Analysis of the Cicatricial Acceleration Method (MAC®) in Skin Repair in Wistar Rattus norvegicus with Induced Chemical Burns

Introduction: The cicatricial acceleration method (MAC®) promotes photobiological effects of an anti-inflammatory and healing nature. Its therapeutic radiation is emitted, producing photobiostimulant effects that result in rapid tissue repair and better tissue quality. The treatment of burns has always been a challenge, which involves both performing surgery and controlling and guiding scar regeneration, avoiding possible morbidities. Objective: To evaluate the effects of applying the MAC methodology with an AlGa (aluminum, gallium arsenide) laser on the time and quality of tissue repair in the skin of rats after induced chemical burns. Method: 22 adult male rats were subjected to a second-degree chemical burn on the back using 50% trichloroacetic acid. After the burns, the animals were randomly separated into 2 groups: control and experimental. The control group (G1) received placebo laser therapy and the laser group (G2) underwent laser irradiation with an energy density of 100 J/cm2. Histological analysis and macroscopic evaluation were carried out by means of the paper template method. Results: Group G1 showed (53%) of the necrosis area and group G2 showed (11%) necrosis area. Conclusion: The cicatricial acceleration method (MAC®) favored the repair of wounds caused by a 2nd-degree chemical burn, optimizing time and improving quality.

Ocular cicatricial pemphigoid:diagnosis and systemic management

Ocular cicatricial pemphigoid(OCP)is a subcategory of mucous membrane pemphigoid(MMP)where the conjunctiva is the main site of inflammation.It is a chronic and autoimmune disease characterized by acute and chronic conjunctivitis that can progress to severe conjunctival cicatrization,corneal opacification,ocular surface keratinization,and eyelid abnormalities.OCP can lead to structural damage that can result in visual impairment,visual loss,and blindness,and can have a significant impact in a patient’s quality of life.Patients may manifest with varying symptoms,degrees of severity and may have different rates of progression.Early diagnosis and appropriate systemic immunosuppression are of utmost importance for prompt and adequate disease control.Various systemic immunomodulatory therapies(IMTs),including anti-metabolites,alkylating,and biologic agents have been utilized to achieve inflammation control and remission.Careful monitoring of disease progression is important to assess response and to modify and escalate therapy if needed.Treatment to alleviate symptoms of dry eye disease and address trichiasis and other eyelid abnormalities is recommended as well.A multidisciplinary approach to optimize clinical care is recommended in the management of patients with OCP.This review will address the immunopathogenesis,clinical features,keys to diagnosis and staging of patients with OCP.It will highlight the current immunomodulators utilized for disease management and proposed stepladder strategies.This review will discuss the updated roles of combination therapy,novel use of biologics as well as the recent use of adrenocorticotropic hormone(ACTH)analog in severe recalcitrant cases.

Application of Paclitaxel as Adjuvant Treatment for Benign Cicatricial Airway Stenosis

Benign cicatricial airway stenosis（BCAS） is a potentially life-threatening disease.Recurrence occurs frequently after endoscopic treatment.Paclitaxel is known to prevent restenosis,but its clinical efficacy and safety is undetermined.Therefore,in this study,we investigated the efficacy and associated complications of paclitaxel as adjuvant treatment for BCAS of different etiologies.The study cohort included 28 patients with BCAS resulting from tuberculosis,intubation,tracheotomy,and other etiologies.All patients were treated at the Department of Respiratory Diseases,Beijing Tian Tan Hospital,Capital Medical University,China,between January 2010 and August 2014.After primary treatment by balloon dilation,cryotherapy,and/or high-frequency needle-knife treatment,paclitaxel was applied to the airway mucosa at the site of stenosis using a newly developed local instillation catheter.The primary outcome measures were the therapeutic efficacy of paclitaxel as adjuvant treatment,and the incidence of complications was observed as well.According to our criteria for evaluating the clinical effects on BCAS,24 of the 28 cases achieved durable remission,three cases had remission,and one case showed no remission.Thus,the durable remission rate was 85.7%,and the combined effective rate was 96.4%.No differences in outcomes were observed among the different BCAS etiologies（P=0.144）,and few complications were observed.Our results indicated that paclitaxel as an adjuvant treatment has greater efficacy than previously reported BCAS treatment methods.

