硅酮凝胶治疗增生性瘢痕疗效观察

2003年3月-2005年10月，我们采用硅铜凝胶喷雾剂（又名疤复新，由上海大学科技园区上大吉申科技开发有限公司研发）治疗增生性瘢痕患者，取得满意效果，现报道如下。     

曲尼司特联合硅酮凝胶超声导入治疗增生性瘢痕疗效探讨

目的：观察曲尼司特联合硅酮凝胶超声导入治疗增生性瘢痕的疗效。方法：选取2018年11月-2020年10月治疗的烧伤及外伤所致增生性瘢痕患者136例,遵照知情同意原则并按照随机数字表法均分为两组,对照组68例采用医用硅酮凝胶超声导入治疗,观察组68例采用曲尼司特联合医用硅酮凝胶超声导入治疗,比较两组临床疗效、美学效果、胶原纤维指标、基质金属蛋白酶(Matrix metalloproteinases,MMPs)及不良反应情况。结果：观察组总有效率为95.6%,略高于对照组的86.8%,但组间比较差异无统计学意义(P>0.05)。治疗前两组温哥华瘢痕量表(Vancouver scar scale,VSS)评分比较差异无统计学意义(P>0.05);治疗后3个月两组VSS评分均显著降低,且观察组VSS评分显著低于对照组,差异有统计学意义(P<0.05)。治疗前两组Ⅰ、Ⅲ型胶原纤维含量及Ⅰ/Ⅲ型胶原纤维含量比值比较差异无统计学意义(P>0.05);治疗后3个月两组以上各项均显著改善,且观察组Ⅰ型胶原纤维含量及Ⅰ/Ⅲ型胶原纤维含量比值显著低于对照组,Ⅲ型胶原纤维含量显著高于对...     

增生性瘢痕与瘢痕疙瘩的治疗体会

增生性瘢痕和瘢痕疙瘩除痒痛不适外 ,且明显影响外观及功能。笔者从 1 997年 7月至 2 0 0 0年 9月 ,针对不同类型的瘢痕分别采用局部注射、手术切除、综合治疗等方法 ,临床上取得了较为满意的效果 ,现报道如下。1　临床资料本组共 1 1 7例 ,其中女性 87例 ,男性 30例。年龄 8岁～ 39岁。瘢痕部位 :面部 36例 ,颈部 7例 ,前胸部 1 8例 ,后背部 1 5例 ,腹部 2 1例 ,会阴部 1例 ,前臂部 1 3例 ,膝部 6例。瘢痕病因 :外伤后瘢痕 49例 ,烫伤性瘢痕 31例 ,激光治疗后瘢痕 37例。2　治疗方法及结果2 .1　注射治疗　本组 43例。耳垂 1 4例 ,眉部 1 8…     

增生性瘢痕及瘢痕疙瘩的非手术治疗

瘢痕是人体组织创伤修复的自然产物,是损伤愈合部位的纤维组织增生的结果.瘢痕治疗棘手,所以瘢痕的预防重于治疗,多种瘢痕的非手术治疗方式同时也是预防手段.根据其组织学和形态学的区别可分为浅表性瘢痕、增生性瘢痕、萎缩性瘢痕和瘢痕疙瘩.其中,瘢痕疙瘩常超出原损伤的边缘,通常不会自行消退,切除后往往会复发,与增生性瘢痕统称为病理性瘢痕.对于瘢痕疙瘩和非功能部位大片增生性瘢痕主要采取非手术治疗的方法.这些方法种类繁多,报道疗效不一,可以说没有任何一种治疗方法对所有患者都是最有效的,为了追求最佳效果往往需要多种治疗方式的联合实施.现将增生性瘢痕和瘢痕疙瘩的非手术治疗综述如下.     

