瘢痕内切除瘢痕瓣回植联合药物注射治疗瘢痕疙瘩

目的:分析手术切除联合药物注射治疗瘢痕疙瘩的疗效。方法:瘢痕部分切除瘢痕瓣回植联合药物扩大注射一个疗程。结果:57块瘢痕疙瘩治愈47块,显效8块。结论:瘢痕内切除瘢痕瓣回植结合药物扩大注射治疗瘢痕疙瘩效果满意。     

复合移植术后局部注射激素治疗瘢痕疙瘩12例

瘢痕疙瘩由于手术切除后容易复发，其治疗一直是整形外科的一个难题。2003--2006年，笔者应用脱细胞异体真皮加自体表皮复合移植治疗瘢痕疙瘩患者12例，术后注射皮质类固醇激素辅助治疗，效果满意。[第一段]     

双侧反向半圆形皮瓣在治疗圆形瘢痕疙瘩中的应用

目的：探讨修复圆形瘢痕疙瘩手术的新方法。方法：采用双侧反向半圆形皮瓣修复圆形瘢痕疙瘩切除后遗留缺损,术后联合应用局部放射治疗和硅凝胶敷贴综合治疗12例。结果：创面修复满意,随访18～24个月,11例有效,1例胸前瘢痕复发。结论：双侧反向半圆形皮瓣技术是修复圆形瘢痕疙瘩有效和理想的方法。     

前胸瘢痕疙瘩手术切除结合浅层X线放疗的疗效观察

目的：观察前胸瘢痕疙瘩切除结合浅层X线放疗的确切疗效。方法：采取手术切除前胸瘢痕疙瘩，手术拆线后连续3天浅层X线照射，每次剂量7Gy，总量21Gy，对70例前胸瘢痕疙瘩患者随访2至5年。结果：70例前胸瘢痕疙瘩患者经此法治疗后部分复发者6例，全部复发者8例，总有效率80%。结论：手术切除前胸瘢痕疙瘩结合浅层X线放疗，疗效确切。     

手术切除联合注射曲安奈德加放疗治疗瘢痕疙瘩的疗效观察

目的：评估手术切除联合术中注射曲安奈德加术后早期放射治疗瘢痕疙瘩的疗效。方法：110例患者随机分为对照组和治疗组,对149处瘢痕疙瘩全部行手术切除,治疗组术中在切缘处皮肤真皮内注射曲安奈德,术后24h内对手术部位行放射治疗。结果：术后切口均为I期愈合,术后随访12～24个月,治疗组治愈率为83．6％,与对照组58．2％相比较,P〈0．05。结论：手术切除瘢痕疙瘩,术中注射曲安奈德加早期术后放疗能够有效提高瘢痕疙瘩的治愈率。     

手术加药物治疗耳环孔瘢痕疙瘩

手术加药物治疗耳环孔瘢痕疙瘩田京发李伯信周成勇王爱英４年来，对２７例（４０耳）因耳环孔所致瘢痕疙瘩进行手术切除加药物治疗，取得了满意效果。现报告如下：一、临床资料本组２７例，全部为女性，年龄１８～３５岁。病程１～５年。瘢痕疙瘩在耳环孔前后呈哑铃状，直...     

瘢痕疙瘩术后电子线治疗66例临床观察

目的：探讨手术切除瘢痕疙瘩后采用电子线放射治疗的效果。方法：随访1998～2005年手术切除瘢痕疙瘩后接受电子线放射治疗的66例（共78处）患者，总照射剂量20Gy，随访时间均在18个月以上，对治疗结果进行统计学分析和评估。结果：疗效分析结果表明，总复发率为25．64％，病程长的瘢痕疙瘩、由感染所致瘢痕疙瘩及存在家族史的患者复发率偏高，分别为40．00％、46．15％和55．56％（与对照组比较P〈0．05）。患者的年龄、性别、病灶大小及解剖位置分布与复发率高低无直接关系。结论：术后电子线放射治疗对于防治瘢痕疙瘩的复发效果较好，是一种治疗瘢痕疙瘩安全、有效的方法。     

