Prospective self-controlled clinical trial on the effects of external sutureless on skin incision healing

Chen Zong'an; Yang Yating; Wang Wenbo; Xia Lingling; Liu Wei; Gao Zhen; Wu Xiaoli

doi:10.3760/cma.j.cn501225-20240206-00051

Volume 40 Issue 12

Dec. 2024

Turn off MathJax

Article Contents

Abstract

References

Supplements

Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2024 > 40(12): 1143-1149

Chen ZA,Yang YT,Wang WB,et al.Prospective self-controlled clinical trial on the effects of external sutureless on skin incision healing[J].Chin J Burns Wounds,2024,40(12):1143-1149.DOI: 10.3760/cma.j.cn501225-20240206-00051.

Citation:

PDF( 2236 KB)

Prospective self-controlled clinical trial on the effects of external sutureless on skin incision healing

doi: 10.3760/cma.j.cn501225-20240206-00051

Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200011, China

Funds:

Clinical Research Boosting Project of Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine JYLJ202212

More Information

Corresponding author: Wu Xiaoli, Email: wuxiaoli528@126.com
Received Date: 2024-02-06

Abstract

Abstract

Objective To compare the impact of whether to apply the external suture after internal suture on skin incision healing. Methods This study was a prospective self-controlled clinical trial. From November 2020 to September 2021, 49 patients who underwent skin resection surgery and met the inclusion criteria were admitted to Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine, including 39 females and 10 males, aged 18 to 55 years. The surgical sites included the upper limbs (17 cases), lower limbs (2 cases), shoulders (3 cases), neck (8 cases), abdomen (8 cases), chest (10 cases), and back (1 case). The surgical incision of each patient was divided equally into the external suture segment (with internal suture and external suture) and the external sutureless segment (with internal suture only) using the random sequence method. On the day of suture removal and at the 1^st month of follow-up after surgery, the incision dehiscence was observed. At the 12^th month of follow-up after surgery, the scar hyperplasia was observed and the scar hyperplasia rate of the incision was calculated. At the 6^th and 12^th months of follow-up after surgery, the scar width of incision was measured. At the 1^st, 6^th, and 12^th months of follow-up after surgery, the Vancouver scar scale (VSS) was used to assess scar condition of the incision in terms of color, thickness, vascularization, and pliability, and the total score was calculated. The number of patients corresponding to the VSS score in the 1^st and 12^th months of follow-up after surgery was 41 and 46, respectively, while the number of patients corresponding to other indicators was 49. Results On the day of suture removal and at the 1^st month of follow-up after surgery, no dehiscence was observed in either the external suture segment or external sutureless segment of any patient's surgical incision. At the 12^th month of follow-up after surgery, the scar hyperplasia rate in the external suture segment was 2.04% (1/49), which was not significantly different from 4.08% (2/49) in the external sutureless segment (P>0.05). At the 6^th and 12^th months of follow-up after surgery, the scar widths in the external sutureless segment of incision were 1.48 (1.01, 1.91) and 1.41 (1.13, 1.93) mm, respectively, which were not significantly different from 1.38 (1.00, 1.94) and 1.45 (1.17, 1.84) mm in the external suture segment (with Z values of 191.00 and 152.00, respectively, P>0.05). At the 1^st, 6^th, and 12^th months of follow-up after surgery, there were no statistically significant differences either in scores of scar color, thickness, vascularization, pliability, or in the total VSS score of the incision scar between the external suture segment and the external sutureless segment (P>0.05). Conclusions After skin incision is finely sutured internally with tension reduction, the presence or absence of external suture has no significant effect on the healing of the incision and the appearance of postoperative scar.
- Wound closure techniques,
- Cicatrix,
- Prognosis,
- External suture

FullText(HTML)

References(55)

