COREMED - Cooperative Centre for Regenerative Medicine, JOANNEUM RESEARCH Forschungsgesellschaft mbH, Graz, Austria.
Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
Wound Repair Regen. 2020 Sep;28(5):656-665. doi: 10.1111/wrr.12839. Epub 2020 Jun 15.
Hypertrophic scars are still a major burden for numerous patients, especially after burns. Many treatment options are available; however, no evidence-based treatment protocol is available with recommendations mostly emerging from experience or lower quality studies. This review serves to discuss the currently available literature. A systematic review was performed and the databases PubMed and Web of Science were searched for suitable publications. Only original articles in English that dealt with the treatment of hypertrophic scars in living humans were analyzed. Further, studies with a level of evidence lower than 1 as defined by the American Society of Plastic Surgeons were excluded. After duplicate exclusion, 1638 studies were screened. A qualitative assessment yielded 163 articles eligible for evidence grading. Finally nine studies were included. Four of them used intralesional injections, four topical therapeutics and one assessed the efficacy of CO -laser. Intralesional triamcinolone + fluorouracil injections, and topical pressure and/or silicone therapy revealed significant improvements in terms of scar height, pliability, and pigmentation. This systematic review showed that still few high-quality studies exist to evaluate therapeutic means and their mechanisms for hypertrophic scars. Among these, most of them assessed the efficacy of intralesional triamcinolone injections with the same treatment protocol. Intralesional injection appears to be the best option for hypertrophic scar treatment. Future studies should focus on a possible optimization of infiltrative therapies, consistent end-point evaluations, adequate follow-up periods, and possibly intraindividual treatments.
增生性瘢痕仍然是许多患者的主要负担，尤其是烧伤后患者。有许多治疗选择，但目前没有基于证据的治疗方案，建议主要来自经验或低质量的研究。本综述旨在讨论目前可获得的文献。进行了系统评价，检索了 PubMed 和 Web of Science 数据库以获取合适的出版物。仅分析了以英文发表的、针对人类活体增生性瘢痕治疗的原始文章。此外，还排除了美国整形外科学会定义的证据水平低于 1 的研究。重复排除后，筛选出 1638 项研究。定性评估得出 163 篇符合证据分级标准的文章。最终纳入了 9 项研究。其中 4 项使用了病灶内注射，4 项采用了局部治疗，1 项评估了 CO2 激光的疗效。病灶内曲安奈德+氟尿嘧啶注射、局部压力和/或硅酮治疗在瘢痕高度、柔韧性和色素沉着方面均显示出显著改善。这项系统综述表明，目前评估增生性瘢痕治疗方法及其机制的高质量研究仍然较少。其中，大多数研究评估了病灶内曲安奈德注射的疗效，且采用了相同的治疗方案。病灶内注射似乎是治疗增生性瘢痕的最佳选择。未来的研究应侧重于浸润性治疗的优化、一致的终点评估、充分的随访期，以及可能的个体化治疗。
