浅谈烧伤后瘢痕整复手术的时机与方案

摘要: 烧伤后瘢痕的形成常引发组织挛缩、功能障碍及美学缺陷,严重影响患者的生活质量和心理健康。随着光电技术、康复理念的发展,非手术治疗成为瘢痕防治的重要手段。然而并非所有患者在瘢痕早期都能得到良好的治疗,且对于明显限制关节运动的瘢痕挛缩或位于暴露部位的瘢痕,手术治疗仍是一种更为直接有效的方法。该文根据该团队临床经验结合最新研究进展,阐述了瘢痕的病理生理机制,烧伤后瘢痕整复手术适应证、时机及各种手术方案的特点,以及未来发展方向,旨在为烧伤后瘢痕整复手术的临床决策提供参考,推动相关技术的优化与推广,促进患者功能和外观的全面改善。
- 烧伤 /
- 瘢痕 /
- 外科手术 /
- 皮肤移植 /
- 外科皮瓣 /
- 组织扩张
Abstract: The formation of scars after burns often leads to tissue contracture, functional impairment, and aesthetic defects, significantly affecting patients' quality of life and mental health. With the advancement of electrooptical technology and rehabilitation concepts, non-surgical treatments have become an important approach in scar prevention and management. However, not all patients receive optimal treatment during the early stage of scarring, and surgical intervention remains a more direct and effective approach for scar contractures that significantly limit joint movement or for scars located in exposed areas. Based on the clinical experience of our team and the latest research advancements, this article elucidates the pathophysiological mechanisms of scars, the indications and timing for the post-burn scar revision surgery, the characteristics of various surgical approaches, as well as the future development directions, with the aim to provide a reference for clinical decision-making in post-burn scar revision surgery, promote the optimization and dissemination of related techniques, and facilitate comprehensive improvement in patient function and appearance.
- Burns /
- Cicatrix /
- Surgical procedures, operative /
- Skin transplantation /
- Surgical flaps /
- Tissue expansion
所有作者声明不存在利益冲突

HTML全文

参考文献(48)

[1]	OgawaR. Update on hypertrophic scar management in burn patients[J]. Clin Plast Surg, 2024, 51(3):349-354. DOI: 10.1016/j.cps.2024.02.001.
[2]	章一新,李洁.瘢痕光电治疗之我见[J].中华烧伤与创面修复杂志,2023,39(6):501-506.DOI: 10.3760/cma.j.cn501225-20220821-00353.
[3]	光电技术治疗皮肤创伤性瘢痕专家共识(2018版)编写组.光电技术治疗皮肤创伤性瘢痕专家共识(2018版)[J].中华烧伤杂志,2018,34(9):593-597.DOI: 10.3760/cma.j.issn.1009-2587.2018.09.007.
[4]	HopMJ,LangenbergLC,HiddinghJ,et al.Reconstructive surgery after burns: a 10-year follow-up study[J].Burns,2014,40(8):1544-1551.DOI: 10.1016/j.burns.2014.04.014.
[5]	XiW, XieY, ZhangZ, et al. 3D mesh releasing method: a retrospective analysis of fractional CO₂ treatment on contracture scars[J]. Lasers Surg Med, 2021, 53(2):227-235. DOI: 10.1002/lsm.23262.
[6]	LiangJ,ZhangN,LiG,et al.Piezo1 promotes peripheral nerve fibrotic scar formation through Schwann cell senescence[J].Neurosci Lett,2024,837:137916.DOI: 10.1016/j.neulet.2024.137916.
[7]	SofroniewMV.Inflammation drives fibrotic scars in the CNS[J].Nat Neurosci,2021,24(2):157-159.DOI: 10.1038/s41593-020-00777-2.
[8]	LiuY, LiuX, DorizasCA, et al. Macrophages modulate optic nerve crush injury scar formation and retinal ganglion cell function[J]. Invest Ophthalmol Vis Sci, 2024, 65(10):22. DOI: 10.1167/iovs.65.10.22.
[9]	OgawaR. Mechanobiology of scarring[J]. Wound Repair Regen, 2011, 19Suppl 1:S2-S9. DOI: 10.1111/j.1524-475X.2011.00707.x.
[10]	Issler-FisherAC. The importance of biomechanics and the kinetic chains of human movement in the development and treatment of burn scars - a narrative review with illustrative cases[J]. Burns, 2023, 49(3):707-715. DOI: 10.1016/j.burns.2022.08.010.
[11]	白璐,石雪芹,杨丽,等.20 MHz高频超声在瘢痕评估中的应用[J].中华整形外科杂志,2023,39(6):583-589.DOI: 10.3760/cma.j.cn114453-20220320-00075.
[12]	尹会男,柴家科,李峰,等.小儿手烧伤后瘢痕挛缩畸形的手术方式选择[J].中华整形外科杂志,2019,35(5):451-455.DOI: 10.3760/cma.j.issn.1009-4598.2019.05.007.
