The Comparison Of Skin Defects Treated With Skin Stretch And Skin Graft

Objective:Skin and soft tissue trauma harm to human health sinceancient times, with the development of social progress, industrialization,modernization of agriculture and transportation, trauma did not decrease, butgrowing. To treat skin and soft tissue defects wounds which caused by traumahas been subject to a great deal of attention, skin graft technique is the mostwidely used. The traditional method of skin grafting has skin donor siteinfections, tissue fluid extravagation, limb deep vein thrombosis, peripheralnerve damage and other complications, the recipient site poor wear resistance,long time wound healing, the skin graft contracture and scar formation, affectthe appearance and limb function. We use Kirschner wire and steel wiremaking simple skin stretching device, for the treatment of soft tissue defects,through force witch is applied to the skin, increasing the area of the skin forreconstruction and repair skin defects. Distraction surrounding healthy layer ofskin to close the wound, has normal function of the epidermis, the dermis andthe subcutaneous tissue to reduce the need of skin grafts, increased satisfactionand achieved good clinical results. In this study, multiple indicators has beenobserved to compare skin stretching and traditional skin graft treatment, forseeking a more effective method of soft tissue wound management.Methods:66patients with soft tissue defects were extracted sinceFebruary2011until February2013Emergency Trauma Orthopedics in ourhospital, Patients were56males,10females; average age was36.9years(range from2to66).32patients of them underwent skin stretch treatment,34cases use conventional skin grafting treatment.32patients of them underwent skin stretch treatment, wound cleaning,with a diameter of1.0mm Kirschner wire, penetration in the dermis layer1cmaway from the wound edge, piercing after appropriate length, suturing the wound with needle wire from the outside of Kirschner wire to the other sidethe skin edge with interrupted suture. According to the Irregular wound edgeand skin involution situation, can be inserted Kirschner in order to facilitateclose the defect. If skin tension is not huge, the wound could once closed,silkcan be used when necessary, in order to facilitate skin edges involutive. Ifcould not closed the wound immediately, the distracter can be temporarilyplaced in, graded increases tension force, close the wound gradually.Postoperative medication, care and functional exercise consistent,dressing change were completed by experienced doctor,gradually increase theamount of activity. Prevention of postoperative complications: regular dailyturn over to prevent bedsores; activities of the lower limbs, subcutaneous lowmolecular weight heparin to prevent deep vein thrombosis.Patient follow-up ranged from2to20months (mean13.7months),analysis the two groups of patients anesthesia, operative time, blood loss,completely healing time, complications, degree of pain relief, the patient andfamily satisfaction degrees, using statistical methods to analyze.Results:166patients were followed up for2to20months, averaging13.7months,all skin wounds healed. Compare surgical time of the two operationmethods, the difference was significant difference (P <0.05); compare surgicalblood loss, the difference was significant difference (P <0.05); comparewound completely healing time, there are significant differences (P <0.05);compare patient satisfaction, the difference was significant difference (P <0.05)(Table2).2Analysis the degree of pain relief. the stretch group is not higher thanthe graft group in the degree of pain relief, there was no significant difference(P>0.05)(Table2).3Analysis of two surgical ways short-term and long-term postoperativecomplications There are significant differences (P <0.05) in the incidence ofshort-term complications and The incidence of long-term complications havesignificant differences (P<0.05)(Table5, Table6) 4Analysis of two sets of surgical anesthesia. there was no significantdifference (P>0.05) in the proportion of general anesthesia, spinal or brachialplexus anesthesia and local anesthesia (Table7, Table8).Conclusion:1Two kinds of operation method both could be fitted to close tissuedefects wounds;2There was no difference in the degree of pain relief after woundhealing;3Skin stretch technique with shorter operative time, less bleeding,short wound completely healed time, less complications, Reduce the need ofskin graft, no skin donor site complications,good skin function and highpatient satisfaction is a more advantageous treatment methods.