术前注射和术中瘢痕核心切除术联合术后放疗治疗耳部瘢痕疙瘩20例临床观察

目的观察耳部瘢痕疙瘩术前注射和核心切除术联合术后放疗的临床疗效和安全性。方法将入选的40例耳部瘢痕疙瘩患者随机分为两组,各20例。治疗组:术前2个月和术前1个月时分别局部注射曲安奈德及得宝松各1次,以使瘢痕疙瘩呈萎缩趋势。术中行瘢痕疙瘩核心切除术,以保留部分瘢痕皮肤形成组织瓣来修复缺损皮肤,术后18h时予6Mev电子线照射(400cGy/次,1次/d,连续4天,总剂量1 600cGy)。对照组:不行术前注射,余同治疗组。两组患者均随访6~30个月。结果治疗组:治愈18例,有效2例;对照组:治愈11例,有效7例,复发2例,两组患者疗效差异有统计学意义(P=0.0390.05)。随访期内患者均未见皮肤萎缩或恶性肿瘤等并发症。结论术前注射和术中瘢痕核心切除术联合术后放疗治疗耳部瘢痕疙瘩临床疗效显著,安全可靠,值得临床医生应用。     

微型环钻切除术联合电子线治疗下颌瘢痕疙瘩36例疗效观察

目的:探讨微型环钻切除术联合电子线在下颌瘢痕疙瘩中的疗效。方法:回顾性分析2017年9月至2019年3月于第四军医大学西京皮肤医院进行微型环钻切除术联合电子线治疗的下颌瘢痕疙瘩患者36例,男16例、女20例,平均年龄23.80岁,中位病程32个月。分别于术前和术后12个月评估瘢痕疙瘩严重程度评分,采用配对 ...     

瘢痕旁和瘢痕下扩张器埋植治疗17例胸部瘢痕疙瘩

目的 探讨瘢痕旁和瘢痕下扩张器埋植治疗前胸部大面积瘢痕疙瘩的疗效。方法 从2006年3月至2009年6月,17例前胸部大面积瘢痕疙瘩患者共接受21个扩张器埋植。瘢痕面积最大15.7 cm × 5.5 cm,最小4.5 cm × 3.0 cm。其中瘢痕旁埋植12个,瘢痕下埋植9个。瘢痕旁埋植扩张器容量70 ~ 400 ml,瘢痕下埋植80 ~ 500 ml。经6 ~ 8周注水扩张后,行瘢痕疙瘩切除、扩张器取出和扩张皮瓣转移术,同时给予术中即时皮内注射复方倍他米松注射液、术后浅表电子束照射联合治疗,随访12 ~ 50个月。结果 除1个扩张器瘢痕下埋植后感染导致提前取出手术失败外,余20个扩张器均顺利完成整个治疗过程。主要并发症为扩张器外露4个,其中瘢痕旁1个,瘢痕下埋植3个,但未影响二期手术。扩张不满意2个,其中瘢痕旁和瘢痕下各1个。除2例复发外,余15例自觉症状均明显缓解,效果满意。2例复发患者均为扩张不满意,缝合时切口张力较大、且术后延期拆线者。结论 瘢痕旁和瘢痕下扩张器埋植为治疗前胸部大面积瘢痕疙瘩的较为理想的选择方法。切口缝合的张力是决定瘢痕疙瘩术后是否复发的关键。     

手术切除联合注射得宝松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得宝松加术后早期放射治疗瘢痕疙瘩的疗效。方法 125例患者随机分为对照组和治疗组,对159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得宝松,术后24 h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,治疗组显效率为86.2%,与对照组58.3%相比较差异有统计学意义P0.05。结论手术切除瘢痕疙瘩,术中注射得宝松加早期术后放疗能够有效提高瘢痕疙瘩的显效率。     

