胸前瘢痕疙瘩次全切除临床观察

我科自1996至1999年采用保留瘢痕边缘的次全切除术，术后给予康宁克通A局部预防注射治疗瘢痕疙瘩共28例，疗效较好。现报道如下。 1　临床资料 　　本组28例，男7例，女21例；病史2年至21年。年龄15～52岁。胸前部26例，右耳后1例，左肩背部1例。其中10例为术后复发再次手术，患者均无明显外伤史，瘢痕疙瘩面积最小为7.5cm2，最大为63cm2，外形欠规则。 2　手术方法 　　全部病例采用局部浸润麻醉，术前美蓝画线，沿瘢痕周围作切口，留边缘瘢痕约0.5cm，于瘢痕深部与脂肪组织交界平面锐性切除，范围在2cm宽以内的条状瘢痕切除后分离创缘两侧，分层无创、无张力缝合。本组采用直接缝合法共10例。瘢痕范围较大，不能直接缝合的行全厚皮移植、打包包扎固定，本组植皮病例18例。     

耳部瘢痕疙瘩的序列综合治疗

目的:探讨耳部瘢痕疙瘩按照外科手术、术后放疗、药物注射的序列进行综合治疗的疗效。方法:对39例(50侧)耳部瘢痕疙瘩病例,根据瘢痕疙瘩的大小、位置、浸润范围,对直径小于1.0cm的采用梭形切除后直接拉拢缝合;对直径为1.0~3.0cm的在切除后采用局部推进皮瓣进行修复;对直径大于3.0cm的巨大瘢痕疙瘩,采用瘢痕内核切除保留瘢痕表皮形成瘢痕皮瓣进行修复。然后所有病例在手术后24h内进行第一次放射治疗,每次剂量3Gy,每天1次,连续5~7d,总剂量15~21Gy,1周后拆线,每月电话随访一次。对随访中发现的有复发倾向者行激素类药物瘢痕内注射治疗,每周1次,总计4次。最后根据刘文阁等疗效标准判定疗效。结果:术后所有患者切口均Ⅰ期愈合,局部皮瓣全部成活。34例(44侧)随访1年,达到临床治愈,临床治愈率为87.18%;5例(6侧)术后有复发倾向者,切口局部注射"曲安奈德注射液"后未见复发。结论:耳部瘢痕疙瘩采用手术切除加术后早期放疗,再结合药物注射的序列综合治疗,可明显降低复发率,取得满意效果。     

手术切除联合多种方法治疗耳廓瘢痕疙瘩的临床观察

目的:观察手术切除耳廓瘢痕疙瘩后分别联合浅层X线放疗,切口内皮下注射糖皮质激素以及弹性鼻夹加压疗法治疗耳廓瘢痕疙瘩的疗效。方法:纳入耳垂瘢痕疙瘩患者150例,男26例,女124例,年龄6~51岁,平均年龄31.2岁,分为放疗组,注射组,加压组,每组各50例。手术方案:根据患者耳廓瘢痕具体特点,选择瘢痕整体切除直接缝合或局部皮瓣修复,瘢痕疙瘩核切除瘢痕瓣修复等方式以恢复耳廓外观形态。术后联合治疗方案:放疗组采用浅层X线放疗,单次剂量200 CGy,连续3d,1次/d,术后24h内进行第一次放疗,总剂量600CGy;注射组在切口缝合前在切口两侧皮下分别注射得宝松1次;加压组在拆线后使用弹性鼻夹加压手术切口3月。结果:三组病例术后切口均未出现感染迹象,外观基本正常。放疗组1例患者出现伤口延迟愈合,延迟拆线后外观正常。随访观察0.5~3年,放疗组4复发,注射组5例复发,加压组8例复发,在持续性外用硅酮膜和得宝松皮损内注射后消退。结论:手术切除瘢痕疙瘩或行瘢痕疙瘩核切除后配合浅层X线放疗,切口内糖皮质激素注射,弹性鼻夹加压治疗耳部瘢痕疙瘩疗效较为满意。可根据具体情况选择不同的方式联合进行。     

