修复重建-arpat 发表于 2023-9-26 21:30:26

外伤或手术之后的创面修复方法,避免留下严重疤痕

外伤或手术之后的创面修复方法,避免留下严重疤痕


文章摘要:痕的形成过程,也是创面的愈合过程,为避免和减少瘢痕的形成,必须把促进创面愈合放在首要的位置,如应用各种促进创面愈合的方法,促进创面愈合。
  (1)创面修复方式:创面较小以直接缝合对齐创缘为好。创面较大、较深时采用皮瓣修复较皮片移植效果好,若让其自行愈合,瘢痕增生必定严重。用自体或异体培养的表皮细胞移植于Ⅲ度烧伤创面,因缺乏真皮层,创面易趋向瘢痕化;若给予断层皮片移植,创面收缩减轻,肌成纤维细胞减少,瘢痕增生减少;若给予全厚皮移植,创面收缩最小,肌成纤维细胞消退最迅速,瘢痕增生最不明显。
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
  (2)伤口闭合方法:与缝合方式、缝合材料和缝合松紧度等有关。
  缝合方式:不同情况下,应采用不同的闭合伤口缝合方法,如间断缝合、褥式缝合、皮内间断缝合、减张缝合等,以期获得最佳的愈合和最小的瘢痕。其中,间断缝合是整形外科最基本和常用的闭合伤口的缝合方法,它可以使皮肤创缘对合整齐,创缘两侧组织高低、厚薄经调整后趋于一致,并利于分次拆线;连续缝合也是一种常用的缝合方法,优点是节省时间,缺点是必须集中拆线;褥式缝合有增加创缘对合接触的组织量及一定的减张作用,故有利于伤口的愈合。但应注意不要缝合过宽、结扎过紧。为了避免皮肤表面出现针孔痕迹,可行创缘真皮内缝合,表皮因此也自行对合,这种方法称之为皮内缝合。
  缝合材料:分吸收和不吸收两种缝合材料。可吸收缝线目前多为肠线、铬肠线和合成材料,优点是深部缝合后不必拆线可自行吸收,其中以合成纤维制成的缝线可操作性能、强度佳,组织反应轻。不吸收缝线,常用的有丝线、人工合成高分子类尼龙线、涤纶线等,以后两种缝线较佳,它们虽不吸收但在组织内引起的反应很轻微,目前普遍使用。应以伤口张力大小和部位不同而选用缝线粗细,通常小针细线引起的缝合创伤小,瘢痕反应当然也小。目前有学者使用生物的和合成的粘合材料,以图替代缝合线,对预防瘢痕增生有一定的作用。
  缝合松紧度:皮肤缝合要求松紧适度,达到创缘完全接触、整齐对合为宜。偏紧,有碍创缘血供,不利愈合,增强瘢痕增生。力量不够,或线结松动而使创缘不能完全接触和整齐对合,也影响愈合和增剧瘢痕增生。
  (3)拆线时间:当伤口经缝合后已初步愈合,伤口相合的力量超过伤口两侧的张力,在没有缝线的协助下,伤口也不会裂开时,即可拆除缝线。因全身状态和局部条件的不同,拆线的日期也不同。拆线早,可减轻缝线反应,减少瘢痕形成;而过早,仅依靠细胞间的结合、蛋白间粘合和纤维素间的聚合,伤口闭合的强度尚不足,有伤口裂开之虞;拆线晚,可避免伤口裂开,但缝线反应强,增加了瘢痕增生,在伤口缘两侧留下明显的缝线及针孔痕迹。
  正常情况下头面颈部伤口缝线宜在术后5~7天折除,躯干、四肢部位7~10天折线,张力较大部位如关节部、低垂的足部10天以后拆线。皮片移植的缝合线约于术后10天拆除;全层皮肤游离移植拆线可延至术后14天。皮瓣移植10天左右拆线。为减轻缝线反应,减少瘢痕形成又无裂开之虞,可采用分期间断拆线。非正常情况下,如全身性营养不良和糖尿病等全身性严重疾患、大量应用糖皮质激素类药物、抗肿瘤药物、免疫抑制剂等,术区存在瘢痕,术前曾施放疗,有静脉曲张等,拆线时间应后延。


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