目的:评价自体颗粒脂肪移植治疗凹陷性瘢痕的效果.方法:对2012年-2020年采用自体颗粒脂肪注射治疗半年以上的120例凹陷性瘢痕患者进行研究.轻度凹陷畸形56例,重度凹陷畸形64例.供脂区:腹部85例,股部23例,腰部7例,臀部5例.自体颗粒脂肪处理静置法72例,离心法48例.1次注射颗粒脂肪治疗者102例,2次注射颗粒脂肪治疗者18例.观察治疗后效果、患者满意度及并发症情况.结果:1次治疗显效率为80.83％(97/120),2次治疗后显效率为95.83％(115/120),总有效率均为100.00％.2次治疗后患者总满意度为100.00％(120/120),无明显并发症发生.结论:自体颗粒脂肪移植治疗凹陷性瘢痕,效果确切,并发症少,是凹陷性瘢痕的重要治疗方法,值得在临床上推广应用;对复杂性瘢痕畸形,需要根据瘢痕状况同时配合其他治疗方式.

探讨瘢痕的形成与发展趋势,阐述增生性瘢痕和瘢痕疙瘩的特性与治疗思路的差别;通过对传统的"瘢痕体质"概念的分析,发现其不符合临床实际情况;再从临床实践出发,阐述了正确定义瘢痕体质概念的理由并提出了瘢痕疙瘩体质的概念;要准确应用瘢痕体质和瘢痕疙瘩体质的概念,并指导临床正确开展瘢痕和瘢痕疙瘩的防治工作.

Objective:To evaluate the clinical efficacy of human-like collagen scar repair gel in the treatment of proliferative hypertrophic scar.Methods:The clinical effect of smear-like silicone ointment on patients with hypertrophic scars after prolonged injury or 4-6 months after surgery, the difference of curative effects between 3-18 years old juvenile group and 19-45 years old adult group, were analyzed by multicenter randomized controlled clinical study. Among them, 58 cases were treated with human-like collagen scar repair gel, 39 cases in adult group and 19 cases in minor group; 30 cases were using Silicone Gel, 20 cases in adult group and 10 cases in minor group. The differences in scar color, thickness, blood vessel distribution, softness, patient's self-conscious symptoms, clinical efficacy scores and adverse reactions were analyzed before and after application of the products at 4, 8, 12 and 24 weeks.Results:The scores of the two groups before treatment were slightly higher than those of the control group except the softness and thickness score test group ( P<0.05). There was no significant difference in the remaining parameters ( P>0.05). The efficacy scores at the 4th, 8th, 12th and the 24th week after application of the two groups showed that there were significant differences in the therapeutic indicators after treatment for different time ( P<0.05) and age grouping. There was no significant difference between juvenile group and adult group ( P>0.05). There was a statistically significant difference in the time points of different clinical evaluation scores ( P<0.05). There was no interaction between the evaluation time and the experimental control group and age group ( P>0.05); and not affected by group or age grouping ( P>0.05), no adverse reactions occurred in either group. Conclusions:Human-like collagen scar repair gel is safe and effective in the treatment of proliferative hypertrophic scar, and the clinical efficacy is not inferior to Silicone gel.

Based on the history of scar research, this paper introduces the current situation of scar prevention and treatment.The contents include the domestic and foreign scar research situation.The domestic scar research on the prevention and treatment of scar has been greatly developed since 1978 in the past 40 years.The prevention and treatment of scar level are promoted by the rich practice in clinical, reached the international advanced level, and the development of this period is divided into three stages: the first stage from 1978 to 1998 prevention and treatment of scar has been increasingly taken seriously by burns and plastic surgery experts and scholars;the second stage from 1999 to 2015 is the rapid development stage of the scar prevention and treatment;the third stage since 2016 is the mature and stable stage of development of the scar prevention and treatment.The main achievements and status quo of the three stages of scar prevention and treatment are introduced.

