腹部不同位置全厚皮片修复小儿功能部位皮肤软组织缺损的前瞻性随机对照研究  

A prospective randomized controlled study on the repair of skin and soft tissue defect in functional areas of children with full-thickness skin grafts from different sites of abdomen

作　　者：佟琳 张万福 胡晓龙 韩飞 韩夫 官浩 Tong Lin;Zhang Wanfu;Hu Xiaolong;Han Fei;Han Fu;Guan Hao(Department of Burns and Cutaneous Surgery,Burn Center of PLA,the First Affiliated Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学第一附属医院全军烧伤中心,烧伤与皮肤外科,西安710032

出　　处：《中华烧伤与创面修复杂志》2022年第8期744-752,共9页Chinese Journal of Burns And Wounds

基　　金：陕西省自然科学基础研究计划(2020JM-322)。

摘　　要：目的对比分析采用腹部不同位置全厚皮片修复小儿功能部位小面积皮肤软组织缺损创面的效果。方法采用前瞻性随机对照研究方法。2019年1月—2020年6月,空军军医大学第一附属医院收治60例符合入选标准的因功能部位小面积皮肤软组织缺损需行全厚皮片移植修复的女性住院患儿。按随机数字表法将患儿分为2组,剔除随访脱落患儿后,侧腹部组纳入28例、下腹部组纳入29例,年龄分别为5(3,8)、5(3,7)岁。对下腹部组患儿20(12,26)cm^(2)创面采用于腹下区横行皮纹处切取的(24±10)cm^(2)全厚皮片修复,侧腹部组患儿23(16,32)cm^(2)创面采用于脐平面以下至腹股沟以上的侧腹部区切取的(24±9)cm^(2)全厚皮片修复,供区切口均行连续皮内缝合。术后供受区均行-10.64~-6.65 kPa持续负压治疗,术后7 d开始应用医用皮肤减张闭合器治疗供区。记录供区使用医用皮肤减张闭合器情况、供区术后并发症发生情况及拆线时间并计算并发症发生率;术后7 d,采用自行设计的疗效满意度调查表调查患儿家长对患儿疗效的满意度;术后1、6个月,采用温哥华瘢痕量表(VSS)评估供区瘢痕情况并计算2个时间点VSS评分差值,用直尺测量供区瘢痕宽度并计算2个时间点瘢痕宽度差值。对数据行独立样本t检验或Cochran&Cox近似t检验、Mann-Whitney U检验、Fisher确切概率法检验。结果侧腹部组术后供区应用医用皮肤减张闭合器时间≥4周患儿比例明显高于下腹部组(P<0.05)。术后7 d,侧腹部组中出现供区切口部分裂开、供区周围皮肤红肿、供区脂肪液化的患儿各1例,下腹部组1例患儿供区出现切口部分裂开;下腹部组患儿供区术后并发症发生率明显低于侧腹部组(P<0.05)。与侧腹部组相比,下腹部组患儿供区术后拆线时间显著缩短(t'=17.23,P<0.01)。术后7 d,下腹部组患儿家长对患儿疗效的满意度评分明显高于侧腹部组(t'=20.14,P<0.0Objective To compare and analyze the effect of repairing small skin and soft tissue defect wounds in functional areas of children with full-thickness skin grafts from different sites of abdomen.Methods A prospective randomized controlled study was conducted.From January 2019 to June 2020,60 female children with small skin and soft tissue defects in functional areas requiring full-thickness skin grafting,who met the inclusion criteria,were admitted to the First Affiliated Hospital of Air Force Medical University.According to the random number table,the children were divided into two groups,with 28 cases left in lateral abdomen group aged 5(3,8)years and 29 cases in lower abdomen group aged 5(3,7)years after the exclusion of several dropped-out children in follow-up.In lower abdomen group,20(12,26)cm^(2) wounds of children were repaired with(24±10)cm^(2) full-thickness skin graft from transverse skin lines in the inferior abdomen area,while in lateral abdomen group,23(16,32)cm^(2) wounds of children were repaired with(24±9)cm^(2) full-thickness skin graft from below the umbilical plane to above the groin in the lateral abdomen area.All the children were treated with continuous intradermal suture at the donor site incision and received continuous negative pressure treatment of-10.64 to-6.65 kPa in the donor and recipient areas after operation.The donor site was treated with a medical skin tension-reducing closure device since post-surgery day(PSD)7.The use of medical skin tension-reducing closure device at the donor site,postoperative complications and suture removal time of the donor area were recorded,and the incidence of complications was calculated.On PSD 7,a self-designed efficacy satisfaction questionnaire was used to investigate the parents'satisfaction with the curative effect of their children.In post-surgery month(PSM)1 and 6,Vancouver scar scale(VSS)was used to evaluate the scar at the donor site,and the VSS score difference between the two time points was calculated;the scar width at the donor site was

关 键 词：儿童 烧伤 伤口愈合 皮肤移植 下腹部 全厚皮片 功能部位 

分 类 号：R726.5[医药卫生—儿科]