References

[1]	ByrneM,AlyA.The surgical suture[J].Aesthet Surg J,2019,39(Suppl_2):S67-72.DOI: 10.1093/asj/sjz036.
[2]	LiY,MengQ,ChenS,et al.Advances, challenges, and prospects for surgical suture materials[J].Acta Biomater,2023,168:78-112.DOI: 10.1016/j.actbio.2023.07.041.
[3]	ZhangY,LeiZ,LinB,et al.Split-level folding, step-type tension-relieving suture technique, and the evaluation on scar minimization[J].J Cosmet Dermatol,2024,23(6):2199-2208.DOI: 10.1111/jocd.16236.
[4]	贾珊珊,王晓川,焦亚,等.皮肤伤口缝合技术及其临床应用研究进展[J].中华烧伤杂志,2021,37(11):1099-1104.DOI: 10.3760/cma.j.cn501120-20200701-00334.
[5]	夏炜舒茂国潘勇伤口关闭方法和材料与瘢痕形成的相关研究中华医学会整形外科学分会第十一次全国会议、中国人民解放军整形外科学专业委员会学术交流会、中国中西医结合学会医学美容专业委员会全国会议论文集乌鲁木齐20118788 夏炜, 舒茂国, 潘勇. 伤口关闭方法和材料与瘢痕形成的相关研究[C]//中华医学会整形外科学分会,解放军整形外科学专业委员会,中国中西医结合学会医学美容专业委员会.中华医学会整形外科学分会第十一次全国会议、中国人民解放军整形外科学专业委员会学术交流会、中国中西医结合学会医学美容专业委员会全国会议论文集,乌鲁木齐, 2011:87-88.
[6]	OgawaR, AkitaS, AkaishiS, et al. Diagnosis and treatment of keloids and hypertrophic scars-Japan Scar Workshop Consensus Document 2018[J/OL]. Burns Trauma, 2019, 7: 39[2024-02-06]. https://pubmed.ncbi.nlm.nih.gov/31890718/. DOI: 10.1186/s41038-019-0175-y.
[7]	ZhangW,XieJ,ZengA.The origin and development of interrupted subcuticular suture: an important technique for achieving optimum wound closure[J].Dermatol Surg,2022,48(6):619-624.DOI: 10.1097/DSS.0000000000003437.
[8]	FernandesMG,da SilvaLP,CerqueiraMT,et al.Mechanomodulatory biomaterials prospects in scar prevention and treatment[J].Acta Biomater,2022,150:22-33.DOI: 10.1016/j.actbio.2022.07.042.
[9]	孟繁君,王莉,王强,等.皮下埋没横向褥式缝合对减轻张力性切口瘢痕的临床效果观察[J].组织工程与重建外科杂志,2023,19(3):236-241.DOI: 10.3969/j.issn.1673-0364.2023.03.004.
[10]	AshrafI,ButtE,VeitchD,et al.Dermatological surgery: an update on suture materials and techniques. Part 1[J].Clin Exp Dermatol,2021,46(8):1400-1410.DOI: 10.1111/ced.14770.
[11]	MoyRL,WaldmanB,HeinDW.A review of sutures and suturing techniques[J].J Dermatol Surg Oncol,1992,18(9):785-795.DOI: 10.1111/j.1524-4725.1992.tb03036.x.
[12]	SklarLR,PourangA,ArmstrongAW,et al.Comparison of running cutaneous suture spacing during linear wound closures and the effect on wound cosmesis of the face and neck: a randomized clinical trial[J].JAMA Dermatol,2019,155(3):321-326.DOI: 10.1001/jamadermatol.2018.5057.
[13]	柴琳琳,汤绪文,李曾显,等.LBD减张缝合技术在瘢痕切除术中的应用探讨[J].中国美容医学,2019,28(8):16-19.
[14]	ButtE,AshrafI,VeitchD,et al.Dermatological surgery: an update on suture materials and techniques. Part 2[J].Clin Exp Dermatol,2021,46(8):1411-1419.DOI: 10.1111/ced.14812.
[15]	AdamsB,LevyR,RademakerAE,et al.Frequency of use of suturing and repair techniques preferred by dermatologic surgeons[J].Dermatol Surg,2006,32(5):682-689.DOI: 10.1111/j.1524-4725.2006.32141.x.
[16]	ShinTM,BordeauxJS.How suture technique affects the cosmetic outcome of cutaneous repairs[J].J Drugs Dermatol,2014,13(8):967-969.
[17]	LiuX,NelemansPJ,FrenkLDS,et al.Aesthetic outcome and complications of simple interrupted versus running subcuticular sutures in facial surgery: a randomized controlled trial[J].J Am Acad Dermatol,2017,77(5):911-919.DOI: 10.1016/j.jaad.2017.04.1128.
[18]	SingerAJ,ClarkRA.Cutaneous wound healing[J].N Engl J Med,1999,341(10):738-746.DOI: 10.1056/NEJM199909023411006.
[19]	LinRL,WuEM,HaleEK.Use of a buried intradermal (subcutaneous) running suture for superficial repair to optimize cosmetic outcome[J].J Drugs Dermatol,2019,18(5):481-482.
[20]	SonD,HarijanA.Overview of surgical scar prevention and management[J].J Korean Med Sci,2014,29(6):751-757.DOI: 10.3346/jkms.2014.29.6.751.
[21]	KimB,SgariotoM,HewittD,et al.Scar outcomes in dermatological surgery[J].Australas J Dermatol,2018,59(1):48-51.DOI: 10.1111/ajd.12570.