增生性瘢痕和瘢痕疙瘩动物模型的研究现状

增生性瘢痕 (ｈｙｐｅｐｔｒｏｐｈｉｃｓｃａｒ,ＨＳ)和瘢痕疙瘩(ｋｅｌｏｉｄ ,Ｋ)一直是困扰整形外科的难题 ,但由于缺乏理想的动物模型 ,这方面的临床和实验室研究一直受到很大限制。自 5 0年代起 ,国内外学者开始尝试建立不同类型的动物模型 ,并利用这些模型对ＨＳ和Ｋ的发病机理和防治等进行了一系列的研究。1　将人的ＨＳ和Ｋ移植于无胸腺鼠 (裸鼠 )1985年 ,Ｓｈｅｔｌａｒ等[1] 将人的瘢痕疙瘩组织块去上皮后移植于无胸腺小鼠 (裸鼠 )背部皮下袋内 ,对其进行了长达 60ｄ的观察 ,发现到 60ｄ时移植的Ｋ组织仍保留有原来的组织形态学…     

增生性瘢痕的分子生物学研究进展

尽管目前临床上针对增生性瘢痕已有了一些较为有效的治疗措施,在治疗效果上也取得了长足的进步,但因其发病机制尚未完全明确,因此仍存在较多问题.本文就增生性瘢痕的基础分子生物学研究进展进行综述,旨在为进一步认识、治疗增生性瘢痕提供参考.     

增生性瘢痕和瘢痕疙瘩裸鼠模型的研制

目的：复制瘢痕动物模型，旨在从形态学和组织学上验证该模型的可靠性，为瘢痕的基础研究开辟一条新途径。方法：将增生性瘢痕和瘢痕疙瘩小组织块分别植入裸鼠皮下，携带一段时间（５～１２０天），且与原瘢痕作光镜和电镜对照。结果：术后裸鼠全部成活。植入物无变性坏死，且无异性细胞浸润，并保持其原有的胶原形态，透射电镜也证实细胞特性保持不变。结论：增生性瘢痕和瘢痕疙瘩植入裸鼠体内能保持其原有的组织学结构特征，裸鼠用作瘢痕动物模型是可行的、可靠的。     

Effects of silicone gel on burn scars

Aim

To study the efficacy of silicone gel applied to hypertrophic burn scars, in reducing scar interference with normal function and improving cosmesis.

Methods

A randomised, double-blind, placebo-controlled trial involving 38 people with hypertrophic burn scars. Each scar was divided into two segments; silicone gel sheet was applied randomly to one of the two and placebo to the other. Participants were seen again after 1 and 4 months. Their data and wound characteristics were collected using the Vancouver scar scale.

Results

The median age of participants was 22 years (1.5–60 years) and 16 were male; 4 did not attend follow-up and were excluded from the study. There were no significant differences in baseline characteristics. Although after 1 month all scar scale measures were lower in treated areas, only the vascularity scale was significantly different between the two areas. After 4 months, all scale measures were significantly lower in the silicone gel group than in the control group, except for the pain score.

Conclusion

Silicone gel is an effective treatment for hypertrophic burn scars.     

Role of silicone derivative plus onion extract gel in presternal hypertrophic scar protection: a prospective randomized, double blinded, controlled trial

Use of silicone derivative and onion extract had been reported in the prevention of hypertrophic scarring. Our experience showed the preventive use of silicone derivative plus onion extract gel on hypertrophic scars after median sternotomy. In a randomized, double blinded, placebo‐controlled study, 60 patients after median sternotomy incisions were separated into two groups. All patients were treated either with silicone derivative plus onion extract gel (Cybele^® scagel) or placebo gel twice daily for a total treatment period of 12 weeks. During each visit, pain and itching scores were graded by the patients and scar characteristics were observed by surgeons using the Vancouver scar scale. Pain and itch score values from patients' who applied silicone derivative plus onion extract gel was less than another group (P < 0·05). Pigmentation was significantly different between two groups (P < 0·05) and the reduction of scores on vascularity, pliability, height in treated group was not superior to the untreated group. No adverse events were reported by any of the patients. A silicone derivative plus onion extract gel is safe and effective for the preventing the hypertrophic scarring after median sternotomy.     