手术联合术后早期放疗治疗瘢痕疙瘩

目的　观察手术联合术后早期放疗治疗瘢痕疙瘩的临床效果。方法　瘢痕疙瘩 35例 ,采用瘢痕疙瘩切除缝合或植皮 ,术后 2 4h内行放射治疗 ,总剂量为 16～ 2 0Gy ,1～ 2周内分 4～ 5次照射。结果　术后随访 7个月～ 4年 ,治愈 2 7例 ( 77.1% ) ,显效 5例 ( 14 .3 % ) ,进步 3例 ( 8.6 % ) ,有效率 91.4% ( 32 /35 )。结论　手术联合术后早期放疗是治疗瘢痕疙瘩的有效方法。     

瘢痕内切除术联合术后放疗治疗瘢痕疙瘩37例疗效观察

瘢痕疙瘩是皮肤创伤后成纤维细胞活性异常增高、胶原大量增生而导致的瘢痕过度生长且超出原有损害范围的一种良性增生性疾病,单纯手术切除治疗的复发率较高.本科自2006年1月～2008年5月采用瘢痕内切除术联合术后放疗治疗瘢痕疙瘩37例患者,取得了满意疗效,现报告如下.     

皮肤软组织扩张术治疗瘢痕疙瘩临床观察

自2003年6月以来,我们应用皮肤软组织扩张术治疗瘢痕疙瘩9例,术后给予曲安奈德局部注射,疗效比较满意,报告如下。1临床资料本组9例,女性6例,男性3例,年龄19～46岁。病史3～25年。胸前部瘢痕7例,肩背部瘢痕2例。瘢痕最大面积为49cm2,最小面积18cm2,外形均为不规则形,宽度均大于2.5cm。2方法与结果2.1扩张器置入术在瘢痕边缘选择长边设计切口线,切口一般设计在瘢痕缘内3mm左右。扩张器大小及个数可根据瘢痕的大小及部肾形扩张器。置入扩张器后,扩张器内注入自身容量5%～10%生理盐水,7～12天拆线,拆线后间断注入生理盐水,每周注水2～3次,每次注…     

手术切除联合局部注射曲安奈德加放疗治疗瘢痕疙瘩46例

目的：观察手术切除结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：对46例63处瘢痕疙瘩行手术切除，术中对靠近切缘1cm处皮肤真皮内注射曲安奈德，术后24小时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12-28月，治愈53处病损，有效8处病损，无效2处病损，总有效率96．83％。结论：术中注射曲安奈德加早期术后放疗是治疗瘢痕疙瘩的有效方法。     

瘢痕疙瘩术后联合放射治疗的研究新进展

瘢痕疙瘩(keloid)是皮肤美容外科常见病、多发病之一,治疗方法很多,但疗效均不甚满意。研究认为,目前术后联合放射治疗是难治性瘢痕疙瘩最安全有效的方法,很大程度地降低了其复发率。但对于术后射线种类、放射时机、总剂量及分割剂量、疗程等尚无统一标准,现就瘢痕疙瘩术后联合放射治疗的研究作一综述。     

瘢痕疙瘩发病机制及术后放疗研究进展

目前研究表明遗传、伤口张力、感染、内分泌因素等均可导致瘢痕疙瘩的发生和发展。单一治疗瘢痕疙瘩的效果不能令人满意，应多种方法联合治疗，手术切除联合放疗是治疗瘢痕疙瘩较有效的方案之一。本文就近年来瘢痕疙瘩的发病机制及术后放疗作一综述。     

Contour first—retrospective study of an algorithmic approach of auricular keloids

Background

Auricular keloids are difficult to treat, and recurrent keloids are more aggressive and more likely to develop aural deformities. Surgical excision, injections, or radiotherapy alone have high recurrence rates. An algorithmic approach of auricular keloid remains to be explored.

Aims

To investigate the sequential treatment protocol for the treatment of auricle keloids to maintain auricle morphology and reduce the postoperative recurrence rate.

Patients/Methods

A retrospective analysis of 42 patients who attended the scar minimally invasive treatment center of the Hospital of Plastic Surgery, Chinese Academy of Medical Sciences for serial treatment from January 2019 to June 2021. According to the size and involvement of the keloid, the core excision of the scar was excised under the condition of ensuring the priority of the auricular contour, and the scar flap was repaired to reconstruct the auricular appearance, and electron beam treatment was performed within 24 h after the operation, ray energy: 6–7 MeV, dose: Dt18Gy/2f; regular trimethoprim combined with 5-Fu injection treatment and the application of silicone ear clips for local compression treatment were performed 1 month after the operation.

