瘢痕疙瘩切除放疗后切口远期愈合问题的分析

Long-term healing problems after keloid excision followed by radiation:an etiology analysis

目的分析瘢痕疙瘩手术切口远期愈合情况和愈合不良的原因及防治方法。方法回顾分析自2016年1月至2018年1月,均行瘢痕疙瘩切除治疗的930例患者。切除创面直接缝合或皮瓣移植修复。术后第1、7天行术区放射治疗,900 c Gy/次。术后6个月内随访1次/月,针对术后1个月后出现的切口感染、破溃等切口远期愈合问题进行统计,并分析发生原因。结果在随访6个月内,930例患者中15例(1.6%)出现远期愈合问题。发生原因包括痂皮引起慢性感染、真皮层假性愈合、伤口化脓性炎症、伤口微小窦道、线结反应、硅胶贴诱发感染等。结论瘢痕疙瘩术后远期切口愈合问题原因复杂,各种原因引起的组织成活不良是其主要因素,术中应注意保护组织血运等,避免远期愈合问题的发生。

Objective To analyze the reasons and prevention and treatment methods in the long-term healing of operative incision of keloid.Methods From January 2016 to 2018,930 patients underwent keloid excision were retrospectively analyzed.The wound was directly sutured or repaired by skin flap transplantation.Radiation was performed in the operative area at first and seventh day after operation,900 c Gy each time.All patients were followed-up for 6 months.The long-term healing problems of incision such as infection and ulceration which occurred in 1 month postoperative were statistically analyzed.The reasons were also analyzed.Results During the follow-up,long-term healing problems occurred in 15 of 930 patients(1.6%).The reasons including chronic infection caused by crust,pseudo healing of dermis layer,suppurative inflammation of wound,micro sinus of wound,knotting reaction and infection induced by silicone gel sheet.Conclusion The reasons of long-term healing problems after keloid excision were complicated.Poor survival of tissue was the main cause.Attention should be paid to protect blood supply of tissue,so as to avoid the occurrence of long-term healing problems.