From the Department of Burn Surgery, The First Affiliated Hospital of Sun Yat-sen University; Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University; and Department of Chemistry, Portland State University.
Plast Reconstr Surg. 2022 Dec 1;150(6):1341-1349. doi: 10.1097/PRS.0000000000009704. Epub 2022 Sep 27.
Tie-over bolster dressing to secure a skin graft is associated with low graft take rates in irregular, high-mobility areas and suboptimal recipient wound beds. Negative-pressure wound therapy has become a well-established method to secure the graft, with a graft take rate of this method reported to be 96.7 percent. However, comparative efficacies between the two methods on irregular, high-mobility areas are yet to be determined.
Patients eligible for skin graft were randomly assigned to receive either negative-pressure wound therapy or tie-over bolster dressing between December of 2014 and December of 2015. The primary outcome was determined by the take rate of skin grafts between postoperative days 5 and 7. The secondary outcomes were dressing time and postoperative complications, including hematoma, seroma, infection, displacement, and necrosis.
A total of 86 patients were assigned to receive either negative-pressure wound therapy ( n = 43) or tie-over bolster dressing ( n = 43) for skin graft treatment. Negative-pressure wound therapy significantly improved the take rate of grafts as compared with tie-over bolster dressing (97.2 versus 90.2 percent; p = 0.005). The improvements came from the grafts in irregular, high-mobility areas in the respective groups (97.6 versus 81.7 percent; p < 0.001). Negative-pressure wound therapy reduced skin graft displacement as a postoperative complication as compared with tie-over bolster dressing (one versus nine patients; p = 0.007). Dressing time using negative-pressure wound therapy was significantly shorter compared with tie-over bolster dressing (15.2 ± 4.2 versus 27.4 ± 4.3 minutes; p = 0.001).
Negative-pressure wound therapy can improve the take rate of skin grafts in irregular, high-mobility areas and shorten the dressing time.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.
在不规则、高活动区域和不理想的受区创面床中，使用绷带加压固定植皮会导致较低的植皮成活率。负压伤口治疗已成为固定移植物的一种成熟方法，该方法的植皮成活率报告为 96.7%。然而，这两种方法在不规则、高活动区域的疗效比较尚待确定。
2014 年 12 月至 2015 年 12 月，符合植皮条件的患者被随机分配接受负压伤口治疗或绷带加压固定。主要结局是术后 5-7 天植皮成活率。次要结局是敷贴时间和术后并发症，包括血肿、血清肿、感染、移位和坏死。
共 86 例患者接受负压伤口治疗（n=43）或绷带加压固定（n=43）进行植皮治疗。与绷带加压固定相比，负压伤口治疗显著提高了植皮成活率（97.2%比 90.2%；p=0.005）。改善来自两组中不规则、高活动区域的移植物（97.6%比 81.7%；p<0.001）。与绷带加压固定相比，负压伤口治疗减少了术后并发症皮肤移植移位（1 例比 9 例；p=0.007）。与绷带加压固定相比，使用负压伤口治疗的敷贴时间明显缩短（15.2±4.2 分钟比 27.4±4.3 分钟；p=0.001）。
负压伤口治疗可以提高不规则、高活动区域的植皮成活率，并缩短敷贴时间。
临床问题/证据水平：治疗性，I 级。
Zotero 插件