耳部瘢痕疙瘩手术切除联合术后放疗的研究进展

耳部是瘢痕疙瘩形成的常见部位,因其发生在头颈部,更容易影响美观甚至妨碍功能,尤其对较大、反复复发的耳部瘢痕疙瘩,应首选手术切除。为了有效保留良好的耳部形态,要灵活选择术式,但手术切除后又易复发,因此,寻找瘢痕疙瘩的综合治疗方法成为新的趋势。目前常用的联合方案包括手术切除联合激素治疗、局部机械压迫治疗以及放射治疗等。但关于瘢痕疙瘩术后放疗相关问题的研究仍有差异。现就近年来应用手术切除联合术后放疗行耳部瘢痕疙瘩治疗的研究进展作一综述。     

三联疗法治疗瘢痕疙瘩临床观察

目的：评价手术、放疗结合瘢痕敌外贴的“三联疗法”治疗瘢痕疙瘩的临床疗效。方法：178例瘢痕疙瘩，手术切除后24h内开始浅层X线放疗，照射剂量每次2Gy，隔日1次，共计10次，创面愈合后1周，再使用瘢痕敌外贴4个月，平均随访1．5年，观察治疗效果。结果：178例瘢痕疙瘩患者，均完成治疗和随访，其中治愈130例，显效38例，进步6例，无效4例，总有效率94．38％。结论：手术、放疗结合瘢痕敌外贴的“三联疗法”是治疗瘢痕疙瘩的一种疗效可靠、副作用小的方法。     

手术切除与注射确炎舒松A治疗瘢痕疙瘩

目的：探讨瘢痕疙瘩的治疗方法及疗效。方法：采用手术切除与局部注射确炎舒松A治疗瘢痕疙瘩87例,其中随访62例。结果：参照朱兆明疗效分类方法,随访62例中优52例（83.87%),良9例（14.52%）,差1例（1.61%）。其中1例注射4例后局部皮肤萎缩。结论：手术切除与注射确炎舒松A是目前治疗瘢痕疙瘩较理想的方法。     

瘢痕切除即刻局部注射曲安奈德联合放疗治疗耳廓瘢痕疙瘩疗效观察

目的:探讨手术切除,术中曲安奈德局部注射,术后放疗联合治疗耳廓瘢痕疙瘩的效果。方法:将病例分为三组:第一组:12例,24个瘢痕疙瘩(手术+曲安奈德注射+放疗),手术切除瘢痕疙瘩,术中注射醋酸曲安奈德,注射剂量依切缘大小而异,每次注射量不大于40mg,术后每周1次,连续4～8次,术后24h内行局部浅层放疗3天;第二组:11例,22个瘢痕疙瘩(手术+放疗),手术切除瘢痕疙瘩,术后24h内行放疗3天;第三组:17例,23个瘢痕疙瘩(手术+曲安奈德注射),手术切除瘢痕疙瘩,术中即刻注射曲安奈德,术后每周1次,连续4～8次。结果:第一组、第二组、第三组有效率分别为95.83%、77.27%、52.17%。第一组与第二组、第三组比较有显著差异(P<0.05)。结论:手术切除,术中曲安奈德局部注射联合术后放疗治疗耳廓瘢痕疙瘩副作用小、复发率低,值得临床应用。     

耳廓瘢痕疙瘩综合治疗的临床观察

目的评价手术联合曲安奈德局部注射治疗耳廓瘢痕疙瘩的临床效果。方法对12例(20侧)患者采用部分或全部切除耳廓瘢痕,皮瓣恢复耳廓正常外形。术后10 d切口及残余瘢痕内注射曲安奈德注射液,曲安奈德10~20 mg以2%利多卡因稀释1倍后注射,每2周1次,视瘢痕消退情况逐渐撤药。结果随访6~36个月,治愈8例,显效4例,有效率100%,疗效满意。结论手术联合曲安奈德局部注射是治疗耳廓瘢痕疙瘩的有效方法。     

