矽膠片及矽膠凝膠的除疤原理-1

游朝慶

    在1983年，Perkins等人第一個發現矽膠片（Silicone gel sheeting, SGS）可用來治療燒燙傷的疤痕¹。

    Ahn於1989年首次以前驅隨機控制臨床研究證明矽膠片對疤痕有效²。

    接著陸續至少有四個隨機控制研究提供證明說矽膠片可以有效治療疤痕^3-6。另外幾個有對照組的研究也證明說矽膠片可以有效預防疤痕增生^7-10。

    在2002年Mustoe等人根據實證醫學發表一篇疤痕處理的臨床建議，在那個年代，對疤痕有實證醫學證明有效的處理方法只有矽膠片及疤痕內注射類固醇兩種¹¹。

    在2006年的考科藍Cochrane實證醫學研究，其從13個有對照組的研究（controlled study），559個病人中，發現矽膠片對易長疤痕的病人有預防的效果，可增加疤痕的彈性，使紅色疤痕淡化顏色¹²。

    最近幾個有對照組的研究都表示矽膠凝膠silicone gel，其治療疤痕的效果至少和矽膠片一樣好，但和矽膠片比較，因為較方便使用，及較舒服，患者較喜歡使用矽膠凝膠^13-15。

    然而為什麼矽膠片及矽膠凝膠可以除疤呢？其原理呢？ 在下一節，我將繼續帶大家探討這個問題。

References

1. Perkins K, Davey RB, Wallis KA. Silicone gel: a new treatment for burn scars and contractures. Burns Incl Therm Inj 1983; 9:201-204.

2. Ahn ST, Monafo WW, Mustoe TA. Topical silicone gel: a new treatment for hypertrophic scars. Surgery 1989; 106:781-786.

3. Lee SM, Ngim CK, Chan YY et al. A comparison of Sil-K and Epiderm in scar management. Burns 1996; 22:483-487.

4. Li-Tsang CW, Lau JC, Choi J et al. A prospective randomized clinical trial to investigate the effect of silicone gel sheeting (Cica-Care) on post-traumatic hypertrophic scar among the Chinese population. Burns 2006; 32:678-683.

5. Carney SA, Cason CG, Gowar JP et al. Cica-Care gel sheeting in the management of hypertrophic scarring. Burns 1994; 20:163-167.

6. Sproat JE, Dalcin A, Weitauer N et al. Hypertrophic sternal scars: silicone gel sheet versus Kenalog injection treatment. Plast Reconstr Surg 1992; 90:988-992.

7. de Oliveira GV, Nunes TA, Magna LA et al. Silicone versus nonsilicone gel dressings: a controlled trial. Dermatol Surg 2001; 27:721-726.

8. Majan JI. Evaluation of a self-adherent soft silicone dressing for the treatment of hypertrophic postoperative scars. J Wound Care 2006; 15:193-196.

9. Cruz-Korchin NI. Effectiveness of silicone sheets in the prevention of hypertrophic breast scars. Ann Plast Surg 1996; 37:345-348.

10. Gold MH, Foster TD, Adair MA et al. Prevention of hypertrophic scars and keloids by the prophylactic use of topical silicone gel sheets following a surgical procedure in an office setting. Dermatol Surg 2001; 27:641-644.

11. Mustoe TA, Cooter RD, Gold MH et al. International clinical recommendations on scar management. Plast Reconstr Surg 2002; 110:560-571.

12. O'Brien L, Pandit A. Silicon gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev 2006;CD003826.

13. Chan KY, Lau CL, Adeeb SM et al. A randomized, placebo-controlled, double-blind, prospective clinical trial of silicone gel in prevention of hypertrophic scar development in median sternotomy wound. Plast Reconstr Surg 2005; 116:1013-1020.

14. Chernoff WG, Cramer H, Su-Huang S. The efficacy of topical silicone gel elastomers in the treatment of hypertrophic scars, keloid scars, and post-laser exfoliation erythema. Aesthetic Plast Surg 2007; 31:495-500.

15. Signorini M, Clementoni MT. Clinical evaluation of a new self-drying silicone gel in the treatment of scars: a preliminary report. Aesthetic Plast Surg 2007; 31:183-187.