To investigate the clinical effect of the first-stage wound vacuum suction after the release of scar, combined with the second-stage autologous medium-thickness skin graft in the functional reconstruction of severe burns.

Thirty-six patients with severe burns in the Kunshan "8·2" incident admitted to the Department of Burns and Plastic Surgery, Affiliated Kunshan Hospital of Jiangsu University from July 2015 to July 2016 were selected. All patients had a burn area greater than 80% of the total body surface area, the full thickness burn area was larger than 50% of the total body surface area, scar area was greater than 50% of the burn area, and the scarring of the functional site after burn (36 places) was limited. Patients were divided into experimental group and conventional surgery group according to different treatment methods used by patients, 18 cases in each group. In the experimental group, after the operation of the functional site scar release, the wound was continuously given negative pressure suction for 6 days. If the base of the wound was good, the second-stage was treated with autologous medium-thickness skin graft to repair the wound, and the dressing was changed regularly. In the conventional surgery group, after the functional site scar was released, the first-stage autologous skin graft was repaired and the dressing was changed regularly. On the 12 d after operation, the wound infection status of the two groups was observed and the survival rate of the two groups was calculated. The wound healing time after skin grafting in the skin grafting area and the scar score difference of the skin grafting area at 3, 6 and 10 months after operation were recorded. The functional recovery of the functional part of the patient was evaluated at 12 months postoperatively. Data were compared using t test, Wilcoxon rank sum test, χ² test and Fisher exact probability method.

On the 12 d after operation, the survival rate of autologous skin in the experimental group was (94.28±3.58)%, which was higher than that in conventional surgery group (89.06±3.89)%, the difference was statistically significant (t=4.245, P<0.05). There was 1 case infection in the experimental group and 3 cases in the conventional surgery group, the difference was no statistically significant (P=0.603). After skin grafting, the average healing time of the skin grafting area in the experimental group was (13.22±0.55) d, which was less than that in the conventional surgery group (16.44±0.57) d, the difference was statistically significant (t=6.462, P=0.0001). The scores of the scar in the skin grafting area of the experimental group were (4.22±0.89), (4.72±0.23), and (6.11±0.29)points at 3, 6 and 10 months after operation, respectively, which were lower than those of the conventional surgery group [(5.00±0.59), (6.78±0.24), (8.22±0.31) points], the differences were statistically significant (t=2.830, 7.857, 6.008; with P values below 0.05). After 12 months of follow-up, the functional recovery of the functional parts of the experimental group: best for 10 cases, better for 7 cases, poor 1 cases; conventional surgery group function recovery: best 5 cases, better 9 cases, poor for 4 cases. The improvement of the function of the experimental group was better than that of the conventional surgery group. The difference was statistically significant (χ²=6.210, P=0.045).

After the scar is released, the vacuum suction of the wound combined with the second-stage autologous skin graft can improve the survival rate of the skin, shorten the wound healing time, improve the scar in the skin graft, improve the activity of the functional parts, and have better clinical function reconstruction effect.