Early application of artificial dermis scaffold in repairing deep wounds on hands and feet after extensive burn / 第二军医大学学报

ABSTRACT

Objective To investigate the clinical efficacy of artificial dermis scaffold combined with autologous split-thickness skin graft in repairing deep wounds on hands and feet after extensive burn by comparing with the traditional ways. Methods The patients with deep wounds on hands and feet, who were treated in Department of Burn Surgery, Changhai Hospital, Second Military Medical University from March 2012 to March 2015, were selected as participants. A total of 28 patients meeting the inclusion criteria were allocated into two groups according to the operations. The observation group (14 cases) received artificial dermis scaffold after crust resectional therapy at 4-7 days after burns, and they also received autologous split-thickness skin graft following crust resectional therapy at 21-28 days after burns. The control group (14 cases) received changing medicine to maintain the scab following crust resectional therapy at 4-7 days after burns, and they also received autologous split-thickness skin graft following crust resectional therapy at 28-35 days after burns. The following data were recorded the operation time, survival rate of skin graft, the cause of the flap necrosis, healing time of donor site and whether it could donor more flap or not, and the hyperplastic scars on hands and feet. Results The observation group needed similar operation time when compared with the control group for the first operation ([4.50±0.76] h vs[4.14±0.86] h,P>0.05), while the second operation time of the observation group was significantly shorter than that of the control group ([2.11±0.35] h vs [3.39±0.49] h, P<0.001). When changing the medicine at the 8th day after skin grafting, the survival rate of skin graft in the observation group was 97.37%(37/38) and the infection rate was 2.63%(1/38); the survival rate of the whole skin graft in control group was 73.68%(28/38), and that of partial skin graft was 23.68%(9/38), with an infection rate of 2.63%(1/38). The healing time of donor site in the observation group was significantly shorter than that of the control group([6.07±0.83] d vs [14.64±0.93] d, P<0.001). And it was estimated that 78.57%(11/14) of the patients in the observation group and 14.29%(2/14) of patients in the control group could donor more graft(P<0.05). One year follow-up showed that hyperplastic scars on hands and feet in the observation group was significantly better than those in the control group according to the Vancouver Scar Scale (VSS, [5.07±1.21] vs [8.07±1.14], P<0.001). Conclusion Artificial dermis scaffold can be used at early time in repairing deep wounds on hands and feet after extensive burn, with no need for additional operation time; and both the survival rate of skin graft and long-term function are good, with less damage to the donor site.