Clinical Study On Artificial Dermis Combined With Negative Pressure Wound Therapy For Wound Treatment After Hand Hot-crush Injuries

Objective To compare the clinical effects of artificial dermis combined with negative pressure wound therapy(NPWT)versus artificial dermis two-stage graft(TSG)and medium-thickness skin graft(MTSG)in repairing wounds after hand hot-crush injuries,to analyze the clinical efficacy of this combined therapy and thereby provide a new direction for wound treatment after hand hot-crush injuries.Data and methods Totally 45 patients with hand hot-crush injuries treated in the Department of Burns and Plastics in Northern Jiangsu People's Hospital between May2015 and October 2018 were enrolled.Clinical data were collected and analyzed retrospectively.Three groups were set up,including(1)TSG+NPWT group(n=13):artificial dermis combined with NPWT for stage ? of wound coverage and stage ? of split-thickness skin autograft after vascularization of the artificial dermis collagen layer;(2)TSG group(n=15): artificial dermis for stage ? of wound coverage and stage ? of split-thickness skin autograft after vascularization of the artificial dermis collagen layer;(3)MTSG group(n=17): medium-thickness skin autograft.During the treatments,all three groups were given periodical wound dressing change and local or systemic antiinfection treatment.These three groups were regularly followed up and compared 3to 12 months postoperatively.The test indices including(1)time duration from stage ?to stage ? in both TSG+NPWT group and TSG group;(2)in-hospital length;(3)survival of grated skins;(4)wound bacterial culture;(5)Vancouver scar scale(VSS)for post-heal cosmesis and scars;(6)post-heal scar scores of donor sites.Statistical analysis were conducted on SPSS 16.0 software.Results(1)Time duration from stage ? to stage ?: The time duration in the TSG+NPWT group was significantly shorter than in the TSG group(9.46±1.71 vs.12.60±1.35 days).(2)Total in-hospital length: The average total in-hospital length of the TSG+NPWT group(22.92±2.87 days)was significantly shorter than the TSG group(27.07±2.40 days).The MTSG group(15.44±1.63 days)was significantly shorter than the TSG+NPWT group.(3)Survival of grated skins: The number of patients with excellent grafted skins in the TSG+NPWT group(13)was significantly larger than the TSG group(10)and not significantly different from the MTSG group(16).(4)Wound bacterial culture: The number of cases with positive culture results in the TSG+NPWT group(1)was not significantly different from the TSG group(3)or the MTSG group(3).(5)Post-heal cosmesis and scar scores: During the long-term follow-up,the VSS scores were not significantly different between the TSG+NPWT group and the TSG group(4.08±0.76 vs.4.20±0.94).The VSS scores were significantly different between the TSG+NPWT group and the MTSG group(4.08±0.76 vs.3.31±0.60).(6)Scar scores of donor sites: The scar scores of donor sites in the TSG+NPWT group were significantly lower than in the MTSG group(2.46 ± 1.05 vs.7.82 ± 1.01).Conclusion NPWT can shorten the time interval of composite graft from stage ? to stage ?,promote the process of artificial dermis vascularization and shorten the total length of hospitalization.NPWT can also improve the effect of composite graft.NPWT combined with artificial dermis two-stage graft for wound repair after hand hot-crush injuries is less invasive to the donor sites and brings satisfactory cosmesis after healing.