摘要
目的探讨儿童颌面部创伤美容缝合术后595 nm脉冲染料激光(595 nm PDL)和二氧化碳点阵激光(CO_(2) AFL)序贯治疗早期增生性瘢痕的效果。方法回顾性分析2023-03—2024-02郑州大学附属儿童医院烧伤整形科收治的59例因颌面部创伤行美容缝合术患儿的临床资料。对照组36例仅常规应用硅酮类制剂(拆线后3 d外用硅酮类制剂,2次/d,持续至术后12个月)。激光治疗组23例于美容缝合术后第3周开始应用595 nm PDL治疗,待瘢痕血管化程度显著降低后转换为CO_(2) AFL治疗。1次/月,持续至美容缝合术后12个月。疗程期间同时应用硅酮类制剂,方法同对照组。美容缝合术后12个月,应用改良版患者报告结局量表(PRO)评估主观疗效,依据温哥华瘢痕量表(VSS)客观评价瘢痕外观,记录术后治疗期间的不良事件。结果激光治疗组临床总有效率显著高于对照组,差异有统计学意义(P<0.05)。客观评估显示,术后12个月时,2组患儿的瘢痕形态均有改善,但激光治疗组的改善效果显著优于对照组,差异有统计学意义(P<0.05)。术后治疗期间,激光治疗组2例患儿出现局部水疱反应,经穿刺引流及红霉素软膏外用后缓解,未观察到色素异常或瘢痕增生加重等远期并发症。结论595 nm PDL和CO_(2) AFL序贯治疗,可优化儿童颌面部创伤美容缝合术后瘢痕病理进程,在改善瘢痕外观、质地等方面具有显著优势,且安全可控,值得临床推广。
Objective To evaluate the clinical efficacy of sequential therapy with 595 nm pulsed dye laser(PDL)and carbon dioxide fractional laser(AFL)in early intervention for hypertrophic scars following cosmetic suturing for pediatric maxillofacial trauma.Methods A retrospective analysis was conducted on the clinical data of 59 pediatric patients treated for maxillofacial trauma with aesthetic suture repair at Department of Burn and Plastic Surgery,Children's Hospital Affiliated to Zhengzhou University,from March 2023 to February 2024.The control group(36 cases)received only routine topical silicone-based agents(applied twice daily starting 3 days after suture removal,continued until 12 months postoperatively).The laser therapy group(23 cases)began treatment with 595 nm PDL at the 3rd week after suture repair.Upon significant reduction in scar vascularity,treatment was switched to CO_(2) AFL.Treatments were administered once monthly until 12 months postoperatively.Silicone-based agents were applied concurrently between laser sessions using the same method as the control group.At 12 months post-suture repair,subjective efficacy was assessed using a modified patient-reported outcome(PRO)scale,scar appearance was objectively evaluated using the vancouver scar scale(VSS),and adverse events during the postoperative treatment period were recorded.Results The intervention group demonstrated significantly superior overall clinical efficacy compared to that of the control group(P<0.05).Objective assessments at 6 months post-laser treatment(12 months post-surgery)revealed scar improvement in both groups,but the intervention group exhibited significantly greater improvements in scar metrics(P<0.05).Regarding safety,2 cases in the intervention group experienced local blistering reactions,which resolved after puncture drainage and topical erythromycin ointment.No long-term complications,such as dyspigmentation or scar exacerbation,were observed.Conclusion Sequential therapy with 595 nm PDL and CO_(2) AFL effectively mitigates the pathological progression of hypertrophic scars in children after cosmetic suturing for maxillofacial trauma,demonstrating significant advantages in scar appearance and texture improvement with a favorable safety profile.This approach is worthy of clinical adoption.
作者
李鹏程
张合成
张晗
孙文超
赵添
刘慧丽
靳三丁
Li Pengcheng;Zhang Hecheng;Zhang Han;Sun Wenchao;Zhao Tian;Liu Huili;Jin Sanding(Department of Burns and Plastic Surgery,Children's Hospital Affiliated to Zhengzhou University,Zhengzhou,Henan 450003,China)
出处
《河南外科学杂志》
2025年第4期1-4,共4页
Henan Journal of Surgery
基金
河南省医学科技攻关计划联合共建项目(LHGJ20240576)。
关键词
儿童
美容缝合术
增生性瘢痕
激光治疗
Children
Cosmetic suture technique
Hypertrophic scar
Laser therapy