Results

Thirty-five patients were followed up from 12 to 40 months after surgery, and three of them showed a tendency of recurrence, and early local treatment with trimethoprim and 5-Fu injection achieved favorable results.

Conclusion

A standardized and sequential treatment plan for keloids with different morphology and anatomical locations can achieve remodeling of the auricular morphology and maintain long-term results.     

Postoperative electron beam radiotherapy for keloids: objective findings and patient satisfaction in self-assessment

AIM: To evaluate the role of postoperative radiotherapy in the management of keloids. METHODS: Forty-seven patients with a combined total of 60 keloids were treated with 6-MeV electron beam radiotherapy after surgical excision of the keloids. Mean daily fractions of 4 Gy (range, 3-5 Gy) were administered up to a total dose of 16 Gy (range, 12-18 Gy). The median follow-up was 70 months. Patients were asked to complete a questionnaire addressing their satisfaction with the treatment results. This self-assessment was compared with the clinical outcome. RESULTS: Four keloids (7%) relapsed completely, and five recurrences (8%) were classified as limited relapses. All recurrences were observed at sites of high stretch-tension. Keloid-associated symptoms, e.g. itching and pain, were improved in 81%. Hypopigmentation was observed in 29 patients (62%), a mild redness of the scar in eight patients (17%), and grade 1 telangiectasias in two patients (4%). No severe complications or secondary malignancies were observed. Self-assessments did not fully correspond to the clinical examination and recurrence status. Twelve patients were not satisfied with the treatment result, but only two of these relapsed completely. Three relapsed patients described the result of therapy as excellent or good. CONCLUSION: Postoperative electron radiotherapy is well tolerated and very effective in preventing keloid recurrence. To avoid an overestimation of cosmetic outcome, patients should be informed about achievable results before therapy starts.     

瘢痕疙瘩的治疗

瘢痕疙瘩发病机制不明,治疗比较困难,临床多采用综合疗法。外科手术切除联合放射治疗,或者联合瘢痕内注射糖皮质激素是治疗瘢痕疙瘩的一线疗法。放疗通常有浅层x线、电子束,其致癌性通常较小。硅凝胶片和压力疗法通常作为基础性辅助治疗,对不同病期的瘢痕疙瘩均有一定疗效,表现为瘢痕变软、变平,主观症状得到改善。抗瘢痕疙瘩药物主要包括积雪草苷和α-积雪草苷乳膏、5％咪喹莫特乳膏等。基因治疗和某些生物制剂可能是瘢痕疙瘩治疗的发展方向。个性化评估瘢痕疙瘩患者的病情,综合运用以上治疗方法可以较好地减轻皮损。     

瘢痕疙瘩的治疗

瘢痕疙瘩发病机制不明,治疗比较困难,临床多采用综合疗法.外科手术切除联合放射治疗,或者联合瘢痕内注射糖皮质激素是治疗瘢痕疙瘩的一线疗法.放疗通常有浅层X线、电子束,其致癌性通常较小.硅凝胶片和压力疗法通常作为基础性辅助治疗,对不同病期的瘢痕疙瘩均有一定疗效,表现为瘢痕变软、变平,主观症状得到改善.抗瘢痕疙瘩药物主要包括积雪草苷和α-积雪草苷乳膏、5%咪喹莫特乳膏等.基因治疗和某些生物制剂可能是瘢痕疙瘩治疗的发展方向.个性化评估瘢痕疙瘩患者的病情,综合运用以上治疗方法可以较好地减轻皮损.

