关键词: 皮肤移植, 移植, 自体, 手部烧伤, 自体大张中厚皮片移植, 创面感觉恢复

Abstract: 【Abstract】 Objective To investigate the recovery of sensory function in hand burn wounds repaired with autologous large-sheet split-thickness skin grafts, and to analyze the correlation between relevant indicators and time. Methods This study was a randomized controlled trial. A total of 100 patients with superficial partial-thickness hand burns were enrolled from the Chinese People′s Liberation Army Rocket Force Characteristic Medical Center between January 2022 and June 2024, and were randomly divided into two groups, with 50 patients in each group. In the treatment group, routine eschar removal and disinfection were performed, followed by immediate autologous large-sheet split-thickness skin grafting, and dressings were changed on postoperative day 7; in the control group, wound cleansing, debridement of necrotic tissues, and routine dressing changes were performed to allow natural healing. The wound healing rate on day 7 after surgery was evaluated by comparison with the baseline wound area, and the time required for complete wound healing was recorded. Fasting venous blood samples were collected before treatment and at 1 week after treatment, and serum levels of high-sensitivity C reactive protein （CRP）, tumor necrosis factor-α （TNF-α）, interleukin-8 （IL-8）, 5-hydroxytryptamine （5-HT）, neuropeptide Y （NPY）, and prostaglandin E2 （PGE2） were detected using enzyme-linked immunosorbent assay. The proportions of patients with recovery of sensations （including touch, pain, warmth and cold sensations） were assessed before treatment and at 6 and 12 months after treatment. Adverse events in both groups were recorded. Measurement data were compared between groups using the t test, and count data were compared using the chi-square test. A generalized estimating equation model was constructed to analyze the effect of time on sensory recovery in the two groups. Results Among the 100 patients, 60 were males and 40 were females, aged 34 - 51 （42.12 ± 7.63） years. The treatment group included 29 males and 21 females, with the age being 41.85 ± 7.54 years, and the control group included 31 males and 19 females, with the age being 42.61 ± 7.83 years. A total of 46 matched pairs were successfully obtained using propensity score matching. After matching, there were no significant differences between the treatment group and the control group in baseline characteristics, including gender distribution, age, and causes of injury （all P > 0.05）. At 7 days after eschar removal and disinfection treatment, compared with the control group, the treatment group showed significantly higher wound healing rates （64.53% ± 6.21% vs. 46.32% ± 5.53%, t = 14.85, P < 0.05）, significantly shorter time to complete wound healing （22.16 ± 2.87 days vs. 29.37 ± 4.57 days, t = 9.06, P < 0.05）, and significantly lower levels of inflammatory factors （high-sensitivity CRP, IL-8, TNF-α） and pain-related factors （5-HT, NPY, PGE2） （all P < 0.05）. At 6 months after treatment, the proportions of patients with recovery of touch, pain, warmth, and cold sensations were significantly higher in both groups compared with those before treatment （all P < 0.05）; at 12 months, these proportions were significantly higher than those at 6 months （all P < 0.05）, and were significantly higher in the treatment group than in the control group （touch sensation: 82.61% ［38/46］ vs. 56.52% ［26/46］; pain sensation: 93.48% ［43/46］ vs. 56.52% ［26/46］; warmth sensation: 45.65% ［21/46］ vs. 32.61% ［15/46］; cold sensation: 86.96% ［40/46］ vs. 52.17% ［24/46］; all P < 0.05）. The generalized estimating equation model showed significant differences in the proportion of patients with sensory recovery across different time points within both groups （all P < 0.05）, and the treatment group showed significantly higher proportions of patients with ?recovery of the four sensory modalities at 6 and 12 months after treatment compared with the control group （all P < 0.05）. During the peri-healing period, the overall incidence of adverse reactions was significantly lower in the treatment group （5 cases, 10.87%） than in the control group （10 cases, 21.74%）, and the risk of adverse reactions was significantly lower in the treatment group than in the control group （RR = 0.342, 95% CI: 0.146 - 0.783, χ2 = 2.55, P < 0.001）. Conclusion Autologous large-sheet split-thickness skin grafting could promote the recovery of hand sensory function, alleviate inflammatory responses, and reduce pain in the repair of hand burn wounds.

Key words: Skin transplantation, Transplantation, autologous, Burns of the hand, Autologous large-sheet split-thickness skin grafting, Wound sensory recovery