van der Veer Willem M, Ferreira José A, de Jong Etty H, Molema Grietje, Niessen Frank B
Department of Plastic and Reconstructive Surgery, VU University Medical Center, Amsterdam, The Netherlands.
Ann Plast Surg. 2010 Sep;65(3):321-5. doi: 10.1097/SAP.0b013e3181c60f88.
Corticosteroids are widely used as treatment for excessive scarring by intralesional injection with variable success rates. It is conceivable that systemically administered corticosteroids affect a wider range of inflammatory processes that influence wound healing and may be more successful in preventing hypertrophic scar formation. To study this presumption, we have used a standardized model of presternal scars caused by cardiothoracic surgery through a median sternotomy incision. During cardiac surgery with cardiopulmonary bypass, 1 mg/kg dexamethasone was administered preoperatively, and 0.5 mg/kg 8 hours postoperatively. The presternal scars were evaluated prospectively 2, 4, 6, 12, and 52 weeks postoperatively at standardized measuring points. The height and width of the scars were measured 12 and 52 weeks postoperatively using both a slide caliper and a 7.5-MHz ultrasound probe. Cardiopulmonary bypass was used in 31 of the 43 participants. Eleven patients (35%) in the dexamethasone group developed clinical hypertrophic scars compared with 4 patients (33%) in the control group. These differences were not statistically significant. However, cranial scars became significantly wider in the dexamethasone group compared with the control group (P = 0.04). Twelve weeks postoperatively scars were significantly higher in the dexamethasone group, both cranial (P = 0.05) and caudal (P = 0.03). The differences in scar width and height were mainly present in patients that developed hypertrophic scars. The present results suggest that administration of high-dose perioperative dexamethasone does not prevent hypertrophic scar formation. Its use together with the cardiopulmonary bypass, however, did affect scar dimensions negatively up to 52 weeks after surgery. These findings contribute to the concept of the involvement of perioperative immunologic responses in the etiology of hypertrophic scar formation.
皮质类固醇通过病灶内注射被广泛用于治疗过度瘢痕形成，但其成功率各不相同。可以想象，全身应用皮质类固醇会影响更广泛的炎症过程，这些过程会影响伤口愈合，并且在预防增生性瘢痕形成方面可能更成功。为了研究这一假设，我们使用了一种标准化模型，该模型通过正中胸骨切开术切口来模拟心胸外科手术引起的胸骨前瘢痕。在进行体外循环心脏手术期间，术前给予1mg/kg地塞米松，术后8小时给予0.5mg/kg。术后2、4、6、12和52周在标准化测量点对胸骨前瘢痕进行前瞻性评估。术后12周和52周使用游标卡尺和7.5MHz超声探头测量瘢痕的高度和宽度。43名参与者中有31人使用了体外循环。地塞米松组有11名患者（35%）出现临床增生性瘢痕，而对照组有4名患者（33%）出现。这些差异无统计学意义。然而，与对照组相比，地塞米松组的头部瘢痕明显更宽（P = 0.04）。术后12周，地塞米松组的瘢痕在头部（P = 0.05）和尾部（P = 0.03）均明显更高。瘢痕宽度和高度的差异主要出现在出现增生性瘢痕的患者中。目前的结果表明，围手术期给予高剂量地塞米松并不能预防增生性瘢痕的形成。然而，它与体外循环一起使用，在术后长达52周的时间里确实对瘢痕尺寸产生了负面影响。这些发现有助于支持围手术期免疫反应参与增生性瘢痕形成病因的概念。