A prospective randomized clinical trial to investigate the effect of silicone gel sheeting (Cica-Care) on post-traumatic hypertrophic scar among the Chinese population

BACKGROUND: This study aimed to determine the efficacy of silicone gel (Cica-Care) on severe post-traumatic hypertophic scars among the Chinese population. METHOD AND MATERIALS: A randomized clinical trial (RCT) was conducted on 45 Chinese patients with post-traumatic hypertrophic scars. Twenty-two subjects were placed in the experimental group with silicone gel sheeting (SGS) applied 24h per day for 6 months while all subjects were taught to massage the scar daily for 15 min serving as the control intervention. Scar assessments were conducted regularly to measure the changes in thickness, pigmentation, vascularity, pliability, itchiness and pain. RESULTS: Two-way repeated ANOVA showed a significant difference between MT group and SGS group on scar thickness. The post hoc comparison analysis showed that the difference was significant at the post-2-month (p=0.008) and post-6-month (p<0.001) intervention. The SGS group also showed changes in pigmentation which resembled normal skin but no statistical significance was found. Pain, itchiness and pliability were also improved after intervention. CONCLUSION: This study indicated that silicone gel sheeting (Cica-Care) was effective to reduce thickness, pain, itchiness and pliability of the severe hypertrophic scar among the Chinese population. The moisturization effect of the tough and hard scar might contribute to the reduction of the skin thickness after 6 month's intervention.     

Occlusion and hydration of scars: moisturizers versus silicone gels

BackgroundThe mainstay of non-invasive scar management, consists of pressure therapy with customized pressure garments often combined with inlays, hydration by means of silicones and/or moisturizers as well as UV protection. It is generally accepted that scar dehydration resulting from impaired barrier function of the stratum corneum and expressed by raised trans epidermal water loss (TEWL) values, can lead to increased fibroblast activity and thereby hypertrophic scar formation. However, we have reached no consensus on exactly what optimal scar hydration is nor on barrier function repair: by means of silicone sheets, liquid silicone gels or moisturizers. Occlusive silicone sheets almost completely prevent TEWL and have been shown to be effective. Nevertheless, many important disadvantages due to excessive occlusion such as difficulties in applying the sheets exceeding 10–12 h, pruritus, irritation, and maceration of the skin are limiting factors for its use. To avoid these complications and to facilitate the application, liquid silicone gels were developed. Despite a reduced occlusion, various studies have shown that the effects are comparable to these of the silicone sheets. However, major limiting factors for general use are the long drying time, the shiny aspect after application, and the high cost especially when used for larger scars. Based on excellent clinical results after using three specific moisturizers for scar treatment in our patients, we wanted to investigate whether these moisturizers induce comparable occlusion and hydration compared to both each other and the widely recognized liquid silicone gels. We wanted to provide a more scientific basis for the kind of moisturizers that can be used as a full-fledged and cost-effective alternative to silicone gel.MethodsA total of 36 healthy volunteers participated in this study. Increased TEWL was created by inducing superficial abrasions by rigorous (20x) skin stripping with Corneofix® adhesive tape in squares of 4 cm². Three moisturizers and a fluid silicone gel were tested: DermaCress, Alhydran, Lipikar and BAP Scar Care silicone gel respectively. TEWL reducing capacities and both absolute (AAH) and cumulative (CAAH) absolute added hydration were assessed using a Tewameter® TM300 and a Corneometer® CM825 at different time points for up to 4 h after application.ResultsWe found an immediate TEWL increase in all the zones that underwent superficial abrasions by stripping. Controls remained stable over time, relative to the ambient condition. The mean percentage reduction (MPR) in TEWL kept increasing over time with Alhydran and DermaCress, reaching a maximum effect 4 h after application. Silicone gel reached maximal MPR almost immediately after application and only declined thereafter. The silicone gel never reached the minimal MPR of Alhydran or DermaCress. Hydration capacity assessed through CAAH as measured by the Corneometer was significantly less with silicone gel compared to the moisturizers. Compared to silicone gel Lipikar provided similar occlusion and the improvement in hydration was highly significant 4 h after application.ConclusionBased on the results of both our previous research and this study it is clearly demonstrated that the occlusive and hydrative effect of fluid silicone gel is inferior to the moisturizers used in our center. Lipikar hydrates well but is less suitable for scar treatment due to the lack of occlusion. A well-balanced occlusion and hydration, in this study only provided by Alhydran and DermaCress, suggests that moisturizers can be used as a scar hydration therapy that replaces silicone products, is more cost-effective and has a more patient-friendly application.     

