改良连续皮内缝合在皮肤外科手术中的临床应用

Clinical application of an improved method of continuous intradermal suture in dermatologic surgery

目的 介绍改良连续皮内缝合闭合手术切口的方法及临床效果.方法 选取82例手术患者,其中色素痣37例,基底细胞癌10例,皮脂腺囊肿16例,脂肪瘤6例,脂溢性角化8例,皮肤纤维瘤3例,凹陷性瘢痕2例.所有皮损均采用单纯手术切除,术后切口长度最短0.8 cm,最长12 cm.术后切口采用改良连续缝合,即将两端带有小三角针的可吸收线,分别按从一侧皮缘真皮内进、出针,然后再从对侧皮缘真皮内进、出针的顺序缝合切口.结果 82例手术患者,术后均采用改良连续皮内缝合法闭合手术切口,80例Ⅰ期愈合,2例术后2d开始红肿,疼痛,经对症处理5d后红肿消失.术后随访3～6个月,78例切口对合平整、光滑,4例出现瘢痕增生,给予糖皮质激素局部封闭后明显缓解好转.无切口裂开.结论 改良连续皮内缝合法用于面颈、躯干、四肢皮肤缺损,术后切口对合好,美容效果满意.

Objective To introduce an improved method of continuous intradermal suture,and to evaluate its clinical efficacy for the closure of surgical incisions.Methods Eighty-two patients were enrolled in this study,including 37 cases of nevus,10 cases of basal cell carcinoma,16 cases of sebaceous cyst,6 cases of lipoma,8 cases of seborrheic keratosis,3 cases of dermatofibroma and 2 cases of depressed scar.All the patients were managed by simple surgical excision with the shortest length of postoperative incisions being 0.8 cm and the longest length being 12 cm.An improved method of continuous intradermal suture was used for the closure of all the postoperative incisions.Specifically,an absorbable thread with a small triangle needle in both ends was inserted through and pulled out from the dermal layer at one side of the incision,and then inserted through and pulled out from the dermal layer at the opposite side of the incision,which was repeated until the incision was entirely closed.Results Among the 82 patients,80 achieved primary healing,and 2 developed erythematous painful swelling at the incision site 2 days after the operation,which disappeared after symptomatic treatment for 5 days.During 3-6 months of follow-up,the incisions closed leaving a flat and smooth surface in 78 patients,and proliferative scar formed in 4 patients,which was obviously improved after local injection with glucocorticoids.No disruption of incisions was observed.Conclusion The improved method of continuous intradermal suture can be applied to the closure of skin defects in the face,neck,trunk and extremities with a favorable healing outcome and cosmetic result.