探讨医用皮肤减张闭合器在胸骨切开术后裂开手术治疗中的作用。

选取空军军医大学第一附属医院烧伤与皮肤外科于2017年1月至2020年6月收治的胸骨切开术后裂开患者24例，按随机数字表法将患者分为联合治疗组(n＝12)和常规治疗组(n＝12)。2组患者均在彻底清创的基础上，根据感染创面的位置、血供及感染程度等因素，选择血运丰富的组织瓣进行修复。联合治疗组患者在手术结束关闭切口时应用医用皮肤减张闭合器，常规治疗组患者仅进行常规缝合。比较2组患者温哥华瘢痕量表(VSS)评分，视觉模拟评分法(VAS)评分，拆线时间及瘢痕宽度，并发症发生情况及患者满意度评价。数据比较采用t检验和χ²检验。

术后6个月，联合治疗组患者VSS、VAS评分分别为(4.46±0.63)、(2.01±0.40)分，均低于常规治疗组[(6.20±1.19)、(3.59±0.56)分]，差异均有统计学意义(t＝4.477、7.953, P<0.05)；联合治疗组患者拆线时间为(6.50±1.09) d，短于常规治疗组[(13.89±3.22) d]，差异有统计学意义(t＝7.530, P<0.05)；联合治疗组患者瘢痕宽度为(5.72±1.12) mm，明显短于常规治疗组[(15.33±3.17) mm]，差异有统计学意义(t＝9.902, P<0.05)。本研究24例患者皮瓣全部成活良好，常规治疗组3例患者术后1周出现局部皮肤红肿、渗出，经换药后缓解，并发症发生率25.00%；联合治疗组1例患者于术后3 d换药时发现局部皮肤发白，血运较差，后经调节闭合器的缝合力，减小负压装置压力后缓解，并发症发生率8.33%，2组并发症发生率比较差异无统计学意义(χ²＝1.200, P>0.05)。联合治疗组术后患者满意度评价优良率83.3%，显著高于常规治疗组(41.67%)，差异有统计学意义(χ²＝4.444, P＝0.035)。

在胸骨切开术后裂开手术治疗中早期应用医用减张闭合器，可减轻术后切口瘢痕，术后外观良好，患者满意率高，值得临床推广。

To explore the clinical effect of medical skin tension reduction device in surgical treatment of dehiscence after sternotomy.

A total of 24 patients with dehiscence after sternotomy admitted to Department of Burns and Cutaneous Surgery, First Affiliated Hospital of Air Force Medical University from January 2017 to June 2020 were selected. According to the random number table method, the patients were divided into the combined treatment group (n=12) and the conventional treatment group (n=12). On the basis of thorough debridement, patients in both groups selected tissue flaps with abundant blood supply for repair according to factors such as the location of the infected wound, blood supply, and degree of infection. Patients in the combined treatment group were treated with a medical skin-reducing closure when the incision was closed at the end of the operation and patients in the conventional treatment group only performed conventional sutures. The vancouver scar scale (VSS) score, visual analogue scale (VAS) score, suture removal time and scar width, complications occurrence and patient satisfaction evaluation were compared between the two groups. Data were compared with t test and χ² test.

At 6 months after surgery, the VSS score and VAS score of the combined treatment group were (4.46±0.63) and (2.01±0.40) points, respectively, which were lower than the conventional treatment group [(6.20±1.19), (3.59±0.56) points], the differences were statistically significant (t=4.477, 7.953; P<0.05); the suture removal time in the combined treatment group was (6.50±1.09) d, which was shorter than the conventional treatment group [(13.89±3.22) d], the difference was statistically significant (t=7.530, P<0.05); the scar width of patients in the combined treatment group was significantly reduced (5.72±1.12) mm, which was significantly shorter than that in the conventional treatment group [(15.33±3.17) mm], and the difference was statistically significant (t=9.902, P<0.05). The skin flaps of the 24 patients in this study all survived well. Three patients in the conventional treatment group developed local skin redness and swelling and exudation one week after the operation, which was relieved after dressing change, and the complication rate was 25.00%; 1 case in the combined treatment group was found that the local skin was whitish and the blood supply was poor after 3 days of dressing change. After adjusted the closure force and reduced the pressure of the negative pressure device, the complication rate was 8.33%. The complication rate of the two groups was compared and the difference was not statistically significant (χ²=1.200, P>0.05). The postoperative excellent and good rate of the combined treatment group was 83.3%, which was significantly higher than the conventional treatment group (41.67%), and the difference was statistically significant (χ²=4.444, P=0.035).

Early application of medical skin tension reduction device in surgical treatment of poststernotomy dehiscence can reduce postoperative incision scars, produce a more beautiful postoperative appearance, and have a high patient satisfaction rate, which is worthy of clinical promotion.