Keloid is a kind of benign disease characterized by fibroblasts hyperplasia and abnormal collagen accumulation. Keloid is a complex disease, its pathogenesis is not yet clear. Genetic, cytokines, inflammatory mediators, immune response and environmental factors all play a role. Genetic factors are thought to be an important cause of keloid. Scar constitution has certain genetic predisposition. Familial heritability, prevalence in twins and ethnicities with darker pigmented skins all support the concept of the genetic susceptibility to keloid scarring. The researches about gene expression, gene mutation, genetic loci will provide valuable theoretical evidences for the confirmation of susceptible population, early prevention and ideal control strategies.

Objective To investigate the expression of aggrecan in keloid (KD) and normal skin (NS).Methods Immunohistochemical staining (IHC) and Western blot (WB) were performed to detect the expression of aggrecan in 10 cases of keloid and 10 cases of normal skin, and statistics was used to analyze the data.Results Aggrecan was expressed in both KD and NS.A significantly higher expression of aggrecan was detected in KD compared with NS (P＜0.05).Conclusion The increased expression of aggrecan in KD implicit that aggrecan may play a role in theformation of keloid.

Objective To identify the special biomarkers and the differentially expressed proteins in keloid tissue and to explore the pathogenesis characteristics of familial keloid by comparing the protein expression differences among familial keloid(FK),sporadic keloid (SK),hypertrophy scar (HS),normal scar (NS).Methods The tissue specimens of FK,SK,HS and NS(6 specimens in each group),were digested,taged and analysed using quantitative proteomic isobaric tags for relative and absolute quantitation (iTRAQ) labeling technology.A difference greater than 1.2 folds and P ＜ 0.05 were selection criteria for differencial expression proteins.Then bioinformatics analysis was applied.The expressions of 2 differential proteins were validated using Western Blot analysis.Results A total of 2 450 differentially expressed proteins were identified.Compared with NS,250 up-regulated and 281 down-regulated proteins were identified in FK;281 up-regulated and 232 down-regulated proteins were identified in SK;199 up-regulated and 233 down-regulated proteins were identified in HS.Compared with SK,64 up-regulated and 164 downregulated proteins were identified in FK;79 up-regulated and 169 down-regulated proteins were identified in HS.Compared with HS,124 up-regulated and 115 down-regulated proteins were identified in FK.These different proteins were concentrated in several vital signal pathways such as the extracellular matrix protein,cell adhesion and biological metabolism pathways.The variation trend of 2 differentially expressed proteins (P3H1 and RCN-3) were validated by Western Blot.Conclusions Proteomic analysis can identify the proteins with variance of keloid,hypertrophy scar and normal skin.Further investigations of these differential proteins may reveal the pathogenesis of keloid and provide new treatments for it.

Objective To discuss the clinical value of micro-plasma radio frequency technology combined with dye pulse light (DPL) on scar. Methods A total of 32 patients presented with superficial and hypertrophic scars on face and limbs were treated by micro-plasma radio frequency technology once every two or three months. After two or three times of micro-plasma treatments, DPL were performed on scar monthly, two or three times totally. Three months after the end of the course, efficacy and adverse effects were evaluated and analyzed. Results 62.5% patients achieved therapeutic effect, 12.5% patients had more than 90% improvement, 50%patients had 60% to 89% improvement, 34.3% patients had 30% to 59% improvement, 3.2% patients had less than 30% improvement, and no obvious side effects were observed. Conclusion Micro-plasma radio frequency technology combined with DPL can be considered as an effective and safe treatment modality for scars with no obvious side effects.

Regenerative medicine is an emerging discipline. Adipose tissue is a rich source of fat cells and mesenchymal stem cells, and autologous fat grafting has increasingly been applied in plastic surgeries and dermatological treatments. This paper reviews the latest advances in autologous fat grafting in scar revision.

