改良全埋垂直褥式减张缝合与皮内连续缝合对儿童手术切口愈合以及瘢痕形成的影响

Outcomes of modified fully buried vertical mattress suture versus intradermic continuous suture during pediatric surgery

目的皮内连续缝合(intradermic continuous suture,ICS)是临床上常用的缝合方法之一,但因减张效果不足容易导致瘢痕增生;改良全埋垂直褥式减张缝合(modified fully buried vertical mattress suture,MFBVMS)在整形外科应用广泛,具有良好的减张效果;本研究旨在比较MFBVMS和ICS对伤口愈合以及瘢痕形成的影响。方法本研究为前瞻性研究,选择2022年1月至8月于上海交通大学医学院附属新华医院儿普外科行开放手术的70例患儿作为研究对象,使用信封法随机分为观察组和对照组,每组各35例;观察组采取MFBVMS,对照组采取ICS,比较两组患儿缝合时间、切口愈合等级、术后1个月、6个月所测量瘢痕宽度以及温哥华评估量表(vancouver scar scale,VSS)评分结果,观察两组患儿切口不良反应发生情况。结果观察组缝合时间(16.66±6.35)min,长于对照组的(7.20±3.48)min,差异有统计学意义(t=-7.729,P<0.001)。术后6个月观察组瘢痕宽度(1.13±0.53)mm,小于对照组的(2.49±1.03)mm,差异有统计学意义(t=6.920,P<0.001);VSS评分(3.69±1.13)分,小于对照组的(5.49±1.25)分,差异有统计学意义(t=6.352,P<0.001)。观察组手术后无一例切口不良反应发生,与对照组11.43%的切口不良反应率相比,差异有统计学意义(χ^(2)=4.242,P<0.05);观察组切口愈合时间(6.77±0.55)d,小于对照组的(7.83±2.47)d,差异有统计学意义(t=2.475,P<0.05)。结论MFBVMS应用于儿童手术能明显减少切口瘢痕形成,改善切口愈合质量。

Objective In clinical practices,intradermic continuous suture(ICS)is one of the most frequently applied.However,it is prone to scar hyperplasia due to insufficient tension reduction.Widely used in plastic surgery,modified fully buried vertical mattress suture(MFBVMS)has a good tension reducing effect.The goal of this study was to compare the effect of MFBVMS versus ICS on wound healing and scar prevention in pediatric surgery.Methods From January 2022 to August 2022,70 children were randomized by envelope method into two groups of study(MFBVMS,n=35)and control(ICS,n=35).During a follow-up period of 6 months.suturing time,scar width,Vancouver scar scale(VSS)score at Month 1/6 post-operation and the incidence of wound adverse events were compared between two groups.Results Suturing time was longer in study group than that in control group[(16.66±6.35)vs.(7.20±3.48)min,P<0.001,t=-7.729].At Month 6 post-operation,scar width was narrower in study group than that in control group[(1.13±0.53)vs.(2.49±1.03)mm,P<0.001,t=6.920];VSS score was lower in study group than that in control group[(3.69±1.13)vs.(5.49±1.25),P<0.001,t=6.352].No incision adverse reactions occurred in study group and it was lower than 11.43%in control group(P<0.05,χ^(2)=4.242).Incision healing time was shorter in study group than that in control group[(6.77±0.55)vs.(7.83±2.47),P<0.05,t=2.475].Conclusions Application of MFBVMS may significantly minimize scar formation and improve the quality of incision healing in pediatric surgery.