褪黑素对增生性瘢痕成纤维细胞生物学活性的调控

目的 探讨褪黑素对增生性瘢痕成纤维细胞生物学活性的调控.方法 分离培养增生性瘢痕成纤维细胞,采用四氮唑复合物/硫酸酚嗪甲酯(XTT/PMS)法检测细胞增殖活性,酶联免疫吸附实验(ELISA)检测细胞培养上清液中β1转化生长因子(TGF-β1)含量和荧光定量聚合酶链反应(PCR)检测细胞α平滑肌肌动蛋白(α-SMA)、胶原Ⅰ和胶原ⅢmRNA表达,评价褪黑素和褪黑素受体拮抗剂(luzindole)对增生性瘢痕成纤维细胞生物学活性的影响.结果 褪黑素抑制增生性瘢痕成纤维细胞的增殖,抑制效果呈浓度依赖性(P＜0.05);高浓度褪黑素(10-3 mmol/L)可降低增生性瘢痕成纤维细胞产生TGF-β1 (P＜0.05)和α-SMA mRNA、胶原Ⅰ mRNA的表达(P＜0.05);褪黑素受体拮抗剂能阻断褪黑素对细胞产生TGF-β1和α-SMA、胶原Ⅰ mRNA表达的抑制作用(P＜0.05);但褪黑素对该细胞胶原ⅢmRNA表达无影响(P＞0.05).结论 褪黑素可通过与受体结合调控增生性瘢痕成纤维细胞的生物学活性.     

针灸、外敷中药膜联合瘢痕霜治疗增生性瘢痕

目的:观察针灸、外敷中药膜联合涂瘢痕霜治疗增生性瘢痕的临床效果。方法:选择外伤愈合后21天～5个月具有可比性的瘢痕患者60例(共计120处),随机分为2组:治疗组:采用针灸、敷中药膜联合涂瘢痕霜进行综合治疗;对照组:仅用瘢痕霜治疗,比较两组治疗后1、3、6个月后的疗效。结果:治疗组与对照组在治疗1、3、6个月后P值分别为0.108、0.000、0.002,说明治疗1个月时两组比较无明显差异,3个月及6个月时两组比较有显著性差异。结论:针灸、外敷中药膜联合涂瘢痕霜治疗外伤后增生性瘢痕效果满意。     

Effect of different pressure magnitudes on hypertrophic scar in a Chinese population

Introduction

This study aimed to investigate the effect of different pressure magnitudes on treatment outcomes of hypertrophic scars, and determine pressure loss over time.

Methods

A randomized clinical trial was adopted. 53 hypertrophic scar samples from 17 Chinese participants were recruited and randomly assigned into a high pressure group (20–25 mmHg) and low pressure group (10–15 mmHg) for a five-month intervention program. The scars were assessed objectively before intervention and monthly after intervention for thickness, color (redness, yellowness and lightness) and scar pliability. Pressure magnitude at each assessment was also measured. Two-way repeated ANOVA was used to compare for differences between groups.

Results

The results showed that both levels of pressure produced reduction in scar thickness and redness, but the improvement in the high pressure group was statistically better than that of the counterpart (both p < 0.05). Monthly pressure measurement revealed that pressure loss in the high pressure group was more severe. However, no major changes in other color parameters and pliability were observed for both the groups.

