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Xu W, Sinaki DG, Tang Y, Chen Y, Zhang Y, Zhang Z. Acne-induced pathological scars: pathophysiology and current treatments. BURNS & TRAUMA 2024; 12:tkad060. [PMID: 38585341 PMCID: PMC10998535 DOI: 10.1093/burnst/tkad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 04/09/2024]
Abstract
Acne is a common chronic inflammatory dermatosis that can lead to pathological scars (PSs, divided into hypertrophic scars and keloids). These kinds of abnormal scars seriously reduce the quality of life of patients. However, their mechanism is still unclear, resulting in difficult clinical prevention, unstable treatment effects and a high risk of recurrence. Available evidence supports inflammatory changes caused by infection as one of the keys to abnormal proliferation of skin fibroblasts. In acne-induced PSs, increasing knowledge of the immunopathology indicates that inflammatory cells directly secrete growth factors to activate fibroblasts and release pro-inflammatory factors to promote the formation of PSs. T helper cells contribute to PSs via the secretion of interleukin (IL)-4 and IL-13, the pro-inflammatory factors; while regulatory T cells have anti-inflammatory effects, secrete IL-10 and prostaglandin E2, and suppress fibrosis production. Several treatments are available, but there is a lack of combination regimens to target different aspects of acne-induced PSs. Overall, this review indicates that the joint involvement of inflammatory response and fibrosis plays a crucial role in acne-induced PSs, and also analyzes the interaction of current treatments for acne and PS.
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Affiliation(s)
- Wanyu Xu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Dorsa Gholamali Sinaki
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Yuchen Tang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Yunsheng Chen
- Department of Burns and Plastic Surgery, Shanghai Institute of Burns Research, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
| | - Zheng Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200011, China
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Tawfik AA, Hanafy NS, Ali RA. Picosecond Nd:YAG versus Fractional CO 2 Lasers in Management of Postburn Scars. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5700. [PMID: 38525494 PMCID: PMC10959566 DOI: 10.1097/gox.0000000000005700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/31/2024] [Indexed: 03/26/2024]
Abstract
Background The picosecond laser was primarily designed to enhance tattoo removal. Because it has a new innovative mechanism for energy delivery, it has been modified to be used in other conditions such as skin resurfacing, which was usually treated with fractional CO2 laser. Comparing both technologies in managing postburn scars has not been widely addressed. Methods The current prospective comparative randomized intrapatient study was done on 15 patients who presented with unsightly postburn scarring. As a split study, one-half of the affected areas were treated using the picosecond Nd: YAG laser. The other areas were treated with a fractional CO2 laser. After three treatment sessions, the results were analyzed both objectively and subjectively. Results The assessment by the image analysis system (Antera camera) showed improvement in all the parameters in both groups. The melanin relative variation decreased from 11.65 ± 2.86, 15.85 ± 5.63 to 10.60 ± 1.96, 12.56 ± 3.98, respectively in picosecond laser sites and fractional CO2 sites. The percentage change in overall opinion decreased in in favor of the fractional CO2 laser sites, which is a statistically significant improvement. Instead, color scores revealed a greater reduction in the picosecond sites in comparison with the fractional CO2 sites, as it decreased from 7.67 ± 1.76, 7.73 ± 1.83 to 2.87 ± 1.06, 6 ± 1.2, respectively. Conclusions When compared with fractional CO2 lasers, picosecond Nd:YAG shows comparable improvements in scars' erythema, texture, and height, with some superiority in the management of hyperpigmented scars.
