个性化美容缝合改善剖宫产术后瘢痕的疗效观察

目的：研究个性化美容缝合术对剖宫产术后瘢痕的改善作用。方法：回顾性分析笔者医院2019年1月-2021年1月收治的剖宫产产妇72例进行研究，按缝合方式不同分为两组，各36例。对照组采取常规缝合术，研究组实施美容缝合术，观察两组切口长度、缝合时长、愈合时间、瘢痕宽度、瘢痕最薄厚度、住院时间、视觉模拟量表（Visualanaloguescale,VAS）评分、温哥华瘢痕量表（Vancouverscarscale,VSS）评分、观察者瘢痕评估量表（observerscarassessment scale,OSAS）评分、患者瘢痕评估量表（Patientscarassessmentscale,PSAS）评分及不良反应情况。结果：两组切口长度比较差异无统计学意义（P>0.05）。研究组缝合时长、愈合时间、瘢痕宽度、住院时间短于对照组，瘢痕最薄厚度少于对照组，差异有统计学意义（P<0.05）。术后7 d两组VAS、VSS评分比较差异无统计学意义（P>0.05）；术后2个月研究组VAS、VSS评分低于对照组，差异有统计学意义（P<0.05）。两组OSAS评分中疼痛程度、软硬度...     

甲状腺术中注射倍他米松超前预防颈部切口瘢痕形成的研究

目的探讨甲状腺开放手术中真皮下小剂量连续注射倍他米松可以超前预防颈部切口瘢痕的形成。方法 200例甲状腺肿瘤患者均行甲状腺开放切除术, 本研究采用自身对照的方法。在甲状腺手术结束前, 关闭颈部切口时, 以切口中点为分界线, 平分为左右两段, 左侧为注射区, 右侧为对照区。注射区切口上下切缘真皮层小剂量连续注射倍他米松, 对照区切口不进行任何注射。持续观察切口瘢痕形成情况, 术后随访至1年。采用温哥华瘢痕量表(VSS)、曼彻斯特瘢痕评定量表(MSS)及斯托尼布鲁克瘢痕评估量表(SBSES)分别对注射区及对照区打分。两组比较采用独立样本t检验。结果术后6个月注射区VSS、MSS、SBSES评分优于对照区[(6.20±3.67)分比(7.14±4.52)分, t=-2.324, P<0.05、(7.46±4.48)分比(9.20±5.08)分, t=-3.638, P<0.05、(2.84±1.42)分比(2.35±1.44)分, t=-3.432, P<0.05];12个月注射区VSS、MSS、SBSES评分优于对照区评分[(6.24±3.92)分比(6.51±4.11)...     

顺皮纹小切口锁定钢板内固定治疗锁骨中段骨折的疗效

目的 探讨顺皮纹小切口锁定钢板内固定治疗锁骨中段骨折的疗效。方法 将60例锁骨中段骨折患者根据切口不同分为微创组(29例,采用顺皮纹小切口锁定钢板内固定治疗)和传统组(31例,采用传统切开复位锁定钢板内固定治疗)。记录手术情况、骨折愈合情况、锁骨上神经损伤情况。采用温哥华瘢痕评分评价术后瘢痕情况,问卷调查患者对术后瘢痕外形的满意度,采用Constant-Murley评分、上肢功能障碍(DASH)评分分别评价肩关节、上肢总体功能。结果 患者均获得随访,时间12～18个月。切口总长度、术中出血量微创组短(少)于传统组(P<0.05),手术时间、骨折愈合时间两组比较差异均无统计学意义(P>0.05)。术后2周锁骨上神经损伤发生率微创组低于传统组(P<0.05)。术后1年,Constant-Murley评分、DASH评分两组比较差异均无统计学意义(P>0.05),温哥华瘢痕评分、患者瘢痕外形满意率微创组均优于传统组(P<0.05)。结论 顺皮纹小切口锁定钢板内固定治疗锁骨中段骨折具有切口小、出血少、术后瘢痕不明显、锁骨上神经损伤率低等优点,疗效满意。     

