摘要目的:比较内线缝合后是否行外线缝合对皮肤切口愈合的影响。方法:该研究为前瞻性自身对照临床试验。2020年11月—2021年9月，上海交通大学医学院附属第九人民医院收治49例符合入选标准的行皮肤切除手术的患者，其中女39例、男10例，年龄18~55岁。手术部位包括上肢（17例）、下肢（2例）、肩部（3例）、颈部（8例）、腹部（8例）、胸部（10例）、背部（1例）。将每例患者的手术切口采用随机序列法等分为外线缝合段（行内线+外线缝合）和外线不缝合段（仅行内线缝合）。术后拆线当日与术后第1个月随访时，观察切口裂开情况。术后第12个月随访时，观察切口瘢痕增生情况并计算切口瘢痕增生率。术后第6、12个月随访时，测量切口瘢痕宽度。术后第1、6、12个月随访时，采用温哥华瘢痕量表（VSS）从颜色、厚度、血管化、柔韧度方面进行切口瘢痕情况评分，并计算总分。术后第1、12个月随访时VSS评分对应的患者数分别为41、46例，其余指标对应的患者数均为49例。结果:术后拆线当日、术后第1个月随访时，所有患者外线缝合段与外线不缝合段手术切口均无裂开情况。术后第12个月随访时，外线缝合段切口瘢痕增生率为2.04%（1/49），与外线不缝合段的4.08%（2/49）无明显差异（ P>0.05）。术后第6、12个月随访时，患者外线不缝合段切口瘢痕宽度分别为1.48（1.01，1.91）、1.41（1.13，1.93）mm，与外线缝合段的1.38（1.00，1.94）、1.45（1.17，1.84）mm均无明显差异（ Z值分别为191.00、152.00， P>0.05）。术后第1、6、12个月随访时，患者外线缝合段与外线不缝合段切口瘢痕VSS中颜色、厚度、血管化、柔韧度评分及总分均无明显差异（ P>0.05）。 结论:皮肤切口经减张并精细内线缝合后，外线缝合与否对切口愈合及术后瘢痕外观无显著影响。

abstractsObjective:To compare the impact of whether to apply the external suture after internal suture on skin incision healing.Methods:This study was a prospective self-controlled clinical trial. From November 2020 to September 2021, 49 patients who underwent skin resection surgery and met the inclusion criteria were admitted to Shanghai Ninth People's Hospital of Shanghai Jiao Tong University School of Medicine, including 39 females and 10 males, aged 18 to 55 years. The surgical sites included the upper limbs (17 cases), lower limbs (2 cases), shoulders (3 cases), neck (8 cases), abdomen (8 cases), chest (10 cases), and back (1 case). The surgical incision of each patient was divided equally into the external suture segment (with internal suture and external suture) and the external sutureless segment (with internal suture only) using the random sequence method. On the day of suture removal and at the 1 st month of follow-up after surgery, the incision dehiscence was observed. At the 12 th month of follow-up after surgery, the scar hyperplasia was observed and the scar hyperplasia rate of the incision was calculated. At the 6 th and 12 th months of follow-up after surgery, the scar width of incision was measured. At the 1 st, 6 th, and 12 th months of follow-up after surgery, the Vancouver scar scale (VSS) was used to assess scar condition of the incision in terms of color, thickness, vascularization, and pliability, and the total score was calculated. The number of patients corresponding to the VSS score in the 1 st and 12 th months of follow-up after surgery was 41 and 46, respectively, while the number of patients corresponding to other indicators was 49. Results:On the day of suture removal and at the 1 st month of follow-up after surgery, no dehiscence was observed in either the external suture segment or external sutureless segment of any patient's surgical incision. At the 12 th month of follow-up after surgery, the scar hyperplasia rate in the external suture segment was 2.04% (1/49), which was not significantly different from 4.08% (2/49) in the external sutureless segment ( P>0.05). At the 6 th and 12 th months of follow-up after surgery, the scar widths in the external sutureless segment of incision were 1.48 (1.01, 1.91) and 1.41 (1.13, 1.93) mm, respectively, which were not significantly different from 1.38 (1.00, 1.94) and 1.45 (1.17, 1.84) mm in the external suture segment (with Z values of 191.00 and 152.00, respectively, P>0.05). At the 1 st, 6 th, and 12 th months of follow-up after surgery, there were no statistically significant differences either in scores of scar color, thickness, vascularization, pliability, or in the total VSS score of the incision scar between the external suture segment and the external sutureless segment ( P>0.05). Conclusions:After skin incision is finely sutured internally with tension reduction, the presence or absence of external suture has no significant effect on the healing of the incision and the appearance of postoperative scar.