原位保留打孔断层瘢痕基质联合头皮移植与负压封闭引流治疗烧伤后非功能部位增生性瘢痕的临床效果

孟艳斌; 雷晋; 张海瑞; 郝振明; 白培懿; 段鹏

doi:10.3760/cma.j.cn501120-20201201-00510

原位保留打孔断层瘢痕基质联合头皮移植与负压封闭引流治疗烧伤后非功能部位增生性瘢痕的临床效果

doi: 10.3760/cma.j.cn501120-20201201-00510

太钢总医院（山西医科大学第六医院）烧伤科，太原　　030009

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段鹏，Email：dp630613@163.com

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- 收稿日期: 2020-12-01

Clinical effects of in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage in the treatment of hypertrophic scar in non-functional sites after burns

Institute of Burns, General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University), Taiyuan 030009, China

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Corresponding author: Duan Peng, Email: dp630613@163.com

摘要

摘要: 目的探讨原位保留打孔断层瘢痕基质后行头皮移植结合负压封闭引流治疗烧伤后非功能部位增生性瘢痕的临床效果。方法采用回顾性观察性研究。2017年6月—2019年6月，太钢总医院（山西医科大学第六医院）收治符合入选标准的烧伤后面部以外非功能部位增生性瘢痕患者33例，其中男24例、女9例，年龄8~50岁，均行原位保留打孔断层瘢痕基质（瘢痕削薄面积为90~500 cm²）联合头皮移植术，术后对其受区行负压封闭引流固定。术后7 d，观察受区创面有无血肿及感染，同时观察并计算植皮成活率。术后12个月，观察受区瘢痕平整度及厚度，记录患者痒痛情况。术前及术后3、6、12个月，采用温哥华瘢痕量表对患者瘢痕进行评分。观察术后供皮区愈合时间及头发生长情况。对数据行重复测量方差分析、配对样本t检验和Bonferroni校正。结果术后7 d，2例患者受区创面出现局部皮下血肿，经换药后愈合；无感染病例。术后7 d，患者植皮成活率为94.6%~99.0%［（96.8±1.2）%］。术后12个月，瘢痕平整度可、厚度未见明显高于正常皮肤，患者痒痛症状消失或较治疗前明显减轻。术前及术后3、6、12个月，患者瘢痕的温哥华瘢痕量表评分分别为（12.1±2.8）、（8.5±1.5）、（7.6±1.6）、（6.7±1.3）分。与术前相比，术后3、6、12个月瘢痕的温哥华瘢痕量表评分均明显降低（t值分别为4.48、4.06、3.97，P<0.01）。所有患者头部供皮部位均在术后4~7 d愈合良好。术后3~6个月，所有患者头部供皮区头发生长良好，达到无瘢痕愈合。结论原位保留打孔断层瘢痕基质联合行头皮移植与负压封闭引流治疗烧伤后面部以外非功能部位增生性瘢痕可改善瘢痕外观及增生程度，且供区可达到无瘢痕愈合。
- 瘢痕 /
- 皮肤移植 /
- 负压伤口疗法 /
- 瘢痕基质 /
- 增生性瘢痕
Abstract: Objective To investigate the clinical effects of in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage in the treatment of hypertrophic scar in non-functional sites after burns. Methods A retrospective observational study was used. From June 2017 to June 2019, 33 patients (24 males and 9 females, aged 8-50 years) who met the inclusion criteria with hypertrophic scars in non-functional sites outside the face after burns were treated in General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University). All patients underwent scalp transplantation after perforation of retained split scar matrix in situ (with scar thinning area of 90-500 cm²), and then the vacuum sealing drainage was performed. The hematoma and infection of wounds were observed on the 7^th day after operation. At the same time, the survival rate of skin grafting was observed and calculated. The flatness and thickness of the scar in the operative area were observed in 12 months after operation, and the itching and pain of the patients were recorded. Vancouver Scar Scale was used to score the scar of patients before operation and at 3, 6 and 12 months after operation. The healing time and hair growth of donor site were observed. Data were statistically analyzed with repeated analysis of variance, paired sample t test and bonferroni correction. Results On the 7^th day after operation, local subcutaneous hematoma appeared in the wound of 2 patients, which healed after dressing change; no infection occurred. On the 7^th day after operation, the survival rate of skin grafting of patients was 94.6%-99.0%(96.8±1.2)%. Scar flatness was well, the thickness of scar was not significantly higher than that of normal skin in 12 months after operation, and the symptoms of itching pain of patients disappeared or significantly relieved. Vancouver Scar Scale scores of patients before operation and at 3, 6, and 12 months after operation were 12.1±2.8, 8.5±1.5, 7.6±1.6, 6.7±1.3, respectively, and the scores of 3, 6, and 12 months after operation were all significantly lower than that before operation (with t values of 4.48, 4.06, and 3.97, respectively, P<0.01). All the donor sites of the head healed well in 4-7 days after operation. By 3-6 months after operation, all patients had good hair growth in the donor site and achieved no scar healing. Conclusions The treatment of hypertrophic scar in non-functional sites outside the face after burns by in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage can effectively improve the appearance of hypertrophic scar in non-functional areas after burn and reduce its degree of hyperplasia, with scar-free donor site healing.
- Cicatrix /
- Skin transplantation /
- Negative-pressure wound therapy /
- Scar matrix /
- Hypertrophic scar
孟艳斌

