摘要
目的探讨瘢痕切除结合负压整复烧伤患儿增生性瘢痕的效果。方法2010年10月-2016年8月，笔者单位收治深度烧伤后遗留增生性瘢痕的25例患儿（共35处瘢痕），瘢痕病程3个月-11年，瘢痕面积为35～427[83（51，98）]cm2，分布于躯干11处、上肢11处、下肢13处。所有患儿均行瘢痕切除术结合负压固定，其中6例患儿为进一步去除瘢痕，行2次瘢痕切除术，术后均结合负压固定，压力值为-40～-20kPa。术中切除瘢痕后应用电子弹簧秤测量手术切口张力，患儿的张力值范围为3．43～23．84[7．16（5．59，9．12）]N，根据切口张力大小选择合适缝线缝合切口。术中测定张力较小的切口，于术后8d首次打开术区，拆线后行负压固定至术后14d；术中测定张力较大的切口，于术后12d首次打开术区，拆线后应用生物半透膜行减张固定至术后16d。所有切口愈合后行抗瘢痕治疗1年、减张固定3个月。术后行切口大体观察；术后半年计算瘢痕面积缩小百分比；于术前及术后半年应用患者和观察者瘢痕评价量表行总体瘢痕评分及躯干、上肢、下肢各项瘢痕评分。对数据行配对￡检验、Wilcoxon秩和检验。结果所有患儿拆线后切口均愈合良好，无红肿、渗液、破溃；术后半年，外观及畸形明显改善，瘙痒、疼痛等症状基本缓解。术后半年患儿瘢痕面积为0～174[21（9，47）]cm2，较术前明显缩小（Z=-5．16，P〈0．05），瘢痕面积缩小百分比为36％～100％[（73±19）％]。患儿术后半年瘢痕各项总体评分以及躯干、上肢、下肢瘢痕各项评分均显著低于术前（t值为6．42～17．37，P值均小于0．05）。结论瘢痕切除结合负压固定整复烧伤患儿增生性瘢痕效果较佳，宜于临床推广。
Objective To explore the effects of scar excision combined with negative-pressure on repair of hypertrophic scar in burn children. Methods From October 2010 to August 2016, 25 children with hypertrophic scar after deep burn were hospitalized, with scar course ranging from 3 months to 11 years and scar area ranging from 35 to 427 [83（51, 98）]cm2. A total of 35 scars of 25 children were located in trunk （11 scars） , upper limb （11 scars） , and lower limb （13 scars）. All children received scar excision operation and negative-pressure treatment （negative-pressure value ranged from -40 to -20 kPa） , among which 6 cases received scar excision operation and negative-pressure treatment for two times for further re- moval of scars. After scar excision, electronic spring scale was used to measure the tension of the incision. The tension value of children ranged from 3.43 to 23.84 [7.16 （5.59, 9.12） I N, and then the incision was closed with appropriate suture according to the value of the tension. The incision with smaller tension was firstly opened on post operation day （POD） 8. After removing the suture, negative-pressure was conduc- ted to POD 14. The incision with larger tension was firstly opened on POD 12. After removing the suture, biological semi-membrane was used to reduce tension to POD 16. All healed incisions were performed with anti-scar treatment for 1 year and relaxation and fixation for 3 months. General condition of the incision was observed after operation. The reduction percentage of scar area was calculated half-year after operation. The Patient and Observer Scar Assessment Scale was used to record the overall score of scar and sear score of trunk, upper limb, and lower limb before operation and half-year after operation. Data were processed with paired t test and Wilcoxon rank sum test. Results After removing the suture, all incisions of children healed well without redness, effusion, and rupture. Half-year after operation, the appearance and deformity of incision were obviously improved, and the symptoms including pruritus and pain were basically relieved. Half-year after operation, the scar area of children ranged from 0 to 174 [ 21 （9, 47） ~ em2, which was sig- nificantly decreased as compared with that before operation （ Z = -5.16, P 〈 0.05）. The reduction per- centage of scar area ranged from 36% to 100% [ （73 ＋ 19） % ]. Half-year after operation, the overall score of scar and scar score of trunk, upper limb, and lower limb of children were obviously decreased as compared with those before operation （ with t values from 6.42 to 17.37, P values below 0.05）. Conclusions Scar excision combined with negative-pressure treatment has a good clinical effect on repair of hypertrophic scar in burn children, which is suitable for clinical application.
作者
蔡建华
邓虎平
申传安
孙天骏
李东杰
李大伟
何丽霞
王亮
金秀
Cai Jianhua Deng Huping Shen Chuan＇an Sun Tianjun Li Dongfie Li Dawei He Lixia Wang Li- ang Jin Xiu.(Burns Institute, the First Hospital Affiliated to the PLA General Hospital, Belting 100048, China)
出处
《中华烧伤杂志》
CAS
CSCD
北大核心
2017年第7期410-414,共5页
Chinese Journal of Burns
关键词
烧伤
儿童
负压伤口疗法
增生性瘢痕
瘢痕切除
Burns
Child
Negative-pressure wound therapy
Hypertrophic scar
Sear exeision