该文在国内首次提出了瘢痕疙瘩的诊疗指南建议，内容包括：瘢痕疙瘩的诊断标准，瘢痕疙瘩的鉴别诊断，根据瘢痕疙瘩的临床分类选择瘢痕疙瘩治疗方法，明确瘢痕疙瘩治疗的主要方法和辅助方法，选择早期手术为主的综合治疗方案治疗瘢痕疙瘩，转变传统观念接受瘢痕的放射治疗，不能泛用“瘢痕体质”的概念，细致沟通、医患配合、定期复诊、动态综合疗法治疗瘢痕疙瘩等，对规范我国瘢痕疙瘩诊疗、保障瘢痕疙瘩患者得到正确的治疗具有重要意义。

ObjectiveTo explore the effects of dermabrasion combined with ReCell® on large superficial facial scars caused by burn, trauma and acnes.MethodsNineteen patients with large superficial facial scars were treated by the same surgeon with dermabrasion combined with ReCell®. According to the etiology, patients were classified into post-burning group (n=5), post-traumatic group (n=7) and post-acne group (n=7). Fifteen patients completed the follow-ups, 5 patients in each group. Healing time, complication rate, the preoperative and 18-month-post-operative assessments using Patient Satisfaction Score (PSS), Vancouver Scar Scale (VSS), and Patient and Observer Scar Assessment Scale (POSAS) of each group were analyzed to compare the effect of the combined therapy on outcomes.ResultsThe healing time of post-burning group (19.6±4.0 days), post-traumatic group (15.8±2.6 days), and post-acne group (11.4±3.1 days) varied remarkably (F=7.701, P=0.007). The complication rates were 60%, 20%, and 0 respectively. The post-operative POSAS improved significantly in all groups (P<0.05), where the most significant improvement was shown in the post-acne group (P<0.05). The post-operative PSS and VSS improved only in the post-traumatic group and post-acne group (all P<0.05), where the more significant improvement was also shown in the post-acne group (P<0.05).ConclusionsThe combined treatment of dermabrasion and ReCell® has remarkable effect on acne scars, moderate effect on traumatic scars and is not suggested for burn scars. POSAS should be applied to assess the therapeutic effects of treatments for large irregular scars.

感谢《中国美容医学》杂志社的信任和支持，我顺利完成了本期专栏--《瘢痕美容整形》的组稿和审阅工作。本专栏组稿，在发出征稿通知后，得到了大家的迅速响应，在此感谢各位作者的辛勤劳动！现对近年来瘢痕美容整形研究的一些进展，结合组稿内容评述如下。

Objective To summarize the postoperative results of acellular allograft dermal matrix combined with autologous skin thin graft in the treatment of extensive post-burn scar deformity late application, provide clinical experience for improving acellular allograft dermal matrix graft success rate.Methods From January 2010 to December 2015, 201 cases of large area post-burn scar plastic surgery were performed in patients with autologous thin skin graft and allograft acellular dermal matrix. Local excision of the surgical scar, contracture release, removal of allogenic acellular dermis matrix to cover the wound, around suture ifxation, to autologous head or other parts of the thin skin graft to cover, antibacterial dressing external compression bandage or local packaged ifxed. The treatment effect of the wound was observed after operation and the patients were followed up for more than half a year.Results In 191 cases (95.02%) allogenic acellular dermal matrix and autologous thin skin graft composite grafting regions skin graft survival better and no signs of pain and infection, after 6 months of follow-up, composite skin graft area local appearance better, soft texture, good elasticity, skin graft without contracture, no obvious scar, joint function improved signiifcantly, but part of the pigmentation. 10 cases (4.98%) patients, scar is located in around the mouth, jaw or axillary, about 1 week postoperation wound pain, surgical dressings have peculiar smell, body heat, razor thin autoskin all liquefaction necrosis, allograft dermal matrix partial inactivation, dissolved off.Conclusion Allograft acellular dermal matrix combined with autologous thin skin graft is a good method for the repair of large area post-burn scar deformity.