Biliary tuberculosis causing cicatricial stenosis after oral anti-tuberculosis therapy

A 36-year-old Philippine woman presented with dark urine and yellow sclera. Endoscopic retrograde cholangiopancreatography （ERCP） confirmed dilatation of the intrahepatic bile ducts and also showed an irregular stricture of the common hepatic duct at the liver hilum. Histological examination of biopsies from the bile duct revealed epithelioid cell granulomas and caseous necrosis. Tubercle bacilli were then detected on polymerase chain reaction （PCR） testing of the bile, giving the diagnosis of biliary tuberculosis. Although microbiological cure was confirmed, the patient developed cicatricial stenosis of the hepatic duct. She underwent repeated treatments with endoscopic biliary drainage （EBD） tubes and percutaneous transhepatic biliary drainage （PTBD） tubes, and the stenosis was corrected after 6 years. We present a case of tuberculous biliary stricture, a condition that requires careful differentiation from the more common malignancies and needs long-term follow-up due to the risk of posttreatment cicatricial stenosis, although it is rare.

Clinical features and in vivo confocal microscopy assessment in 12 patients with ocular cicatricial pemphigoid

AIM： To describe the clinical features and microstructural characteristics assessed by in vivo confocal microscopy（IVCM） in patients with ocular cicatricial pemphigoid（OCP）.· METHODS： A descriptive, uncontrolled case series study. Patients diagnosed with OCP were examined by clinical history, slit-lamp biomicroscopy features and IVCM images. The results of direct immunofluorescence（DIF） biopsies and indirect immunofluorescence（IIF） were also recorded. Local and systemic immunosuppressive therapy were administered and adjusted according to response.·RESULTS： A total of 12 consecutive OCP patients（7male, 5 female; mean age 60.42 ±10.39y） were recruited.All patients exhibited bilateral progressive conjunctival scarring and recurrent chronic conjunctivitis was the most frequent clinical pattern. The mean duration of symptoms prior to diagnosis of OCP was 2.95 ±2.85y（range： 5mo to 10y）. The Foster classification varied from stage I to IV and 20 eyes（83%） were within or greater than Foster stage Ⅲ on presentation. Two of the 12patients（17%） demonstrated positive DIF; 3 of the 12（25%） patients reported positive IIF. The mean duration of the follow-up period was 20.17 ±11.88mo（range： 6 to48mo）. IVCM showed variable degrees of abnormality in the conjuctiva-cornea and conjuctival scarring was detected in all the involved eyes. Corneal stromal cell activation and dendritic cell infiltration presented asocular surface inflammation, ocular surface keratinization along with the destroyed Vogt palisades was noted in eyes with potential limbal stem cell deficiency. After treatment, remission of ocular surface inflammation was achieved in all the patients, 18 eyes（75%） remained stable, 6 eyes（25%） had recurrent conjunctivitis and cicatrization in 2 eyes（8%） was progressing.· CONCLUSION： As an autoimmune disease, OCP manifests as variable degrees of clinical and laboratory abnormalities with both local and systemic immunosuppressive treatment playing important roles in disease therapy. IVCM can be as a valuable non-invasive technique to assess ocular surface changes in a cellular level with a potential value for providing diagnostic evidence and monitoring therapeutic effects during follow-up.

