自体刃厚皮片+脱细胞异体真皮联合创面封闭负压引流修复皮肤软组织缺损

Repair of skin and soft tissue defects with autologous split-thickness skin graft and acellular allogeneic dermis combined with negative pressure vacuum sealing drainage

目的探讨不同方法修复皮肤软组织缺损的可行性及临床效果。方法选择安阳市人民医院烧伤整形科于2017年2月至2020年12月收治的不同原因所致的皮肤软组织缺损创面病例60例,按照手术方法不同分成试验组和对照组,每组30例。试验组应用脱细胞异体真皮(HADM)+自体刃厚皮片联合创面封闭负压引流(VSD)修复皮肤软组织缺损;对照组应用中厚皮片联合VSD修复皮肤软组织缺损。观察两组临床病例的皮片成活率、手术次数、住院时间及血液和分泌物细菌培养;6个月随访,采用温哥华瘢痕量表评估术后6个月瘢痕评分。结果试验组皮片成活率高于对照组,差异有统计学意义[(92.0±7.0)%vs(86.8±9.0)%,P<0.05];手术次数、住院时间、术后6个月VSS评分,试验组均低于对照组,差异有统计学意义(P<0.05)。试验组血培养、分泌物培养细菌阳性率均低于对照组,差异有统计学意义(P<0.05)。结论脱细胞异体真皮+自体刃厚皮片联合VSD修复皮肤软组织缺损创面具有较好的临床效果,瘢痕轻,修复效果好的优点。

Objective To explore the feasibility and clinical effect of different methods in repairing skin and soft tissue defects.Methods Sixty cases of skin and soft tissue defects caused by different causes treated from February 2017 to December 2020 were selected and randomly divided into experimental group and control group(n=30,each).In experimental group,the patients underwent heterogeneous acellular dermis matrix(HADM)and autologous blade thick skin combined with vacuum sealing drainage(VSD)to repair skin and soft tissue defects.In control group,split-thickness skin graft combined with VSD was conducted to repair skin and soft tissue defects.The skin graft survival rate,operation times,hospital stay,bacterial culture of blood and secretions were observed and compared between two groups.Vancouver Scar Scale(VSS)was used to evaluate the scar tissue formation at 6 months after operation.Results The survival rate of skin graft in experimental group was significantly higher than that in control group[(92.0±7.0)%vs(86.8±9.0)%,P<0.05].The number of operations,hospital stay and VSS score at 6 months after operation in experimental group were statistically lower than those in control group(P<0.05).The positive rates of blood and secretions bacterial culture in experimental group were significantly lower than those in control group(P<0.05).Conclusion For repairing skin and soft tissue defects,HADM and autologous blade thick skin combined with VSD has good clinical effect,with lighter healing scar and excellent outcome for repairing.