Abstract：

The pathogenesis of keloids remains obscure, and its treatment is troublesome.Comprehensive therapy is usually applied for its management in clinical settings.Surgical removal combined with radiotherapy or intralesional glucocorticoids is the first-line treatment for keloids.Radiotherapy, which includes superficial X ray therapy, electron beam therapy, etc, often has little carcinogenicity.Sillicon gel sheet and pressure therapy usually serve as the basic adjunctive treatment of keloids, which can soften and flatten keloids and improve subjective symptoms and have shown favorable efficacy in all stages of keloids.Effective drugs for keloids mainly include asiaticoside, alpha asiaticoside cream, imiquimod 5% cream, etc.Gene therapy as well as biological preparations may have an inviting prospect for the management of keloids.Satisfactory outcomes may be achieved by combined modality therapy with the above regimens following individual evaluation of eonditions in patients with keloids.     

Recurrent plantar keloid.

Keloids of the plantar foot present a unique challenge to the surgical dermatologist. Many of the established regimens often fall short of their desired goals. Some of the obstacles to overcome include the repetitive nature of ambulation, the inability to primarily close the plantar foot, and the exquisite tendency for even fine suturing of skin grafts to form keloids. The use of excision, postoperative electron beam therapy, and secondary intention healing provides a useful approach in the management of plantar keloids.     

【开放获取】局部皮瓣联合修复鼻及鼻周Mohs显微外科手术后较大缺损11例效果分析

【摘要】 目的 探讨局部皮瓣联合应用修复鼻及鼻周非黑素瘤皮肤癌Mohs显微外科手术后较大缺损的效果及优势。方法 2018年3月至2020年11月,于河北医科大学第二医院皮肤科收集行Mohs显微外科切除术后应用局部皮瓣联合修复的11例鼻及鼻周非黑素瘤皮肤癌患者。 根据术后缺损部位及大小,遵循鼻亚单位美学原则设计皮瓣进行修复,对于直接缝合或单个局部皮瓣无法覆盖的较大缺损,联合应用风筝皮瓣、改良菱形皮瓣、鼻唇沟皮瓣、双叶皮瓣等局部皮瓣中2 ~ 3种皮瓣修复创面。结果 11例患者中,基底细胞癌10例,鳞状细胞癌1例,缺损面积2.0 cm × 2.3 cm～2.7 cm × 3.6 cm。经Mohs显微外科手术联合局部皮瓣修复后皮瓣均存活良好,未出现血运障碍,修复皮瓣质地、颜色、轮廓等与周围正常皮肤相近,缺损未见明显瘢痕。术后随访4 ~ 32个月,肿瘤无复发,患者对外观满意。结论 联合应用2 ~ 3种皮瓣修复鼻及鼻周非黑素瘤皮肤癌Mohs手术后的较大缺损,可保持鼻及鼻周正常形态结构和美学效果,达到满意的美容修复效果。     

肿胀麻醉联合皮肤软组织扩张术修复先天性巨痣41例

目的:探讨肿胀麻醉联合皮肤软组织扩张术修复先天性巨痣的效果。方法:2015年7月至2019年12月在第四军医大学西京皮肤医院收集41例先天性巨痣患者,男24例,女17例,年龄7~45岁,皮损面积5 cm × 12 cm~12 cm × 18 cm;皮损位于头皮13例,面部18例,躯干10例。术前依据体重、手术时间、皮损...     

UVA1联合复方倍他米松注射液治疗瘢痕疙瘩疗效观察

目的探讨长波紫外线1(ultraviolet A1,UVA1)照射联合复方倍他米松注射液治疗瘢痕疙瘩的疗效。方法实验组予复方倍他米松注射液0.10~0.15mL/cm2于瘢痕皮损内注射,1次/月,同时予以UVA1照射,隔日1次,初始剂量46.8J/cm2,最大剂量93.6J/cm2;对照组仅予复方倍他米松注射液治疗。两组均连续治疗2~4月,治疗结束后10~12周时评价疗效。共随访9个月。结果治疗组总有效率(78.13%)显著高于对照组(62.16%),差异有统计学意义(P=0.043)。但治疗组有6例在大剂量照射时(78J/cm2)出现局部红肿等不良反应,而对照组无该现象。结论 UVA1联合复方倍他米松注射液治疗瘢痕疙瘩能显著促进其临床症状改善,但高剂量时可能具有一定的皮肤刺激反应。