Lv Tao, Zhang Peichao, Shi Huirong, Zhang Jiaojiao, Zhang Zhiying, Huo Ran
From the Department of Plastic and Aesthetic Surgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou.
Department of Neurosurgery, Qilu Hospital of Shandong University Dezhou Hospital, Dezhou.
Ann Plast Surg. 2024 Oct 1;93(4):434-442. doi: 10.1097/SAP.0000000000004087. Epub 2024 Sep 3.
Scars disrupt the normal structure and function of the skin. The primary goal of plastic surgery is to prevent and reduce scarring. Therefore, we aimed to establish a comparison scheme between normal skin (NS) tissues of different ages and locations; hypertrophic scars (HTS) of different ages, locations, and maturities; and NS and HTS tissues to provide evidence on scar severity for improving treatment evaluation.
Various methods including histology, immunohistochemistry, and immunofluorescence were employed to compare the general appearance, macrophage infiltration, fibroblast activity, degree of angiogenesis, and collagen fiber type and arrangement in human-sourced NS and HTS tissues of different ages, locations, and maturities in seven patients (three with NS and four with HTS) from the Department of Burn and Plastic Surgery of the Shandong Provincial Hospital from January 2019 to December 2020.
The thicknesses of the epidermis and dermis of NS tissues varied with age and location. The epidermis of the upper arms, face, and upper eyelids of NS tissues sequentially thickened, whereas the dermis was sequentially thinner. Several glandular structures were identified in the upper eyelids but rarely in the face and upper arms. Histological changes in HTS tissue of different ages, locations, and maturity occur as scar formation time is prolonged, accompanied by increased CD86 levels and fibrosis. As the scar matured, connexin and VEGFR2 expression decreased, indicating reduced inflammation, fibroblast activity, and angiogenesis. The comparison between NS and HTS tissue also revealed significant differences; the positive expression of VEGFR2 and total collagen in HTS tissue was higher than that in NS tissue.
We discovered significant differences among NS, HTS, and NS and HTS tissues of different ages, locations, and maturities. Further, this study may provide a basis for clarifying the treatment effect of different methods for HTS compared with those for NS, efficiently individualizing patients' treatment plans and ultimately shortening the scar treatment process.
瘢痕会破坏皮肤的正常结构和功能。整形手术的主要目标是预防和减少瘢痕形成。因此，我们旨在建立不同年龄和部位的正常皮肤（NS）组织；不同年龄、部位和成熟度的增生性瘢痕（HTS）；以及NS和HTS组织之间的比较方案，为改善治疗评估提供瘢痕严重程度的证据。
采用组织学、免疫组织化学和免疫荧光等多种方法，对2019年1月至2020年12月山东省立医院烧伤整形科7例患者（3例NS患者和4例HTS患者）不同年龄、部位和成熟度的人源NS和HTS组织的大体外观、巨噬细胞浸润、成纤维细胞活性、血管生成程度以及胶原纤维类型和排列进行比较。
NS组织的表皮和真皮厚度随年龄和部位而变化。NS组织上臂、面部和上眼睑的表皮依次增厚，而真皮依次变薄。在上眼睑中发现了几个腺结构，但在面部和上臂中很少见。随着瘢痕形成时间的延长，不同年龄、部位和成熟度的HTS组织发生组织学变化，同时CD86水平和纤维化增加。随着瘢痕成熟，连接蛋白和VEGFR2表达降低，表明炎症、成纤维细胞活性和血管生成减少。NS和HTS组织之间的比较也显示出显著差异；HTS组织中VEGFR2和总胶原蛋白的阳性表达高于NS组织。
我们发现NS、HTS以及不同年龄、部位和成熟度的NS与HTS组织之间存在显著差异。此外，本研究可能为阐明与NS相比不同方法治疗HTS的效果、有效个性化患者治疗方案并最终缩短瘢痕治疗过程提供依据。
