皮瓣修复术治疗手部烧伤缺损的效果及安全性

Effect and safety of skin flap repair in treatment of hand burn defect

目的 探讨皮瓣修复术治疗手部烧伤缺损的效果及安全性。方法 选择2019年6月—2021年7月周口市妇幼保健院收治的66例手部烧伤患者,按照随机数表法,分为皮瓣修复组和常规组,每组33例。常规组实施人工软组织修复术,皮瓣修复组实施游离穿支皮瓣修复术治疗。术前、术后7 d,运用SPSS 18.0软件处理数据,比较两组血清干扰素-γ(INF-γ)、白介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)及脂多糖(LPS)水平;术前、术后1年,比较两组温哥华瘢痕量表(VSS评分)、总主动活动度评级标准(TAM)、Allen试验,同时比较治疗有效性及安全性。结果 术后1年,两组INF-γ、IL-6、TNF-α均上升,且皮瓣修复组的INF-γ、IL-6、TNF-α[16.74±1.86、8.88±1.29、2.33±0.27]均低于常规组[20.09±2.24、11.36±1.84、3.19±0.59],差异有统计学意义(P<0.05);皮瓣修复组的LPS、色泽、血管、柔软度、厚度评分[0.25±0.07、1.07±0.23、0.89±0.18、1.23±0.28、0.49±0.08]低于常规组[1.15±0.29、1.95±0.29、1.87±0.24、2.27±0.39、1.67±0.11],差异有统计学意义(P<0.05);皮瓣修复组总关节屈曲度、关节伸直受限度[83.57±3.15、85.55±3.67]高于常规组[72.13±3.03、73.47±3.19],差异有统计学意义(P<0.05);皮瓣修复组Allen试验时间[3.25±0.52]低于常规组[5.46±0.63],差异有统计学意义(P<0.05);皮瓣修复组治疗总有效率(90.90%)高于常规组(75.76%),差异无统计学意义(P>0.05);皮瓣修复组不良反应发生率(6.06%)低于常规组(30.30%),差异有统计学意义(P<0.05)。结论 皮瓣修复术治疗手部烧伤缺损,效果确切,可降低机体炎症反应,促进缺损部位修复及手部功能恢复,对手部美观度、手部血运循环影响小,且安全性较高。

Objective To investigate the effect and safety of skin flap repair in the treatment of hand burn defect.Methods Totally 66 patients with hand burns admitted to hospital from June 2019 to July 2021 were selected and divided into the skin flap repair group and the conventional group according to the random number table method,with 33 patients in each group.The conventional group was treated with artificial soft tissue repair,and the flap repair group was treated with free perforator flap repair.The serum levels of IFN-γ(INF-γ),INTERleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and liposolysaccharide(LPS)in both groups were compared by SPSS18.0 software before and 7 days after operation.Vancouver scar scale(VSS score),total active activity rating scale(TAM)and Allen test were compared between the two groups before and 30 days after surgery,and the efficacy and safety of treatment were compared.Results Thirty days after operation,INF-γ,IL-6 and TNF-αincreased in both groups.The levels of INF-γ,IL-6 and TNF-αin the flap repair group[16.74±1.86,8.88±1.29,2.33±0.27]were lower than those in the conventional group[20.09±2.24,11.36±1.84,3.19±0.59],and the differences were statistically significant(P<0.05).LPS,color,vascular,softness and thickness scores of the flap repair group[0.25±0.07,1.07±0.23,0.89±0.18,1.23±0.28,0.49±0.08]were lower than those of the conventional group[1.15±0.29,1.95±0.29,1.87±0.24,2.27±0.39,1.67±0.11],the difference was statistically significant(P<0.05);The total joint flexion and joint extension limits of the flap repair group[83.57±3.15,85.55±3.67]were higher than those of the conventional group[72.13±3.03,73.47±3.19],and the differences were statistically significant(P<0.05).The Allen test time of flap repair group[3.25±0.52]was lower than that of conventional group[5.46±0.63],and the difference was statistically significant(P<0.05).The total effective rate of flap repair group(90.90%)was higher than that of conventional group(75.76%),and the difference was not statistically significant(P>0.05).The incidence of adverse reactions in flap repair group(6.06%)was lower than that in conventional group(30.30%),and the difference was statistically significant(P<0.05).Conclusion Skin flap repair for the treatment of hand burn defect has definite effect,can reduce the body inflammation,promote the repair of the defect site and the recovery of hand function,and has little influence on hand aesthetics and blood circulation,and high safety.