Schmidt M, Serror K, Chaouat M, Mimoun M, Boccara D
Unité fonctionnelle de chirurgie des brûlés, service de chirurgie plastique, reconstructrice et esthétique du Pr Mimoun, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France.
Ann Chir Plast Esthet. 2018 Jun;63(3):246-254. doi: 10.1016/j.anplas.2017.10.006. Epub 2017 Nov 16.
Permanent hypopigmentation of burn scars is a common consequence after partial and full thickness burns that heal by secondary intent, and they can cause severe aesthetic issues. The surgical goals for effective treatment of postburn hypopigmentation are to remove scar tissues, and to produce healthy melanocytes, with minimal donor site morbidity. This article reviews the current literature about the different ways to treat hypopigmentation following burn injuries and discusses the indications.
The PubMed database was searched for articles published from 1985 and up to 2016. Papers with regards to the management of hypopigmented lesions were included only if scars were following burn injuries. The treatments were assessed according to body region treated, surface involved, skin color, effectiveness on restoring skin pigmentation.
Sixteen studies were included in this review. Non-surgical treatments like makeup and tattooing, and surgical treatments including thin skin grafting, chip skin grafting, punch grafting, non-cultured keratinocyte-melanocyte cell suspension, and cultured epidermal cells were all compared.
Thin skin grafting is a reliable treatment especially for patient who suffer from small hypopigmented lesions as this method requires a donor skin of the same size. The cell suspension procedure may be beneficial for larger scars. Moreover demarcation between skin graft and normal skin may exist and when a precise color match is required, particularly in the head, tattooing and chip skin grafting produce a good pigmentation outcome.
对于通过二期愈合的部分厚度和全层烧伤而言，烧伤瘢痕永久性色素减退是常见的后果，并且会引发严重的美学问题。有效治疗烧伤后色素减退的手术目标是去除瘢痕组织，并产生健康的黑素细胞，同时使供区发病率降至最低。本文综述了目前关于烧伤后色素减退不同治疗方法的文献，并讨论了其适应症。
在PubMed数据库中检索1985年至2016年发表的文章。仅纳入瘢痕由烧伤引起的色素减退性病变管理方面的论文。根据治疗的身体部位、受累面积、皮肤颜色、恢复皮肤色素沉着的有效性对治疗方法进行评估。
本综述纳入了16项研究。对诸如化妆和纹身等非手术治疗方法，以及包括薄皮移植、微粒皮移植、打孔移植、非培养角质形成细胞-黑素细胞悬液和培养表皮细胞等手术治疗方法进行了比较。
薄皮移植是一种可靠的治疗方法，尤其适用于患有小面积色素减退性病变的患者，因为该方法需要相同大小的供皮。细胞悬液方法可能对较大的瘢痕有益。此外，移植皮肤与正常皮肤之间可能存在界限，当需要精确的颜色匹配时，特别是在头部，纹身和微粒皮移植可产生良好的色素沉着效果。