耳部瘢痕疙瘩综合治疗的临床分析

目的评价耳部瘢痕疙瘩手术后联合放射治疗及局部注射激素类抗瘢痕药物治疗的临床效果。方法采用手术切除直接缝合或转移皮瓣修复术，术后1周内行放射治疗，每日1次，连续照射3次，每次剂量5Gy，总剂量15Gy。对有复发倾向者行局部注射激素类抗瘢痕药物，以曲安奈德40mg加2％利多卡因稀释一倍后瘢痕内注射，每周1次，视瘢痕消退情况逐渐撤药。结果本组10例患者，术后随访1．5～5．0年，治愈6例（6096），显效4例（4096），有效率10096。结论手术联合放射治疗及局部注射激素类抗瘢痕药物是治疗耳部瘢痕疙瘩的有效方法。     

综合治疗躯干部瘢痕疙瘩50例临床分析

目的：探讨综合方法治疗躯干部瘢痕疙瘩的疗效。方法：50例患者,位于躯干部的瘢痕疙瘩共60处,手术直接切除或埋置扩张器II期切除后采用皮下改良减张缝合,术后24h内即开始接受电子线照射治疗,总量15～20Gy,拆线后局部使用硅凝胶6个月。结果：59处切口I期愈合（98.3%）。切口隆起处在术后2～3个月左右开始变平,12个月左右基本平复。经1年定期随访观察,仅1处复发（1.7%）,治愈率达98.3%。结论：手术切除瘢痕疙瘩后采用皮下改良减张缝合,可以充分降低切口处的张力,同时联合术后早期电子线照射以及局部使用硅凝胶等方法,可以有效降低躯干部瘢痕疙瘩的复发率,值得临床推广。     

耳部瘢痕疙瘩个体化的综合治疗

目的 探讨耳部瘢痕疙瘩手术切除方式和术后放疗等综合治疗的疗效. 方法 2000年1月-2005年12月收治42例(71侧) 耳部瘢痕疙瘩患者.男8例,女34例;年龄16～50岁,平均26.2岁.病程6个月～4年.穿耳孔32例,创伤7例,耳部病变手术3例.瘢痕疙瘩范围 0.3 cm × 0.3 cm×0.2 cm～6.0 cm×4.0 cm×1.0 cm,形状呈球形、哑铃形、结节形.根据瘢痕疙瘩不同大小和范围,选择不同术式,切除瘢痕并行缺损修复.术后24 h内,高能电子束照射 10 次,每次2 Gy,总剂量20 Gy,对有复发倾向者,及时行"得宝松"1 mg 及 2%利多卡因按1∶3 混合液局部瘢痕内注射3次,每3周1次. 结果 术后患者切口均Ⅰ期愈合,皮瓣均成活.37例(64侧)获随访 1 年,获临床治愈;5 例(7侧)于术后3～6个月有复发倾向,及时局部注射"得宝松"后未见复发.根据刘文阁等疗效标准判定治愈37例,显效5例. 结论 耳部瘢痕疙瘩尽早采用个体化手术方式,结合早期放疗,可取得满意效果,是治疗的选择方案之一.     

耳部瘢痕疙瘩综合治疗的临床分析

目的 评价耳部瘢痕疙瘩手术后联合放射治疗及局部注射激素类抗瘢痕药物治疗的临床效果. 方法 采用手术切除直接缝合或转移皮瓣修复术,术后1周内行放射治疗,每日1次,连续照射3次,每次剂量5Gy,总剂量15Gy.对有复发倾向者行局部注射激素类抗瘢痕药物,以曲安奈德40mg加2%利多卡因稀释一倍后瘢痕内注射,每周1次,视瘢痕消退情况逐渐撤药. 结果 本组10例患者,术后随访1.5～5.0年,治愈6例(60%),显效4例(40%),有效率100%. 结论 手术联合放射治疗及局部注射激素类抗瘢痕药物是治疗耳部瘢痕疙瘩的有效方法.     

