Clinical Characteristics And Plastic Repair Of Skin Wounds Of Different Shapes In Emergency Department

Objective:The purpose of this study is to evaluate the long-term appearance of the skin wounds of different shapes closed with plastic principle and techniques according to their clinical characteristics.Methods:(1) Grouping of operation:92 cases (56 males and 36 females; mean age:32.8 years) with open wounds from 2014.1 to 2015.1 of Department of Emergency of the Second Hospital of Shandong University (hereinafter referred to as our hospital) were collected. Primary sutures were managed in accordance with the minimally invasive principles of plastic surgery in all the wounds. These cases were named with Operative Group which was subdivided into 9 groups:G1 (general linear wound), G2 (beveled linear wound), G3 (V-shaped wound), G4 (triangle wound), G5 (U-shaped flap-like wound), G6 (round or irregular wound), G7 (paralleled wound), G8 (uneven-height wound) and G9 (uneven-length wound). Notably, the wounds of all the 27 cases (16 males and 11 females; mean age:30.3 years) of G1 (general linear wound) were in maxillofacial regions, which were caused by blunt forces. (2) Another 22 cases (13 males and 9 females; mean age:33.0 years) with open wounds were collected, and we named these cases Control Group (G10). Dressing changes of the 22 cases in Control Group were performed in our hospital while their wounds (all of the 22 cases belonged to general linear wounds in maxillofacial regions) had been closed with traditional interrupted simple sutures in other hospitals. Besides, we learned that all the wounds of G10 (Control Group) were caused by blunt forces by reviewing the case history in detail. Diabetes, vascular diseases and malnutrition were excluded in all the 114 cases. (3) Observation target:Follow-up visits were carried out after 6-12 months. We evaluated the scars of the Control Group and Operative Group by Vancouver scar scale (VSS). At the same time, a questionnaire was designed to investigate the degree of satisfaction of the injured. The satisfaction rate and average of VSS were calculated. (4) Statistical method:SPSS 17.0 software was used to compare the average score of VSS in G10(Control Group) to that of G1 (general linear wound) by t test score. P<0.05 was considered statistically significant.Results:(1) All the 114 cases in Operative Group (G1～9) and Control Group (G10) were healed by first intention. (2) All the 92 cases in Operative Group were healed with slight and soft scars, and the scar color matched the surrounding tissues well in configuration, without contracture deformity, tissue strain or dysfunction. The low average of VSS (0 to 4 points) was gotten and the satisfaction rate was high (66.67%～100.00%). The lowest satisfaction rate (66.67%) was found in G7 (paralleled wound) while G8 (uneven-height wound) had the highest (100.00%). (3) All the 22 cases in Control Group were healed, while most of them turned up with hyperplastic, hard and wide scars with slender vessels on the surface, which shew great difference with the surrounding tissues in appearance. But no tissue strain or dysfunction had been found. The high average of VSS (4 to 12 points) came with the low satisfaction rate (22.73%) in Control Group. (4) The difference of the average of VSS between G10(Control Group) and G1 (general linear wound) was statistically significant (P<0.001).Conclusions:(1) It is necessary to abide by the principles of plastic surgery to repair the skin wounds in emergency department in accordance with traumatogenic factors, shape, location of the wound and so on. (2) Those wounds repaired with plastic techniques have a high satisfaction rate, with slight scar hyperplasia in configuration. (3) Compared with simple sutures, the utilization of plastic techniques in the repair of the wounds in maxillofacial regions has a lower average of VSS, which means that the scar formation after wound healing is much slighter. (4) Management of skin wounds according to the principles of plastic surgery can satisfy people’s pursuit of beauty maximally. That is the tendency of present and future emergency trauma surgery.