耳后皮肤扩张法治疗耳轮瘢痕疙瘩

目的 为治疗耳轮瘢痕疙瘩提供一种较好的外科治疗方法。方法 手术分两期：第一期，在耳廓背侧及耳后乳突区皮下置入容量为50ml的肾形扩张器，定期向扩张器内注水行耳后皮肤扩张；第二期，约2个月后切除耳轮瘢痕疙瘩，取出扩张器，将耳后扩张皮瓣向耳轮推进，覆盖创面。术后无需其它辅助治疗。结果 2000年以来，采用本术式共治疗12例16只耳的耳轮瘢痕疙瘩，随访3个月～2年，让实效果满意，无复发，修复后的耳轮外形良好。结论 本术式以血运丰富的耳后扩张皮瓣，无张力修复耳轮瘢痕疙瘩切除后的创面，对耳后乳突区为正常皮肤条件下的耳轮瘢痕疙瘩提供了一种较为理想的治疗方法。     

利用原位瘢痕瓣修复耳廓瘢痕疙瘩切除后创面的临床效果

目的 探讨利用原位瘢痕瓣修复耳廓瘢痕疙瘩切除术后创面,24 h内即行放射治疗预防瘢痕复发的临床疗效.方法 在耳廓瘢痕疙瘩病变上设计出将其切除后足以覆盖创面的原位瘢痕瓣,在局部浸润麻醉下,按设计线将瘢痕疙瘩切除,在保障原位瘢痕瓣能够成活的前提下,修剪瘢痕瓣使其厚薄均匀、大小适宜、无张力的修复创面,必要时放置引流条,加压包扎.术后18～24 h内即行Siemens Primus直线加速器5MeV高能电子束(β射线)垂直照射,照射前拔除引流条常规换药,照射时打开敷料暴露伤口,分割剂量3～4 Gy/次,照射后继续加压包扎,隔天1次,连续4次,照射总剂量12～16 Gy.术后8～10 d拆线.结果 25例术后原位瘢痕瓣无缺血性坏死,伤口均Ⅰ期愈合,表面皮肤颜色正常,外形良好,患者满意.随访8～42个月,23例无复发,2例4～6个月出现复发倾向,应用复方倍他米松局部注射2～4次,得到控制.结论 原位瘢痕瓣修复治疗耳廓瘢痕疙瘩,无另取皮片或皮瓣修复在供区可能形成瘢痕疙瘩的后顾之忧,手术就地取材,简单易行,术后耳廓外形良好,24 h内即行放射治疗预防复发,效果满意.     

瘢痕疙瘩术后电子线治疗效果分析

目的：观察瘢痕疙瘩术后电子线照射在预防手术部位瘢痕疙瘩复发的效果。方法：瘢痕疙瘩术后第1天起手术部位给予电子线照射1～2周，剂量150～300cGY／次，2～5次／周，总剂量1050～2500cGY。结果：瘢痕疙瘩术后电子线照射的伤口无明显缝线反应，愈合良好，无裂开，瘢痕呈细线状，随访病例手术部位未见瘢痕疙瘩复发。结论：瘢痕疙瘩术后电子线治疗是预防瘢痕疙瘩复发的有效方法之一。     

皮质类固醇在增生性瘢痕和瘢痕疙瘩患者治疗中的应用效果

探讨在临床中运用皮质类固醇治疗增生性瘢痕和瘢痕疙瘩的效果。方法 应用回顾性分析 方法，选取我院在2022年5月-2023年5月收治的50例增生性瘢痕和瘢痕疙瘩患者为研究对象，根据治疗方 法的不同分为对照组和观察组，各25例。对照组采用常规瘢痕疙瘩切除手术，观察组采用瘢痕疙瘩切除手 术联合皮质类固醇药物治疗，比较两组临床疗效、瘢痕改善情况。结果 观察组治疗总有效率为92.00%，高 于对照组的64.00%（P＜0.05）；观察组皮肤色泽、瘢痕柔软度、瘢痕厚度以及周围血管分布评分均低于对 照组（P ＜0.05）。结论 在对临床增生性瘢痕和瘢痕疙瘩患者治疗中，运用皮质类固醇药物进行治疗，可 提高患者的临床疗效，改善瘢痕情况，安全性良好。     

