负压创面修复技术联合皮肤移植治疗小儿大面积皮肤撕脱伤的疗效观察  

Efficacy observation of negative pressure wound therapy combined with skin grafting for the treatment of large-scale skin avulsions in children

作　　者：廖新成[1] 江政英 付忠华[1] 刘名倬[1] 郭光华[1] Liao Xincheng;Jiang Zhengying;Fu Zhonghua;Liu Mingchuo;Guo Guanghua(Medical Center for Burn Plastic Surgery and Wound Repair,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院烧伤整形与创面修复医学中心,南昌330006

出　　处：《临床小儿外科杂志》2024年第11期1062-1067,共6页Journal of Clinical Pediatric Surgery

基　　金：国家自然基金地区科学基金项目(82160380);江西省中医药管理局科技计划(2023B0821)。

摘　　要：目的探讨负压创面修复技术(negative pressure wound therapy,NPWT)联合皮肤移植治疗小儿大面积皮肤撕脱伤的疗效,并总结手术经验。方法回顾性分析2018年6月至2023年6月于南昌大学第一附属医院烧伤整形与创面修复医学中心就诊的40例大面积皮肤撕脱伤患儿临床资料。患儿均先在急诊手术室彻底清创,采取原位植皮方式缝合固定创面,并以NPWT覆盖。观察患儿初次植皮手术后14 d植皮存活情况、肉芽生长时间、NPWT治疗时间、创面愈合时间、住院时间等。随访患儿术后8个月植皮部位皮肤的色泽、弹性、皮下丰满度、瘢痕增生情况、关节功能情况。检测患儿炎症因子水平变化和植皮部位菌株及细菌检出率情况。结果患儿皮片移植一期完全存活29例(29/40,72.50%),无血运皮肤存活25例(25/40,62.50%)。40例患儿术后植皮存活率为(85.18±2.18)%,肉芽生长时间(8.55±1.18)d,创面愈合时间(21.55±6.37)d,NPWT治疗时间(19.55±6.02)d,住院时间(36.25±3.18)d。NPWT治疗期间创面细菌总检出率与治疗前相比,差异无统计学意义(P>0.05)。无一例出现严重并发症,2例手术后初期出现创面感染,1例住院过程中出现轻度褥疮。40例随访时间均超过8个月,皮肤色泽评分(2.63±0.63)分,皮肤质地评分(2.85±0.36)分。治疗后白细胞介素-6(Interleukin-6,IL-6)、白细胞介素-23(Interleukin-23,IL-23)及肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)水平较治疗前均明显降低,分别为(102.26±12.21)pg/mL比(58.93±7.44)pg/mL、(182.54±13.52)pg/mL比(110.74±10.25)pg/mL、(6.92±0.47)pg/mL比(4.57±0.52)pg/mL,差异均有统计学意义(P<0.05)。结论使用NPWT联合皮肤移植治疗儿童大面积皮肤撕脱伤,能促进创面肉芽修复,植皮成活率高,感染发生率低,可改善皮片与创面的贴敷,具有较高的临床应用价值。ObjectiveTo explore the efficacy and surgical experience of combining negative pressure wound therapy(NPWT)with skin grafting in the treatment of large-scale skin avulsions in children.MethodsA retrospective analysis was conducted on the clinical data of 40 children with large-scale skin avulsions who were treated at the Medical Center of Burn Plastic Surgery and Wound Repair of the First Affiliated Hospital of Nanchang University from June 2018 to June 2023.All patients underwent thorough debridement in the emergency operating room,with split-thickness skin grafting and NPWT applied.Outcomes observed included skin graft survival at 14 days post-surgery,granulation growth time,NPWT treatment duration,wound healing time,and hospital stay.Follow-up assessments at 8 months included skin color,elasticity subcutaneous fullness,scar proliferation,and joint function.Levels of inflammatory factors and bacterial detection rates in the grafted areas were also measured.ResultsAmong the 40 children,29 had complete skin graft survival(29/40,72.50%),and 25 had surviving grafts with blood supply(25/40,62.50%).The overall skin graft survival rate was(85.18±2.18)%,with granulation growth time of(8.55±1.18)days,wound healing time of(21.55±6.37)days,NPWT treatment duration of(19.55±6.02)days,and hospital stay of(36.25±3.18)days.There was no statistically significant difference in the overall bacterial detection rate during NPWT compared to before treatment(P>0.05).No severe complications were reported;2 cases had initial wound infections,and 1 case had mild pressure sores during hospitalization.Follow-up duration exceeded 8 months,with skin color scores of(2.63±0.63)and skin texture scores of(2.85±0.36).Levels of Interleukin-6(IL-6),Interleukin-23(IL-23),and tumor necrosis factor-α(TNF-α)decreased significantly after treatment compared to before,with values of(102.26±12.21 vs.58.93±7.44),(182.54±13.52 vs.110.74±10.25),and(6.92±0.47 vs.4.57±0.52),respectively(P<0.05).ConclusionsThe combination of NPWT and skin graftin

关 键 词：儿童 皮肤撕脱 负压创面修复技术 皮肤移植 疗效 

分 类 号：R47[医药卫生—护理学]