Kafka Mona, Collins Vanessa, Kamolz Lars-Peter, Rappl Thomas, Branski Ludwik K, Wurzer Paul
Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
School of Medicine, University of Texas Medical Branch, Galveston, Texas.
Wound Repair Regen. 2017 Jan;25(1):139-144. doi: 10.1111/wrr.12507. Epub 2017 Jan 31.
Currently, there are various therapeutic approaches to reduce hypertrophic scarring; however, there is no standard evidence-based treatment protocol. Hence, a systematic review was performed to obtain a summary of the latest clinical trials to evaluate evidence for the treatment of hypertrophic scars. The review protocol was registered and approved by PROSPERO (CRD42015027040). PubMed and Web of Science were searched using predefined MeSH-Terms to identify studies published within the last 10 years regarding treatment for hypertrophic scars. Exclusion criteria included a level of evidence (LoE) lower than I, nonhuman in vivo studies, in vitro studies, studies on keloids, literature reviews, and non-English articles. The literature search identified 1,029 unique articles, whereas 6 articles were prospective, randomized, blinded, controlled clinical trials with a LoE I, and were thus included in the systematic analysis. Three clinical trials evaluated silicone products and pressure garments, and the other three studies investigated the efficacy of intralesional injections of triamcinolone (TAC), 5-Fluorouracil (5-FU) combined with TAC as well as the additional irradiation with a 585 nm pulsed-dye laser (PDL). Intralesional injections revealed significant improvements of the scar quality in terms of height, thickness, erythema, and pigmentation. Pressure garments showed favorable results but there was no evidence that silicone products were able to improve the scar quality. The systematic review demonstrated that there are just a few clinical trials with a LoE of I. Consequently, evidence is still lacking especially for noninvasive treatment regimens for hypertrophic scars. Intralesional injections of 5-FU mixed with a low dose of TAC can be seen as most appropriate treatment modality. Prospective clinical trials to determine the efficiency of silicone products are warranted.
目前，有多种治疗方法可减少增生性瘢痕形成；然而，尚无基于证据的标准治疗方案。因此，进行了一项系统评价，以总结最新临床试验，评估增生性瘢痕治疗的证据。该评价方案已在国际前瞻性系统评价注册库（PROSPERO，注册号：CRD42015027040）注册并获批。使用预定义的医学主题词（MeSH）在PubMed和科学网（Web of Science）中进行检索，以识别过去10年内发表的关于增生性瘢痕治疗的研究。排除标准包括证据等级（LoE）低于I级的研究、非人体体内研究、体外研究、瘢痕疙瘩研究、文献综述以及非英文文章。文献检索共识别出1029篇独特文章，其中6篇为前瞻性、随机、双盲、对照临床试验，证据等级为I级，因此纳入系统分析。三项临床试验评估了硅酮产品和压力衣，另外三项研究调查了曲安奈德（TAC）皮损内注射、5-氟尿嘧啶（5-FU）联合TAC皮损内注射以及585nm脉冲染料激光（PDL）辅助照射的疗效。皮损内注射在瘢痕高度、厚度、红斑和色素沉着方面显示瘢痕质量有显著改善。压力衣显示出良好效果，但没有证据表明硅酮产品能够改善瘢痕质量。该系统评价表明，证据等级为I级的临床试验较少。因此，尤其是增生性瘢痕的非侵入性治疗方案仍缺乏证据。5-FU与低剂量TAC混合皮损内注射可被视为最合适的治疗方式。有必要开展前瞻性临床试验以确定硅酮产品的疗效。
