A Randomized Controlled Trial Of The Effect Of Vacuum Sealing Drainage And Tie-over Dressing For Skin Graft In Patients With Congenital Syndactyly Of The Hand

The congenital syndactyly of the hand is the second most common deformity of the upper extremity after the polydactyly,its incidence in the newborn is about 1/2000~3000,accounting for 20% of all congenital hand deformities.The congenital syndactyly of the hand is the malformation of differentiation disorder.Pathologic association of two or more fingers is the main clinical manifestation.The congenital syndactyly of the hand has seriously affected the appearance and function of hand.The hand function of abduction,adduction,flexion and extension is damaged.If not treated in time,it would cause mental damage to the child,who would be shame to use the affected hand and finally lead to loss of hand function.There are many treatments for congenital syndactyly of the hand in the literature.But,the most common method is digits separation,web space reconstruction and skin grafting.In order to ensure the survival of the graft,the skin graft is usually immobilized by tie-over dressing.However,due to the particularity of the skin graft between the fingers and the self-defect of tie-over dressing,it often leads to low survival rate.Vacuum sealing drainage uses special sponge and drainage tube to cover the skin and soft tissue,and wraps the wound with biological membrane.Then connect the closed wound with negative pressure.The negative pressure will draw the excess liquid out of the wound to promote wound healing.Vacuum sealing drainage has been applied to the treatment of wound surface since it was introduced into clinical,especially for some chronic and refractory wounds.With the development of science and technology,vacuum sealing drainage is also gradually applied to the field of skin grafting,as a kind of fixed method after skin grafting.In this study,the vacuum sealing drainage was used for the fixation after the digits separation,web space reconstruction and skin grafting,expecting that it could improve the survival rate of the skin graft.Objective: After digits separation,web space reconstruction and skin grafting,the patients were fixed with vacuum sealing drainage or tie-over dressing.Comparing the effects of the two methods on the survival of the skin,we expected to explore the better way of treating congenital syndactyly of the hand.Methods: Patients who meet the inclusion criteria were randomly divided into experimental group and control group,then they received digits separation,web space reconstruction and skin grafting.The experimental group received vacuum sealing drainage,while the control group received tie-over dressing.10 days postoperatively,the skin graft was photographed with the same light,camera parameters and distance.The necrosis rate was assessed by 2 plastic surgeons with more than 5 years working experience,and the assessment tool is computer graphics software(Image-Pro Plus,v6.0).Results: 12 patients with congenital syndactyly of the hand were included in this study.The sex ratio was 7 male/5 female patients.The age ranged from 0.75 years to 8 years.Average age was 3.43±2.12 years.8 patients with syndactyly were unilateral and 4patients were bilateral.There were 16 affected hands in this study,8 in the experimental group and 8 in the control group.The skin necrosis rate of the experimental group was1.82%,and the control group was 12.05%,and the difference was statistically significant(P<0.05).Conclusion: Vacuum sealing drainage can reduce the necrosis rate of the skin graft than traditional tie-over dressing in patients with congenital syndactyly of the hand which is a good choice and worth popularizing in the clinical speciality.