Chi Yunfei, Yin Huinan, Chen Xin, Hu Quan, Liu Wei, Feng Li, Chai Jiake
Burn Institute, The Fourth Medical Center of the PLA General Hospital, Beijing, China.
Transl Pediatr. 2021 Nov;10(11):3014-3022. doi: 10.21037/tp-21-500.
The choice of treatment methods for children with deep partial-thickness burn wounds (DPBWs) is an issue that requires careful consideration from surgeons. The purpose of this study was to evaluate the efficacy of precise partial scab removal (PPSR) in the treatment of DPBWs in children.
We retrospectively analyzed the clinical data of 78 children with DPBWs. The children were divided into a PPSR group (n=37) and a routine dressing change (RDC) group (n=41). In the PPSR group, an electric dermatome was used to cut the scab in the early post-injury period. The thickness scale of the electric dermatome was set to 0.1 mm. The scab was removed to the base with scattered bleeding points. There was still a small amount of necrotic tissue in the base of the wound. For the acellular dermal matrix, the first dressing change was about 1 week after surgery. The RDC group was given conventional wound-dressing treatment. The wound dressing was changed with epidermal growth factor, silver-zinc antibacterial cream, and dressing change. The frequency of dressing change was adjusted once a day or once every other day depending on the condition of wound secretions. The hospitalization time, wound-healing time, fever duration, antibiotic use time, number of subsequent operations, and overall hospitalization expenses were compared between the two groups.
The wound-healing time of the PPSR group was 19.86±6.4 days, and the wound-healing time of the RDC group was 24.15±7.12 days (P=0.0068). The duration of fever in the PPSR group and RDC group was 2.62±1.99 and 4.44±3.10 days, respectively (P=0.0032). The antibiotic use time in the PPSR group and RDC group was 4.0±1.33 and 4.83±1.88 days, respectively (P=0.0292). The overall hospitalization cost of the PPSR group and RDC group was yuan renminbi ¥37,852.84±10,894.64 and ¥38,047.46±19,450.37, respectively (P=0.9573).
PPSR can shorten wound-healing time, reduce the frequency of dressing changes, shorten the time of fever in children, lower the frequency of antibiotic use, and decrease number of dressing changes on the wound.
儿童深Ⅱ度烧伤创面（DPBWs）治疗方法的选择是外科医生需要仔细考虑的问题。本研究的目的是评估精准削痂术（PPSR）治疗儿童DPBWs的疗效。
我们回顾性分析了78例DPBWs患儿的临床资料。将患儿分为PPSR组（n = 37）和常规换药（RDC）组（n = 41）。PPSR组在伤后早期使用电动取皮刀削痂。电动取皮刀的厚度刻度设定为0.1mm。削痂至创面基底，见散在出血点。创面基底仍有少量坏死组织。对于脱细胞真皮基质，术后约1周首次换药。RDC组给予常规创面换药治疗。用表皮生长因子、银锌抗菌乳膏换药。根据创面分泌物情况，换药频率调整为每日1次或隔日1次。比较两组的住院时间、创面愈合时间、发热持续时间、抗生素使用时间、后续手术次数及总住院费用。
PPSR组创面愈合时间为19.86±6.4天，RDC组创面愈合时间为24.15±7.12天（P = 0.0068）。PPSR组和RDC组的发热持续时间分别为2.62±1.99天和4.44±3.10天（P = 0.0032）。PPSR组和RDC组的抗生素使用时间分别为4.0±1.33天和4.83±1.88天（P = 0.0292）。PPSR组和RDC组的总住院费用分别为人民币37,852.84±10,894.64元和38,047.46±19,450.37元（P = 0.9573）。
PPSR可缩短创面愈合时间，减少换药频率，缩短患儿发热时间，降低抗生素使用频率，减少创面换药次数。
