对“厚裂皮肤供区湿润与非湿润敷料的综合分析”的批判性评价

IF 2.1 Q2 MEDICINE, GENERAL & INTERNAL
Ayesha Khaliq, Ashfaq Ahmad, Javed Iqbal
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I share five specific recommendations below, followed by supporting academic literature.</p><p>First, the study considers dressing change frequency as an outcome, but it is unclear whether consistent, standardized protocols were used across centers. Whether a fixed schedule, clinical need, or provider choice drove dressing changes is unknown. Differences in the frequency of dressing changes could also bias results because some dressings need to change more frequently regardless of the healing efficacy. Moreover, the study does not include a cost analysis of dressing changes, which is important for determining clinical feasibility in resource-limited settings. Reporting how dressings were monitored and replaced, including costs, would increase the generalizability of the study [<span>1</span>]. 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This would ensure a broader assessment of how dressings affect healing, extending beyond short-term wound healing to patient-centered concerns about long-term skin appearance (and function).</p><p>Lastly, the study does not consider patient preferences and compliance, which are important in postoperative care. Patients value outcomes such as pain relief, comfort, and ease of dressing use, but these were not evaluated. Implementation of a validated patient-reported outcomes tool like a Likert-based satisfaction scale would allow these perspectives to be captured [<span>5</span>]. For instance, moist dressings may be less painful during changes but less comfortable if bulky or prone to leakage. Balancing clinical efficacy with usability would inform dressing selection, contributing to understanding patient experiences. 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If the data is pooled, subgroup analysis could identify whether moist dressings are superior to non-moist dressings across anatomical sites or wound sizes. This data would instruct clinicians to select dressing choices specific to the donor site, optimizing outcomes (Such analyses could reveal, for example, if scalp sites heal faster with moist dressings due to better blood supply).</p><p>Fourth, there is a significant gap in data regarding long-term follow-up on donor site outcomes like hypertrophic scarring and aesthetic quality. The study evaluated only initial re-epithelialization; however, functional and cosmetic issues are often experienced by donor sites after healing. Scar quality is a heterogeneous entity where dark skin type, female gender, and lower leg sites were found to correlate with poor outcomes like scar color mismatch and elevated scars [<span>4</span>]. 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引用次数: 0

