对腹股沟区全厚皮片修复儿童皮肤缺损的疗效观察

doi:10.3877/cma.j.issn.1673-9450.2023.03.010

目的

比较腹股沟区全厚皮片、大腿中厚皮片修复儿童皮肤缺损的术后效果，探讨儿童皮肤缺损修复的更优化供区选择。

方法

选择2019年8月至2021年1月昆明医科大学附属儿童医院收治的皮肤缺损需行游离皮片植皮术患儿50例作为研究对象，其中腹股沟区全厚皮片供皮(腹股沟组)26例，大腿中厚皮片供皮(对照组)24例。观察对比两组供区愈合时间、疼痛、瘙痒及瘢痕情况，受区皮片色素沉着、柔软度、挛缩度、皮片边缘瘢痕情况。数据比较采用独立样本t检验、χ²检验、秩和检验。

结果

两组患者性别、年龄、致伤原因、植皮面积差异无统计学意义，具有可比性(P>0.05)。腹股沟区全厚皮片及大腿中厚皮片术后均存活良好，成活率差异无统计学意义(84.0%±6.9% vs 88.0%±7.7%，P>0.05)；腹股沟组供区愈合时间[(7.80±1.67)d]明显短于对照组[(11.67±1.95)d]，差异有统计学意义(P<0.001)；腹股沟组供区术后疼痛、瘙痒评分[(0.73±0.53)、(0.62±0.57)分]明显低于对照组[(1.42±0.65)、(1.78±0.46)分]，差异有统计学意义(P<0.001)；术后6个月随访，腹股沟组供区瘢痕评分[(0.57±0.58)分]明显低于对照组[(1.58±0.50)分]，差异有统计学意义(P<0.001)。腹股沟组受区色素沉着、皮片柔软度、挛缩度[(1.04±0.54)、(0.39±0.50)、(0.36±0.49)分]优于对照组[(1.48±0.66)、(0.70±0.56)、(0.71±0.55)分]，差异有统计学意义(P<0.05)；腹股沟组受区皮片边缘瘢痕与对照组比较差异无统计学意义[(1.04±0.72)分vs (1.00±0.60)分，P>0.05]。

结论

对于儿童皮肤缺损修复，腹股沟区全厚皮片能有效缩短供区术后愈合时间，减少术后不良反应，供区及受区均有较好的美观效果，安全有效。

关键词: 腹股沟, 全厚皮片, 中厚皮片, 皮肤移植, 儿童

Objective

To compare the postoperative effects of full-thickness inguinal skin graft and medium-thickness thigh skin graft in children, and to explore more optimal donor site selection for repairing skin defects in children.

Methods

From August 2019 to January 2021, 50 children with skin defects who needed free skin grafting were selected as the research objects. Among them, 26 cases received inguinal skin donors (inguinal group) and 24 cases received thigh medium thickness skin donors (control group). The healing time, pain, itching and scar of the donor area, pigmentation, softness, contracture and marginal scar of the recipient area were observed and compared between the two groups. Data were compared by t-test, chi-square test and rank sum test.

Results

There were no significant differences in gender, age, cause of injury and skin graft area between the two groups (P>0.05). The survival rate of full-thickness inguinal skin grafts and medium-thickness thigh skin grafts had no significant differences (84.0%±6.9% vs 88.0%±7.7%, P>0.05). The healing time of donor site [(7.80±1.67)d] in inguinal group was significantly shorter than that of the control group [(11.67±1.95)d], and the difference was statistically significant (P<0.001). The pain and pruritus score of the donor site in inguinal group after operation (0.73±0.53, 0.62±0.57) were significantly lower than those of the control group (1.42±0.65, 1.78±0.46), and the difference was statistically significant (P<0.001). The scar score of donor site (0.57±0.58) in inguinal group was significantly lower than that of the control group (1.58±0.50), and the difference was statistically significant (P<0.001). The pigmentation, skin softness and contracture of the recipient area (1.04±0.54, 0.39±0.50, 0.36±0.49) in inguinal group were better than those of the control group (1.48±0.66, 0.70±0.56, 0.71±0.55), and the differences were statistically significant (P<0.05). There was no significant difference in marginal scar between the two groups (1.04±0.72 vs 1.00±0.60, P>0.05).

Conclusion

For the repair of skin defects in children, full-thickness inguinal skin graft, which is safe and effective can effectively shorten the postoperative healing time of the donor site, reduce postoperative adverse reactions, and has good aesthetic effect in both the donor site and the recipient site.