手术联合平阳霉素和曲安奈德治疗胸部瘢痕疙瘩

目的:探讨能否通过手术切除联合使用平阳霉素和曲安奈德局部注射的方法达到增加手术治疗胸部瘢痕疙瘩的有效率以及显著降低胸部瘢痕疙瘩手术后复发率的目的。方法:37例患者,共计52个胸部瘢痕疙瘩,其中35个瘢痕疙瘩位于胸骨柄处,17个瘢痕疙瘩位于胸骨柄上下方及左右。病史0.5～10年。34例患者有明确胸部抓挠史。术前先于手术切口注射0.25mg/ml的平阳霉素与20mg曲安奈德混合液,然后手术切除胸部瘢痕疙瘩,恢复胸部皮肤平整的外观。手术后3～4周开始于手术切口愈合处再次注射0.25mg/ml的平阳霉素与20mg曲安奈德混合液,每4周复查及必要时注射一次,如果瘢痕稳定无复发,可以每2月复查及必要时注射一次。如果不需药物治疗半年以上无复发视为治愈,如果上次注射半年内需要再次注射者为有效。结果:2009年5月～2012年5月,采用上述手术方法共治疗胸部瘢痕疙瘩患者37例,手术后注射治疗时间为2～5个月(平均3个月),不需药物治疗随访期3～24个月(平均10个月)。治愈32例(86.5%),有效5例(13.5%),总有效率100%。结论:手术切除联合局部注射平阳霉素和曲安奈德混合液是治疗胸部瘢痕疙瘩的有效方法。     

曲安奈德联合玻璃酸酶注射辅助浅层X线放射治疗多发性瘢痕疙瘩的有效性研究

目的探讨曲安奈德联合玻璃酸酶注射辅助浅层X线放疗,在治疗多发性瘢痕疙瘩中的临床应用价值。方法回顾性分析南方医科大学皮肤病医院门诊2018年3月至2019年10月治疗的144例多发性瘢痕疙瘩患者资料,男性89例,女性55例,年龄16~68岁,平均28岁;病程1~20年,平均6年。根据治疗方法分为A组65例,采用曲安奈德联合玻璃酸酶局部注射辅助浅层X线放疗;B组79例,采用曲安奈德联合玻璃酸酶局部注射治疗。治疗后随访6~18个月,对2组患者进行温哥华瘢痕量表(VSS)评估和有效性评价。采用两独立样本t检验及卡方检验进行统计分析。结果 A组治疗前VSS评分为(11.9±0.9)分,治疗后为(6.5±1.1)分,51例好转、14例显效,显效率为21.54%(14/65),不良反应主要表现为一过性色素沉着。B组治疗前VSS评分为(12.1±1.0)分,治疗后为(8.3±1.0)分,74例好转、2例显效、3例无效,显效率为2.63%(2/76),不良反应主要包括毛细血管扩张、皮肤萎缩等,有部分女性患者出现月经周期异常(3例),毛发增多(2例)。2组患者治疗前VSS评分比较差异无统计学意义(t=-1.114,P=0.267),治疗后VSS评分比较差异有统计学意义(t=-10.208,P<0.001)。2组显效率比较差异有统计学意义(χ2=12.450,P<0.001)。结论曲安奈德联合玻璃酸酶注射辅助浅层X线治疗多发性瘢痕疙瘩效果理想,不良反应发生率低,是具有临床应用前景的干预方法。     

KELOIDS AND HYPERTROPHIC SCARS: RESULTS WITH INTRA-OPERATIVE AND SERIAL POSTOPERATIVE CORTICOSTEROID INJECTION THERAPY

Background : The management of keloids and hypertrophic scars continues to be controversial. Experience of treating 58 such lesions, 58.62% of which were recurrent, is presented. Methods : Each lesion was subjected to surgical excision with intra-operative local injection of triamcinolone acetonide, followed by repeat injection of the same drug at weekly intervals for 2–5 weeks depending on the symptomatic relief, and then monthly injections for 4–6 months. Results : Complete symptomatic relief was achieved in all patients within 5 weeks of surgery. Objective response in terms of no recurrence was noted in 91.9% of patients with keloids, and 95.24% of patients with hypertrophic scars at a mean follow-up of 30.5 months. Local or systemic complications were insignificant. Conclusion : Because of promising results, further use and evaluation of this method of treatment is recommended for large, recurrent and complicated keloids and hypertrophic scars.     

Keloids and hypertrophic scars: results with intraoperative and serial postoperative corticosteroid injection therapy.