皮下“心形”美容缝合技术在初次剖宫产术后切口愈合中的应用效果

目的:探讨皮下"心形"美容缝合技术在改善初次剖宫产术后切口瘢痕的临床效果。方法:2019年1月至2019年12月,将82例初次剖宫产妇为研究对象,根据切口缝合方法不同,将82例孕产妇分为观察组和对照组,观察组采用皮下"心形"缝合术,对照组采用常规传统缝合技术。分析两种缝合方法的临床效果、术后并发症发生情况,并比较两组患者瘢痕评分量表(Patient scar assessment scale,PSAS)、观察者瘢痕评分量表(Observer scar assessment scale,OSAS)、温哥华瘢痕评分量表(Vancouver scar scale,VSS)和视觉模拟评分量表(Visual analogue scale,VAS)评分情况。结果:观察组缝合时间、切口愈合时间短于对照组,差异有统计学意义(P 0.05)。两组住院时间及术后并发症发生率比较,差异无统计学意义(P0.05)。术后1d,两组VAS评分比较差异无统计学意义(P0.05);术后7d,观察组VAS评分低于对照组,差异有统计学意义(P 0.05)。PSAS评分中,观察组的瘢痕厚薄及平整程度均低于对照组,OSAS评分中,观察组瘢痕表面积、表面平整度、厚度及总分均低于对照组,差异均有统计学意义(P 0.05)。观察组VSS评分及瘢痕宽度低于对照组,差异有统计学意义(P 0.05)。结论:皮下"心形"缝合术可更好改善切口瘢痕形成,术后恢复快,可缓解术后切口疼痛,且不延长住院时间,在初产妇中应用获得了满意的愈合效果,值得在临床推广应用。     

经乳晕入路腔镜下行甲状腺切除术对女性患者临床疗效及切口瘢痕满意度的研究

目的:研究经乳晕入路行腔镜甲状腺切除术对女性甲状腺腺瘤患者临床疗效及切口瘢痕满意度的影响。方法:选取笔者医院2016年4月-2018年4月收治的180例甲状腺腺瘤患者纳入研究,以随机数表法分为观察组与对照组,每组90例。对照组实施传统甲状腺切除手术治疗,观察组经乳晕入路实施腔镜甲状腺切除手术。对比两组围术期手术时间、出血量、拆线时间、住院时间、住院费用及术后温哥华瘢痕量表(Vancouver scar scale,VSS)、患者与观察者瘢痕评估量表(Patient and observer scar assessment scale,POSAS)、术后并发症发生情况。结果:观察组出血量、拆线时间、住院时间、住院费用显著少于对照组,差异有统计学意义(P0.05);观察组手术时间显著长于对照组,差异有统计学意义(P0.05)。观察组术后VSS、PSAS、OSAS评分显著低于对照组,且观察组术后并发症总发生率4.44%显著低于对照组的14.44%,差异有统计学意义(P0.05)。结论:经乳晕入路行腔镜甲状腺切除手术可提高女性甲状腺腺瘤患者美容满意度,且术后并发症风险低,值得临床应用。     

小切口甲状腺腺瘤切除术体会

目的探讨小切口甲状腺腺瘤切除术的方法和效果。方法随机将50例接受择期甲状腺腺瘤切除术的患者分为2组,各25例。对照组实施传统切口,观察组实施改良小切口,观察对比2组手术效果。结果 2组患者住院时间与手术时间比较,差异无统计学意义(P0.05)。但观察组切口长度小于对照组,且术中出血量少于对照组,2组比较,差异均有统计学意义(P0.05)。结论小切口甲状腺腺瘤切除术术中出血量少,术后切口瘢痕小,符合患者的美容要求。     

甲状腺单发腺瘤腔镜辅助颈部小切口手术效果观察

目的探讨甲状腺单发腺瘤腔镜辅助颈部小切口手术的效果。方法选取2015-04—2017-03间平舆县中心医院收治的98例甲状腺单发腺瘤患者,按不同术式分为2组,各49例。观察组行腔镜辅助颈部小切口手术,对照组行传统手术。比较2组疗效。结果 2组并发症发生率差异无统计学意义(P0.05)。观察组手术时间长于对照组,但术中失血量、术后24 h VAS评分、住院时间及切口瘢痕满意度均优于对照组,差异有统计学意义(P0.05)。结论腔镜辅助颈部小切口手术治疗甲状腺单发腺瘤,创伤小、并发症少、切口美观满意度高,效果确切。     

