额部外伤清创缝合术后即刻注射A型肉毒毒素防治瘢痕的效果

The effect of botulinum toxin A injection immediately after operation on frontal traumatic scars

目的探讨额部外伤清创缝合术后即刻注射A型肉毒毒素防治瘢痕的临床效果。方法从2016年1月至2018年1月于陆军军医大学大坪医院整形外科收治的152例额部外伤患者中选择伤口近乎垂直于Langer线的病例,行清创美容缝合,术后即刻于伤口边缘肌层注射A型肉毒毒素,浓度为每0.10 ml溶液中含2 U肉毒毒素。根据额肌力量每1 cm长注射0.05~0.10 ml(1~2 U),2个注射点间距为1 cm,注射范围为整个额部,以保证额部左右对称,注射总量不超过100 U。参考观察者瘢痕评估量表和温哥华瘢痕量表,在随访时评估患者额部伤口术后瘢痕的色泽、宽度、质地、厚度、有无疼痛及瘙痒等。结果共纳入44例患者,男22例,女22例,年龄(31.5±8.4)岁,伤口长度为1~12 cm,平均3.5 cm,伤口周围肉毒毒素注射量为0.10~0.90 ml(2~18 U),额部注射总量为8~40 U。术后随访6~24个月。术后有1例患者发生轻到中度上睑下垂,1个月左右症状完全消失。术后6周内,44例患者伤口瘢痕均呈粉红色且质硬,3~6个月以后,42例患者瘢痕颜色逐渐贴近肤色、质地变软,窄且平坦、无疼痛和瘙痒症状,患者表示满意,满意率达95.5%(42/44),2例患者因瘢痕色素沉着和瘢痕略宽不满意。结论额部外伤清创缝合术后即刻注射A型肉毒毒素能有效防治瘢痕,患者满意度较高。

Objective To investigate the clinical effect of botulinum toxin type A injection in the prevention and treatment of frontal traumatic scars immediately after operation.Methods From January 2016 to January 2018,among the 152 patients with frontal trauma admitted to the Department of Plastic Surgery,Daping Hospital,Army Military Medical University,patients with wounds almost perpendicular to the Langer line were selected.Immediately after debridement and suture,botulinum toxin type A was injected with a concentration of 2 U botulinum toxin per 0.10 ml of solution,0.05 to 0.10 ml(1 to 2 U)per 1 cm was injected into the frontal muscle according to frontal muscle strength.With reference to the observer scar assessment scale and Vancouver scar scale,the color,width,texture,thickness,pain,and itching of the postoperative scar of the frontal wound were evaluated at follow-up.Results A total of 44 patients were included,22 males and 22 females,aged(31.5±8.4)years old,with a wound length of 1-12 cm(average,3.5 cm)and a Botox injection volume around wounds of 0.10-0.90 ml(2-18 U).The patients were followed up for 6 to 24 months.One patient had mild to moderate ptosis,which completely disappeared within one month.Within 6 weeks after operation,the scars in 44 patients were pink and hard.3-6 months later,the scars gradually became soft,narrow and flat with similiar skin color,no pain and itching left in 42 patients.The satisfaction rate was 95.5%(42/44).Two patients were dissatisfied because of scar pigmentation and width.Conclusions Immediate injection of botulinum toxin type A after debridement and suture of the frontal trauma wound can effectively prevent and improve scar appearance with a high rate of satisfaction.