Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
Burns. 2013 Feb;39(1):89-97. doi: 10.1016/j.burns.2012.05.009. Epub 2012 Jul 3.
The intervention of pressure therapy on management of hypertrophic scar (HS) after burn is based on the theoretical assumption that the mechanical force added onto the scar tissue will reduce the growth of myofibroblasts which create the collagen clusters and the interstitial space, and to realign fibrous tissues, thus reducing the thickness of HS. In this experimental study, a high frequency ultrasound imaging system (12 MHz) was applied to measure the real time changes of thickness of the post burn HS under a mechanical loading system with similar pressure generated to the scar tissue. The validity of the ultrasound system in measurement of the changes of scar thickness underneath the tissue was tested on the porcine skin in vitro followed by measurement of human skin in vivo. Results showed that the ultrasound measurement of thickness had both good validity (r(2)=0.98, p<0.0001) and good intra-rater reliability (ICC=0.89). Then, the system was used to test the thickness of 14 human HS samples in vivo among 7 subjects. External loading force with similar pressure range (10-45 mmHg) was then applied to these scar samples via ultrasound probe with rectangular contacting area at 4 cm(2) and each loading force was maintained unchange for 2 min over the scar tissue. The real time scar thickness was documented. Results showed that the mean scar thickness was found to be significantly decreased when the loading force applied was increased from 5 to 35 mmHg (with 10 mmHg interval) (p<0.001). A significant negative correlation between the pressure level and scar thickness was observed (r(2)=0.96, p=0.005). The decline of thickness was found more significant between 0 mmHg and 15 mmHg. The findings were in line with the postulate that pressure therapy is effective in reducing the thickness of HS. A long term followup study should be administered to determine the prolonged effect of pressure intervention.
压力治疗对烧伤后肥厚性瘢痕（HS）的管理干预基于理论假设，即施加在瘢痕组织上的机械力将减少产生胶原簇和细胞间隙的肌成纤维细胞的生长，并使纤维组织重新排列，从而减少 HS 的厚度。在这项实验研究中，应用高频超声成像系统（12MHz）测量在类似压力产生于瘢痕组织的机械加载系统下，烧伤后 HS 厚度的实时变化。在体外猪皮上测试了超声系统测量组织下瘢痕厚度变化的有效性，然后在体内测量了人皮。结果表明，超声测量厚度具有良好的有效性（r(2)=0.98，p<0.0001）和良好的内部评估者可靠性（ICC=0.89）。然后，该系统用于测试 7 名受试者中 14 个人类 HS 样本的体内厚度。通过具有 4cm(2)矩形接触面积的超声探头，将类似压力范围（10-45mmHg）的外部加载力施加到这些瘢痕样本上，并且每个加载力在瘢痕组织上保持不变 2 分钟。记录实时瘢痕厚度。结果表明，当施加的加载力从 5mmHg 增加到 35mmHg（间隔 10mmHg）时，平均瘢痕厚度明显减小（p<0.001）。观察到压力水平与瘢痕厚度之间存在显著负相关（r(2)=0.96，p=0.005）。在 0mmHg 和 15mmHg 之间，厚度的下降更为显著。这些发现与压力治疗有效降低 HS 厚度的假设一致。应进行长期随访研究，以确定压力干预的长期效果。
