Cai J H, Deng H P, Shen Z A, Sun T J, Li D J, Li D W, He L X, Wang L, Jin X
Burns Institute, the First Hospital Affiliated to the PLA General Hospital, Beijing 100048, China.
Zhonghua Shao Shang Za Zhi. 2017 Jul 20;33(7):410-414. doi: 10.3760/cma.j.issn.1009-2587.2017.07.003.
To explore the effects of scar excision combined with negative-pressure on repair of hypertrophic scar in burn children. From October 2010 to August 2016, 25 children with hypertrophic scar after deep burn were hospitalized, with scar course ranging from 3 months to 11 years and scar area ranging from 35 to 427 [83(51, 98)]cm(2). A total of 35 scars of 25 children were located in trunk (11 scars), upper limb (11 scars), and lower limb (13 scars). All children received scar excision operation and negative-pressure treatment (negative-pressure value ranged from -40 to -20 kPa), among which 6 cases received scar excision operation and negative-pressure treatment for two times for further removal of scars. After scar excision, electronic spring scale was used to measure the tension of the incision. The tension value of children ranged from 3.43 to 23.84 [7.16 (5.59, 9.12)] N, and then the incision was closed with appropriate suture according to the value of the tension. The incision with smaller tension was firstly opened on post operation day (POD) 8. After removing the suture, negative-pressure was conducted to POD 14. The incision with larger tension was firstly opened on POD 12. After removing the suture, biological semi-membrane was used to reduce tension to POD 16. All healed incisions were performed with anti-scar treatment for 1 year and relaxation and fixation for 3 months. General condition of the incision was observed after operation. The reduction percentage of scar area was calculated half-year after operation. The Patient and Observer Scar Assessment Scale was used to record the overall score of scar and scar score of trunk, upper limb, and lower limb before operation and half-year after operation. Data were processed with paired test and Wilcoxon rank sum test. After removing the suture, all incisions of children healed well without redness, effusion, and rupture. Half-year after operation, the appearance and deformity of incision were obviously improved, and the symptoms including pruritus and pain were basically relieved. Half-year after operation, the scar area of children ranged from 0 to 174 [21(9, 47)]cm(2,) which was significantly decreased as compared with that before operation (=-5.16, <0.05). The reduction percentage of scar area ranged from 36% to 100% [(73±19)%]. Half-year after operation, the overall score of scar and scar score of trunk, upper limb, and lower limb of children were obviously decreased as compared with those before operation (with values from 6.42 to 17.37, values below 0.05). Scar excision combined with negative-pressure treatment has a good clinical effect on repair of hypertrophic scar in burn children, which is suitable for clinical application.
探讨瘢痕切除联合负压对小儿烧伤后增生性瘢痕修复的影响。2010年10月至2016年8月，收治25例深度烧伤后增生性瘢痕患儿，瘢痕病程3个月至11年，瘢痕面积35至427[83(51,98)]cm²。25例患儿共35处瘢痕，位于躯干11处、上肢11处、下肢13处。所有患儿均接受瘢痕切除手术及负压治疗（负压值为-40至-20 kPa），其中6例因需进一步去除瘢痕而接受2次瘢痕切除手术及负压治疗。瘢痕切除后，用电子弹簧秤测量切口张力。患儿的张力值为3.43至23.84[7.16(5.59,9.12)]N，然后根据张力值用合适的缝线缝合切口。张力较小的切口于术后第8天首次拆线。拆线后，进行负压治疗至术后第14天。张力较大的切口于术后第12天首次拆线。拆线后，使用生物半膜减张至术后第16天。所有愈合切口均进行1年抗瘢痕治疗及3个月的松弛固定。术后观察切口一般情况。术后半年计算瘢痕面积缩小百分比。采用患者和观察者瘢痕评估量表记录术前及术后半年瘢痕的总体评分以及躯干、上肢和下肢的瘢痕评分。数据采用配对t检验和Wilcoxon秩和检验进行处理。拆线后，患儿所有切口愈合良好，无红肿、渗液及裂开。术后半年，切口外观及畸形明显改善，瘙痒、疼痛等症状基本缓解。术后半年，患儿瘢痕面积为0至174[21(9,47)]cm²，与术前相比明显减小（t=-5.16，P<0.05）。瘢痕面积缩小百分比为36%至100%[(73±19)%]。术后半年，患儿瘢痕总体评分以及躯干、上肢和下肢的瘢痕评分与术前相比明显降低（t值为6.42至17.37，P值均<0.05）。瘢痕切除联合负压治疗对小儿烧伤后增生性瘢痕修复具有良好的临床效果，适合临床应用。
