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  • Title: [Clinical application of negative-pressure wound therapy in split-thickness skin grafting at hard-to-fix sites].
    Author: Li SH, Zhang WF, Hu XL, Wang YC, Han F, Ji P, Han F, Hu DH, Guan H.
    Journal: Zhonghua Shao Shang Za Zhi; 2020 Jul 20; 36(7):528-533. PubMed ID: 32842398.
    Abstract:
    Objective: To compare the clinical effects of continuous negative-pressure wound therapy (NPWT) and conventional pressure dressing at at hard-to-fix sites after split-thickness skin grafting. Methods: From September 2017 to August 2019, 129 patients who met the inclusion criteria and had spilt-thickness skin grafting at hard-to-fix sites were admitted to the First Affiliated Hospital of Air Force Medical University and included in this retrospective cohort study. The patients were divided into NPWT group (67 patients, 41 males and 26 females, aged (32±6) years) and conventional pressure dressing group (62 patients, 37 males and 25 females, aged (30±5) years) according to whether the hard-to-fix sites were applied with NPWT after spilt-thickness skin grafting. After debridement and spilt-thickness skin grafting at hard-to-fix sites in patients of 2 groups, the wounds of patients in conventional pressure dressing group were applied with conventional pressure bandaging after being filled with dry gauze; for the wounds of patients in NPWT group, the semi-permeable membrane was pasted and sealed for continuous negative pressure suction after filled with dry gauze and placed the drainage foam or drainage tube, with the negative pressure ranging from -16.6 to -9.9 kPa. The bandage was opened during the first dressing change on the 5th day after surgery in NPWT group and on the 7th day after surgery in conventional pressure dressing group. The skin graft surviving area and proportion, the area and proportion of hematoma, the incidence of common complications of skin graft were observed and calculated. The times of postoperative dressing change and the length of hospital stay were counted. Data were statistically analyzed with two independent sample t test, Cochran & Cox approximate t test, chi-square test, and Fisher's exact probability test. Results: (1) At the first dressing change, the skin graft surviving area of patients in NPWT group was (420±94) cm(2), which was significantly larger than (322±97) cm(2) in conventional pressure dressing group (t'=12.33, P<0.01); the skin graft surviving area proportion of patients in NPWT group was (97.0±2.3)%, which was significantly higher than (74.4±4.8)% in conventional pressure dressing group (t'=50.11, P<0.01). (2) At the first dressing change, the skin hematoma area of patients in conventional pressure dressing group was (31.7±10.1) cm(2), which was significantly larger than (3.2±0.7) cm(2) in NPWT group (t'=23.04, P<0.01); the skin hematoma area proportion of patients in conventional pressure dressing group was (7.3±2.3)%, which was significantly higher than (0.7±0.3)% in NPWT group (t'=76.21, P<0.01). (3) At the first dressing change, there was 1 case of skin movement and no case of skin graft edge tear in NPWT group with an incidence of 1.5% (1/67). In the conventional pressure dressing group, there were 4 cases of skin movement and 2 cases of skin graft edge tear with an incidence of 9.7% (6/62), P<0.05. The incidence of complication of skin graft of patients in NPWT group was significantly lower than that in conventional pressure dressing group (P<0.05). (4) The times of postoperative dressing change of patients in NPWT group was significantly less than that in conventional pressure dressing group (t=7.93, P<0.01). The postoperative length of hospital stay in NPWT group was significantly less than that in conventional pressure dressing group (t=11.71, P<0.01). Conclusions: Continuous NPWT can effectively promote wound healing, improve the survival rate of skin graft, reduce the incidence of complications after skin grafting, and shorten the length of hospital stay in split-thickness skin grafting at hard-to-fix sites. 目的： 对比持续负压伤口疗法(NPWT)与常规打包加压包扎在难固定部位创面中厚皮移植术中的临床效果。 方法： 2017年9月—2019年8月，空军军医大学第一附属医院收治符合入选标准的难固定部位需行中厚皮移植术患者129例，纳入本回顾性队列研究。根据中厚皮移植术后难固定部位是否采用了NPWT将患者分为NPWT组67例[男41例、女26例，年龄(32±6)岁]和常规加压包扎组62例[男37例、女25例，年龄(30±5)岁]。2组患者难固定部位清创移植中厚皮后，常规加压包扎组患者创面采用干纱布填塞后，绷带常规加压包扎；NPWT组患者创面干纱布填塞后放置引流泡沫或引流管，半透膜粘贴密闭，行持续负压吸引，压力范围-16.6～-9.9 kPa。NPWT组于术后5 d、常规加压包扎组于术后7 d首次换药时打开包扎，观察并计算皮片成活面积和比例、血肿面积和比例、皮片常见并发症发生率；另统计术后换药次数和住院天数。对数据行两独立样本t检验、Cochran & Cox近似t检验、χ(2)检验、Fisher确切概率法检验。 结果： (1)首次换药时，NPWT组患者的皮片成活面积为(420±94)cm(2)，明显大于常规加压包扎组的(322±97)cm(2)(t′＝12.33，P<0.01)；NPWT组患者的皮片成活面积比例为(97.0±2.3)%，明显高于常规加压包扎组的(74.4±4.8)%(t′＝50.11，P<0.01)。(2)首次换药时，常规加压包扎组患者的皮片血肿面积为(31.7±10.1)cm(2)，明显大于NPWT组的(3.2±0.7)cm(2)(t′＝23.04，P<0.01)；常规加压包扎组患者的皮片血肿面积比例为(7.3±2.3)%，明显高于NPWT组的(0.7±0.3)%(t′＝76.21，P<0.01)。(3)首次换药时，NPWT组患者中皮片移动1例、无皮片边缘撕裂病例，皮片并发症发生率为1.5%(1/67)；常规加压包扎组患者中皮片移动4例、皮片边缘撕裂2例，皮片并发症发生率为9.7%(6/62)。NPWT组患者皮片并发症发生率明显低于常规加压包扎组(P<0.05)。(4)NPWT组患者术后换药次数明显少于常规加压包扎组(t＝7.93，P<0.01)，术后住院天数明显少于常规加压包扎组(t＝11.71，P<0.01)。 结论： 在难固定部位中厚皮移植术中，持续NPWT能有效促进创面愈合，提高皮片成活率，减少植皮术后并发症的发生，并缩短住院时间。.
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