烧伤愈合早期创面外用干扰素和康宁克通组合预防瘢痕增生的研究

目的 观察烧伤愈合早期创面外用干扰素和康宁克通组合预防瘢痕增生的疗效.方法 将所选106例患者随机分为实验组和对照组,实验组54例,在外用湿润烧伤膏的同时创面用干扰素和康宁克通组合喷洒创面,对照组52例,继续外用湿润烧伤膏直至创面完全愈合.创面愈合后分别于3、6、12个月监测瘢痕指标.结果 结果显示,实验组在监测瘢痕的色素、柔韧性、血管、高度等指标方面明显优于对照组.结论 烧伤愈合早期创面外用干扰素和康宁克通组合预防瘢痕增生为防治瘢痕增生的有效方法,值得在临床推广.     

生物敷料A治疗深度烧伤创面疗效观察

目的 探讨应用生物敷料A治疗深度烧伤创面的临床疗效.方法 将50例中小面积深度烧伤患者随机分为观察组和对照组各25例,对照组应用凡士林油纱覆盖术后创面,观察组应用生物敷料A覆盖术后创面,观察两组创面皮片扩展速度、创面感染情况及术后瘢痕增生等情况.结果 对照组患者皮片生长慢,有5例创面发生创面感染,创面愈合后瘢痕增生明显;观察组患者创面均一期愈合,无创面感染的发生,创面愈合后柔软、无明显瘢痕增生.结论 生物敷料A具有良好的组织相容性,能够有效减少创面感染,加速创面愈合,对于中、小面积深度烧伤的创面覆盖及愈合具有显著疗效.     

一种改进型增生性瘢痕动物模型

目的对传统的增生性瘢痕动物模型进行改进,为增生性瘢痕发病机制的研究建立更实用的动物模型。 方法将20只裸鼠随机分成观察组和对照组,每组10只。观察组裸鼠背部皮下移植人全厚皮肤,皮片存活后用加热的铜柱造成深Ⅱ度烧伤;对照组裸鼠如同观察组移植人全厚皮片,但未予热烧伤,观察皮片存活、创面愈合与瘢痕增生情况。 结果观察组裸鼠存活9只,移植存活皮片与正常成人皮肤相比,无明显差异;烧伤后有8只可见明显、持续的瘢痕增生,其外观和组织学特点与人体增生性瘢痕相似,组织学观察可见丰富胶原纤维和炎症浸润。对照组存活8只,皮片干痂脱落后,有6只出现类似瘢痕样增生。 结论与以往模型相比,改进后模型的组织来源更可靠,皮片存活率及瘢痕复制率更高,建立周期更短,且瘢痕增生明显,可用于观察创面愈合至瘢痕形成的全过程,因此是一种较理想的研究增生性瘢痕的动物模型。     

自体头皮移植在修复瘢痕皮肤中厚供皮区创面中的应用价值探讨

回顾性分析我院2006年8月~2014年3月收治的118例大面积烧伤患者的临床资料,按瘢痕皮肤中厚供皮区不同修复方法分为试验组和对照组。试验组采用自体头皮移植治疗,对照组采用油纱覆盖治疗,比较两组患者愈合时间、并发症以及综合评判治疗效果。结果两组患者手术均取得成功,试验组患者平均愈合时间为平均为7.1±0.2d,对照组患者平均愈合时间为20.3±1.4d,两组患者差异明显(P0.05)。试验组患者临床治疗效果显著优于对照组(P0.05)。瘢痕皮肤中厚供皮区创面应用自体头皮移植可取得良好治疗效果,具有安全性高,愈合速度快的特点,值得在临床中推广应用。探讨自体头皮移植在修复瘢痕皮肤中厚供皮区创面中的应用价值。     

生长因子对烧伤创面瘢痕增生的影响

目的探讨碱性成纤维细胞生长因子减少瘢痕的作用。方法纳入河南科技大学第一附属医院烧伤科2000-01/2004-11住院的深Ⅱ度烧伤创面患者480例,将因无经济条件不能接受治疗的240例设为对照组,治疗组240例。治疗组入院后,创面清创,喷洒外用重组牛碱性成纤维细胞生长因子于创面,150AU/cm2创面,给药1次/d,至创面痊愈。对照组创面清创后,用碘伏纱布或油纱半暴露创面。观察两组创面愈合时间及3个月愈合后皮肤瘢痕增生情况。结果按实际处理分析,进入结果分析426例。治疗组较对照组提前1周愈合,3个月瘢痕增生少。结论重组牛碱性成纤维细胞生长因子可使深Ⅱ度创面提前愈合、减少瘢痕增生。     

