Friedstat Jonathan S, Hultman C Scott
From the Division of Plastic and Reconstructive Surgery, University of North Carolina, Chapel Hill, NC.
Ann Plast Surg. 2014;72(6):S198-201. doi: 10.1097/SAP.0000000000000103.
Hypertrophic scars (HTS) are a source of morbidity for burn survivors and can present with a range of lifestyle-limiting problems. These include pruritus, pain, burning, stiffness, and contractures. Many solutions have been developed, but few have been studied in the form of a prospective, randomized control trial (RCT). Given the importance these RCTs carry in shaping the treatment of burn patients, we sought to systematically and critically review this portion of the burn literature.
PubMed was used to perform 2 separate searches with limits that included Humans, English, and Randomized Controlled Trial. A keyword search using "hypertrophic," "Scar," "burn," and "treatment" was cross-referenced with a MeSH subject-heading search using "Cicatrix, Hypertrophic" AND "Burn." Studies were then reviewed and excluded if they did not address management of burn HTS in the non-acute setting.
Two literature searches resulted in a total of 32 articles. Twelve articles were excluded because they were not relevant to the topic (n = 10) or could not be obtained (n = 2). The remaining 20 articles contained 882 patients treated for hypertrophic scars. Breakdown based on topics included laser therapy (58 patients, 2 articles), silicone gel (204 patients, 7 articles), compression garment (236 patients, 4 articles), silicone + pressure (226 patients, 3 articles), topical emollients (58 patients, 2 articles), systemic therapy (62 patients, 1 article), intralesional therapy (18 patients, 1 article), and surgical treatment (20 patients, 1 article). While some articles had favorable conclusions (laser, emollients, surgical, and intralesional therapy) or unfavorable conclusions (systemic therapy), there were conflicting results on silicone and/or compression.
Despite hypertrophic scars being a common occurrence in burn survivors, both the number of studies and consensus for treatment are limited. Efforts to perform larger, adequately powered RCTs are needed, specifically in the areas of silicone, compression garments, and combination therapy.
肥厚性瘢痕（HTS）是烧伤幸存者发病的一个原因，可出现一系列限制生活方式的问题。这些问题包括瘙痒、疼痛、烧灼感、僵硬和挛缩。已经开发了许多解决方案，但很少以前瞻性随机对照试验（RCT）的形式进行研究。鉴于这些RCT在烧伤患者治疗中所起的重要作用，我们试图对烧伤文献的这一部分进行系统和批判性的综述。
使用PubMed进行2次单独搜索，限制条件包括人类、英文和随机对照试验。使用“肥厚性”“瘢痕”“烧伤”和“治疗”进行关键词搜索，并与使用“肥厚性瘢痕”和“烧伤”的医学主题词搜索交叉引用。然后对研究进行审查，如果它们没有涉及非急性环境下烧伤HTS的管理，则将其排除。
两次文献搜索共得到32篇文章。12篇文章被排除，因为它们与主题无关（n = 10）或无法获取（n = 2）。其余20篇文章包含882例接受肥厚性瘢痕治疗的患者。按主题分类包括激光治疗（58例患者，2篇文章）、硅胶（204例患者，7篇文章）、压力衣（236例患者，4篇文章）、硅胶 + 压力（226例患者，3篇文章）、外用润肤剂（58例患者，2篇文章）、全身治疗（62例患者，1篇文章）、病灶内治疗（18例患者，1篇文章）和手术治疗（20例患者，1篇文章）。虽然一些文章有有利的结论（激光、润肤剂、手术和病灶内治疗）或不利的结论（全身治疗），但关于硅胶和/或压力的结果存在冲突。
尽管肥厚性瘢痕在烧伤幸存者中很常见，但研究数量和治疗共识都很有限。需要努力进行更大规模、有足够效力的RCT，特别是在硅胶、压力衣和联合治疗领域。
