皮下减张美容缝合在皮肤科面部手术中的应用及瘢痕预防进展

Progress in Subcutaneous Tension-Reducing Cosmetic Suture in Dermatological Facial Surgery and Scar Prevention

摘要: 头面颈区域切口术后瘢痕是困扰病人外观及生存质量的重要因素之一。皮下减张美容缝合术从力学角度入手为减少瘢痕形成提供了主要途径。现对皮下减张缝合技术的作用原理进行归纳总结，分析头面颈部皮肤受力情况与瘢痕的关系，讨论缝合线的理化性能及生物学特征；回顾传统的皮下缝合方式、减张缝合改良方法(LBD缝合、鱼骨线缝合、阶梯型缝合)及其他器械(锚钉)的应用进展。主要概括了此术式针对额颞部、颊鼻部、眼周口周等不同的头面部位置的应用方法以及治疗结果；从评价标准的角度出发，本文归纳了温哥华瘢痕量表(VSS)、患者与观察者瘢痕评估量表(POSAS)等定量评分系统的应用现状，并比较分析了术后晚期瘢痕疙瘩复发率，同时探讨患者主观满意程度与生存质量的关系。目前有文献报道皮下减张缝合可有效分散切口张力，促进伤口一期愈合，瘢痕评分明显下降，患者满意度高。未来研究需进一步统一评价标准，优化缝合材料与技术，并探索多模态联合干预策略。

Abstract: Postoperative scar formation after face skin surgery is an important problem that affects the patient’s beauty and quality of life. Subcutaneous tension-reducing cosmetic suture technique, through mechanical intervention, is now an essential measure in prevention of postoperative scar hyperplasia. The biomechanical mechanism of subcutaneous tension-reducing suture technique was reviewed in this article, elucidates the intrinsic relation between facial skin tension distribution and scar formation, and analyzes the physical property and biocompatibility of suture material. The article systematically outlines the technical evolution from classic subcutaneous suturing to modified tension-reducing techniques (such as LBD suture, barbed suture, and step type suture), and describes an application of auxiliary instruments such as clamps, and it aims to summarize the clinical techniques and outcomes used for this approach in each region of face, including the fronto-temporal, buccal-nasal, and periorbital-perioral areas. In terms of effectiveness assessment, this article examines the use of objective rating instruments including the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS), compares the long-term rates of postoperative scar hypertrophy, and investigates the relationship between patients’ subjective satisfaction and their quality of life. Existing evidence indicates that subcutaneous tension-reducing suture can effectively disperse incisional tension, promote primary wound healing, significantly reduce scar scores, and improve patient satisfaction. Future research needs to further unify evaluation standards, optimize suture materials and techniques, and explore multimodal combined intervention strategies.