Verhaegen Pauline D H M, Bloemen Monica C T, van der Wal Martijn B A, Vloemans Adrianus F P M, Tempelman Fenike R H, Beerthuizen Gerard I J M, van Zuijlen Paul P M
Association of Dutch Burn Centers, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Burn Center, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, VU Medical Center, Amsterdam, The Netherlands.
Association of Dutch Burn Centers, Red Cross Hospital, Beverwijk, The Netherlands; Burn Center, Red Cross Hospital, Beverwijk, The Netherlands.
Burns. 2014 Dec;40(8):1727-37. doi: 10.1016/j.burns.2014.03.014. Epub 2014 Apr 16.
In burn care, a well-acknowledged problem is the suboptimal scar outcome from skin grafted burn wounds. With the aim of improving this, we focused on a new technique: excision of the burn wound followed by primary closure, thereby using a skin-stretching device to stretch the adjacent healthy skin. The short- and long-term effect of Skin Stretch was compared to split skin grafting (SSG) in a randomized controlled trial.
Patients with burn wounds were randomized for SSG or primary wound closure using Skin Stretch. Follow-up was performed at 3 and 12 months postoperatively. The scar surface area was calculated and the scar quality was assessed, using subjective and objective measurement methods.
No significant differences between the SSG and the Skin Stretch group were found for scar surface area. In the Skin Stretch group, a significant reduction of the surface area from 65.4cm(2) (13.6-129.1) to 13.4cm(2) (3.0-36.6) was found at 3 months (p=0.028) and at 12 months postoperatively (65.4cm(2) (13.6-129.1) to 33.0cm(2) (8.9-63.7), p=0.046, Wilcoxon signed ranks test).
Skin Stretch for primary closure of acute burn wounds is a suitable technique and can be considered for specific circumscript full-thickness burn wounds. However, future research should be performed to provide additional scientific evidence.
在烧伤护理中，一个公认的问题是植皮烧伤创面的瘢痕愈合效果欠佳。为改善这一情况，我们聚焦于一种新技术：切除烧伤创面后进行一期缝合，从而使用皮肤拉伸装置拉伸相邻的健康皮肤。在一项随机对照试验中，将皮肤拉伸术（Skin Stretch）的短期和长期效果与中厚皮片移植术（SSG）进行了比较。
将烧伤创面患者随机分为接受中厚皮片移植术或采用皮肤拉伸术进行创面一期缝合的两组。术后3个月和12个月进行随访。使用主观和客观测量方法计算瘢痕表面积并评估瘢痕质量。
中厚皮片移植组和皮肤拉伸组在瘢痕表面积方面未发现显著差异。在皮肤拉伸组中，术后3个月时表面积从65.4cm²（13.6 - 129.1）显著减少至13.4cm²（3.0 - 36.6）（p = 0.028），术后12个月时从65.4cm²（13.6 - 129.1）减少至33.0cm²（8.9 - 63.7）（p = 0.046，Wilcoxon符号秩检验）。
皮肤拉伸术用于急性烧伤创面的一期缝合是一种合适的技术，对于特定的局限性全层烧伤创面可以考虑采用。然而，未来应开展更多研究以提供更多科学证据。
