| Objective:To observe the effect of artificial dermis and autologous split-thickness skin grafting combined with negative pressure wound therapy(NPWT)in repairing deep wounds of limbs,as well as explore the effects of NPWT on artificial dermal vascularization and survival rate of autologous split-thickness skin.Methods:From January 2019 to December 2020,a retrospective cohort study was conducted on the case data of 40 patients with wounds of deep of limbs who met the screening criteria admitted to the Center for Burn and Wound Repair of the First Affiliated Hospital of Nanchang University.According to the wound repair method adopted,20 patients were included in the observation group[14 males and 6females,(41.45±9.90)years old,wound area was(59.20±28.60)cm~2],and 20 patients were included in the control group[15 males and 5 females,(40.1±12.19)years old,wound area was(66.35±29.96)cm~2].On the basis of conventional treatment,the observation group was treated with artificial dermis implantation+autologous split-thickness skin grafting+NPWT to repair the wound,while the control group was treated with artificial dermis implantation+autologous split-thickness skin grafting to repair the wound.The two groups of patients were compared between the vascularization time of the artificial dermis,the survival rate of the skin on the 6th day after autologous skin grafting,the results of bacterial culture of wound secretions,the length of hospital stays,the cost of hospital stays and the scar formation in the operative area at 3 months after wound healing(using Vancouver Scar Score,VSS).The count data were represented by case(n),while the measurement data conforming to normal distribution were represented by mean±standard deviation(?x±S),and the measurement data of non-normal distribution were represented by Median and quartile spacing[MD(QR)].Use SPSS 22.0 software to doχ~2test,Fisher exact test,independent sample t test and Mann-Whitney U test.Results:1.The time of artificial dermal vascularization was(13.90±1.33)days in the observation group,meanwhile,it was(15.35±2.54)days in the control group.The time of artificial dermal vascularization in the observation group was significantly shorter than that in the control group(t=-2.26,P<0.05).2.The survival rate of skin on the 6th day after autologous skin grafting was 95(4)%in observation group,simultaneously,it was 90(13)%in control group.The survival rate of skin on the 6th day after autologous skin grafting in the observation group was strikingly higher than that in the control group(Z=-2.09,P<0.05).3.The results of bacterial culture of wound secretions:At admission,the number of patients with positive wound bacterial culture was 5 in the observation group and 4in the control group.When it was seven days after artificial dermis implantation,the number of patients with positive bacterial culture was 0 in the observation group and2 in the control group.There was no significant difference in bacterial culture between the two groups(P>0.05).4.The length of hospital stays was(32.05±4.64)days in the observation group and(38.30±6.86)days in the control group.The former had shorter length of hospital stays than the latter(t=-3.375,P<0.05).5.The cost of hospital stays was￥64.8(18.6)thousand yuan in the observation group,in addition,it was￥72.1(19.5)thousand yuan in the control group.which was similar of the two groups(Z=-1.27,P>0.05).6.Follow-up at 3 months after discharge showed that all the patients had good skin appearance and elasticity,what’s more,there was no recurrence of skin ulceration and adverse reactions.The VSS score of the skin grafting area was(3.40±1.27)scores in the observation group,as a consequence,it was(4.35±1.18)scores in the control group,the former scored lower than the latter(t=-2.45,P<0.05).The VSS score of the donor site was 1(1)scores in the observation group,which was similar to that 1(2)scores in the control group(Z=-0.58,P>0.05).Conclusion:Artificial dermis and autologous split-thickness skin grafting combined negative pressure wound therapy to repair deep wounds of limbs,it can accelerate the vascularization of artificial dermis to form dermal like tissue,improve the survival rate of skin grafting,reduce the length of hospital stay,improve appearance and function after healing,improve the quality of wound repair.consequently,it probably has bright clinical application value. |
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