| ObjectiveThrough a comparative study of cases admitted to our hospital with functional site wounds requiring surgical implant repair,the advantages and disadvantages of different repair methods for functional site wounds were summarized by applying two types of tissue-engineered dermis,namely,acellular dermal matrix（ADM）and artificial dermis,combined with autologous edged-thickness skin slice grafting and traditional autologous medium-thickness skin slice grafting,to provide a basis for clinical basis for the selection of trauma repair options for such patients.Materials and Methods.Seventy-five patients with functional site trauma who met the screening criteria and were admitted to Jiangsu Subei People’s Hospital between September 2019 and December 2021 were retrospectively studied for their case data.According to the wound repair method used,15 patients were included in the decellularized allogeneic dermal matrix combined with autologous blade-thickness skin graft treatment group（Group A）;30 patients were included in the artificial dermis combined with autologous blade-thickness skin graft treatment group（Group B）;and 30 patients were included in the autologous medium-thickness skin graft treatment group（Group C）.The patients in the three groups were compared in terms of wound healing time in the implant area,skin fragment survival rate 6 days after autologous skin grafting,wound healing time in the donor area,wound bacterial culture results,hospital costs and scar formation in the implant area 6 months after wound healing,scar formation in the donor area（using the Vancouver scar scale（VSS））,and functional recovery in the implant area.The results of the study were as follows The statistical data were expressed as cases（n）,and the measures conforming to normal distribution were expressed as mean ± standard deviation（x ± S）,and the measures with non-normal distribution were expressed as median and interquartile spacing[Md（QR）].Theχ2 test,Fisher’s exact test,analysis of variance,and Mann-Whitney U（Mann-Whitney U）test were performed on the study data using SPSS 26.0 software.Results（1）Wound healing time in the skin graft area:group A（11.87± 1.88）days,group B（21.57± 1.41）days,group C（11.30±1.24）days,no statistically significant difference between groups A and C（p>0.05）;statistically significant difference between groups A and B and groups B and C（p<0.01）.patients in group B had longer wound healing time than groups A and C.（2）The survival rate of skin pieces 6 days after autologous skin grafting:the survival rate of skin pieces 6 days after autologous skin grafting was 91%（2%）in group A,91%（5%）in group B and 92%（4%）in group C.The difference between the three groups was not statistically significant（p>0.05）.（3）Healing time of donor area wound:group A（10.67± 1.23）days,group B（11.03±1.21）days,group C（15.23±1.28）days.the difference between groups A and B was not statistically significant（p>0.05）;the difference between groups A and C and groups B and C was statistically significant（p<0.01）.the healing time of donor area wound was longer in group C than in groups A and B.group.（4）Trabecular bacterial culture results:the number of positive trabecular bacterial culture cases at admission was 3 cases in group A,6 cases in group B and 7 cases in group C.The number of positive trauma bacterial culture cases 7 days after implantation was 1 case in group A,2 cases in groups B and C respectively.The difference between the three groups was not statistically significant（P=0.989）（5）Hospitalization cost:6.58（1.2）million yuan for group A,5.34（1.3）million yuan for group B,and 3.27（1.09）million yuan for group C.The difference between the three groups was statistically significant（P<0.05）,and the average hospitalization cost was the highest in group A,the second highest in group B and the lowest in group C.（6）VSS scores in the implant area:5（1.00）in group A,6（1.25）in group B,and 4（1.00）in group C.VSS scores were statistically different between groups（P<0.05）,with group B having the highest,group A the second highest and group C the lowest.（7）VSS scores in the donor area:1（1.00）in group A,1（1.00）in group B,and 4（1.25）in group C.There was no statistically significant difference between groups A and B（p=0.673）;there was a statistically significant difference between groups A and C and groups B and C（p<0.01）.the VSS scores in the donor area of patients in group C were higher than those in groups A and B.（8）Functional recovery of the implant area:excellent functional activity rate in group A（93.3%）,group B（93.3%）,and group C（90%）.The difference between the three groups was not statistically significant（P=0.873）.ConclusionThe functional recovery after wound repair using decellularized allogeneic dermal matrix combined with autologous blade-thickness skin slice graft,artificial dermis combined with autologous blade-thickness skin slice graft and autologous medium-thickness skin slice graft was close.One-step decellularized allograft combined with autologous blade-thickness skin graft has the advantage of shorter treatment time than autologous medium-thickness skin graft and less scarring of the donor area than the latter,but has the disadvantage of higher cost.In contrast,artificial dermis combined with autologous blade-thickness skin graft has the advantages of good wound repair function,light donor scar,and moderate treatment cost,but the disadvantage is that the treatment period is relatively long and requires two operations.In the future,artificial dermis will be able to meet the clinical demand more if a one-step method can be used to repair the trauma. |
