To explore the clinical effect of autologous dermal transplantation combined with vacuum sealing drainage (VSD) in the treatment of anterior tibial bone exposure wound.

From August 2014 to September 2018, 13 patients with exposed bones in the anterior tibial region who were admitted to the Department of Burns and Plastic Surgery, First People′s Hospital of Kunshan who met the selection criteria and required surgical repair were selected. The patients were divided into two groups according to the random number table method, with 6 cases in the control group and 7 cases in the experimental group. Wound bacterial culture and drug sensitivity test were performed on both groups of patients after admission. The wound was wet compressed with 0.1% benzalkonium chloride solution. In the control group, the necrotic tissue on the wound was removed and the wound was repaired with an adjacent rotating skin flap. The donor area was transplanted with an autologous blade thick skin, fixed with 4-0 silk thread intermittently, and covered with a steriled dressing. After the operation, sensitive antibiotics were selected to prevent and treat infections in the operation area according to the drug susceptibility test. In the experimental group, the necrotic tissue on the wound surface was completely removed, and the exposed cortex was excised until the blood oozing was active. Electric dermatome was used to take an ultra-thin skin graft from the thigh on the same side of the limb where the wound was located. Kept the pedicle of the skin graft intact, turned it upwards to protect the skin graft, the electric dermatome was used to cut the dermal tissue with a thickness of 0.3 mm, cut off the obtained dermal tissue to stop the bleeding in the donor site, and replanted the uncut ultra-thin skin flaps in situ, 4-0 silk thread was used to interrupt sutures, and sterile dressings was used to compression bandage. The VSD device was used to cover the transplant area, and the film was closed, the pipeline was connected, the negative pressure was set to 75 mmHg (1 mmHg=0.133 kPa). After operation, sensitive antibiotics were selected to prevent infection in the surgical area according to the results of bacterial culture and drug sensitivity test on the admission wound. On the 5th day after the surgery, the dressing of the operation area in the two groups were changed for the first time, and then the wound were disinfected and steriled dressing once every 3 days until the wound healed. Five days after operation, the survival of skin flap and skin flap in the two groups were observed and calculated. The bed days from the first day after operation to the day of discharge in the two groups were counted. Six months after operation, Vancouver scar scale was used to evaluate the scar growth in the operation area of the two groups, and the patient satisfaction was counted. Data were compared with t test and chi-square test.

The excellent and good rate of skin graft survival in the experimental group was 100.0%(7/7), which was higher than that of the control group [83.3%(5/6)], but the difference was not statistically significant (χ²=1.264, P>0.05); the experimental group′s postoperative bed days were (12.9±1.3) d, which was lower than the control group′s [(14.5±1.1) d], the difference was statistically significant (t=2.472, P<0.05); six months after surgery, the Vancouver scar score in the operation area in the experimental group was (7.1±1.3) points, which was significantly lower than that in the control group [(13.5±1.0) points], the difference was statistically significant (t=9.564, P<0.05); six months after surgery, the satisfaction rate in the experimental group was 85.7%(6/7), which was significantly higher than that in the control group [16.7%(1/6)], the difference was statistically significant(χ²=6.198, P<0.05).

Autologous dermal transplantation combined with VSD for the treatment of bone exposed wounds in the anterior tibial area has its feasibility. The overall clinical effect is no less than that of traditional flap transplantation.