小切口与传统开放手术治疗甲状腺腺瘤效果对比研究

研究小切口与传统开放手术治疗甲状腺腺瘤患者的疗效和意义。选取58例甲状腺腺瘤患者作为研究对象。随机分为观察组29例,对照组29例。对照组实施传统开放术,观察组行小切口治疗。观察两组术中及术后情况。观察组手术时间(79.52±12.15)min、住院时间(3.1±1.5)d、手术瘢痕(4.2±0.5)cm、术中出血量(32.5±4.6)mL、切口长度(1.52±0.15)cm、术后引流量(29.31±3.25)mL,均低于对照组的(88.57±12.18)min、(7.4±2.8)d、(6.6±1.4)cm、(94.2±11.2)mL、(6.56±1.18)cm、(48.52±4.88)mL,差异有统计学意义(P<0.05);观察组患者复发率为0、并发症发生率6.90%,均显著低于对照组的13.79%、27.57%,差异有统计学意义(P<0.05);观察组满意度93.10%,高于对照组的68.97%,差异有统计学意义(P<0.05)。治疗后,观察组促甲状腺激素(TSH)、总甲状腺素(T4)与总三碘甲状腺原氨酸(T3)水平显著低于治疗前,且显著低于对照组,差异有统计学意义(P<0.05);观察组治疗疗效为优占比89.66%、优良率占比96.55%,显著高于对照组的58.62%、79.31%,差异有统计学意义(P<0.05)。采用小切口术式治疗甲状腺腺瘤,可大大改善患者美观问题,减少术中出血量、治疗时间等,改善预后,效果显著。     

甲状腺手术采用双向倒刺缝线缝合皮肤对改善切口瘢痕形成的临床观察

目的比较甲状腺术后应用不同缝线对患者颈部切口瘢痕的影响,为临床治疗提供帮助和指导。方法对2012年9月至2015年6月收治的600例进行甲状腺手术的患者进行回顾性分析,双向倒刺缝线组采用双向倒刺缝线(179例)、普通可吸收缝线组(165例)以及传统丝线缝合组(256例)三种方式闭合手术切口对患者术后瘢痕大小、体积的影响,通过自评统计患者对切口满意程度。采用SPSS22.0统计学软件进行数据的统计分析,三组样本间瘢痕评分和满意度比较采用χ2检验。检验水平a=0.05,当P0.05时认为差异有统计学意义。结果双向倒刺缝线组瘢痕评分良好率为77.65%,明显高于可吸收缝线组69.09%以及传统缝线组62.50%的良好率。在体积方面双向倒刺缝线组瘢痕体积为(0.67±0.18)cm3,普通可吸收缝线组为(0.82±0.23)cm3,传统缝线组为(2.01±0.35)cm3,差异具有统计学意义(P=0.00)。随访1个月后,患者满意程度双向倒刺缝线组满意率高达88.27%。同样显著高于其他两组患者(P=0.00)。结论双向倒刺缝线及普通可吸收缝线均能有效减少术后瘢痕体积大小,但双向倒刺缝线缩短了缝合时间,提高了缝合效率,给患者带来的瘢痕更小,减值得临床上推广应用。     

压力治疗联合点阵CO2激光治疗增生性瘢痕的疗效观察

目的观察压力治疗联合点阵CO₂激光治疗增生性瘢痕的临床疗效。方法回顾分析2018年1月至2020年6月收治的烧伤后增生性瘢痕患者74例。其中,对照组采用压力治疗(42例);观察组采用压力联合点阵CO₂激光治疗(32例)。治疗结束6个月后采用温哥华瘢痕量表(VSS)进行瘢痕评分,以视觉模拟评分法(VAS)进行瘢痕瘙痒及疼痛评分,并记录不良反应发生情况。结果观察组VSS评分显著高于对照组(P<0.05),且瘢痕的瘙痒及疼痛较对照组明显减轻,差异有统计学意义(P<0.05)。两组不良反应发生率差异无统计学意义(P>0.05)。结论压力治疗联合点阵CO₂激光是一种安全有效的治疗增生性瘢痕的方法。     