Ablative laser assisted topical delivery of antifibrotics in the management of cicatricial ectropion

A variety of surgical techniques have traditionally been used to manage cicatricial ectropion. These techniques primarily aim at vertical lengthening of the anterior lamella and include a variety of skin flaps and grafts. Alternative techniques such as dermal filler injection to support the eyelid margin may also be used in the management of select patients with cicatricial ectropion. The application of different types of laser for scar revision throughout the body has rapidly evolved; similar mechanisms, principles and treatment rationale can be applied to the use of lasers in the management of cicatricial ectropion. Additionally, ablative lasers, such as Carbon Dioxide and Erbium:yttrium-aluminumgarnet lasers, may be used in the transdermal delivery of antifibrotic agents, such as interferon gamma, interferon alpha, vitamin D, triamcinolone and 5-fluorouracil, resulting in efficient target tissue penetration, limitation of systemic drug toxicity and decreased degradation. Although the combination of ablative fractional resurfacing and topical antifibrotic agents is a new treatment modality, there is a great potential for its efficient utilityin the management of periocular scarring and cicatricial ectropion. The introduction of these innovative therapeutic modalities offers ophthalmologists a greater range of possible effective treatments to address periocular scar tissue and the resultant cicatricial ectropion.

Cicatricial Pemphigoid in Accompany with Rheumatoid Arthritis:a Case Report

CICATRICIAL pemphigoid （CP, also known as benign mucous membrane pemphigoid） is a rare chronic autoimmune subepithelial blister- ing disease, with an incidence of 1 per million,characterized by erosive lesions of mucous membranes and skin that result in scarring. Rheumatoid arthritis （RA） is a symmetric inflammatory arthritis that mainly affects the small joints of hands and feet, with a prevalence of 0.3% in China.3 In this case report we described the diagnosis of and treatment for a patient developing CP 18 years after the onset of RA, a combination rarely encountered or reported so far.

Incidence, prevalence, and demographic characteristics of ocular cicatricial pemphigoid in Colombia: data from the National Health Registry 2009-2019

AIM:To provide an epidemiological characterization of ocular cicatricial pemphigoid(OCP)in Colombia.METHODS:We conducted a cross-sectional study using SISPRO.We applied the specific code of the International Classification of Diseases for Ocular Pemphigoid,from 2009-2019 to estimate prevalence,incidence,and the demographic status of the disease in Colombia.RESULTS:The estimated average prevalence was 0.22 per 1000000 inhabitants,and the estimated average incidence was 0.24 per 1000000 inhabitants.With a female predominance of 62.5%,and a male/female ratio of 1:1.6.The group of patients diagnosed with the disease after the age of 80 presented the highest prevalence.The departments with the highest prevalence were Antioquia,Bogotá,and Santander.CONCLUSION:There are important differences between worldwide and Colombian prevalence and incidence data,which may be related to genetic and epigenetic factors,and the possible underdiagnosis of the disease.According to the results,OCP is an extremely rare disease in Colombia.Nevertheless,it is important to encourage awareness of the disease due to its devastating consequences.

Coexistence of ocular cicatricial pemphigoid with Stevens Johnson syndrome

Dear Sir, I am Dr. Hande Taylan Sekeroglu, from the Ophthalmology Department of Cukurova University Faculty of Medicine. I want to present a case of recalcitrant ocular cicatricial pemphigoid (OCP) which was coincidently diagnosed with Stevens

眼瘢痕性类天疱疮的研究现状

眼瘢痕性类天疱疮是一种罕见、难于治愈,有致盲风险的自身免疫性眼科疾病。我们通过阅读文献,在有限的临床病例中,总结出一些有关此疾病的临床诊断、治疗方法以及对未来的展望,以此更好地促进眼瘢痕性类天疱疮的诊断与治疗。

