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Volume 38 Issue 8
Aug.  2022
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Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2022  >  38(8): 744-752
Tong Lin,Zhang Wanfu,Hu Xiaolong,et al.A prospective randomized controlled study on the repair of skin and soft tissue defect in functional areas of children with full-thickness skin grafts from different sites of abdomen[J].Chin J Burns Wounds,2022,38(08):744-752.DOI: 10.3760/cma.j.cn501120-20210709-00243.
Citation: Tong Lin,Zhang Wanfu,Hu Xiaolong,et al.A prospective randomized controlled study on the repair of skin and soft tissue defect in functional areas of children with full-thickness skin grafts from different sites of abdomen[J].Chin J Burns Wounds,2022,38(08):744-752.DOI: 10.3760/cma.j.cn501120-20210709-00243.
shu

A prospective randomized controlled study on the repair of skin and soft tissue defect in functional areas of children with full-thickness skin grafts from different sites of abdomen

doi: 10.3760/cma.j.cn501120-20210709-00243

  • Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital, Air Force Medical University, Xi'an 710032, China

Funds:

Natural Science Basic Research Project of Shaanxi Province of China 2020JM-322

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    Abstract
  •   Objective  To compare and analyze the effect of repairing small skin and soft tissue defect wounds in functional areas of children with full-thickness skin grafts from different sites of abdomen.  Methods  A prospective randomized controlled study was conducted. From January 2019 to June 2020, 60 female children with small skin and soft tissue defects in functional areas requiring full-thickness skin grafting, who met the inclusion criteria, were admitted to the First Affiliated Hospital of Air Force Medical University. According to the random number table, the children were divided into two groups, with 28 cases left in lateral abdomen group aged 5 (3, 8) years and 29 cases in lower abdomen group aged 5 (3, 7) years after the exclusion of several dropped-out children in follow-up. In lower abdomen group, 20 (12, 26) cm2 wounds of children were repaired with (24±10) cm2 full-thickness skin graft from transverse skin lines in the inferior abdomen area, while in lateral abdomen group, 23 (16, 32) cm2 wounds of children were repaired with (24±9) cm2 full-thickness skin graft from below the umbilical plane to above the groin in the lateral abdomen area. All the children were treated with continuous intradermal suture at the donor site incision and received continuous negative pressure treatment of -10.64 to -6.65 kPa in the donor and recipient areas after operation. The donor site was treated with a medical skin tension-reducing closure device since post-surgery day (PSD) 7. The use of medical skin tension-reducing closure device at the donor site, postoperative complications and suture removal time of the donor area were recorded, and the incidence of complications was calculated. On PSD 7, a self-designed efficacy satisfaction questionnaire was used to investigate the parents' satisfaction with the curative effect of their children. In post-surgery month (PSM) 1 and 6, Vancouver scar scale (VSS) was used to evaluate the scar at the donor site, and the VSS score difference between the two time points was calculated; the scar width at the donor site was measured with a ruler, and the scar width difference between the two time points was calculated. Data were statistically analyzed with independent sample t test or Cochran & Cox approximate t test, Mann-Whitney U test, and Fisher's exact probability test.  Results  The proportion of children in lateral abdomen group who used the medical skin tension-reducing closure device in the donor area for equal to or more than 4 weeks after surgery was significantly higher than that in lower abdomen group (P<0.05). On PSD 7, there was one case of partial incision dehiscence in the donor area, one case of peripheral skin redness and swelling in the donor area, and one case of fat liquefaction in the donor area in lateral abdomen group, and one case of partial incision dehiscence in the donor area in lower abdomen group. The incidence of postoperative complications at the donor site of children in lower abdomen group was significantly lower than that in lateral abdomen group (P<0.05). Compared with that in lateral abdomen group, the suture removal time at the donor site of children after surgery in lower abdomen group was significantly shorter (t'=17.23, P<0.01). On PSD 7, the satisfaction score of parents with the curative effect of their children in lower abdomen group was significantly higher than that in lateral abdomen group (t'=20.14, P<0.01). In PSM 1 and 6, the VSS scores of scar at the donor site of children in lower abdomen group were 2.7±0.9 and 2.8±1.0, respectively, which were significantly lower than 7.1±2.2 and 9.1±2.7 in lateral abdomen group (with t values of 10.00 and 11.15, respectively, P<0.01). In PSM 6, the VSS score of scar at the donor site of children in lateral abdomen group was significantly higher than that in PSM 1 (t=3.10, P<0.01), while the VSS score of scar at the donor site of children in lower abdomen group was not significantly higher than that in PSM 1 (P>0.05). The VSS score difference of scar at the donor site of children in lateral abdomen group was significantly greater than that in lower abdomen group (Z=-8.12, P<0.01). In PSM 1 and 6, the scar widths at the donor site of children in lower abdomen group were 2.0 (1.0, 2.0) and 2.0 (2.0, 3.0) mm, respectively, which were significantly narrower than 6.0 (4.0, 10.0) and 8.5 (5.0, 12.0) mm in lateral abdomen group (with Z values of -13.41 and -14.70, respectively, P<0.01). In PSM 6, the scar width at the donor site of children in lateral abdomen group was significantly wider than that in PSM 1 (Z=-2.79, P<0.01), while the scar width at the donor site of children in lower abdomen group was not significantly wider than that in PSM 1 (P>0.05). The difference of scar width at the donor site of children in lateral abdomen group was significantly greater than that in lower abdomen group (Z=-14.93, P<0.01).  Conclusions  The use of full-thickness skin grafts from the lower abdomen to repair small skin and soft tissue defect wounds in functional areas of children, especially girls, is effective, simple and easy to operate, and conforms to the principle of aesthetic repair. Compared with transplantation with full-thickness skin graft from the lateral abdomen, lower abdominal full-thickness skin grafting has a low incidence of donor site complications and no obvious scar hyperplasia, which is worthy of clinical promotion.

