Comparison of Split-Thickness Skin Graft Donor Site Healing Time Between Micrografting and Secondary Intention Healing

以微皮膚移植和二級癒合來比較供皮區之治療

莊富捷(Fu-Chieh Chuang) ； 游家孟(Chia-Meng Yu) ； 董光義(Kwang-Yi Tung) ； 黃文成(Wen-Chen Huang) ； 姚文騰(Wen-Teng Yao) ； 陳昱帆(Yu-Fan Chen) ； 尤傑銘(Chieh-Ming Yu)

《臺灣整形外科醫學會雜誌》 30卷4期 (2021/12) Pp. 228-237

摘要

Background: Split-thickness skin grafting (STSG) has been widely used for skin defect reconstruction and can be complicated with donor site healing problems in patients at high risks. Skin micrografting can accelerate the epithelialization in larger wounds. The objective of this study was to investigate whether the chopped remaining skin as micrografts onto the donor site could reduce the healing time in patients with the high risk of delayed wound healing. Methods: We compared the STSG donor site healing time between micrografting (n = 21) and secondary intention (n = 30) in our hospital from March 2017 to March 2020. In the micrografting group, remaining skin grafts were chopped into micrografts and regrafted to the donor site with Allevyn® foam dressing coverage. In the secondary intention group, only Allevyn® foam dressing was applied to the donor site. Data on the baseline characteristics of the patients, risk factors of delayed wound healing, and healing time were obtained and analyzed. Results: We retrospectively reviewed 51 patients, of whom 21 were treated with micrografts and 30 with secondary intention. The donor site healing time in the general population and the patients with high risk of delayed wound healing were both significantly shorter in the micrografting group than in the secondary intention group (16.24 vs. 23.47 days, P ＜ 0.05) and (16.94 vs. 26.35 days, P ＜ 0.05), respectively. For each comorbidity, only the older patients who underwent micrografting have significantly shorter healing time (17.64 vs. 29.18 days, P＜0.05). Conclusions: Using micrografts from remaining skin grafts to regraft the donor site can accelerate re-epithelialization. For patients with high risk of delayed wound healing, micrografting of remaining skin grafts onto the donor site shortened the healing time, especially significant in the older patients. As long as there are remaining skin grafts, micrografts can be considered performing on the donor site to reduce healing time.

關鍵字

STSG donor site treatment ； micrograft

並列摘要

背景：分層皮膚移植是利用健康的表皮組織來重建有皮膚缺損傷口的手術，然而，在具有傷口癒合不良風險的病人身上，時而會產生供皮區延遲癒合之情形。此研究運用將多餘之移植皮膚剪碎後以微皮膚移植至供皮區之方式，研究其減少傷口延遲癒合之效益。研究方法：在我們所屬醫院進行的回溯性研究，總共回溯51位患者（21位微皮膚移植，30位二級癒合）。比較接受自體皮膚移植之患者，在供皮區比較顯微再植皮和二級癒合之癒合時間。結果：共51位患者（21位微皮膚移植，30位二級癒合）列入研究。微皮膚移植組之供皮區癒合時間平均為16.24天；二級癒合組之供皮區癒合時間平均為23.47天，兩組間有統計學上顯著之差異。在具有分層皮膚移植供皮區癒合不良風險之病患，微皮膚移植組之供皮區癒合時間平均為16.94天；二級癒合組之供皮區癒合時間平均為26.35天，兩組間亦有統計學上顯著之差異。對於每種合併症，只有老年患者接受微皮膚移植後的癒合時間顯著縮短。結論：將多餘之移植皮膚剪碎後以微皮膚移植至供皮區可以加速再上皮化。對於供皮區癒合不良高風險的患者，能縮短癒合時間，這對老年患者尤其顯著。只要有剩餘的皮膚移植物，就可以考慮在供皮區進行微皮膚移植以減少癒合時間。