自体毛囊单位提取移植术治疗烧伤后小面积继发性瘢痕秃发的临床效果

戴娇娇; 王玲; 邱海洋; 黄鑫怡; 田雨欣; 彭琴; 刘洋; 官浩

doi:10.3760/cma.j.cn501120-20210224-00064

自体毛囊单位提取移植术治疗烧伤后小面积继发性瘢痕秃发的临床效果

doi: 10.3760/cma.j.cn501120-20210224-00064

空军军医大学第一附属医院全军烧伤中心，烧伤与皮肤外科，西安　　710032

基金项目:

国家自然科学基金应急管理项目 81741105

教育部科技发展中心产学研创新基金 2021JH030

详细信息

通讯作者:
官浩，Email：guanhao@hotmail.com

计量
- 文章访问数: 299
- HTML全文浏览量: 77
- PDF下载量: 32
- 被引次数: 0
出版历程
- 收稿日期: 2021-02-24

Clinical effects of autologous follicular unit extraction transplantation in the treatment of small area secondary cicatricial alopecia after burns

Department of Burns and Cutaneous Surgery, Burn Center of PLA, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China

Funds:

Emergency Management Project of National Natural Science Foundation of China 81741105

Industry-University-Research Innovation Fund of the Science and Technology Development Center of the Ministry of Education of China 2021JH030

More Information

Corresponding author: Guan Hao, Email: guanhao@hotmail.com

摘要

摘要: 目的探讨自体毛囊单位提取（FUE）移植术治疗烧伤后小面积继发性瘢痕秃发（以下简称瘢痕秃发）的临床效果。方法采用回顾性观察性研究方法。根据采用的治疗方法，将空军军医大学第一附属医院2017年3月—2019年11月收治的采用自体FUE移植术治疗烧伤后小面积瘢痕秃发的18例患者［男12例、女6例，年龄（29±6）岁］纳入FUE移植组，将该单位同一时期由同一手术团队采用扩张皮瓣移植术治疗烧伤后小面积瘢痕秃发的18例患者［男13例、女5例，年龄（33±5）岁］纳入扩张皮瓣移植组。所有患者均随访1年以上，于末次随访时，采用Folliscope毛发检测系统测量移植区毛囊单位密度并计算毛发成活率，采用视觉模拟评分法（VAS）评估疗效，询问患者对治疗效果的满意度及随访期间的并发症发生情况，记录移植区毛发生长情况及头皮厚度、疼痛、瘙痒、色素沉着与表面粗糙度等表征。对数据行Fisher确切概率法检验、独立样本t检验。结果末次随访时，FUE移植组患者移植区毛囊单位密度为（46.8±2.0）个/cm²，明显高于扩张皮瓣移植组的（42.5±4.3）个/cm²（t=3.84，P<0.01）；2组患者的毛发成活率接近（P>0.05）。末次随访时，2组患者治疗效果VAS评分相近（P>0.05）；FUE移植组患者对治疗效果的满意度评分为（8.6±1.1）分，明显高于扩张皮瓣移植组的（7.6±0.8）分（t=2.89，P<0.01）。随访期间，2组患者均无炎症、感染等并发症发生，仅扩张皮瓣移植组2例患者发生术后疼痛。末次随访时，2组患者移植区均被新生毛发覆盖，毛发生长方向与周围正常毛发基本一致；2组患者移植区头皮厚度、疼痛、瘙痒、色素沉着与表面粗糙度等表征情况比较，差异均无统计学意义（P>0.05）。结论采用自体FUE移植术治疗烧伤后小面积瘢痕秃发较扩张皮瓣移植术具有更好的远期毛囊单位密度和患者满意度，术后效果较好，具有良好的临床应用前景。
- 烧伤 /
- 瘢痕 /
- 秃发 /
- 扩张术 /
- 毛囊单位提取 /
- 皮瓣移植术
Abstract: Objective To explore the clinical effects of autologous follicular unit extraction (FUE) transplantation in the treatment of small area secondary cicatricial alopecia (hereinafter referred to as cicatricial alopecia) after burns. Methods A retrospective observational study was carried out. According to the adopted treatment methods, 18 patients (12 males and 6 females, aged (29±6) years) who received autologous FUE transplantation for small area cicatricial alopecia after burns from March 2017 to November 2019 in the First Affiliated Hospital of Air Force Medical University were included in FUE transplantation group, and 18 patients (13 males and 5 females, aged (33±5) years) who were treated with expanded flap transplantation for small area cicatricial alopecia after burns by the same surgery team during the same period in the same hospital were included in expanded flap transplantation group. All the patients were followed up for more than 1 year. At the last follow-up, the follicular unit density in the transplanted area was measured by Folliscope hair detection system and the hair survival rate was calculated; the visual analogue scale (VAS) method was adopted to evaluate the treatment effect; patients were asked their satisfaction with the treatment effect and the occurrence of complications during follow-up; the hair growth and the scalp thickness, pain, pruritus, pigmentation, and surface roughness of the transplanted area were recorded. Data were statistically analyzed with Fisher's exact probability test and independent sample t test. Results At the last follow-up, the follicular unit density in the transplanted area of patients in FUE transplantation group was (46.8±2.0)/cm², which was significantly higher than (42.5±4.3)/cm² in expanded flap transplantation group (t=3.84, P<0.01); the hair survival rates of patients were similar between the two groups (P>0.05). At the last follow-up, VAS scores evaluating the treatment effect of patients were similar between the two groups (P>0.05); the satisfaction score of patients toward the treatment effect in FUE transplantation group was 8.6±1.1, which was significantly higher than 7.6±0.8 in expanded flap transplantation group (t=2.89, P<0.01). During the follow-up, no inflammation or infection occurred in patients of the two groups, but only 2 patients in expanded flap transplantation group had postoperative pain. At the last follow-up, the transplanted area of patients in the two groups was covered with new hair, and the hair growth direction was basically consistent with the surrounding normal hair; scalp thickness, pain, pruritus, pigmentation, and surface roughness of the transplanted area of patients were similar between the two groups (P>0.05). Conclusions Autologous FUE transplantation has better long-term follicular unit density and patients' satisfaction than expanded flap transplantation in the treatment of small area cicatricial alopecia after burns, showing better postoperative effect and a good prospect of clinical application.
- Burns /
- Cicatrix /
- Alopecia /
- Dilatation /
- Follicular unit extraction /
- Flap transplantation
戴娇娇：研究整体设计、论文撰写；王玲：技术支持；邱海洋、黄鑫怡：数据采集和分析；田雨欣、彭琴、刘洋：论文修改、研究指导；官浩：论文评阅、经费支持

