厚中厚皮片原位回植进行供皮区的修复:一项随机对照试验

A novel technique to reconstruct the donor site by replanting thick split-thickness skin graft in situ:a randomized controlled trial

目的采用厚中厚皮片原位回植新技术修复供皮区,并与薄中厚皮片移植修复法比较。方法本研究为前瞻性随机对照试验,选择接受厚中厚皮片移植术来修复功能及关节部位皮肤缺损的患者,并随机分为A、B两组。A组在供皮区切取超过受区面积的厚中厚皮片,对多切取的厚中厚皮片经打孔、扩张、拉拢缝合后原位回植的方法修复供皮区;B组在供皮区切取受区所需尺寸的厚中厚皮片,采用背部再次切取薄中厚皮片移植的方法修复供皮区。主要结局指标为患者供皮区的愈合时间,次要结局指标包括供皮区的瘢痕评分、疼痛评分和瘙痒评分以及患者的生活质量评分。结果共纳入100例患者,A组50例,B组50例。A组患者供皮区愈合时间为(12.20±1.64)d,显著低于B组(17.24±2.14)d,t检验P值<0.001。A组中位愈合时间为12 d[95%CI(11.53,12.47)],B组中位愈合时间为17 d[95%CI(15.94,18.06)],Log-rank检验P值<0.001。与B组相比,A组患者供皮区瘢痕评分、疼痛评分、瘙痒评分均显著降低,均数差分别为-4.74[95%CI(-5.09,-4.39)]、-1.88[95%CI(-2.14,-1.62)]、-1.10[95%CI(-1.27,-0.93)],差异均具有统计学意义(P<0.001)。A组患者健康功能评分、心理功能评分、社会功能评分、日常生活评分改善程度均显著高于B组,均数差分别为10.89[95%CI(9.22,12.55)]、12.54[95%CI(10.98,14.09)]、12.73[95%CI(10.92,14.55)]、11.66[95%CI(9.99,13.34)],差异均具有统计学意义(P<0.001)。A组患者供皮区泌汗、皮脂腺分泌和感觉功能均强于B组,A组患者对供皮区的外观和功能均感到满意,其供皮区的皮肤质量显著优于B组。结论与薄中厚皮片移植法相比,厚中厚皮片原位回植的新技术可显著提高患者术后的生活质量。

Objective This article presented a novel technique to reconstruct the donor site with a large sheet of thick split-thickness skin graft(STSG)in situ,and to compare the efficacy of this novel technique with that of the thin STSG.Methods A prospective,randomized controlled trial(RCT)was conducted.The patients who received thick STSGs for repairing skin defects at functional sites or joint sites were enrolled,and were randomly divided into two groups.For the patients in the group A,the surgeons harvested thick STSGs that were larger than the size of the recipient sites,the extra skin was punctured and stretched to completely cover the donor site.For the patients in the group B,the surgeons harvested thick STSGs of the size of the recipient sites,their donor sites were covered with thin STSGs which were harvested from other parts of the patients.The primary outcome was the healing time of the donor sites.The secondary outcomes were scar scores,pain scores,and pruritus scores of the donor sites and the patients’life quality scores.Results 100 Patients were included and each group was 50 patients.The healing time of the donor sites was(12.20±1.64)days in the group A,which was markedly shorter than that in the group B(17.24±2.14)days,P<0.001.The median healing time of group A was 12 days[95%CI(11.53,12.47)],while the median healing time of group B was 17 days[95%CI(15.94,18.06)],Log-rank test P<0.001.Patients in the group A had lower scar scores,pain scores,and pruritus scores than those in the group B(mean difference respectively:-4.74[95%CI(-5.09,-4.39)];-1.88[95%CI(-2.14,-1.62)];-1.10[95%CI(-1.27,-0.93)]).The improvement in general health scores,mental health scores,social function scores,and vitality scores was significantly greater in group A than in the group B(mean difference respectively:10.89[95%CI(9.22,12.55)];12.54[95%CI(10.98,14.09)];12.73[95%CI(10.92,14.55)];11.66[95%CI(9.99,13.34)]).The sweating functions,sebaceous gland secretion and sensation functions of donor sites in the patients from the group A were stronger than that from the group B.Patients from the group A were highly satisfied with the aesthetic appearance and functions of the donor sites.The skin quality of the donor sites of patients from the group A was significant better than that from the group B.Conclusion The novel technique significantly improved the postoperative quality of life of the patients.