Application of layered fishbone-type suture combined with multi-dimensional tension reduction in the surgical treatment of keloid in high-tension Areas
Objective To explore the effect of multi-dimensional reduction in the treatment of keloid in high-tension areas,using layered fishbone-type reduction suture,combined with superficial X-ray radiotherapy as postoperative treatment.Methods From July 2020 to January 2023,a total of 110 cases(162 lesions)were selected from the outpatient department and inpatient department of Dermatology of Sichuan People's Hospi-tal,who were treated with fishbone layered tensioning suture,combined with superficial X-ray radiotherapy af-ter surgery and were able to follow up.According to the location,number and tension of keloids,the scar tis-sue was removed by single or partial resection.In the operation,the improved multi-layer reduction suture was used to form the fishbone type,and the skin was tension-free and mildly eversion.superficial X-ray radiothera-py was started 24-72 hours after operation,four times,the total dose was 20 Gy;the skin tension was reduced by 3-6 months using a needle-free suture device,and the silicone preparation was externally applied for three months.Follow-up observations were 8-24 months.Patients with postoperative recurrence were treated with dye laser and(or)intra-cicatricial drug injection according to the situation,and shallow X-ray radiotherapy was added twice if necessary.Results In 110 cases(162 lesions),keloid was clinically cured in 103 cases(151 lesions),no obvious signs of recurrence were found,and the average scar stretching was less than 5 mm.Signs of recurrence occurred in seven cases(11 lesions),which were improved after superficial X-ray therapy,dye la-ser therapy,and local injection of fluorouracil and glucocorticoid.Conclusion Keloid in the high tension area is still difficult in treatment.The method of layered fishbone suture combined with multi-dimensional tension re-duction in the surgical treatment can reduce the postoperative incision tension in the high tension area,which is worthy of popularization and application in clinic.
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