Weber R S, Hankins P, Limitone E, Callender D, Frankenthaler R M, Wolf P, Goepfert H
Department of Head and Neck Surgery, University of Texas M. D. Anderson Cancer Center, Houston, USA.
Arch Otolaryngol Head Neck Surg. 1995 Oct;121(10):1145-9. doi: 10.1001/archotol.1995.01890100055009.
Traditionally, skin graft donor sites have been covered with fine-mesh gauze dressings, and a dry eschar has been allowed to form. Newer dressings that can provide a moist wound environment may facilitate reepithelialization. We compared a hydrophilic semipermeable absorbent polyurethane foam dressing that provides a moist wound environment with a petrolatum gauze dressing for donor sites.
Prospective randomized trial; follow-up at 14 days.
Department of head and neck surgery in a tertiary care center.
Sixty-eight eligible patients received one of the two dressings. Harvested skin grafts were 0.375-mm (0.015-in) thick; donor site surface areas were recorded. At postoperative day 14, the dressings were removed, and wound epithelialization was scored: 1, none; 2, scattered or spotty; and 3, complete. Donor site and operative site pain intensities were assessed by a visual numeric scale: none (0) to the worst (100) experienced over the preceding 24-hour period. Pain scores were available for 58 patients.
Dressings were compared based on these criteria: healing at 14 days, infection, and donor site and operative site pain.
A healing score of 3 was seen in 37% (14/38) of patients with hydrophilic semipermeable absorbent polyurethane foam dressings and in 17% (5/30) of patients with petrolatum gauze dressings (P = .06) by day 14. Overall, however, mean healing scores were similar in both groups. Mean healing scores for the patients who received a hydrophilic semipermeable absorbent polyurethane foam dressing was 2.3 (SD = 0.6) vs 2.2 (SD = 0.6) for patients who received the petrolatum gauze dressing (P = .20). Numbers of days required for complete epithelialization in these groups were 20.6 (SD = 10.1) and 19.3 (SD = 5.1), respectively (P = .49). One infection occurred in the group who received the petrolatum gauze dressing. The mean maximum pain intensity scores were lower for those who were given the hydrophilic semipermeable absorbent polyurethane foam dressing on postoperative days 1 through 3 (P = .003, .03, and .04, respectively). Pain increased with a larger donor site surface area for the patients with the petrolatum gauze dressing but not for the patients with the hydrophilic semipermeable absorbent polyurethane foam dressing.
The hydrophilic semipermeable absorbent polyurethane foam dressing appears to have potential advantages over the petrolatum gauze dressing; it produces less initial patient donor site discomfort and tends to produce more complete donor site healing by postoperative day 14.
传统上，皮肤移植供区一直用细网眼纱布敷料覆盖，让干燥焦痂形成。能提供湿润伤口环境的新型敷料可能会促进上皮再形成。我们比较了一种能提供湿润伤口环境的亲水性半透性吸收性聚氨酯泡沫敷料与凡士林纱布敷料用于供区的情况。
前瞻性随机试验；随访14天。
三级护理中心的头颈外科。
68例符合条件的患者接受了两种敷料中的一种。所取的皮肤移植片厚度为0.375毫米（0.015英寸）；记录供区表面积。术后第14天，去除敷料，并对伤口上皮形成情况进行评分：1分，无上皮形成；2分，散在或点状；3分，完全上皮形成。通过视觉数字评分法评估供区和手术部位的疼痛强度：从无疼痛（0）到前24小时内经历的最严重疼痛（100）。58例患者有疼痛评分。
根据以下标准比较敷料：14天时的愈合情况、感染情况以及供区和手术部位的疼痛情况。
到第14天，使用亲水性半透性吸收性聚氨酯泡沫敷料的患者中有37%（14/38）愈合评分为3分，使用凡士林纱布敷料的患者中有17%（5/30）愈合评分为3分（P = 0.06）。然而，总体而言，两组的平均愈合评分相似。接受亲水性半透性吸收性聚氨酯泡沫敷料的患者平均愈合评分为2.3（标准差 = 0.6），接受凡士林纱布敷料的患者平均愈合评分为2.2（标准差 = 0.6）（P = 0.20）。这些组完全上皮形成所需的天数分别为20.6（标准差 = 10.1）和19.3（标准差 = 5.1）（P = 0.49）。接受凡士林纱布敷料的组发生了1例感染。在术后第1天至第3天，接受亲水性半透性吸收性聚氨酯泡沫敷料的患者的平均最大疼痛强度评分较低（分别为P = 0.003、0.03和0.04）。对于使用凡士林纱布敷料的患者，疼痛随着供区表面积增大而增加，但对于使用亲水性半透性吸收性聚氨酯泡沫敷料的患者则不然。
亲水性半透性吸收性聚氨酯泡沫敷料似乎比凡士林纱布敷料有潜在优势；它使患者供区初始不适较轻，到术后第14天供区愈合往往更完全。