复发性瘢痕疙瘩手术切除减张缝合联合电子线照射的临床疗效观察

目的探讨复发性瘢痕疙瘩再次手术切除减张缝合联合电子线照射的临床效果。方法选择2016年5月至2019年8月在运城市中心医院整形外科治疗的术后复发的瘢痕疙瘩患者,行再次手术切除,切口两侧皮下广泛剥离,对创面张力过大无法缝合的患者行局部皮瓣转移修复,皮下采用2-0~4-0的PDSⅡ缝线以"心"形缝合技术减张缝合,皮肤采用6-0或7-0的Prolene缝线间断缝合,伤口外贴3M拉力胶带减张。术后6 h内及术后1周分别行电子线照射治疗,每次8 Gy,总剂量16 Gy。拆线后外用拉力胶带、硅凝胶瘢痕贴及弹力套压迫,定期复查,观察患者瘢痕宽度及增生程度,根据瘢痕美容评估与评级量表评价治疗效果(0~15分,得分越高瘢痕越严重)。结果共选择36例术后复发的瘢痕疙瘩患者,男28例,女8例,年龄17~68岁,平均42.5岁。所有患者术后切口均一期愈合,随访18~36个月,均未见瘢痕疙瘩复发。患者术后半年瘢痕美容评估与评级量表评分最高4分,最低0分。结论手术切除瘢痕疙瘩,术中减张缝合以降低创缘两侧的张力,术后联合电子线照射治疗,是治疗复发性瘢痕疙瘩的一种有效方法。     

瘢痕切除即刻局部注射曲安奈德联合放疗治疗耳廓瘢痕疙瘩疗效观察

目的:探讨手术切除,术中曲安奈德局部注射,术后放疗联合治疗耳廓瘢痕疙瘩的效果。方法:将病例分为三组:第一组:12例,24个瘢痕疙瘩(手术+曲安奈德注射+放疗),手术切除瘢痕疙瘩,术中注射醋酸曲安奈德,注射剂量依切缘大小而异,每次注射量不大于40mg,术后每周1次,连续4～8次,术后24h内行局部浅层放疗3天;第二组:11例,22个瘢痕疙瘩(手术+放疗),手术切除瘢痕疙瘩,术后24h内行放疗3天;第三组:17例,23个瘢痕疙瘩(手术+曲安奈德注射),手术切除瘢痕疙瘩,术中即刻注射曲安奈德,术后每周1次,连续4～8次。结果:第一组、第二组、第三组有效率分别为95.83%、77.27%、52.17%。第一组与第二组、第三组比较有显著差异(P<0.05)。结论:手术切除,术中曲安奈德局部注射联合术后放疗治疗耳廓瘢痕疙瘩副作用小、复发率低,值得临床应用。     

手术切除联合浅层X线放疗在瘢痕疙瘩治疗中的应用

目的 观察手术联合浅层X线放疗在瘢痕疙瘩中的治疗效果。方法 共200例瘢痕疙瘩患者,其中瘢痕疙瘩直径10 cm以下166例(83%),直径10 cm以上34例(17%);病程5年68例(29%)。采取手术切除后立即照射121例(60.5%),拆线后照射58例(29%),切口痊愈后照射21例(10.5%)。所有患者放疗后均随访2年,观察瘢痕大小、病程长短、术后不同时间点进行放疗对疗效的影响。结果 本组患者2年内复发31例(15.5%),总有效率80%以上。术后立即照射及拆线后照射的有效率分别为97%及90%,切口痊愈后照射的治疗有效率为58%。直径10cm以下瘢痕疙瘩复发率6.63%,直径10cm以上的瘢痕疙瘩复发率23.5%。病程5年的复发率为11.7%。本组中仅有1例发生放射性溃疡(0.5%),未见放射性皮炎等其他严重并发症。结论 瘢痕疙瘩手术切除联合浅层X线放疗是一种安全的治疗方式,疗效明显。术后即刻或拆线后立即开始放疗可有效降低复发率,小面积或短病程的患者疗效更为明显。     

A Review of the Biologic Effects, Clinical Efficacy, and Safety of Silicone Elastomer Sheeting for Hypertrophic and Keloid Scar Treatment and Management

Silicone elastomer sheeting is a medical device used to prevent the development of and improve the appearance and feel of hypertrophic and keloid scars. The precise mechanism of action of silicone elastomer sheeting has not been defined, but clinical trials report that this device is safe and effective for the treatment and prevention of hypertrophic and keloid scars if worn over the scar for 12 to 24 hours per day for at least 2 to 3 months. Some of the silicone elastomer sheeting products currently on the market are durable and adhere well to the skin. These products are an attractive treatment option because of their ease of use and low risk of adverse effects compared to other treatments, such as surgical excision, intralesional corticosteroid injections, pressure therapy, radiation, laser treatment, and cryotherapy. Additional controlled clinical trials with large patient populations may provide further evidence for the efficacy of silicone elastomer sheeting in the treatment and prevention of hypertrophic and keloid scars. The purpose of this article is to review the literature on silicone elastomer sheeting products and to discuss their clinical application in the treatment and prevention of hypertrophic and keloid scars.     