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参考文献(28)

[1]	GauglitzGG,KortingHC,PavicicT,et al.Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies[J].Mol Med,2011,17(1/2):113-125.DOI: 10.2119/molmed.2009.00153.
[2]	PratsinisH,MavrogonatouE,KletsasD.Scarless wound healing: from development to senescence[J].Adv Drug Deliv Rev,2019,146:325-343.DOI: 10.1016/j.addr.2018.04.011.
[3]	LvKY, XiaZF. Chinese expert consensus on clinical prevention and treatment of scar [J/OL].Burns Trauma,2018,6:27 [2022-01-27]. https://pubmed.ncbi.nlm.nih.gov/30263894/. DOI: 10.1186/s41038-018-0129-9.
[4]	中国整形美容协会瘢痕医学分会.瘢痕早期治疗全国专家共识(2020版)[J].中华烧伤杂志,2021,37(2):113-125.DOI: 10.3760/cma.j.cn501120-20200609-00300.
[5]	SongT,KimKH,LeeKW.Randomised comparison of silicone gel and onion extract gel for post-surgical scars[J].J Obstet Gynaecol,2018,38(5):702-707.DOI: 10.1080/01443615.2017.1400524.
[6]	LiK, NicoliF, XiWJ, et al. The 1470 nm diode laser with an intralesional fiber device: a proposed solution for the treatment of inflamed and infected keloids[J/OL]. Burns Trauma,2019,7:5[2022-02-26]. https://pubmed. ncbi. nlm. nih. gov /30783604. DOI: 10.1186/s41038-019-0143-6.
[7]	KarmisholtKE, BanzhafCA, GludM, et al. Laser treatments in early wound healing improve scar appearance: a randomized split-wound trial with nonablative fractional laser exposures vs. untreated controls[J]. Br J Dermatol, 2018,179(6):1307-1314. DOI: 10.1111/bjd.17076.
[8]	ShirakamiE,YamakawaS,HayashidaK.Strategies to prevent hypertrophic scar formation: a review of therapeutic interventions based on molecular evidence[J].Burns Trauma, 2020.8:tkz003 [2022-03-15].https://pubmed.ncbi.nlm.nih.gov/33477421/.DOI: 10.1093/burnst/tkz003.
[9]	陈舜,郑林文,刘维,等.人工真皮联合负压封闭引流及自体刃厚皮整复大面积烧伤后瘢痕挛缩畸形的临床效果[J].中华烧伤杂志,2019,35(8):608-610.DOI: 10.3760/cma.j.issn.1009-2587.2019.08.010.
[10]	韩军涛,谢松涛,陶克,等.自体瘢痕复合皮修复大面积深度烧伤后期畸形12例[J].中华烧伤杂志,2014,30(5):457-458.DOI: 10.3760/cma.j.issn.1009-2587.2014.05.025.
[11]	KafkaM,CollinsV,KamolzLP,et al.Evidence of invasive and noninvasive treatment modalities for hypertrophic scars: a systematic review[J].Wound Repair Regen,2017,25(1):139-144.DOI: 10.1111/wrr.12507.
[12]	AtiyehBS.Nonsurgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods[J].Aesthetic Plast Surg,2020,44(4):1320-1344.DOI: 10.1007/s00266-020-01820-0.
[13]	CadetN,HardyI,DudekD,et al.Prospective case-control trial evaluating silicone gel for the treatment of direct brow lift scars[J].Can J Ophthalmol,2018,53(1):29-33.DOI: 10.1016/j.jcjo.2017.07.017.