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Affiliation(s)
- Abeer Attia Tawfik
- From Dermatology and Laser, National Institute of Laser Enhanced Sciences (NILES), Cairo University, Cairo, Egypt
| | - Noha Sami Hanafy
- Research Department of Dermatology and Venereology, Medical Research Division, National Research Centre, Cairo, Egypt
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Macdonald JK, Mehta AS, Drake RR, Angel PM. Molecular analysis of the extracellular microenvironment: from form to function. FEBS Lett 2024; 598:602-620. [PMID: 38509768 PMCID: PMC11049795 DOI: 10.1002/1873-3468.14852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/22/2024]
Abstract
The extracellular matrix (ECM) proteome represents an important component of the tissue microenvironment that controls chemical flux and induces cell signaling through encoded structure. The analysis of the ECM represents an analytical challenge through high levels of post-translational modifications, protease-resistant structures, and crosslinked, insoluble proteins. This review provides a comprehensive overview of the analytical challenges involved in addressing the complexities of spatially profiling the extracellular matrix proteome. A synopsis of the process of synthesizing the ECM structure, detailing inherent chemical complexity, is included to present the scope of the analytical challenge. Current chromatographic and spatial techniques addressing these challenges are detailed. Capabilities for multimodal multiplexing with cellular populations are discussed with a perspective on developing a holistic view of disease processes that includes both the cellular and extracellular microenvironment.
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Affiliation(s)
- Jade K Macdonald
- Department of Cell and Molecular Pharmacology & Experimental Therapeutics, Medical University of South Carolina, Charleston, SC
| | - Anand S Mehta
- Department of Cell and Molecular Pharmacology & Experimental Therapeutics, Medical University of South Carolina, Charleston, SC
| | - Richard R Drake
- Department of Cell and Molecular Pharmacology & Experimental Therapeutics, Medical University of South Carolina, Charleston, SC
| | - Peggi M. Angel
- Department of Cell and Molecular Pharmacology & Experimental Therapeutics, Medical University of South Carolina, Charleston, SC
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Taleb E, Gallo ES, Salameh F, Koren A, Shehadeh W, Artzi O. Fractional ablative CO 2 laser and oral isotretinoin-A prospective randomized controlled split-face trial comparing concurrent versus delayed laser treatment for acne scars. Lasers Surg Med 2024; 56:54-61. [PMID: 37555247 DOI: 10.1002/lsm.23713] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/17/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
BACKGROUND Therapeutic dogma has been to treat acne scars with ablative fractional laser no less than 6 months after isotretinoin (ITN) cessation. OBJECTIVE To evaluate the safety and efficacy of fractional ablative CO2 laser (FACL) in patients treated concurrently with ITN. METHODS We conducted a prospective split-face randomized control trial in patients treated with FACL concurrently with ITN versus patients treated with FACL 6 months post-ITN treatment. Patients received 3 monthly sessions of FACL with concurrent ITN treatment on half of the face; the other side of the face received the same FACL treatment regimen 6 months post-ITN cessation. Patients were followed for adverse effects up to 6 months post-FACL treatment. Final cosmesis was scored using the Quantitative Global Acne Scarring Grading System (GASGS) by three independent dermatologists. RESULTS The GASGS of the concurrent ITN-FACL treated side of the face was significantly lower than the side treated with delayed laser therapy (4.7 ± 2.5 vs. 7.7 ± 2.9, respectively, p < 0.001). LIMITATIONS The laser's settings were standardized, and not adjusted per patient skin type. CONCLUSION Per our prospective trial, concurrent treatment of FACL -ITN is superior to delayed FACL treatment 6 months post-ITN cessation. Fractional ablative laser treatment is effective in improving acne scars, which persist despite isotretinoin therapy.