[22]	KouzuK,KabataD,ShinkawaH,et al.Association between skin suture devices and incidence of incisional surgical site infection after gastrointestinal surgery: systematic review and network meta-analysis[J].J Hosp Infect,2024,150:134-144.DOI: 10.1016/j.jhin.2024.04.029.
[23]	ZareiF,AhmadinejadM.Comparison of wound infection in uncomplicated acute appendicitis by subcuticular suture and interrupted suture[J].Infect Disord Drug Targets,2021,21(6):e270421190327.DOI: 10.2174/1871526521666210114160130.
[24]	OgawaR.The most current algorithms for the treatment and prevention of hypertrophic scars and keloids: a 2020 update of the algorithms published 10 years ago[J].Plast Reconstr Surg,2022,149(1):79e-94e.DOI: 10.1097/PRS.0000000000008667.
[25]	VerberktC,StegweeSI,Van der VoetLF,et al.Single-layer vs double-layer uterine closure during cesarean delivery: 3-year follow-up of a randomized controlled trial (2Close study)[J].Am J Obstet Gynecol,2024,231(3):346.e1-346.e11.DOI: 10.1016/j.ajog.2023.12.032.
[26]	JooJS,ZhuangAR,Tchanque-FossuoC,et al.Dermal suture only versus layered closure: a randomized, split wound comparative effectiveness trial[J].J Am Acad Dermatol,2019,81(6):1346-1352.DOI: 10.1016/j.jaad.2019.08.040.
[27]	PourangA,CrispinMK,ClarkAK,et al.Use of 5-0 fast absorbing gut versus 6-0 fast absorbing gut during cutaneous wound closure on the head and neck: a randomized evaluator-blinded split-wound comparative effectiveness trial[J].J Am Acad Dermatol,2019,81(1):213-218.DOI: 10.1016/j.jaad.2019.02.037.
[28]	ZuberTJ.Fusiform excision[J].Am Fam Physician,2003,67(7):1539-1544, 1547-1548, 1550.
[29]	WangYF,YangYT,ChenZA,et al.The running barbed tension-offloading suture: an updated technique update on tension wound closure[J].Asian J Surg,2023,46(9):3773-3776.DOI: 10.1016/j.asjsur.2023.05.114.
[30]	SinhaS.Management of post-surgical wounds in general practice[J].Aust J Gen Pract,2019,48(9):596-599.DOI: 10.31128/AJGP-04-19-4921.
[31]	BaryzaMJ,BaryzaGA.The Vancouver scar scale: an administration tool and its interrater reliability[J].J Burn Care Rehabil,1995,16(5):535-538.DOI: 10.1097/00004630-199509000-00013.
[32]	WangD,DingJ,JiangY,et al.Continuous tension reduction technique in facial scar management: a comparison of W-plasty and straight-line closure on aesthetic effects in Asian patients[J].Int Wound J,2022,19(5):1064-1070.DOI: 10.1111/iwj.13702.
[33]	HsuYL,HsiehCE,LinPY,et al.Postoperative incision scars and cosmetic satisfaction of living liver donors[J].Medicine (Baltimore),2021,100(23):e26187.DOI: 10.1097/MD.0000000000026187.
[34]	HwangK,KimHJ,KimKY,et al.Skin tension related to tension reduction sutures[J].J Craniofac Surg,2015,26(1):e48-50.DOI: 10.1097/SCS.0000000000001311.
[35]	XuH, LiJ, ZhouZ, et al.Skin wound tension reduction device combined with ablative fractional carbon dioxide laser to reduce scar formation after excision of pediatric facial skin lesions: a prospective cohort study[J]. Clin Cosmet Investig Dermatol, 2022,15:283-292. DOI: 10.2147/CCID.S347065.
[36]	刘宗辉,舒茂国,刘翔宇,等.改良垂直埋没褥式缝合在乳房切口中的应用效果观察[J].中国美容医学,2019,28(4):120-124.
[37]	MengF,AndreaS,ChengS,et al.Modified subcutaneous buried horizontal mattress suture compared with vertical buried mattress suture[J].Ann Plast Surg,2017,79(2):197-202.DOI: 10.1097/SAP.0000000000001043.
[38]	ChenJ,MoY,ChenY,et al.Application and effect of tension-reducing suture in surgical treatment of hypertrophic scar[J].BMC Surg,2024,24(1):119.DOI: 10.1186/s12893-024-02390-7.