皮肤器官原位再生复原技术治疗大面积深度烧伤的疗效分析

目的:回顾分析皮肤原位再生复原疗法治疗大面积深度烧伤的临床应用效果,总结人体深度烧伤创面的再生复原规律和实施规范,从而使救治大面积烧伤方法不断完善。方法:通过"皮肤器官原位再生复原技术"临床研究课题组规范应用"皮肤器官原位再生复原技术"治疗的1290例大样本资料统计学分析,论证皮肤原位再生复原法的理论基础和临床实用价值。结果:1290例样本病例中,浅Ⅱ度创面10d无瘢痕再生复原愈合实现率为100%;深Ⅱ度创面20d无瘢痕再生愈合实现率为98.98%;浅Ⅲ度创面40d无瘢痕再生愈合实现率为95.90%;深Ⅲ度创面60d无瘢痕或浅瘢痕再生愈合实现率为65.87%;配合微粒皮种植或网状皮移植可达100%再生愈合,无明显残废。结论:皮肤器官原位再生复原技术能使深度烧伤创面达到生理性再生复原愈合,是深II度和浅III度烧伤的首选方法。     

海普林软膏配合弹力套防治上肢烧伤后增生性瘢痕的护理体会

目的 观察海普林软膏配合弹力套对上肢烧伤创面增生性瘢痕的防治作用。方法 对45例上肢烧伤患者（深Ⅱ度36例,Ⅲ度9例）在创面愈合后1周内开始外用海普林软膏,同时配合上肢弹力套加压治疗,持续6个月以上,观察评定治疗效果。结果 显效28例,有效16例,无效1例,总有效率97.8%。结论 上肢Ⅱ、Ⅲ度烧伤创面愈合后,早期应用海普林软膏配合加压治疗可保持皮肤湿润,缓解瘢痕痒痛症状及预防瘢痕过度增生。     

生长因子对烧伤创面瘢痕增生的影响

目的探讨碱性成纤维细胞生长因子减少瘢痕的作用。方法纳入河南科技大学第一附属医院烧伤科2000-01／2004-11住院的深Ⅱ度烧伤创面患者480例，将因无经济条件不能接受治疗的240例设为对照组，治疗组240例。治疗组入院后，创面清创，喷洒外用重组牛碱性成纤维细胞生长因子于创面，150AU／cm^2创面，给药1次／d，至创面痊愈。对照组创面清创后，用碘伏纱布或油纱半暴露创面。观察两组创面愈合时间及3个月愈合后皮肤瘢痕增生情况。结果按实际处理分析，进入结果分析426例。治疗组较对照组提前1周愈合，3个月瘢痕增生少。结论重组牛碱性成纤维细胞生长因子可使深Ⅱ度创面提前愈合、减少瘢痕增生。     

海普林软膏配合弹力套防治上肢烧伤后增生性瘢痕的护理体会

目的观察海普林软膏配合弹力套对上肢烧伤创面增生性瘢痕的防治作用。方法对45例上肢烧伤患者(深Ⅱ度36例,Ⅲ度9例)在创面愈合后1周内开始外用海普林软膏,同时配合上肢弹力套加压治疗,持续6个月以上,观察评定治疗效果。结果显效28例,有效16例,无效1例,总有效率97.8%。结论上肢Ⅱ、Ⅲ度烧伤创面愈合后,早期应用海普林软膏配合加压治疗可保持皮肤湿润,缓解瘢痕痒痛症状及预防瘢痕过度增生。     

