Wang Zhi, Long Xiao, Huang Jiuzuo, Zeng Ang, Liu Zhifei, Wang Xiaojun
Department of Cosmetic and Plastic Surgery, Peking Union Medical College Hospital, Beijing, China.
Wounds. 2021 Apr 21.
The management of skin graft donor area has been a troublesome problem in reconstructive surgery. Currently, no guidelines exist for the management of skin graft donor areas, and the disposal methods vary from clinician to clinician.
With the goal of providing a better basis for improved patient care, the authors conducted a case control study to investigate whether a combination of silver ion hydrocolloid gauze and self-adhesive polyurethane foam dressing (AG+foam group) was effective in healing skin graft donor sites.
Forty-eight patients requiring intermediate-thickness skin graft between January 2014 and December 2015 were included in the study. Inclusion criteria included a skin graft measuring at least 40 cm2 to be harvested from the ipsilateral thigh and patient age of 14 years to 60 years. All patients were treated differently according to the experience of their own doctor. Donor sites were covered with silver ion hydrocolloid gauze and self-adhesive polyurethane foam dressing (AG+foam group, n = 23]) or petrolatum gauze, sterile gauze, and compression bandage (control group, n = 25]).
Wounds healed faster (mean, 12.7 days ± 2.4 standard deviation vs 22.0 days ± 5.8; P < .001), with fewer dressing changes (median [interquartile range, IQR], 2 [IQR, 2-3] vs 4 [IQR, 2.5-5]; P = .002), and with reduced pain on first dressing change (median visual analog scale score, 5 [4-6] vs 7 [6-7.5]; P < .001) in the AG+foam group compared with the control group. The Patient and Observer Scar Assessment Scales and overall scar ratings were better in the AG+foam group than in the control group (P < .001 for all). The AG+foam group had no infections; 2 infections occurred in the control group.
Combined use of AG+foam dressing may enhance skin graft donor site healing, alleviate pain, and require fewer dressing changes.
在重建手术中，皮肤移植供区的处理一直是个棘手的问题。目前，对于皮肤移植供区的处理尚无指南，不同临床医生的处理方法各异。
为了能为改善患者护理提供更好的依据，作者开展了一项病例对照研究，以调查银离子水胶体纱布与自粘性聚氨酯泡沫敷料联合使用（AG + 泡沫组）对皮肤移植供区愈合是否有效。
纳入2014年1月至2015年12月期间需要进行中厚皮片移植的48例患者。纳入标准包括：将从同侧大腿获取面积至少为40平方厘米的皮片，患者年龄在14岁至60岁之间。所有患者根据各自医生的经验接受不同治疗。供区用银离子水胶体纱布和自粘性聚氨酯泡沫敷料覆盖（AG + 泡沫组，n = 23），或用凡士林纱布、无菌纱布和加压绷带覆盖（对照组，n = 25）。
与对照组相比，AG + 泡沫组伤口愈合更快（平均12.7天±2.4标准差 vs 22.0天±5.8；P <.001），换药次数更少（中位数[四分位间距，IQR]，2[IQR，2 - 3] vs 4[IQR，2.5 - 5]；P =.002），首次换药时疼痛减轻（视觉模拟评分中位数，5[4 - 6] vs 7[6 - 7.5]；P <.001）。AG + 泡沫组的患者和观察者瘢痕评估量表及总体瘢痕评级均优于对照组（所有P <.001）。AG + 泡沫组无感染发生；对照组发生2例感染。
联合使用AG + 泡沫敷料可促进皮肤移植供区愈合，减轻疼痛，减少换药次数。
