Application Of Vacuum Sealing Drainage And Cryopreservation Technology In Hand And Foot Skin Transplant

Objective:To summarize the clinical effect of avulsed skin replantation of hand and foot via vacuum sealing drainage (VSD) combing low temperature technique.Methods:From March2012to October2013by using combined technology and implant the brotherhood of avulsed skin,26cases were randomly divided into experimental group and control group, each group of13cases. Experimental group adopts closed wound closed negative pressure drainage technology,4℃or80℃save avulsed skin,4℃low temperature preservation in situ back to plant in5cases,4days after skin repair skin flap for the area3cases;-80℃frozen skin injury after7～8d and implant4cases,45d and implant in1case. The male8cases, female5cases; Ages18to62years, an average of40.8years. Injury to see a doctor for1～4h, an average of2.4h. Cause:7cases of injury to the machine, wheel rolling6cases. Injured area:2cases of finger, hand side in5cases, dorsal foot6cases. Avulsed skin area:5cm*6cm to13cm*16cm, and4patients with tendons, bone exposed; Control group adopts skin avulsion in emergency and implant method, including9cases of male, female4cases; Aged17to60years old, average35.3years. Injury to see a doctor for1～4h, an average of2.3h. Cause:machine6cases, wheel rolling7cases. Injured area:3cases of finger, hand side in4cases, dorsal foot6cases. Avulsed skin area:4cm*6cm to12cm*16cm, and3patients with tendons, bone exposed. Two groups of patients in statistical differences in the basic situation of the meaningless, comparable. Compare wound pressure suction combined refrigeration technology back of skin graft living situation.Results:Among of13cases of the Experimental group, in one case of degloved injury from lower leg to dorsal foot, the replanted skin was necrosis completely, one case of degloving injury with fourth finger, the skin which replanted after45days survived approximately30%, cured after skin-graft many times. In the other cases, the survival area of replanted skin was more than85%, all cured after dressing. According to the standard of skin survival area evaluation by Jia et al,11cases showed excellent, one showed medium and another showed inferior, the good and excellent rate was84%. There was no complication about grafted skin rupture after the skin survived in11patients, after4to22months follow-up, the resiliency of grafted skin showed well. Sensation recovery was measured by BMRC standard:2cases of S3+,8cases of S3,3cases of S2. As excellent for S3+and good for S3, the good and excellent rate was77%. After the patients’ skin of the control group was replanted in Emergency room, as for the survival area of replanted skin,2cases showed excellent,4cases showed good,2cases showed medium and5cases showed inferior. Sensation recovery of the control group was measured by BMRC standard:2cases of S3+,7cases of S3,4cases of S2, the good and excellent rate was69%. Differences between the two groups was significantly survival area of skin. There was statistically significant (P<0.05).Conclusion:VSD combining lower temperature technique in skin replantation provides time and space for wound preparation and treatment plan for the patients who need second surgery, especially for the large area skin degloving, this method could utilize the degloved skin efficiently, decrease the donor site area, alleviate the pain and financial burden, reduce the scar formation of donor site and impediment, the curative effect is manifested.