VSD辅助人工真皮联合自体刃厚皮移植治疗难愈性创面效果分析OA

Objective To explore the efficacy of VSD-assisted artificial dermis combined with autologous split-thickness skin grafting in the treatment of refractory wounds.Methods The research subjects were selected from patients with refractory wound who received treatment at Anqing Petrochemical Hospital of Nanjing Gulou Hospital Group from January 2021 to January 2024,a total of 130 cases were included,and were divided into the control group(68 cases)and the ADM group(62 cases),based on different treatment methods.The control group was given negative pressure closed drainage technique combined with autologous thick skin graft transplantation,while the ADM group was treated with ADM,VSD combined with autologous thick skin composite transplantation for repair.The postoperative recovery-related indicators(wound recovery time,skin graft survival and complications),positive rate of wound bacterial culture,levels of growth factors and inflammatory factors,and scar conditions 6 months after surgery were compared between the two groups.Results Compared with the the control group,the times from the first treatment to autologous skin transplantation and the time of total hospitalization in the ADM group were longer(P＜0.05).The excellent and good survival rate of skin grafting 14 d after skin grafting surgery in the ADM group was higher than the control group(P＜0.05).Compared with before surgery,7 d after skin grafting surgery,the levels of serum erythropoietin(EPO),vascular endothelial growth factor(VEGF),and hyaluronic acid(HA)increased in both groups,and the ADM group showed a greater increase compared to the control group;The levels of serum interleukin-1 β(IL-1 β)and tumor necrosis factor alpha(TNF-α)decreased in both groups,and compared with the control group,the ADM group showed a greater decrease(P＜0.05).6 months after skin grafting surgery,compared with the control group,the scores of Vancouver Scar Scale(VSS)for the graft and donor areas in the ADM group were lower;During the follow-up period,the incidence of complication in the ADM group was lower than the control group(P＜0.05).Conclusion The combination of ADM,VSD,and autologous thick skin composite transplantation could effectively promote wound healing in patients with refractory wound,reduce inflammatory reactions,improve skin graft survival rate,and enhance scar aesthetics.It does not affect the antibacterial effect of simple VSD and can reduce the occurrence of complication.However,there were still certain shortcomings in the time from initial treatment to autologous skin transplantation and time of total hospitalization.