[14]	FangQQ,ChenCY,ZhangMX,et al.The effectiveness of topical anti-scarring agents and a novel combined process on cutaneous scar management[J].Curr Pharm Des,2017,23(15):2268-2275.DOI: 10.2174/1381612822666161025144434.
[15]	李廷,王晨,程大胜,等.人工真皮联合自体薄皮片治疗增生性瘢痕临床效果分析[J].中华烧伤杂志,2015,31(6):451-453.DOI: 10.3760/cma.j.issn.1009-2587.2015.06.015.
[16]	胡克苏,祁俊,王磊,等.人工真皮支架联合负压封闭引流和自体刃厚皮片移植治疗难愈创面20例[J].中华烧伤杂志,2017,33(11):708-711.DOI: 10.3760/cma.j.issn.1009-2587.2017.11.011.
[17]	TorkS,JeffersonRC,JanisJE.Acellular dermal matrices: applications in plastic surgery[J].Semin Plast Surg,2019,33(3):173-184.DOI: 10.1055/s-0039-1693019.
[18]	OhSJ.Simultaneous two-layer harvesting of scalp split-thickness skin and dermal grafts for acute burns and postburn scar deformities[J].Arch Plast Surg,2019,46(6):558-565.DOI: 10.5999/aps.2018.00990.
[19]	KhansaI,HarrisonB,JanisJE.Evidence-based scar management: how to improve results with technique and technology[J].Plast Reconstr Surg,2016,138 (3 Suppl): S165-178.DOI: 10.1097/PRS.0000000000002647.
[20]	LeeKT,PyonJK,LimSY,et al.Negative-pressure wound dressings to secure split-thickness skin grafts in the perineum[J].Int Wound J,2014,11(2):223-227.DOI: 10.1111/j.1742-481X.2012.01078.x.
[21]	雷磊,高优,许建允,等.游离植皮联合负压创面治疗技术治疗Ⅲ/Ⅳ度烧伤创面效果分析[J].中国美容医学,2018,27(7):20-23.
[22]	WebsterJ,ScuffhamP,StankiewiczM,et al.Negative pressure wound therapy for skin grafts and surgical wounds healing by primary intention[J].Cochrane Database Syst Rev,2014(10):CD009261.DOI: 10.1002/14651858.CD009261.pub3.
[23]	KantakNA,MistryR,HalvorsonEG.A review of negative- pressure wound therapy in the management of burn wounds[J].Burns,2016,42(8):1623-1633.DOI: 10.1016/j.burns.2016.06.011.
[24]	李志强, 吴文杰, 刘树江,等. 负压封闭引流技术在游离植皮中的应用[J]. 临床和实验医学杂志, 2017,16(10):1022-1025.DOI: 10.3969/j.issn.1671-4695.2017.10.028.
[25]	SogorskiA,LehnhardtM,GoertzO,et al.Improvement of local microcirculation through intermittent Negative Pressure Wound Therapy (NPWT)[J].J Tissue Viability,2018,27(4):267-273.DOI: 10.1016/j.jtv.2018.08.004.
[26]	郭振荣，陆江阳.大面积烧伤植皮与供皮区的选择[J].人民军医,2001,44(1):21-22.DOI: 10.3969/j.issn.1000-9736.2001.01.018.
[27]	ChongSJ,ChokeA,TanBK.Technical tips to enhance micrografting results in burn surgery[J].Burns,2017,43(5):983-986.DOI: 10.1016/j.burns.2017.01.030.
[28]	申传安, 柴家科, 张琳,等. 自体头皮移植修复瘢痕皮肤中厚供皮区创面的效果观察[J]. 中华医学杂志, 2013, 93(12):921-923.DOI: 10.3760/cma.j.issn.0376-2491.2013.12.010.

1 原位保留打孔断层瘢痕基质联合头皮移植与负压封闭引流治疗患者前臂烧伤后增生性瘢痕。1A.术前右前臂瘢痕外观；1B.右前臂瘢痕削薄即刻，原位保留瘢痕基质进行打孔；1C.术后6个月复查，瘢痕较术前变薄，整体外观及瘢痕不适症状改善；1D.术后12个月复查，瘢痕整体外观特别是厚度得到明显改善

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