不同植皮技术在颈部急性坏死性筋膜炎创面修复中的临床应用

Clinical effects of different skin grafts on wound repair of acute necrotizing fasciitis in neck region

目的探讨自体薄层皮片与异体人工皮两种植皮技术治疗颈部急性坏死性筋膜炎术后创面修复的临床疗效。方法回顾2017年1月-2019年1月新疆医科大学第一附属医院附属口腔医院颌面肿瘤外科收治的18例颈部急性坏死性筋膜炎患者。所有患者均采用负压封闭引流(VSD)技术联合手术清创技术,顺利完成I期的手术清创,均待创面肉芽组织恢复良好后,行植皮手术。将采用自体薄层皮片修复10例作为实验组,采用异体人工脱细胞真皮皮片修复8例作为对照组。植皮后分别记录两组患者术后5、15、30 d的创面愈合率、视觉模拟评分(VAS)、并发症发生率、植皮成活率等各项指标以及上皮完全覆盖创面时间、患者住院时间、住院期间更换敷料次数及平均间隔时间。结果①创面愈合率:术后5 d实验组与对照组两组比较,差异无统计学意义(t=4.144,P>0.05);术后15、30 d实验组平均创面愈合率分别高于对照组,两组比较差异均具有统计学意义(t=8.554,27.417,P<0.05);②VAS评分:术后5 d实验组与对照组两组比较差异无统计学意义(P>0.05);术后15、30 d实验组患者自评分别高于对照组,差异均具有统计学意义(P<0.05);③皮片成活率:实验组成活率100.0%,对照组成活率75.0%;④并发症发生率:实验组30.0%,对照组87.5%;⑤实验组患者在住院时间、住院期间平均更换敷料次数均小于对照组,差异均具有统计学意义(P<0.05)。结论采用自体薄层皮片修复颈部急性筋膜炎感染创面能增加皮片成活率,缩短治疗时间,能够带来很好的治疗效果,值得临床推广;人工皮片成活率较自体薄层皮片低,价格昂贵,应严格把握手术适应证。

Objective To investigate the effects of two different skin grafts on wound repair of acute necrotizing fasciitis in neck region.Methods Clinical data of 18 patients with acute necrotizing fasciitis in neck region admitted to our department from Jan 2017 to Jan 2019 were analyzed retrospectively.All the patients were initially and successfully treated with vacuum sealing drainage(VSD)combined with surgical debridement technology.After recovery of the granulation tissue,skin grafting was performed for repair of wound surface to all the patients.All the 18 patients were randomly divided into two groups,i.e.experimental group and control group according to the skin graft adopted.Autologous thin skin graft was adopted in the patients of the treatment group(n=10),while specific artificial acellular dermal graft in the control group(n=8).The wound healing rate,visual analogue score(VAS),complication rate,graft survival rate and other indicators of both groups at 5,15 and 30 d after surgery,as well as the time of complete remucosalization of the wound,total length of hospitalization,times of dressing change and mean time between changes were recorded and compared.Results①The difference of wound healing rate between both groups at 5 d after surgery was statistically insignificant(P>0.05),while the wound healing rates of the experimental group at 15 d,30 d were higher than those of the control group with statistically significant differences(P<0.05).②The difference of VAS between both groups at 5 d after surgery was statistically insignificant(P>0.05),while the VAS scores of the experimental group at 15 d,30 d were higher than those of the control group with statistically significant differences(P<0.05).③The flap survival rate of the experimental group was 100%and that of the control group was 75%.④The complication rate of the experimental group was 30.0%,while that of the control group was 87.5%.⑤The total length of hospital stay of the experimental group was shorter than that of the control group,and the times of dressing change of the experimental group were less than those of the control.Conclusions With advantages of improving flap survival rate,shortening length of hospital stay and good therapeutic effect,autologous thin skin graft is worth promoting for wound repair of acute necrotizing fasciitis in neck region.The indications of artificial acellular dermal grafting should be strictly held due to low graft survival rate and high cost.