Georgetown University School of Medicine, Washington, DC.
Georgetown University School of Medicine, Washington, DC; Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC.
J Foot Ankle Surg. 2024 Jan-Feb;63(1):13-17. doi: 10.1053/j.jfas.2023.05.002. Epub 2023 Aug 22.
Split-thickness skin grafts can provide effective autologous wound closure in patients with dysvascular comorbidities. Meshing the graft allows for reduced donor site morbidity and expanded coverage. This study directly compares outcomes across varying meshing ratios used to treat chronic lower extremity wounds. Patients who received split-thickness skin grafts to their lower extremity for chronic ulcers from December 2014 to December 2019 at a single center were retrospectively reviewed. Patients were stratified by meshing ratios: nonmeshed (including pie crusting), 1.5:1, and 3:1. The primary outcome was clinical "healing" as determined by surgeon discretion at 30 days, 60 days, and the latest follow-up. Secondary outcomes included postoperative complications, graft loss, ulcer recurrence, progression to amputation, and mortality. A total of 321 patients were identified. Wound sizes and location differed significantly, with 3:1 meshing applied to the largest wounds (187.8 ± 157.6 cm; 1.5:1 meshed, 110.4 ± 103.9 cm; nonmeshed 38.7 ± 55.5 cm; p < .0001) mostly of the lower leg (n = 18, 75%; 1.5:1 meshed, n = 23, 43.4%; nonmeshed n = 62, 25.7%; p < .0001). Meshed grafts displayed a significantly higher proportion of healing at 30 and 60 days, but no differences persisted by the final follow-up (16.5 ± 20.5 months). Longitudinally, nonmeshed STSG was associated with most graft loss (46, 19.1%; p = .011) and ulcer recurrence (44, 18.3%; p = .011). Of the 3 meshing ratios, 3:1 exhibited the lowest rates of complications. Our results suggest that 3:1 meshing is a safe option for coverage of large lower extremity wounds to minimize donor site morbidity.
分层皮片移植可有效实现合并血运障碍并发症患者的自体创面闭合。皮片移植时进行网格切割可减少供区发病率并扩大覆盖范围。本研究直接比较了不同网格切割比例治疗慢性下肢创面的结果。
回顾性分析 2014 年 12 月至 2019 年 12 月期间在单一中心接受下肢慢性溃疡分层皮片移植的患者。患者按网格切割比例分层：非网格（包括馅饼皮状）、1.5:1 和 3:1。主要结局为 30 天、60 天和末次随访时由外科医生判断的临床“愈合”。次要结局包括术后并发症、皮片移植物丢失、溃疡复发、进展为截肢和死亡。共纳入 321 例患者。伤口大小和位置差异显著，最大的伤口应用 3:1 网格切割（187.8 ± 157.6cm；1.5:1 网格切割 110.4 ± 103.9cm；非网格切割 38.7 ± 55.5cm；p<.0001），主要位于小腿（n=18，75%；1.5:1 网格切割，n=23，43.4%；非网格切割，n=62，25.7%；p<.0001）。30 天和 60 天时，网格皮片移植物愈合比例显著更高，但末次随访时无差异（16.5 ± 20.5 个月）。纵向来看，非网格 STSG 与大多数皮片移植物丢失（46，19.1%；p=.011）和溃疡复发（44，18.3%；p=.011）相关。在 3 种网格切割比例中，3:1 显示并发症发生率最低。我们的结果表明，3:1 网格切割是覆盖大的下肢创面的安全选择，可最大限度减少供区发病率。
