Barani C, Viard R, Aimard R, Lalloue C, Vincent P L, Comparin J P, Voulliaume D
Centre Hospitalier Saint Joseph Saint Luc, Lyon, France.
Ann Burns Fire Disasters. 2018 Sep 30;31(3):238-242.
The use of lipostructure to treat burn sequelae is more and more common today. The regeneration capacities of mesenchymal stem cells appear promising on this sequelae skin, which is poorly vascularized, retractile and often painful. The aim of our study is to establish the analgesic properties, and the functional and aesthetic improvements gained by using lipostructure to treat burn sequelae. Forty-three patients who received lipostructure for burn sequelae according to the Coleman method between 2005 and 2017 were selected. Results regarding aesthetic, analgesic and mobility gain were recorded, with a minimum follow-up of one year postoperatively. Our patients consisted of 32 women and 11 men, with a mean age of 31.7 years (15 to 64 years). The mean follow-up during the study was 49.8 months (2 to 205 months). Patients received an average of 1.3 (1 to 3) sessions of lipostructure with an average of 153 cc (10 to 1040 cc) per session. Sequela sites were the face for 13 patients, the upper limb for 13 patients, the lower limb for 16 patients and the trunk for 4 patients. Twelve patients had lesions on multiple locations. Twenty patients benefited from this surgery for purely aesthetic or functional reasons, and 23 for painful sequelae. A significantly lower EVA was observed after surgery and a functional gain thanks to the restoration of no longer painful amplitudes. An aesthetic gain was also reported in more than three quarters of cases. In two cases, the analgesic effect decreased after one year and required a second lipostructure. The use of lipostructure in burn sequelae has already proved its efficiency with regard to the functional aspect, aesthetics and also analgesia. However, the evaluation of results is based on scales that are still imperfect. Lipostructure is not the only type of surgery used in burn sequelae. Local plasty or skin grafts are also used, but they are more invasive and have no direct analgesic effect. Lipostructure is only possible on mature, soft and non-adherent scars in order not to traumatize adipose cells. Post-burn skin is defined by retractions and adhesions to deep planes, requiring heavy rehabilitation work beforehand. Finally, the effect is not always sustainable and the duration of efficiency remains unknown. Lipostructure has its place in the treatment of hyperalgic and unsightly burn sequelae that are responsible for a functional and social disability in the patient.
如今,利用脂肪结构疗法治疗烧伤后遗症越来越普遍。间充质干细胞的再生能力在这种血管化不良、具有收缩性且常伴有疼痛的后遗症皮肤上似乎很有前景。我们研究的目的是确定使用脂肪结构疗法治疗烧伤后遗症所获得的镇痛特性以及功能和美学方面的改善。选取了2005年至2017年间按照科尔曼方法接受脂肪结构疗法治疗烧伤后遗症的43例患者。记录了术后美学、镇痛及活动能力改善方面的结果,术后随访时间最短为一年。我们的患者包括32名女性和11名男性,平均年龄为31.7岁(15至64岁)。研究期间的平均随访时间为49.8个月(2至205个月)。患者平均接受了1.3次(1至3次)脂肪结构疗法治疗,每次平均注射量为153立方厘米(10至1040立方厘米)。后遗症部位,13例在面部,13例在上肢,16例在下肢,4例在躯干。12例患者有多处损伤。20例患者因纯粹的美学或功能原因接受了该手术,23例因疼痛后遗症接受手术。术后观察到视觉模拟评分法(VAS)显著降低,并且由于恢复了无痛幅度而获得了功能改善。超过四分之三的病例还报告有美学改善。有2例患者,术后一年镇痛效果下降,需要再次进行脂肪结构疗法治疗。脂肪结构疗法在治疗烧伤后遗症方面,在功能、美学以及镇痛方面已证明其有效性。然而,结果评估是基于仍不完善的量表。脂肪结构疗法并非治疗烧伤后遗症的唯一手术方式。也会使用局部整形术或皮肤移植,但它们创伤性更大且没有直接的镇痛效果。脂肪结构疗法仅适用于成熟、柔软且无粘连的瘢痕,以免损伤脂肪细胞。烧伤后的皮肤表现为收缩以及与深层组织粘连,这需要事先进行大量康复工作。最后,效果并非总是可持续的,且有效持续时间仍不清楚。脂肪结构疗法在治疗导致患者功能和社交障碍的疼痛性及难看的烧伤后遗症方面有其用武之地。