| Objectives: This study selected the superior technique,Vacuum Sealing Drainage(VSD),to investigate the therapeutic efficacy of comparing two-stage skin grafting combined with VSD in the implantation phase with the addition of Platelet-Rich Plasma(PRP),growth factors,nano-silver ionic antibacterial dressing and two-stage skin grafting combined with traditional packing technique in the repair of traumatic chronic wounds.Methods: From September 2020 to December 2022,patients with chronic trauma to the lower extremities due to trauma were admitted to the Department of Burns and Plastic Surgery of Hezhou People’s Hospital.Patients were randomly grouped by applying the numerical table method to set up a control group and a test group,and different treatment protocols were administered to the control group and the test group respectively.In the control group,the patients with chronic trauma repair were treated with the conventional packing technique and in the test group,the patients with chronic trauma repair were treated with the two-stage skin grafting combined with the vacuum seal drainage technique.In both groups,PRP,growth factor and nano-silver ion antibacterial dressing were added to the wounds and the dressing was removed 7 days after surgery.During the whole study,we collected and recorded the general data of patients in both groups,observed and recorded the survival of skin graft in both groups,calculated the survival rate of skin graft in the control group and the experimental group of chronic wound repair patients,counted the number and proportion of cases with 85% or more of the skin graft survived,and collected and recorded the healing of skin graft in both groups,for example,the incidence of subcutaneous blood accumulation,antibiotic usage rate,VAS score,wound healing time,wound healing rate,patient satisfaction,etc.By comparing and analyzing the above indexes between the two groups,the clinical effect of the second-stage skin graft combined with VSD in the wound repair of chronic trauma patients was comprehensively evaluated.Results: A total of 80 patients with chronic trauma were included in this study and randomly assigned to the control and experimental groups,with 40 patients in both groups.There was no significant difference between the control and test groups in terms of age,gender,duration of trauma formation,and trauma area(P > 0.05),and no statistically significant difference was found between the groups,so this randomization grouping can be considered to have a good randomization.The results showed that at 7,10 and 14 days postoperatively,the survival rate of skin graft and the number of patients with a skin graft survival rate greater than 85% in the test group of patients with chronic wounds treated with second-stage implants combined with VSD were significantly higher than those in the control group treated with second-stage implants combined with traditional packing(P < 0.05),and the statistical significance of the data difference was found;at 1-7 days postoperatively,no healing occurred in patients treated with second-stage implants combined with traditional packing and in patients treated with second-stage implants combined with VSD.The number of healed patients in the control group treated with phase II implants combined with conventional packing was significantly lower than that in the trial group treated with phase II implants combined with VSD at 8-14 days postoperatively(P < 0.05).The mean healing time of the implant skin fragments of the chronic trauma patients in the test group treated with second-stage implants combined with VSD was significantly better than that of the control group treated with second-stage implants combined with traditional packing,i.e.,P < 0.05,and the data difference was statistically significant.At 3days after surgery,the number of patients with positive bacterial culture,white blood cell level and number of patients using antibiotics were significantly lower in the test group treated with second-stage implant combined with VSD than in the control group treated with second-stage implant combined with traditional packing(P < 0.05),and the data differences were statistically significant.At 3 days after completion of surgery,the pain perception score was lower in the trial group treated with second-stage skin grafting combined with VSD than in the control group treated with second-stage skin grafting combined with traditional packing(P < 0.05),and at 7 days after surgery,the pain perception VAS score was lower in the trial group treated with second-stage skin grafting combined with VSD than in the control group treated with second-stage skin grafting combined with traditional packing,i.e.,P < 0.05.At14 days after surgery,the pain VAS score of the test group treated with second-stage implants combined with VSD was significantly lower than that of the control group treated with second-stage implants combined with conventional packing(P < 0.05),and the difference was statistically significant;the incidence of rash blisters,subcutaneous blood accumulation(hematoma),and traumatic bleeding in the test group treated with second-stage implants combined with VSD were significantly lower than that of the control group treated with second-stage implants combined with conventional packing(P <0.05).The incidence of wound aggravation was not significantly different between the two groups(P>0.05).The test group treated with stage II skin grafting combined with VSD showed better data on graft adaptability,graft flatness,graft texture and abrasion resistance than the control group(treated with stage II skin grafting combined with traditional packing),i.e.P<0.05.The test group was treated with stage II skin grafting combined with VSD.The incidence of scar growth at the suture site was lower in the trial group than in the control group(treated with second-stage implant combined with traditional packing)by the treatment protocol of second-stage implant combined with VSD,i.e.,P < 0.05,and the difference between the two groups was statistically significant;patient satisfaction was significantly higher in the trial group(treated with second-stage skin graft combined with VSD)than in the control group(treated with second-stage skin graft combined with traditional packing)(P <0.05).Conclusions:Through a comparative study of the randomized controlled clinical efficacy of these two types of implant repair of chronic wounds,based on the intraoperative treatment with PRP,growth factors and nano-silver ionic antibacterial dressing in the experimental and control groups,it was concluded that the second-stage skin graft combined with VSD repair of chronic wounds can effectively improve the survival rate of patients’ postoperative skin graft,reduce the rate of patients’ postoperative antibiotic use and the incidence of infection and inflammation during the healing process,reduce the healing time of chronic wounds,reduce the risk of postoperative complications(e.g.,bleeding,rash and blistering,scarring,etc.),reduce the level of postoperative pain,and provide more satisfying treatment and repair results for patients with chronic wounds.It is a more effective and feasible surgical treatment option than traditional repair methods and can be easily applied in primary care hospitals. |
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