[13]	HarnHI,OgawaR,HsuCK,et al.The tension biology of wound healing[J].Exp Dermatol,2019,28(4):464-471.DOI: 10.1111/exd.13460.
[14]	LiN,YangL,ChengJ,et al.Early intervention by Z-plasty combined with fractional CO₂ laser therapy as a potential treatment for hypertrophic burn scars[J].J Plast Reconstr Aesthet Surg,2021,74(11):3087-3093.DOI: 10.1016/j.bjps.2021.03.079.
[15]	雷颖,谭军,欧阳华伟,等.瘢痕皮下改薄术联合复合激光技术治疗肥厚增生性瘢痕的临床疗效[J].中国医疗美容,2021,11(8):10-15.DOI: 10.19593/j.issn.2095-0721.2021.08.002.
[16]	刘柳宏,詹济滂,钟静,等.环钻减容术联合浅层X线放射和局部注射治疗泛发性瘢痕疙瘩的临床观察[J].皮肤性病诊疗学杂志,2024,31(4):232-236.DOI: 10.3969/j.issn.1674-8468.2024.04.003.
[17]	汤于瑱,张铮,章一新.鹊桥术-微粒皮移植治疗线性白色瘢痕的临床效果[J].中华烧伤与创面修复杂志,2025,41(4):333-340.DOI: 10.3760/cma.j.cn501225-20250213-00057.
[18]	KhanAA, KhanIM, NguyenPP, et al. Skin graft techniques[J]. Clin Podiatr Med Surg, 2020, 37(4):821-835. DOI: 10.1016/j.cpm.2020.07.007.
[19]	曹大勇,郑军杰,王磊,等.自体刃厚头皮回植修复中厚供皮区创面的安全有效性[J].中国组织工程研究,2025,29(18):3804-3810.DOI: 10.12307/2025.664.
[20]	狄海萍,母心灵,史继静,等.人工真皮联合刃厚皮修复手足骨骼与肌腱外露创面效果的前瞻性随机对照研究[J].中华烧伤杂志,2021,37(12):1130-1136.DOI: 10.3760/cma.j.cn501120-20210325-00103.
[21]	GamelM,GaelM,BursztejnAC.Skin graft bolstered by negative pressure therapy in chronic wounds: a systematic review[J].J Eur Acad Dermatol Venereol,2026,40(2):296-304.DOI: 10.1111/jdv.20808.
[22]	JinZH,NiuZH,WuWW,et al.Musculocutaneous flaps in the treatment of delayed-healing and infected burn wounds with exposure of vital tissues on the extremities[J].Plast Reconstr Surg,2012,129(1):208e-210e.DOI: 10.1097/PRS.0b013e3182365fa4.
[23]	PerraultD, RochlinD, PhamC, et al. Timing of flap surgery in acute burn patients does not affect complications[J]. J Burn Care Res, 2020, 41(5):967-970. DOI: 10.1093/jbcr/iraa096.
[24]	唐银科,楚菲菲,丁健科,等.皮肤软组织扩张术治疗瘢痕和色素痣的效果[J].中华医学美学美容杂志,2022,28(6):467-470.DOI: 10.3760/cma.j.issn.1671-0290.2022.06.005.
[25]	马显杰,夏炜,郑岩,等.扩张后胸三角皮瓣修复面颈部瘢痕[J].中华烧伤杂志,2008,24(3):207-209.DOI: 10.3760/cma.j.issn.1009-2587.2008.03.013.
[26]	夏成德,薛继东,邢培朋,等.额顶部扩张带蒂皮瓣整复儿童颈部烧伤后瘢痕挛缩畸形的效果[J].中华烧伤与创面修复杂志,2022,38(5):454-461.DOI: 10.3760/cma.j.cn501120-20210507-00172.
[27]	夏成德, 薛继东, 狄海萍, 等. 扩张颞浅动脉双蒂皮瓣整复中下面部瘢痕挛缩的临床效果[J]. 中华烧伤与创面修复杂志, 2026, 42(4): . DOI: 10.3760/cma.j.cn501225-20260103-00001.
[28]	KoshimaI,SoedaS.Inferior epigastric artery skin flaps without rectus abdominis muscle[J].Br J Plast Surg,1989,42(6):645-648.DOI: 10.1016/0007-1226(89)90075-1.
[29]	胡瑞斌,周丹亚,王欣,等.游离胸背动脉穿支皮瓣整复面部亚单位大面积瘢痕的临床效果[J].中华烧伤杂志,2020,36(7):586-589.DOI: 10.3760/cma.j.cn501120-20190505-00223.
[30]	何林,朱婵,贾晶,等.以胸廓内动脉穿支为蒂的预扩张胸三角皮瓣游离移植整复面部瘢痕的临床效果[J].中华烧伤与创面修复杂志,2023,39(3):241-247.DOI: 10.3760/cma.j.cn501225-20220123-00012.
