Introduction of a kind of skin graft in situ replantation with punched skin grafting in donor site
10.3760/cma.j.cn114453-20200523-00310
- VernacularTitle:供皮区皮片打孔扩张原位回植取皮术的临床效果
- Author:
Hongfeng ZHAI
1
;
Changhong QIU
;
Jun JIN
;
Xin SHAO
;
Ying LIAN
Author Information
1. 河南省人民医院，郑州大学人民医院，河南大学人民医院整形美容外科，郑州 450003
- Keywords:
Hypertrophic scar;
In situ replantation;
Drum dermatome;
Wound healing
- From:
Chinese Journal of Plastic Surgery
2022;38(3):316-320
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of the replantation in situ of donor skin graft with perforation and expansion in small and medium-sized skin transplantation. Methods:Patients were selected as group A with skin and soft tissue defects caused by various reasons treated in the Plastic and Aesthetic Surgery Department of Henan Provincial People’s Hospital from January 2002 to December 2019. A medium thick skin piece was harvested from the donor area with a drum dermatome, covering an area of 200-220 cm 2. The skin piece at the root of the drum dermatome was not broken, but the free skin piece of the drum dermatome was removed to the required area, transplanted to the wound surface, stitched intermittently and dressed with packing heap. The remaining skin graft in the donor area was punctured evenly with No. 15 surgical blade, then covered all the wounds in the donor area, sutured intermittently, and bandaged under pressure. The same kind of patients treated in other medical groups in our department in the same time were selected as group B. The skin donor area was not covered with skin graft in situ, but wrapped with traditional gauze. The patients were followed up in the outpatient department after operation, when the healing of the donor skin area and the degree of local scar was evaluated for data statistical analysis. The scars were scored according to Vancouver Scar Scale. The quantitative data were expressed in M( Q1, Q2), and were analyzed by Mann-Whitney U test. The qualitative data were analyzed by Chi-square test. P< 0.05 was statistically significant. Results:Group A had 63 cases, except for 1 case of graft avulsion, 2 cases of hematoma under the skin with partial survival of skin graft, 1 case of poor survival of infected skin graft after operation, the other skin grafts in the recipient area survived well. Group B included 59 patients, 38 males and 21 females, aged from 4 to 78 years old, with a skin defect area of 40 to 80 cm 2. The patients in both groups were followed up for 7-12 months. The healing time in group A was 11.1(10.2, 12.2) days. There were no skin pigmentation, severe hypertrophic scar and delayed healing of donor area. Four cases had mild scar hyperplasia and no keloid. The score of Vancouver Scar Scale was 3(2, 4). The healing time of group B was 15.8(13.9, 17.5) days with 23 cases of hypertrophic scar and 2 cases of keloid after healing. The score of Vancouver Scar Scale was 17(17, 17). There was significant difference in healing time between group A and group B ( P<0.01); there was significant difference in Vancouver Scar Scale scores between the two groups( P<0.01); what’s more, there was significant difference in the number of cases of hypertrophic scar between the two groups ( P<0.01). Conclusions:Compared with the traditional skin transplantation, the improved technology of the replantation in situ of donor skin graft with perforation and expansion has the advantages of intact skin, uniform thickness, timely blood circulation establishment after transplantation, no wound exposure in the donor area, natural skin color after primary healing, less scar and more in line with the skin function and aesthetic requirements of human body.
