中厚皮供区创面愈合临床研究
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摘要
目的观察中厚皮供区应用刃厚皮回植促进创面愈合减少瘢痕的作用。方法对2002—2010年收治的192例患者行背部或大腿外侧取中厚皮,将供皮区创面分为3组,治疗组(A组)即大张及邮票刃厚皮回植覆盖,对照组功能性敷料覆盖(B组)和凡士林纱布覆盖(C组),刃厚皮供区又分为头部、大腿和后背3个部位。分别观察治疗组和对照组供皮区创面的愈合时间、局部疼痛、瘢痕生长情况。结果创面愈合的平均时间,A组为6.2±1.1 d,B组为11.1±2.1 d,C组为13.5±2.5 d;术后第2天和第5天疼痛评分,A组平均疼痛评分为2.3±0.86和1.9±0.8,B组为2.5±1.1和3.9±1.3,C组为3.8±1.4和5.9±2.1;术后6~12个月瘢痕评分,A组评分为2.8±1.5,B组为6.6±2.1,C组为8.2±3.6,3组比较差异有统计学意义(P<0.01)。刃厚皮供区头部愈合时间、疼痛评分和瘢痕生长优于后背和大腿(P<0.01)。结论刃厚皮回植能显著缩短中厚皮供区创面愈合时间,减轻患者治疗期间中厚皮供区疼痛,预防中厚皮供区瘢痕增生。
Objective To observe the effect of ultra thin thickness skin regraft onto split-thickness skin graft(STSG) donor sites in healing wound and reducing scar formation. Methods 192 cases of patients who were harvested the STSG from the back or fermoribusinternus in our department from 2002 to 2010 were divided into 3 Groups, the treatment Group(Group A) were regrafted with the ultra thin thickness skin, the control Group(Group B) were covered with the occlusive hydrocellular dressing(ALLEVYN adhensive, Smith &Nephew) and(Group C) were covered with vaseline gauze. The skin donor site included the head, thigh and back. The wound healing time, local pain and the scar formation were observed respectively. Results The average wound healing time was 6.2 ± 1.1 days for Group A, 11.1 ± 2.1 days for Group B and 13.5 ± 2.5 days for Group C. The pain scores on day 2 and day 5 post operation assessed by the standard Baker Faceis were 2.3±0.86 and 1.9±0.8 for Group A, 2.5±1.1 and 3.9±1.3 for Group B and 3.8±1.4 and 5.9±2.1 for Group C. The scar scores assessed by Vancouver Scar Scale Assessment for the donor site following up 6~12 months post surgery were 2.8±1.5 for Group A, 6.6±2.1 for Group B and 8.2±3.6 for Group C. There were significant differences among these three Groups(P < 0.01). The differences were found between donor site form head, thighand back(P < 0.01). Conclusion Using thin thickness skin regraft onto STSG donor sites can significantly shorten the healing time of the STSG donor site, reduce the pain and prevent hyperplastic scar.
Objective To observe the effect of ultra thin thickness skin regraft onto split-thickness skin graft(STSG) donor sites in healing wound and reducing scar formation. Methods 192 cases of patients who were harvested the STSG from the back or fermoribusinternus in our department from 2002 to 2010 were divided into 3 Groups, the treatment Group(Group A) were regrafted with the ultra thin thickness skin, the control Group(Group B) were covered with the occlusive hydrocellular dressing(ALLEVYN adhensive, Smith &Nephew) and(Group C) were covered with vaseline gauze. The skin donor site included the head, thigh and back. The wound healing time, local pain and the scar formation were observed respectively. Results The average wound healing time was 6.2 ± 1.1 days for Group A, 11.1 ± 2.1 days for Group B and 13.5 ± 2.5 days for Group C. The pain scores on day 2 and day 5 post operation assessed by the standard Baker Faceis were 2.3±0.86 and 1.9±0.8 for Group A, 2.5±1.1 and 3.9±1.3 for Group B and 3.8±1.4 and 5.9±2.1 for Group C. The scar scores assessed by Vancouver Scar Scale Assessment for the donor site following up 6~12 months post surgery were 2.8±1.5 for Group A, 6.6±2.1 for Group B and 8.2±3.6 for Group C. There were significant differences among these three Groups(P < 0.01). The differences were found between donor site form head, thighand back(P < 0.01). Conclusion Using thin thickness skin regraft onto STSG donor sites can significantly shorten the healing time of the STSG donor site, reduce the pain and prevent hyperplastic scar.
引文
[1]Birol C,Ibrahim Inal H,Kubilay O,et al.The effect of sucralfate,an agent for gastroprotection on the healing of split thickness skin graft donor sites[J].Eur J Plast Sury,2007,30:25-28.
[2]Gyger D,Genin B,Bugmann P,et al.Skin harvesting on the scalp in children:utopia or reality[J].Eur J Pediatr Surg,1996,6:166-169.
