纳米脂肪移植联合CO_(2)点阵激光治疗面部凹陷性瘢痕的临床效果观察

Application of nanofat grafting combined with fractional laser to improve depressed facial scars

目的探讨纳米脂肪移植联合CO_(2)点阵激光治疗面部凹陷性瘢痕的临床效果。方法回顾性分析2016年1月至2018年6月浙江大学医学院附属第二医院及其余杭院区收治的面部凹陷性瘢痕患者的临床资料。进行1个周期的治疗:首先进行1次自体纳米脂肪移植,用26 G针头对凹陷性瘢痕进行皮下分离,将自体纳米脂肪注射至凹陷性瘢痕组织内,注射量为0.5~1.0 ml/cm^(2);3个月后进行CO_(2)点阵激光治疗,共2次,间隔3个月。治疗前和治疗后6个月,患者和医生通过患者和观察者瘢痕评估量表(POSAS)对瘢痕各指标分别进行评分,单项总分为1~10分,分数越高表示瘢痕越严重。根据患者及医生的POSAS总评分,对凹陷性瘢痕改善程度进行分级和疗效评价:一级,总分减小≤5分,为无效;二级,总分减小>5分且≤10分,为好转;三级,总分减小>10分且≤20分,为有效;四级,总分减小>20分,为显效。随访时观察并发症发生情况。采用SPSS 23.0对治疗前、后数据进行配对t检验,P<0.05为差异有统计学意义。结果共纳入27例患者,男16例,女11例,年龄(29.1±7.9)岁。患者对治疗前和治疗后6个月瘢痕各项指标评分比较,差异均有统计学意义(P<0.05);医师评分比较,差异均有统计学意义(P<0.01);治疗前、后POSAS总分分别为(43.7±10.8)分和(23.3±3.2)分,差异有统计学意义(P<0.01)。治疗后6个月,患者在凹陷性瘢痕的疼痛、瘙痒、颜色、硬度、厚度(凹陷)、弹性、张力等方面均改善明显,其中二级改善1例,三级改善14例,四级改善12例,总有效率为96.3%(26/27)。27例患者面部填充部位均未出现团状或条索状硬结。所有患者纳米脂肪移植后均未发生栓塞、感染、血肿等并发症。点阵激光治疗后早期均出现皮肤潮红、灼热、水肿、疼痛等症状,一个治疗周期后6个月随访均无明显色素沉着。结论纳米脂肪移植联合CO_(2)点阵激光治疗面部凹陷性瘢痕效果明确,并发症少,而且操作简便,治疗周期短。

Objective To investigate the clinical effect of nanofat transplantation combined with CO_(2) fractional laser in the treatment of depressed facial scars.Methods Through a retrospective study,a total of 27 patients with depressed facial scars who got admitted to the plastic surgery department of our hospital from January 2016 to June 2018 were recruited for autologous nanofat transplantation and carbon dioxide fractional laser treatment in combination to treat moderate to severe depressed facial scars.The treatment was carried out as follows:autologous nanofat transplantation was performed,the depressed scar was subcutaneously separated with a 26 G needle,and injected with the autologous nanofat 0.5-1.0 ml/cm^(2).After 3 months,the fractional CO_(2) laser treatment was performed for a total of 2 times,with an interval of 3 months each time.Before and six months after treatment,patients and surgeons used the Patient and Observer Scar Assessment Scale(POSAS)to evaluate each aspect of scar.The total score for each item was 1-10 points.According to the total POSAS scores of patients and doctors,the degree of improvement of depressed scars was classified and evaluated.Grade 1:invalid,total score reduction≤5 points;grade 2:mildly effective,total score reduction>5 points and≤10 points;grade 3,effective,total score reduction>10 points and≤20 points;grade 4,markedly effective,total score reduction>20 points.Using SPSS 23.0 to do t-test on the data before and after treatment.P<0.05 indicates that the difference is statistically significant.Results A total of 27 patients were enrolled,including 16 males and 11 females,aged(29.1±7.9)years old.Before and after six months of treatment,the difference between the scores of the patients on all indicators of scar was statistically significant(P<0.05);the difference between the doctor’s scores was statistically significant(P<0.01).The total scores of post-total POSAS were(43.7±10.8)and(23.3±3.2)points respectively,the difference was statistically significant(P<0.01).After six months of treatment,the degree of pain,itching,color,hardness,thickness(depression),elasticity,tension of the depressed scar were significantly improved.Among them,there was 1 case of second-level improvement,14 cases of third-level improvement,and 12 cases of fourth-level improvement.The total effective rate reached 96.3%(26/27).None of the 27 patients had lumps or cord-like indurations on the filling parts of the face.No embolism,infection,hematoma and other complications occurred after nanofat transplantation in all patients.Skin flushing,burning,edema,pain and other symptoms occurred early after the fractional CO_(2) laser treatment,and no hyperpigmentation occurred in the 6-month follow-up after a treatment cycle.Conclusions The combination of nanofat transplantation technology and carbon dioxide fractional CO_(2) laser can produce a significant effect on improving depressed scar,reducing treatment period,rendering a simple operation with few complications.