外用中药瘢痕膏对兔耳瘢痕模型表皮生长因子及局部愈合的影响

目的:瘢痕膏由对抑制瘢痕、止痒有效地验方配制而成,且已经临床证实对增生性瘢痕有防治作用。观察瘢痕膏对创面是否有促进愈合作用。方法:实验于2007-01在广西医科大学实验室完成。①实验分组:选用新西兰大耳白兔12只,体质量2kg左右,随机数字表法分为实验组、对照组和空白组,每组8只兔耳。②实验方法:适应性喂养24h,制备兔耳瘢痕模型,每只兔耳建立6个创面,即每组48个创面。实验组和对照组于瘢痕模型建立后24h开始用药,实验组采用瘢痕膏涂抹创面(瘢痕膏为一种外用中药制剂,其主要成分为丹参酮、积雪甙、黄芪甙、甘草酸、苦参碱等,按3∶3∶2∶2∶1的比例加基质制作而成);对照组采用湿润烧伤膏涂抹;空白组涂抹基质;连续用药30d。③实验评估:用药第6,12,18,24天观察各组瘢痕组织颜色、质地的变化及创面愈合情况;用药第7,14,21天检测各组标本白细胞计数及生长因子(表皮生长因子、碱性成纤维细胞生长因子)的表达。结果:纳入实验兔12只(24只耳),中途无脱失。①用药后第14天,实验组圆形创面局部稍隆起,对照组和空白组也有如上表现,3组瘢痕在外观形态上无明显差别;用药第28天,实验组瘢痕略高于兔耳皮肤表面,颜色稍红,触之质软;其余两组明显高于兔耳皮肤表面,颜色较红,质地硬。②用药第24天,实验组兔耳的创面愈合情况要好于其他两组。③用药第14天和第28天,3组间创面的白细胞计数无显著差异(P>0.05)。④用药第21天,实验组和对照组表皮生长因子的表达差异无显著性意义(P>0.05),但两组都高于空白组(P<0.05);第7,14,21天的数据显示,实验组和对照组碱性成纤维细胞生长因子的表达亦无显著差异(P>0.05),但都高于空白组(P<0.05)。结论:此外用中药在创伤早期应用,对创面的愈合具有促进作用。     

The effect of silicone gel sheets on perfusion of hypertrophic burn scars

The mechanism of action of topical silicone gel sheets on hypertrophic scars is not well understood and their effect on the blood flow within hypertrophic scars has not been investigated. The purpose of this study was to examine whether application of silicone gel sheets produced any acute effects on blood flow in hypertrophic burn scars. Perfusion of hypertrophic scars and adjacent normal skin was measured using a laser Doppler with and without application of silicone gel sheets. Continuous measurements were made for 5 minutes before gel application, for 30 minutes during gel application and for 5 minutes following gel removal. Surface temperature of the scar was continuously monitored. An occupational therapist, blinded to the perfusion level, rated each scar using the Vancouver Scar Scale. Eighteen scars and adjacent control sites in sixteen adult burn patients (11 male, 5 female; mean age: 42 +/- 14 years) were evaluated. The mean scar age was 5.4 +/- 3.7 months. The mean Vancouver Scar Scale was 5.5 +/- 2.4. Hypertrophic scars demonstrated higher perfusion measurements at baseline compared to control areas (58.5 +/- 19.3 flux units vs 25.0 +/- 8.4 flux units; P < 0.001). Application of silicone sheeting gel did not significantly alter perfusion in either the hypertrophic scar or normal tissue from the baseline measurements. However, application of silicone gel sheeting did significantly increase the mean baseline surface temperature of the hypertrophic scar from 29 +/- 0.8 degrees C to 30.7 +/- 0.6 degrees C (P < 0.001). The mechanism of action of silicone gel sheeting probably does not involve an acute alteration in blood flow within the scar. However, surface temperature of the scar increased significantly following gel application, raising the possibility that temperature alteration is involved in the mechanism of action.     

瘢痕防治及其研究进展

瘢痕是当前医学研究的重点领域之一,尤其是评价指标和防治手段已经受到越来越多的关注。瘢痕一般分为表浅性瘢痕、萎缩性瘢痕、增生性瘢痕和瘢痕疙瘩。其发生机制一般认为是皮肤创伤愈合过程中,由于各种因素导致的伤口中成纤维细胞异常增生、胶原合成分泌和降解失衡,最终形成伤口皮肤组织异常过度增生。瘢痕严重程度主要依靠温哥华瘢痕量表（VSS）、患者和观察者瘢痕评估量表（POSAS）进行评测。其治疗手段主要有压力疗法、硅凝胶疗法、放射疗法、激光疗法、激素注射疗法以及手术切除治疗等,目前认为多种疗法联合治疗仍是瘢痕防治安全、有效的策略。     

异种脱细胞真皮移植联合自体刃厚皮片移植修复手部深度烧伤创面

目的探讨异种脱细胞真皮(s-ADM)移植联合自体刃厚皮片(auto-OTS)移植修复手部深度烧伤创面的效果。方法选取2017年2月~2019年8月我院手部深度烧伤患者72例,依据随机数字表法分组,各36例。常规治疗基础上,对照组采用auto-OTS移植治疗,研究组在对照组基础上采用s-ADM移植治疗。比较两组创面细菌量、皮片存活率、创面愈合时间、手部功能优良率、温哥华瘢痕量表(VSS)评分、术后并发症发生率。结果研究组皮片存活率94.44%高于对照组77.78%,创面细菌量少于对照组,创面愈合时间短于对照组(P<0.05);研究组手部功能优良率91.67%高于对照组72.22%,VSS评分低于对照组,术后并发症发生率5.56%低于对照组25.00%(P<0.05)。结论 s-ADM移植联合auto-OTS移植修复手部深度烧伤创面,可减少创面细菌量,提高皮片存活率,促进创面愈合,提高手部功能优良率,减轻瘢痕增生,且安全性高。     

