Clinical efficacy of the Magpie-bridge Microskin Grafting in treating linear white scars
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摘要:
目的 评价采用鹊桥术-微粒皮移植（以下简称鹊桥术）治疗线性白色瘢痕（LWS）的临床效果。 方法 该研究为回顾性队列研究。2022年10月—2023年12月,上海交通大学医学院附属第九人民医院整复外科收治37例符合入选标准的接受鹊桥术治疗的LWS患者,其中男9例、女28例,年龄25（17,36）岁。术前瘢痕宽度均<2 mm,长度为1~10 cm。鹊桥术步骤：采用电动环钻间隔钻除瘢痕组织形成创面,从耳后或腋窝顶部钻取与钻除瘢痕组织同等大小及厚度的微粒皮片,将微粒皮片种植至创面处,以减张胶带固定。对供皮区创面行常规换药治疗。首次术后12个月,根据瘢痕白色面积较首次术前缩小程度进行疗效评估并计算治疗有效率；首次术前、首次术后12个月,通过皮肤成像分析系统评估瘢痕周围正常皮肤区域与瘢痕区域的黑色素评分并计算二者差值。前述患者中6例患者因追求更好疗效要求行第2次鹊桥术,取其首次手术未钻除的白色瘢痕组织（以下称为未治疗瘢痕组织）、钻除瘢痕并行微粒皮移植处术后12个月组织（以下称为首次术后12个月受区皮肤组织）,通过苏木精-伊红染色和Masson-Fontana染色观察组织结构及黑色素数量和分布,通过免疫荧光染色观察酪氨酸酶阳性黑色素细胞活性。 结果 首次术后12个月,疗效评估结果：治愈者24例,改善者11例,无效、病情加重者各1例,治疗有效率为94.6%（35/37）。37例患者首次术后12个月瘢痕周围正常皮肤区域与瘢痕区域的黑色素评分差值为0.45（0.10,1.65）分,较首次术前的2.50（1.40,5.96）分显著减少（Z=-5.02,P<0.05）。6例患者未治疗瘢痕组织表皮扁平,真皮与表皮交界处平坦；真皮内胶原纤维束粗大且单向平行；未见毛囊等皮肤附属器；表皮基底层可见黑色素颗粒沉积,未见广泛色素脱失。与未治疗瘢痕组织相比,首次术后12个月受区皮肤组织表皮厚度增加且真皮与表皮交界处出现表皮突结构,可见毛囊、皮脂腺,真皮中胶原纤维排列纵横有序；表皮基底层可见黑色素颗粒沉积,单位面积组织内黑色素含量增加。未治疗瘢痕组织和首次术后12个月受区皮肤组织中酪氨酸酶阳性黑色素细胞均主要位于表皮基底层,细胞活性均正常且无明显差别。 结论 鹊桥术可显著改善患者LWS外观,疗效确切,具有临床推广价值；鹊桥术对LWS外观的改善可能与单位面积组织内黑色素含量增加、组织结构正常化均有关系。 Abstract:Objective To evaluate the clinical efficacy of the Magpie-bridge Microskin Grafting (hereinafter briefly referred to as Magpie-bridge surgery) in treating linear white scars (LWS). Methods This study was a retrospective cohort study. From October 2022 to December 2023, 37 LWS patients were treated with the Magpie-bridge surgery at the Department of Plastic and Reconstructive Surgery of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, including 9 males and 28 females, aged 25 (17, 36) years. All scars were <2 mm in width and 1–10 cm in length before surgery. Magpie-bridge surgery procedure: an electric punch was used to excise scar tissue at intervals to form wounds and harvest microskin grafts of the same size and thickness as the removed scar tissue from behind the ear or axillary apex. The microskin grafts were implanted at the wound sites and fixed with tension-reducing adhesive tape. The donor area wounds were treated with routine dressing changes. Twelve months after the first surgery, the efficacy was evaluated based on the degree of reduction in scar white area compared with that before the first surgery, and the treatment effectiveness rate was calculated. Before the first surgery and 12 months after the first surgery, the melanin scores of the normal skin area surrounding the scar and the scar area were evaluated using a skin imaging analysis system, and the difference between the two was calculated. Six of the aforementioned patients requested a second Magpie-bridge surgery in pursuit of better therapeutic effects. The white scar tissue left untreated during the first surgery (hereinafter referred to as untreated scar tissue) and the tissue from the site at 12 months post scar removal and microskin transplantation (hereinafter referred to as the recipient skin tissue at 12 months after the first surgery) were collected. The tissue structure, melanin quantity