Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, PR China.
Aesthetic Plast Surg. 2023 Feb;47(1):465-472. doi: 10.1007/s00266-022-03163-4. Epub 2022 Dec 19.
There is no consensus regarding the choice of injected drugs for pathological scars. Although the clinical efficacy of different drug treatments was shown in many randomized controlled trials, the efficacies of many drugs are inconsistent. Therefore, this study aimed to determine how different effective drugs are for treating pathological scars. It is anticipated that the study findings may serve as guidelines for plastic surgeons.
Relevant literature was extracted from the following databases Cochrane Library, Embase, PubMed, Web of Science, CNKI, Weipu, and Wanfang until June 2022, such as randomized clinical trials (RCTs) evaluating different injected drugs for the treatment of pathological scars, including BTA, TAC, 5-Fu, VER, and BLE.
This network meta-analysis of 1539 patients from 23 articles revealed that the most effective treatment for a pathological scar was TAC + BTA. The effective rate of TAC + BTA combination therapy was significantly different from that of the BTA, TAC, 5-Fu, VER, and BLM monotherapies. TAC+5-FU was more effective than TAC, 5-FU, VER, or BLM alone, and BTA was more effective than both TAC and 5-Fu. The effectiveness of VER and BLM was the same, but both were better than TAC and 5-Fu. No big differences were found between any of the other local injection therapies.
According to this network meta-analysis, a combination of keloid and hypertrophic scar injection treatment is recommended, especially BTA+TAC. However, this network meta-analysis has some limitations and must be further verified by larger samples and higher quality RCTs.
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
对于病理性瘢痕的注射药物选择尚无共识。虽然许多随机对照试验显示了不同药物治疗的临床疗效，但许多药物的疗效并不一致。因此，本研究旨在确定不同有效药物治疗病理性瘢痕的效果。预计研究结果可为整形外科医生提供指导。
从 Cochrane 图书馆、Embase、PubMed、Web of Science、CNKI、维普和万方等数据库中提取截至 2022 年 6 月评估不同注射药物治疗病理性瘢痕的随机临床试验（RCT）相关文献，包括 BTA、TAC、5-Fu、VER 和 BLE。
这项纳入 23 项研究的 1539 例患者的网络荟萃分析显示，病理性瘢痕最有效的治疗方法是 TAC+BTA。TAC+BTA 联合治疗的有效率与 BTA、TAC、5-Fu、VER 和 BLM 单药治疗有显著差异。TAC+5-Fu 比 TAC、5-Fu、VER 或 BLM 单独使用更有效，BTA 比 TAC 和 5-Fu 更有效。VER 和 BLM 的疗效相同，但均优于 TAC 和 5-Fu。其他局部注射治疗之间没有发现明显差异。
根据这项网络荟萃分析，建议对瘢痕疙瘩和增生性瘢痕的注射治疗进行联合治疗，特别是 BTA+TAC。然而，本网络荟萃分析存在一些局限性，必须通过更大的样本量和更高质量的 RCT 进一步验证。
证据等级 III：本杂志要求作者为每篇文章分配一个证据等级。有关这些循证医学评级的完整描述，请参考目录或在线作者指南 www.springer.com/00266。