磷脂多不饱和脂肪酸抑制兔耳增生性瘢痕

背景：多不饱和脂肪酸有抑制细胞炎症反应及免疫功能的作用,增生性瘢痕的形成与炎症、细胞免疫、细胞因子有着密切关系,但目前尚无应用多不饱和脂肪酸防治增生性瘢痕的实验研究。目的：探讨磷脂多不饱和脂肪酸对兔耳增生性瘢痕的抑制作用。方法：在9只新西兰大白兔兔耳腹侧做直径1cm的圆形全层皮肤缺损创面,每侧6个,共108个,其中形成增生性瘢痕92个,瘢痕形成率为85%。实验分3组：每只兔耳靠前3个创面涂磷脂多不饱和脂肪酸霜,右耳靠后3个创面涂多磺酸黏多糖乳膏,创面上皮化后立即涂药,每日1次,左耳靠后3个创面自然愈合。分别在术后28,42,63,90d,观察创面的愈合情况;显微镜下观察瘢痕组织的厚度、胶原纤维和成纤维细胞密度;免疫组织化学染色检测胶原纤维的表达。结果与结论：涂抹磷脂多不饱和脂肪酸霜和多磺酸黏多糖乳膏可使增生性瘢痕体积缩小、厚度变薄、成纤维细胞密度减小、胶原纤维表达减少。尤以磷脂多不饱和脂肪酸霜的效果最为明显。说明磷脂多不饱和脂肪酸可抑制兔耳增生性瘢痕的形成,减轻瘢痕的增生程度。     

A polarized multispectral imaging system for quantitative assessment of hypertrophic scars

Hypertrophic scars (HTS) are a pathologic reaction of the skin and soft tissue to burn or other traumatic injury. Scar tissue can cause patients serious functional and cosmetic issues. Scar management strategies, specifically scar assessment techniques, are vital to improve clinical outcome. To date, no entirely objective method for scar assessment has been embraced by the medical community. In this study, we introduce for the first time, a novel polarized multispectral imaging system combining out-of-plane Stokes polarimetry and Spatial Frequency Domain Imaging (SFDI). This imaging system enables us to assess the pathophysiology (hemoglobin, blood oxygenation, water, and melanin) and structural features (cellularity and roughness) of HTS. To apply the proposed technique in an in vivo experiment, dermal wounds were created in a porcine model and allowed to form into scars. The developed scars were then measured at various time points using the imaging system. Results showed a good agreement with clinical Vancouver Scar Scale assessment and histological examinations.OCIS codes: (110.0110) Imaging systems, (110.4234) Multispectral and hyperspectral imaging     

Analysis of hypertrophic and normal scar gene expression with cDNA microarrays

Hypertrophic scar is one form of abnormal wound healing. Previous studies have suggested that hypertrophic scar formation results from altered gene expression of extracellular matrix molecules. A broadscale evaluation of gene expression in hypertrophic scars has not been reported. To better understand abnormalities in hypertrophic scar gene expression, we compared messenger RNA expression in hypertrophic scars, normal scars, and uninjured skin with the use of complementary (c)DNA microarrays. Total RNA was extracted from freshly excised human hypertrophic scars, normal scars, or uninjured skin and reverse transcribed into cDNA with the incorporation of [33P] deoxycytidine triphosphate. The resulting radioactive cDNA probes were hybridized onto cDNA microarrays of 4000 genes. Hybridization signals were normalized and analyzed. In the comparison of tissue samples, mean intensities were calculated for each gene within each group (hypertrophic scars, normal scars, and uninjured skin). Ratios of the mean intensities of hypertrophic scars to normal scars, hypertrophic scars to uninjured skin, and normal scars to uninjured skin were generated. A ratio that was greater than 1 indicated upregulation of any particular gene and a ratio that was less than 1 indicated downregulation of any particular gene. Our data indicated that 142 genes were overexpressed and 50 genes were underexpressed in normal scars compared with uninjured skin, 107 genes were overexpressed and 71 were underexpressed in hypertrophic scars compared with uninjured skin, and 44 genes were overexpressed and 124 were underexpressed in hypertrophic scars compared with normal scars. Our analysis of collagen, growth factor, and metalloproteinase gene expression confirmed that our molecular data were consistent with published biochemical and clinical observations of normal scars and hypertrophic scars. cDNA microarray analysis provides a powerful tool for the investigation of differential gene expression in hypertrophic scar samples and either uninjured skin or normal scars. Our data validate the use of this technology for future studies on gene expression during repair processes of normal and abnormal wounds.     