MRI联合血清AMH、AFP水平在剖宫产术后早期子宫瘢痕妊娠诊断中的临床价值分析

目的 探讨核磁共振(MRI)联合血清抗苗勒管激素(AMH)、甲胎蛋白(AFP)对剖宫产术后早期子宫瘢痕妊娠(CSP)的诊断价值。方法 选取2020年2月-2022年3月期间本院收治的疑似CSP患者133例为研究对象。收集其基本资料(年龄、距上次剖宫产时间、停经天数、剖宫产史等),所有CSP患者均接受MRI检查。酶联免疫吸附法(ELISA)测定血清AMH、 AFP水平;受试者工作特征(ROC)曲线分析血清AMH、AFP水平对CSP的诊断效能;采用Kappa检验分析MRI单独及联合血清AMH、AFP诊断CSP与金标准病理结果的一致性;采用四线格分析并比较MRI、血清AMH、AFP单独及联合对CSP的诊断效能。结果本研究经MRI确诊81例CSP孕妇,52例非CSP孕妇。以手术病理诊断结果作为参考,MRI诊断CSP的灵敏度为78.72%,特异度为82.05%。CSP组血清AMH水平显著低于非CS P组,AF P水平显著高于非CSP组(P<0.05);血清AMH、AFP诊断CSP的AUC分别为0.785、0.824,特异度分别为84.62%、87.18%,灵敏度分别为76.60%、78.72%。MRI、血清AM H、血清AFP单独诊断CS P的Kappa值为0.554、0.547、0.592,三者联合诊断CSP的Kappa值最高,为0.746(P<0.05)。MRI联合血清AMH、AFP诊断CSP的灵敏度及阴性预测值明显高于MRI、血清AMH、AFP单独诊断,准确度明显高于MRI、血清AMH单独诊断(P<0.05)。结论 CSP患者血清AMH低表达,血清AFP高表达,MRI联合血清AMH、AFP对早期CSP进行综合诊断弥补了单一MRI诊断的不足,具有较高临床应用价值。

不同术式对剖宫产瘢痕部位妊娠疗效及预后的影响

目的:探讨不同术式对剖宫产瘢痕部位妊娠(CSP)患者治疗效果及预后的影响。方法:选择2021年2月1日至2022年1月31日于井冈山大学附属医院妇产科收治的Ⅱ型或Ⅲ型CSP患者90例为研究对象,按照纳入、排除标准及入院治疗的时间顺序依次入组,根据治疗方式依次纳入A组30例、B组30例和C组30例。A组接受腹腔镜下子宫动脉结扎术(UAL)+子宫瘢痕妊娠病灶切除术(FER)+子宫瘢痕修补术(UCR),B组接受子宫动脉栓塞术(UAE)+超声监测下宫腔镜FER,C组接受腹腔镜下FER+UCR。比较3组的术中、术后情况及随访复发性CSP(RCSP)的发生率和再妊娠率。结果:①A组、B组的术中出血量、术后宫腔引流量、术后疼痛视觉模拟(VAS)评分低于C组,而手术时间、住院费用高于C组,以上差异均有统计学意义(P<0.05);A组手术时间、住院费用低于B组(P<0.05)。②A组、B组术后阴道停止流血时间、月经恢复时间和血β-人绒毛膜促性腺激素(β-hCG)恢复时间短于C组(P<0.05)。③3组术后并发症(盆腔粘连、感染、术后大出血及下腹疼痛)的发生率差异均无统计学意义(P>0.05)。④术后平均随访时间17.60±5.61个月,A组、C组RCSP发生率低于B组(P<0.05)。A组、B组、C组再次妊娠率分别为82.14%(23/28)、77.78%(21/27)、81.48%(22/27),差异无统计学意义(P>0.05)。结论:腹腔镜下UAL+FER+UCR和UAE+超声监测下宫腔镜FER能减少术中出血量,促进术后康复,只是手术时间延长、住院费用较高;采用UCR治疗后RCSP发生率更低,临床应结合Ⅱ型、Ⅲ型CSP患者具体病情、经济条件和保留生育功能需求等进行综合评估并制定个体化的治疗方案。

