修复重建-arpat 发表于 2023-9-26 21:31:41

手术切缝治疗疤痕的禁忌证

手术切缝治疗疤痕的禁忌证


文章摘要:切除缝合术是瘢痕治疗中常用的一种手术方法,面积较小的瘢痕都可采用此法治疗。根据瘢痕的性质、大小、周围皮肤与器官的关系、基底状态等因素不同,切除缝合手术也是有一定的禁忌证,希望大家能了解一下!
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  1. 瘢痕疙瘩 瘢痕疙瘩直接切除缝合后复发率几乎是100%,不仅如此,复发后的瘢痕疙瘩较切除前扩大,故将其视为单纯直接切缝的绝对禁忌证。若与放射、激素注射等治疗方法结合时,手术直接切除缝合方可考虑。  2. 估计切除后直接缝合时有张力的瘢痕 瘢痕切除后的创面不同于一般外科良性肿物切除后的创面,前者当切除瘢痕后,由于瘢痕的收缩,周围皮肤明显向两侧裂开,原位缝合时已经存在张力,若瘢痕面积宽,虽经创缘游离但仍有张力者,即使勉强缝合,术后切口必然留下较宽瘢痕,不符合瘢痕治疗原则。  3. 宽度较大的瘢痕 瘢痕切除后能否直接缝合,取决于瘢痕的宽度。切除瘢痕的宽度又与瘢痕的形状相关。线状或椭圆形瘢痕切除的宽度与瘢痕的宽度相等,而方形或不规则形瘢痕,切除的宽度就要超过瘢痕自身的宽度。另外一个重要因素是瘢痕周围与基底的条件,瘢痕位于皮肤宽松的部位(如腹部),创缘下可以作较大程度游离,允许切除宽度可达4cm左右,而在颧弓部,基底坚硬且上有下眼睑所在,切除的宽度仅限于1cm以内,否则不仅切口缝合时有张力,还可能造成周围器官移位变形。一般来讲,宽度2cm以内的瘢痕是可以直接切除缝合的,过宽的瘢痕直接切除缝合则是禁忌的。


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查看完整版本: 手术切缝治疗疤痕的禁忌证