The Influence Of Emergency Treatment For Facial Trauma On Scar Formation

Background:Scars caused by facial trauma would affect facial appearance and function,and had influence on mental health and quality of life of patients to varying degrees.Generally speaking,as for the emergency treatment of facial trauma in the Department of Emergency Surgery,more attention has been paid to reduce infection and promote wound healing,and the treatment of post-traumatic scars mainly relied on auxiliary interventions.With the continuous development of the understanding on the scar formation process after trauma and the intervention means,an increasing number of scholars began to pay attention to the importance of early intervention after trauma,but with the failure of finding unified and effective methods for the time and modes of early intervention.Objective:The study aimed to to explore the influence of time and modes of early intervention on scar formation by retrospectively analyzing the data of patients with facial trauma and facial trauma-caused scars in our department in recent years.Methods:From September 2015 to August 2019,clinical data of 620 patients with facial trauma and facial trauma-caused scars admitted to the Department of Plastic and Cosmetic Surgery,Huaihe Hospital of Henan University,were analyzed retrospectively.According to the inclusion and exclusion criteria,141 patients were finally selected,including 73 males and 68 females.Treatment: patients were treated according to the time of visit and the condition of wound surface.For patients with facial trauma and delayed suture,subtle suture in plastic and cosmetic surgery was applied after radical debridement.Among them,the wound surface with an included angle between the wound and the relaxed skin tension lines(RSTL)> 30° was subjected to direction changing design.For patients with facial trauma-caused scars,tension-reduced fixation,laser therapy,silicone preparation,local injection and pressure therapy were carried out.Grouing:(1)according to suture modes,patients were divided into: Group A1: plastic subtle suture(n = 88)and Group B1: general emergency surgery suture(n = 10).(2)according to the included angle between the wound direction and RSTL,patients were divided into: Group A2: the included angle between the wound direction and RSTL was ? 30°,and patients were performed with direct plastic subtle suture(n = 20);Group B2: the angle between the wound direction and RSTL was > 30 °,and patients were performed with wound direction-changing suture(n = 22);and Group C2: the angle between the wound direction and RSTL was > 30 °,and patients were performed with direct plastic subtle suture(n = 19).(3)according to the time of post-traumatic intervention,patients were divided into: Group A3: the time of visit after trauma(T)? 24 h(n = 96);Group B3: 24 h < T < 1 week(n = 11);Group C3: 1 week ? T < 1 month(n = 14);and Group D3: 1 month ? T < 3 months(n = 20).Evaluation: Vancouver Scar Scale(VSS)and Stony Brook Scar Evaluation Scale(SBSES)were used to evaluate the prognosis of all patients at 10 days(short-term prognosis)and 6 months(long-term prognosis)after trauma.In addition,100-mm Visual Analogue Scale(VAS)was used for satisfaction evaluation.Results:(1)The influence of suture modes on scar formation: in terms of VSS,the long-term scores were lower than the short-term scores in Group A1 and Group B1(p<0.05),as for SBSES,the long-term scores were higher than the short-term scores(p<0.05).Compared with the Group B1,lower short-term and long-term VSS scores,higher short-term and long-term SBSES scores and higher VAS scores were found in the Group A1(all p<0.05).(2)The influence of the included angle between the wound direction and the RSTL on scar formation: in Group A2,Group B2 and Group C2,the long-term VSS scores were lower than the short-term VSS scores(p<0.05),and long-term SBSES scores were higher than the short-term SBSES scores(p<0.05).Comparisons were carried out among the three groups,and the results suggested that the short-term VSS score of Group A2 was the lowest(p<0.05),and there was no significant difference in the short-term VSS score between Group B2 and Group C2(p=0.148);and the long-term VSS score was the lowest in Group A2 and the highest in Group C2(p<0.05).Group A2 had the highest short-term SBSES score(p<0.05),and the short-term SBSES score was higher in Group B2 when compared with Group C2(p<0.05);and no significant difference in the long-term SBSES score was found between Group A2 and Group B2(p= 0.375),and Group A2 and Group B2 had higher long-term SBSES score than Group C2(p<0.05).The VAS scores in Group A2 and Group B2 were higher in comparison with Group C2(p<0.05),but without significant difference in VAS score between Group A2 and Group B2(p=0.644).(3)The influence of intervention time after trauma on scar formation: in the Group A3,Group B3,Group C3 and Group D3,the long-term VSS scores were lower than the short-term VSS scores(p<0.05),and the long-term SBSES scores were higher than the short-term SBSES scores(p<0.05).Comparisons among the four groups found that there was no significant difference in short-term VSS score between Group A3 and Group B3(p=0.758),the short-term VSS scores in Group A3 and Group B3 were lower than those in Group C3 and Group D3,respectively(p<0.05),and the highest short-term VSS score was observed in Group D3(p<0.05);no significant difference in long-term VSS score was found between Group A3 and Group B3(p=0.309),the long-term VSS score was significantly lower in Group A3 than that in Group C3(p<0.05),and similar association was also found between Group B3 and Group C3(p< 0.05);and Group D3 showed the highest long-term VSS score(p<0.05).There was no significant difference in long-term SBSES score between Group A3 and Group B3(p=0.075),and the long-term SBSES scores in Group A3 and Group B3 were significantly higher when compared with Group C3 and Group D3,respectively(p<0.05);and Group D3 had the lowest long-term SBSES score(p<0.05).There was no significant difference in VAS score between Group A3 and Group B3(p=0.879),and the VAS score in Group A3 and Group B3 were significantly higher compared with Group C3 and Group D3,respectively(P<0.05);and Group D3 had the lowest VAS score(p<0.05).Conclusion:(1)Optimized treatment and subtle operation could effectively reduce scar formation;(2)The included angle between the wound direction of facial trauma and the RSTL had influence on the scar formation after facial trauma,and changing the wound direction may reduce scar formation;(3)Timely intervention after facial trauma could effectively reduce scar formation,and the earlier the time of intervention,the better the effect.