外线不缝合对皮肤切口愈合的影响的前瞻性自身对照临床试验

陈宗安; 杨雅婷; 王文波; 夏玲玲; 刘伟; 高振; 武晓莉

doi:10.3760/cma.j.cn501225-20240206-00051

外线不缝合对皮肤切口愈合的影响的前瞻性自身对照临床试验

doi: 10.3760/cma.j.cn501225-20240206-00051

上海交通大学医学院附属第九人民医院整复外科,上海　　200011

基金项目:

上海交通大学医学院附属第九人民医院临床研究助推计划项目 JYLJ202212

详细信息

通讯作者:
武晓莉,Email：wuxiaoli528@126.com

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出版历程
- 收稿日期: 2024-02-06
- 网络出版日期: 2024-12-06

Prospective self-controlled clinical trial on the effects of without outer suture on skin incision healing

Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai200011, China

Funds:

Clinical Research Boosting Project of the Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine JYLJ202212

More Information

Corresponding author: Wu Xiaoli, Email: wuxiaoli528@126.com

摘要

摘要: 目的比较内线缝合后是否行外线缝合对皮肤切口愈合的影响。方法该研究为前瞻性自身对照临床试验。2020年11月—2021年9月,上海交通大学医学院附属第九人民医院收治49例符合入选标准的行皮肤切除手术的患者,其中女39例、男10例,年龄18~55岁。手术部位包括上肢（17例）、下肢（2例）、肩部（3例）、颈部（8例）、腹部（8例）、胸部（10例）、背部（1例）。将每例患者的手术切口采用随机序列法等分为外线缝合段（行内线+外线缝合）和外线不缝合段（仅行内线缝合）。术后拆线当日与术后第1个月随访时,观察切口裂开情况。术后第12个月随访时,观察切口瘢痕增生情况并计算切口瘢痕增生率。术后第6、12个月随访时,测量切口瘢痕宽度。术后第1、6、12个月随访时,采用温哥华瘢痕量表（VSS）从颜色、厚度、血管化、柔韧度方面进行切口瘢痕情况评分,并计算总分。术后第1、12个月随访时VSS评分对应的患者数分别为41、46例,其余指标对应的患者数均为49例。结果术后拆线当日、术后第1个月随访时,所有患者外线缝合段与外线不缝合段手术切口均无裂开情况。术后第12个月随访时,外线缝合段切口瘢痕增生率为2.04%（1/49）,与外线不缝合段的4.08%（2/49）无明显差异（P>0.05）。术后第6、12个月随访时,患者外线不缝合段切口瘢痕宽度分别为1.48（1.01,1.91）、1.41（1.13,1.93）mm,与外线缝合段的1.38（1.00,1.94）、1.45（1.17,1.84） mm均无明显差异（Z值分别为191.00、152.00,P>0.05）。术后第1、6、12个月随访时,患者外线缝合段与外线不缝合段切口瘢痕VSS中颜色、厚度、血管化、柔韧度评分及总分均无明显差异（P>0.05）。结论皮肤切口经减张并精细内线缝合后,外线缝合与否对切口愈合及术后瘢痕外观无显著影响。
- 伤口缝合技术 /
- 瘢痕 /
- 预后 /
- 外线缝合
Abstract: Objective To compare the impact of whether to apply the outer suture after inner suture on skin incision healing. Methods This study was a prospective self-controlled clinical trial. From November 2020 to September 2021, 49 patients who underwent skin resection surgery and met the inclusion criteria were admitted to Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine, including 39 females and 10 males, aged 18 to 55 years. The surgical sites included the upper limbs (17 cases), lower limbs (2 cases), shoulders (3 cases), neck (8 cases), abdomen (8 cases), chest (10 cases), and back (1 case). Each patient's surgical incision was divided equally into the outer suture segment (with inner suture and outer suture) and the outer sutureless segment (only with inner suture) using the random sequence method. On the day of suture removal and at the 1^st month of follow-up after surgery, the incision dehiscence was observed. At the 12^th month of follow-up after surgery, the scar hyperplasia was observed and the scar hyperplasia rate was calculated. At the 6^th and 12^th months of follow-up after surgery, the scar width of incision was measured. At the 1^st, 6^th, and 12^th months of follow-up after surgery, the Vancouver Scar Scale (VSS) was used to assess scar condition of the incision in terms of color, thickness, vascularization, and pliability, and the total score was calculated. The number of patients corresponding to the VSS score in the 1^stand 12^th months of follow-up after surgery was 41 and 46, respectively, while the number of patients corresponding to other indicators was 49. Results On the day of suture removal and at the 1^st month of follow-up after surgery, no dehiscence was observed in either the outer suture segment or outer sutureless segment of any patient's surgical incision. At the 12^th month of follow-up after surgery, the scar hyperplasia rate in the outer suture segment was 2.04% (1/49), which was not significantly different from 4.08% (2/49) in the outer sutureless segment (P>0.05). At the 6^th and 12^th months of follow-up after surgery, the scar widths in the outer sutureless segment of incision were 1.48 (1.01, 1.91) and 1.41 (1.13, 1.93) mm, respectively, which were not significantly different from 1.38 (1.00, 1.94) mm and 1.45 (1.17, 1.84) mm in the outer sutureless segment (P>0.05). At the 1^st, 6^th, and 12^th months of follow-up after surgery, there were no statistically significant differences either in scores of scar color, thickness, vascularization, pliability, or in the total score of scar of the incision between the outer suture segment and the outer sutureless segment (P>0.05). Conclusions After tension reduction and fine inner suture of skin incisions, outer suture has no significant effect on incision healing or postoperative scar appearance.
- Wound closure techniques /
- Cicatrix /
- Prognosis /
- Outer suture
陈宗安：试验设计、论文撰写与修改；杨雅婷：数据整理、论文撰写；王文波、夏玲玲：术后随访、数据收集；刘伟：研究指导；高振：论文修改、手术实施；武晓莉：经费支持、手术实施