手术切除配合术后早期放疗对瘢痕疙瘩的疗效分析

目的:观察手术切除结合早期放射治疗瘢痕疙瘩的临床效果。方法:对87例瘢痕疙瘩采用瘢痕疙瘩直接切除后放疗,术后12～24h内开始对手术部位给予电子线照射治疗。结果:瘢痕疙瘩术后放疗切口无明显缝线反应,愈合良好,切口愈后呈细线状,术后随访4个月～3年,所随访病例手术部位均未见瘢痕疙瘩复发。结论:手术切除配合术后早期放疗是治疗瘢痕疙瘩的有效方法。     

穿支桨状皮瓣移植术后早期联合放射疗法治疗胸壁瘢痕疙瘩

目的探讨胸廓内动脉穿支桨状皮瓣术后早期联合放射疗法治疗胸壁瘢痕疙瘩的手术要点及疗效。方法应用多普勒定位胸廓内动脉穿支位置及血管走行,根据胸壁瘢痕疙瘩大小设计螺旋桨状皮瓣,Ⅰ期修复创面,于术后24h及术后7d分别进行术区放射治疗。结果15例胸壁瘢痕疙瘩的患者中,1例出现静脉回流障碍,术后第3天清除部分皮瓣;其余皮瓣成活良好。术后随访所有患者8～24个月（平均12个月）。1例患者术后12个月皮瓣周围出现增生性瘢痕,其余无复发。结论我们的初步经验表明,胸廓内动脉穿支桨状皮瓣术后早期联合放射疗法治疗胸壁瘢痕疙瘩,手术的供区损伤小,复发率低,为较好的治疗方法。     

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。     

瘢痕皮微粒回植治疗大面积增生性瘢痕的临床研究

目的；本研究的目的在于治疗大面积增生性瘢痕，合理利用瘢痕切除后的表皮组织，提高病人的生活质量。方法：在切除大面积增生性瘢痕后，将其瘢痕表皮制成的０．１￣０．２ｍｍ＾３微粒皮浆，回植于创面上，结果：治疗３６例病人，显示微粒皮生长同愈合良好。随访６￣１２个月表明，皮肤颜色，质地均匀一致，继发瘢痕轻、无明显增生性瘢及色素沉着。结论：用瘢痕皮微凿回相干治疗大面积增生性瘢痕，能够促进创面愈合，减轻继发性瘢痕     

病理性瘢痕治疗进展

增生性瘢痕和瘢痕疙瘩是创面愈合过程失控后的不同表达产物，虽然胶原等细胞外间质的过度沉积是两者的共同特点，但它们的生长特点和临床特征明显不同。增生性瘢痕高出皮肤表面但损伤局限在原范围，常在损伤后的4周内出现并随着时间的推移自行消退，伴有组织挛缩，手术切除后大多数不会复发，胶原分布均匀且细小规则；瘢痕疙瘩高出皮肤表面并向周围增生扩展超出其基底，出现时间晚且不能自行消退，手术切除后常会复发，胶原分布紊乱且粗大呈波浪形。瘢痕的类型、首次治疗是否正确，直接影响着其后续治疗和康复。[第一段]     

瘢痕皮瓣修复上睑皮肤瘢痕性缺损

目的：探讨局部瘢痕皮瓣修复上睑皮肤瘢痕性缺损的效果。方法：烧伤、感染后的瘢痕疙瘩所致上睑皮肤瘢痕性缺损10例;采用保留瘢痕皮肤的瘢痕内剥除塑形手术方法,同时松解复位外翻的眼睑,术后曲安奈德瘢痕内注射2～5次。结果：除1例皮瓣坏死改善不明显外,其余病例瘢痕疙瘩和睑外翻完全矫正。随访3～12月,无复发,重睑形态良好。结论：瘢痕皮瓣是修复上睑皮肤瘢痕性缺损的良好办法。     

组织粘合剂"爱必肤"在整形外科中的应用

将组织粘合剂“爱必肤”(EPIGLU)直接应用于65例新鲜伤口、手术切口，探讨组织粘合剂“爱必肤”的应用方法及效果。方法：将组织粘合剂“爱必肤”直接应用于手术切口、新鲜伤口共65例，所有的创口皮肤均不用缝线缝合，观察创口愈合情况。结果：6l例患者创口(92．3％)I期愈合，创口对合平整、无针眼，瘢痕增生不明显。4例患者创口(7．7％)因创缘对合不齐，愈合后痕迹明显。结论：“爱必肤”是一种很好的组织粘合剂，值得临床上推广使用。     

