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العنوان
Study of the Influencing Factors and their Predictive Value of Skin Graft Take in Early Excision and Grafting in Severe Burns :
المؤلف
Mohamed, Mostafa Mohamed.
هيئة الاعداد
باحث / مصطفى محمد محمد
مشرف / صلاح ناصر محمد
مشرف / أحمد محمد عبد السلام
مشرف / إبراهيم محمد امين عبد الجواد
تاريخ النشر
2022.
عدد الصفحات
150 p. :
اللغة
الإنجليزية
الدرجة
ماجستير
التخصص
جراحة
تاريخ الإجازة
1/1/2022
مكان الإجازة
جامعة عين شمس - كلية الطب - جراحة التجميل و الحروق و الوجه و الفكين
الفهرس
Only 14 pages are availabe for public view

from 150

from 150

Abstract

Burn injury is one of the most devastating trauma worldwide especially in developing countries. After severe burns, the patients suffer from loss of multiple functions of skin, as fluid loss, and high infection rate with burn sepsis and septic shock.
Although early excision and grafting has become the gold standard of care in most of the recent burn centers, the success rate of grafting procedure still varies significantly, with high rate of skin graft loss.
In these conditions as the source of autologous skin is limited, this adds more to the problem of early excision and coverage.
The graft loss either partial or total at the early period of treatment was found to be attributed to multiple factors in the patient, either pre-operative, intra-operative or postoperative.
The aim of the study is to investigate the different factors that influence the survival rate of skin grafts in early excision and grafting procedures (from 3rd to 7th day) in patients with severe burns.
75 patients who underwent early excision of burnt skin and early coverage by autologous skin graft were analyzed. According to the survival rate of skin graft after-operation, the patients were divided into good skin graft take group (GSGT, survival rate ≥ 70%, 45 cases) and poor skin graft take group (PSGT, survival rate < 70%, 30 cases). The baseline data, surgical information, perioperative laboratory indicators and prognosis of the patients were statistically analyzed.
The Univariate analysis and repeated measurement showed the burn severity, the post-operative sepsis, the neutrophil lymphocytic ratio in day 3 (NLR3) in the GSGT group were significantly lower than those in the PSGT group, while the perioperative average albumin levels and the perioperative average PreAlbumin levels were higher. Receiver operating characteristic curve showed that NLR3, the perioperative average albumin levels and the perioperative average PreAlbumin levels had a good predictive value for the survival of skin grafts.
In conclusion, this study found that the survival of autologous skin graft was affected by multiple factors, such as burn severity, perioperative nutrition status and post-operative infection. The perioperative average albumin levels ≤3.18 gm/dl, average PreAlbumin ≤23.9 mg/dl, and NLR3 ≥ 12 were independent risk factors for the survival of skin grafts.
In clinical practice, we recommend maintaining the patients’ albumin at a high level preoperatively, actively control the infections, and especially pay more attention to the infections occurring on the 1st to 3rd days after the operation and timely deal with it.