[39]	ZhaoE, TarkinIS, MoloneyGB, et al. Subcuticular barbed suture and skin glue wound closure decreases reoperation and length of stay in geriatric hip fractures when compared with staples[J]. J Am Acad Orthop Surg Glob Res Rev, 2021, 5(10): e21.00205. DOI: 10.5435/JAAOSGlobal-D-21-00205.
[40]	TangX,ShiW,QianY,et al.Effect of suture closure and staple closure on postoperative wound complications in patients undergoing knee replacement surgery: a meta-analysis[J].Int Wound J,2024,21(1):e14372.DOI: 10.1111/iwj.14372.
[41]	WeinkleA,HarringtonA,KangA,et al.Aesthetic outcome of simple cuticular suture distance from the wound edge on the closure of linear wounds on the head and neck: a randomized evaluator blinded split-wound comparative effect trial[J].J Am Acad Dermatol,2022,86(4):863-867.DOI: 10.1016/j.jaad.2021.10.036.
[42]	StoeckerA,BlattnerCM,HowerterS,et al.Effect of simple interrupted suture spacing on aesthetic and functional outcomes of skin closures[J].J Cutan Med Surg,2019,23(6):580-585.DOI: 10.1177/1203475419861077.
[43]	陈立彬,陈亚红,高振,等.皮肤伤口减张器抑制切口瘢痕作用的临床观察[J].组织工程与重建外科杂志,2015(5):316-319.DOI: 10.3969/j.issn.1673-0364.2015.05.008.
[44]	赵倩楠,周粤闽,孙朝阳.机械张力对创伤后增生性瘢痕形成的影响研究进展[J].中华烧伤杂志,2021,37(6):586-590.DOI: 10.3760/cma.j.cn501120-20200315-00167.
[45]	YangS,OzogD.Comparison of traditional superficial cutaneous sutures versus adhesive strips in layered dermatologic closures on the back-a prospective, randomized, split-scar study[J].Dermatol Surg,2015,41(11):1257-1263.DOI: 10.1097/DSS.0000000000000507.
[46]	MinP,ZhangS,SinakiDG,et al.Using Zhang's supertension-relieving suture technique with slowly-absorbable barbed sutures in the management of pathological scars: a multicenter retrospective study[J/OL].Burns Trauma,2023,11:tkad026[2024-02-06].https://pubmed.ncbi.nlm.nih.gov/37334139/.DOI: 10.1093/burnst/tkad026.
[47]	陈珺,章一新.章氏超减张缝合在闭合高张力创面中的临床应用效果[J].中华烧伤杂志,2020,36(5):339-345.DOI: 10.3760/cma.j.cn501120-20200314-00163.
[48]	ChanVWK, ChanPK, ChiuKY, et al. Does barbed suture lower cost and improve outcome in total knee arthroplasty? A randomized controlled trial[J]. J Arthroplasty, 2017, 32(5): 1474-1477. DOI: 10.1016/j.arth.2016.12.015.
[49]	CustisT,ArmstrongAW,KingTH,et al.Effect of adhesive strips and dermal sutures vs dermal sutures only on wound closure: a randomized clinical trial[J]. JAMA Dermatol,2015,151(8):862-867.DOI: 10.1001/jamadermatol.2015.0174.
[50]	CamardaL, GiambartinoS, LauriaM, et al. Surgical time for graft preparation using different suture techniques[J]. Muscles Ligaments Tendons, 2016, 6(2): 236-240. DOI: 10.11138/mltj/2016.6.2.236.
[51]	JenkinsonRJ,KissA,JohnsonS,et al.Delayed wound closure increases deep-infection rate associated with lower-grade open fractures: a propensity-matched cohort study[J].J Bone Joint Surg Am,2014,96(5):380-386.DOI: 10.2106/JBJS.L.00545.
[52]	ChengH, ChenBP, SoleasIM, et al. Prolonged operative duration increases risk of surgical site infections: a systematic review[J]. Surg Infect (Larchmt), 2017, 18(6): 722-735. DOI: 10.1089/sur.2017.089.
[53]	TamuraM,FurumatsuT,YokoyamaY,et al.Initial tension at suture fixation affects the suture breakage following medial meniscus posterior root repair: a retrospective cohort study[J].J ISAKOS,2024,9(3):258-263.DOI: 10.1016/j.jisako.2024.01.004.
[54]	HeJ,FangB,ShanS,et al.Mechanical stretch promotes hypertrophic scar formation through mechanically activated cation channel Piezo1[J].Cell Death Dis,2021,12(3):226.DOI: 10.1038/s41419-021-03481-6.
[55]	MarsidiN, ScheepensKMJ, GoemanJJ, et al. Dynamic characteristics of skin reaction force in different body postures[J]. Sci Rep, 2023, 13(1): 2222. DOI: 10.1038/s41598-023-27489-4.

