Yeh Jui-Po, Lin Ko-Chien
Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Int Wound J. 2025 Jan;22(1):e70116. doi: 10.1111/iwj.70116.
We aimed to compare the scar quality and recovery rate of joint activity for patients with joint-involved burn injuries receiving either artificial dermis (AD) with split-thickness skin graft (STSG) or full-thickness skin graft (FTSG) for reconstruction. The primary outcomes were %skin graft (SG) take. Secondary outcomes included complications such as the infection rate and donor site morbidity, 12-month scar quality evaluated using the Vancouver scar scale (VSS), recovery rate of joint activity and incidence of scar contracture requiring further revision. Twenty-eight patients between 1 August 2021, and 1 August 2023, were enrolled. Twelve patients received AD-STSG while the other 16 patients underwent FTSG for reconstruction. The median %SG take was 95.0% (interquartile range [IQR] 6.3%) and 96.0% (IQR 10.0%) for the AD-STSG and FTSG groups (p = 0.71). The FTSG group had significantly better 12-month scar quality (median VSS 4.0 [IQR 1.3] vs. 6.0 [IQR1.5], p < 0.01) and recovery rate of joint activity (median 82.5% [IQT 15.0%] vs. 70.0% [IQR 7.5%], p < 0.01) compared with AD-STSG group. However, two patients in the FTSG group (12.5%) suffered partial wound dehiscence of the donor site, whereas no patients experienced donor site morbidity in the AD-STSG group (p = 0.49). The incidence of scar contracture requiring further revision was 25.0% (3/12) in the AD-STSG group and 12.5% (2/16) in the FTSG group (p = 0.62). In conclusion, AD-STSG could be an alternative treatment over FTSG for larger joint-involved burn wounds (>200 cm) owing to lesser donor site morbidity with admissible cosmetic outcomes and functional recovery.
我们旨在比较接受人工真皮（AD）联合中厚皮片移植（STSG）或全厚皮片移植（FTSG）进行重建的关节烧伤患者的瘢痕质量和关节活动恢复率。主要结局指标是皮片（SG）成活率。次要结局指标包括感染率和供区并发症等并发症、使用温哥华瘢痕量表（VSS）评估的12个月瘢痕质量、关节活动恢复率以及需要进一步修复的瘢痕挛缩发生率。2021年8月1日至2023年8月1日期间共纳入28例患者。12例患者接受AD-STSG重建，另外16例患者接受FTSG重建。AD-STSG组和FTSG组的SG成活率中位数分别为95.0%（四分位间距[IQR] 6.3%）和96.0%（IQR 10.0%）（p = 0.71）。与AD-STSG组相比，FTSG组的12个月瘢痕质量显著更好（VSS中位数4.0 [IQR 1.3] 对6.0 [IQR 1.5]，p < 0.01），关节活动恢复率也更高（中位数82.5% [IQT 15.0%] 对70.0% [IQR 7.5%]，p < 0.01）。然而，FTSG组有2例患者（12.5%）供区出现部分伤口裂开，而AD-STSG组无患者出现供区并发症（p = 0.49）。AD-STSG组需要进一步修复的瘢痕挛缩发生率为25.0%（3/12），FTSG组为12.5%（2/16）（p = 0.62）。总之，对于较大的关节烧伤创面（>200 cm），AD-STSG可作为FTSG的替代治疗方法，因为其供区并发症较少，美容效果和功能恢复可接受。
