疤痕治療的實證基礎

10.6666/ClinMed.202011_86(5).0118

石育仲

增生性疤痕（hypertrophic scar） ； 蟹足腫（keloid）

臨床醫學月刊

86卷5期（2020 / 11 / 27）

664 - 671

繁體中文

疤痕是外傷、燒燙傷、手術等遺留的印記。一方面因為外觀上突起、凹陷、泛紅造成患者困擾，另一方面，疤痕也會造成痛、癢、緊繃等症狀。雖然目前有各種相關產品或治療推陳出新，但實際臨床療效卻不清楚。利用文獻回顧與分析，可以進一步了解各種產品與治療的臨床療效證據強度作為疤痕治療的指引。對於預防增生性疤痕，矽膠、張力緩和產品、傷口邊緣外翻具較高療效，但洋蔥萃取物、染料雷射、壓力衣、疤痕按摩則療效較低。對於已形成的增生性疤痕，矽膠產品、染料雷射、二氧化碳雷射、利用類固醇、5-FU或bleomycin的注射療法、疤痕按摩等具較高療效，但洋蔥萃取物和脂肪移植則療效較差。對於蟹足腫的治療則應以手術切除加上有效的輔助治療如類固醇、mitomycin C或bleomycin的注射治療或放射治療。

1. Aggarwal, H,Saxena, A,Lubana, PS,Mathur, RK,Jain, DK(2008).Treatment of keloids and hypertrophic scars using bleom.J Cosmet Dermatol,7,43-49.
2. Alam, M,Pon, K,Van Laborde, S(2006).Clinical effect of a single pulsed dye laser treatment of fresh surgical scars: randomized controlled trial.Dermatol Surg,32,21-25.
3. Allison, KP,Kiernan, MN,Waters, RA(2003).Pulsed dye laser treatment of burn scars. Alleviation or irritation?.Burns,29,207-213.
4. Alster, T(2003).Laser scar revision: comparison study of 585-nm pulsed dye laser with and without intralesional corticosteroids.Dermatol Surg,29,25-29.
5. Alster, TS,Williams, CM(1995).Treatment of keloid sternotomy scars with 585 nm flash lamp-pumped pulsed-dye laser.Lancet,345,1198-1200.
6. Anzarut, A,Olson, J,Singh, P(2009).The effectiveness of pressure garment therapy for the prevention of abnormal scarring after burn injury: a meta-analysis.J Plast Reconstr Aesthet Surg,62,77-84.
7. Asilian, A,Darougheh, A,Shariati, F(2006).New combination of triamcinolone, 5-Fluorouracil, and pulsed-dye laser for treatment of keloid and hypertrophic scars.Dermatol Surg,32,907-915.
8. Chan, KY,Lau, CL,Adeeb, SM(2005).A randomized, placebo-controlled, double-blind, prospective clinical trial of silicone gel in prevention of hypertrophic scar development in median sternotomy wound.Plast Reconstr Surg,116,1013-1020.
9. Cho, YS,Jeon, JH,Hong, A(2014).The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial.Burns,40,1513-1520.
10. Chung, VQ,Kelley, L,Marra, D(2006).Onion extract gel versus petrolatum emollient on new surgical scars: prospective double-blinded study.Dermatol Surg,32,193-197.
11. Connell, PG,Harland, CC(2000).Treatment of keloid scars with pulsed dye laser and intralesional steroid.J Cutan Laser Ther,2,147-150.
12. Conologue, TD,Norwood, C(2006).Treatment of surgical scars with the cryogen-cooled 595 nm pulsed dye laser starting on the day of suture removal.Dermatol Surg,32,13-20.
13. Cruz-Korchin, NI.(1996).Effectiveness of silicone sheets in the prevention of hypertrophic breast scars.Ann Plast Surg,37,345-348.
14. Davari, P,Gorouhi, F,Hashemi, P(2012).Pulsed dye laser treatment with different onset times for new surgical scars: a single-blind randomized controlled trial.Lasers Med Sci,27,1095-1098.
15. Denton, CP,Merkel, PA,Furst, DE(2007).Recombinant human anti-transforming growth factor betal antibody therapy in systemic sclerosis: a multicenter, randomized, placebo-controlled phase I/II trial of CAT-192.Arthritis Rheum,56,323-333.
16. Field, T,Peck, M,Scd(2000).Postburn itching, pain, and psychological symptoms are reduced with massage therapy.J Burn Care Rehabil,21,189-193.
17. Jenwitheesuk, K,Surakunprapha, P,Jenwitheesuk, K(2012).Role of silicone derivative plus onion extract gel in presternal hypertrophic scar protection: a prospective randomized, double blinded, controlled trial.Int Wound J,9,397-402.
18. Karagoz, H,Yuksel, F,Ulkur, E(2009).Comparison of efficacy of silicone gel, silicone gel sheeting, and topical onion extract including heparin and allantoin for the treatment of postburn hypertrophic scars.Burns,35,1097-1103.