所有作者均声明不存在利益冲突

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下载: 全尺寸图片幻灯片

图 1 手术切除患者右肩部瘢痕后切口采用内线缝合后行外线缝合或不缝合的愈合效果。1A.术前标记瘢痕梭形切除区域及预设计手术切口分段和标记；1B.术中瘢痕切除后；1C.根据随机结果,内线缝合后对A段切口行外线缝合,对B段切口不行其他处理；1D、1E、1F.分别为术后第1、6、12个月,A、B段切口瘢痕宽度和颜色均未见明显差异

注：外线缝合段切口行内线缝合+外线缝合,外线不缝合段切口仅行内线缝合

下载: 全尺寸图片幻灯片

Table 1. 皮肤切除术后各时间点外线缝合段与外线不缝合段切口瘢痕VSS评分比较[分,M（Q₁,Q₃）]

切口分段与时间点	例数	颜色	厚度	血管化	柔韧度	总分
外线缝合段
第1个月	41	2.0（1.5,3.0）	1.0（0.5,2.0）	1.0（1.0,1.0）	1.0（1.0,2.0）	6.0（3.5,7.0）
第6个月	49	2.0（2.0,3.0）	0.0（0.0,0.0）	1.0（0.0,1.0）	0.0（0.0,0.0）	3.0（1.0,3.0）
第12个月	46	2.0（1.0,2.0）	0.0（0.0,0.0）	0.0（0.0,0.0）	0.0（0.0,0.0）	1.0（1.0,2.0）
外线不缝合段
第1个月	41	2.0（1.0,3.0）	1.0（1.0,2.0）	1.0（1.0,1.0）	1.0（1.0,2.0）	6.0（3.5,7.0）
第6个月	49	2.0（2.0,3.0）	0.0（0.0,0.0）	1.0（0.0,1.0）	0.0（0.0,0.0）	2.0（1.0,3.0）
第12个月	46	1.0（1.0,2.0）	0.0（0.0,0.0）	0.0（0.0,0.0）	0.0（0.0,0.0）	1.0（1.0,2.0）
Z₁值		-6.00	-3.00	0.00	-2.00	-21.00
P₁值		0.250	>0.999	>0.999	>0.999	0.363
Z₂值		-22.00	3.00	12.00	1.00	-18.00
P₂值		0.172	0.750	0.562	>0.999	0.678
Z₃值		13.00	1.00	14.00	1.00	31.00
P₃值		0.774	>0.999	0.359	>0.999	0.323
注：外线缝合段切口行内线缝合+外线缝合,外线不缝合段切口仅行内线缝合；VSS为温哥华瘢痕量表；Z₁值、P₁值,Z₂值、P₂值,Z₃值、P₃值分别为术后第1、6、12个月2段切口瘢痕各方面评分比较所得