Conclusion

High pressure was demonstrated to be more effective for scar management, but it was also more prone to higher pressure loss. Pressure therapy integrated with regular monitoring of the interface pressure is suggested to improve its therapeutic efficacy.     

三苯氧胺对兔耳增生性瘢痕形成的影响

目的:观察三苯氧胺在体内环境中对瘢痕形成的影响,为其抑制瘢痕增生提供动物实验依据。方法:新西兰长耳兔共30只,建立兔耳增生性瘢痕模型,对照组以正常饲料喂养,实验组加服三苯氧胺溶液。在不同时间点对比创面愈合程度、组织形态学变化、瘢痕组织的厚度、纤维细胞密度及TGF-β2含量的差异。结果:创面愈合时间实验组(12·3±0·6d)较对照组(11·0±0·4d)延长(P<0·05);实验组与对照组瘢痕厚度第30d(153·7±17·1μm,162·1±51·14μm)差异无统计学意义(P<0·05);第60d(173·2±11·97μm,211·2±22·14μm)、第90d(121·1±7·912μm,231·0±32·52μm)差异有统计学意义,实验组与对照组纤维细胞密度第30d(3679·4±506·2,4749·4±697·56)、60d(3788·4±627·91,4553·0±578·84)、90d实验组(3589·5±554·29,4431·7±632·52)差异均有统计学意义(P<0·05);实验组与对照组瘢痕中TGF-β2含量第30d(37·47±7·5,45·25±3·9)差异无统计学意义(P<0·05),第60天(40·69±3·1,56·97±5·02)、第90d实验组(37·76±6·3,54·69±6·9)差异有统计学意义。结论:在体内环境中,三苯氧胺可抑制瘢痕的增生,其具体机制尚待进一步研究。     

光动力学疗法对兔耳增生性瘢痕作用的初步研究

目的 探讨光动力学疗法对兔耳增生性瘢痕的作用。方法 建立兔耳增生性瘢痕模型后，将增生性瘢痕块随机分为血卟啉单甲醚（HMME）一光动力学疗法（PDT）治疗组和对照组（n=12）。观察瘢痕生长情况，建模术后28d取材行常规HE染色和胶原纤维VG染色，计算微血管密度，观察PDT对瘢痕的影响。结果 PDT治疗后瘢痕厚度显著降低，真皮层变薄；微血管数量及成纤维细胞数量减少，且主要位于真皮深层；胶原含量下降，胶原纤维排列较规则有序。结论 在瘢痕形成早期，HMME—PDT能够有效抑制兔耳瘢痕的增生，该方法有可能成为瘢痕预防与治疗的有效方法。     

超脉冲CO2点阵激光辅助中药苦参油膏治疗增生性瘢痕的临床疗效观察

目的探讨超脉冲CO₂点阵激光辅助中药苦参油膏治疗增生性瘢痕的临床疗效。方法选取增生性瘢痕患者72例,随机分为对照组和研究组,每组各36例。对照组采用CO₂点阵激光治疗,冷敷冷疗后直接包扎,研究组在此基础上配合中药苦参油膏外敷,观察疗效和不良反应情况,比较两组患者疼痛指数、创面愈合时间、温哥华瘢痕量表(VSS)评分以及治疗后色沉发生率。结果每次治疗后研究组疼痛指数评分及创面愈合时间均低于对照组(P<0.05)。治疗前两组患者VSS评分无统计学差异(P>0.05);治疗后2个月和6个月时,研究组VSS评分均明显小于对照组(P<0.05)。研究组色沉发生率38.88%,明显低于对照组的72.22%,差异有统计学意义(P<0.05)。结论超脉冲CO₂点阵激光辅助中药苦参油膏治疗增生性瘢痕,可明显降低疼痛指数和VSS评分,缩短创面愈合时间,且不良反应较少,值得临床推广应用。