| BackgroundSkin and soft tissue expansion can provide "extra" skin to repair skin and soft tissue defects without creating new scars in the donor site,so it is widely used in plastic surgery.Scaring is a normal physiological manifestation of self-healing after injury or burn,but excessive hypertrophic scar tissue will affect the skin appearance of patients,thus affecting the psychological state of patients.Therefore,hypertrophic scars have always been the focus and difficulty of plastic surgery.The use of skin and soft tissue expansion for the treatment of hypertrophic scars has already achieved good results in the clinic,and has been gradually improved after years of development,but there are still many problems in the clinical treatment process.After the expansion of soft tissue,the volume and expansion flaps increase.Areas,skin tension changes and other indicators during the expansion process are not quantified,and often rely on experience for simple evaluation,which will inevitably result in inaccurate results and affect the final surgical effect.Therefore,we hope that through the application of some digital technologies,we can reduce the inaccurate metrics during the entire surgical process,thereby improving the surgical effect.Research purposeImage analysis technique and pressure measurement technique were applied in soft tissue dilatation and the results were compared with those of traditional experience.The clinical effects of digital technology in the treatment of hypertrophic scars were discussed.Methods1.Forty-eight patients with hypertrophic scar treated with soft tissue expansion were randomly divided into a control group(23 cases)and an experimental group(25 cases).The control group underwent soft tissue expansion based on clinical experience.In the experimental group,soft tissue dilatation was performed with the assistance of image analysis technology.The specific steps were: 3D scan of the scar site before the dilator was placed in the first stage,the software was used to measure the scar area,and the software was used to simulate the removal of the scar to calculate the skin defect area.Guide the selection of a suitable dilator;perform a 3D scan of the dilated skin before the second phase of surgery,and measure the area of the expanded skin in the software,and perform the second phase of surgery when the expanded area was sufficient to repair the defect;intraoperative scanning of the skin defect after scar removal,used the software to measure actual defect area.The injection time,injection volume,incision healing time,flap survival rate,and scar hyperplasia at 6 months after operation were compared between the two groups of patients.2.35 cases of hypertrophic scar treated by skin and soft tissue dilatation were randomly divided into control group(16 cases)and experimental group(19 cases).The control group underwent skin and soft tissue expansion based on clinical experience.The experimental group assisted the soft tissue expansion with pressure measurement technology.The specific steps were: the patient used a rebound tonometer to measure the dilated skin pressure after each injection to ensure that the skin dilatation pressure was between 35 mmHg and 40 mmHg after each injection.The 3D scanner was used to scan the expanded area,and the scanned image was imported into the corresponding software to calculate the volume of skin and soft tissue expansion.The pain of two groups of patients before and after water injection,the effect of secondary surgery,and the scar growth at 6 months after operation were compared.Results1.With the aid of image analysis technology,the water injection volume and water injection time in the experimental group were(496.40 ± 64.09)m L and(17.02 ± 0.87)week,which were lower than the control group(730.60 ± 73.52)m L and(19.74 ± 0.93)week.The incision healing time in the experimental group(11.40 ± 0.38)day was lower than that in the control group(12.65 ± 0.46)day,while the proportion of flap survival area(98.28 ± 0.24)% was significantly higher than that in the control group(97.20 ± 0.33)%.The differences were all statistically significant(P <0.05).In the experimental group,the scar at the incision at 6 months after operation,regardless of color(1.20 ± 0.13),thickness(1.52 ± 0.10),blood vessel distribution(1.12 ± 0.12),or the softness(1.44 ± 0.10)scores were lower than the control group(1.78 ± 0.15),(1.87 ± 0.11),(1.53 ± 0.12),(1.87 ± 0.16),and the differences were statistically significant(P <0.05).The patients in the experimental group achieved the expected degree of operation(8.36 ± 0.17),postoperative recovery(8.08 ± 0.16),and psychological status(7.72 ± 0.13),which were significantly higher than those in the control group(7.39 ± 0.21),(7.26 ± 0.17),and(7.22 ± 0.18),the differences were statistically significant(P <0.05).The score of postoperative scar hyperplasia in the experimental group(2.52 ± 0.21)was lower than that in the control group(3.26 ± 0.19),and the difference was statistically significant(P <0.05).2.After applying the pressure measurement technique,the pain score before the water injection in the experimental group(0.33 ± 0.06)was compared with the control group(0.30 ± 0.06),and there was no significant difference(P> 0.05).After 30 minutes of water injection,the pain score in the experimental group(3.83 ± 0.11))was significantly lower than the control group(4.39 ± 0.12),and the difference was statistically significant(P <0.05).The difference between the actual and planned resection scar area of the experimental group was(2.47 ± 0.23)cm2,and the incision healing time(11.00 ± 0.29)day was lower than that of the control group(3.50 ± 0.35)cm2,(12.19 ± 0.40)day.The differences were all statistically significant(P <0.05).In the experimental group,the scar at the incision at 6 months after operation,regardless of color(1.16±0.18),thickness(1.42±0.16),blood vessel distribution(1.16±0.12),or the softness(1.47±0.14)scores were lower than the control group(1.88 ± 0.18),(2.00 ± 0.18),(1.63 ± 0.13),(2.06 ± 0.19),and the differences were statistically significant(P <0.05).Conclusion1.The results of this study showed that the application of image analysis technology could accurately measure the scar area,simulated scar resection,estimated the area of the skin to be dilated,and measured the actual area of the skin.Effectively guide the choice of dilators,reduce the amount of water injection and shorten the time of water injection,and reduce the scar hyperplasia at the incision in the postoperative period.2.Application of pressure measurement technology could ensure that the skin pressure within the appropriate range after each dilator injection,alleviate discomfort during water injection and improve the quality of the expanded flap.3.The application of digital technology in soft tissue expansion surgery could effectively improve the clinical treatment effect of hypertrophic scars and increase patient satisfaction. |
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