瘢痕防治指南解读医学演示课件.ppt

. Given the natural course of scar improvement during healing, the use of any scale must include the parameter of time relative to initial scar formation or subsequent treatment intervention. For routine clinical practice, at minimum, evaluation of size, thickness, symptom severity (e.g., pain, itching), and patient concerns are recommended. * . Management algorithm for hypertrophic scars. Light gray indicates initial management strategies; dark gray indicates secondary management options. PDL, pulsed-dye laser. aPreferred initial option. b2.5 to 20 mg/mL (face); 20 to 40 mg/mL (body). cAlternative therapy options for severe lesions include bleomycin, mitomycin C, laser therapy, and cryotherapy. dScar prevention and treatment should not begin before epithelium and wound stabilization. eCombination and alternative therapies include massage, physical therapy, corticosteroids, tension-relieving surgical intervention, excision, grafting or flap coverage, hydrocolloid dressings, antihistamines, and laser therapy. * 201瘢痕防治指南 * 瘢痕的分类 成熟瘢痕：轻微色素改变，平整； 未成熟瘢痕：发红，时有痛痒感，轻度突出。通常随着时间变平整，有轻微色素改变。 线性增生性瘢痕（手术创伤后）：发红，突出，通常发痒，限于原有创伤范围内，通常在术后数周发生。可在3-6月内迅速增大，在稳定期后进入衰退期。通常成熟后形成一个突起的，绳索一样的外观，完全成熟需要长达2年。 广泛增生性瘢痕（烧伤后）：范围广，发红，突起，时有发痒，在烧伤范围内。 小瘢痕疙瘩：局部增生的，发痒瘢痕，延至正常组织；生长超过1年，不自行消退；单纯手术切除常复发；可能存在基因异常，常见于耳部 大瘢痕疙瘩：大的，突出的瘢痕（0.5cm），可有疼痛及瘙痒，延至正常组织；常因为微小创伤，并持续生长数年 * * Cutaneous Scar Grading Systems individual scar rating scales and found that available tools (e.g., Vancouver scar scale [VSS] visual analog scale, patient observer scar assessment scale [POSAS]) Fearmonti and colleagues2 concluded that current scales have acceptable onsistency and reliability but have limited sensitivity and are at least partially subjective in nature. Moreover, the POSAS has been found to be more consistent and reliable when compared with the widely used VSS.2,3 * Scar prevention * Scar prevention 硅胶产品在伤口上皮化后开始使用至少1个月 硅胶贴每天至少使用12小时，24小时最好 对大面积或者活动多的部位，面部或者天气湿热地区，硅胶软膏是更好选择 对严重病例，应同时局部注射激素 对风险轻度升高病例，可使用硅胶，低过敏微孔胶布或