不同皮片获取方式联合VSD对急诊创伤伴大面积皮肤撕脱病情转归影响  

Effect of different skin graft harvest methods combined with VSD on the outcome of emergency trauma with large-area skin avulsion

作　　者：牛陆杰[1] 陈卫鑫[2] NIU Lu-jie;CHEN Wei-xin(Department of Trauma and Emergency Surgery,the Second Affiliated Hospital of Soochow University,Jiangsu Province,Suzhou 215008,China;Department of Burn Plastic Surgery,the First Affiliated Hospital of Soochow University,Jiangsu Province,Suzhou 215008,China)

机构地区：[1]苏州大学附属第二医院急诊创伤外科,江苏苏州215008 [2]苏州大学附属第一医院急诊烧伤整形科,江苏苏州215008

出　　处：《河北医科大学学报》2024年第8期940-945,共6页Journal of Hebei Medical University

摘　　要：目的探讨不同薄中厚皮片联合负压封闭引流术(vacuum sealing drainage,VSD)对急诊创伤伴大面积皮肤撕脱病情转归影响。方法选取急诊创伤伴大面积皮肤撕脱患者70例,根据皮片获取方式不同分为切取组、反取组,各35例。比较2组愈合情况、换药次数、住院时间、治疗费用、治疗后12 h、治疗后24 h、治疗后48 h、治疗后72 h视觉模拟评分法(visual analogue scale,VAS)评分、温哥华瘢痕量表评分、患处皮肤感觉及并发症。结果反取组Ⅰ期愈合率高于切取组,换药次数少于切取组,住院时间短于切取组(P<0.05);2组术后12~72 h的VAS评分呈降低趋势,组间、时点间、组间时点间交互作用之间差异有统计学意义(P<0.05)。反取组温哥华瘢痕量表色泽、厚度、柔软度评分低于切取组,患处皮肤感觉分级优于切取组(P<0.05);反取组治疗费用、并发症发生率与切取组比较,差异无统计学意义(P>0.05)。结论相比切取薄中厚皮片,反取薄中厚皮片联合VSD治疗急诊创伤伴大面积皮肤撕脱患者Ⅰ期愈合率更高,疼痛度更低,美学效果、皮肤感觉更好,换药次数少、住院时间短,且不会增加并发症发生风险及治疗费用。Objective To investigate the effect of different thin-medium-thick skin grafts combined with vacuum sealing drainage(VSD)on the outcome of emergency trauma with large-area skin avulsion.Methods Seventy patients with emergency trauma with large-area skin avulsion were selected and divided into skin graft harvesting group(n=35)and reverse skin graft harvesting group(n=35)according to different methods of skin graft harvesting.The two groups were compared in terms of healing,number of dressing changes,length of hospital stay,treatment expenses,visual analogue scale(VAS)score at 12 h,24 h,48 h and 72 h after treatment,Vancouver Scar Scale(VSS)score,skin sensation at the affected area and complications.Results The rate of primary healing in the reverse skin graft harvesting group was higher than that of the skin graft harvesting group,the number of dressing changes was less than that of the skin graft harvesting group,and the length of hospital stay was shorter than that of the skin graft harvesting group(P<0.05).The VAS score at 12-72 h after surgery showed a decreasing trend in both groups,and there were significant differences in interaction between groups,time points and time points between groups(P<0.05).The color,thickness,and softness of the VSS score in the reverse skin graft harvesting group were lower than those in the skin graft harvesting group,and the skin sensory grading of the affected area was better than that in the skin graft harvesting group(P<0.05).There was no significant difference in the treatment expenses and complication rate between the reverse skin graft harvesting group and the skin graft harvesting group(P>0.05).Conclusion Compared with thin-medium-thick skin graft harvesting,reverse thin-medium-thick skin graft harvesting combined with VSD in the treatment of emergency trauma patients with large-area skin avulsion have a higher primary healing rate,lower pain,better aesthetic effects,better skin sensation,fewer dressing changes,and shorter hospital stay,and will not increase the risk of c

关 键 词：皮肤撕脱 引流术 治疗结果 

分 类 号：R658.3[医药卫生—外科学]