Chen Xin-Xin, Yin Zhe, Cai Duo, Ma Tai-Yuan, Zhang Xiu-Hang, Li Yu-Tang, He Yi-Yi, Yu Qing-Hua, Yu Jia-Ao
The First Hospital of Jilin University, China.
The First Hospital of Jilin University, China.
Burns. 2025 Sep;51(7):107578. doi: 10.1016/j.burns.2025.107578. Epub 2025 Jun 24.
This study aims to identify the therapeutic outcomes of punch excision in severe burn patients with extensive, excessive and long-lasting growth scars.
A retrospective comparative clinical observational study was conducted on patients with burn hypertrophic scars who were treated at the Department of Burn and Skin Wound Repair, First Hospital of Jilin University, between October 2022 and October 2024.
A total of 49 patients with severe burn scars were included. Of these, 20 received combined treatment with ablative fractional carbon dioxide laser (AFCL) and punch excision (PE), while 29 were treated with AFCL alone. The AFCL+PE group showed faster and more significant improvements in scar height, pliability, and paresthesias. At 1 week post-treatment, the University of North Carolina 4P Scar Scale (UNC4P) pliability score decreased from 2.7 ± 0.5-2.2 ± 0.6, and the paresthesias score improved from 2.5 ± 0.7-1.9 ± 0.9. The Vancouver Scar Scale (VSS) pliability score dropped from 4.1 ± 0.8-3.4 ± 0.9, and the height score improved from 3.0 ± 0.0-2.1 ± 0.6. Significant improvements in scar sensation were noted, with the Semmes-Weinstein monofilament test decreasing from 32.9 ± 27.2 g pre-treatment to 15.0 ± 10.3 g at 1 week, further improving to 9.5 ± 7.7 g at 1 month and 8.4 ± 7.6 g at 3 months. All 20 patients tolerated the AFCL+PE treatment well, with no complications. The average healing time for PE was 11.7 ± 2.2 days. Postoperative adverse effects included pigmentation (n = 5), which appeared 7 days post-treatment, and mild itching (n = 1).
PE is a safe and effective method for scar management, with excellent suitability for hypertrophic burn scars. It can achieve significant rates of scar volume reduction, rapidly and extensively improve scar thickness, hardness, and scar sensation. As an emerging treatment, punch excision offers a distinct therapeutic mechanism and indications compared to existing methods. It holds the potential to become an integral part of current multi-modal scar management approaches. In the future, scar thickness and hardness may no longer be the primary concerns for patients with scars.
本研究旨在确定对严重烧伤后出现广泛、过度增生且持续时间长的瘢痕患者进行打孔切除的治疗效果。
对2022年10月至2024年10月期间在吉林大学第一医院烧伤与皮肤创面修复科接受治疗的烧伤后增生性瘢痕患者进行回顾性对比临床观察研究。
共纳入49例严重烧伤瘢痕患者。其中，20例接受了剥脱性点阵二氧化碳激光（AFCL）联合打孔切除（PE）治疗，29例仅接受AFCL治疗。AFCL + PE组在瘢痕高度、柔韧性和感觉异常方面的改善更快且更显著。治疗后1周，北卡罗来纳大学4P瘢痕量表（UNC4P）柔韧性评分从2.7±0.5降至2.2±0.6，感觉异常评分从2.5±0.7改善至1.9±0.9。温哥华瘢痕量表（VSS）柔韧性评分从4.1±0.8降至3.4±0.9，高度评分从3.0±0.0改善至2.1±0.6。瘢痕感觉有显著改善，Semmes - Weinstein单丝试验从治疗前的32.9±27.2 g降至1周时的15.0±10.3 g，1个月时进一步改善至9.5±7.7 g，3个月时为8.4±7.6 g。20例患者对AFCL + PE治疗耐受性良好，无并发症发生。PE的平均愈合时间为11.7±2.2天。术后不良反应包括色素沉着（5例），于治疗后7天出现，以及轻度瘙痒（1例）。
打孔切除是一种安全有效的瘢痕治疗方法，对增生性烧伤瘢痕适用性良好。它能显著减少瘢痕体积，快速且广泛地改善瘢痕厚度、硬度及瘢痕感觉。作为一种新兴治疗方法，打孔切除与现有方法相比具有独特的治疗机制和适应证。它有可能成为当前多模式瘢痕管理方法的重要组成部分。未来，瘢痕厚度和硬度可能不再是瘢痕患者的主要担忧。
