瘢痕皮下改薄术联合复合激光技术治疗肥厚增生性瘢痕的临床疗效

Clinical effect of scar thinning techniques combined with composite lasers technique in the treating extra-hypertrophic scar

目的探讨瘢痕皮下改薄术(Scar Thinning Techniques,STT)联合复合激光技术(Composite Lasers Therapy,CLT)应用于肥厚增生性瘢痕中的临床效果方法2018年1月-2020年12月,增生性瘢痕(Extra Hypertrophic Scar,EHS)患者于湖南省人民医院(湖南师范大学附属第一医院)整形激光美容外科门诊就诊,30例符合肥厚增生性瘢痕入选标准的患者,病例采用自身前后对照的方法进行回顾性分析。患者男12例,女18例,其中前胸5例、足背15例、下颌5例、下腹4例、肘部1例。首先行瘢痕皮下改薄技术(STT),拆线后当日予以复合激光首次治疗,间隔3个月再次复合激光治疗,2次复合激光技术治疗后6个月采用温哥华瘢痕量表(VSS)评估瘢痕外观并评分,统计患者疗效满意度并计算总体满意率。随访记录整个治疗过程中的不良反应情况。对数据行Wilcoxon符号秩和检验。结果①治疗后6个月随访,VSS评分瘢痕厚度、色泽、柔软度、血管分布评分及总分均明显低于首次治疗前(Z=-4.940、-4.761、-4.882、-4.886、-4.816,P<0.01);②治疗后6个月随访,26例(86%)患者对疗效非常满意,3例(10%)满意,1例(3%)较为满意,总满意率为96%;③28例患者术后创面全部愈合。2例患者足部瘢痕因打包松动导致缝线处裂开,激光治疗后创面愈合,无瘢痕增生。首次激光治疗后4-5天,2例患者创面及创面周边发生红疹伴随瘙痒症状,对症治疗后改善。所有治疗创面均未出现瘢痕加重、感染等不良反应。结论STT联合CLT在肥厚增生性瘢痕治疗中在瘢痕病损范围内修复瘢痕,避免传统瘢痕手术治疗的供区损害,能有效减少瘢痕的厚度,改善瘢痕的质地、色泽,疗效较明显,治疗周期较短,且不良反应少。

Objective To explore the effect of combined application of Scar Thinning Techniques(STT)and Composite Lasers Technique(CLT)in treatment of extra-hypertrophic scar.Methods Thirty patients with extra-hypertrophic scar(the lowest point of scar protruding skin surface≥10mm)were admitted to Plastic and Laser Cosmetic Surgery(Hunan Provincial People’s Hospital,1st Affiliated Hospital of Hunan Normal University)from January 2018 to December 2020.Their data were retrospectively analyzed by the method of single case-control study.Among the patients,12 were male and 18 were female.The surgical sites involved the anterior chest in 5 cases,dorsal foot in 15 cases,mandible in 5 cases,lower abdomen in 4 cases,and elbow in 1 case.First,STT was performed.CLT was used to treat the wound on the same day after stitches were removed.The wound was treated twice,each time with an interval of 3 months.The appearance of scar was evaluated by Vancouver Scar Scale 6 months after the two times of combination laser Therapy,and patient's satisfaction with curative effect was counted and the overall satisfaction rate was calculated.The adverse reactions during the whole treatment process were record in the postoperative outpatient follow-up.Results(1)After 6 months of follow-up,the average thickness score(1.4mm),color score(0.73 points),softness score(1.4 points),and vascular distribution score(0.43 points)of scar score were obtained by Vancouver Scale.(2)After 6 months of follow-up,26 patients(86%)were very satisfied with the curative effect,3 patients(10%)were satisfied,and 1 patient(3%)was relatively satisfied.All patients were satisfied and very dissatisfied,and the total satisfaction rate was 96%.(3)Post-operation:among them,28 cases wound healing well.2 cases,loose stitches caused some wounds to heal poorly.After laser treatment,the wound healed without scar hyperplasia.4-5 days after 1st laser treatment,the wound and around area appeared red rash with pruritus,which relieved after symptomatic treatment.There were no adverse reactions such as scar aggravation and infection on all the cases.Conclusions STT combined with CLT in the treatment of extra-hypertrophic scar can effectively improve the thickness of scar,with obvious curative effect,short treatment period,relief of patients'symptoms,and less adverse reactions,which can be promoted in clinical application.