Key words: Inguina, Full thickness skin, Medium thickness skin, Skin graft, Children

表1 两组患儿一般资料比较

组别	例数	性别(例)		致伤原因(例)					年龄(岁，±s)
组别	例数	男	女	烧伤	车祸伤	机械伤	瘢痕及巨痣切除	植皮面积(cm²，±s)	年龄(岁，±s)
对照组	24	17	7	6	3	5	10	43.56±6.57	6.67±3.18
腹股沟组	26	18	8	9	4	7	6	41.29±6.96	5.62±3.67
χ²值/t值		0.015		1.999				1.316	1.87
P值		>0.05		>0.05				>0.05	>0.05

表1 两组患儿一般资料比较

组别	例数	性别(例)		致伤原因(例)					年龄(岁，±s)
组别	例数	男	女	烧伤	车祸伤	机械伤	瘢痕及巨痣切除	植皮面积(cm²，±s)	年龄(岁，±s)
对照组	24	17	7	6	3	5	10	43.56±6.57	6.67±3.18
腹股沟组	26	18	8	9	4	7	6	41.29±6.96	5.62±3.67
χ²值/t值		0.015		1.999				1.316	1.87
P值		>0.05		>0.05				>0.05	>0.05

表2 两组供区术后评估比较(±s)

组别	疼痛(分)	瘙痒(分)	瘢痕(分)	愈合时间(d)
对照组	1.42±0.65	1.78±0.46	1.58±0.50	11.67±1.95
腹股沟组	0.73±0.53	0.62±0.57	0.57±0.58	7.80±1.67
Z值/t值	145	64.50	82	7.53
P值	<0.001	<0.001	<0.001	<0.001

表2 两组供区术后评估比较(±s)

组别	疼痛(分)	瘙痒(分)	瘢痕(分)	愈合时间(d)
对照组	1.42±0.65	1.78±0.46	1.58±0.50	11.67±1.95
腹股沟组	0.73±0.53	0.62±0.57	0.57±0.58	7.80±1.67
Z值/t值	145	64.50	82	7.53
P值	<0.001	<0.001	<0.001	<0.001

表3 两组受区术后评估比较(±s)

组别	色素沉着(分)	皮片柔软度(分)	皮片挛缩度(分)	皮片边缘瘢痕(分)	皮片存活率(%)
对照组	1.48±0.66	0.70±0.56	0.71±0.55	1.00±0.60	88.0±7.7
腹股沟组	1.04±0.54	0.39±0.50	0.36±0.49	1.04±0.72	84.0±6.9
Z值/t值	191	201	207.5	289.5	1.62
P值	<0.05	<0.05	<0.05	>0.05	>0.05

表3 两组受区术后评估比较(±s)

组别	色素沉着(分)	皮片柔软度(分)	皮片挛缩度(分)	皮片边缘瘢痕(分)	皮片存活率(%)
对照组	1.48±0.66	0.70±0.56	0.71±0.55	1.00±0.60	88.0±7.7
腹股沟组	1.04±0.54	0.39±0.50	0.36±0.49	1.04±0.72	84.0±6.9
Z值/t值	191	201	207.5	289.5	1.62
P值	<0.05	<0.05	<0.05	>0.05	>0.05

图1 腹股沟区全厚皮片修复儿童皮肤缺损。A示左手背Ⅲ°擦伤创面，皮肤如皮革样；B示清除创面坏死皮肤，见皮肤坏死达深筋膜表面；C示大张全厚皮移植于左手创面；D示术后6个月随访皮片存活良好，色泽、柔软度、挛缩度均良好；E示腹股沟梭型切取皮肤范围；F示切取皮肤至深筋膜表面；G示充分减张缝合术后；H示腹股沟供区术后6个月随访，仅见线状瘢痕，未见明显增生

图2 大腿中厚皮片修复儿童皮肤缺损。A示右手背深Ⅱ°擦伤创面，皮肤发白；B示伤后2周右手背创面大部分坏死物质溶解；C示清除右手背创面坏死皮肤，见皮肤坏死达脂肪层；D示大张中厚皮移植术后12 d，皮片完全存活；E示术后6个月随访，移植皮片存活良好，皮片有轻度色素沉着，轻度挛缩，柔软度尚可，皮片边缘轻度瘢痕增生；F示右大腿内侧供皮区见轻度瘢痕增生，稍凸出皮肤表面，充血明显

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Efficacy of full-thickness inguinal skin graft to repair skin defects in children

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Efficacy of full-thickness inguinal skin graft to repair skin defects in children