自体毛囊单位提取术治疗藏族继发性稳定性瘢痕性秃发的疗效观察

目的 探讨自体毛囊单位提取术在治疗藏族患者继发性稳定性瘢痕性秃发中的效果。方法 研究纳入了2021年1月至2022年12月于成都恒美毛发医疗美容门诊部收治的13例患者,均为继发性稳定性瘢痕性秃发的藏族个体,采用自体毛囊单位提取术进行治疗,并监测术后并发症的发生情况,随后于术后12个月评估患者的满意度。结果 本组患者中非常满意69.2%(9/13),比较满意15.4%(2/13),有点不满意15.4%(2/13)。未发现任何患者出现皮肤坏死、明显的淤血肿胀、不自然外观、暂时性毛发脱落等并发症。结论 自体毛囊单位提取术是治疗藏族患者继发性稳定性瘢痕性秃发的有效方法,术后患者满意度高,并发症发生率低,恢复速度快。

经阴道子宫下段瘢痕妊娠病灶清除术联合子宫壁修补术治疗剖宫产术后瘢痕子宫妊娠的临床效果

目的:分析经阴道子宫下段瘢痕妊娠病灶清除术联合子宫壁修补术在剖宫产术后瘢痕子宫妊娠患者中的效果。方法:选取2021年11月—2022年12月鹰潭一八四医院收治的50例剖宫产术后瘢痕子宫妊娠患者,按照随机数字表法将其分成对照组(n=25)、观察组(n=25)。对照组给予子宫动脉栓塞术+甲氨蝶呤+清宫术治疗,观察组行经阴道子宫下段瘢痕妊娠病灶清除术+子宫壁修补术,术后随访3个月。对比两组围手术期指标、术后恢复情况、生活质量、并发症。结果:观察组术中出血量为(65.21±4.48)mL,少于对照组的(87.49±6.37)mL(P<0.05);观察组住院时间为(6.96±1.54)d、月经复潮时间为(31.35±2.56)d、血β-人绒毛膜促性腺激素(β-hCG)恢复正常时间为(18.36±1.59)d,均短于对照组的(8.37±1.89)、(42.58±4.39)、(25.44±2.57)d(P<0.05);观察组并发症发生率为8.00%(2/25),低于对照组的32.00%(8/25),差异有统计学意义(P<0.05)。术前,两组世界卫生组织生存质量测定量表(WHOQOL-BREF)各维度评分比较,差异均无统计学意义(P>0.05);术后,观察组WHOQOL-BREF各维度评分分别为(75.96±3.42)、(74.39±4.08)、(76.84±3.44)、(72.49±3.49)分,高于对照组的(69.84±2.98)、(68.44±3.57)、(70.38±2.96)、(66.84±2.96)分,差异均有统计学意义(P<0.05)。结论:经阴道子宫下段瘢痕妊娠病灶清除术+子宫壁修补术具有创伤小、手术时间短等优势,有助于剖宫产术后瘢痕子宫妊娠患者术后恢复,提升生活质量,且并发症较少。

透明质酸钠对瘢痕子宫妊娠患者剖宫产术后宫腔粘连的预防价值研究

目的:研究透明质酸钠对瘢痕子宫妊娠患者剖宫产术后宫腔粘连的预防价值.方法:选择2020年3月至2022年3月在本院收治的瘢痕子宫妊娠患者(n=70)为研究对象.使用随机数字表法把所有纳入患者分成对照组(n=35)和观察组(n=35).对照组患者术后给予抗生素预防治疗,观察组患者术后给予透明质酸钠预防治疗.对比术后两组患者的月经情况(阴道流血量、阴道出血时间、首次月经恢复时间)、炎性因子水平[C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-6(IL-6)]、疼痛程度(NRS疼痛评分)、宫腔粘连情况及其他并发症.结果:观察组患者术后阴道流血量、阴道出血时间、首次月经恢复时间均低于对照组(P<0.05).观察组患者术后1 w炎性因子TNF-α、CRP、IL-6水平均低于对照组(P<0.05).观察组术后24 h的NRS评分低于对照组(P<0.05).观察组患者术后宫腔粘连发生率低于对照组(P<0.05).两组患者术后其他并发症差异无统计学意义(P>0.05).结论:透明质酸钠可有效改善瘢痕子宫妊娠患者剖宫产术后月经恢复情况和阴道流血情况,降低炎性因子水平,降低剖宫产术后疼痛感以及宫腔粘连发生率.