所有作者均声明不存在利益冲突

HTML全文

戴娇娇：研究整体设计、论文撰写；王玲：技术支持；邱海洋、黄鑫怡：数据采集和分析；田雨欣、彭琴、刘洋：论文修改、研究指导；官浩：论文评阅、经费支持

所有作者均声明不存在利益冲突

参考文献(33)

[1]	AhmadM. Alopecia[M]. London: IntechOpen,2018:89-111.
[2]	YooH,MohJ,ParkJU.Treatment of postsurgical scalp scar deformity using follicular unit hair transplantation[J].Biomed Res Int,2019,2019:3423657.DOI: 10.1155/2019/3423657.
[3]	张家平,袁希,江旭品,等.基于“MRIS”原则采用扩张皮瓣美学整复颏颈部瘢痕挛缩畸形[J].中华烧伤与创面修复杂志,2022,38(4):306-312.DOI: 10.3760/cma.j.cn501120-20211130-00401.
[4]	王光华,卫伟,卢雪涛.扩张器在修复瘢痕性秃发中的应用[J].中国美容整形外科杂志,2017,28(7):431-432,435.DOI: 10.3969/j.issn.1673-7040.2017.07.017.
[5]	李长青,韩颖,郑建中.扩张皮瓣修复瘢痕性秃发的临床效果[J].中华医学美学美容杂志,2015,21(3):178-179.DOI: 10.3760/cma.j.issn.1671-0290.2015.03.016.
[6]	OgawaR. Surgery for scar revision and reduction: from primary closure to flap surgery[J/OL]. Burns Trauma,2019,7:7[2022-02-10].https://pubmed. ncbi.nlm.nih.gov/30891462/.DOI: 10.1186/s41038-019-0144-5.
[7]	张菊芳,沈海燕,韩蕾,等.高密度毛发移植术在瘢痕性脱发治疗中的应用[J].中国美容整形外科杂志,2011,22(7):388-390.DOI: 10.3969/j.issn.1673-7040.2011.07.002.
[8]	田治国,杨云蔚,陈立,等.毛囊单位抽取术治疗头皮短小瘢痕毛发缺损[J].中华整形外科杂志,2016,32(3):229-230.DOI: 10.3760/cma.j.issn.1009-4598.2016.03.017.
[9]	蒋文杰,王梦,王博,等.毛囊取出移位种植矫正瘢痕性秃发术后毛发方向错乱[J].中华整形外科杂志,2020,36(10):1085-1087.DOI: 10.3760/cma.j.cn114453-20200613-00362.
[10]	蒋文杰,赵永刚,成倩秋,等.扩张头皮皮瓣与毛发移植修复鬓角缺损的临床效果[J].中华医学美学美容杂志,2016,22(5):274-276.DOI: 10.3760/cma.j.issn.1671-0290.2016.05.006.
[11]	贺苏,于杰,艾岩岩.整形美容手术患者的心理分析及护理方法研究[J].中国医疗美容,2017,7(5):72-74.DOI: 10.19593/j.issn.2095-0721.2017.05.027.
[12]	JungS,OhSJ,Hoon KohS.Hair follicle transplantation on scar tissue[J].J Craniofac Surg,2013,24(4):1239-1241.DOI: 10.1097/SCS.0b013e31828a78ad.
[13]	LeeBS,ChanJY,MonseliseA,et al.Assessment of hair density and caliber in Caucasian and Asian female subjects with female pattern hair loss by using the Folliscope[J].J Am Acad Dermatol,2012,66(1):166-167.DOI: 10.1016/j.jaad.2011.04.023.
[14]	ReipsUD,FunkeF.Interval-level measurement with visual analogue scales in internet-based research: VAS Generator[J].Behav Res Methods,2008,40(3):699-704.DOI: 10.3758/brm.40.3.699.
[15]	王志军,刘林嶓.美容外科学[M].北京:人民卫生出版社,2012:67.
[16]	马显杰,李威扬,刘超华,等.面部烧伤后瘢痕的美学整复策略及疗效[J].中华烧伤杂志,2016,32(8):469-473.DOI: 10.3760/cma.j.issn.1009-2587.2016.08.006.
[17]	刘家祺,何安琪,杨燕文,等.毛囊单位移植在皮肤创面修复中的应用[J].中国美容医学,2018,27(2):15-18.
[18]	ShaoH,HuH, JinY,et al.Follicular unit transplantation for the treatment of secondary cicatricial alopecia[J].Plast Surg (Oakv),2014,22(4):249-253.DOI: 10.4172/plastic-surgery.1000885.