OBJECTIVE:To explore the structural and biomechanical properties of acellular dermal matrix (ADM) of human scar tissue.METHODS:Randomly choose 8 human mature scar tissue, 8 human hypertrophic scar tissue, and 4 normal human tissue as experimental samples respectively. Then 0.5 mm split-thickness skin grafts were obtained by drum-type scalpel, further acellularized by 2.5 g/L trypsin-0.5% TritonX-100. Structural analyses were performed by macroscopic observation, hematoxylin and eosin histological staining and scanning electron microscope. Then human epithelial stem cells were inoculated, cultured on those materials and observe their adhesive properties. Finally the biomechanical properties of ADM were analyzed through the detection of stress-strain relation, stress relaxation, creep and ultimate stress strength to distinguish different origins.RESULTS:Prepared ADM was milky white in color despite their distinct origins, physiological and mature scar tissue derived ADM was soft and flexible in texture while ADM from hypertrophic scar showed a more tenacious character. Optical microscopic and electron microscopic analyses showed no sign of visible cellular structures. ADM from physiological group had relatively homogeneous and inerratic collagenous fibers, ADM from hypertrophic group presented with fibers of various diameters and arrayed in a compact and disordered manner. ADM from mature scar tissue possessed traits between the other two groups. Adhesion growth could be observed 2 weeks after inoculating human epithelial stem cells on ADM and cells grew in a cohesive fashion on ADM both from normal skin and mature scar tissue and in an adhesive fashion on hypertrophic scar tissue ADM. Stress-strain β value (3.024 ± 0.413, 2.595 ± 0.443, 2.590 ± 0.366), creep slope (0.018 ± 0.003, 0.019 ± 0.009, 0.023 ± 0.010) and ultimate stress strength (8.971 ± 2.434, 11.011 ± 1.492, 15.567 ± 2.931) of ADM showed no significant differences in hypertrophic scar, mature scar and normal skin tissues (all P > 0.05). ADM from mature scar and normal skin tissue showed no differences in stress-strain stretch ratio (0.238 ± 0.083 vs 0.291 ± 0.048), relaxation slope (-0.041 ± 0.009 vs -0.047 ± 0.008), total relaxation (0.775 ± 0.194 vs 0.968 ± 0.211) or total creep (0.033 ± 0.022 vs 0.049 ± 0.020) (all P > 0.05). However, the above related indices of ADM from hypertrophic scar tissue (0.188 ± 0.036, -0.033 ± 0.006, 0.481 ± 0.058, 0.020 ± 0.005) were significantly lower than those from normal tissue (all P < 0.05).CONCLUSIONS:No significant differences exist between mature scar and normal skin tissues derived ADM both in structural and biomechanical properties. However ADM from mature scar appears to be superior in biomechanical properties than hypertrophic scar derived ADM so that it may become a replacement for original dermis in wound repair.

目的:评价细胞自体体外再生技术(ReCell技术)联合机械磨削技术在治疗面部凹陷性痤疮瘢痕中的治疗效果.方法:通过10例面部凹陷性痤疮瘢痕患者应用ReCel1联合机械磨削技术,观察术后3个月面部皮肤的平整程度、光泽度,与手术前患者面部皮肤情况对比来判断此方法的治疗效果.结果:9例患者治疗效果明显,皮肤光泽平整度较前明显好转,1例面部痤疮瘢痕无改善.结论:ReCe11联合机械磨削技术与单纯的机械磨削相比能促进创面的愈合,加速磨削后创面的上皮化,减少由于磨削不均匀而造成的皮肤色度不均匀,能有效的改善患者的面部痤疮瘢痕外观,提高患者的满意度,是治疗面部凹陷性痤疮瘢痕的有效手段,具有很好地应用价值.