摘要

我写这篇文章是为了回应最近发表的一项研究,“湿润与非湿润敷料对裂厚皮肤移植供体部位的综合分析”,该研究随机分配患者以确定STSG的最佳供体部位护理。这表明,湿润敷料促进愈合更快,并发症比非湿润敷料应用于皮肤缺陷更少。其全面的文献综述和适当的纳入标准支持其结论。然而,我在这项研究中发现了一些方法和报告上的缺陷,如果加以纠正,可以提高研究的科学严谨性和临床重要性。我在下面分享五个具体的建议,然后是支持性的学术文献。首先,该研究将换药频率视为结果,但尚不清楚各中心是否使用了一致的标准化协议。是否一个固定的时间表,临床需要,或提供者的选择驱动换药是未知的。更换敷料频率的差异也可能影响结果,因为一些敷料需要更频繁地更换,而不管愈合效果如何。此外,该研究没有包括换药的成本分析,这对于在资源有限的情况下确定临床可行性很重要。报告敷料是如何监测和更换的,包括成本,将增加研究的普遍性。例如,记录每位患者的平均变化和相关的人工成本可以指导提供者(添加此类数据可以帮助医院计划伤口护理用品的预算)。其次,该研究没有涉及伤口愈合的变量,如吸烟、糖尿病和营养状况。这些合并症显著影响再上皮化和感染风险,这可能会混淆湿性和非湿性敷料之间的比较。例如,糖尿病会因血管生成受损而降低愈合速度,而吸烟会降低组织氧合,这两者都可能掩盖敷料的特异性作用[2]。这种限制可以通过使用多元回归等统计模型来调整这些因素并提高研究的有效性来缓解。根据合并症状况对患者进行分层可以进一步阐明敷料的疗效是否在高危人群中有所不同,并确保结果可推广到不同的临床人群(例如,单独分析糖尿病患者可以显示湿敷料在延迟愈合的情况下是否仍然有效)。第三,该研究没有根据解剖位置或伤口大小进行亚组分析,这可能会影响愈合结果。头皮供体部位不同于大腿供体部位,因为它们的血管和皮肤厚度不同。此外,伤口大小会影响敷料性能,较大面积的伤口与较小的伤口相比,可能具有不同的渗出水平和张力。如果数据汇总,亚组分析可以确定湿润敷料在解剖部位或伤口大小上是否优于非湿润敷料。这些数据将指导临床医生选择特定于供体部位的敷料,从而优化结果(例如,这种分析可以揭示,由于血液供应更好,湿润的敷料是否会使头皮部位愈合得更快)。第四,关于供体部位的长期随访结果,如增生性疤痕和美学质量的数据存在显著差距。该研究仅评估了初始的再上皮化;然而,在愈合后,供体部位经常会遇到功能和美容问题。疤痕质量是一个异质性实体,其中发现深色皮肤类型,女性性别和小腿部位与疤痕颜色不匹配和疤痕bbb升高等不良结果相关。量化这些效果可以通过1、3和6个月的随访评估来实现,使用诸如患者和观察者疤痕评估量表(POSAS)等工具。这将确保对敷料如何影响愈合进行更广泛的评估,从短期伤口愈合扩展到以患者为中心的长期皮肤外观(和功能)。最后,该研究没有考虑患者的偏好和依从性,这在术后护理中很重要。患者重视疼痛缓解、舒适和敷料使用的便利性等结果,但这些都没有进行评估。实施有效的患者报告结果工具,如基于李克特的满意度量表,将允许这些观点被捕获。例如,湿敷料在更换时可能不那么痛苦,但如果笨重或容易渗漏,则不太舒服。平衡临床疗效与可用性将告知敷料的选择,有助于了解患者的经验。未来的研究应包括这样的指标,以确保敷料满足患者的需求,增加对治疗的依从性和提高满意度。 (一种可以测量疼痛的量表,范围在1-5之间,以量化患者的舒适度)。综上所述,尽管研究表明湿敷料优于非湿敷料用于STSG供区愈合,但其方法局限性可以改进以加强其影响。解决所列出的缺陷,规范敷料方案,控制合并症,分析亚组,评估长期结果,并优先考虑患者的观点将支持其结论。我的呼吁是进一步研究,以更好地了解敷料策略,确保有效愈合,并满足患者的需求。这可以确认湿敷料作为护理标准,同时确保所有临床决策考虑患者的舒适度和满意度。Ayesha Khaliq:方法论,验证,可视化,撰写原始草案,数据管理和形式分析。阿什法克·艾哈迈德:写作-原稿,写作-审查和编辑,方法论,软件,形式分析和概念化。Javed Iqbal:概念化、调查、资金获取、可视化、项目管理、资源、监督、数据管理和软件。作者没有什么可报告的。作者声明无利益冲突。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Critical Appraisal of “A Comprehensive Analysis of Moist Versus Non-Moist Dressings for Split-Thickness Skin Graft Donor Sites”

I am writing to respond to the recently published study, “A Comprehensive Analysis of Moist Versus Non-Moist Dressings for Split-Thickness Skin Graft Donor Sites,” randomized patients to determine the best donor site care for STSG. This reveals that moist dressings promote faster healing with fewer complications than non-moist dressings applied to skin defects. Its comprehensive literature review and appropriate inclusion criteria bolster its conclusions. However, I observed a few methodological and reporting shortcomings in this study, which, if rectified, could improve the study's scientific rigor and clinical importance. I share five specific recommendations below, followed by supporting academic literature.