米索前列醇联合米非司酮在终止瘢痕子宫妊娠中的应用效果

目的观察米索前列醇联合米非司酮在终止瘢痕子宫妊娠中的应用效果。方法选取2016年3月—2020年4月湖南省妇幼保健院收治的瘢痕子宫妊娠患者768例,采用随机数字表法分为观察组和对照组,每组384例。对照组患者给予米非司酮治疗,观察组患者在对照组基础上加用米索前列醇治疗。比较2组患者药物流产效果、妊娠物排出时间、阴道出血量及不良反应。结果观察组患者药物流产总成功率高于对照组(99.74%vs.93.23%,χ^(2)=23.992,P<0.001);观察组患者妊娠物排出时间短于对照组,阴道出血量少于对照组(P均<0.01);对照组与观察组患者不良反应总发生率比较差异无统计学意义(2.60%vs.2.08%,χ^(2)=0.057,P=0.811)。结论米索前列醇联合米非司酮在终止瘢痕子宫妊娠中的应用效果较好,有利于妊娠物排出,阴道出血量较少,值得临床应用。

叙事护理对瘢痕子宫产妇麻醉期应激反应及分娩结局的影响

目的探讨叙事护理对瘢痕子宫产妇麻醉期应激反应及分娩结局的影响。方法2021年1—12月选取在医院分娩的瘢痕子宫产妇95例为研究对象,按组间基本资料匹配原则将产妇分为观察组48例和对照组47例,对照组行产科常规护理,观察组在对照组基础上行叙事护理,比较两组产妇干预前后不良情绪、分娩自我效能、麻醉期应激反应、分娩结局情况。结果叙事护理干预后,观察组汉密尔顿焦虑量表(HAMA)评分、汉密尔顿抑郁量表(HAMD)评分低于对照组,差异有统计学意义(P<0.05),而分娩自我效能评分高于对照组,差异有统计学意义(P<0.05)。实施叙事护理干预后,两组产妇入组时(T0)、麻醉5 min(T1)及术毕后5 min(T2)三个时点心率(HR)及平均脉动压(MAP)呈略微增高趋势且T1和T2两时点的HR、MAP较T0明显高,时间之间差异有统计学意义(P_(时间)<0.05),各时点均以观察组低于对照组,差异有统计学意义(P_(组间)<0.05),并且随观察时间延长,组间差异逐渐增大,差异有统计学意义(P交互<0.05)。观察组产后不良妊娠发生率低于对照组,差异有统计学意义(P<0.05),而观察组产妇分娩满意率高于对照组,差异有统计学意义(P<0.05)。结论叙事护理能有效减轻瘢痕子宫产妇不良情绪,增强产妇分娩自我效能,减轻产妇麻醉期应激反应,从而改善产妇分娩结局,提高产妇对分娩的满意度。

