背景:肥厚性瘢痕和瘢痕疙瘩治疗是整形外科的主要问题。虽然小瘢痕疙瘩可以通过切除后放疗来治疗,大型瘢痕疙瘩需要用组织扩张器治疗。传统方法增加了对辅助切口的需求,引起新的疤痕增生。
目的:介绍一种扩张器治疗瘢痕疙瘩的新方法。
方法:在2018年至2021年之间,我们进行了手术,以两阶段方法治疗9名患者的大型瘢痕疙瘩。在第一阶段,在瘢痕疙瘩上做了一个小切口,在瘢痕疙瘩和周围的正常皮肤下植入定制的扩张器。允许3-6个月的时间进行皮肤扩张。在第二阶段,最初的切口愈合后,进行了后续手术以移除扩张器,切除瘢痕疙瘩,修复扩张的皮瓣。要做到这一点,沿着疤痕边界做一个切口,以避免做一个新的手术切口和产生新的疤痕。术后进行表面放疗。
结果:2例患者有胸部前瘢痕疙瘩。治疗后,胸部前切口反复断裂,清创后再次缝合。愈合顺利,无瘢痕增生。7例瘢痕疙瘩成功切除,无复发。
结论:该方法是通过瘢痕疙瘩切口进行的,并嵌入了定制的扩张器。经过全面扩张,使用线性缝线直接切除瘢痕疙瘩,这避免了新的手术切口和疤痕,可以成功地去除大面积瘢痕疙瘩。治疗是有效的,为今后类似大面积瘢痕疙瘩和增生性瘢痕病例的治疗提供新的见解和策略。
BACKGROUND: Hypertrophic scars and keloid treatment is a major problem in plastic surgery. While small keloids can be treated with resection followed by radiotherapy, large keloids require treatment with a tissue
expander. Conventional methods increase the need for auxiliary incisions, causing new scar hyperplasia.
OBJECTIVE: To introduce a new method for the treatment of keloids with an
expander.
METHODS: Between 2018 and 2021, we performed surgeries to treat large keloids in nine patients with a two-stage approach. In the first stage, an intrascar incision was made in the keloid, and a customized
expander was implanted under the keloid and the surrounding normal skin. A period of 3-6 mo was allowed for skin expansion. In the second stage, after the initial incision healed, a follow-up surgery was performed to remove the
expander, resect the keloid, and repair the expanded skin flap. To accomplish this, an incision was made along the scar boundary to avoid making a new surgical incision and creating new scars. Superficial radiotherapy was then performed postoperatively.
RESULTS: Two patients had anterior chest keloids. After treatment, the anterior chest incision was broken repeatedly and then sutured again after debridement. It healed smoothly without scar hyperplasia. Keloids were successfully removed in 7 patients without recurrence.
CONCLUSIONS: This method was performed through a keloid incision and with a custom
expander embedded. After full expansion, the keloid was directly resected using a linear suture, which avoids new surgical incisions and scars and can successfully remove large-area keloids. The treatment is effective, providing new insights and strategies for the treatment of similar large-area keloid and hypertrophic scar cases in the future.