远位埋没缝合切口减张技术联合电子线照射治疗瘢痕疙瘩九例  

Distal subcutaneous buried suture incision tension reduction technique combined with electron irradiation for the treatment of keloids

作　　者：周莉萍[1] 张文浩[1] 王玉龙 Zhou Liping;Zhang Wenhao;Wang Yulong(Department of Burn and Plastic Surgery, Jining First People's Hospital, Jining 272100, China)

机构地区：[1]济宁市第一人民医院烧伤整形外科,272100

出　　处：《中华整形外科杂志》2019年第3期278-281,共4页Chinese Journal of Plastic Surgery

摘　　要：目的探讨距切缘远位皮下组织埋没缝合切口减张技术联合电子线照射,手术治疗瘢痕疙瘩的临床效果。方法2014年5月至2016年7月,济宁市第一人民医院烧伤整形外科,对9例躯干部瘢痕疙瘩术后复发的女性患者行瘢痕疙瘩完整切除术,年龄43~56岁。于切口两侧浅筋膜层广泛剥离,用4-0PDSⅡ缝线,在远离切缘约1.5cm处皮下组织行数针埋没缝合,间隔约1cm,待所有埋没线缝好后,依次从切口纵轴两端向中间打结,将切口两侧正常皮肤向中央牵拉推进,使切口皮肤呈完全松弛的无张力状态。4-0薇乔可吸收线间断缝合皮下组织,5-0薇乔可吸收线皮内连续缝合封闭切口。术后10~22h接受电子线照射治疗,采用多次分割模式,总剂量控制在16~20Gy,分4~5次完成,每天1次。结果本组病例术后随访12~18个月,平均15个月。参照蔡景龙制定的疗效评价3级分类方法,即临床症状消失,瘢痕扁平、质软,随访12个月以上未见复发者为治愈(优良),本组病例全部达到治愈标准。结论距切缘远位皮下组织埋没缝合技术,通过PDSⅡ缝合材料,将切缘两侧正常皮肤向中央牵拉推进,不仅能使切口皮肤全层完全松弛,并可较长时间维持切口这种无张力状态,联合电子线照射治疗,使切口在愈合、恢复过程中炎性反应轻微,减少瘢痕疙瘩的术后复发。Objective To investigate the clinical effect of the combination of distal subcutaneous buried suture, to reduce local tension, and electron irradiation for the treatment of keloid. Methods From May 2014 to July 2016, nine female patients with recurrent keloid in torso were treated by above method. After eligibility was confirmed, surgery was performed to completely excise the keloid. An extensive subcutaneous segregation was made around the incision. The 4-0 PDS Ⅱ sutures were buried in the subcutaneous layer, 1.5 cm from the edges of incision, 1 cm apart from each other, and were knotted from both ends of the incision to the center. The normal skin on both sides of the incision were pulled toward the center, and completely relaxed without tension. An interrupted subcutaneous suture was made with a 4-0 Coated VICRYL absorbable suture, and a continuous intradermic suture was made using a 5-0 Coated VICRYL absorbable suture. Superficial electron irradiation was implemented 10-22 h postoperatively. The dose of radiation was 4 Gy each time, with the frequency of 4-5 times in 4-7 days, once a day, and the total dose was up to 16-20 Gy. Results The average follow-up was 15 months (12-18 months). Based on the three-stage classification system formulated by Dr. Cai, an asymptomatic flat and soft scar without recurrence up to 12 months was classified as cured (excellent). All the patients in this series met the criterion of cure. Conclusions The distal subcutaneous buried suture technique, pulling bilateral normal skin toward the center with a PDS Ⅱ suture, could completely relax the skin around the incision, and maintain a prolonged tension-free state, combination therapy of electron irradiation and surgery may reduce the inflammation during the healing process, and result in a dramatic inhibition of the recurrent of keloids after surgery.

关 键 词：瘢痕疙瘩 手术治疗 减张缝合 放射治疗 

分 类 号：R622[医药卫生—整形外科]