First, the study considers dressing change frequency as an outcome, but it is unclear whether consistent, standardized protocols were used across centers. Whether a fixed schedule, clinical need, or provider choice drove dressing changes is unknown. Differences in the frequency of dressing changes could also bias results because some dressings need to change more frequently regardless of the healing efficacy. Moreover, the study does not include a cost analysis of dressing changes, which is important for determining clinical feasibility in resource-limited settings. Reporting how dressings were monitored and replaced, including costs, would increase the generalizability of the study [1]. For instance, recording average changes per patient and associated labor costs could guide providers (Adding such data could help hospitals plan budgets for wound care supplies).

Secondly, the study does not address wound healing variables such as smoking, diabetes, and nutritional status. These comorbidities significantly impact re-epithelialization and infection risk, which may confound the comparison between moist and non-moist dressings [2]. For example, diabetes reduces the rate of healing due to impaired angiogenesis, while smoking reduces tissue oxygenation, both of which may obscure dressing-specific effects [2]. This limitation could have been mitigated by using a statistical model like multivariate regression to adjust for these factors and improve the study's validity. Stratifying patients by comorbidity status could further elucidate whether dressing efficacy varies across high-risk groups and ensure that results are generalizable to different clinical populations (For instance, analyzing diabetic patients separately could show if moist dressings remain effective despite delayed healing).

Third, the study does not explore subgroup analyses according to anatomical location or wound size, which may affect healing outcomes. Scalp donor sites differ from thigh donor sites because of their vascularity and skin thickness. Moreover, wound size can affect dressing performance, with more extensive wounds potentially having different exudate levels and tension than smaller ones [3]. If the data is pooled, subgroup analysis could identify whether moist dressings are superior to non-moist dressings across anatomical sites or wound sizes. This data would instruct clinicians to select dressing choices specific to the donor site, optimizing outcomes (Such analyses could reveal, for example, if scalp sites heal faster with moist dressings due to better blood supply).

Fourth, there is a significant gap in data regarding long-term follow-up on donor site outcomes like hypertrophic scarring and aesthetic quality. The study evaluated only initial re-epithelialization; however, functional and cosmetic issues are often experienced by donor sites after healing. Scar quality is a heterogeneous entity where dark skin type, female gender, and lower leg sites were found to correlate with poor outcomes like scar color mismatch and elevated scars [4]. Quantifying these effects could be achieved through follow-up assessments at 1, 3, and 6 months using tools such as the Patient and Observer Scar Assessment Scale (POSAS). This would ensure a broader assessment of how dressings affect healing, extending beyond short-term wound healing to patient-centered concerns about long-term skin appearance (and function).

Lastly, the study does not consider patient preferences and compliance, which are important in postoperative care. Patients value outcomes such as pain relief, comfort, and ease of dressing use, but these were not evaluated. Implementation of a validated patient-reported outcomes tool like a Likert-based satisfaction scale would allow these perspectives to be captured [5]. For instance, moist dressings may be less painful during changes but less comfortable if bulky or prone to leakage. Balancing clinical efficacy with usability would inform dressing selection, contributing to understanding patient experiences. Future studies should include such metrics to ensure that dressings meet the needs of patients, increasing adherence to treatment and improving satisfaction (e.g., a scale could measure pain on a 1–5 range to quantify patient comfort).

To conclude, although the study shows that moist dressings are superior to non-moist dressings for STSG donor site healing, its methodological limitations could be improved to strengthen its impact. Resolving the deficiencies listed, standardizing dressing protocols, controlling for comorbidities, analyzing subgroups, assessing long-term outcomes, and prioritizing patient perspectives would bolster its conclusions. My appeal is for further research to understand dressing strategies better, ensure effective healing, and address patient needs. This could confirm moist dressings as the standard of care while ensuring that all clinical decisions consider patient comfort and satisfaction.

Ayesha Khaliq: methodology, validation, visualization, writing – original draft, data curation, and formal analysis. Ashfaq Ahmad: writing – original draft, writing – review and editing, methodology, software, formal analysis, and conceptualization. Javed Iqbal: conceptualization, investigation, funding acquisition, visualization, project administration, resources, supervision, data curation, and software.

The authors have nothing to report.

The authors declare no conflicts of interest.

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来源期刊
Health Science Reports
Health Science Reports Medicine-Medicine (all)
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