19. Ketchum, LD,Smith, J,Robinson, DW(1966).The treatment of hypertrophic scar, keloid and scar contracture by triamcinolone acetonide.Plast Reconstr Surg,38,209-218.
20. Khansa, I,Harrison, B,Janis, JE(2016).Evidence-Based Scar Management: How to Improve Results with Technique and Technology.Plast Reconstr Surg,138,165S-178S.
21. Khoo, TL,Halim, AS,Zakaria, Z(2011).A prospective, randomised, double-blinded trial to study the efficacy of topical tocotrienol in the prevention of hypertrophic scars.J Plast Reconstr Aesthet Surg,64,e137-e145.
22. Klinger, M,Marazzi, M,Vigo, D,Torre, M(2008).Fat injection for cases of severe burn outcomes: a new perspective of scar remodeling and reduction.Aesthetic Plast Surg,32,465-469.
23. Koc, E,Arca, E,Surucu, B(2008).An open, randomized, controlled, comparative study of the combined effect of intralesional triamcinolone acetonide and onion extract gel and intralesional triamcinolone acetonide alone in the treatment of hypertrophic scars and keloids.Dermatol Surg,34,1507-1514.
24. Majid, I,Imran, S(2014).Fractional CO2 Laser Resurfacing as Monotherapy in the Treatment of Atrophic Facial Acne Scars.J Cutan Aesthet Surg,7,87-92.
25. Mamalis, AD,Lev-Tov, H,Nguyen, DH(2014).Laser and light-based treatment of Keloids--a review.J Eur Acad Dermatol Venereol,28,689-699.
26. Mojallal, A,Lequeux, C,Shipkov, C(2009).Improvement of skin quality after fat grafting: clinical observation and an animal study.Plast Reconstr Surg,124,765-774.
27. Momeni, M,Hafezi, F,Rahbar, H(2009).Effects of silicone gel on burn scars.Burns,35,70-74.
28. Moody, BR,McCarthy, JE,Linder, J,Hruza, GJ(2005).Enhanced cosmetic outcome with running horizontal mattress sutures.Dermatol Surg,31,1313-1316.
29. Norris, JE(1991).The effect of carbon dioxide laser surgery on the recurrence of keloids.Plast Reconstr Surg,87,44-49.
30. Nouri, K,Jimenez, GP,Harrison-Balestra, C(2003).585-nm pulsed dye laser in the treatment of surgical scars starting on the suture removal day.Dermatol Surg,29,65-73.
31. Payapvipapong, K,Niumpradit, N,Piriyanand, C(2015).The treatment of keloids and hypertrophic scars with intralesional bleomycin in skin of color.J Cosmet Dermatol,14,83-90.
32. Recalcati, S,Caccialanza, M,Piccinno, R(2011).Postoperative radiotherapy of auricular keloids: a 26-year experience.J Dermatolog Treat,22,38-42.
33. Rigotti, G,Marchi, A,Galie, M(2007).Clinical treatment of radiotherapy tissue damage by lipoaspirate transplant: a healing process mediated by adipose-derived adult stem cells.Plast Reconstr Surg,119,1409-1422.
34. Stewart, CEt,Kim, JY(2006).Application of mitomycin-C for head and neck keloids.Otolaryngol Head Neck Surg,135,946-950.
35. Walia, S,Alster, TS(1999).Prolonged clinical and histologic effects from CO2 laser resurfacing of atrophic acne scars.Dermatol Surg,25,926-930.
36. Walmsley, GG,Maan, ZN,Wong, VW(2015).Scarless wound healing: chasing the holy grail.Plast Reconstr Surg,135,907-917.
37. Wananukul, S,Chatpreodprai, S,Peongsujarit, D(2013).A prospective placebo-controlled study on the efficacy of onion extract in silicone derivative gel for the prevention of hypertrophic scar and keloid in median sternotomy wound in pediatric patients.J Med Assoc Thai,96,1428-1433.
38. Wray, RC(1983).Force required for wound closure and scar appearance.Plast Reconstr Surg,72,380-382.
39. Zampieri, N,Zuin, V,Burro, R(2010).A prospective study in children: Pre- and post-surgery use of vitamin E in surgical incisions.J Plast Reconstr Aesthet Surg,63,1474-1478.
40. Zide, MF(1996).Scar revision with hypereversion.J Oral Maxillofac Surg,54,1061-1067.