摘要
目的:观察负压封闭引流(Vacuum-assisted closure,VAC)联合植皮手术对儿童下肢大面积皮肤缺损的修复效果。方法:2017年1月-2020年1月笔者医院收治的76例下肢大面积皮肤缺损患儿,按照随机数字表法分为对照组和观察组,每组38例。对照组采用植皮手术,观察组在对照组基础上联合VAC治疗。比较两组创面修复效果、临床指标、疼痛程度及感染情况。结果:手术6个月后,观察组创面修复优良率高于对照组(84.21% vs 63.16%),差异具有统计学意义(P<0.05)。术后,观察组植皮存活时间、换药次数、住院天数及瘢痕评估量表(Patient and observer scar assessment scale,POSAS)均少于对照组,皮片存活率高于对照组(81.58% vs 65.79%),差异均具有统计学意义(P<0.05)。术后1周,观察组血小板衍生生长因子(Platelet derived growth factor,PDGF)表达水平高于对照组,血管内皮生长因子(Vascular endothelial growth factor,VEGF)低于对照组,差异具有统计学意义(P<0.05)。手术2个月后,观察组中文版儿童疼痛行为量表(The face,legs,activity,cry,consolability behavioral tool,FLACC)各项评分低于对照组,差异具有统计学意义(P<0.05)。观察组不良反应总发生率低于对照组(15.79% vs 31.58%),差异具有统计学意义(P<0.05)。结论:VAC联合植皮手术修复儿童下肢大面积皮肤缺损效果较佳,其创面修复效果较好,美观度较高,利于术后恢复,缓解疼痛,可有效降低不良反应,值得临床推广。
Objective To observe the clinical effect of vacuum-assisted closure (VAC) combined with skin grafting on children with lower limb large-area skin defects.Methods 76 children with lower limb large-area skin defects admitted to the hospital between January 2017 and January 2020 were divided into the control group and the observation group according to the random number table method,with 38 cases in each group.The control group was given skin grafting,and the observation group was combined with VAC treatment on the basis of the control group.The wound repair effect,clinical indicators,pain degree and infection status of the two groups were compared.Results Six months after operation,the excellent and good rate of wound repair in the observation group was higher than that in the control group (84.21% vs 63.16%),and the difference was statistically significant (P<0.05).After operation,the survival time,dressing change times,hospital stay and POSAS score of skin grafting in the observation group were shorter than those in the control group,and the survival rate of skin grafting in the observation group was higher than that in the control group (81.58% vs 65.79%,P<0.05).One week after operation,the expression level of PDGF in the observation group was higher than that in the control group,and the level of VEGF was lower than that in the control group (P<0.05).Two months after operation,the FLACC scores of the observation group were lower than those of the control group (P<0.05).The total incidence of adverse reactions in the observation group was lower than that in the control group (15.79% vs 31.58%,P<0.05).Conclusion VAC combined with skin grafting has a better effect in repairing large skin defects of children’s lower limbs.Its wound repair effect is good and its aesthetics is high.It is conducive to postoperative recovery,relieve pain,and effectively reduce adverse reactions.It is worthy of clinical promotion.
作者
李明霞
LI Mingxia(Department of Burn and Plastic Surgery,Children’s Hospital of Nanjing Medical University,Nanjing 210000,Jiangsu,China)
出处
《中国美容医学》
CAS
2022年第6期74-77,共4页
Chinese Journal of Aesthetic Medicine
关键词
负压封闭引流
植皮
皮肤缺损
创面修复
下肢
儿童
vacuum-assisted closure(VAC)
skin grafting
skin defect
wound repair
lower limbs
children
