Clinical Observation On The Effect Of Expansion And Skin Grafting Combined With Negative Pressure Closed Drainage In The Treatment Of Three-degree Burn Wound

Objective:To investigate the clinical effect of the combination of skin grafting and vacuum sealing technique(VSD)in the treatment of three-degree burn wounds.Methods:The Department of Burns,Second Affiliated Hospital of Kunming Medical University,from November 2016 to November 2018,received 30 patients with three-degree burns of the extremities,which were divided into VSD treatment group(experimental group)and conventional treatment group(control group).Each group was 15 cases.Patients were generally stable after elective surgery.Patients in the conventional treatment group were treated with wound expansion+transplanted autologous blade thickness to repair the wound+compression dressing.After 3 days from the routine,the patient was treated with pressure dressing and dressing until the wound was completely healed;VSD The treatment group expanded the wound surface+transplanted autologous blade thickness stamp skin repair wound+postoperative continuous VSD treatment,maintained a stable negative pressure value,and regularly replaced the VSD dressing until the wound was completely healed.The pain intensity of the wound dressing was scored on the 7th and 14th day before treatment and on the 7th and 14th postoperative day using the numerical rating scale(NRS).Intraoperative examination of the wound secretion was performed after the wound was expanded.On the 7th and 14th postoperative day,the general condition of the wounds was observed in the two groups.The survival of the skin grafts was evaluated,and the wound secretions were taken for bacteriological culture.The white blood cell count(WBC)and procalcitonin(PCT)were detected 3 days after operation.),high-sensitivity C-reactive protein(hs-CRP),the complete healing time of wounds in the two groups of patients was counted,and the satisfaction evaluation of patients at the time of discharge was counted.Perform statistical analysis on the data.Results:The positive rate of wound secretion in the experimental group was 40.0%,and that in the control group was 33.3%.The positive rate of wound secretion in the experimental group was 20.0%on the 7th day after operation,and 66.7%in the control group.The wound secretion in the experimental group was positive on the 14th day after operation.The rate was 6.7%,and the control group was 46.7%.There was significant difference between the 7th day and the 14th day after operation(P<0.05).The average WBC count of the experimental group was(7.83±0.44)×109 after 3 days.The control group was(11.05±0.90)×109/L;the averadge PCT was(0.10±0.03)ng/ml in the experimental group and(0.31±0.08)ng/ml in the control group;The mean hs-CPR was(25.08±6.94)mg/L in the last 3 days and(58.15±10.52)in the control group.P<0.05 in the three groups.The preoperative pain score was(6.73±0.70)in the experimental group.The control group was(6.87±0.74)points.There was no significant difference in pain between the two groups before operation(P>0.05).The experimental group was 7d(3.27±0.88)and the control group was(7.67±0.72).The group scored on the 14th day after operation(2.80±0.77),the control group was(6.27±0.88),and the pain scores on the 7th and 14th postoperative groups were P<0.01.The 7th postoperative experiment was performed.The survival rate of skin graft was 80.0%,and that of the control group was 20.0%.The comparison between the two groups was P<0.01.On the 14th day after operation,the survival rate of the skin was 86.7%,and that of the control group was 26.7%.The comparison between the two groups was P<0.01.The complete healing time of the wounds was(25.2±3.13)days in the group and(32.13±4.64)days in the control group,P<0.01 in the two groups;the satisfaction of the experimental group was(8.67±0.90)points,and the control group was(5.73).±0.88),P<0.01 for the two groups.Conclusion:In the treatment of three-degree burn with skin grafting and VSD technology,VSD technology can significantly reduce the proliferation of wound aerobic bacteria,reduce inflammatory reaction,effectively promote the survival of skin,shorten the healing time of wounds,save medical resources,significantly reduce pain and improve medical satisfaction degree,worthy of clinical promotion.