The Application Of Skin Harvested By Alternating Method In Full-thickness Skin Grafts

ObjectThe purpose of this article is the traditional skin excision method was improved, theestablishment of an ideal mathematical model, the establishment of experimental animalmodel, the scar length, local tension, and the control group (traditional fusiform skinexcision method) for data comparison, analysis of data, the method for clinical application,thus proving the feasibility interleaved flaying method in full thickness skin graft in theadvantages and disadvantages, and discuss the application of the method of full thicknessskin graft, for clinical selection of the appropriate method to provide clinical basis for fullthickness skin graft.Materials and Methods1. Establishment of mathematical model:（1）Skin graft design: Will need to repair the wound along the diagonal is divided intotwo parts, the two part skin graft with the long axis as the boundary, the vertical distributionon both sides, skin long overlap. The rectangle as an example, the rectangle diagonal to thelong axis, along the long axis is divided into two parts of equal area, a diagonal axis isperpendicular to the long axis of B, B diagonal to the short axis A, two skin staggered part isX, scar line length is S, the maximum tension with L.（2）On alternateing part X: To study the relationship between X and scar line length Sand tension of L, establish the ideal mathematical model, a staggered part of X were0, R,2R,and the relationship to size calculation scar line length S and tension of L.2. Animal experiments:⑴The ideal mathematical model, when the cross part of staggered flap design method isthe long half, the skin incision, the highest efficiency, establishing the animal model ofguinea pig, the same in the back position respectively with staggered method and traditionalfusiform skin excision resection of same area, compared to the scar line length S, localtension L the relationship between the amount of waste, and skin, provide guidance forclinical full-thickness skin excision method selection and application. ⑵Statistical method:The data were processed by SPSS19.0software, two groups of data were compared by ttest, interleaved differences between skin graft group and control group, the correlationanalysis between skin area and the median line offset length.3. Clinical observation:From2010October to2013February, application of interlaced skin taking law of28patients, including14cases of9cases divided nevus, nevus facial,5cases of facialmalignant tumor (2cases of squamous cell carcinoma,2cases of basal cell carcinoma,1cases of trichilemmal carcinoma), skin donor medial upper arm in19cases, with9cases oftumor region width, maximum14cm, minimum5cm, for a single skin graft area maximum is12cm*7cm,8cm*4cm is the minimum.Results1. In the ideal mathematical model, when X=2R, scar line length S minimum, localtension L maximum; with staggered part of X gradually decreased, the local tension Ldecreased gradually, scar line length S gradually whole big; but when X> R, L invariantlocal tension, scar line length S is still growing. When the cross part of X is R, and thesmallest local tension, scar line length S relatively shortest, namely when the cross part of Xis the long half, skin cut the highest efficiency.2. In the animal experiment model, using SPSS19.0software data processing, two setsof data were compared by t test, interleaved differences between skin graft group and controlgroup, the skin area≤2×2.0cm2, the difference between the two groups of scar line lengthof no statistical significance (p>0.05), in the skin area>2×2.0cm2, there was significantdifference between the two groups of scar line length (p <0.01).Analysis of skin area and the median line shift correlation length: when the skin areaand the median line offset length was positive, statistically significant (p <0.01).3. In clinical application, the group of28patients with skin grafts all survived well,wound healing. In addition to a case of medial arm wound were lymph fistula, after2weeksof dressing pressurization treatment delayed healing, healing. The donor site was indwellingapproximate cross "S" operation incision scar, medial arm did not cause obvious depression,groin no umbilical deformation or displacement.Conclusions1. When interleaved skin slice interleaving part of law is the long half, skin cut the highest efficiency.2. Interleaved flap design than traditional fusiform excision method, scar line length,local tension, stretch deformation is not obvious, local deformity is not obvious, less wasteof skin graft.3. Cut of small area skin piece, application of traditional fusiform skin excision methodis suitable for linear, scar and no significant growth.4. Cut a large area or large area skin piece, application of interlaced skin excisionmethod is more suitable, scar is in a S shape, the local pull is not obvious, no obviousdeformity.