Abnormal wound healing is likely to induce scar formation, leading to dysfunction, deformity, and psychological trauma in burn patients. Despite the advancement of medical care treatment, scar contracture in burn pati...Abnormal wound healing is likely to induce scar formation, leading to dysfunction, deformity, and psychological trauma in burn patients. Despite the advancement of medical care treatment, scar contracture in burn patients remains a challenge. Myofibroblasts play a key role in scar contracture. It has been demonstrated that myofibroblasts, as well as inflammatory cells, fibroblasts, endothelial cells, and epithelial cells, secrete transforming growth factor-β1 (TGF-β1) and other cytokines, which can promote persistent myofibroblast activation via a positive regulation loop. In addition to the cellular contribution, the microenvironments, including the mechanical tension and integrin family, are also involved in scar contracture. Most recently, eukaryotic initiation factor 6 (eIF6), an upstream regulator of TGF-β1, has been demonstrated to be involved in myofibroblast differentiation and contraction in both in vitro fibroblast-populated collagen lattice (FPCL) and in vivo external mechanical stretch models. Moreover, the data showed that P311 could induce the transdifferentiation of epidermal stem cells to myofibroblasts by upregulating TGF-β1 expression, which mediated myofibroblast contraction. In this review, we briefly described the most current progress on the biological function of myofibroblasts in scar contracture and subsequently summarized the molecular events that initiated contracture. This would help us better understand the molecular basis of scar contracture as well as to find a comprehensive strategy for preventing/managing scar contracture.展开更多
Patients with burn scars often experience functional problems because of scar contractures. Surgical treatment may be indicated for those burn scar contractures. If the contractures are small and linear, the contracti...Patients with burn scars often experience functional problems because of scar contractures. Surgical treatment may be indicated for those burn scar contractures. If the contractures are small and linear, the contraction bands can be treated with local transposition flaps like the Z-plasty. Broader, diffuse contractures are more challenging and require a different surgical approach, such as the use of local tissue. The use of perforator-based flaps is promising;however, their true clinical significance for this type of burn reconstructions still needs to be determined. Therefore, we performed a review to evaluate the role of perforator-based flaps for burn scar contracture treatment. Electronic databases were searched using a predefined search strategy. Studies evaluating the long-term outcome of perforator-based flaps for the treatment of burn scar contractures were included. The methodological quality was tested and data was summarized. Five hundred and ten papers were identified of which eleven met the inclusion criteria. One study was a randomized controlled trial;ten were cohort studies of a pre-postoperative design. The papers described outcomes of free flaps and local flaps. Most studies had methodological shortcomings and used inappropriate statistical methods. Perforator-based interposition flaps appear to be highly relevant for burn scar contracture treatment. However, due to the paucity and low quality of the studies that were assessed, no definitive conclusions about the true clinical significance could be reached. And therefore, only recommendations could be given for improvement of the quality of further primary research on the effectiveness of perforator-based flaps for burn scar contracture release.展开更多