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Affiliation(s)
- Eyal Taleb
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Elisa S Gallo
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Fares Salameh
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Amir Koren
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Waseem Shehadeh
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ofir Artzi
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Zhang Y, Ye R, Dong J, Bai Y, He Y, Ni W, Yao M. Efficacy and safety of ablative CO 2 fractional laser and narrowband intense pulsed light for the treatment of hypertrophic scars: a prospective, randomized controlled trial. J DERMATOL TREAT 2023; 34:2202287. [PMID: 37070799 DOI: 10.1080/09546634.2023.2202287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Hypertrophic scarring is a complex process, and numerous methods have been introduced to treat scars. This study aims to evaluate the effect of combined CO2 fractional laser and narrowband intense pulsed light (IPL) compared to IPL alone in the treatment of hypertrophic scars. MATERIALS AND METHODS This was a prospective, randomized controlled study enrolled 138 patients with hypertrophic scars. The participants were randomly divided into two groups: CO2-IPL and IPL group, and received three sessions at 10-14-week intervals for 3-month follow-up. Two independent plastic surgeons evaluated the treatments using the Patient and Observer Scar Assessment Scales (POSAS). Overall satisfaction was evaluated using the Patient Satisfaction Scale (PSS). RESULTS 101 subjects completed the study. Compared to single IPL, the combination CO2-IPL group showed a significant improvement in itching, color, stiffness, thickness, and irregularity, except for pain, and an enhancement in vascularization, pigmentation, thickness, relief, and pliability of the scar, assessed by POSAS (p < .01). 100% patients in the combination group were satisfied compared to 84% in IPL alone. CONCLUSION The combination of CO2 fractional laser and narrowband IPL efficiently improved the appearance and profile of hypertrophic scars, offering a comprehensive and reliable approach for scar therapy.
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Affiliation(s)
- Yiqiu Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Rongan Ye
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Jiying Dong
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Yubing Bai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Yu He
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
| | - Wei Ni
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan, China
| | - Min Yao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University of Medicine, Shanghai, China
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Ma Y, Barnes SP, Chen YY, Moiemen NS, Lord JM, Sardeli AV. Influence of scar age, laser type and laser treatment intervals on adult burn scars: A systematic review and meta-analysis. PLoS One 2023; 18:e0292097. [PMID: 37756273 PMCID: PMC10529539 DOI: 10.1371/journal.pone.0292097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
AIM The study aims to identify whether factors such as time to initiation of laser therapy following scar formation, type of laser used, laser treatment interval and presence of complications influence burn scar outcomes in adults, by meta-analysis of previous studies. METHODS A literature search was conducted in May 2022 in seven databases to select studies on the effects of laser therapy in adult hypertrophic burn scars. The study protocol was registered with PROSPERO (CRD42022347836). RESULTS Eleven studies were included in the meta-analysis, with a total of 491 patients. Laser therapy significantly improved overall VSS/POSAS, vascularity, pliability, pigmentation and scar height of burn scars. Vascularity improvement was greater when laser therapy was performed >12 months (-1.50 [95%CI = -2.58;-0.42], p = 0.01) compared to <12 months after injury (-0.39 [95%CI = -0.68; -0.10], p = 0.01), the same was true for scar height ((-1.36 [95%CI = -2.07; -0.66], p<0.001) vs (-0.56 [95%CI = -0.70; -0.42], p<0.001)). Pulse dye laser (-4.35 [95%CI = -6.83; -1.86], p<0.001) gave a greater reduction in VSS/POSAS scores compared to non-ablative (-1.52 [95%CI = -2.24; -0.83], p<0.001) and ablative lasers (-0.95 [95%CI = -1.31; -0.59], p<0.001). CONCLUSION Efficacy of laser therapy is influenced by the time lapse after injury, the type of laser used and the interval between laser treatments. Significant heterogeneity was observed among studies, suggesting the need to explore other factors that may affect scar outcomes.
