Clinical Effect Analysis Of Skin Stretching And Skin Flap Transplantation In Wound Repair Of Limbs

Objective:This clinical study is to retrospectively compare the multiple indicators of skin stretching and flap transplantation in the treatment of skin and soft tissue defects of limbs.To systematically analyze and evaluate the efficacy,advantages and disadvantages of the two treatment methods,to explore the clinical superiority of skin stretching in limb wound repair,and provide reference for clinic.Methods:Retrospective analysis of 56 cases of limb skin and soft tissue defects admitted by the department of hand and foot surgery in our hospital from October 2016 to December2018.10 cases of upper limbs and 46 cases of lower limbs were injured.There were 42 male patients and 14 female patients.Age distribution was 2-68 years old;The defect area was 4cm×3cm-10cm×18cm.Among them,30 patients were treated with skin stretching and kirschner wire wound-closure system,and 26 patients were treated with skin flap transplantation in the control group.30 patients were treated with skin stretching and kirschner wire wound-closure system,first of all,debridement,then,kirschner needles with a diameter of about 1.0mm were placed in the subcutaneous or deep fascia at a distance of about 2cm from the wound edges on both sides,finally,install the skin stretching wound-closure system and fix it on the kirschner wire.Wound cleaning and adjust the skin stretching and kirschner wire wound-closure system were performed daily after the operation,until the wound heals or narrows to the desired range.In the control group,26 patients were treated with skin flap transplantation.The patients in the two groups were observed and followed up for 3-15 months.Observation and follow-up indexes were as follows: length of operation,intraoperative bloodloss,number of operations,days of hospitalization,wound healing time,patient satisfaction,VSS evaluation of postoperative scar degree,postoperative scar length,short-term complications,long-term complications(long-term therapeutic effect).Summarize and statistically analyze the above data.Results:All 56 patients were followed up(the average is 11.6 months),at the last follow-up,all the wounds healed.After the treatment of 30 patients with skin stretching,there were 27 patients who could directly close the wound,suture the wound or only a small amount of skin grafting,the effective rate of skin stretching treatment was 90%(27/30).In the flap transplantation group,24 flaps survived with an effective rate of 92.3%(24/26).The duration of operation was shorter in the stretching group than the flap transplantation group(P < 0.05).The intraoperative blood loss was less in the stretching group than the flap transplantation group(P<0.05).The number of patients need to double or multiple surgeries was higher in the stretching group than the flap transplantation group(P<0.05).The wound healing time in the stretching group was longer than that in the flap transplantation group(P<0.05).The total length of scar was shorter in the stretching group than in the flap transplantation group(P<0.05).The short-term complications in the stretching group were less than those in the flap transplantation group(P <0.05).The long-term complications in the stretching group were less than those in the flap transplantatio group(P<0.05).Compare and analyze the two groups of patients,there was no statistically significant differences(P>0.05)in the postoperative scar degree,hospital stay and patient satisfaction.Conclusion:1.Both skin stretching and skin flap transplantation have good results in the treatment of limb skin and soft tissue defects,and both groups had high levels of satisfaction.2.Compared with flap transplantation,skin stretching did not prolong the hospital stay of patients with skin and soft tissue defects of limbs.3.Compared with the two treatment plans,skin stretching treatment has the advantages of simple operation,shorter operation time,less intraoperative bleeding,fewer complications,no severe complications,no skin donor site injury,less postoperative scar healing and aesthetic appearance,and no major complications,which are worthy of promotion and application.