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具有三种不同愈合潜力的烧伤患者的长期瘢痕质量:一项多中心前瞻性队列研究。

Long-term scar quality in burns with three distinct healing potentials: A multicenter prospective cohort study.

作者信息

Goei Harold, van der Vlies Cornelis H, Hop M Jenda, Tuinebreijer Wim E, Nieuwenhuis Marianne K, Middelkoop Esther, van Baar Margriet E

机构信息

Association of Dutch Burn Centers, Burn Center Maasstad Hospital, Rotterdam, The Netherlands.

Department of Plastic, Reconstructive and Hand Surgery, MOVE Research Institute, VU University Medical Center, Amsterdam, The Netherlands.

出版信息

Wound Repair Regen. 2016 Jul;24(4):721-30. doi: 10.1111/wrr.12438. Epub 2016 Jun 1.

Abstract

The laser Doppler imager is used in cases of indeterminate burn depth to accurately predict wound healing time at an early stage. The laser Doppler imager classifies burns into three estimated healing potentials as follows: high, <14 days; intermediate, 14-21 days; and low, >21 days. At this time, the relationship between these healing potentials and long-term scar quality is unknown. The objective of this study was to determine the long-term scar quality of burns with three distinct healing potentials. The secondary objectives were to compare treatment strategies in intermediate wounds, to study the effect of the timing of surgery on low healing potential wounds and to identify predictors of reduced scar quality. Hence, in a prospective cohort study, scar quality was determined in patients whose burns were assessed with laser Doppler imaging. Scar Quality was assessed with objective and subjective measurement tools, including overall scar quality (Patient and Observer Scar Assessment Scale) as a primary outcome and color and elasticity parameters. A total of 141 patients (>19 months postburn) with 216 scars were included. Wounds with high and intermediate healing potential did not significantly differ regarding scar quality. Wounds with a low healing potential had a significantly lower scar quality. Analysis of 76 surgically treated low healing potential wounds showed no significant differences in the primary outcome regarding the timing of surgery (≤14 days vs. >14). Predictors of reduced long-term scar quality were darker skin type and multiple surgeries. In conclusion, scar quality was strongly related to the healing potential category. Scar quality was very similar in high and intermediate healing potential wounds. No positive effects were found on scar quality or on healing time in surgically treated wounds with intermediate healing potential, advocating a conservative approach. Further studies should focus on the optimal timing of surgery in low healing potential wounds.

摘要

激光多普勒成像仪用于烧伤深度不确定的病例,以在早期准确预测伤口愈合时间。激光多普勒成像仪将烧伤分为三种估计的愈合潜力,如下:高,<14天;中,14 - 21天;低,>21天。此时,这些愈合潜力与长期瘢痕质量之间的关系尚不清楚。本研究的目的是确定具有三种不同愈合潜力的烧伤的长期瘢痕质量。次要目的是比较中度伤口的治疗策略,研究手术时机对低愈合潜力伤口的影响,并确定瘢痕质量降低的预测因素。因此,在一项前瞻性队列研究中,对通过激光多普勒成像评估烧伤的患者确定瘢痕质量。使用客观和主观测量工具评估瘢痕质量,包括作为主要结果的总体瘢痕质量(患者和观察者瘢痕评估量表)以及颜色和弹性参数。共纳入141例患者(烧伤后>19个月),有216处瘢痕。高愈合潜力和中度愈合潜力的伤口在瘢痕质量方面无显著差异。低愈合潜力的伤口瘢痕质量显著较低。对76例接受手术治疗的低愈合潜力伤口的分析显示,手术时机(≤14天与>天)在主要结果方面无显著差异。长期瘢痕质量降低的预测因素是皮肤类型较深和多次手术。总之,瘢痕质量与愈合潜力类别密切相关。高愈合潜力和中度愈合潜力的伤口瘢痕质量非常相似。在接受手术治疗的中度愈合潜力伤口中,未发现对瘢痕质量或愈合时间有积极影响,主张采用保守方法。进一步的研究应关注低愈合潜力伤口的最佳手术时机。

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