Scarring occurs at a critical depth of skin injury: Precise measurement in a graduated dermal scratch in human volunteers
Scarring occurs at a critical depth of skin injury: Precise measurement in a graduated dermal scratch in human volunteers
复制标题
DOI：
10.1097/01.prs.0000258829.07399.f0
复制
发表时间：
2007-05-01
影响因子：
3.6
通讯作者：
McGrouther, D. Angus
中科院分区：
文献类型：
--
作者：
Dunkin, Christopher S. J.;Pleat, Jonathon M.;McGrouther, D. Angus
背景：瘢痕形成与皮肤损伤或烧伤深度之间的关系已在临床上得到承认，但尚未量化。作者检验了I假设，即存在一个临界深度，超过这个深度纤维疤痕就会发展。方法：一种新型夹具产生一个伤口，一端是深真皮，另一端是浅真皮。对身体和体外乳房皮肤的初步研究证实了损伤的深度。健康志愿者的髋关节外侧有一个标准化的真皮伤口。数码摄影记录了伤口愈合和瘢痕形成的表面形态。高频超声在活体内显示创面愈合的深度和后续的瘢痕。结果：113名受试者参与了临床研究。平均随访28.6+/-13.2周。伤后18周创面真皮深端愈合，浅端无明显残留痕迹。创面长度为5 1.3±0.6 mm，36周时瘢痕缩小至34.9±1.0min(2例为196.6±7.5 mm，2例为92.7±9.4 mm)。高频超声分析显示，深端瘢痕厚度逐渐减少，浅端瘢痕不明显。瘢痕与无疤痕之间的过渡点是瘢痕形成的阈值深度。计算结果为0.56+/-0.03 mm，相当于正常髋部皮肤厚度的33.1%。结论：真皮划痕为研究不同深度真皮损伤的愈合反应提供了一种耐受性好、标准化、重复性好的创面模型。有一个皮肤损伤的阈值深度，在这个深度上会形成疤痕。
Background: The association between scarring and the depth of dermal injury or burn is clinically recognized but not quantified. The authors tested the I hypothesis that there is a critical depth beyond which a fibrous scar develops.Methods: A novel jig produced a wound that was deep dermal at one end and superficial dermal at the other. Pilot studies in cadaveric and ex vivo breast skin confirmed the depth of injury. Healthy volunteers had a standardized dermal wound made on the lateral aspect of the hip. Digital photography recorded the surface appearance of wound healing and scar development. High-frequency ultrasound demonstrated the depth of the healing wound and subsequent scar in vivo.Results: One hundred thirteen human subjects participated in the clinical study. Mean length of follow up was 28.6 +/- 13.2 weeks. The deep dermal end of the wound healed with a visible scar and the superficial end had no visible residual mark after week 18. The initial length of injury was 51.3 +/- 0.6 mm, which reduced to a scar of 34.9 +/- 1.0 min at 36 weeks (corresponding areas were 196.6 +/- 7.5 mm(2) and 92.7 +/- 9.4 mm(2)). High-frequency ultrasound analysis showed a gradual reduction in scar thickness at the deep end and no detectable scar at the shallow end. The transition point between scar and no scar marked the threshold depth for scarring. This was calculated as 0.56 +/- 0.03 mm, or 33.1 percent of normal hip skin thickness.Conclusions: The dermal scratch provides a well-tolerated, standardized, and reproducible wound model for investigating the healing response to dermal injury of different depths. There is a threshold depth of dermal injury at which scarring develops.