以皮肤软组织扩张术为主的综合疗法治疗胸部瘢痕疙瘩

目的:探讨和评价以皮肤软组织扩张术为主的综合疗法治疗瘢痕疙瘩的效果。方法:在瘢痕疙瘩周围正常皮肤的皮下置入皮肤软组织扩张器,定期对扩张器进行注水达到瘢痕疙瘩切除后的切口无张力缝合;Ⅱ期手术后24h辅以电子线照射、拆线后应用免缝胶布或免缝拉链对切口垂直方向减张、硅凝胶贴局部贴敷3个月至半年、术后根据个体瘢痕增生情况决定是否需行曲安奈德+玻璃酸酶注射抗瘢痕治疗、或几种疗法联合应用。取同一患者的胸部瘢痕疙瘩组织、正常皮肤组织、扩张的正常皮肤组织做病理学检查,观察其组织结构的不同之处,以探讨扩张后组织学的改变以及对治疗效果的影响。结果:20例患者中经随访时间最长4年,2例复发,治愈率90%。结论:通过皮肤软组织扩张术结合辅助治疗可明显降低瘢痕疙瘩切除术后的复发率,其可能的机制为:组织扩张后可减少切口的张力;扩张后局部组织结构发生了改变;能够彻底切除瘢痕疙瘩。

The comprehensive therapy for chest keloid based on skin soft tissue expansion

Objective To study the comprehensive therapy effect on chest keloid based on skin soft tissue expansion. Methods Step 1： place the expander next to the keloid, then inflation the expander with normal saline routinely. Step 2： take out the expander and remove the keloid, then close the defect without tension. Electron beam irradiation, triamcinolone acetonide injection, etc were chosen to taken after operation. Observe the histological character differences of normal chest skin, expanded chest skin and chest keloid. Probe into the mechanism how the expanding-therapy effect on curing keloid. Results Curative ratio was 90%. The longest follow-up case without recidivation was 4 years. Conclusion Comprehensive therapy for chest keloid based on skin soft tissue expansion could reduce the rate of keloid recidivation remarkably, and its possible mechanism is： decrease of the tension of incision, the histological change after tissue expanded and remove the keloid thoroughly.