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)

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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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