Prevention of Hypertrophic Scars and Keloids by the Prophylactic Use of Topical Silicone Gel Sheets Following a Surgical Procedure in an Office Setting

BACKGROUND: Topical silicone gel sheeting has been used for more than 20 years to help reduce the size of hypertrophic scars and keloids. Its clinical efficacy and safety is well established. OBJECTIVE: To determine whether topical silicone gel sheeting can be used to prevent hypertrophic scars and keloids from forming following dermatologic skin surgery. METHODS: Patients undergoing skin surgery were stratified into two groups: those with no history of abnormal scarring (low-risk group) and those with a history of abnormal scarring (high-risk group). Following the procedure, patients within each group were randomized to receive either routine postoperative care or topical silicone gel sheeting (48 hours after surgery). Patients were followed for 6 months. RESULTS: In the low-risk group, there were no statistical differences between individuals using routine postoperative care or using topical silicone gel sheets. In the high-risk group, there was a statistical difference (39% versus 71%) between patients who did not develop abnormal scars and used topical silicone gel sheeting and patients who developed abnormal scars after routine postoperative treatment. Those individuals having a scar revision procedure also showed a statistical difference if topical silicone gel sheeting was used following surgery. CONCLUSION: Topical silicone gel sheeting, with a 20-year history of satisfaction in dermatology, now appears to be useful in the prevention of hypertrophic scars and keloids in patients undergoing scar revision.     

Comparison of a Silicone Gel-Filled Cushion and Silicon Gel Sheeting for the Treatment of Hypertrophic or Keloid Scars

BACKGROUND: The exact mechanisms of action responsible for the effectiveness of silicone gel dressings are unknown, although it has been proposed that static electricity generated by friction could be the reason for their anti-scarring effects. OBJECTIVE: We compared the efficacy of a cushion of silicone filled with liquid silicone gel reported to induce greater negative static-electric charge with silicone gel sheeting in the treatment of hypertrophic and keloid scars. METHODS: The size, volume, symptoms (tenderness and itching), and signs (color and induration) of hypertrophic (10 patients) or keloid scars (22 patients) were measured at baseline at 16 weeks following use of either the silicone gel cushion or silicone gel sheeting, as determined by random assignment. RESULTS: Both the silicone gel cushion and the silicone gel sheeting treatments were effective in decreasing scar volume, 53.0% and 36.3%, respectively. The percentages of keloids and hypertrophic scars benefiting from the silicone cushion and the silicone sheeting were similar with respect to reduction in tenderness (36.3% vs 33.3%), itching (45.5% vs 33.3%), and redness (0.1% vs 0.1%), and in the degree of softening (45.5 vs 25.0%). CONCLUSIONS: Both the silicone gel cushion and the silicone gel sheeting treatments were effective in the treatment of keloids and hypertrophic scars, although no statistically significant differences were found between the two treatment modalities.     

双侧反向半圆形皮瓣在治疗圆形瘢痕疙瘩中的应用

目的：探讨修复圆形瘢痕疙瘩手术的新方法。方法：采用双侧反向半圆形皮瓣修复圆形瘢痕疙瘩切除后遗留缺损,术后联合应用局部放射治疗和硅凝胶敷贴综合治疗12例。结果：创面修复满意,随访18～24个月,11例有效,1例胸前瘢痕复发。结论：双侧反向半圆形皮瓣技术是修复圆形瘢痕疙瘩有效和理想的方法。     

