褚晶晶1 王和庚1 罗志军1 田举1 齐向东2

本文来源：《中华整形外科杂志》2023年8月 第39卷 第8期

DOI:10. 3760 / cma.j.cn114453-20230504-00094

作者单位：1中山市人民医院烧伤整形美容科， 中山528400；2南方医科大学珠江医院整形美容中心， 广州510220

通信作者：齐向东，Email: create_beauty@hotmail.com

【摘要】 

目的 研究A型肉毒毒素(BTX-A)注射防治中厚皮片供区瘢痕的效果。

方法 采用前瞻性随机对照研究方法，于2021年9月至2022年9月招募中山市人民医院烧伤整形美容科采用大腿中厚皮片移植修复功能部位烧伤及慢性创面的患者。大腿供皮区创面愈合后10 d(约术后4周),采用随机数字表法将患者分为2组：试验组和对照组。试验组术后1、3个月使用等间距注射法于供区注射BTX-A溶液，每点注射0.1 ml(1 U)，各点间距1 cm；对照组术后1、3个月在供皮区采用等间距法注射等量生理盐水。观察不良反应发生情况，治疗半年后进行随访，通过医生的温哥华瘢痕量表(VSS)评分(包括色泽、血管分布、柔软度、厚度4个维度)和患者瘢痕痛痒程度的视觉模拟评分法(VAS)评分评估疗效。VSS评分和VAS评分均符合正态分布，以x±s表示，采用独立样本t检验进行分析。

结果 共招募60例受试者，试验组和对照组各30例。试验组男16例，女14例，年龄(32.7±5.4)岁(18~60岁)；对照组男13例，女17例，年龄(31.4±4.8)岁(18~55岁)。2组性别构成和年龄的差异均无统计学意义(P均>0.05)。试验组在治疗过程中及治疗后无严重不良反应发生。治疗半年后随访时，试验组VSS总分[(3.57±0.60)分vs. (8.52±0.84)分]以及瘢痕色泽、血管分布、柔软度、厚度4个维度评分[(0.88±0.22)分vs. (2.30±0.52)分；(0.73±0.27)分vs. (2.16±0.40)分；(1.29±0.39)分vs. (2.49±0.39)分；(0.66±0.23)分vs. (1.56±0.34)分]均明显小于对照组，差异均有统计学意义(P均<0.01)；试验组的瘢痕痛痒程度VAS评分亦明显小于对照组[(1.06±0.34)分vs. (2.92±0.63)分]，差异有统计学意义(P<0.01)。

结论 BTX-A注射防治中厚皮片供区瘢痕安全且有效，同时对缓解瘢痕患者的痛痒症状也具有良好的效果。

基金项目： 中山市医学科研项目(2021J009)
 

The cosmetic effects of botulinum toxin type A in the prevention and treatment of cicatrix on split-thickness skin graft donor site

Chu  Jingjing1, Wang  Hegeng1, Luo  Zhijun1, Tian  Ju1, Qi  Xiangdong2

1Department of Burn & Plastic Surgery, Zhongshan People’s Hospital, Zhongshan 528400, China; 2Plastic Surgery Center, Southern Medical University Zhujiang Hospital, Guangzhou 510220, China

Corresponding author: Qi Xiangdong,  Email: create_beauty@hotmail.com

  【Abstract】

Objective To investigate the cosmetic effects of botulinum toxin type A(BTX-A) in the prevention and treatment of cicatrix on split-thickness skin graft donor site.

Methods A prospective randomized controlled study was commenced to recruit patients with functional burns and chronic wounds who were repaired with split-thickness skin graft in the Department of Burn and Plastic Surgery of Zhongshan People’s Hospital from September 2021 to September 2022. Ten days after wound healing in the donor area of the thigh (about 4 weeks after surgery), the patients were randomly divided into two groups: the experimental group and the control group. The experimental group was injected with BTX-A solution at the skin donor site by equal interval injection method 1 and 3 months after surgery, 0.1 ml (1 U) was injected at each point, and the interval of each point was 1 cm. The control group was injected with equal amount of normal saline at the skin donor area by equal spacing method 1 and 3 months after operation. The adverse reactions was observed. Follow-up was performed six months after treatment. Evaluation indicators included the doctor’s Vancouver scar scale (VSS) score (including color, vascular distribution, softness and thickness), the visual analogue scale (VAS) score of the patient’s scar pain and itching degree. Both VSS scores and VAS scores were in line with normal distribution, expressed as Mean±SD, and analyzed by independent sample t-test.

Results A total of 60 subjects were recruited, 30 in the experimental group and 30 in the control group. In the experimental group, there were 16 males and 14 females, aged (32.7±5.4) years (18-60 years). In the control group, there were 13 males and 17 females, aged (31.4±4.8) years (18-55 years). There were no significant differences in gender composition and age between the two groups (all P > 0.05). No serious adverse reactions occurred in the experimental group during and after treatment. At the follow-up six months after treatment, the total score of VSS in the experimental group [(3.57±0.60) points vs. (8.52±0.84) points] and the scores of scar color, vascular distribution, flexibility and thickness[(0.88±0.22) points vs. (2.30±0.52) points; (0.73±0.27) points vs. (2.16±0.40) points; (1.29±0.39) points vs. (2.49±0.39) points; (0.66±0.23) points vs. (1.56±0.34) points] were significantly lower than those in the control group, and the differences were statistically significant (P < 0.01). The VAS score of scar pain and itching degree in the experimental group was also significantly lower than that in the control group [(1.06±0.34) points vs. (2.92±0.63) points], and the difference was statistically significant (P < 0.01).

Conclusion BTX-A injection is safe and effective in preventing and treating cicatrix in the donor area of split-thickness skin graft, and also has a good effect on relieving the pain and itching symptoms of cicatrix patients.

Fund program: Zhongshan Medical Research Project (2021J009)

Disclosure of Conflicts of Interest: The authors have no financial interest to declare in relation to the content of this article.

Ethical Approval: Ethical approval was given by the Medical Ethics Committee of Zhongshan People’s Hospital(2023-015).