皮下埋没横向褥式缝合对减轻张力性切口瘢痕的临床效果观察

Clinical observation of subcutaneous buried transverse mattress suture on reducing high-tension incision scar

目的探讨皮下埋没横向褥式缝合技术对减轻张力性切口术后瘢痕的效果。方法选取体表色素痣或局部瘢痕患者12例,门诊手术切除病灶,然后于皮下浅筋膜层向切缘两侧游离1~1.5 cm,术中对切口进行减张缝合。采用自身对照方法,将切口分为改良缝合组和传统对照组。改良缝合组应用皮下埋没横向褥式缝合减张闭合切口创面,传统对照组应用皮下埋没垂直褥式缝合减张闭合切口创面,之后间断缝合法缝合皮肤表层。观察拆线时切口愈合情况,术后6个月测量切口瘢痕宽度,并进行温哥华瘢痕量表评分。结果12例患者均完成了手术及术后切口愈合情况观察,术后6个月时对10例患者完成了瘢痕测量和评估。瘢痕宽度比较,改良缝合组(0.66±0.22)mm,小于传统对照组(0.98±0.24)mm,差异显著(P<0.05)。温哥华瘢痕量表评分比较,改良缝合组(1.70±0.55)分,瘢痕评分亦明显低于传统对照组(3.07±0.97)分,差异显著(P<0.01)。结论皮下埋没横向褥式缝合较传统减张缝合方法能更充分地减小手术切口张力,减轻张力性切口术后的瘢痕增生。

Objective To investigate the effect of subcutaneous buried transverse mattress suture on reducing high-tension incision scar.Methods Twelve patients with body surface pigmented nevus or local scar were selected,and the lesions were removed by outpatient operation.Then the superficial fascia layer was dissociated 1-1.5 cm to both sides of the incisal margin,and the incisions were sutured.The incisions were divided into modified suture group and traditional control group by self control method.In the modified suture group,subcutaneously buried transverse mattress suture was used to reduce tension and close the incision,while in the traditional suture group,subcutaneously buried vertical mattress suture was used to reduce tension and close the incision,and then interrupted suture was used to close the skin surface.Incision healing was observed during suture removal.Scar width was measured 6 months after operation,and the score of Vancouver scar scale was performed.Results Among the 12 patients,10 patients completed the operation and incision healing observation.Scar measurement and evaluation were completed in 10 patients 6 months after the operation.Scar width in the modified suture group was(0.66±0.22)mm,smaller than the traditional control group[(0.98±0.24)mm],and the difference was significant(P<0.05).Vancouver scar scale score in the modified suture group was 1.70±0.55,also significantly lower than the traditional control group(3.07±0.97)with signif icant difference(P<0.05).Conclusion Subcutaneous buried transverse mattress suture can more fully relieve incision tension and reduce postoperative scarring than traditional tension-reducing suture method.