A nine-year-old girl sustained extreme postburn contractures of the face, neck, both axillae, elbows, wrists, and ankles, due to flame injury 5 years ago. No primary and plastic surgical burn treatment was available i...A nine-year-old girl sustained extreme postburn contractures of the face, neck, both axillae, elbows, wrists, and ankles, due to flame injury 5 years ago. No primary and plastic surgical burn treatment was available in a remote area of China. From October, 2005 to April, 2007, all adhesions were released in five operations and the huge defects covered with local musculo-cutaneous flaps, z-plasties, and with thick split skin gafts. This led to an optimal functional result and an aesthetic restoration of the face, giving her, back her self-esteem in daily life.展开更多
Objective:To evaluate the clinical efficacy of combination of surgery and rehabilitation for patients with scar contracture after hand burn.Methods:Subjects of data calculation in this study were 66 patients with scar...Objective:To evaluate the clinical efficacy of combination of surgery and rehabilitation for patients with scar contracture after hand burn.Methods:Subjects of data calculation in this study were 66 patients with scar contracture after hand burn who were admitted from May 2018 to May 2019.The subjects were divided into regular group and combined group according to random number table method.The regular group(n=33)received surgical treatment alone.The combined group(n=33)patients were given surgery combined with rehabilitation.Recovery of hand function,efficacy of clinical treatment,hand function recovery and ADL score were calculated and compared between the two groups of patients with scare contracture after hand burn.Results:Efficacy,recovery of hand function(finger,finger flexion and extension,palm and finger adduction or abduction,daily activity,wrist rotation,wrist flexion and extension,appearance and sensory function)and ADL score were more superior in combined group when compared with regular group patients with scar contracture after hand burn.P<0.05,the indicator data showed statistical significance.Conclusion:Surgery combined with rehabilitation therapy shown significant value for patients with scar contracture after hand burn.展开更多
目的探讨皮下组织蒂菱形皮瓣成形术治疗烧伤后瘢痕挛缩的效果。方法选取2019年10月至2022年10月莆田市第一医院烧伤整形科收治的烧伤后瘢痕挛缩患者共100例,按治疗方式不同分成研究组(50例)与对照组(50例),对照组采用游离皮片移植术,研...目的探讨皮下组织蒂菱形皮瓣成形术治疗烧伤后瘢痕挛缩的效果。方法选取2019年10月至2022年10月莆田市第一医院烧伤整形科收治的烧伤后瘢痕挛缩患者共100例,按治疗方式不同分成研究组(50例)与对照组(50例),对照组采用游离皮片移植术,研究组采用皮下组织蒂菱形皮瓣成形术,统计两组术后1年皮瓣成活率、瘢痕挛缩复发率,比较两组生活质量[生活质量综合评定问卷(Generic Quality of Life Inventory-74,GQOLI-74)]、并发症。结果术后1年,研究组(100.00%)皮瓣成活率与对照组(92.00%)比较差异有统计学意义(P<0.05),研究组(4.00%)瘢痕挛缩复发率较对照组(18.00%)更低(P<0.05);两组术后1年GQOLI-74评分升高(P<0.05),研究组较对照组更高(P<0.05);研究组(4.00%)并发症发生率较对照组(24.00%)更低(P<0.05)。结论皮下组织蒂菱形皮瓣成形术治疗烧伤后瘢痕挛缩皮瓣成活率较高,可降低瘢痕挛缩复发率、生活质量提高,降低并发症发生风险。展开更多
文摘Abnormal wound healing is likely to induce scar formation, leading to dysfunction, deformity, and psychological trauma in burn patients. Despite the advancement of medical care treatment, scar contracture in burn patients remains a challenge. Myofibroblasts play a key role in scar contracture. It has been demonstrated that myofibroblasts, as well as inflammatory cells, fibroblasts, endothelial cells, and epithelial cells, secrete transforming growth factor-β1 (TGF-β1) and other cytokines, which can promote persistent myofibroblast activation via a positive regulation loop. In addition to the cellular contribution, the microenvironments, including the mechanical tension and integrin family, are also involved in scar contracture. Most recently, eukaryotic initiation factor 6 (eIF6), an upstream regulator of TGF-β1, has been demonstrated to be involved in myofibroblast differentiation and contraction in both in vitro fibroblast-populated collagen lattice (FPCL) and in vivo external mechanical stretch models. Moreover, the data showed that P311 could induce the transdifferentiation of epidermal stem cells to myofibroblasts by upregulating TGF-β1 expression, which mediated myofibroblast contraction. In this review, we briefly described the most current progress on the biological function of myofibroblasts in scar contracture and subsequently summarized the molecular events that initiated contracture. This would help us better understand the molecular basis of scar contracture as well as to find a comprehensive strategy for preventing/managing scar contracture.
