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- Title
不同时期瘢痕挛缩状态的临床治疗方式探索.
- Authors
葛小静; 苏新; 王立夫; 李楚鋆; 周芳; 姚刚
- Abstract
Objective To explore the treatment modalities for different periods of scar contracture and the summary of clinical treatment results. Methods From March 2019 to March 2021, A retrospective study of 55 patients admitted to the Department of Jiangsu Provincial People's Hospital (The First Affiliated Hospital of Nanjing Medical University). A group of 34 cases with early scarring (early group, within 1-6 months after injury) were treated with ultra-pulsed CO2 fractional laser, with a second treatment at an interval of 3 months. Scarring was assessed according to the Vancouver Scar Scale (VSS) score before the first treatment and 3 months after the last treatment. Comparison of the maximum range of motion (ROM) before and after treatment. Record the adverse reactions during the treatment. The other group was stable contracture scar with joint dysfunction. A total of 21 patients(stable period group, with scar formation time of 6 months to 48 years) were treated with scar tissue flaps (including subcutaneous pedicle rhomboid flap, Z-plasty flap and their combination model) and minor defects in combination with little scattered skin grafts. The designed release incisions are all within the scar tissue, and some defects are repaired with a small amount of 0.35 mm fault skin graft. Maximal active ROM was measured preoperatively and 6 months postoperatively to compare the improvement of joint function; flap/skin piece survival and surgical complications were recorded. Results In the early group, 3 months after the last treatment, the color, thickness, vascular distribution, pliability, and total VSS score were significantly lower than in the pre-treatment period (t=4.95, 5.78, 6.40, 5.92, 15.37, P<0.05). None of the joints were dysfunctional, and ROM became significantly greater than before treatment (t=-5.07, -4.97, -4.29, -4.68, P<0.05). Both 28 cases (82.4%) showed significant efficacy, 5 cases (14.7%) were effective, and 1 case (2.9%) was ineffective. The total effective rate was 97.06% (33/34),and all cases showed no thick ening or infection. All joint functions were effectively improved in stable period group, and the difference in data comparison was statistically significant (P<0.05). 17 cases (81.0%) showed significant efficacy, 4 cases (19.0%) were effective, and there were no ineffective patients. The total effective rate was 100% (21/21). One case with a bit of necrosis of the skin flap and one with bruising of the flap tip was healed after the dressing change. Conclusion The treatment of scar contracture should interfere in the early stage to improve the scar texture, and treat or prevent joint dysfunction. CO2 fractional laser is effective in the treatment of early scar contracture. Scar tissue flap surgery to treat stable contracture scars can effectively improve the contracture status and joint dysfunction while minimizing damage to normal skin.
- Publication
Chinese Journal of Aesthetic & Plastic Surgery, 2023, Vol 34, Issue 11, p647
- ISSN
1673-7040
- Publication type
Article
- DOI
10.3969/j.issn.1673-7040.2023.11.002