and distribution were examined by using hematoxylin eosin staining and Masson-Fontana staining, and the activity of tyrosinase positive melanocytes was observed by using immunofluorescence staining. Results At 12 months after the first surgery, the results of efficacy evaluation showed that 24 cases were cured, 11 cases were improved, 1 case was ineffective, and 1 case was in a worsened condition, yielding a 94.6% (35/37) treatment effectiveness rate. The melanin score difference between the surrounding normal skin area of scar and the scar area was 0.45 (0.10, 1.65) at 12 months after the first surgery, which was significantly less than 2.50 (1.40, 5.96) before the first surgery (Z=-5.02, P<0.05). Six patients had untreated scar tissue with flat epidermis and a flat junction between dermis and epidermis; the collagen fiber bundles in the dermis were thick and unidirectionally parallel; no skin appendages such as hair follicles were observed; the basal layer of the epidermis showed deposition of melanin particles, but no extensive depigmentation was observed. Compared with those of untreated scar tissue, the epidermal thickness increased, and epidermal protrusions appeared at the junction of dermis and epidermis of the recipient skin tissue at 12 months after the first surgery; hair follicles and sebaceous glands were visible, and collagen fibers in the dermis were arranged vertically and horizontally in an orderly manner. Melanin particles were deposited in the basal layer of the epidermis, and the melanin content per unit area of tissue was increased. Tyrosinase-positive melanocytes in untreated scar tissue and in the recipient skin tissue at 12 months after the first surgery were mainly located at the basal layer of the epidermis, with normal cell activity and no significant difference. Conclusions The Magpie-bridge surgery can significantly improve the appearance of LWS in patients, with definite therapeutic effects and value for clinical promotion; the improvement of LWS appearance by Magpie-bridge surgery may be related to the increase of melanin content per unit area of tissue and the normalization of tissue structure. -
Key words:
- Cicatrix /
- Skin transplantation /
- Melanocytes /
- Linear white scar /
- Magpie-bridge Microskin Grafting /
- Tissue structure
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参考文献
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图 1 鹊桥术-微粒皮移植治疗患者面部口区线性白色瘢痕的手术步骤。1A.行面部口区局部麻醉后即刻；1B.面部口区瘢痕钻除后即刻；1C.耳后微粒皮钻取后即刻；1D.将微粒皮种植到面部口区钻除瘢痕部位后即刻；1E.用减张胶带固定受区后即刻
图 2 行鹊桥术-微粒皮移植治疗线性白色瘢痕患者瘢痕组织与移植微粒皮后组织结构及黑色素分布和黑色素细胞活性。2A、2B.分别为瘢痕组织、移植微粒皮后组织,图2B较图2A表皮厚度增加且真皮与表皮交界处出现表皮突结构,可见毛囊、皮脂腺,真皮中胶原纤维纵横排列趋于正常 苏木精-伊红×100；2C、2D.分别为瘢痕组织、移植微粒皮后组织,黑色素颗粒均位于表皮基底层 Masson-Fontana×100；2E、2F.分别为图2C、2D中黑框中区域放大图,图2F较图2E单位面积组织内黑色素含量增加 Masson-Fontana×400；2G、2H.分别为瘢痕组织、移植微粒皮后组织,黑色素细胞活性均正常且无明显差别 Alexa Fluor 594-4',6-二脒基-2-苯基吲哚×400
注：瘢痕组织为第2次手术中钻取的首次手术未钻除的白色瘢痕组织,移植微粒皮后组织为第2次手术中钻取的于首次手术中行瘢痕钻除及微粒皮移植处术后12个月组织；图2G、2H中细胞核阳性染色为蓝色,酪氨酸酶阳性染色为绿色（指示黑色素细胞）,黄色线条为真皮与表皮交界线
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