Relative Articles

[1]	Ma Qimin, Tang Wenbin, Li Xiaojian, Chang Fei, Yin Xi, Chen Zhaohong, Wu Guohua, Xia Chengde, Li Xiaoliang, Wang Deyun, Chu Zhigang, Zhang Yi, Wang Lei, Wu Choulang, Tong Yalin, Cui Pei, Guo Guanghua, Zhu Zhihao, Huang Shengyu, Chang Liu, Liu Rui, Liu Yongji, Wang Yusong, Liu Xiaobin, Shen Tuo, Zhu Feng. Multicenter retrospect analysis of early clinical features and analysis of risk factors on prognosis of elderly patients with severe burns[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2024, 40(3): 249-257. doi: 10.3760/cma.j.cn501225-20230808-00042
[2]	Chen Huayong, Xin Guohua. Research advances on prognosis-related forecasting models for burn patients[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(9): 891-895. doi: 10.3760/cma.j.cn501225-20221022-00468
[3]	Chen Nuo, Xi Maomao, Ruan Qiongfang, Chu Zhigang, Zhang Wei, Zhang Jinli, Xie Weiguo. Risk factors of early myocardial injury and the impact of early myocardial injury on prognosis of patients with extensive burns[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2023, 39(5): 417-423. doi: 10.3760/cma.j.cn501225-20230308-00074
[4]	Chen Xiaorong, Jiang Danwei, Tang Yahui, Xu Chang, Zhi Shaoce, Hong Guangliang, Lu Zhongqiu, Zhao Guangju. Predictive values of serum 8-hydroxydeoxyguanosine on disease progression and prognosis of patients with sepsis[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(3): 207-214. doi: 10.3760/cma.j.cn501120-20210910-00311
[5]	Yao Yongming, Zhang Hui. Rehabilitation strategy for the improvement of long-term outcomes of patients after sepsis[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2022, 38(3): 201-206. doi: 10.3760/cma.j.cn501120-20211004-00344
[6]	Hu Zhengxiang, Bian Huining, Ma Dan, Luo Hongmin, Sun Chuanwei, Lai Wen. Analysis of the clinical features and prognostic influencing factors of toxic epidermal necrolysis[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2021, 37(8): 738-746. doi: 10.3760/cma.j.cn501120-20200416-00230
[7]	Jia Shanshan, Wang Xiaochuan, Jiao Ya, Jiang Duyin, Zhao Jie. Research advances on skin wounds suturing techniques and their clinical application[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2021, 37(11): 1099-1104. doi: 10.3760/cma.j.cn501120-20200701-00334
[8]	Zheng Jianjun, Wang Zi′en, Zheng Linwen, Xu Zhaorong, Chen Shun, Chen Zhaohong. Value of blood routine indexes and their ratios in judging the prognosis of adult patients with extensive burns[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2020, 36(12): 1167-1172. doi: 10.3760/cma.j.cn501120-20200308-00133
[9]	Wang Xin, Zhang Xuening, Wu Menglin, Jia Licong, Xie Li′na, Meng Yue, Feng Shihai, Ma Wei. Dynamic variation trend and prognostic value of bronchial wall thickness in severely burned patients combined with inhalation injury[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2018, 34(4): 208-213. doi: 10.3760/cma.j.issn.1009-2587.2018.04.004