儿童烧伤后功能的修复重建和外观的整形治疗往往需要多期手术才能获得较好的效果[1]，由于治疗时间长，痛苦大，同时因患儿的父母担心子女的身心健康及未来生活，往往会出现恐惧、精神退行性改变、抑郁、自责、焦虑等负性情绪[2]。认知行为疗法是心理学界近20多年来非常有影响力的心理治疗方法，由行为疗法和认知疗法整合而成，通过改变人对事情或情景的解释，从而改变其情绪、行为及生理的不良反应[3]。自2013年7月至2014年8月，我们开展了应用认知行为疗法对烧伤整形患儿父母实施心理干预的研究。现报道如下。

Background Keloid is a fibrotic skin disease for which immune cell infiltration is a primary pathological hallmark. Meanwhile, in autoimmune diseases, triggering of the inflammation response can lead to tissue injury and subsequent organ fibrosis. When the skin is involved in autoimmune disease, skin fibrosis such as that seen in scleroderma can occur. In this study, we propose that keloid possesses features of autoimmune disease. Methods To verify whether keloid possesses features of autoimmune disease, immune cell infiltration and immune complex deposits were detected with immunohistochemical staining and immunofluorescence, respectively, in keloid and normal skin tissues. A routine antinuclear antibody profile was tested in sera from 28 keloid patients and 28 healthy controls. Lastly, the anti - hnRNPA2B1 autoantibody in sera was evaluated by enzyme-linked immunosorbent assay. Results The numbers of CD1α + Langerhans cells, CD3 + T lymphocytes, CD68 + macrophages, and CD20 + B lymphocytes increased in keloid tissues compared to normal skin. IgA, IgM, C3, and C1q deposits were found in keloid tissues but not in normal skin, while anti - hnRNPA2B1 levels in sera from keloid patients were elevated. Conclusion The above findings suggest that keloids have some characteristics that are similar to autoimmune disease and might be mediated by autoimmune responses. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

瘢痕是机体损伤修复后形成的结果,它不仅影响患者的外观,而且导致严重的功能障碍,重者可出现溃疡、感染和癌变,危及生命.瘢痕的形成机制复杂,目前的研究虽然已经取得一定进展,但总体来说仍不十分清楚[1],人们尚不能有效地控制其发生和发展过程.当前,瘢痕的治疗方法很多,但都还不能达到完全满意的疗效,对瘢痕的防治目前仍然是医学难题[2].创伤是造成瘢痕的原因之一,笔者拟重点介绍对创伤性瘢痕防治的认识.

瘢痕疙瘩是常见的纤维结缔组织增生性疾病,创伤、烧伤、手术、感染等原因均可引起其发生,主要表现为皮肤创伤愈合过程中成纤维细胞过度增殖和胶原过度合成,超出原有皮损范围,具有侵袭性生长、易复发、对放化疗有效等肿瘤的生物学特点,但其发病机制尚不清楚[1].目前,对瘢痕疙瘩的诊断主要依据其临床表现,主观因素明显,具有不确定性,且不利于早期诊断.生物标志物一般是指可供客观测定和评价的一个生理、病理或治疗过程中的某种特征性的生化指标,通过对它的测定可以获知机体当前所处的生物学状态.开展对瘢痕疙瘩相关标志物的深入研究,筛选出某种或某类对瘢痕疙瘩具有高度特异性的标志物应用于临床,对瘢痕疾病早期快速诊断具有重要意义.笔者就瘢痕疙瘩相关标志物的研究进展综述如下。

ObjectiveTo investigate the clinical efifcacy of skin expansion combined with early postoperative electron beam radiotherapy in keloids after acne on mandibular angle.MethodsTen patients with keloids after acne on mandibular angle were received treatment of skin expansion combined with early postoperative electron beam radiotherapy. The keloid size varied from 5.0 cm×5.0 cm to 15.0 cm × 7.0 cm and the height varied from 0.5cm to 1.5cm. We followed up from 12 to 24 months to investigate the clinical efifcacy.ResultsTen patients completed the whole course of treatment successfully without lfap necrosis and wound keloids recurrence. The main complications were 1 case of hematoma and 1 case of the injection dififculty, the questions were solved by removing the hematoma and adjusting the injection pot operation separately.ConclusionsSkin expansion combined with early postoperative electron beam radiotherapy is a good method for keloids after acne on mandibular angle.