| ObjectiveTension incision is very common in the clinical work of plastic surgery.Too much tension of incision can lead to skin cutting injury,tissue necrosis,incision dehiscence,over width and hyperplasia of scar at the edge of sutured incision,and even more,it can lead to prolonged wound or serious scar hyperplasia or contracture deformity after healing.Therefore,it is important and difficult to ensure the primary grade a healing of tension incision and prevent the scar hyperplasia after incision healing to the greatest extent.Silicone gel dressing is commonly used in clinical prevention and treatment of scar.It has become a non-invasive drug for clinical treatment of scar,and is often used as a reference for evaluating new treatment of scar.Noninvasive skin stapler is a new technology in recent years.It was originally used to close the common surgical incision in orthopedics,obstetrics and Gynecology,cardiac surgery and other departments.It has the characteristics of simple operation and firm fixation.In clinical application,we found that the non-invasive skin suture device can close the incision and close the skin of 2cm area around the incision,which can effectively reduce the tension of the incision,and has a certain braking andfixation effect on the incision,and can promote the healing of the tension incision and reduce the scar hyperplasia of the incision.Tension incision can occur in areas with low mobility,such as chest and back,and also in areas with high mobility,such as elbow and knee joints.In this study,noninvasive skin suture and silicone gel dressing were applied to the tension incision of elbow joint and chest and back.The clinical effects of noninvasive skin suture on healing of tension incision and scar hyperplasia after operation were evaluated by comparing wound healing and scar growth and proliferation of noninvasive skin suture and silicone gel dressing respectively.MethodsFrom November 2017 to October 2019,120 patients with tension incision formed after plastic surgery in the First Affiliated Hospital of Zhengzhou University were collected in this study,including 60 patients with elbow tension incision and 60 patients with chest and back tension incision.Two groups of incision patients were randomly divided into suture device group(n=15),silicone gel group(n=15),combined group(n=15)and control group(n=15)according to the order of admission.All tension incisions were sutured subcutaneously,dermis and Cosmetology.Suture device group: clean the skin surface after cosmetic suturing,fix the non-invasive skin suturer on both sides of the incision,and the non-invasive skin suturer shall be fixed for at least 3 months.Combined group: After skin suture,a noninvasive skin suture device was fixed on both sides of the incision.Silicone gel was applied 3 days after removal of the suture,and the noninvasive skin suture device and silicone gel were applied for at least 3 months.Silicone gel group: cosmetic suture skin,3 days after the removal of silicone gel,at least 3 months;control group: no other anti scar treatment.All incisions were sutured 14 days after operation.When sutures were removed,the healing of incisions was observed and the number of patients with different grades of incision healing was recorded.The number of cases with incision dehiscence was recorded at any time.Patients in each group were followed up one month,three months and six months after operation.The width of incision scar was measured by vernier caliper and the scar hyperplasia was scored by Vancouver ScarScale VSS.The data were processed by SPSS 21.0 software.ResultsFinally,the tension incision in the elbow joint: 3 cases in the control group fell off,2 cases fell out in the silicone gel group,2 cases fell out in the suture device group,2 cases fell off in the joint group,2 cases in the control group,and 2 cases in the silicone gel group fell off,and 2 cases in the suture device group fell off,and 2cases in the combined group fell off.A total of 103 patients completed the experiment,including 51 in elbow group and 52 in thoracolumbar group.There was no significant difference in age,gender,operation site,incision length and width.1.Healing of incision: Grade a healing rate of incision joint group and the suture device group of elbow joint was significantly higher than that of silicone gel group and control group,and the difference was statistically significant(P < 0.05).The grade a healing rate of incision joint group and the suture device group in the chest and back tension incision group was significantly higher than that in the silicone gel group and the control group,but the difference was not statistically significant(P > 0.05).2.The incidence of incision dehiscence: the incidence of incision dehiscence in the joint group and suture device group of the elbow joint and chest and back tension incision was significantly lower than that of the silicone gel group and the control group,but the difference was not statistically significant(P > 0.05).3.Comparison of scar width: 1 months,3 months and 6 months after operation,the scar width of the joint group,suture device group,silicone gel group and control group of the patients with elbow joint and chest and back tension incision were statistically significant(P < 0.05).The width of incision scar in four groups of two sites,suture device group,silicone gel group and control group was statistically significant at 1 months,3 months and 6 months after operation(P < 0.05).After 1months,3 months and 6 months,the scar width of the combined group and suture device group was smaller than that of the silicone gel group(P < 0.05).The width of incision scar in the combined group and suture device group was smaller than that inthe control group(P < 0.05).There was no significant difference between the two groups(P > 0.05).4.Postoperative scar VSS score: the total score of scar VSS score in the joint group,the suture device group,the silicone gel group and the control group was statistically significant at 1 months,3 months and 6 months after operation(P < 0.05).One month,three months and six months after operation,the combined group,suture device group and silica gel group were all lower than that of the control group(P <0.05).Patients with tension incision of elbow joint: one month after operation,there was significant difference in VSS scores among the three groups(P < 0.05).After 3months and 6 months follow-up,the scar VSS score of the combined group was smaller than that of the postoperative scar VSS score of the suture device group,but the difference was not statistically significant(P > 0.05).The postoperative scar VSS score in the combined group and suture device group was less than that in the silicone gel group,and the difference was statistically significant(P < 0.05).Patients with tension incision on the chest and back: one month after operation,there was a significant difference in VSS scores among the three groups(P < 0.05).At 3 months after operation,the VSS scores of combined group and suture device group were lower than those of silica gel group(P < 0.05).However,there was no significant difference between the two groups(P > 0.05).Six months after operation,the VSS score of combined group was lower than that of silica gel group(P < 0.05).There was no significant difference between the two groups(P > 0.05).There was no significant difference(P > 0.05).Conclusions(1)The non-invasive skin suture device can effectively promote the healing of tension incision,reduce the occurrence of incision cracking,and the effect is more obvious in the joint.(2)The non-invasive skin suture can significantly reduce the width of scar after tension incision,and silicone gel has little effect on the width of scar after tension incision.(3)The non-invasive skin suture and silica gel can reduce the scar proliferation aftertension incision,and the effect of noninvasive skin suture is better.Especially in the joints with larger mobility,the combination of the two is better than the single application. |
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