Quantitative measurement of hypertrophic scar: interrater reliability and concurrent validity.

Research into the pathophysiology and treatment of hypertrophic scar (HSc) remains limited by the heterogeneity of scar and the imprecision with which its severity is measured. The objective of this study was to test the interrater reliability and concurrent validity of the Cutometer measurement of elasticity, the Mexameter measurement of erythema and pigmentation, and total thickness measure of the DermaScan C relative to the modified Vancouver Scar Scale (mVSS) in patient-matched normal skin, normal scar, and HSc. Three independent investigators evaluated 128 sites (severe HSc, moderate or mild HSc, donor site, and normal skin) on 32 burn survivors using all of the above measurement tools. The intraclass correlation coefficient, which was used to measure interrater reliability, reflects the inherent amount of error in the measure and is considered acceptable when it is >0.75. Interrater reliability of the totals of the height, pliability, and vascularity subscales of the mVSS fell below the acceptable limit ( congruent with0.50). The individual subscales of the mVSS fell well below the acceptable level (< or =0.3). The Cutometer reading of elasticity provided acceptable reliability (>0.89) for each study site with the exception of severe scar. Mexameter and DermaScan C reliability measurements were acceptable for all sites (>0.82). Concurrent validity correlations with the mVSS were significant except for the comparison of the mVSS pliability subscale and the Cutometer maximum deformation measure comparison in severe scar. In conclusion, the Mexameter and DermaScan C measurements of scar color and thickness of all sites, as well as the Cutometer measurement of elasticity in all but the most severe scars shows high interrater reliability. Their significant concurrent validity with the mVSS confirms that these tools are measuring the same traits as the mVSS, and in a more objective way.     

压力治疗及硅酮敷料治疗对增生性瘢痕疗效的短期研究

目的　采用客观的测试来比较硅酮敷料和压力治疗增生性瘢痕 2个月后的效果。方法　将96例具有增生性瘢痕的患者随机分为压力治疗组、硅酮敷料 (cicacare)组、压力及硅酮敷料综合治疗组 (综合治疗组 )和对照组。除对照组外 ,所有患者接受为期 2个月的治疗。结果　温哥华瘢痕量表总分显示 ,只有压力治疗组治疗前、后的差异有显著性意义。超声测量仪和色谱仪所测结果的双因素重复方差分析显示差异无显著性意义。配对t检验显示 ,与对照组相比 ,压力治疗组、硅酮敷料组以及综合治疗组在 2个月后瘢痕厚度的治疗差异均有显著性意义 ,但 3个治疗组之间的差异无显著性意义。在颜色参数方面 ,压力治疗组瘢痕的亮度 (P <0 .0 1)和红色 (P <0 .0 5 )改变的差异有显著性意义 ;硅酮敷料组瘢痕黄色 (P <0 .0 1)变化的差异有显著性意义。结论　根据初步的结果 ,压力治疗及综合治疗对减低增生性瘢痕厚度有较好效果。硅酮敷料治疗对改善瘢痕的血管增生和色素较为有效     

兔耳增生性瘢痕的形态学观察与羟脯氨酸含量变化

Inrecentyears，excessivedermalhyperplasiafollowingtotalskinlossofrabbit＇seariswidelyreportedbydomesticandforeignre－searchers．Histologicalstudiesshowexcessivedermalhyperplasiahascloserelationwithhypertrophicscarofhuman犤１－２犦．Characteristicsofcollagenmetabolismandmorphologicalchangeslawaboutexcessivedermalhyperplasiaremainunclear．Theinvolvedmechanismistheobjectiveofthisstudy．１Materialandmethod１．１Treatmentandcreationofwoundsinanimals８Japaneselarge－earrabbitsregardingnogenderwerei…     

血小板源生长因子及其受体在烧伤肉芽组织和增生性瘢痕中的表达

目的探讨血小板源生长因子 (PDGF)及其受体在瘢痕增生过程中的作用。方法采用多克隆抗体并以免疫组织化学方法检测 9例正常真皮、7例肉芽组织及 34例增生性瘢痕标本中的PDGF及其受体和Ⅰ型胶原的表达情况。结果PDGF及其受体在肉芽组织和增生性瘢痕中的表达明显增强 ,在 6个月以内的增生性瘢痕中达到高峰 ,此后逐渐减弱 ;而正常真皮组织中仅少数标本呈微弱表达 (P <0 .0 5 )。结论PDGF及其受体表达的增强可能与瘢痕的增生密切相关