Kubiak Rainer, Lange Bettina
Department of Pediatric Surgery, Medical Center Mannheim (UMM), Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.
Department of Pediatric Surgery, Medical Center Mannheim (UMM), Heidelberg University, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.
Burns. 2017 Aug;43(5):1097-1102. doi: 10.1016/j.burns.2017.02.006. Epub 2017 Mar 7.
Thermal injuries are one of the most physically and psychologically devastating causes of pediatric trauma. Post-traumatic sequelae such as hypertrophic scars and contractures often result in long lasting morbidity and disfigurement. Conservative therapy, including pressure garments and silicone, is the gold standard for scar management in the pediatric population. Most recently percutaneous collagen induction (PCI) was introduced as an alternative treatment in adults. The aim of this report was to share our experience with PCI in children and adolescents in scar management following thermal injuries.
Between July 2013 and February 2016, a total of 99 PCI treatments were performed on forty-seven children and adolescents for scar formation following thermal injuries in this retrospective study. A medical roller device (Dermaroller, Dermaroller GmbH, Wolfenbüttel, Germany) with 2.5mm long needles was used. All procedures were carried out under general anesthesia. At the end of the operation vitamin A and vitamin C oil (ENVIRON AVST Body Oil; Environ Skin Care, Pty. Ltd., Cape Town, South Africa) was applied topically. Photographs were taken before and a minimum of 4 weeks after the first PCI in order to document the effect on scar tissue. These images were graded according to the Vancouver Scar Scale (VSS).
The median age at the time of the first PCI was 8.3 years (range, 0.8-21.2 years). The median time interval between the injury and PCI was 18 months (range, 4-170 months). There were no intraoperative problems noted. Minor postoperative complications occurred in 2 patients (4.3%). All patients reported subjective improvement and were satisfied with the procedure and the results. Pre- and post-treatment photographs were available in 40 patients, and overall VSS scores improved post-treatment in all patients. Following a single PCI treatment, scar vascularity, pliability and height all improved, however there was no statistically significant effect on pigmentation.
PCI is an enrichment of the armamentarium for scar treatment following thermal injuries in children and adolescents. Further prospective studies are recommended regarding the optimal timing for this treatment and long term outcome in the pediatric population.
热烧伤是儿童创伤中对身体和心理造成最严重破坏的原因之一。创伤后后遗症，如增生性瘢痕和挛缩，常常导致长期的发病率和毁容。保守治疗，包括压力衣和硅胶，是儿童瘢痕管理的金标准。最近，经皮胶原诱导（PCI）被引入作为成人的一种替代治疗方法。本报告的目的是分享我们在儿童和青少年热烧伤后瘢痕管理中应用PCI的经验。
在这项回顾性研究中，2013年7月至2016年2月期间，共对47名儿童和青少年进行了99次PCI治疗，用于治疗热烧伤后的瘢痕形成。使用了一种带有2.5毫米长针头的医用滚轮装置（Dermaroller，Dermaroller GmbH，德国沃尔芬比特尔）。所有手术均在全身麻醉下进行。手术结束时，局部应用维生素A和维生素C油（ENVIRON AVST身体油；Environ Skin Care，Pty. Ltd.，南非开普敦）。在首次PCI治疗前和至少4周后拍摄照片，以记录对瘢痕组织的影响。这些图像根据温哥华瘢痕量表（VSS）进行分级。
首次PCI治疗时的中位年龄为8.3岁（范围为0.8 - 21.2岁）。受伤与PCI之间的中位时间间隔为18个月（范围为4 - 170个月）。术中未发现问题。2例患者（4.3%）出现轻微术后并发症。所有患者均报告主观症状改善，并对手术及结果满意。40例患者有治疗前后的照片，所有患者治疗后的VSS总分均有所改善。单次PCI治疗后，瘢痕的血管化、柔韧性和高度均有所改善，但对色素沉着无统计学显著影响。
PCI是儿童和青少年热烧伤后瘢痕治疗手段的一种补充。建议针对该治疗的最佳时机以及儿科人群的长期预后进行进一步的前瞻性研究。