BACKGROUND: The management of keloids and hypertrophic scars continues to be controversial. Experience of treating 58 such lesions, 58.62% of which were recurrent, is presented. METHODS: Each lesion was subjected to surgical excision with intra-operative local injection of triamcinolone acetonide, followed by repeat injection of the same drug at weekly intervals for 2-5 weeks depending on the symptomatic relief, and then monthly injections for 4-6 months. RESULTS: Complete symptomatic relief was achieved in all patients within 5 weeks of surgery. Objective response in terms of no recurrence was noted in 91.9% of patients with keloids, and 95.24% of patients with hypertrophic scars at a mean follow-up of 30.5 months. Local or systemic complications were insignificant. CONCLUSION: Because of promising results, further use and evaluation of this method of treatment is recommended for large, recurrent and complicated keloids and hypertrophic scars.     

手术切除配合磁铁片加压及曲安奈德注射治疗耳垂瘢痕疙瘩

目的：观察手术切除配合磁铁片加压及曲安奈德注射在耳垂瘢痕疙瘩矫正中的临床应用。方法：对12例耳垂瘢痕疙瘩手术切除患者从术后10天开始以磁铁片加压。持续至少3个月;结合瘢痕内注射曲安奈德4次,术后第3、40、80、120天各一次。结果：随访6月～2.5年,12例耳垂瘢痕疙瘩获得不同程度矫正,效果满意。结论：手术切除配合磁铁片加压及曲安奈德注射联合应用是矫正耳垂瘢痕疙瘩的有效方法。     

Treatment of Small Keloids Using Intralesional 5-fluorouracil and Triamcinolone Acetonide versus Intralesional Bleomycin and Triamcinolone Acetonide

BACKGROUND: The aberration of wound healing leads to scar formation in the form of hypertrophic scars and keloids. Various modalities with variable results have been used in the treatment of keloids. OBJECTIVE: We sought to evaluate outcomes in the treatment of small keloids with the combination of intralesional 5-fluorouracil (5-FU) and triamcinolone acetonide versus intralesional bleomycin and triamcinolone acetonide. DESIGN: Sixty clinically diagnosed keloid lesions in 40 patients aged 18 to 60 years were divided equally into Groups A (n=30) and B (n=30). The combination of intralesional 5-FU and triamcinolone acetonide (TAC) was given to Group A and the combination of intralesional bleomycin and triamcinolone acetonide was given to Group B. Treatment was repeated in both groups at three-week intervals until keloid flattening was achieved or a maximum of 10 treatments were completed. Before treatment, the lesions were assessed using the Vancouver Scar Scale and their size was measured using vernier calipers. RESULTS: In Group A, 15 (50%) keloids showed an excellent response, 10 (33.33%) keloids showed a good response, three (10%) keloids showed a fair response, and two (6.66%) keloids showed a poor response. In Group B, 23 (76%) keloids showed an excellent response, three (10%) keloids showed a good response, two (6.66%) keloids showed a fair response, and two (6.66%) keloids showed a poor response. CONCLUSION: Patient response regarding treatment duration, flattening of lesions, improvements in the Vancouver Scar Scale score, and recurrence rates were statistically significant in Group B. A greater improvement in the signs and symptoms of keloids (with respect to cosmetic problems, restriction of movement, and tenderness) was observed in the patients treated with a combination of intralesional bleomycin and triamcinolone acetonide compared to those treated with a combination of intralesional 5-FU and triamcinolone acetonide.     

Combination of different techniques for the treatment of earlobe keloids

Management of keloids is still controversial. Many different treatment modalities may be used for this purpose, however, no one method has been found completely successful. Therefore, we combined these techniques to improve therapeutic outcomes for earlobe keloids. Nine patients with earlobe keloids of a total number of 12 with auricular keloids were treated with a combined approach between 1995 and 2001. The keloids varied in size 2 × 1 to 5 × 3 cm and the patient age ranged 15–63 years. The patient group consisted of nine females, three males. Ear piercing was the main etiological factor for females. In the first session, surgical excision of the keloids was performed. It was followed with triamcinolone acetonide injection to the surgical field on the postoperative second week. Slight pressure was applied by silicone gel sheet coated earring for four months. No recurrence was noted in eight patients over longterm followup. One of nine patients had keloid recurrence. The authors found the results promising a combination of four techniques for treatment of ear lobe keloids is recommended even for recurrent lesions.