[3]Barnea Y,Amir A,Leshem D,et al.Clinical comparative study of aquacel and paraffin gauze dressing for split-skin donor site treatment[J].Ann Plast Surg,2004,53:132-136.
[4]Akan M,Misirlioglu A,Yildirim,S,et al.Ice application to minimize pain in the split thickness skin graft donor site[J].Aesthet Plast Surg,2003,27:305-307.
[5]Losada F,Garcia-Luna P P,Gomez-Cia T,et al.Effects of human recombinant growth hormone on donor site healing in burned adults[J].World J Surg,2002,26:2-8.
[6]Misirlioglu A,Eroglu S,Karacaoglan,et al.Use of honey as an adjunct in the healing of split thickness skin graft donor site[J].Dermatol Surg,2003,29:168-172.
[7]Stone C A,Wright H,Clarke T,et al.Healing at skin graft donor sites dressed with chitosan[J].Br J Plast Surg,2000,53:601-606.
[8]Wong D L,Hockenberry E M,Wilson D,et al.Whaley and Wongg Essentials of Pediatric Nursing[M].5thed.St.Louis:Mosby,2001:1301.
[9]Nesrin T B Ayse Y B,Unzile B A,et al.High-valve vapor-permeable film dressing versus fine mesh gauze dressing on skin graft donor areas in diabetic patients:a prospective randomized controlled trial[J].Eur J Plast Surg,2008,31:219-228.
[10]Liebau J,Arens A,Kasten H,et al.The scalp as a favorable donor site for limited-sized split-thickness shin grafts in comparison to the thigh donor site[J].Eur J Plast Surg,2004,27:238-240.
[11]Martinot V,Mitchell V,Fevrier P,et al.Comparative study of split thickness skin grafts taken from the scalp and thigh in children[J].Burns,1994,20:146-150.
[12]Fowler A,Dempsey A.Split-thickness skin graft donor sites[J].J Wound Care,1998,7:339-341.
[13]Mc Cain D,Sutherland S.Nursing essentials:skin grafts for patients with burns[J].Am J Nurs,1998,98:34-38.
[14]Takabayashi Y,Ishihara M,Sumi Y,et al.Platelet-rich plasma-containing fragmin-protamine micro-nanoparticles promote epithelialization and angiogenesis in splitthickness skin graft donor sites[J].Journal of Surgical Research,2015,193(1):483-491.
[15]Dhanraj P.A clinical study comparing Helicoll with Scarlet Red and Op Site in the treatment of split thickness skin graft donor sites:a randomized controlled trial[J].Indian J Surg,2015,77(Suppl 2):385-392.
[16]Muneuchi G,Suzuki S,Moriue T.Combined treatment using artificial dermis and basic fibroblast growth factor(b FGF)for intractable fingertip ulcers caused by atypical burn injufies[J].Bums,2005,31:514-517.
[17]Barnea Y,Amir A,Leshem D,et al.Clinical comparative study of aquacel and paraffin gauze dressing for splitskin donor site treatment[J].Ann Plast Surg,2004,53:132-136.
[18]Uysal C,Alagoz S,Orbay H,et al.An alternative dressing material for the split-thickness skin graft donor site oxidized regenerated cellulose[J].Ann Plast Surg,2006,57:60-64.
[19]Kilinc H,Sensoz O,Ozdemir R,et al.Which dressing for split-thickness skin graft donor sites?[J].Ann Plast Surg,2001,46:409-411.
[20]Griswold J A,Cepica T,Rossi L,et al.A comparison of Xeroform and Skin Temp dressings in the healing of skin graft donor sites[J].J Burn Care Rehabil,1995,16:136-140.
[21]Akan M,Misirlioglu A,Yildirim S,et al.Ice application to minimize pain in the split thickness skin graft donor site[J].Aesthet Plast Surg,2003,27:305-307.
[22]Malpass K G,Snelling C F,Tron V,et al.Comparison of donor site healing under Xeroform and Jelonet dressings:unexpected findings[J].Plast Reconstr Surg,2003,112:430-439.
[23]Innes M E,Umraw N,Fish J S,et al.The use of silver coated dressings on donor site wounds:a prospective,controlled matched pair study[J].Burns,2001,27:621-627.
[24]Pannier M,Martinot V,Castede J C.Efficacy and tolerance of Algosteril(calcium alginate)versus Jelonet(paraffin gauze)in the treatment of scalp graft donor sites in children:results of a randomized study[J].Ann Chir Plast Esthet,2002,47:285-290.
[25]Chang L Y,Yang J Y,Chuang S S,et al.Use of the scalp as a donor site for large burn wound coverage:review of150 patients[J].World J Surg,1998,22:296-300.
