Mataro I, Delli Santi G, Palombo P, D'Alessio R, Vestita M
Department of Plastic and Reconstructive Surgery and Burn Unit, Hospital A. Cardarelli, Naples, Italy.
Department of Plastic and Reconstructive Surgery and Burn Unit, Hospital Sant'Eugenio, Rome, Italy.
Ann Burns Fire Disasters. 2017 Dec 31;30(4):313-316.
Scarring after a burn injury remains the greatest unmet challenge in the treatment of functional and psychosocial sequelae of burns. The hypertrophic scar represents the most common type of cicatrix after burns, and it has a prevalence of up to 70%. We present a case of upper and lower extremity partial-thickness burns in a female patient treated in two different modalities. Superficial seconddegree burns on the upper extremities were treated with conservative dressing with fairly early wound closure but they developed hypertrophic scars. Deeper, lower extremity burns were debrided with a new bromelain-based debriding agent, resulting in scar-free healing. The pathophysiology of hypertrophic scar formation is based on the perturbation of collagen production or degradation or both. The duration and magnitude of the inflammatory phase of wound healing also appears to play a role in hypertrophic scarring. Bromelain has demonstrated an anti-angiogenic effect in various cancer cell lines and it has been shown to regulate a variety of pro-angiogenic growth factors. This case raises the classical question of the relationship between time to healing and formation of hypertrophic scars after burn injury, pointing to other potential factors that may play an important role in burn healing.
烧伤后的瘢痕形成仍然是烧伤功能和心理社会后遗症治疗中最大的未解决挑战。增生性瘢痕是烧伤后最常见的瘢痕类型，其发生率高达70%。我们报告一例女性患者上下肢浅Ⅱ度烧伤，采用两种不同治疗方式。上肢浅Ⅱ度烧伤采用保守换药并较早闭合伤口，但出现了增生性瘢痕。下肢较深的烧伤使用一种新的基于菠萝蛋白酶的清创剂进行清创，实现了无瘢痕愈合。增生性瘢痕形成的病理生理学基于胶原蛋白产生或降解或两者的紊乱。伤口愈合炎症期的持续时间和程度似乎也在增生性瘢痕形成中起作用。菠萝蛋白酶已在多种癌细胞系中显示出抗血管生成作用，并且已证明它能调节多种促血管生成生长因子。该病例引发了关于烧伤后愈合时间与增生性瘢痕形成之间关系的经典问题，指出了其他可能在烧伤愈合中起重要作用的潜在因素。
