基于创面生长因子研究皮肤软组织扩张术对烧伤整形患儿创面修复的促进作用

Wound-healing Promoting Effect of Skin and Soft Tissue Expansion in Children Undergoing Burns and Plastic Surgery Based on Wound Growth Factor

目的基于创面生长因子研究皮肤软组织扩张术对烧伤整形患儿创面修复的促进作用。方法选取2019年1月—2020年1月我院103例烧伤整形患儿,根据手术方案的不同分为扩张组52例和移植组51例,分别行皮肤软组织扩张术和复合皮移植术。统计2组临床疗效、创面愈合时间、创面愈合率、皮肤血运恢复时间、术后24 h视觉模拟评分法(VAS)评分,比较手术前后创面生长因子[骨形态发生蛋白-7(BMP-7)、转化生长因子-β1(TGF-β1)、碱性成纤维细胞生长因子(bFGF)]和温哥华瘢痕量表(VSS)评分,以及美容效果、并发症发生情况。结果术后3个月,扩张组治疗总有效率高于移植组(P<0.01);扩张组创面愈合时间、皮肤血运恢复时间短于移植组,创面愈合率高于移植组,术后24 h VAS评分低于移植组,差异有统计学意义(P<0.05);术后3个月2组血清BMP-7、TGF-β1、bFGF水平均升高,且扩张组高于移植组,差异有统计学意义(P<0.05);术后3个月2组柔软度、色泽、血管分布、厚度评分均低于术前,且扩张组上述评分低于移植组,差异有统计学意义(P<0.05);术后3个月,扩张组美容优良率高于移植组(P<0.05);扩张组并发症总发生率低于移植组(P<0.05)。结论皮肤软组织扩张术有利于改善烧伤整形患儿创面生长因子水平,缩短创面愈合时间,提高治疗效果、创面瘢痕状态及美容效果,并减少了并发症的发生。

Objective To study the wound-healing promoting effect of skin and soft tissue expansion in children undergoing burn and plastic surgery based on wound growth factor.Methods A total of 103 children undergoing burn and plastic surgery between January 2019 and January 2020 were divided into expansion group(n=52)and transplantation group(n=51)according to different surgical schemes.Skin and soft tissue expansion and composite skin transplantation were performed respectively in two groups.Clinical efficacy,wound healing time,wound healing rate,recovery time of skin blood circulation and visual analogue scale(VAS)score within 24 h after operation were recorded in two groups.Wound growth factors[bone morphogenetic protein-7(BMP-7),transforming growth factor-β1(TGF-β1),basic fibroblast growth factor(bFGF)]and Vancouver Scar Scale(VSS)score before and after operation,as well as cosmetic effect and incidence rate of complications were compared between two groups.Results After operation for 3 months,the total effective rate in the expansion group was significantly higher than that in transplantation group(P<0.01).Compared with those in transplantation group,wound healing time and recovery time of skin blood circulation were shorter,while wound healing rate was significantly higher,but the VAS score within 24 h after operation was significantly lower in expansion group(P<0.05).After operation for 3 months,serum levels of BMP-7,TGF-β1 and bFGF were significantly increased in two groups,and the levels in expansion group were significantly higher than those in transplantation group(P<0.05);scores of scratchability,color,vascular distribution and thickness were significantly lower than those before operation in two groups,and the above scores in expansion group were significantly lower than those in transplantation group(P<0.05);the excellent and good rate of cosmetic effect in expansion group was significantly higher than that in transplantation group(P<0.05).The total incidence rate of complications in expansion group was significantly lower than that in transplantation group(P<0.05).Conclusion Skin and soft tissue expansion is helpful to improve levels of wound growth factors,shorten wound healing time,improve therapeutic effect,wound scar state and cosmetic effect and reduce the occurrence of complications in children undergoing burn and plastic surgery.