From the Division of Hand, Plastic and Aesthetic Surgery, University Hospital, Ludwig Maximilian University of Munich.
Plast Reconstr Surg. 2022 Nov 1;150(5):1104-1113. doi: 10.1097/PRS.0000000000009629. Epub 2022 Sep 2.
Polyurethane film dressings are commonly applied for coverage of split-thickness skin graft donor sites, although previous studies have suggested reduced morbidity using a polylactic acid membrane. To further investigate the optimal treatment approach, the authors compared outcomes of donor sites in patients receiving either polylactic acid membrane or polyurethane film.
This randomized clinical trial allocated patients requiring split-thickness skin grafting to receive either polylactic acid membrane or polyurethane film at the donor site. The primary endpoint was difference in donor-site scar appearance between groups 3 months postoperatively, using the Vancouver Scar Scale. Secondary endpoints included pain, number of and time required for wound dressing changes, and costs related to the wound dressing.
Thirty patients were allocated to each group. The median Vancouver Scar Scale score was lower for patients receiving polylactic acid membrane [polyurethane film, 3 (interquartile range, 2 to 4); polylactic acid membrane, 2 (interquartile range, 1 to 3); p = 0.049]. Pain during change of wound dressing (polyurethane film, 2.0 ± 0.2; polylactic acid membrane, 0.5 ± 0.2; p < 0.001) and mobilization (polyurethane film, 0.8 ± 0.2; polylactic acid membrane, 0.3 ± 0.1; p = 0.032) were reduced in the polylactic acid membrane group. Patients with polylactic acid membrane required fewer dressing changes per day of hospital stay (polyurethane film, 0.44 ± 0.06; polylactic acid membrane, 0.28 ± 0.02; p = 0.015). Mean time for wound dressing changes per patient was higher in the polyurethane film group (polyurethane film, 74.50 ± 5.72 minutes; polylactic acid membrane, 21.43 ± 2.61 minutes; p < 0.001). Costs were higher in the polylactic acid membrane group (polyurethane film, €67.83 ± €5.56; polylactic acid membrane, €162.79 ± €21.76; p < 0.001).
Polylactic acid membrane improves outcome of split-thickness skin grafting donor sites; however, higher treatment costs must be taken into consideration.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.
聚氨酯薄膜敷料常用于覆盖切皮供区，但先前的研究表明使用聚乳酸膜可降低发病率。为了进一步探究最佳治疗方法，作者比较了接受聚乳酸膜或聚氨酯薄膜治疗的供区患者的结局。
这项随机临床试验将接受切皮植皮的患者分配至供区接受聚乳酸膜或聚氨酯薄膜治疗。主要终点为术后 3 个月时温哥华瘢痕量表（Vancouver Scar Scale）评估的两组供区瘢痕外观差异。次要终点包括疼痛、伤口换药次数和时间，以及与伤口敷料相关的费用。
30 例患者被随机分配至每组。接受聚乳酸膜治疗的患者温哥华瘢痕量表评分中位数较低[聚氨酯薄膜组：3（四分位距，2 至 4）；聚乳酸膜组：2（四分位距，1 至 3）；p=0.049]。换药时疼痛（聚氨酯薄膜组：2.0±0.2；聚乳酸膜组：0.5±0.2；p<0.001）和活动时疼痛（聚氨酯薄膜组：0.8±0.2；聚乳酸膜组：0.3±0.1；p=0.032）减轻。聚乳酸膜组患者每天的住院伤口敷料更换次数较少（聚氨酯薄膜组：0.44±0.06；聚乳酸膜组：0.28±0.02；p=0.015）。每位患者的伤口敷料更换时间均值在聚氨酯薄膜组更高（聚氨酯薄膜组：74.50±5.72 分钟；聚乳酸膜组：21.43±2.61 分钟；p<0.001）。聚乳酸膜组费用更高（聚氨酯薄膜组：67.83±5.56 欧元；聚乳酸膜组：162.79±21.76 欧元；p<0.001）。
聚乳酸膜可改善切皮供区植皮的结局，但需要考虑更高的治疗费用。
临床问题/证据水平：治疗性，II 级。