脂肪颗粒移植修复面部凹陷性组织缺损

探讨面部凹陷性组织缺损的修复方法。方法：用10ml的常用注射器吸取腹部脂肪颗粒移植充填面部凹陷性组织缺损畸形。结果：本组治疗12例，一次性充填组织缺损，全部成功，术后无感染，伤口I期愈合。结论：注射器吸取脂肪颗粒移植修复组织凹陷畸形，方法简便，不需做手术切口，术后不遗留瘢痕，痛苦少，脂肪颗粒吸收少，治疗后外形理想，是一种较简便的治疗方法。     

Intra-lesional injections of collagenase are ineffective in the treatment of keloid and hypertrophic scars.

The treatment of keloid and hypertrophic scars remains difficult. Enzymatic digestion of keloid scars has been previously proposed as an effective treatment strategy for reducing the volume of keloid scars. To test this, we administered intra-lesional injections of pure collagenase (between 600 and 4500 units for each scar) into the keloid and hypertrophic scars of seven human volunteers (five keloid and two hypertrophic scars). Five patients (three keloid and two hypertrophic) received more than one injection of collagenase. The treatment resulted in a temporary reduction in scar volume for three of the patients with keloid scars. However, scar volumes for these three patients returned to the same (or greater) levels after 6 months of follow-up. Treatment with collagenase produced no change in scar volume for the two patients with hypertrophic scar. Side effects were numerous and severe including; pain, swelling, blistering, ulceration and ecchymosis at the site of injection. One patient required admission to hospital for 48 h after the first injection. Maximum length of follow-up was 6 months. None of the seven patients completed the study and returned for final follow-up at 2 years. This pilot study suggests that treatment of keloid and hypertrophic scars with intra-lesional injections of collagenase is ineffective.     

A new surgical treatment of keloid: keloid core excision

Keloids and hypertrophic scars result from excessive collagen deposition, the cause of which is not yet known. Unlike hypertrophic scars, keloids frequently persist at the site of injury, often recur after excision and always overgrow the boundaries of the original wound. There have been many trials to control keloids, but most of them have been unsuccessful. The authors propose a new surgical technique to treat keloids and name it keloid core extirpation. They excise the inner fibrous core from the keloid and cover the defect with a keloid rind flap, which is arterialized by the subcapsular vascular plexus. The authors treated 24 keloids of the ear, trunk, face, and genitalia with keloid core excision. Four cases of partial rind flap congestion or necrosis occurred. Those patients who healed primarily after surgery showed no evidence of keloid recurrence as long as they were followed. The authors have found the keloid core extirpation technique to be excellent in preventing keloid recurrence, with no adjuvant therapy after surgery.     

乳晕双环切口乳腺病变切除同期行乳房悬吊术

探讨乳腺病变切除同期行乳房悬吊的方法及意义。方法：以乳头为中心在乳晕缘及其外周作双环切口，去除双环间表皮，在外环切口以外乳房范围内作广泛的皮下分离；切除病变组织，分层缝合乳腺组织并作适当塑形，以7号丝线缝合乳房上部悬吊于第二肋骨骨膜，外环切口荷包缝合缩小后与内环切口间断缝合。结果：共为41例(81只乳房)患有乳腺增生症、乳腺纤维瘤、乳腺导管内乳头状瘤、乳腺导管扩张症等合并有乳房松垂者施行此类手术，所有病例术后乳房外形满意，切口瘢痕不明显。结论：乳晕双环切口切除乳腺病变组织及同期行松垂乳房悬吊术是一种设计合理、易于掌握、无明显瘢痕、外形满意的手术方式，值得推广应用。     

The effect of the anti-allergic agent avil on abnormal scar fibroblasts.

