摘要
目的探讨复发性瘢痕疙瘩再次手术切除减张缝合联合电子线照射的临床效果。方法选择2016年5月至2019年8月在运城市中心医院整形外科治疗的术后复发的瘢痕疙瘩患者,行再次手术切除,切口两侧皮下广泛剥离,对创面张力过大无法缝合的患者行局部皮瓣转移修复,皮下采用2-0~4-0的PDSⅡ缝线以"心"形缝合技术减张缝合,皮肤采用6-0或7-0的Prolene缝线间断缝合,伤口外贴3M拉力胶带减张。术后6 h内及术后1周分别行电子线照射治疗,每次8 Gy,总剂量16 Gy。拆线后外用拉力胶带、硅凝胶瘢痕贴及弹力套压迫,定期复查,观察患者瘢痕宽度及增生程度,根据瘢痕美容评估与评级量表评价治疗效果(0~15分,得分越高瘢痕越严重)。结果共选择36例术后复发的瘢痕疙瘩患者,男28例,女8例,年龄17~68岁,平均42.5岁。所有患者术后切口均一期愈合,随访18~36个月,均未见瘢痕疙瘩复发。患者术后半年瘢痕美容评估与评级量表评分最高4分,最低0分。结论手术切除瘢痕疙瘩,术中减张缝合以降低创缘两侧的张力,术后联合电子线照射治疗,是治疗复发性瘢痕疙瘩的一种有效方法。
Objective To explore the clinical effect of de-stretching suture combined with electronic irradiation after resection of recurrent keloid.Methods From May 2016 to August 2019,the patients with postoperative recurrent keloid were selected for the Department of Plastic Surgery,Yuncheng Central Hospital.The keloid lesions were resected,and the subcutaneous skin on both sides of the incision was extensively elevated to reduce the tension for direct suture.Local flap transfer was used when the direct suture is impossible due to too much tension.The PDSⅡsuture of 2-0 to 4-0 was used subcutaneously to reduce the suture tension with the"heart"suture technology,and the skin was intermittently sutured with the Prolene suture of 6-0 or 7-0 and 3M tensile tape was applied on the wound to reduce tension.Besides,electronic irradiation was performed within 6 hours and 1 week after the operation,with 8 Gy for each time,a total dose of 16 Gy.After the suture was removed,tension glue and elastic sleeve were used for external compression,and regular follow-up was conducted to observe the width and degree of scar hyperplasia of the patients.The therapeutic effect was evaluated according to the scar beauty evaluation and rating scale.Results A total of 36 patients with postoperative recurrent of keloids were included in this group,including 28 males and 8 females,aged 17-68 years,with an average of 42.5 years old.The incisions healed in all patients after the operation,and no recurrence of keloids was found in the follow-up period of 18 to 36 months.The highest score of scar cosmetic evaluation and rating scale was 4,and the lowest was 0.Conclusions Surgical resection combining with electronic irradiation is an effective method for the treatment of recurrent keloid.
作者
崖骞
杨韩芳
王婵娟
任晓萍
秦辉燕
秦轩
Ya Qian;Yang Hanfang;Wang Chanjuan;Ren Xiaoping;Qin Huiyan;Qin Xuan(Department of Plastic Surgery,Yuncheng Central Hospital,Yuncheng 044000,China)
出处
《中华整形外科杂志》
CSCD
2022年第1期74-77,共4页
Chinese Journal of Plastic Surgery
关键词
瘢痕疙瘩
复发
外科手术
放射疗法
Keloid
Recidivism
Surgical procedures,operative
Radiotherapy
