应用榫卯结构原理修复体表增宽瘢痕的临床效果

A new method for repair of superficial widened scars by applying the Chinese wood joinery mortise-and-tenon principle

目的探讨在体表增宽瘢痕修复中采用榫卯结构原理进行切缘以外的皮下真皮内缝合的临床效果。方法回顾性分析2017年1月至2022年1月就诊于中国医学科学院整形外科医院进行体表增宽瘢痕修复术患者的临床资料。采用真皮内榫卯结构缝合对瘢痕进行修复,术中沿瘢痕外缘梭形切开,去除瘢痕表皮及真皮层浅层瘢痕组织。在保留的真皮层深层瘢痕组织上设计连续榫头结构,在对侧切缘同层真皮内设计与榫头相对应的连续卯眼结构。将所形成榫卯结构样真皮相互嵌插缝合,最后间断缝合皮肤。随访观察切口愈合情况,术后6个月采用温哥华瘢痕量表(VSS)评估瘢痕外观,评分越高表明瘢痕越严重,同时测量瘢痕宽度,并记录患者满意度。结果共纳入32例患者,男性8例,女性24例,年龄8~44岁,平均34岁;术前瘢痕均为条索样,VSS评分3~7分,平均4.6分;瘢痕宽度2~11 mm,平均4 mm。术后随访6~24个月,所有患者切口均为一期愈合,4例(12.5%)出现一定程度的瘢痕增生,给予局部压迫和药物治疗后增生有所缓解,其余28例(87.5%)可见切口瘢痕细小,外观平整,较术前明显改善。此28例患者术后VSS评分0~2分,平均0.9分;瘢痕宽度0.1~1.0 mm,平均0.3 mm,其中11例瘢痕宽度<0.3 mm,8例为0.3~0.5 mm,9例为>0.5~1.0 mm。满意度评价显示,满意28例(满意率为87.5%),良好4例。结论瘢痕修复中真皮层缝合时保留真皮层深层瘢痕组织进行榫卯样缝合能够有效降低皮肤缝合张力,最终形成的切口瘢痕细微。

Objective To investigate the clinical effect of intradermal suturing using the principle of mortise-and-tenon suture in repair of superficial widened scars.Methods A retrospective analysis was performed on the clinical data of patients with superficial widened scars repaired in the Plastic Surgery Hospital,Chinese Academy of Medical Sciences from January 2017 to January 2022.All patients were treated with this mortise-and-tenon method.During the operation,a pike incision was made along the outer margin of the scar to remove the top half of the dermal scar tissue,along with the epidermis.Serial tenon structures were created on the retained dermal scar tissue.Corresponding serial mortise structures were created by the removal of identically shaped blocks of dermal tissue opposite to the corresponding tenon structures.By suturing each tenon into its corresponding mortise,tensionless incision closure was readily achieved.Then,the skin was intermittently sutured.The incision was observed at postoperative follow-up,the Vancouver scar scale(VSS)was used to assess scar appearance,while higher scores indicated more severe scars;the scar width was measured,and patient satisfaction was recorded at 6 months postoperatively.Results A total of 32 patients,8 males and 24 females,aged from 8 to 44 years old(mean,34 years old),were enrolled.All scars were elongated in shape and the VSS score was 3-7(mean,4.6).The scar width ranged from 2 to 11 mm(mean,4 mm).The postoperative follow-up was 6 to 24 months.All incisions were healed by primary intention.4 cases(12.5%)showed some degree of scar hyperplasia,which was improved by local compression and medication,and the remaining 28 cases(87.5%)showed small incision scars with a flat appearance,which were significantly improved compared with the preoperative period.Among these 28 cases,the VSS score was 0-2(mean,0.9).The scar width was 0.1-1.0 mm,(mean,0.3 mm),including 11 cases with scar width<0.3 mm,8 cases with scar width of 0.3-0.5 mm,and 9 cases with scar width of>0.5-1.0 mm.28 patients were satisfied(satisfaction rate of 87.5%)and 4 cases were good.Conclusion The proposed mortise-and-tenon scar repair technique can effectively reduce incision tension and thus the final incision scar is minimal.