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Affiliation(s)
- Yangmyung Ma
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | | | - Yung-Yi Chen
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Naiem S. Moiemen
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- Department of Burns and Plastic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Scar Free Foundation Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Janet M. Lord
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- Scar Free Foundation Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Amanda V. Sardeli
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
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Lewis CJ, Douglas H, Martin L, Deng Z, Melton P, Fear MW, Wood FM, Rea S. Carbon dioxide laser treatment of burn-related scarring: Results of the ELIPSE (Early Laser Intervention Promotes Scar Evolution) prospective randomized controlled trial. J Plast Reconstr Aesthet Surg 2023; 84:368-376. [PMID: 37393760 DOI: 10.1016/j.bjps.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023]
Abstract
AIM To investigate the impact of ablative fractional carbon dioxide laser (AFCO2L) on patient-reported outcomes measures, subjective scar appearance, dermal architecture, and gene transcription in early burn scars. METHODS Fifteen adult patients with a burn-related scar were recruited. Inclusion criteria were two non-contiguous scar areas of 1% total body surface area, similar baseline Vancouver scar scale (VSS) score and 3months since the time of injury. All participants acted as their own control. Scars were randomized to treatment or control. Treatment scars received three AFCO2L treatments at 6-week intervals. Outcome measures were recorded at baseline, 3, 6, and 12-months post-treatment. Measures included blinded VSS, Patient Observer Scar Assessment Scale (POSAS), Brisbane Burn Scar Impact Profile (BBSIP), blinded scar photo assessment, histological tissue analysis, and RNA sequencing analysis. RESULTS No significant difference was found in VSS, scar erythema, or pigmentation. Patient POSAS improved in scar thickness and texture following AFCO2L. All elements of BBSIP improved in control and laser groups. AFCO2L-treated scars were scored better than control scars by blinded raters. RNA sequencing illustrated that AFCO2L induced sustained changes in fibroblast gene expression. CONCLUSIONS AFCO2L treated scars had significantly altered scar thickness and texture 6 months post-laser and were rated better than controls on blinded photo analysis after 3 treatments. RNASeq results suggest laser treatment alters the transcriptome of treated fibroblasts for at least 3 months after treatment. Expansion of this research to study in more depth fibroblast changes in response to laser, as well as assessing the impact on daily activity and quality of life, will be beneficial.
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Affiliation(s)
- Christopher J Lewis
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia.
| | - Helen Douglas
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia
| | - Lisa Martin
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Zhenjun Deng
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Phillip Melton
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; School of Global and Population Health, University of Western Australia, Crawley, WA, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Fiona M Wood
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia; Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Suzanne Rea
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia; Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
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8
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Kurup S, Travis TE, Shafy RAE, Shupp JW, Carney BC. Treatment of burn hypertrophic scar with fractional ablative laser-assisted drug delivery can decrease levels of hyperpigmentation. Lasers Surg Med 2023. [PMID: 37051876 DOI: 10.1002/lsm.23662] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Laser treatments have been used to treat a variety of scar symptoms, including the appearance of scars following burn injury. One such symptom is hyperpigmentation. There are several qualitative and quantitative measures of assessing improvement in hyperpigmentation over time. The Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS) are two scales that describe characteristics of scar such as pigmentation level. These scales are limited by their qualitative nature. On the other hand, spectrophotometers provide quantitative measures of pigmentation. Prior studies have reported that laser can change scar pigmentation, but no quantitative values have been reported. The current study examines changes in scar melanin index after CO2 fractional ablative laser scar revision (FLSR) via noninvasive probe measurement in patients of various Fitzpatrick skin types (FST). MATERIALS AND METHODS Patients with scars of various sizes and etiologies were treated with FLSR. A database was constructed including 189 patients undergoing laser treatment. From this pool, individuals were selected based on the criteria that they completed at least two laser sessions and had Melanin index measurements for both of these sessions and the pre-operative visit. This criteria resulted in 63 patients of various FST in the cohort. Melanin index, POSAS-Observer (O) and -Patient (P) pigmentation and color scores and VSS-pigmentation scores were examined over time. Demographic information (age of patient at time of first treatment, age of scar at time of first treatment, use of laser-assisted drug delivery (LADD), gender, FST, and Ethnicity) were collected from the medical record. Patients were grouped as "responder" if their Melanin index indicated decreased levels of hyperpigmentation after FLSR treatment in more than half of their total number of visits and "nonresponder" if it did not. RESULTS The majority of patients were responders (41/63). In responder patients, measurements of Melanin index showed significantly improved levels of hyperpigmentation in hypertrophic scars after two FLSR sessions (p < 0.05). Age of patient, gender, FST, age of scar, ethnicity, or type of drug delivered by LADD did not predict responder grouping. POSAS-O and -P pigmentation/color scores showed improved scores after two FLSR sessions within the responder group. POSAS-P color scores showed improved scores after two and three FLSR sessions in the nonresponder group. VSS pigmentation scores showed improved scores after three FLSR sessions in the responder group only. CONCLUSION Based on Melanin index values, FLSR leads to improvements in hyperpigmentation in certain patients.
