不同程度皮肤外翻缝合对股前外侧皮瓣供区切口瘢痕影响的前瞻性随机对照研究  

Effect of different degrees of wound eversion sutures on scar formation at donor site of anterolateral thigh flaps:A prospective randomized controlled study

作　　者：韩建素 李芳 邓呈亮 HAN Jiansu;LI Fang;DENG Chengliang(Department of Burn and Plastic Surgery,Affiliated Hospital of Zunyi Medical University,Zunyi Guizhou,563003,P.R.China)

机构地区：[1]遵义医科大学附属医院烧伤整形外科,贵州遵义563003

出　　处：《中国修复重建外科杂志》2024年第11期1386-1390,共5页Chinese Journal of Reparative and Reconstructive Surgery

基　　金：贵州省科技计划重点项目(ZK2021-011);贵州省科技计划项目([2021]079);中国教育部协同创新中心(2020-39);遵义医科大学未来临床名医计划项目(rc220211202)。

摘　　要：目的采用前瞻性临床随机对照研究,探究不同程度皮肤外翻缝合对股前外侧皮瓣供区切口瘢痕愈合的影响。方法根据切口皮肤外翻程度,试验分为不外翻组(A组)、外翻0.5 cm组(B组)、外翻1.0 cm组(C组)。以2021年9月—2023年3月接受股前外侧皮瓣移植患者作为研究对象,根据选择标准共纳入36例患者。术中股前外侧皮瓣切取后,每例患者皮瓣供区切口均分为二,采用随机数字表法分组(n=24),并进行对应处理。其中30例患者完成随访纳入最终研究(A组n=18、B组n=23、C组n=19),男26例,女4例;年龄35~62岁,中位年龄53岁;身体质量指数17.88~29.18 kg/m^(2),平均23.09 kg/m^(2)。3组患者年龄及身体质量指数比较,差异均无统计学意义(P>0.05)。比较3组切口愈合及瘢痕程度,6个月时行患者观察者瘢痕评估量表(POSAS)评分[包括观察者评估(OSAS)评分及患者自我评估(PSAS)评分]、温哥华瘢痕评估量表(VSS)评分、瘢痕宽度,并参照视觉模拟量表行患者满意度评分。结果术后C组1例供区切口愈合欠佳,清创换药后愈合;1例术后3个月切口坏死,经积极换药后二次手术缝合,切口Ⅱ期愈合。其余两组切口均Ⅰ期愈合。术后6个月,PSAS、OSAS评分以及患者满意度评分均为B组最低、A组次之、C组最高,组间差异均有统计学意义(P<0.05);VSS评分、瘢痕宽度组间差异无统计学意义(P>0.05)。结论适度创缘外翻缝合在一定程度上可减少股前外侧皮瓣供区切口增生性瘢痕的形成。Objective To investigate the effect of different degrees of wound eversion on scar formation at the donor site of anterolateral thigh flaps by a prospective clinical randomized controlled study.Methods According to the degree of wound eversion,the clinical trial was designed with groups of non-eversion(group A),eversion of 0.5 cm(group B),and eversion of 1.0 cm(group C).Patients who underwent anterolateral femoral flap transplantation between September 2021 and March 2023 were collected as study subjects,and a total of 36 patients were included according to the selection criteria.After resected the anterolateral thigh flaps during operation,the wound at donor site of each patient was divided into two equal incisions,and the random number table method was used to group them(n=24)and perform corresponding treatments.Thirty of these patients completed follow-up and were included in the final study(group A n=18,group B n=23,and group C n=29).There were 26 males and 4 females with a median age of 53 years(range,35-62 years).The body mass index was 17.88-29.18 kg/m^(2)(mean,23.09 kg/m^(2)).There was no significant difference in the age and body mass index between groups(P>0.05).The incision healing and scar quality of three groups were compared,as well as the Patient and Observer Scar Assessment Scale(POSAS)score[including the observer component of the POSAS(OSAS)and the patient component of the POSAS(PSAS)],Vancouver Scar Scale(VSS)score,scar width,and patient satisfaction score[visual analogue scale(VAS)score].Results In group C,1 case had poor healing of the incision after operation,which healed after debridement and dressing change;1 case had incision necrosis at 3 months after operation,which healed by second intention after active dressing change and suturing again.The other incisions in all groups healed by first intention.At 6 months after operation,the PSAS,OSAS,and patient satisfaction scores were the lowest in group B,followed by group A,and the highest in group C.The differences between the groups were sign

关 键 词：切口缝合 皮肤外翻 瘢痕 股前外侧皮瓣 前瞻性随机对照研究 

分 类 号：R622[医药卫生—整形外科]