| Research background:Scalp defect is one of the common diseases of plastic surgery.Scalp defects with exposed skull are also common in clinic.At present,there are many ways to repair the exposed skull in clinic,but there are some problems such as long treatment time,difficult treatment and poor appearance.How to quickly and easily repair exposed skull surfaces is still a challenge to plastic surgeons.With the continuous development and application of tissue engineering technology,repair of various wounds has become simple and easy,and after the appearance of good.The artificial dermis with its own three-dimensional scaffold structure,induced dermal reconstruction,the formation of dermis-like tissue,thereby increasing the thickness of granulation,play a good buffering effect,skin graft transplanted to the wound is easy to survive,the more the skin elasticity and wear-resistant.Negative pressure closed drainage(VSD)technology since 1992,first by Fleischman,in a variety of acute and chronic soft tissue defects or infected wounds to obtain satisfactory results.The existing studies have confirmed that VSD is an effective treatment for various acute and chronic wounds by thoroughly removing lacunar,exudate,secretions and some necrotic tissue in the wound area so as to reduce the risk of wound infection,promote the growth of wound granulation and accelerate wound healing method.The study found that artificial dermis combined with VSD repair all kinds of refractory wounds(such as pressure ulcers,venous ulcers,diabetic foot,tendon exposure,extremities bone exposed wounds)have been satisfied with the repair effect.It has been reported that artificial dermis repair skull exposed wounds can achieve good results.If artificial dermis combined with negative pressure drainage technology to repair scalp defects with skull exposed wounds can get better repair effect?Objective:To investigate the therapeutic effect of skull drilling or(and)grinding combined with artificial dermis and negative pressure closed drainage technique to repair scalp defects with exposed skull.Methods:A retrospective analysis of our hospital plastic surgery from October 2014 to May 2017 scalp defects with skull exposed patients.According to inclusion and exclusion criteria,patients eligible for this study were divided into group A or group B(18 in total).Group A(9 cases)was treated with skull drilling or(and)grinding combined with Nike coating and negative pressure suction plus second-stage blade skin grafting to repair wounds.Group B(9 cases)Cutting combined with Nike cover plus two blade thick skin graft repair wound.For the treatment of head wounds,the granulation incubation time,operation time,intraoperative blood loss,complications,skin graft survival rate,wound healing time and treatment costs of the two groups of wounds were recorded from available data.Because two groups of wounds two skin graft surgery and treatment are exactly the same,so do not record.The patients were followed up for more than 10 months.The Vancouver Scar Evaluation Scale(VSS)was used to evaluate the wounds in terms of scar color,thickness,vascularity and softness.Long-term follow-up observation of scar skin ulceration,and survey patients satisfaction with the treatment score.The data obtained using SPSS 23.0statistical package processing,measurement data to(X±s),said t test;count used?~2 test.P>0.05 for the difference was not statistically significant;P<0.05 for the difference was statistically significant.Result:In group A,the mean granulation incubation time was(16.44±1.42)days;in group B,the average granulation incubation time was(29.11±13.32)days.A group of wound granulation training time significantly less than the B group,P<0.05,the difference was statistically significant.In group A,the average operation time was(143.33±45.89)minutes;in group B,the average operation time was(135.00±30.21)minutes.A group than the B group wound surgery slightly more time,P>0.05,the difference was not statistically significant.The mean intraoperative blood loss in group A was(161.11±54.65)ml;in group B,the mean intraoperative blood loss was(150.00±50.00)ml.A group than in group B wound surgery slightly more bleeding,P>0.05,the difference was not statistically significant.A group of wounds occurred in 1 case of complications,accounting for11.11%of the A group;B group of wounds occurred in 5 cases of complications,accounting for 55.56%of the B group.The postoperative complications in group B were significantly more than those in group A,P<0.05,the difference was statistically significant.In group B,severe complications occurred in 1 case,the treatment time was significantly increased,and the scar was more obvious.The average skin graft survival rate in group A was(97.11±3.44)%.The average skin graft survival rate in group B was(95.00±4.74)%.The survival rate of wounds in group A was slightly higher than that in group B,P>0.05,but the difference was not statistically significant.The mean wound healing time was(26.00±3.32)days in group A and40.67±14.37 days in group B,respectively.The wound healing in group A was 15 days earlier than that in group B,P<0.05,the difference was statistically significant.The average cost of treatment in group A was(3.40±1.13)and the average cost in group B was(4.24±1.76)ten thousand yuan.P>0.05,the difference was not statistically significant.The patients were followed up for more than 10 months.The average score of wound scar VSS in group A was(7.67±1.32).The average score of scar in group B was(8.78±1.99).P>0.05,the difference was not statistically significant.The patients were followed up for more than 10 months.The satisfaction score of the patients in group A was(4.89±0.33)and the satisfaction of patients in group B was(4.22±0.83).P<0.05,the difference was statistically significant.Long-term follow-up of patients,all the wounds did not appear abnormal skin ulceration.In conclusion,the wound healing time and the wound healing time of group A were significantly faster than those of group B.The postoperative complications of group A were less than that of group B and no serious complications were found.The satisfaction of group A was higher than that of group B;The amount of intraoperative bleeding,the survival rate of skin grafts,the cost of treatment and the condition of scar after healing were similar between the two groups.Conclusion:1,the use of skull drilling or(and)grinding combined with artificial leather cover plus second-stage blade thickness skin graft scalp defect with exposed skull is feasible,simple and easy to promote the repair method.2,the use of skull drilling or(and)grinding combined with artificial leather cover and vacuum suction plus two blade thickness skin graft can not only well repair scalp defects with skull exposed wounds,but also can significantly accelerate the wound healing time,at the same time Reduce postoperative complications,has a good prospect of application.3,The patients were followed up for more than 10 months,the patients had no ulceration on wound surface,no obvious hyperplasia of scar on the wound surface,scar color,thickness,blood vessel distribution and good softness,scarring in the donor area and only a few pigmentation Way to get the patient's satisfaction evaluation. |
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