| Objective:The application of skin soft tissue expansion in clinical plastic repair surgery had a great influence on cosmetic repair of skin and soft tissue reconstruction. Implantation of skin soft tissue expander can provide more additional skin with higher quality. It is an efficient and practical method of tissue repair, which is much closer to the aesthetic standard. At present, there are many related researches at home and abroad, but the samples are small. This meta-analysis aims to analyze the efficacy and safety of skin tissue expansion compared with the traditional method of composite skin grafting in the treatment of burn scar, in order to provide decision-making basis for clinicians by more objective and reliable results. Methods:Pub Med, EMBASE, CNKI, VIP and Wanfang databases were searched from January, 2000 to September,2016. The randomized controlled trials(RCT) or control clinical research(CCT) were included. To carry out strict literature screening in accordance with the inclusion and exclusion criteria and conduct bias assessment based on Cochrane System Evaluation Handbook. To extract data independently according to predesigned table. Outcome indicators included effective rate, average healing time of wounds, wound blood recovery time and the cases of adverse reactions. To carry out heterogeneity test and pooled statistical analysis by Review Manage 5.1 software provided by the Cochrane Collaboration using the odds ratio(OR) as the pooled statistics for two categorical variables and mean difference(MD) for continuous variables. According to the heterogeneity test results to select the corresponding model for pooled statistical analysis. Publication bias were presented by funnel plots which were finished by using Rev Man 5.1 and examined by Begg's tests which were conducted by Stata13.0 software. Results:(1) 16 articles were included in this meta-analysis. Three articles with high risk bias and the others were not clear;(2) 16 articles were available to evaluate effective rate. There was no evidence of heterogeneity(P=0.99>0.05). Thus, fixed-effect model was selected for the pooled analysis. Results showed that pooled OR(95%CI) was 6.95(4.64,10.44). There was statistically difference in effectivity between skin soft tissue expansion group and composite skin graft group(Z=9.19, P<0.01);(3) 4 articles were available for average healing time of wounds and wound blood recovery time. There was good homogeneity(P=0.82>0.05). Thus, fixed-effect model was selected for the pooled analysis. Pooled results of average healing time of wounds showed that MD(95%CI) was-4.2(-4.93,-3.47). There was statistically difference in average healing time of wounds between skin soft tissue expansion group and composite skin graft group(Z=11.32, P<0.01). Pooled results of wound blood recovery time showed that MD(95%CI) was-5.35(6.24,-4.46). There was statistically difference in wound blood recovery time between skin soft tissue expansion group and composite skin graft group( Z=11.81, P<0.01);(4) 12 articles were available for safety of treatment. There was good homogeneity(P=0.98>0.05). Thus, fixed-effect model was selected for the pooled analysis. Pooled results of treatment safety showed that OR(95%CI) was 0.33(0.29,0.49). The occurrence of adverse reactions in skin soft tissue expansion was lower compared with composite skin graft group(Z=5.74, P<0.01);(5) The results of publication bias showed that the P value was greater than 0.5, and there was no publication bias. Sensitivity analysis showed that the results were stable. Conclusion:This study has confirmed that skin soft tissue expansion technique in the treatment of burn scar had higher effective rate, shorter healing time of wounds and wound blood recovery time, lower incidence of adverse reactions and higher safety compared with composite skin grafting. Therefore, it is worth popularizing in the treatment of burn scar.16 articles included in this study were relatively poor in quality, however, there was no publication bias and the stability was good in this metaanalysis. |
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