毛囊单位提取移植术联合富血小板血浆治疗继发性瘢痕秃发的临床效果

目的 探讨毛囊单位提取移植术(FUE)联合富血小板血浆(PRP)治疗继发性瘢痕秃发的临床效果。方法 采用回顾性研究,将在选取2017年6月-2019年6月在滨州医学院附属医院美容医学部就诊的仅行毛囊单位移植术的继发性瘢痕秃发患者30例纳入FUE组,将2019年8月-2021年8月在滨州医学院附属医院美容医学部就诊行毛囊移植术+富血小板血浆(术前2h及术后30d-180d使用)的30例继发性瘢痕秃发患者纳入FUE+PRP组。观察2组患者术后3、6、12个月毛发成活率、患者12个月术后满意率及患者12个月内植发区不良反应发生率。结果 术后3、6、12个月,FUE+PRP组患者成活率分别为(35.7±1.8)%、(79.4±2.5)%、(90.4±2.3)%,明显高于单纯FUE组(25.1±1.9)%、(71.5±2.5)%、(83.5±1.8)%。术后12个月,单纯FUE组患者非常满意10例,满意13例,不满意7例。FUE+PRP组患者非常满意21例,满意7例,不满意2例。FUE组患者满意率76.7%,FUE+PRP组患者满意率93.3%(P<0.05)。术后12个月内FUE联合PRP治疗组患者植发区皮肤坏死、毛囊炎发生率低于单纯FUE治疗组。但差异无统计学意义(P>0.05)。结论 与单纯的行FUE移植术相比,FUE联合富血小板血浆能有效提高继发性瘢痕秃发患者行FUE移植术后毛发的成活率及患者的满意率,有利于继发性瘢痕秃发的治疗。

重度瘢痕性睑外翻个性化手术治疗1例报告及文献复习

目的:探讨关于重度瘢痕性睑外翻个性化手术治疗的影响因素,为该类患者的临床个性化治疗提供参考。方法:收集1例烧伤后双眼上、下睑重度外翻29年并患暴露性角膜炎患者的临床资料,采用水平缩短眼睑后层和全厚皮片移植的手术方法进行治疗。分析患者的诊疗过程并进行文献复习。结果:患者,女性,33岁,因“烧伤致双眼上、下睑外翻29年,加重1年”就诊于本院。眼科查体显示眼睑前层皮肤和轮匝肌严重缺失及眼睑后层睑板和睑结膜水平延长,诊断为瘢痕性睑外翻和暴露性角膜炎。手术避免上、下睑的手术切口相连,扩大松解瘢痕的范围至内侧超过内眦角接近鼻根部,外侧超过外眦角,上、下方达到眶缘,水平缩短眼睑后层,4块全厚皮片移植分别修复上、下睑的前层缺损。术后14 d移植皮片呈现正常肤色,眼睑形态良好,与眼球表面贴合紧密;术后12个月复查,皮片完全成活,无色素沉着;眼睑形态正常、无外翻,活动度良好;角膜溃疡修复,视力提高,患者对术后外观满意。结论:对于重度瘢痕性睑外翻患者,瘢痕牵拉的彻底松解、眼轮匝肌的最大限度保留和加强、睑板的选择性切除和皮瓣或皮片尺寸及厚度确定均为个性化治疗中必须重视的因素。临床上需全面评估患者情况,综合考量术式选择和手术细节,以达到理想的手术效果。

扩张头皮瓣结合毛囊移植治疗大面积瘢痕秃发术后美学效果观察

目的 探讨合理地设计头皮瓣结合皮瓣边缘微小区域毛发移植改善扩张头皮转移治疗瘢痕秃发的美学效果。方法 2018年7月至2021年10月,空军军医大学西京医院整形外科应用头皮扩张术修复瘢痕性秃发患者18(男14,女4)例,平均年龄26.3岁。所有患者根据秃发面积、部位和邻近区域毛发生长情况选择扩张器大小和数量,在秃发区周边正常毛发区行一期扩张器置入手术,定期注水达到满意扩张效果。二期手术切除瘢痕秃发区头皮组织,合理设计扩张头皮局部推进、易位旋转皮瓣,修复瘢痕切除后的创面。18例患者均在扩张皮瓣覆盖后的边缘及发际线区等微小区域实施了毛囊移植。结果 扩张头皮瓣主要并发症2例(11.1%)、次要并发症1例(5.5%)。扩张皮瓣重建配合毛囊移植后随访观察,扩张皮瓣成活良好,毛发分布均匀,密度适中,扩张头皮边缘线状瘢痕不明显,发际线区毛发生长方向自然。结论 采用扩张头皮瓣可修复大面积瘢痕秃发,结合毛囊移植可改善修复后美学细节。