Application of interventional tissue remodeling strategy in scar prevention and treatment
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摘要: 有效的瘢痕防治仍然是外科领域的一个临床难题,而理念创新和技术进步将成为其突破的关键所在。尽管组织重塑是伤口愈合过程中的重要一环,但自然愈合的结果往往伴随着瘢痕的形成,其根本的原因在于天然的组织重塑效果欠佳。笔者提出了用于瘢痕防治的干预性组织重塑策略,即采用点阵激光和离子束、药物和生物活性因子以及组织再生方法人为干预伤口愈合的自然进程,使其在一定程度上向组织再生模式转变,达到天然重塑所不能及的完美效果。根据已有的文献报道和笔者的临床实践经验,该文对干预性组织重塑策略在瘢痕防治领域的可应用范围进行述评,并提供相关的临床案例作为佐证,以期引起广大同行的关注和进一步的临床实践验证,为解决瘢痕这一临床难题起“抛砖引玉”的作用。Abstract: Effective scar prevention and treatment remain a clinical challenge in the field of surgery, while concept innovation and technological progress will be the key to making the breakthrough. Although tissue remodeling is an important part of wound healing process, natural healing often results in scar formation. The fundamental reason is that the natural tissue remodeling is not effective enough. The author proposes that the strategy of interventional tissue remodeling can be used for scar prevention and treatment. This strategy involves artificially interfering the wound healing process using various feasible means such as laser and microplasma therapy, drugs, bioactive molecules as well as tissue regenerative methods. Therefore, the natural wound healing process can be transformed towards the process of tissue regeneration to a certain extent. As a result, it is likely to achieve better tissue remodeling effect that is not possible by the natural remodeling process. Based on reported literature and the author's own clinical experience, this article reviews the feasible application areas of interventional tissue remodeling strategies in the field of scar prevention and treatment along with clinical evidence of case report, and hopes to draw attention from peer colleagues to this clinical challenge in order to establish such an effective strategy with further clinical validation by additional evidence.
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Key words:
- Cicatrix /
- Laser therapy /
- Wound healing /
- Tissue remodeling /
- Cicatrix remodeling /
- Tissue regeneration /
- Wound interference
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参考文献
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图 1 对儿童面部外伤伤口行早期干预防治瘢痕的效果。1A.鼻部玻璃切割伤外院缝合术后1周,可见鼻背下部线状伤口,缝合粗糙,伤口缘轻度错位、高低不平；1B.伤后35周,3次二氧化碳点阵激光和1次小针刀松解皮下粘连治疗后,鼻部伤口部位平整,鼻外形和结构完全恢复正常
图 2 联合应用精细缝合与离子束综合组织重塑干预成人早期面部伤口的效果。2A.左侧面部裂伤后3.5 d,外院缝合较为粗糙；2B.清创重新缝合后即刻外观,伤口平整且对合良好；2C.拆线后2周,即刻给予首次离子束治疗；2D.首次离子束治疗后2个月,瘢痕外观明显改善,即刻给予第2次离子束治疗；2E.第2次离子束治疗后2个月,伤口瘢痕基本消除
图 3 联合应用口服药物、局部注射、离子束和二氧化碳点阵激光长期综合重塑干预成人早期面部伤口的效果。3A.伤后2周,见额鼻部纵向愈合伤口和面部数条细小伤口；3B.伤后17周,已经接受药物口服、局部药物注射和2次光电治疗,伤口外观有改善,即刻给予第3次光电治疗；3C.伤后25周,第3次光电治疗后8周,伤口瘢痕外观明显改善,即刻给予第4次离子束治疗；3D.伤后33周,第4次离子束治疗后8周,额鼻部伤口瘢痕外观进一步改善,但仍可见纤细瘢痕痕迹,即刻给予第5次离子束治疗；3E.伤后41周,第5次离子束治疗后8周,治疗区域瘢痕几乎肉眼不可见
图 4 环钻切除术重塑患者面部烫伤后陈旧性瘢痕的效果。4A.就诊时见右面颊部陈旧性白色瘢痕,表面凹凸不平；4B.环钻切除术后即刻外观；4C.环钻切除术后1个月,见瘢痕趋平整,色泽明显改善
图 5 长期药物注射重塑治疗患者胸部瘢痕疙瘩的效果。5A.就诊时,可见片状瘢痕疙瘩充血明显；5B.低浓度5-氟尿嘧啶和曲安奈德交替注射26周后,瘢痕疙瘩发展得到有效控制；5C.继续药物注射8周后,瘢痕趋于平复；5D.进一步调整注射药物浓度重塑瘢痕4个月后,见部分区域瘢痕明显重塑（红色箭头）；5E.继续降低浓度和延长注射间隔期进行重塑治疗9个月后,重塑区域进一步扩展（红色箭头）；5F.停药14个月后随访,大部分瘢痕区域重塑为类似正常皮肤外观（红色箭头）
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