手术切口瘢痕的预防和管理

Prevention and Management of Surgical Incision Scar

手术切口瘢痕的管理与伤口愈合的阶段密切相关。择期手术患者切口的管理,从术前谈话开始,在这个过程中,患者要了解个人的临床情况,例如年龄、种族和既往有无增生性瘢痕的病史。在手术切口瘢痕的预防中,唯一可改变的最重要因素是增殖和重塑阶段切口的张力,这是由切口主刀医师设计决定的。传统的手术切口方向通常平行于松弛的皮肤张力线,在高表面张力区域不存在这样的线。如果高张力方向切口不可避免,则必须提前告知患者。手术切口瘢痕的管理和治疗应从拆除手术缝线时持续一年,患者遵循医嘱对于达到最佳治疗效果是至关重要的。术后的随访应筛查有无瘢痕增生,同时可以加强患者瘢痕护理的意识。早期干预是控制瘢痕增生的关键。6个月后未改善的增生性瘢痕是瘢痕疙瘩,应及时病灶内注射类固醇或者通过其他方式积极处理。对干细胞谱系、生物分子信号级联反应、细胞反应和伤创面愈合动力学的研究,使我们对创面愈合的机制有了更深入的了解,基础科学科研究的重大发现已转化为临床应用。然而,对大多数医生和病人来说,创面愈合的临床处理及管理仍然有所不足。大量的商业产品让患者感到困惑甚至会误导患者。本文旨在阐明创面愈合的管理及预防理念,回顾了创面愈合的过程,特别是在重塑阶段,如何预防和管理创面愈合不佳的手术瘢痕。

The management of surgical incision scars is closely related to the stage of wound healing. Man-agement of incisions in patients undergoing elective surgery begins with a pre-operative interview, during which the patient is informed of the individual’s clinical circumstances, such as age, ethnici-ty, and history of hypertrophic scars. The single most important factor that can be changed in the prevention of surgical incision scarring is the tension of the incision during the proliferation and remodeling stages, which is determined by the design of the incision practitioner. Conventional surgical incision directions are usually parallel to relaxed skin tension lines, which are absent in areas of high surface tension. If a high-tension directional incision is unavoidable, the patient must be informed in advance. The management and treatment of surgical incision scars should continue for one year after the removal of surgical sutures, and it is essential that patients follow the doctor’s advice to achieve optimal treatment results. Postoperative follow-up should be screened for scar hyperplasia, and the awareness of scar care can be strengthened. Early intervention is the key to controlling scar hyperplasia. Hypertrophic scars that do not improve after 6 months are keloids and should be treated promptly with intralesional steroid injections or by other means. The research on stem cell lineage, biomolecular signaling cascade, cellular response and wound healing dynamics has enabled us to have a deeper understanding of the mechanism of wound healing, and the major findings of basic science research have been translated into clinical applications. However, for most doctors and patients, the clinical management and management of wound healing are still inade-quate. A large number of commercial products are confusing and even misleading to patients. This article aims to clarify the management and prevention of wound healing, and review the process of wound healing, especially in the remodeling stage, how to prevent and manage surgical scars with poor wound healing.