Meng Y B, Lei J, Zhang H R, Hao Z M, Bai P Y, Duan P
Institute of Burns, General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University), Taiyuan 030009, China.
Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi. 2022 Mar 20;38(3):251-255. doi: 10.3760/cma.j.cn501120-20201201-00510.
To investigate the clinical effects of in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage in the treatment of hypertrophic scar in non-functional sites after burns. A retrospective observational study was used. From June 2017 to June 2019, 33 patients (24 males and 9 females, aged 8-50 years) who met the inclusion criteria with hypertrophic scars in non-functional sites outside the face after burns were treated in General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University). All patients underwent scalp transplantation after perforation of retained split scar matrix in situ (with scar thinning area of 90-500 cm), and then the vacuum sealing drainage was performed. The hematoma and infection of wounds were observed on the 7 day after operation. At the same time, the survival rate of skin grafting was observed and calculated. The flatness and thickness of the scar in the operative area were observed in 12 months after operation, and the itching and pain of the patients were recorded. Vancouver Scar Scale was used to score the scar of patients before operation and at 3, 6 and 12 months after operation. The healing time and hair growth of donor site were observed. Data were statistically analyzed with repeated analysis of variance, paired sample test and bonferroni correction. On the 7 day after operation, local subcutaneous hematoma appeared in the wound of 2 patients, which healed after dressing change; no infection occurred. On the 7 day after operation, the survival rate of skin grafting of patients was 94.6%-99.0%(96.8±1.2)%. Scar flatness was well, the thickness of scar was not significantly higher than that of normal skin in 12 months after operation, and the symptoms of itching pain of patients disappeared or significantly relieved. Vancouver Scar Scale scores of patients before operation and at 3, 6, and 12 months after operation were 12.1±2.8, 8.5±1.5, 7.6±1.6, 6.7±1.3, respectively, and the scores of 3, 6, and 12 months after operation were all significantly lower than that before operation (with values of 4.48, 4.06, and 3.97, respectively, <0.01). All the donor sites of the head healed well in 4-7 days after operation. By 3-6 months after operation, all patients had good hair growth in the donor site and achieved no scar healing. The treatment of hypertrophic scar in non-functional sites outside the face after burns by in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage can effectively improve the appearance of hypertrophic scar in non-functional areas after burn and reduce its degree of hyperplasia, with scar-free donor site healing.
探讨保留劈裂瘢痕基质原位打孔联合头皮移植及封闭式负压引流治疗烧伤后非功能部位增生性瘢痕的临床效果。采用回顾性观察研究。2017年6月至2019年6月，太钢总医院（山西医科大学第六医院）收治符合纳入标准的烧伤后面部以外非功能部位增生性瘢痕患者33例（男24例，女9例，年龄8 - 50岁）。所有患者均行保留劈裂瘢痕基质原位打孔（瘢痕变薄面积90 - 500 cm）后行头皮移植，然后进行封闭式负压引流。术后第7天观察创面血肿及感染情况，同时观察并计算植皮成活率。术后12个月观察手术区域瘢痕的平整度和厚度，记录患者瘙痒及疼痛情况。采用温哥华瘢痕量表对患者术前及术后3、6、12个月的瘢痕进行评分。观察供皮区愈合时间及毛发生长情况。数据采用重复测量方差分析、配对样本t检验及Bonferroni校正进行统计学分析。术后第7天，2例患者创面出现局部皮下血肿，经换药后愈合；未发生感染。术后第7天，患者植皮成活率为94.6% - 99.0%（96.8±1.2）%。瘢痕平整度良好，术后12个月瘢痕厚度不显著高于正常皮肤，患者瘙痒疼痛症状消失或明显缓解。患者术前及术后3、6、12个月温哥华瘢痕量表评分分别为12.1±2.8、8.5±1.5、7.6±1.6、6.7±1.3，术后3、6、12个月评分均显著低于术前（P值分别为4.48、4.06、3.97，均<0.01）。头部所有供皮区术后4 - 7天愈合良好。术后3 - 6个月，所有患者供皮区毛发生长良好，达到无瘢痕愈合。保留劈裂瘢痕基质原位打孔联合头皮移植及封闭式负压引流治疗烧伤后面部以外非功能部位增生性瘢痕，可有效改善烧伤后非功能区增生性瘢痕外观，降低其增生程度，供皮区无瘢痕愈合。
