新疆千禧丽人整形美容中心康小燕
人体因各种原因造成的疤痕是美容外科常见病之一。其中已面部疤痕最多见。我中心从1986年至今采用手术`，磨削，注射，海棠中医疤痕平超生导入等单项或综合方法396例疤痕，取得了很好的效果。现介绍如下。
1 一般资料：
本组396例，男性193例，女性203例。年龄最大59岁，最小6岁半，其中外伤疤痕251例，烧伤性疤痕101例，外科手术疤痕44例。
2 手术方法：
1、中医海棠疤痕平超生导入法：适应于表浅疤痕（真皮生发层以上的疤痕）
2陈旧性创面：先对创面打磨，待微微渗血时，以庆大复合溶液湿抚创面局部，在点滴疤痕平进行导入。
此法局部一般无须包扎。一般做2-3次。患者如在家每天一支疤痕平棉线吐沫效果最好，15天即可看到表皮生长的显著效果。
2高压注射法：
用泼泥松或去炎松-A同盐酸利多卡因以1：1比例混合液对消毒过的疤痕疙瘩进行高压注射。将药液完全、足量的诸如疤痕组织内。强大的液压。使药液均匀的分布在疤痕组织内，单位面积药液浓度高，发挥作用充分，药物必须进入疤痕疙瘩中下金雅中 整容1/3处。注射位置恰当、药量和药液准确，不会造成疤痕表面坏死和萎缩，能提高疗效，减少副作用发生。由于缩短疗程，也不会造成药物蓄积所致的全身激素副作用的发生。
此法疤痕疙瘩每周一次，少则2-3次多则8-10次，均能获得疤痕平复的良好效果。
3磨削法：
适用烧伤疤痕，天花疤痕，痤疮疤痕等。
步骤：局部常规消毒，铺巾，采用阻滞麻醉和局部浸润麻醉，12岁以下儿童以氧安酮麻醉，施术者以左手固定局部皮肤，右手持钻机磨头，适度加压。手术层次按病变皮损分别采用不同型号的钢轮和砂轮进行推磨、斜磨、圆磨、点磨及平磨依次磨至真皮乳头层，可就秒年局部创面并压迫止血，在创面上冲洗庆大霉素液。覆盖无菌凡士林纱条，纱条上反复冲洗庆大霉素液，上覆盖无菌纱条 、包扎。术后可抗生素常规给量，可给强的松片10㎎。日3次口服，以减轻素沉着，术后4天打开术部敷料换药，在室内采取暴露疗法，使创面干燥。
对于磨削偏深的术部在第四天打开敷料时进行海棠疤痕平超生导入，确保愈后创面平整。
4手术法：
1﹚直接切除缝合术：适用于条状小面积疤痕。对疤痕与皮纹一致者，切除疤痕后充分游离两侧皮肤，使两侧皮肤在无张力直接拉拢缝合。疤痕与皮纹不一致者，则用“Z”或多个“Z”成型术。对手术性疤痕两侧伴有明显突出的点状疤痕可采用多个或连续“W”成形术。
凹陷型疤痕可保留部分深层疤痕组织，以使缝合后局部保持平整。
2局部皮瓣移植术：对疤痕组织较深，面积较大，切除后两侧组织难以拉拢缝合，而又不适合游离皮片移植术者可采用此方法。
3分次切除缝合术：对疤痕组织面积教大，依次手术难以切除者，可采用分次切除缝合术，其效果同直接切除术，每次手术间隔3个月。
4游离皮片移植术：疤痕切除后，因创面太大，不能直接缝合关闭创面或强行拉拢缝合可导致面部器官发生畸形，但创面平整，血运良好，可行游离皮片移植术。
Three hundred and ninety -six case of scar plastic operation
Xinjiang Qian Xi Li Ren plastic operation cosmetic center
Since nineteen eighty-six our center has cured three hundred and ninety-six cases of cicatrices by many single or comprehensive methods and has gained some good effect. There are 193 males and 203 females including 251 external, 101scalded and 44 surgical cicatrices. The ages rang from 6 to 59.
One. Traditional Chinese Medical Haitang recovery of cicatrices by ultrasonic ingress: fits superficial cicatrices(above the dermis germinal layer).
a. New wound: get one ml Haitang recovery of cicatrices with I ml syringe, give local infiltration to the cicatrices, import by disinfected ultrasonic probe. It costs about 15 minutes.
b. Old wound: burnish the wound until it turns to a little hemorrhage, dress local wound with gentamicin double solvents, infiltrate the recovery of cicatrices to import.
It has no need to bound up but 2-3 treatment every week. It can get better effect if it is dressed with recovery of cicatrices on the wound by cotton ball. It gets obvious effect in 15 days.
Two. High pressure injection:
Give high pressure injection to the wound with double solvents which is made by prednisone or triamcinolone-A and lidocaine hydrochloride in 1:1 proportion. It needs once
a week and at least 2-3, no more than 8-10 times in all.
Three: Abrasion: fits scalded, variola or acne cicatrices
Step: local routine disinfection, draping, adopt local anesthesia by infiltration and block anesthesia, bumish to dermal papilla and hemostasis by compression, irrigate gentamicin, dress asepsis Vaseline gauze and bind up it by ribbon gauze, give routine quantity of antivitamin, prednisone 10 mg (take by oral administration three times a day) to light tissue tydrops, take large dosage of vitamin C for 2-3 months to light pigmentation give exchange of dressing 4 days after the operation(can give ultrasonic ingress to the profound wound simultaneously).
Four. Operation
a.Direct resection and suture: fits small or cord like wound. Adopt direct suture without tension when the wound and veins are uniform. Otherwise, suture in the” Z” shape or “W” shape.
b.Local skin pedide transplantation: fits deep, big ones which can not be cutured directly or use free skin graft transplantation.
c.Gradual resection and suture: fits big ones which can not be resected in one time, needs once every 3 months.
d.Free skin graft transplantation: after resection, the wound which is flight and with good moving of blood but can not be sutured directly can adopt this method.
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