[19]	杨青,薛萍,窦文婕,等.毛囊单位提取移植术联合重组牛碱性成纤维细胞生长因子以及米诺地尔治疗继发性瘢痕秃发的临床效果[J].中华烧伤杂志,2021,37(8):718-724.DOI: 10.3760/cma.j.cn501120-20210416-00132.
[20]	祝飞,张菊芳,刘筱雯,等.自体毛囊单位提取技术在瘢痕性秃发中的应用[J].中国美容整形外科杂志,2017,28(9):523-524,528.DOI: 10.3969/j.issn.1673-7040.2017.09.004.
[21]	张伟,陈莹,王芳,等.毛囊单位提取移植术治疗瘢痕性秃发的临床应用和疗效观察[J].中华烧伤杂志,2021,37(5):469-474.DOI: 10.3760/cma.j.cn501120-20200315-00170.
[22]	SharmaR,RanjanA.Follicular unit extraction (FUE) hair transplant: curves ahead[J].J Maxillofac Oral Surg,2019,18(4):509-517.DOI: 10.1007/s12663-019-01245-6.
[23]	VasudevanB,NeemaS,GhoshK,et al.Hair transplantation by follicular unit extraction for male androgenetic alopecia: a retrospective observational study from two centers[J].Med J Armed Forces India,2020,76(4):430-437.DOI: 10.1016/j.mjafi.2019.11.001.
[24]	PangtiR,GuptaV,GuptaS.Follicular unit extraction of leukotrichia and replacement with follicular units from scalp in combination with epidermal cell suspension in a case of vitiligo[J].Dermatol Ther,2020,33(6):e13916.DOI: 10.1111/dth.13916.
[25]	田子红,徐华飞,田治国.毛囊单位提取术治疗发际缘不同类型瘢痕性秃发临床观察[J].中华皮肤科杂志,2017,50(12):923-925.DOI: 10.3760/cma.j.issn.0412-4030.2017.12.017.
[26]	BarrL,BarreraA.Use of hair grafting in scar camouflage[J].Facial Plast Surg Clin North Am,2011,19(3):559-568.DOI: 10.1016/j.fsc.2011.06.010.
[27]	GargAK,GargS.Donor harvesting: follicular unit excision[J].J Cutan Aesthet Surg,2018,11(4):195-201.DOI: 10.4103/JCAS.JCAS_123_18.
[28]	Humayun MohmandM,AhmadM.Effect of follicular unit extraction on the donor area[J].World J Plast Surg,2018,7(2):193-197.
[29]	KerureAS,AgrawalS,DhuratR,et al.Using the combination of the Kerure clamp and serrated punch to decrease the transection rate in follicular unit extraction (FUE)[J/OL].J Am Acad Dermatol,2019:S0190-9622(19)32439-9(2019-07-24)[2021-02- 24].https://pubmed.ncbi.nlm.nih.gov/31351095/.DOI:10.1016/j.jaad.2019.07.056.[publised online ahead of print].
[30]	NakatsuiT,WongJ,GrootD.Survival of densely packed follicular unit grafts using the lateral slit technique[J].Dermatol Surg,2008,34(8):1016-1022; discussion 1022-1025.DOI: 10.1111/j.1524-4725.2008.34200.x.
[31]	张春韶广东健康成年人头发密度及其与中医体质的关系广州广州中医药大学2014 张春韶.广东健康成年人头发密度及其与中医体质的关系[D].广州:广州中医药大学,2014.
[32]	EpsteinGK,EpsteinJ,NikolicJ.Follicular unit excision: current practice and future developments[J].Facial Plast Surg Clin North Am,2020,28(2):169-176.DOI: 10.1016/j.fsc.2020.01.006.
[33]	OrsS,OzkoseM,OrsS.Follicular unit extraction hair transplantation with micromotor: eight years experience[J].Aesthetic Plast Surg,2015,39(4):589-596.DOI: 10.1007/s00266-015-0494-8.