原位缝合结合负压封闭引流治疗手及前臂皮肤逆行撕脱伤

目的探讨原位缝合结合负压封闭引流（vacuum sealing drainage。VSD）治疗手或前臂皮肤逆行撕脱伤的临床疗效。方法对2012年3月-2013年3月收治的10例手或前臂皮肤逆行撕脱伤患者,共计11处逆行撕脱皮肤（其中1例为手掌和手背2处逆行撕脱伤）,根据每例逆行撕脱皮肤局部血运情况,分别采取不同的手术方法。其中,3处采取对整块逆行撕脱皮肤原位缝合后辅以VSD治疗（原位缝合组）;2处采取对整块逆行撕脱皮肤反取植皮并辅以VSD治疗（反取植皮组）;其余6处分别同时进行了原位缝合辅以VSD治疗和反取植皮辅以VSD治疗方法,即对每处逆行撕脱的皮肤一部分进行原位缝合（原位缝合组,6处）,另一部分进行反取植皮（反取植皮组,6处）。因此,研究对象包括原位缝合组（3＋6）处和反取植皮组（2＋6）处,共计17处逆行撕脱皮肤。比较两组术后的皮肤功能。结果术后所有逆行撕脱皮肤均成活,全部患者均获2-6个月随访。平均3．7个月。原位缝合组皮肤感觉：S3＋5处,S33处,S21处;反取植皮组皮肤感觉：S22处,S16处。原位缝合组皮肤在外观、耐磨度上均优于反取植皮组。结论原位缝合结合VSD治疗手及前臂皮肤逆行撕脱伤临床效果好．术中应尽可能保留有血运、适合原位缝合的皮肤及皮下组织。     

外用罂粟碱抑制植皮片术后挛缩的实验研究

目的探讨外用罂粟碱霜对自体游离植皮片术后晚期挛缩的影响。方法在每头小型猪背部两侧皮肤制备10个2cm×2cm创面,从动物腹部正中取2cm×2cm的断层皮片并植于背部创面上,术后2周拆线,取同一动物身上100%成活且位置恰好左右侧相对的植皮片共12对,按左右侧分成A(罂粟碱治疗组)、B(空白霜剂对照组)2组,自拆线之日起,A组每日在植皮片表面外涂2%罂粟碱霜2次,B组仅涂抹空白对照霜剂,最后观察两组植皮片成活后1、2、3、4、5、6个月收缩率及植皮片成活后6个月时的组织学差异。结果A组植皮片收缩率较B组明显降低,两组之间差异有显著性意义(P<005)。组织切片显示A组植皮片成纤维细胞较B组明显减少,微血管数量较B组数量多,两组之间差异有显著性意义(P<005)。结论外用罂粟碱霜剂能够抑制自体游离植皮片术后挛缩,提高植皮效率。     

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.     

耳部瘢痕疙瘩切除后减张及抗瘢痕治疗防止复发的疗效分析

目的：探讨耳部瘢痕疙瘩的治疗方法;方法：手术切除耳部瘢痕疙瘩后减张缝合＋伤口胶固定十硅酮凝胶,部分病例配合注射曲安奈德。结果：共治疗38例,失访6例,32例随访12个月,其中治愈27例（84．3％）,未界定3例（9．3％）,复发2例占随访病例6．2％。结论：耳部瘢痕疙瘩切除术后减张缝合＋伤口胶固定＋硅酮凝胶保水是综合治疗耳部瘢痕疙瘩防止复发的有效方法。     

皮肤减张器联合LBD缝合技术治疗瘢痕疙瘩的临床效果

目的 探究皮肤减张器结合LBD缝合技术在瘢痕疙瘩患者中的应用效果。方法 选取2021年 1月-2022年2月我院收治的100例瘢痕疙瘩患者为研究对象,随机分为对照组和观察组,每组50例。对照组 采用手术切除联合LBD缝合技术及浅层放疗,观察组采用皮肤减张器联合LBD缝合技术,比较两组临床疗 效、瘢痕评分及瘢痕宽度。结果 观察组治疗总有效率为98.00%,高于对照组的74.00%（P ＜0.05）;观察 组术后3、6、12、24个月VSS评分均低于对照组（P ＜0.05）;观察组术后3、6、12、24个月瘢痕宽度均小 于对照组（P ＜0.05）。结论 皮肤减张器联合LBD缝合技术治疗瘢痕疙瘩的效果良好,可提高治疗总有效 率,有效减轻瘢痕增生程度,缩小瘢痕宽度,值得临床应用。