3.9±1.1)分,VSS评分(3.5±1.2)分,并发症1例;自制皮肤牵张器组Ⅰ期直接闭合12例,创面愈合时间≤3周9例,VAS评分(4.8±1.4)分,VSS评分(5.3±1.6)分,并发症9例;两组比较差异有统计学意义(P<0.05).结论:TRS较自制皮肤牵张器闭合器治疗创面效果好,损伤小,愈合时间短,手术疼痛小,创面愈合美观和并发症少.

Objective:To compare clinical effects of tension-relief system(TRS)and self-made skin-stretching devices in treating skin and soft tissue defects caused by trauma.Methods:Totally 41 patients with skin and soft tissue defects caused by trauma treated by skin-stretching devices were retrospectively analyzed from June 2015 to October 2016,including 28 males and 13 females,aged from 22 to 64 years old with an average of(43.2±10.4)years old.The patients were divided into two groups according to therapeutic methods,18 patients were treated by TRS,including 11 males and 7 females,aged from 22 to 61 years old with an average of(41.7±9.5)years old;5 patients injured on the upper limb,11 patients on lower limb and 2 patients on the back;the area of defect ranged from 42 to 160 cm2 with an average of(78.6±17.4)cm2.Twenty-three patients were treated by self-made skin stretching device,included 17 males and 6 females,aged from 25 to 64 years old with an average of(44.4±12.7)years old;6 patients injured on the upper limb,13 patients on lower limb and 4 patients on the back;the area of defect ranged from 54 to 175 cm2 with an average of(75.2±14.3)cm2.Primary closure at stageⅠ,blood loss,operation time,healing time of wound,complications between two groups were compared,VAS score was used to evaluate pain relief,vancouver scar scale(VSS)was used to assess recover of postoperative scars.Results:Forty-one patients were followed up ranged from 3 to 12 months with an average of(16.2±3.7)months.There were no significant difference between two groups in blood loss and operation time(P>0.05).In TRS group,16 patients’injury were closured directly,wound healing time of 16 patients were over 3 about weeks,VAS score was 3.9±1.1,VSS score was 3.5±1.2,and 1 patient occurred complication;In self-made skin stretch group,12 patients’injury were closured directly,wound healing time of 9 patients were over 3 about weeks,VAS score was 4.8±1.4,VSS score was 5.3±1.6,and 9 patients occurred complication;there were no statistical differences between two groups in these items.Conclusion:Compared with self-made skin stretch,TRS has advantages of good effect of wound,minimal trauma,short healing time,less pain,good outlook,and less complication.