文摘Patients with burn scars often experience functional problems because of scar contractures. Surgical treatment may be indicated for those burn scar contractures. If the contractures are small and linear, the contraction bands can be treated with local transposition flaps like the Z-plasty. Broader, diffuse contractures are more challenging and require a different surgical approach, such as the use of local tissue. The use of perforator-based flaps is promising;however, their true clinical significance for this type of burn reconstructions still needs to be determined. Therefore, we performed a review to evaluate the role of perforator-based flaps for burn scar contracture treatment. Electronic databases were searched using a predefined search strategy. Studies evaluating the long-term outcome of perforator-based flaps for the treatment of burn scar contractures were included. The methodological quality was tested and data was summarized. Five hundred and ten papers were identified of which eleven met the inclusion criteria. One study was a randomized controlled trial;ten were cohort studies of a pre-postoperative design. The papers described outcomes of free flaps and local flaps. Most studies had methodological shortcomings and used inappropriate statistical methods. Perforator-based interposition flaps appear to be highly relevant for burn scar contracture treatment. However, due to the paucity and low quality of the studies that were assessed, no definitive conclusions about the true clinical significance could be reached. And therefore, only recommendations could be given for improvement of the quality of further primary research on the effectiveness of perforator-based flaps for burn scar contracture release.
文摘A nine-year-old girl sustained extreme postburn contractures of the face, neck, both axillae, elbows, wrists, and ankles, due to flame injury 5 years ago. No primary and plastic surgical burn treatment was available in a remote area of China. From October, 2005 to April, 2007, all adhesions were released in five operations and the huge defects covered with local musculo-cutaneous flaps, z-plasties, and with thick split skin gafts. This led to an optimal functional result and an aesthetic restoration of the face, giving her, back her self-esteem in daily life.
文摘Objective:To evaluate the clinical efficacy of combination of surgery and rehabilitation for patients with scar contracture after hand burn.Methods:Subjects of data calculation in this study were 66 patients with scar contracture after hand burn who were admitted from May 2018 to May 2019.The subjects were divided into regular group and combined group according to random number table method.The regular group(n=33)received surgical treatment alone.The combined group(n=33)patients were given surgery combined with rehabilitation.Recovery of hand function,efficacy of clinical treatment,hand function recovery and ADL score were calculated and compared between the two groups of patients with scare contracture after hand burn.Results:Efficacy,recovery of hand function(finger,finger flexion and extension,palm and finger adduction or abduction,daily activity,wrist rotation,wrist flexion and extension,appearance and sensory function)and ADL score were more superior in combined group when compared with regular group patients with scar contracture after hand burn.P<0.05,the indicator data showed statistical significance.Conclusion:Surgery combined with rehabilitation therapy shown significant value for patients with scar contracture after hand burn.
文摘目的探讨皮下组织蒂菱形皮瓣成形术治疗烧伤后瘢痕挛缩的效果。方法选取2019年10月至2022年10月莆田市第一医院烧伤整形科收治的烧伤后瘢痕挛缩患者共100例,按治疗方式不同分成研究组(50例)与对照组(50例),对照组采用游离皮片移植术,研究组采用皮下组织蒂菱形皮瓣成形术,统计两组术后1年皮瓣成活率、瘢痕挛缩复发率,比较两组生活质量[生活质量综合评定问卷(Generic Quality of Life Inventory-74,GQOLI-74)]、并发症。结果术后1年,研究组(100.00%)皮瓣成活率与对照组(92.00%)比较差异有统计学意义(P<0.05),研究组(4.00%)瘢痕挛缩复发率较对照组(18.00%)更低(P<0.05);两组术后1年GQOLI-74评分升高(P<0.05),研究组较对照组更高(P<0.05);研究组(4.00%)并发症发生率较对照组(24.00%)更低(P<0.05)。结论皮下组织蒂菱形皮瓣成形术治疗烧伤后瘢痕挛缩皮瓣成活率较高,可降低瘢痕挛缩复发率、生活质量提高,降低并发症发生风险。