[31]	侯健,宋慧锋,陈保国,等.预扩张颈横动脉前穿支皮瓣与预扩张胸部随意皮瓣接力整复大面积面颈部瘢痕的临床效果[J].中华烧伤杂志,2021,37(4):350-355.DOI: 10.3760/cma.j.cn501120-20201023-00445.
[32]	刘云菡,黄昕,李海洲,等.扩张的胸廓内动脉穿支皮瓣联合血管增压在面颈部瘢痕整复中的临床应用[J].中华烧伤与创面修复杂志,2022,38(4):313-320.DOI: 10.3760/cma.j.cn501120-20210928-00334.
[33]	张淼淼,潘晓峰,刘坤,等.旋肩胛动脉穿支皮瓣治疗腋窝严重瘢痕挛缩[J].实用医学杂志,2022,38(10):1298-1301.DOI: 10.3969/j.issn.1006-5725.2022.10.024.
[34]	胡骁骅,覃凤均,李娟,等.穿支皮瓣整复严重烧伤患者四肢大关节部位瘢痕增生挛缩畸形的效果[J].中华烧伤杂志,2019,35(6):417-422.DOI: 10.3760/cma.j.issn.1009-2587.2019.06.004.
[35]	昝涛, 李青峰. 预构皮瓣基础研究进展[J]. 中华整形外科杂志, 2007, 23(3):258-260. DOI: 10.3760/j.issn:1009-4598.2007.03.025.
[36]	ZanT,WangW,LiH,et al.Autologous tissue repair and total face restoration[J].JAMA Otolaryngol Head Neck Surg,2024,150(8):695-703.DOI: 10.1001/jamaoto.2024.1572.
[37]	TanPC,WangYW,XieY,et al.Enhancing skin regeneration during expansion: a multicenter randomized controlled trial of stromal vascular fraction and fat grafting[J].Plast Reconstr Surg,2026,157(2):360-371.DOI: 10.1097/PRS.0000000000012347.
[38]	HuangX,QuX,LiQ.Risk factors for complications of tissue expansion: a 20-year systematic review and meta-analysis[J].Plast Reconstr Surg,2011,128(3):787-797.DOI: 10.1097/PRS.0b013e3182221372.
[39]	DongC,ZhuM,HuangL,et al.Risk factors for tissue expander infection in scar reconstruction: a retrospective cohort study of 2374 consecutive cases[J/OL].Burns Trauma,2020,9:tkaa037[2026-01-08].https://pubmed.ncbi.nlm.nih.gov/33426134/.DOI: 10.1093/burnst/tkaa037.
[40]	齐鸿燕.儿童瘢痕的管理策略[J].中华烧伤杂志,2019,35(10):712-714.DOI: 10.3760/cma.j.issn.1009-2587.2019.10.002.
[41]	中华医学会烧伤外科学分会.儿童瘢痕预防与治疗临床实践指南(2025版)[J].中华烧伤与创面修复杂志,2025,41(11):1011-1028.DOI: 10.3760/cma.j.cn501225-20250630-00285.
[42]	中国老年医学学会烧创伤分会. 老年难愈性创面系统评估与治疗的专家共识(2025版)[J]. 中华烧伤与创面修复杂志, 2025, 41(5):401-416. DOI: 10.3760/cma.j.cn501225-20241128-00466.
[43]	GodleskiM,OefflingA,BruflatAK,et al.Treating burn-associated joint contracture: results of an inpatient rehabilitation stretching protocol[J].J Burn Care Res,2013,34(4):420-426.DOI: 10.1097/BCR.0b013e3182700178.
[44]	MurphyKE,McCueSW,McElwainDL.Clinical strategies for the alleviation of contractures from a predictive mathematical model of dermal repair[J].Wound Repair Regen,2012,20(2):194-202.DOI: 10.1111/j.1524-475X.2012.00775.x.
[45]	LeiZ,ChenX,ChenK,et al.Exosome-like vesicles encapsulated with specific microRNAs accelerate burn wound healing and ameliorate scarring[J].J Nanobiotechnology,2025,23(1):264.DOI: 10.1186/s12951-025-03337-7.
[46]	NilforoushzadehMA,TorkamanihaE,DahmardeheiM,et al.Treatment of superficial and deep partial width second degree burn's wound with allogeneic cord blood platelet gel[J].Skin Res Technol,2023,29(9):e13471.DOI: 10.1111/srt.13471.
[47]	ChoiHJ,PaekSH,LeeJH,et al.The first multicenter study of robot-assisted breast-conserving surgery: insights from the KoREa-BSG group[J].Surg Endosc,2025,39(9):6222-6229.DOI: 10.1007/s00464-025-11964-2.
[48]	AwadL,BollenE,ReedB,et al.Clinical, preclinical, and educational applications of robotic-assisted flap reconstruction and microsurgery: a systematic review[J].Microsurgery,2024,44(8):e31246.DOI: 10.1002/micr.31246.