下载: 全尺寸图片幻灯片

1 采用毛囊单位提取移植术治疗患者烧伤后右鬓角小面积继发性瘢痕秃发。1A.术前秃发区域；1B、1C.分别为术后即刻受区和供区表征；1D、1E.分别为术后1年受区和供区表征，可见供区和受区恢复情况较好，头皮表面无二次瘢痕、色素沉着等

下载: 全尺寸图片幻灯片

表1 2组烧伤后小面积继发性瘢痕秃发患者临床资料比较

组别	例数	性别（例）		年龄（岁，x¯±s）	继发性瘢痕秃发面积（cm²，x¯±s）	手术时长（h，x¯±s）	随访时间（个月，x¯±s）
组别	例数	男	女	年龄（岁，x¯±s）	继发性瘢痕秃发面积（cm²，x¯±s）	手术时长（h，x¯±s）	随访时间（个月，x¯±s）
毛囊单位提取移植组	18	12	6	29±6	30±6	4.1±0.7	13.8±1.6
扩张皮瓣移植组	18	13	5	33±5	31±6	4.1±0.6	14.3±2.0
t值		—		-1.66	-0.64	0.25	-0.95
P值		>0.999		0.107	0.528	0.807	0.350
注：“—”表示无此统计量值；手术时长指毛囊单位提取移植术的整个手术过程或扩张皮瓣移植术移植皮瓣的手术过程耗时，不包括前期皮肤软组织扩张器置入及扩张的过程耗时

下载: 导出CSV

表2 2组烧伤后小面积继发性瘢痕秃发患者末次随访时移植区表征比较（例）

组别	例数	头皮厚度		疼痛		瘙痒		色素沉着		表面粗糙度
组别	例数	正常	较厚	有	无	有	无	有	无	正常	粗糙
毛囊单位提取移植组	18	16	2	0	18	2	16	12	6	13	5
扩张皮瓣移植组	18	14	4	0	18	5	13	13	5	11	7
P值		0.658		1.000		0.402		>0.999		0.725