Li Zong-yu, Su Hai-tao, Lu Shu-liang, Huang Li-bin, Yang Xin-bo, Shao Tie-bin, Li Yi-shu, Qu Bin, Wang Cheng-gang, Zhang Xiu-ying, Yang Shao-feng, Sun Jia-xin, Xu Bing-zhou, Sun Man, Xiang Jun
Department of Burns, The Fifth Hospital of Harbin, Harbin 150040, P.R. China.
Zhonghua Shao Shang Za Zhi. 2004 Dec;20(6):343-6.
To explore the influence of dermal defect and fat dome structure destruction in burn wounds on the formation of hyperplastic scar.
Fifty two wounds in 24 burn patients with deep partial thickness burn indicating tangential excision in the extremities were enrolled in the study, and they were divided into three groups according to the extent of exposure of dermal fat granules, i.e. A (without fat exposure), B (with little fat exposure) and C (with much fat exposure) groups. These three groups were subdivided into A1 (without grafting), A2 (grafting with razor thin skin), B1 (without grafting), B2 (with razor thin skin grafting), C1 (without grafting) and C2 (with split-thickness skin grafting) groups, with 9 wounds in each group. The dermal depth and exposure rate of the fat granules in each group were measured and analyzed by KS400 photography analysis apparatus. The follow-up conditions of the scars 6 months after operation were evaluated with Vancouver remark system by Vancouver score assessment.
There was obvious difference in the dermal depth and exposure rate of the fat granules among all the groups (P < 0.05 or 0.01). The fat exposure rate was positively correlated with the extent of the dermal defect (gamma = 0.554, P < 0.05). The Vancouver score in group A was lower than that in B and C groups (P < 0.05), while that in B1 group (3.714 +/- 2.498) was evidently higher than that in other groups (P < 0.01). The scar score was lowered when the wounds were grafted with the dermis with its thickness similar to the depth of the defect, The scar score was increased along with the elevation of fat exposure rate (P < 0.05).
There was a positive correlation between the degree of dermal defect and that of hyperplastic scar after burns. The disruption of fat dome structure might also be an important factor in the scar development.
探讨烧伤创面真皮缺损及脂肪球结构破坏对增生性瘢痕形成的影响。
选取24例需行四肢削痂术的深Ⅱ度烧伤患者的52个创面，根据真皮脂肪颗粒暴露程度分为三组，即A组（无脂肪暴露）、B组（少量脂肪暴露）和C组（大量脂肪暴露）。这三组又再分为A1组（未植皮）、A2组（刃厚皮片移植）、B1组（未植皮）、B2组（刃厚皮片移植）、C1组（未植皮）和C2组（中厚皮片移植），每组9个创面。采用KS400图像分析系统测量并分析各组真皮深度及脂肪颗粒暴露率。术后随访6个月，采用温哥华瘢痕评定系统进行温哥华评分评估瘢痕情况。
各组真皮深度及脂肪颗粒暴露率差异有统计学意义（P<0.05或0.01）。脂肪暴露率与真皮缺损程度呈正相关（γ=0.554，P<0.05）。A组温哥华评分低于B组和C组（P<0.05），而B1组（3.714±2.498）明显高于其他组（P<0.01）。用与缺损深度相似厚度的真皮植皮时瘢痕评分降低，瘢痕评分随脂肪暴露率升高而增加（P<0.05）。
烧伤后真皮缺损程度与增生性瘢痕程度呈正相关。脂肪球结构破坏可能也是瘢痕形成的重要因素。