[11]	Yang Xinjing, Jin Jun, Xu Hua, Zhao Daguo, Sun Xue, Liu Shenglan, Guo Qiang. Prognostic significance of serum procalcitonin in patients with extremely severe burn and sepsis[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2016, 32(3): 147-151. doi: 10.3760/cma.j.issn.1009-2587.2016.03.004
[12]	Huang Lifeng, Yao Yongming, Dong Ning, He Lixin, Zhang Qinghong, Yu Yan, Sheng Zhiyong. Prognostic significance of plasma gelsolin in severe burn patients with sepsis[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2016, 32(2): 77-81. doi: 10.3760/cma.j.issn.1009-2587.2016.02.005
[13]	Zang Zhidong, Yan Zheng, Hui Jiaojie, Yan Jiong, Chen Haiyan. Prognostic significance of mean amplitude of glycemic excursion in patients with severe burn[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2016, 32(1): 35-39. doi: 10.3760/cma.j.issn.1009-2587.2016.01.010
[14]	Wang Fan, Hu Gaozhong, Chen Jing, Gong Yali, Yuan Zhiqiang, Peng Yizhi. Prognostic significance of serum procalcitonin in patients with burn sepsis[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2014, 30(3): 223-226. doi: 10.3760/cma.j.issn.1009-2587.2014.03.010
[15]	HUANG Li feng, YAO Yong-ming, DONG Ning, HE Li-xin, ZHANG Qing-hong, YU Yan, SHENG Zhi-yong. Plasma gelsolin level and its relationship with the prognosis of patients with severe burns[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2013, 29(2): 148-151. doi: 10.3760/cma.j.issn.1009-2587.2013.02.014
[16]	ZHOU Hua, TU Jia-jin, HUANC YI, CHEN Xing-guang, DENG Yong-jun. Changes in serum contents of interleukin-6 and interleukin-10 and their relation with occurrence ofsepsis and prognosis of severely burned patients[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2012, 28(2): 111-115. doi: 10.3760/cma.j.issn.1009-2587.2012.02.008
[17]	ZHANG Qing-fu, ZHOU Hui-min, WANG Che-jiang, FENG Jian-ke, SHAO Hong-bo, BAI Yong-qiang, XU Shun-jiang, CUI Dong-sheng, YAN Bao-yong, LI Zeng-ning. Clinical effect of the concentrated suture fixation method on skin transplantation in the jaw and neck region[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2012, 28(4): 244-247. doi: 10.3760/cma.j.issn.1009-2587.2012.04.002
[18]	ZENG Jing, ZHAO Xiao-yu, HUANG Qiong, WANG En-ren. Effects of glutamine-enriched enteral nutrition on nutritional status and prognosis of patients with severe head injury[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2009, 25(5): 335-338. doi: 10.3760/cma.j.issn.1009-2587.2009.05.004
[19]	YAN Bai-gang, XU Shi-wei, LIU Wei, LI Hua, ZHAO Wen-feng, LIU Jian, WAN Zhong-geng, ZENG Jun. Effects of intensive insulin therapy on inflammatory response and prognosis of patients with severe trauma[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2009, 25(3): 215-217. doi: 10.3760/cma.j.issn.1009-2587.2009.03.020
[20]	CHEN Guo-xian, HAN Chun-mao. Influence of recombinant human growth hormone on the prognosis of patients with severe burns--a prospective multi-center clinical trial[J]. CHINESE JOURNAL OF BURNS AND WOUNDS, 2005, 21(5): 347-349.