Wu Min, Gu Jie-Yu, Duan Ran, Wei Bo-Xuan, Xie Feng
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China.
World J Clin Cases. 2022 Jun 26;10(18):6032-6038. doi: 10.12998/wjcc.v10.i18.6032.
Hypertrophic scars and keloid treatment is a major problem in plastic surgery. While small keloids can be treated with resection followed by radiotherapy, large keloids require treatment with a tissue expander. Conventional methods increase the need for auxiliary incisions, causing new scar hyperplasia.
To introduce a new method for the treatment of keloids with an expander.
Between 2018 and 2021, we performed surgeries to treat large keloids in nine patients with a two-stage approach. In the first stage, an intrascar incision was made in the keloid, and a customized expander was implanted under the keloid and the surrounding normal skin. A period of 3-6 mo was allowed for skin expansion. In the second stage, after the initial incision healed, a follow-up surgery was performed to remove the expander, resect the keloid, and repair the expanded skin flap. To accomplish this, an incision was made along the scar boundary to avoid making a new surgical incision and creating new scars. Superficial radiotherapy was then performed postoperatively.
Two patients had anterior chest keloids. After treatment, the anterior chest incision was broken repeatedly and then sutured again after debridement. It healed smoothly without scar hyperplasia. Keloids were successfully removed in 7 patients without recurrence.
This method was performed through a keloid incision and with a custom expander embedded. After full expansion, the keloid was directly resected using a linear suture, which avoids new surgical incisions and scars and can successfully remove large-area keloids. The treatment is effective, providing new insights and strategies for the treatment of similar large-area keloid and hypertrophic scar cases in the future.
增生性瘢痕和瘢痕疙瘩的治疗是整形外科的一个主要问题。小的瘢痕疙瘩可通过切除后放疗进行治疗，而大的瘢痕疙瘩则需要使用组织扩张器进行治疗。传统方法增加了辅助切口的需求，导致新的瘢痕增生。
介绍一种使用扩张器治疗瘢痕疙瘩的新方法。
2018年至2021年期间，我们采用两阶段方法对9例患者的大瘢痕疙瘩进行了手术治疗。在第一阶段，在瘢痕疙瘩内做一个瘢痕内切口，将定制的扩张器植入瘢痕疙瘩及其周围正常皮肤下方。进行3至6个月的皮肤扩张。在第二阶段，初始切口愈合后，进行后续手术取出扩张器，切除瘢痕疙瘩，并修复扩张的皮瓣。为此，沿瘢痕边界做切口，以避免制造新的手术切口和产生新的瘢痕。术后进行浅表放疗。
2例患者胸前有瘢痕疙瘩。治疗后，胸前切口反复裂开，清创后再次缝合。愈合顺利，无瘢痕增生。7例患者的瘢痕疙瘩成功切除，无复发。
该方法通过瘢痕疙瘩切口进行，植入定制扩张器。充分扩张后，使用直线缝合直接切除瘢痕疙瘩，避免了新的手术切口和瘢痕，能够成功切除大面积瘢痕疙瘩。该治疗方法有效，为未来类似大面积瘢痕疙瘩和增生性瘢痕病例的治疗提供了新的思路和策略。
