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官方杂志> 儿童烧伤创面愈合时间和增生性瘢痕的发生:每一天都值得争取!
儿童烧伤创面愈合时间和增生性瘢痕的发生:每一天都值得争取!
      来源:Burns & Trauma

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Highlights:

  1. 创面愈合越快,增生性瘢痕发生率越低;

  2. 传统观念里认为<3周愈合时间是预防增生性瘢痕的相对安全期,然而“安全期”并不安全;

  3. 本研究中增生性瘢痕最早发生在创面愈合时间为8天的患者。随后,创面愈合时间每增加一天,增生性瘢痕风险增加1.138倍。


RESEARCH ARTICLE

A prospective study of time to healing and hypertrophic scarring in paediatric burns: every day counts

引用格式 Chipp E, Charles L, Thomas C, Whiting K, Moiemen N, Wilson Y. A prospective study of time to healing and hypertrophic scarring in paediatric burns: every day counts. Burns & Trauma 2017; 5:3.


众所周知,烧伤创面愈合时间超过三周时,增生性瘢痕的发生率大大增加。但是,三周内愈合的烧伤创面仍然有发生增生性瘢痕的可能。

 

为研究创面愈合时间与增生性瘢痕发生率的关系,英国伯明翰儿童医院烧伤中心的Elizabeth Chipp医生团队开展了一项为期两年的前瞻性研究。该研究共纳入383名儿童烧伤患者,创面均接受非手术治疗,瘢痕评价采用温哥华瘢痕量表,由经验丰富的烧伤医师完成。

 

研究样本中,增生性瘢痕的总体发生率为17.2%。创面愈合时间是预测增生性瘢痕发生的最强指标。增生性瘢痕最早发生在创面愈合时间为8天的患者。创面愈合时间每增加一天,增生性瘢痕风险就增加1.138倍。有色人种较白色人种皮肤增生性瘢痕的发生率增高,但未见显著性差异。

 

由于增生性瘢痕的发生风险随创面愈合时间延长逐日升高,因此应尽一切努力缩短创面愈合时间。传统观念认为将创面愈合时间控制在3周以内显然是不够的。加速儿童烧伤患者创面愈合以减少增生性瘢痕的发生,每一天都值得争取!


Abstract

Background    It is commonly accepted that burns taking longer than 3 weeks to heal have a much higher rate of hypertrophic scarring than those which heal more quickly. However, some of our patients develop hypertrophic scars despite healing within this 3-week period.

Methods    We performed a prospective study of 383 paediatric burns treated non-operatively at a regional burns centre over a 2-year period from May 2011 to April 2013. Scar assessment was performed by a senior burns therapist using the Vancouver Scar Scale.

Results    Overall rates of hypertrophic scarring were 17.2%. Time to healing was the strongest predictor of developing hypertrophic scarring, and the earliest hypertrophic scar developed in a patient who was healed after 8 days. The risk of hypertrophic scarring was multiplied by 1.138 for every additional day taken for the burn wound to heal. There was a trend towards higher rates of hypertrophic scarring in non-white skin types but this did not reach statistical significance.

Conclusions    The risk of hypertrophic scarring increases with every day and, therefore, every effort should be made to get the wound healed as quickly as possible, even within the traditional 3-week period usually allowed for healing. We believe that the traditional dogma of aiming for healing within 3 weeks is overly simplistic and should be abandoned: in paediatric burns, every day counts.