滚轮微针联合皮下分离术和皮肤瘢痕化学重建技术治疗痤疮凹陷性瘢痕疗效分析

目的:观察滚轮微针、皮下分离术联合皮肤瘢痕化学重建技术在痤疮凹陷性瘢痕中的应用效果。方法:选取笔者医院2018年1月-2019年1月治疗的76例痤疮凹陷性瘢痕患者,随机分为两组。对照组:36例,采用滚轮微针、皮下分离术治疗;观察组:40例,采用滚轮微针、皮下分离术联合皮肤瘢痕化学重建技术治疗,比较两组患者的临床疗效、瘢痕改善情况、不良反应以及患者的面部满意度。结果:观察组总有效率显著高于对照组(P<0.05)。治疗前,两组患者的温哥华瘢痕量表(VSS)评分无显著性差异(P>0.05);治疗后3个月两组VSS评分均显著降低(P<0.05),且观察组显著低于对照组(P<0.05)。两组并发症发生率比较无显著性差异(P>0.05)。观察组患者的面部满意度显著高于对照组(P<0.05)。结论:滚轮微针、皮下分离术联合皮肤瘢痕化学重建技术在痤疮凹陷性瘢痕中的应用效果满意,能够显著改善患者的瘢痕情况,提高临床疗效,并且安全性好,患者的面部满意度更高。     

美容缝合法关闭切口对锁骨骨折切开复位内固定术患者切口愈合效果及美观满意度的影响

目的 探究在锁骨骨折切开复位内固定术患者的切口关闭中使用美容缝合法对其切口愈合效果及 美观满意度的影响。方法 于2022年2月-2023年2月在黄骅市人民医院行锁骨骨折切开复位内固定术的53 例患者作为研究对象,根据缝合方法不同分为对照组（n =26）和观察组（n =27）。对照组采用常规外 科缝合法,观察组采用美容缝合法,比较两组切口愈合效果、温哥华瘢痕量表（VSS）评分及美观满意 度。结果 观察组术后4周切口愈合情况优于对照组,差异有统计学意义（P＜0.05）;观察组VSS各维度评 分及总分均低于对照组,差异有统计学意义（P ＜0.05）;观察组美观总满意度为74.07%,高于对照组的 26.92%,差异有统计学意义（P ＜0.05）。结论 美容缝合法能有效地促进锁骨骨折复位内固定患者切口愈 合,改善瘢痕情况,并能提高患者的美观满意度。     

Early intervention by Z-plasty combined with fractional CO2 laser therapy as a potential treatment for hypertrophic burn scars

The aim of this study is to determine whether Z-plasty combined with fractional CO₂ laser therapy can be a potential management option for hypertrophic burn scars in the proliferation stage. A total of 105 patients (46 male and 59 female patients) diagnosed with hypertrophic scars under tension but without any functional limitations were enrolled in this study. The Vancouver Scar Scale (VSS) score and scar height were analyzed and compared. The VSS scores for all scars were improved in all groups after treatment. The scar height was also significantly decreased in each group after treatment (P < 0.05). In the C group, the scar height decreased significantly to 2.62 ± 0.21 mm, which was the maximum extent at the ≦ 6 month time point compared to the decrease in the other groups. Compared to the > 12 month time point for the C group, there was a significant difference between the ≦ 6 month time point for the L group and the > 12 month time point for the Z group. The proportion of satisfied patients was highest at 89.47% at the ≦6 month time point in the C group and lowest at 65.52% at the > 12 month time point in the L group. Six representative cases are presented. Z-plasty can decrease the thickness of a hypertrophic burn scar, which not only reduces the scar tension but also makes it easy to treat the scar with a fractional CO₂ laser. Subsequent treatment with a fractional CO₂ laser can better improve the color and texture of the scar.     

