MBChB, Walsall Healthcare NHS Trust, West Midlands, UK.
MBChB, Farwaniya Hospital, Kuwait City, Kuwait.
Burns. 2023 Aug;49(5):1017-1027. doi: 10.1016/j.burns.2022.09.010. Epub 2022 Sep 29.
Our objective was to compare the outcomes of full thickness skin grafts versus split thickness skin grafts in paediatric hand burn patients. A systematic review and meta-analysis were carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Guidelines, and an electronic search was conducted to identify all Randomised Controlled Trials and non-randomised studies comparing the outcomes of full thickness skin grafts versus split thickness skin grafts in paediatric hand burn patients. Primary outcomes included development of post-graft contracture and the necessity for surgical release. Secondary outcomes consisted of evaluation of function, cosmesis and colour, scar and feeling, hair growth, and other complaints. For the analysis, fixed effects modelling was applied. Results: ten non-randomised trials with a total of 532 grafts were found. Full thickness skin grafts exhibited a statistically significant decrease in the development of post-graft contracture (Odds Ratio [OR] = 0.35, P = 0.0001) and later surgical releases (OR = 0.06, P = 0.00001). For secondary outcomes, full thickness skin grafts outperformed split thickness skin grafts in post-operative functional ability. However, split thickness skin grafts, showed to be superior in scar, aesthetic, and colour assessments, and less hair growth was observed for split thickness skin grafts. No significant difference was seen in sensation and donor or recipient site complaints. Overall, full thickness skin grafts are a better alternative for paediatric hand burns than split thickness skin transplants because they are linked with reduced post-graft contracture and the requirement for surgical release.
我们的目的是比较全厚皮片移植与断层皮片移植治疗儿童手部烧伤的疗效。我们按照系统评价和荟萃分析的首选报告项目（PRISMA）指南进行了系统评价和荟萃分析，并进行了电子检索，以确定所有比较全厚皮片移植与断层皮片移植治疗儿童手部烧伤疗效的随机对照试验和非随机研究。主要结局包括移植后挛缩的发生和是否需要手术松解。次要结局包括功能、美容和色泽、瘢痕和感觉、毛发生长和其他并发症的评估。分析采用固定效应模型。结果：共纳入 10 项非随机试验，共计 532 个皮片。全厚皮片移植后挛缩的发生率明显降低（比值比 [OR] = 0.35，P = 0.0001），且后续手术松解的需求也降低（OR = 0.06，P = 0.00001）。在次要结局中，全厚皮片移植术后的功能能力优于断层皮片移植。然而，在瘢痕、美容和色泽评估方面，断层皮片移植则表现更佳，且全厚皮片移植后毛发生长较少。在感觉和供区或受区并发症方面，两种皮片之间无显著差异。总的来说，全厚皮片移植是治疗儿童手部烧伤的更好选择，因为它与减少移植后挛缩和手术松解的需求相关。
