局部筋膜组织皮瓣修复与自体皮移植在慢性溃疡创伤患者治疗中的应用价值分析

Effect of local fasciocutaneous flap repair on wound healing and inflammatory factor levels in patients with chronic ulcer trauma

目的比较分析局部筋膜组织皮瓣修复与自体皮移植在慢性溃疡创伤患者治疗中的应用价值。方法自2020年7月至2022年7月,宿州市第一人民医院烧伤整形科收治的82例面部慢性溃疡创伤患者作为研究对象,按随机数字表法分为观察组与对照组,41例/组。对照组采取自体皮移植治疗,观察组采取局部筋膜组织皮瓣修复治疗。比较两组患者术后及预后相关指标(手术时间、术中出血量、住院时间、创面愈合);两组不同时间(术前、术后1个月、术后3个月、术后6个月)面部3D偏差值;比较两组不同时间(术后1、3.6个月)温哥华瘢痕评估量表(vancouver scar scale,VSS)评分;统计并比较两组患者并发症发生情况。结果观察组手术时间长于对照组,住院及创面愈合时间短于对照组,术中出血量低于对照组(P<0.05);偏回归系数解释:术后1、3、6个月时β=-0.120、-0.270、-0.300,P均<0.001,表明术后1、3、6个月时患者面部3D偏差值较术前降低0.120、0.270、0.300;观察组术后1、3、6个月β=-0.080、-0.080、-0.110,P=0.047、0.029、0.008观察组术后1、3、6个月较术前的差值较对照组降低0.080、0.080、0.110,即观察组术后1、3、6个月较术前降低0.20、0.35、0.41;偏回归系数解释:术后3、6个月时β=3.170、4.660,P均<0.001,表明术后3、6个月时患者VSS评分较术后1个月降低3.170、4.660;观察组术后3、6个月β=-0.200、-0.740,P=0.358、0.001,即观察组术后6个月较术后1个月的差值较对照组降低0.740,即观察组术后6个月较术前降低5.400;观察组并发症发生率(7.32%)低于对照组(21.95%),但差异无统计学意义(P>0.05)。结论局部筋膜组织皮瓣修复能够有效地促进面部慢性溃疡创伤患者创面愈合,并获得较好的术后外观。

Objective To compare and analyze the application value of local fascia tissue flap repair and autologous skin transplantation in the treatment of patients with chronic ulcer trauma.Methods Prospective study,a total of 82 patients with facial chronic ulcer trauma admitted to the Burn and Plastic Surgery Department of Suzhou First People's Hospital from July 2020 to July 2022 were selected as the research objects.They were divided into observation group and control group according to the random number table method,with41 cases in each group.The control group was treated with autologous skin grafting,and the observation group was treated with Local fascia tissue flap repair.The postoperative operation and prognosis related indicators(operation time,intraoperative blood loss,hospitalization time,wound healing)were compared between the two groups.The facial 3D deviation value of the two groups at different time points(preoperative,postoperative 1 month,postoperative 3 months,postoperative 6 months);the levels of Vancouver scar scale(VSS)at different time points(1 month,3 months and 6 months after operation)were compared between the two groups.Results The operation time of the observation group was longer than that of the control group,the hospitalization and wound healing time was shorter than that of the control group,and the intraoperative blood loss was lower than that of the control group(P<0.05).Partial regression coefficient interpretation β=-0.120、-0.270、-0.300 at 1,3 and 6 months after operation,P<0.001,indicating that the facial 3D deviation of patients at 1,3 and6 months after operation was 0.120,0.270 and 0.300 lower than that before operation.The observation group 1 month after operation,the observation group 3 months after operation,and the observation group 6 months after operation β=-0.080、-0.080、-0.110,P=0.047、0.029、0.008,respectively.The difference between the observation group 1 month after operation,the observation group 3 months after operation,and the observation group 6 months after operation was 0.080,0.080,0.110 lower than that before operation,that is,the observation group 1 month after operation,the observation group 3 months after operation,and the observation group 6 months after operation were0.20,0.35,0.41 lower than those before operation.Partial regression coefficient interpretation:3,6 months after operation β=3.170、4.660,P<0.001,indicating that the VSS score of patients at 3,6 months after operation was 3.170,4.660 lower than that at 1 month after operation.The observation group 3 months after operation and the observation group 6 months after operation β=-0.200、-0.740,P=0.358、0.001,respectively,that is,the difference between the observation group 6 months after operation and 1 month after operation was 0.740 lower than that of the control group,that is,the observation group 6 months after operation was 5.400 lower than that before operation.The incidence of complications in the observation group(7.32%)was lower than that in the control group(21.95%),no statistically significant difference(P>0.05).Conclusion Local fasciocutaneous flap repair can effectively promote wound healing in patients with facial chronic ulcer wounds,reduce inflammation levels,and obtain a better postoperative appearance.