585-nm Pulsed Dye Laser in the Treatment of Surgical Scars Starting on the Suture Removal Day

BACKGROUND: The optimal time frame to improve the quality and cosmetic appearance of scars by laser therapy has not been clearly elucidated by prior controlled clinical trials. OBJECTIVE: To determine the efficacy of the 585-nm pulsed dye laser (PDL) in the treatment of surgical scars starting on the day of suture removal. METHODS: Eleven patients (skin types I-IV) with 12 postoperative linear scars that were greater than 2 cm were treated three times on monthly intervals with the 585-nm PDL (450 micro s, 10-mm spot size, 3.5 J/cm2 with 10% overlap) on one scar half, whereas the other half received no treatment. Scars were later evaluated by a blinded examiner using the Vancouver Scar Scale (VSS) for pigmentation, vascularity, pliability, and height. Scars were then blindly examined for cosmetic appearance using a visual analog scale. RESULTS: One month after the last treatment, final scar analysis by the blinded examiner revealed a significant difference between treated and untreated sites, with the treated halves scoring better in all scar parameters in the VSS and in cosmetic appearance. The treated halves demonstrated an overall average improvement in the VSS between the first treatment score and the final score of 54% versus 10% in the controls (P=0.0002). The cosmetic appearance score (0=worst; 10=best) at final assessment was significantly better for the treated scars, scoring 7.3 versus the averaged control score of 5.2 (P=0.016). CONCLUSION: The 585-nm PDL is effective and safe in improving the quality and cosmetic appearance of surgical scars in skin types I-IV starting on the day of suture removal.     

铒像素激光联合硅凝胶软膏预防面部术后瘢痕的疗效观察

目的:观察铒像素激光联合硅凝胶软膏预防面部术后瘢痕的疗效。方法:治疗组35例,面部切口愈合后1月内开始铒像素激光治疗,每月1次,共5次,同时使用硅凝胶软膏治疗;对照组41例,仅使用硅凝胶软膏治疗,方法同治疗组。术后6个月时以温哥华瘢痕测量表为依据,比较两组患者瘢痕的治疗效果。结果:瘢痕总评分均值:治疗组3.43±1.945,对照组4.37±1.593,t=-2.310,P<0.05;瘢痕色泽评分均值:治疗组1.09±0.919,对照组1.78±0.881,t=-3.359,P<0.05。结论:铒像素激光联合硅凝胶软膏预防面部术后瘢痕的效果,在术后6个月时优于单独使用硅凝胶软膏,其中瘢痕色泽的改善优于单独使用硅凝胶软膏。     

Objective quantification of burn scar stiffness using shear-wave elastography: Initial evidence of validity

Shear-wave elastography (SWE) is an ultrasound based technology that can provide reliable measurements (velocity) of scar stiffness. The aim of this research was to evaluate the concurrent validity of using both the measured velocity and the calculated difference in velocity between scars and matched controls, in addition to evaluating potential patient factors that may influence the interpretation of the measurements.MethodsA cross-sectional study of 32 participants, with 48 burn scars and 48 matched contralateral control sites were evaluated with SWE, the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS) tactile sub-scores.ResultsSpearman’s rho demonstrated high correlations (r > 0.7) between the measured scar velocity and both the POSAS and VSS pliability sub-scores, whereas moderate correlations (r > 0.6) were found with the calculated difference in velocity. Regression analysis indicated that the association of increased velocity in scars, varied by length of time after burn injury and gender. Body location and Fitzpatrick skin type also demonstrated significant associations with velocity, whereas age did not.ConclusionSWE shows potential as a novel tool to quantify burn scar stiffness, however patient factors need to be considered when interpreting results. Further research is recommended on a larger variety of scars to support the findings.     

