阶梯状递进式超减张缝合法闭合胸背部及四肢高张力创面  

Effectiveness of stepwise progressive ultra-tension-reducing suture method in treatment of high-tension wounds on chest,back,and limbs

作　　者：刘航 胡铭 饶明军 李丰 张其 唐修俊 LIU Hang;HU Ming;RAO Mingjun;LI Feng;ZHANG Qi;TANG Xiujun(Department of Medical Cosmetology,Guizhou Provincial People’s Hospital,Guiyang Guizhou,550002,P.R.China;Department of Plastic and Aesthetic Surgery,Guizhou Provincial Third People’s Hospital,Guiyang Guizhou,550018,P.R.China)

机构地区：[1]贵州省人民医院医学美容科,贵阳550002 [2]贵州省第三人民医院整形美容科,贵阳550018

出　　处：《中国修复重建外科杂志》2024年第12期1505-1509,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨阶梯状递进式超减张缝合法用于闭合胸背部及四肢高张力创面的疗效。方法2022年1月—12月,采用阶梯状递进式超减张缝合法闭合25例胸背部及四肢高张力创面。男8例,女17例;年龄18~56岁,平均30.5岁。均为瘢痕、皮肤肿物切除术后创面,其中胸部8例、背部6例、上肢9例、下肢2例,切除后创面范围3.5 cm×2.8 cm~40.0 cm×15.0 cm。所有患者术后外用硅酮类药物预防瘢痕。术后观察切口隆起情况,测量隆起高度,观察减张作用维持时间。术后6个月观察切口瘢痕形成情况,使用温哥华瘢痕量表(VSS)评估瘢痕外观,测量瘢痕宽度。记录患者满意度以及切口不良反应。结果术后切口明显隆起,高度0.3~2.5 cm,减张作用维持8.5~18.0周,平均13.6周。所有切口均Ⅰ期愈合。1例出现一过性色素沉着后自行好转。3例瘢痕疙瘩患者术后出现局部发红,其中2例局部复发,予以曲安奈德、5-氟尿嘧啶注射及激光治疗后明显好转。患者均获随访,随访时间6.0~13.5个月,平均10.1个月。术后6个月,切口均遗留线性瘢痕,VSS评分为1.0~3.5分,平均2.0分;瘢痕宽度0.5~3.0 mm,平均1.4 mm。患者对治疗效果表示满意。结论对于胸背部及四肢高张力创面,采用阶梯状递进式超减张缝合法可有效降低张力,维持较长时间减张效果,术后效果满意。Objective To investigate effectiveness of a novel suture method—stepwise progressive ultratension-reducing suture method in closing high-tension wounds on the chest,back,and limbs.Methods A retrospective analysis was conducted on 25 patients with high-tension wounds on the chest,back,and limbs who were treated with stepwise progressive ultra-tension-reducing suture method between January 2022 and December 2022.Among the patients,there were 8 males and 17 females,with an average age of 30.5 years(range,18-56 years).All wounds after scar or tumor resection were located on the chest,back,upper limbs,and lower limbs in 8,6,9,and 2 cases,respectively.The size of wounds ranged from 3.5 cm×2.8 cm to 40.0 cm×15.0 cm.All patients were advised to use topical silicone-based treatments postoperatively.The protrusion of the incision,the height of the protrusion,and the duration of the tension reduction effect were observed.The scar formation at the incision site at 6 months after operation was observed,the scar appearance was evaluated by Vancouver Scar Scale(VSS)score,and the scar width was measured.The patient’s satisfaction and adverse reactions to incisions were also evaluated.Results The incisions significantly elevated,with a height of 0.3-2.5 cm,and the tension reducing effect lasted for 8.5-18.0 weeks after operation,with an average of 13.6 weeks.All incisons healed by first intention.One patient experienced transient hyperpigmentation,which resolved spontaneously.Three keloid patients showed localized redness postoperatively,and 2 experienced local recurrence,which improved significantly after treatment with triamcinolone,5-fluorouracil injections,and laser therapy.All patients were followed up 6.0-13.5 months,with an average of 10.1 months.At 6 months after operation,all patients had linear scars,with VSS scores ranging from 1.0 to 3.5(mean,2.0).The width of the scars ranged from 0.5 to 3.0 mm(mean,1.4 mm).The patients expressed satisfaction with the effectiveness.Conclusion The stepwise progressive ultra-tens

关 键 词：超减张缝合 高张力创面 瘢痕 

分 类 号：R641[医药卫生—外科学]