     

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    • References(32)
  • [1]
    牛大伟,李志保,马启海.大张次全厚皮片在功能部位软组织缺损修复术中的应用[J].中国美容医学,2020,29(1):118-119,144.
    [2]
    JiangY,GuoR,ZhouS,et al.Functional and aesthetic reconstruction of digital flexion contractures with full-thickness plantar skin grafts in children[J].Dermatol Ther,2020,33(6):e14466.DOI: 10.1111/dth.14466.
    [3]
    秦小琰.全厚皮片移植修复手掌侧皮肤缺损的供区选择及应用研究进展[J].现代医药卫生,2020,36(23):3799-3802.DOI: 10.3969/j.issn.1009-5519.2020.23.023.
    [4]
    李云峰,吴泽勇,黄海华,等.全厚皮片游离移植矫治儿童足背瘢痕挛缩畸形[J].中国美容医学,2018,27(3):27-29.
    [5]
    ElrodJ,MoellmeierD,SchiestlC,et al.Comparative analysis of functional and aesthetic outcomes of retroauricular full thickness versus plantar glabrous split thickness skin grafts in pediatric palmar hand burns[J].Burns,2020,46(3):639-646.DOI: 10.1016/j.burns.2019.09.004.
    [6]
    DunstCM,ScottEC,KraatzJJ,et al.Contact palm burns in toddlers from glass enclosed fireplaces[J].J Burn Care Rehabil,2004,25(1):67-70.DOI: 10.1097/01.BCR.0000105093.55037.63.
    [7]
    GaffneyP.The domestic iron. A danger to young children[J].J Accid Emerg Med,2000,17(3):199-200.DOI: 10.1136/emj.17.3.199.
    [8]
    BentivegnaK,McCollumS,WuR,et al.A state-wide analysis of pediatric scald burns by tap water, 2016-2018[J].Burns,2020,46(8):1805-1812.DOI: 10.1016/j.burns.2020.06.009.
    [9]
    FergusonDM,ParkerTD,MarinoVE,et al.Risk factors for nonaccidental burns in children[J].Surg Open Sci,2020,2(3):117-121.DOI: 10.1016/j.sopen.2020.05.002.
    [10]
    ZhouB,ZhouX,OuyangLZ,et al.An epidemiological analysis of paediatric burns in urban and rural areas in south central China[J].Burns,2014,40(1):150-156.DOI: 10.1016/j.burns.2013.04.020.
    [11]
    程文凤,赵东旭,申传安,等.14岁以下儿童大面积烧伤的多中心流行病学调查[J].中华医学杂志,2017,97(6):462-467.DOI: 10.3760/cma.j.issn.0376-2491.2017.06.013.
    [12]
    李长青,李子健,孙晋中,等.超全厚定型皮片治疗面部瘢痕的疗效[J].中华医学美学美容杂志,2019,25(4):341-342.DOI: 10.3760/cma.j.issn.1671-0290.2019.04.025.
    [13]
    夏双印,王洁,杨大平,等.下腹部大面积全厚皮片修复手部创面[J].中华手外科杂志,1995,11(2):123.DOI: 10.3760/cma.j.issn.1005-054X.1995.02.138.
    [14]
    刘胜哲,巨积辉,柳志锦,等.串并联双侧股前外侧超长穿支皮瓣修复四肢大面积创面的临床效果[J].中华烧伤杂志,2021,37(3):250-256.DOI: 10.3760/cma.j.cn501120-20200226-00096.
    [15]
    武淑霞,耿巍.腹部横切口皮内缝合术式剖宫产的临床评价[J/CD].实用妇科内分泌电子杂志,2016,3(16):81,83.DOI: 10.3969/j.issn.2095-8803.2016.16.048.
    [16]
    Birke-SorensenH,MalmsjoM,RomeP,et al.Evidence-based recommendations for negative pressure wound therapy: treatment variables (pressure levels, wound filler and contact layer)--steps towards an international consensus[J].J Plast Reconstr Aesthet Surg,2011,64 Suppl:S1-16.DOI: 10.1016/j.bjps.2011.06.001.
    [17]
    LeeKN,Ben-NakhiM,ParkEJ,et al.Cyclic negative pressure wound therapy: an alternative mode to intermittent system[J].Int Wound J,2015,12(6):686-692.DOI: 10.1111/iwj.12201.
