整形外科缝合技术在面部急诊外伤处理中的临床应用

Clinical application of plastic surgery suture technique in the treatment of emergency facial trauma

目的探讨整形外科缝合技术及医师缝合熟练度在面部外伤后瘢痕抑制方面的效果,探索提高低年资医师缝合熟练度的关键因素。方法回顾性分析2017年6月至2019年7月在宁波市第一医院整形修复重建外科行面部外伤整形缝合的患者资料,按主刀医师年资分为高年资组和低年资组。分析2组患者的一般情况、瘢痕外观、局部症状等,采用瘢痕美容评定量表进行瘢痕外观评分,包括瘢痕扩张、红斑、色素沉着或色素减退、缝合痕迹、瘢痕增生或萎缩、瘢痕瘙痒、瘢痕疼痛,并对上述结果进行统计学分析。连续性数据用均值±标准差表示,组间差异比较采用t检验,分类数据用百分数表示,组间差异比较采用χ2检验。结果该研究共纳入83例急诊接受面部伤口整形外科缝合的患者,男性29例,女性54例,年龄(31.7±13.3)岁,范围3~63岁;高年资组52例,低年资组31例,2组患者性别、年龄、受伤时间、伤口长度、并发症比较,差异无统计学意义。高、低年资组的瘢痕美容评定量表的总分分别为(2.18±0.98)分和(2.78±1.30)分,2组比较差异有统计学意义(P=0.020)。高年资组在抑制瘢痕扩张(P=0.035)、缝合痕迹(P=0.018)、瘢痕总体印象(P=0.038)、色素沉着或色素减退(P=0.045)方面优于低年资组;在红斑、瘢痕增生或萎缩方面,2组比较差异无统计学意义(P>0.05)。高年资组有4例24 h内出现疼痛,3例出现瘙痒;低年资组有2例出现疼痛,3例出现瘙痒。结论整形外科缝合技术能有效地改善面部外伤后瘢痕外观,特别是在抑制瘢痕扩张、红斑产生、瘢痕增生或萎缩、总体印象方面。低年资医师能一定程度上胜任整形缝合这项工作,但是熟练掌握该技术需要长期训练,娴熟的操作能进一步提升疗效。

Objective To explore the effect of plastic surgery suture technique and its proficiency in facial scar inhibition after trauma,and to explore the key factors to improve the suture proficiency of junior residents.Methods The data of patients with facial trauma who underwent plastic surgery suture in the Department of Plastic and Reconstructive Surgery of Ningbo First Hospital from June 2017 to July 2019 were retrospectively analyzed.They were divided into senior group and junior group according to the seniority of chief surgeon.The general condition,scar appearance and local symptoms of the two groups were evaluated by the scar cosmesis assessment and rating scale(SCAR),including scar expansion,erythema,hyperpigmentation or hypopigmentation,suture marks,hyperplasia or atrophy,scar pruritus,scar pain,and the results were statistically analyzed.The mean of continuous data were calculated and expressed as Mean±SD,the differences between groups were tested by t-test,and the classified data were expressed by rate,and the differences between groups were tested by chi-square test.Results A total of 83 patients(54 females and 29 males)were included in this study,the maximum age was 63,the minimum age was 3,and the average age was 31.7±13.3 years old,including senior group(52 cases)and junior group(31 cases).The differences were not statistically significant in gender,age,injury time,wound length and complications between the two groups.The total scores of SCAR scale in the senior and junior groups were 2.18±0.98 and 2.78±1.30,respectively,the difference was statistically significant(P=0.020).The senior group was better than the junior group in inhibiting scar expansion(P=0.035),eliminating suture marks(P=0.018),overall scar impression(P=0.038)and reducing pigment abnormality(P=0.045).However,in inhibiting erythema and inhibiting scar hyperplasia or atrophy,the differences were not statistically significant between two groups.In the senior group,4 patients had pain within 24 hours,3 patients had pruritus;in the junior group,2 patients had pain,3 patients had pruritus.Conclusions Plastic surgery suture technique will effectively improve the appearance of facial scar after trauma,especially in inhibiting scar expansion,erythema,hyperplasia or atrophy,and overall impression.Junior doctors can be competent for this work to a certain extent,but thay need long-term training to master the technology,and skilled operation can further improve the curative effect.