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.
作者比较了三种疤痕1. 疤痕增生(hypertrophic scars), 2. 蟹足肿 (keloid scars), 3. 妊娠纹 (striae distensae) 的各种处理方法包括洋葱萃取物、Vit E、矽胶、染料雷射、压力衣、按摩、激素TGF-b3，抗TGF-b1抗体、降低张力、伤口边缘外翻(eversion)、CO2雷射、类固醇注射、抗癌药物(5-FU, Bleomycin, Mitomycin)注射、放射线、橄榄油、可可脂(cocoa butter)等等。
这里要解释“Level of Evidence”, 证据力最强的依次为I>II>III>IV>V。例如我们看脂肪移植(fat grafting)在疤痕增生的治疗证据力是level III, IV, V，这表示有些医师说有效但样本数不够或实验方法不完善，所以不是那么可信；同理，我们看A酸(Tretinoin)在妊娠纹的治疗是无效的(none to low)，而且证据力是level II，表示相当可信。其它的就请各位自行查阅了。