Abnormal wound healing in humans leads to the formation of hypertrophic scar and keloids. These abnormal scars accumulate excessive extracellular matrix proteins through increased synthesis as well as decreased degradation. In order to find a therapeutic control for scar formation, we investigated the effect of avil (pheniramine maleate) on fibroblasts cultured from abnormal scars in comparison to normal skin. We observed a decrease in the proliferation rate in cells from normal skin (39%), hypertrophic scar (44%), keloid (63%) and in DNA synthesis in cells from normal skin (50%), hypertrophic scar (55%) and keloid (63%) treated with 8 mM avil (72 h). The rate of decrease in collagen synthesis in normal skin (44%), hypertrophic scar (74%) and keloid fibroblast (73%) correlated with changes in DNA synthesis.     

Expression of apoptosis-associated genes by human dermal scar fibroblasts

The purpose of this study was to determine if aberrant apoptosis plays a role in pathologic wound healing as manifested by hypertrophic scarring and keloid formation. Apoptosis has recently been found to participate in the transition between granulation tissue and the development of definitive scar. The question that remains to be answered is what stimuli initiate apoptosis during wound healing. Hitherto, regulatory factors and pathways involved have been largely undefined. We investigated heterogeneity among fibroblasts derived from normal skin and keloid scar, by examining apoptotic profiles and pathways for these cells. Quantitative analysis of apoptotic cells using an Annexin-V-FITC binding assay showed that normal skin fibroblast cultures were found to have a two-fold higher percentage of apoptotic cells than did keloid fibroblast cultures. To study apoptotic pathways and related death-associated genes, a ribonuclease protection assay was performed for fibroblasts exposed to anti-Fas antibody and tumor necrosis factor-alpha to activate the Fas/TNF receptor apoptotic pathway. Compared with normal skin fibroblasts, keloid fibroblasts exhibited decreased expression of apoptosis-associated genes.     

眼袋整复术350例体会

复习下睑局部解剖，探讨眼袋的解剖学原因，寻求较满意的手术方法，为眼袋整复积累临床经验。方法：对350例患者进行眼袋整复术，根据不同患者下睑局部解剖结构特点，采用皮肤径路法或下睑结膜径路法进行手术。结果：12例因眶脂去除不够，经再次手术后获得满意结果；8例术后下睑轻度外翻，3～6个月均自行恢复正常；其余效果均满意。结论：眼袋整形手术的效果与下睑局部解剖结构特点有密切的关系。     

增生性瘢痕和瘢痕疙瘩P53基因多态性的分析

目的 探讨p53基因codon-72部位的多态性分布是否与增生性瘢痕及瘢痕疙瘩的易发性有关。方法 以日本医科大学整形外科行手术治疗患者的切除瘢痕标本为材料，利用限制性片段长度多态性分析法(RFLP)及DNA序列分析法(DNA-sequence)，对54例瘢痕疙瘩标本和30例增生性瘢痕标本的p53基因codon-72部位编码精氨酸(Arg)和脯氨酸(Pro)的等位基因CGC(Arg)和CCC(Pro)进行了分析。结果 与正常日本人群外周血p53基因codon-72部位的多态性频度分布相比，瘢痕疙瘩差异无显著性，而增生性瘢痕则差异有显著性。此外，由穿耳孔所致的耳部瘢痕疙瘩CGC(Arg)基因型显著增高。结论 推测p53codon 72部位具有CGC／CGC(Arg／Arg)纯合型者耳部瘢痕疙瘩的发生率明显增高，具有CCC／CCC(pro／pro)纯合型者增生性瘢痕发生率增高。     

Double‐edged effects of neuropeptide substance P on repair of cutaneous trauma

To explore further the role of substance P (SP) in wound healing and scar formation, SP concentrations in wounds of scalded rats were assayed. Expressions of apoptosis‐associated genes in fibroblasts cultured with SP were detected. SP concentrations in superficial wounds increased earlier than those in deep wounds. SP was associated with an increased proliferation and a decreased apoptosis of fibroblasts. It had a greater influence on keloid fibroblasts than on hypertrophic scar fibroblasts by elevating the expression of proliferating cell nuclear antigen and BCL‐2 in fibroblasts. Spantide completely suppressed the effects of SP on hypertrophic scar fibroblasts, and partly inhibited its effects on keloid scar fibroblasts. SP may play an important role in wound healing by promoting wound fibroblast proliferation and inhibiting apoptosis. It may also participate in pathological scar formation by modulating the expression of apoptosis‐associated genes. SP is postulated to play a dual role in wound repair.