外科手术切除治疗面部瘢痕146例分析

Experience of surgical wound closure in facial scar resection

目的探讨用外科手术切除法治疗面部瘢痕的方法。方法对面部瘢痕患者146例采用不同术式,切除缝合。分别采用直接切除缝合术、"Z"成形术、"W"成形术、分次切除术和即时扩张术等方法,观察其疗效。结果临床共治疗146例,效果满意。结论面部瘢痕如顺皮纹可不做或少做"Z"成形术,需做"Z"成形术时,一般"Z"的臂长1 cm、夹角约60°为佳,且与轴线长度相等;"W"成形术对顺皮纹的线状瘢痕及早期缝合不佳,留有针脚的瘢痕较适宜;对直径大于2.0 cm的圆形瘢痕最好分次切除;一次切除张力较大的瘢痕可采用即时扩张术。同时术中注意剥离的范围及层次,皮下缝合不宜过多过密。

Objective To investigate the principles for the suture of surgical wound in facial scar resection.Methods 146 patients underwent facial scar resection were reviewed.The patients were treated with resection and direct suture,＂Z＂ or ＂W＂ plasty,fractional resection and instant dilation,respectively.Results The 146 patients were treated with satisfactory results.Conclusion ＂Z＂ plasty should not or rarely be performed on the facial scars in direction with cleavage lines.When needed,the ＂Z＂plasty should be done with preference of the ＂Z＂ arm 1cm long,which is equal to the axial line,and the inclination of 60°.＂W＂plasty is preferred for the linear scars with cleavage lines and scars with remnant stitches due to earlier faulty suture.