    [18]
    佟琳,胡晓龙,张万福,等.腹部带蒂皮瓣修复上肢软组织缺损创面术后应用桥梁式持续负压吸引固定的临床效果[J].中华烧伤杂志,2021,37(11):1048-1053.DOI: 10.3760/cma.j.cn501120-20210204-00050.
    [19]
    OgawaR.Surgery for scar revision and reduction: from primary closure to flap surgery[J/OL].Burns Trauma,2019,7:7[2021-07-09].https://pubmed.ncbi.nlm.nih.gov/30891462/.DOI: 10.1186/s41038-019-0144-5.
    [20]
    蔡景龙.现代瘢痕学[M].2版.北京:人民卫生出版社,2008,342.
    [21]
    KubotaY,MitsukawaN,ChumaK,et al.Hyperpigmentation after surgery for a deep dermal burn of the dorsum of the hand: partial-thickness debridement followed by medium split-thickness skin grafting vs full-thickness debridement followed by thick split-thickness skin grafting[J/OL].Burns Trauma,2016,4:9[2021-07-09].https://pubmed.ncbi.nlm.nih.gov/27574679/.DOI: 10.1186/s41038-016-0039-7.
    [22]
    马芸,马蕾,邹继军,等.全厚皮片植皮修复在小儿手部瘢痕整形中的应用[J].中国美容医学,2021,30(9):48-50.
    [23]
    MarsidiN,BotevaK,VermeulenSAM,et al.To tie or not to tie-over full-thickness skin grafts in dermatologic surgery: a systematic review of the literature[J].Dermatol Surg,2021,47(1):18-22.DOI: 10.1097/DSS.0000000000002549.
    [24]
    RotatoriRM,StarrB,PeakeM,et al.Prevalence and risk factors for hypertrophic scarring of split thickness autograft donor sites in a pediatric burn population[J].Burns,2019,45(5):1066-1074.DOI: 10.1016/j.burns.2019.02.003.
    [25]
    任静,韩岩,王白石,等.全厚植皮与扩张胸三角皮瓣转移修复面部大面积皮肤缺损[J].中国美容整形外科杂志,2017,28(10):596-598.DOI: 10.3969/j.issn.1673-7040.2017.10.005.
    [26]
    慕森,赵春燕,高成贵,等.全厚皮片移植修复皮肤缺损34例[J].中华皮肤科杂志,2015,48(6):431-432.DOI: 10.3760/cma.j.issn.0412-4030.2015.06.018.
    [27]
    尹会男,柴家科,李峰,等.小儿手烧伤后瘢痕挛缩畸形的手术方式选择[J].中华整形外科杂志,2019,35(5):451-455.DOI: 10.3760/cma.j.issn.1009-4598.2019.05.007.
    [28]
    PalmgrenJ,PaoliJ,SchmidtchenA,et al.Variability in the diagnosis of surgical-site infections after full-thickness skin grafting: an international survey[J].Br J Dermatol,2019,180(5):1169-1175.DOI: 10.1111/bjd.17517.
    [29]
    李允.全厚皮片移植及大张厚中厚皮移植对烧伤后手外形功能恢复的疗效分析[J].中国实用医药,2016,11(19):73-74.DOI: 10.14163/j.cnki.11-5547/r.2016.19.048.
    [30]
    DağdevirenEG,DurR,FadıloğluE,et al.Molar pregnancy in cesarean section scar: a case report[J].Turk J Obstet Gynecol,2017,14(4):249-251.DOI: 10.4274/tjod.26878.
    [31]
    ChengQ,ZhangW,LuY,et al.Ropivacaine vs. levobupivacaine: analgesic effect of combined spinal-epidural anesthesia during childbirth and effects on neonatal Apgar scores, as well as maternal vital signs[J].Exp Ther Med,2019,18(3):2307-2313.DOI: 10.3892/etm.2019.7776.
    [32]
    Laurita LongoV,OdjidjaEN,BeiaTK,et al."An unnecessary cut?" multilevel health systems analysis of drivers of caesarean sections rates in Italy: a systematic review[J].BMC Pregnancy Childbirth,2020,20(1):770.DOI: 10.1186/s12884-020-03462-1.
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