全厚与断层皮片移植修复儿童软组织创面的比较△（开放获取）

Full-thickness versus split-thickness skin grafting for repairing wounds secondary to necrotizing soft tissue infection in children (OA)

摘要:

［目的］ 探讨全厚与断层皮片移植修复儿童坏死性软组织感染 （necrotizing soft tissue infection, NSTI） 创面的疗效。 ［方法］回顾性分析河北省儿童医院 2014 年 1 月—2022 年 6 月收治的 56 例 NSTI 患儿的临床资料，依据医患沟通结果，31 例行全厚皮片移植（全厚组），25 例行断层皮片移植（断层组）。比较两组围手术期及随访资料。［结果］ 两组手术时间、术中失血量、清创后缺损面积、供区部位及处理、移植皮片成活率、下地行走时间和住院时间比较差异均无意义 （P>0.05）。所有患儿均获随访，随访时间平均 （12.0±2.4） 个月。随术后时间推移，两组受区和供区外观视觉模拟评分 （visual analogue scale, VAS）和温哥华瘢痕量表（Vancouver scar scale, VSS）评分均显著减少（P<0.05），受区功能显著改善（P<0.05），供区功能无显著变化（P>0.05）。术后 3 个月、末次随时全厚组受区 VAS [(5.7±0.7) vs (6.0±0.4), P=0.017; (2.0±0.7) vs (3.6±0.7), P<0.001] 及受区 VSS 评分 [(4.3±0.8) vs (5.4±0.7), P<0.001; (2.5±0.6) vs (4.1±0.5), P<0.001]、受区功能 [正常/受限/畸形, (11/16/4) vs (4/11/10), P= 0.045; (24/7/0) vs (9/16/0), P=0.002] 均显著优于断层组。［结论］全厚皮片在坏死性软组织感染创面修复的治疗中具有良好效果， 可用于坏死性软组织感染创面的修复。

Abstract:

[Objective] To explore the therapeutic outcomes of full-thickness versus split-thickness skin grafting for repairing the wounds secondary to necrotizing soft tissue infection (NSTI) in children. [Methods] A retrospective study was conducted on 56 children who had wound of NSTI treated in the Children's Hospital of Hebei Province from January 2014 to June 2022. According to patient-doctor communication, 31 children underwent full-thickness skin grafting (FT group), while other 25 patients had split-thickness skin grafting performed (ST group). The documents regarding perioperative period and follow-up were compared between the two groups. [Results] There were no significant differences in operation time, intraoperative blood loss, defect area after debridement, donor site and treatment, graft survival rate, walking time and hospital stay between the two groups (P＞0.05). As time went during follow-up period lasted for an average of (12.0±2.4) months, the visual analogue scale (VAS) for appearance, and Vancouver scar scale (VSS) of recipient and donor areas significantly decreased (P＜0.05), while the function of recipient area significantly improved (P＜0.05), despite of the fact that function of donor area remained unchange in both groups (P＞0.05). The FT group proved significantly superior to the ST group in terms of VAS for appearance [(5.7±0.7) vs (6.0±0.4), P=0.017; (2.0±0.7) vs (3.6±0.7), P＜0.001] VSS score [(4.3±0.8) vs (5.4±0.7), P＜0.001; (2.5±0.6) vs (4.1±0.5), P＜ 0.001], the area function [normal/ limited/deformity, (11/16/4) vs (4/11/10), P=0.045; (24/7/0) vs (9/16/0), P=0.002] 3 months postoperatively and at the latest follow-up. [Conclusion] Full-thickness skin grafting have good consequence in wound repair, and can be used for the repair of wound secondary to necrotic soft tissue infection in children.