| Background:Burns not only damage the skin barrier function of patients,but also damage the multi-organ function of the whole body.Therefore,severe burns have a high disability rate and mortality rate.At present,the repair of burn wounds mainly depends on autologous skin grafts,which can be mesh skin grafts,stamp skin grafts,microparticle skin grafts,Meek skin grafts and autologous epidermal cell culture grafts.Meek skin graft has been popularized and applied in burn patients due to its advantages of simple operation,skin source conservation,and good curative effect.During the clinical treatment,we found that there was a significant difference in skin survival among different patients after Meek skin grafting,which affected the prognosis of patients after surgery.Therefore,it is of great significance to explore the factors influencing the survival of Modified Meek Micrografting to improve the survival rate of skin grafts.Negative pressure wound therapy(NPWT)closely contacts the wound with the microporous foam material and seals it with a biofilm to form a one-way negative pressure environment on the wound surface.Drainage through the foam micropores removes the necrotic tissue and exudate that bacteria rely on for survival,and at the same time forms a pressure difference between the inside and outside of the bacterial cell membrane to destroy its integrity.At the same time,with the help of negative pressure micro-force to improve local tissue microcirculation,increase the secretion of cell growth factors,accelerate cell proliferation and angiogenesis,and promote wound healing.At present,there are many literature reports on the application of NPWT technology after skin grafting,but there are few reports on the application of NPWT after Meek skin graftingThis topic firstly collected the case data of severe burn patients who underwent Meek skin grafting,and explored the relevant factors affecting the survival of the grafted skin of Meek skin grafting through retrospective analysis.On this basis,A prospective clinical randomized controlled study was designed to explore the effect of the NPWT combined with Meek skin grafting on the survival rate of skin grafts.Methods:1.Factors Influencing the Survival of Modified Meek Micrografting in Severe Burn PatientsA retrospective analysis of the clinical data of 83 patients who met the inclusion criteria from January 2013 to December 2018.The data of the patients who underwent Meek skin grafting for the first time were taken.Collected the demographic and injury data of the patients,surgery-related conditions,protein nutritional status,platelets,and infection-related indicators during the perioperative period(before surgery and on the 1st,3rd,and 5th days after surgery).According to the postoperative skin survival,the patients were divided into good skin survival group(survival rate≥70%)and poor skin survival group(survival rate<70%).Independent sample T test,Mann-Whitney U test,chi-square,repeated measurement and Logistic regression analysis were performed for the above indicators.2.Effect of negative pressure wound therapy on survival rate of Meek graftA prospective controlled study was conducted.From August 2020 to June 2021,13patients with similar injury degree of bilateral affected limbs were admitted to our hospital.The affected limbs were randomly divided into Meek+NPWT skin graft group and Meek skin graft group.Related operations were performed in groups.One week after surgery,the crepe adhesion rate and wound microbe culture were compared between the two groups.Two weeks after surgery,the skin survival rate was compared between the two groups.Then the effects of NPWT on postoperative crepe adhesion and the survival rate of skin were compared according to whether the patients had low preoperative platelets,intraoperative wound depth and postoperative shock symptoms.Paired T test,Wilcoxon test,chi-square,independent sample T test and Mann-Whitney U test were performed on the data.Results:1.Factors Influencing the Survival of Modified Meek Micrografting in Severe Burn Patients1.1 The severity of burn,operation area,operation time,incidence of postoperative septic shock,mortality and percentage of neutrophil on the third day after surgery in poor skin survival group were higher than those in good skin survival group(P<0.05).The preoperative platelet count,mean perioperative platelet count,mean perioperative albumin and mean perioperative albumin in the poor skin survival group were lower than those in the good skin survival group(P<0.05).1.2 The area under receiver operating characteristic curve of preoperative platelet count,mean perioperative albumin,mean perioperative albumin and percentage of neutrophil on the third day after surgery for poor skin survival postoperative were 0.709,0.686,0.635 and 0.740,respectively.The cut-values were≤69×10~9/L,≤28.43g/L,≤0.11g/L,>84.7%,respectively.1.3 Preoperative platelet count≤69×10~9/L,perioperative mean albumin≤28.43g/L,and percentage of neutrophil on the third day after surgery>84.7%were independent risk factors for poor skin survival after Meek skin grafting.2.Effect of negative pressure wound therapy on survival rate of Meek graft2.1 Meek+NPWT skin graft group had higher postoperative crepe adhesion rate and skin survival rate than Meek skin graft group(84.3±21.3%VS 72.6±25.8%,63.3±29.4%VS50.8±35.5%,P<0.05).2.2 Among 13 patients,10 patients(20 sides)had preoperative platelet count>100×10~9/L.6 patients(12 sides)had preoperative platelet count≤100×10~9/L.The postoperative skin survival rate of the group with preoperative platelet count>100×10~9/L was higher than that of the group with preoperative platelet count≤100×10~9/L(68.7±26.0%VS 18.0±18.9%,P<0.01).Patients with preoperative platelet count≤100×10~9/L:the postoperative skin survival rate of the limbs treated with Meek operation was lower than that of the limbs treated with Meek+NPWT operation(11.0±16.5%VS 25.0±21.8%,P<0.05).2.3 Among the 13 patients,5patients(10 sides)received Meek skin graft in the dermis on bilateral limbs after debridement;8patients(16 sides)received Meek skin graft in the fat layer on bilateral limbs after debridement.The crepe adhesion rate and postoperative skin survival rate in the dermis skin graft group were higher than those in the fat layer skin graft group(93.6±8.7%VS 68.9±25.7%,86.5±9.7%VS 38.6±27.8%,P<0.01).The crepe adherence rate and postoperative skin survival rate of the limbs treated with Meek operation on the fat layer were lower than those of the limbs treated with Meek+NPWT operation(60.3±25.5%VS77.6±24.4%,28.7±26.4%VS 48.5±27.1%,P<0.05).2.4 Among 13 patients,7 patients(14 sides)were stable after surgery.6 patients(12 sides)were unstable and appeared shock symptoms after surgery.The crepe adhesion rate and postoperative skin survival rate in the stable group were higher than those in the unstable group(90.6±11.6%VS 64.2±27.1%,79.6±17.5%VS 30.7±25.3%,P<0.01).Patients with postoperative shock:the postoperative skin survival rate of the limbs treated with Meek operation was lower than that of the limbs treated with Meek+NPWT operation(22.1±25.1%VS 39.2±24.6%,P<0.05).Conclusions:1.Preoperative platelet count≤69×10~9/Land the percentage of neutrophil on the third day after surgery>84.7%have good predictive value for postoperative skin survival.When preoperative platelet count≤69×10~9/L in patients who undergoing Meek surgery,clinicians should actively supplement patients’platelets before surgery and determine whether current is the best time for Meek skin grafting.Clinicians also should maintain the patients’albumin>28.43g/L from preoperatively,actively control the infections,especially pay more attention to the infections occurring on the first to third days after the surgery and timely deal with it.the operation time should be shortened as much as possible under the premise of ensuring the quality of the operation.2.NPWT replaces gauze for dressing after Meek skin graft,which can improve the skin survival rate after surgery.Especially in patients with adverse conditions such as low preoperative platelets,deep intraoperative skin graft base,and postoperative shock. |
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