Randomized Controlled Study Of NPWT Combined With Recombinant Human Baisc Fibroblast Growth Factor In The Treatment Of Chronic Wound

ObjectiveTo observe and compare the clinical efficacy of flushing with negative pressure wound therapy(NPWT)combined with recombinant human basic fibroblast growth factor(rh-bFGF)solution and flushing with NPWT combined with normal saline(NS)before skin graft on chronic wounds.To discuss the appropriate technology of preparation and treatment of the wound bed before skin graft surgery.MethodsAccording to the inclusion and exclusion criteria,50 patients with chronic wounds who were admitted to the burn and plastic surgery department of Subei hospital from November 2019 to November 2020 were selected.Patients were divided into 2 groups randomly and averagely:1.Applying NPWT combined with rh-bFGF after debridement(NPWT+rh-bFGF);2.Applying NPWT combined with NS after debridement(NPWT+NS).During the treatment,both groups were treated with regular wound dressing,local or systemic anti-infection therapy.A 6-month follow-up was performed after the operation,observation indicators included:1.Time interval between stage Ⅰ and stage Ⅱ operation;2.Length of hospital stay;3.Survival rate of autologous skin grafts;4.Bacterial culture of wounds;5.Visual analog scale(VAS)in different periods after stage Ⅰ operation;6.Scar score of wound healing(with the Vancouver scar scale,VSS).All data were analyzed with SPSS 19.0.Results(1)Time interval between stage Ⅰ and stage Ⅱ operation:the interval between stageⅠ and stage Ⅱ operation of the NPWT+rh-bFGF group was 5.80±1.00 days,which was lower than 7.04±1.17 days of the NPWT+NS group.The difference was statistically significant(P<0.05).(2)Length of hospital stay:Length of hospital stay of the NPWT+rh-bFGF group was 16.32±2.37 days,which was statistically lower than that of the NPWT+NS group(P<0.05).(3)Survival rate of autologous skin grafts:94.36±3.03%in the NPWT+rh-bFGF group and 89.96±5.50%in the NPWT+NS group.There was a significant difference in the survival evaluation of the skin grafts(p<0.05)(table 3).(4)Bacterial culture of wounds:wounds’ bacterial culture after admission showed that 18 cases in NPWT +rh-bFGF group and 16 cases in the NPWT+NS group were positive.The difference was not statistically significant(P>0.05).Wounds’ bacterial culture before stage Ⅱ operation showed that 2 cases in NPWT+rh-bFGF group and 3 cases in the NPWT+NS group were positive.The difference was not statistically significant as well(P>0.05).(5)VAS:The results showed that when NPWT was routinely used after stage Ⅰ surgery,VAS of the NPWT+rh-bFGF group and the NPWT+NS group was 3.32±1.02 and 3.36± 1.22.It was not statistically different during conventional NPWT after surgery(P>0.05).When liquid lavage was used after the stage Ⅰ operation,VAS of the NPWT+rh-bFGF group was 2.32± 1.18,and the NPWT+NS group was 2.52± 1.32.VAS of the two groups during postoperative liquid lavage treatment was not statistically different(P>0.05).(6)Scar score of wound healing:after the long-term follow-up,VSS of the NPWT+rh-bFGF group was 3.68± 1.07,and VSS of the NPWT+NS group was 3.76+0.88.There was no significant difference between 2 groups.(P>0.05).ConclusionFlushing with NPWT combined with rh-bFGF solution before stage Ⅱ skin grafting can shorten the interval between stage Ⅰ and stage Ⅱ operations,promote the growth of wound granulation tissue,shorten the length of hospital stay,and increase the survival rate of autologous skin grafts.It is feasible in clinical applications.