webbed scar
Introduction
Introduction Scars to scorpion, shaped like duck plague. Such scars occur in the flexion of the joint, and can also be seen in the opening of the lumen of the organ, such as the mouth, nostrils, urethra, vaginal opening. A scar-like scar is actually a characteristic manifestation of scar contracture in the above-mentioned special parts. Occasionally, the cutting tear of the skin and the position of the surgical incision are improper. Large blemishes often occur in the anterior neck, axillary fossa, elbow fossa and perineum. Small ones are common in internal and external spasm, nasolabial folds, mouth, nostrils, palmar scapula, finger sputum, vaginal opening and other parts.
Cause
Cause
The formation of a scar is caused by a narrow long wound or a vertical straight wound that vertically crosses the flexion side of the joint, or due to the current wound along the free edge of the lumen opening, the ends of the scar after healing gradually toward the center. The result of shrinkage.
Examine
an examination
Related inspection
Fungal histopathology
1. Histopathological examination: The synthesis of extracellular matrix components such as collagen and fibronectin showing fibroblasts is increased.
2. Hydroxyproline determination: Hydroxyproline is a characteristic amino acid of collagen. Hydroxyproline exists in plasma in the form of free, peptide binding and protein binding. Free and peptide-bound hydroxyproline is The metabolite of collagen, 5% of hydroxyproline excreted in the urine is present in free form, and the hydroxyproline content in serum and urine is related to the area of scar.
3. Determination of scar hardness: It was modified by industrial scale indicator: firstly made of 12mm diameter stainless steel round sleeve, fixed on the indicator shaft of the indicator, as the hardness tester base, the measuring shaft protruded from the base 5mm. Secondly, in order to match the elasticity of the indicator with the hardness of the scar, the internal spring of the indicator is replaced with another spring with a larger elasticity, so that the telescopic movement of the spring drives the rotation of the pointer.
During the measurement, the hardness tester is placed vertically on the skin or scar to be tested, and the hardness is compressed by the hardness of the hardness tester. The hardness of the surface of the tissue is determined to be different, and the length of the shaft retraction is determined to be different, and the data displayed on the meter is also different. 3 times, calculate the average, and convert the reading to the scar hardness (calculated according to the formula), the unit is N/mm2.
4. B-type ultrasonic scar thickness measurement: Since the scar grows on the body surface, if the probe of the B-ultrasound is directly in contact with it, it is difficult to measure, so a water bag must be added between the measurement site and the probe during the measurement. Move the measured image to the middle of the screen, and then move the "X" mark to the upper and lower boundaries of the skin or scar, respectively, and the distance between them is the thickness of the scar. However, you must pay attention to the measurement:
(1) Determine the thickness of the scar before resection or treatment.
(2) After a period of treatment, the thickness of the scar changes.
(3) The thickness of the scar before resection is compared with the thickness of the surrounding skin.
(4) It is preferable to compare the thickness of the scar at the symmetrical portion.
(5) In the measurement, it is best to fix a doctor's operation to minimize human error.
5. Determination of scar surface temperature: Due to the large number of new capillaries in the early scar tissue, even filamentous dilated capillaries can be seen. As the scar matures and dissipates, the capillaries in the vein gradually become occluded. This process is a dynamic The change reveals changes in blood circulation in scar tissue and also affects the temperature of the scar surface. The temperature of the scar surface can be measured using a semiconductor temperature meter or an infrared temperature scanner. However, you must pay attention to the measurement:
(1) The patient must rest for half an hour before the measurement.
(2) The environment is quiet, there is no wind, and the room temperature is controlled within a certain range.
(3) Simultaneous determination of the scar and the normal skin temperature beside it, if there is a symmetrical scar, it is best to compare it.
(4) Pre-treatment and post-treatment measurement (the same environmental conditions), observe its dynamic changes.
6. Percutaneous oxygen partial pressure measurement: studies have shown that in the hypertrophic scar of pressure treatment, when the clinical scar is relieved and the oxygen partial pressure rises to more than 80% of normal, the pressure is removed, the hypertrophic scar no longer recurs, and the oxygen partial pressure is Elevation is consistent with clinically observed scar relief and ultrasound measurements, and it is believed that transcutaneous oxygen partial pressure measurement can be used as a stable and reliable indicator of scar treatment effect.
7. Vascular thermal stimulation diastolic index measurement: normal skin blood vessels are significantly dilated in the stimulation of thermal factors, while the scar-proliferative phase of the blood vessels due to lack of innervation and special structural features, no significant expansion during thermal stimulation, thermal stimulation diastolic index decreased, with During the scar maturation process, the thermal stimulation diastolic index increased. This method can also be used as one of the criteria for assessing scar conditions.
Diagnosis
Differential diagnosis
A scar is a type of scar. Care should be taken to identify all types of scars.
1. Contracture scar: A contracture scar is a scar named after the dysfunction caused by it. More common after deep burn healing, due to scar contraction, often lead to shape changes and dysfunction, long-term scar contracture can affect the development of bones, muscles, blood vessels, nerves and other tissues, should be treated early.
2. Hyperplastic scar: Hyperplastic scar: also known as hypertrophic scar or hypertrophic scar, is not qualitatively different from keloid in histopathology. After the skin damage is healed, the scar continues to proliferate and develops. Hypertrophic scars. Hypertrophic scars protrude from the skin, irregular in shape, uneven, flushed and bloody, and firm in texture. It has a burning and itching sensation, which is exacerbated by increased ambient temperature, emotional agitation, or eating spicy and irritating food.
3. Sag scars: Defects in the dermis and subcutaneous tissues of the skin can cause depressed scars, often caused by hemorrhoids, trauma, and chickenpox.