针对性护理在腔镜下甲状腺切除术患者中的应用效果及对美观满意度的影响

目的 探讨在腔镜下甲状腺切除术患者中应用针对性护理的效果及对美观满意度的影响。方法 选取2022年1月-2023年1月于莱西市人民医院普外科行腔镜下甲状腺切除术的66例患者为研究对象,随 机分为对照组和观察组,每组33例。对照组给予常规护理,观察组给予针对性护理,比较两组负面情 绪、瘢痕情况、瘢痕关注度、美观满意度及恢复情况。结果 观察组干预后SAS评分、SDS评分均低于对 照组（P ＜0.05）;观察组VSS评分低于对照组（P ＜0.05）;观察组瘢痕关注度为96.67%,高于对照组的 81.82%（P ＜0.05）;观察组美观满意度为96.67%,高于对照组的78.79%（P ＜0.05）;观察组干预后情绪 状态、机体舒适水平、心理支持、自理能力及疼痛评分均高于对照组（P ＜0.05）。结论 针对性护理在 腔镜下甲状腺切除术患者中的应用效果确切,可提高瘢痕关注度,减轻瘢痕情况,能够改善患者的不良 情绪,提高美观满意度,有利于促进患者身心健康发展。     

Application of tissue ultrasound palpation system (TUPS) in objective scar evaluation

One of the characteristics of hypertrophic scarring is its raised appearance. Its maturation often results in increased thickness. Therapists usually rely on subjective observation and palpation to document scar thickness. The result of these subjective assessments may reflect only the superficial scar thickness but is unable to measure the whole scar volume and thickness under the skin surface. Measurement of scar thickness using ultrasound imaging has been previously reported, but has not been commonly used in clinics due to its complex operation method and high cost. In this study, we have adopted a newly developed and user-friendly Tissue ultrasound palpation system (TUPS) for the assessment of scar thickness. It consists of a finger size palpation probe, connected to an ultrasound transducer and an in-series load cell to measure the thickness of the soft tissue over the human body. The method of operation is easy and it can be used to measure skin thickness on various parts of the body, thus reflecting the skin thickness. The reliability of the TUPS in clinical application was tested on 30 subjects with a hypertrophic scar at a local hospital. Three raters implemented two assessments on each subject to study its test-retest and inter-rater reliabilities. It was then used to assess 100 subjects with various severity of hypertrophic scar caused by trauma, scald, burn or surgery. They were assessed using TUPS as well as the Vancouver Scar Scale (VSS) for rating scar thickness, pliability, pigmentation and vascularity. Two-way mixed intra-class correlation showed a high test-retest reliability with Intraclass Correlation Coefficient (ICC)=0.98 and inter-rater reliability ICC=0.84. Fair positive correlations with VSS thickness score and VSS total score r=0.34 (p<0.05) and 0.42 (p<0.05), respectively. A significant difference between two scar type groups (50 burn scald scars and 50 surgical scars) was demonstrated (d.f.=52.94, t=3.99, p<0.01). TUPS was proved to have high inter-rater, test-retest reliability and it had a moderate correlation with the VSS that clinicians used for assessment of the scar. This system is recommended for clinical assessment of scar thickness.     

The effect of incisional negative pressure wound therapy on the improvement of postoperative cosmetic suture wounds and scar hyperplasia

This study aimed to explore the effects of early incisional negative pressure wound therapy (INPWT) on cosmetic suture wounds and postoperative scar hyperplasia. We retrospectively evaluated 120 patients who underwent abdominoperineal resection at the Changhai Hospital between February 2018 and October 2021 and divided them into two groups according to their treatment: the INPWT group (n = 60) and the control group (n = 60). The quality of post-surgical wound healing in the two groups was evaluated. The Patient Scar Assessment Scale (PSAS), the Vancouver Scar Scale (VSS), and the visual analogue scale (VAS) were used to evaluate the surgical incision scar at 1-year follow-up. At this follow-up visit, 115 patients underwent reexamination; five patients were lost to follow-up, including two patients in the INPWT group and three patients in the control group. The INPWT group showed better wound healing than the control group (P < .05). The proportion of patients who received INPWT was significantly higher in the non-surgical site infection (SSI) group than in the SSI group (P < .05). The PSAS, VSS and VAS scores were significantly improved in the INPWT group compared with those in the control group (P < .05). Our results show that INPWT improved the quality of cosmetic suture wounds and reduced the degree of postoperative scar hyperplasia.