Dunkin Christopher S J, Pleat Jonathon M, Gillespie Patrick H, Tyler Michael P H, Roberts Anthony H N, McGrouther D Angus
Aylesbury, United Kingdom From the Stoke Mandeville Burns and Reconstructive Surgery Research Trust, Stoke Mandeville Hospital.
Plast Reconstr Surg. 2007 May;119(6):1722-1732. doi: 10.1097/01.prs.0000258829.07399.f0.
The association between scarring and the depth of dermal injury or burn is clinically recognized but not quantified. The authors tested the hypothesis that there is a critical depth beyond which a fibrous scar develops.
A novel jig produced a wound that was deep dermal at one end and superficial dermal at the other. Pilot studies in cadaveric and ex vivo breast skin confirmed the depth of injury. Healthy volunteers had a standardized dermal wound made on the lateral aspect of the hip. Digital photography recorded the surface appearance of wound healing and scar development. High-frequency ultrasound demonstrated the depth of the healing wound and subsequent scar in vivo.
One hundred thirteen human subjects participated in the clinical study. Mean length of follow up was 28.6 +/- 13.2 weeks. The deep dermal end of the wound healed with a visible scar and the superficial end had no visible residual mark after week 18. The initial length of injury was 51.3 +/- 0.6 mm, which reduced to a scar of 34.9 +/- 1.0 mm at 36 weeks (corresponding areas were 196.6 +/- 7.5 mm and 92.7 +/- 9.4 mm). High-frequency ultrasound analysis showed a gradual reduction in scar thickness at the deep end and no detectable scar at the shallow end. The transition point between scar and no scar marked the threshold depth for scarring. This was calculated as 0.56 +/- 0.03 mm, or 33.1 percent of normal hip skin thickness.
The dermal scratch provides a well-tolerated, standardized, and reproducible wound model for investigating the healing response to dermal injury of different depths. There is a threshold depth of dermal injury at which scarring develops.
瘢痕形成与真皮损伤或烧伤深度之间的关联在临床上已得到认可，但尚未进行量化。作者检验了这样一种假设，即存在一个临界深度，超过该深度会形成纤维性瘢痕。
一种新型夹具制造出一端为深部真皮损伤而另一端为浅部真皮损伤的伤口。在尸体和离体乳房皮肤中进行的初步研究证实了损伤深度。健康志愿者在髋部外侧制造一个标准化的真皮伤口。数码摄影记录伤口愈合和瘢痕形成的表面外观。高频超声显示体内愈合伤口及后续瘢痕的深度。
113名受试者参与了这项临床研究。平均随访时间为28.6±13.2周。伤口的深部真皮端愈合后形成可见瘢痕，而浅部端在第18周后没有可见的残留痕迹。损伤初始长度为51.3±0.6毫米，在36周时缩小至34.9±1.0毫米的瘢痕（相应面积分别为196.6±7.5平方毫米和92.7±9.4平方毫米）。高频超声分析显示深部瘢痕厚度逐渐减小，浅部未检测到瘢痕。瘢痕与无瘢痕之间的过渡点标志着瘢痕形成的阈值深度。经计算，该深度为0.56±0.03毫米，即正常髋部皮肤厚度的33.1%。
真皮划痕为研究不同深度真皮损伤的愈合反应提供了一种耐受性良好、标准化且可重复的伤口模型。存在一个真皮损伤的阈值深度，超过该深度会形成瘢痕。
