Fukuoka Kohei, Yagi Shunjiro, Suyama Yoshiko, Kaida Wataru, Morita Maki, Hisatome Ichiro
Department of Plastic and Reconstructive Surgery, Tottori University Hospital, Yonago 683-8504, Japan.
Department of Plastic and Reconstructive Surgery, Shimane Prefectural Central Hospital, Izumo 693-0068, Japan.
Yonago Acta Med. 2021 Feb 1;64(1):107-112. doi: 10.33160/yam.2021.02.014. eCollection 2021 Feb.
Subcutaneous injection of tumescent solution, which contains local anesthetic, adrenaline, and saline, before split-thickness skin graft harvesting, shows a significant hemostatic effect. This method can reduce the initial bleeding from the donor site. The aim of this study is to assess the benefits of controlling the bleeding from donor sites by tumescent injection. A randomized, controlled trial was performed to compare the wound healing of split-thickness skin graft donor sites treated with or without tumescent injection.
This randomized, controlled trial examined donor site healing days as the main measure of outcome. postoperative pain, donor site ulceration, and scar quality were evaluated as secondary outcome measures. Patients planned for split-thickness skin graft harvest were randomly assigned to receive either pre-harvest subcutaneous injection of local anesthetic, adrenaline, and saline solution (tumescent solution) (Group 1) or post-harvest application of adrenaline solution-soaked gauze to the skin graft donor sites (Group 2). Donor sites were treated with calcium alginate dressings after graft harvesting. On the 10th postoperative day, the dressings were removed and donor site healing were measured. Follow-up evaluation of scar quality was performed 6 months after surgery. Postoperative pain was evaluated on the 1st day after operating.
Forty-five patients (26 males; average age 61.8 years) completed the late follow-up evaluation (6 months postoperatively), with 26 patients in group 1 and 19 in group 2. There were no significant differences between the two groups in any of the outcome measures.
Tumescent technique provides sufficient hemostasis in split skin graft donor sites, especially the initial bleeding just after graft harvesting, without any negative effects. Larger series should be studied to evaluate the effect in donor site wound healing.
在取分层皮片前皮下注射含有局部麻醉剂、肾上腺素和生理盐水的肿胀液，具有显著的止血效果。该方法可减少供皮区的初始出血。本研究的目的是评估通过肿胀液注射控制供皮区出血的益处。进行了一项随机对照试验，以比较接受或未接受肿胀液注射的分层皮片供皮区的伤口愈合情况。
这项随机对照试验将供皮区愈合天数作为主要结局指标进行研究。术后疼痛、供皮区溃疡和瘢痕质量作为次要结局指标进行评估。计划进行分层皮片取皮的患者被随机分配，一组在取皮前皮下注射局部麻醉剂、肾上腺素和生理盐水溶液（肿胀液）（第1组），另一组在取皮后将浸有肾上腺素溶液的纱布应用于皮片供皮区（第2组）。取皮后用海藻酸钙敷料处理供皮区。术后第10天，去除敷料并测量供皮区愈合情况。术后6个月对瘢痕质量进行随访评估。术后第1天评估术后疼痛情况。
45例患者（26例男性；平均年龄61.8岁）完成了后期随访评估（术后6个月），第1组26例，第2组19例。两组在任何结局指标上均无显著差异。
肿胀技术在分层皮片供皮区提供了足够的止血效果，尤其是在取皮后即刻的初始出血，且无任何负面影响。应研究更大样本系列以评估其对供皮区伤口愈合的影响。