[2]Gyger D,Genin B,Bugmann P,et al.Skin harvesting on the scalp in children:utopia or reality[J].Eur J Pediatr Surg,1996,6:166-169.
[3]Barnea Y,Amir A,Leshem D,et al.Clinical comparative study of aquacel and paraffin gauze dressing for split-skin donor site treatment[J].Ann Plast Surg,2004,53:132-136.
[4]Akan M,Misirlioglu A,Yildirim,S,et al.Ice application to minimize pain in the split thickness skin graft donor site[J].Aesthet Plast Surg,2003,27:305-307.
[5]Losada F,Garcia-Luna P P,Gomez-Cia T,et al.Effects of human recombinant growth hormone on donor site healing in burned adults[J].World J Surg,2002,26:2-8.
[6]Misirlioglu A,Eroglu S,Karacaoglan,et al.Use of honey as an adjunct in the healing of split thickness skin graft donor site[J].Dermatol Surg,2003,29:168-172.
[7]Stone C A,Wright H,Clarke T,et al.Healing at skin graft donor sites dressed with chitosan[J].Br J Plast Surg,2000,53:601-606.
[8]Wong D L,Hockenberry E M,Wilson D,et al.Whaley and Wongg Essentials of Pediatric Nursing[M].5thed.St.Louis:Mosby,2001:1301.
[9]Nesrin T B Ayse Y B,Unzile B A,et al.High-valve vapor-permeable film dressing versus fine mesh gauze dressing on skin graft donor areas in diabetic patients:a prospective randomized controlled trial[J].Eur J Plast Surg,2008,31:219-228.
[10]Liebau J,Arens A,Kasten H,et al.The scalp as a favorable donor site for limited-sized split-thickness shin grafts in comparison to the thigh donor site[J].Eur J Plast Surg,2004,27:238-240.
[11]Martinot V,Mitchell V,Fevrier P,et al.Comparative study of split thickness skin grafts taken from the scalp and thigh in children[J].Burns,1994,20:146-150.
[12]Fowler A,Dempsey A.Split-thickness skin graft donor sites[J].J Wound Care,1998,7:339-341.
[13]Mc Cain D,Sutherland S.Nursing essentials:skin grafts for patients with burns[J].Am J Nurs,1998,98:34-38.
[14]Takabayashi Y,Ishihara M,Sumi Y,et al.Platelet-rich plasma-containing fragmin-protamine micro-nanoparticles promote epithelialization and angiogenesis in splitthickness skin graft donor sites[J].Journal of Surgical Research,2015,193(1):483-491.
[15]Dhanraj P.A clinical study comparing Helicoll with Scarlet Red and Op Site in the treatment of split thickness skin graft donor sites:a randomized controlled trial[J].Indian J Surg,2015,77(Suppl 2):385-392.
[16]Muneuchi G,Suzuki S,Moriue T.Combined treatment using artificial dermis and basic fibroblast growth factor(b FGF)for intractable fingertip ulcers caused by atypical burn injufies[J].Bums,2005,31:514-517.
[17]Barnea Y,Amir A,Leshem D,et al.Clinical comparative study of aquacel and paraffin gauze dressing for splitskin donor site treatment[J].Ann Plast Surg,2004,53:132-136.
[18]Uysal C,Alagoz S,Orbay H,et al.An alternative dressing material for the split-thickness skin graft donor site oxidized regenerated cellulose[J].Ann Plast Surg,2006,57:60-64.
[19]Kilinc H,Sensoz O,Ozdemir R,et al.Which dressing for split-thickness skin graft donor sites?[J].Ann Plast Surg,2001,46:409-411.
[20]Griswold J A,Cepica T,Rossi L,et al.A comparison of Xeroform and Skin Temp dressings in the healing of skin graft donor sites[J].J Burn Care Rehabil,1995,16:136-140.
[21]Akan M,Misirlioglu A,Yildirim S,et al.Ice application to minimize pain in the split thickness skin graft donor site[J].Aesthet Plast Surg,2003,27:305-307.
[22]Malpass K G,Snelling C F,Tron V,et al.Comparison of donor site healing under Xeroform and Jelonet dressings:unexpected findings[J].Plast Reconstr Surg,2003,112:430-439.
[23]Innes M E,Umraw N,Fish J S,et al.The use of silver coated dressings on donor site wounds:a prospective,controlled matched pair study[J].Burns,2001,27:621-627.
[24]Pannier M,Martinot V,Castede J C.Efficacy and tolerance of Algosteril(calcium alginate)versus Jelonet(paraffin gauze)in the treatment of scalp graft donor sites in children:results of a randomized study[J].Ann Chir Plast Esthet,2002,47:285-290.
[25]Chang L Y,Yang J Y,Chuang S S,et al.Use of the scalp as a donor site for large burn wound coverage:review of150 patients[J].World J Surg,1998,22:296-300.