Title: Evidence-Based Scar Management: How to Improve Results with Technique and Technology
Authors: Khansa, Ibrahim MD; Harrison, Bridget MD; Janis, Jeffrey E. MD, FACS
Journal: PRS, 2016, 138.3S: 165S-178S.
Background: Scars represent the visible sequelae of trauma, injury, burn, or surgery. They may induce distress in the patient because of their aesthetically unpleasant appearance, especially if they are excessively raised, depressed, wide, or erythematous. They may also cause the patient symptoms of pain, tightness, and pruritus. Numerous products are marketed for scar prevention or improvement, but their efficacy is unclear.
Methods: A literature review of high-level studies analyzing methods to prevent or improve hypertrophic scars, keloids, and striae distensae was performed. The evidence from these articles was analyzed to generate recommendations. Each intervention’s effectiveness at preventing or reducing scars was rated as none, low, or high, depending on the strength of the evidence for that intervention.
Results: For the prevention of hypertrophic scars, silicone, tension reduction, and wound edge eversion seem to have high efficacy, whereas onion extract, pulsed-dye laser, pressure garments, and scar massage have low efficacy. For the treatment of existing hypertrophic scars, silicone, pulsed-dye laser, CO2 laser, corticosteroids, 5-fluorouracil, bleomycin, and scar massage have high efficacy, whereas onion extract and fat grafting seem to have low efficacy. For keloid scars, effective adjuncts to excision include corticosteroids, mitomycin C, bleomycin, and radiation therapy. No intervention seems to have significant efficacy in the prevention or treatment of striae distensae.
Conclusion: Although scars can never be completely eliminated in an adult, this article presents the most commonly used, evidence-based methods to improve the quality and symptoms of hypertrophic scars, as well as keloid scars and striae distensae.
作者比較了三種疤痕1. 疤痕增生(hypertrophic scars), 2. 蟹足腫 (keloid scars), 3. 妊娠紋 (striae distensae) 的各種處理方法包括洋蔥萃取物、Vit E、矽膠、染料雷射、壓力衣、按摩、激素TGF-b3，抗TGF-b1抗體、降低張力、傷口邊緣外翻(eversion)、CO2雷射、類固醇注射、抗癌藥物(5-FU, Bleomycin, Mitomycin)注射、放射線、橄欖油、可可脂(cocoa butter)等等。
這裡要解釋“Level of Evidence”, 證據力最強的依次為I>II>III>IV>V。例如我們看脂肪移植(fat grafting)在疤痕增生的治療證據力是level III, IV, V，這表示有些醫師說有效但樣本數不夠或實驗方法不完善，所以不是那麼可信；同理，我們看A酸(Tretinoin)在妊娠紋的治療是無效的(none to low)，而且證據力是level II，表示相當可信。其它的就請各位自行查閱了。