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Affiliation(s)
- Sanjana Kurup
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- Howard University College of Medicine, Washington, District of Columbia, USA
| | - Taryn E Travis
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Rahma Abd El Shafy
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- Howard University College of Medicine, Washington, District of Columbia, USA
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Biochemistry, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Bonnie C Carney
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Biochemistry, Georgetown University School of Medicine, Washington, District of Columbia, USA
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9
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Lin MJ, Dubin DP, Torbeck RL, Bernstein DM, Nabatian A, Dolan CK, Bacigalupi R, Zade J, Zheng Z, Desman G, Khorasani H. Early Fractional Ablative Laser for Skin Cancer Excision Scars: A Randomized Split-Scar Study. Dermatol Surg 2023; 49:338-342. [PMID: 36763896 DOI: 10.1097/dss.0000000000003720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
BACKGROUND Fractional ablative laser resurfacing has been shown to improve the final cosmetic appearance of surgical scars, but optimal timing is unknown. OBJECTIVE To compare surgical scars treated with fractional carbon dioxide (CO 2 ) laser performed on Day 0 and Day 14. METHODS Prospective, randomized, split-scar, physician-blinded study of 30 surgical scars on the limbs. Scars halves received fractional CO 2 laser on either Day 0 or Day 14. Scar assessment at 6 months evaluated patient preference, physician modified Manchester Scar Scale (MMSS) score, and quantitative scar analysis on histology (fractal dimension [F D ] and lacunarity [L] analysis). RESULTS There was no significant difference in patient assessment (54% preferred Day 0 side, 46% preferred Day 14 side, p = .58) or physician assessment (mean MMSS 8.4 for Day 0 vs 8.7 for Day 14, p = .28). Fractal dimensions were similar for both interventions (mean 1.778 for Day 0 vs 1.781 for Day 14, p = .80). Lacunarity was similar for both interventions (mean 0.368 for Day 0 vs 0.345 for Day 14, p = .44). LIMITATIONS Single-center study with wounds limited to limbs of skin Phototype I-II subjects; 4 of whom were lost to follow-up. CONCLUSION Intraoperative CO 2 laser is noninferior to Day 14 laser resurfacing for surgical scar treatment.
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Affiliation(s)
- Matthew J Lin
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Danielle P Dubin
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Richard L Torbeck
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Daniel M Bernstein
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Adam Nabatian
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher K Dolan
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Robert Bacigalupi
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - John Zade
- Private Practice, Fort Smith, Arkansas
| | - Zhong Zheng
- School of Dentistry, University of California, Los Angeles, California
| | - Garrett Desman
- Division of Anatomic Pathology & Clinical Pathology, Icahn School of Medicine at Mount Sinai, New York, New York
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10
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Zhang T. Extended Application of Fractional Carbon Dioxide Laser in the Treatment of Port Wine Stain Birthmarks with Hypertrophy: A Case Report. Photobiomodul Photomed Laser Surg 2023; 41:189-192. [PMID: 36976837 DOI: 10.1089/photob.2022.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background: Conventional treatments of port wine stain birthmarks often do not achieve the desired outcome in patients with hypertrophy. Potential reasons include deeper and larger blood vessels, abnormal arrangement of blood vessels, and darker or thicker epidermis. However, these factors may not significantly limit the efficacy of fractional carbon dioxide (CO2) laser. The aim of this case report was to examine the extended application of fractional CO2 laser in treating patients with hypertrophic port wine stain birthmarks. Methods: Two cases with hypertrophic port wine stain birthmarks treated with fractional CO2 laser for 5 years are described in this case report. Results: When compared with conventional treatment, both cases reported better outcomes, including a reduced risk of infection, pigmentation, and scarring, a decrease of clinical erythema, and much less pain. Conclusions: The findings demonstrate that fractional CO2 laser has the potential to be an effective modality for the treatment of patients with hypertrophic port wine stains.
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Affiliation(s)
- Tingwei Zhang
- Visiting Scholar, Lillian Carter Center for Global Health and Social Responsibility, Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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11
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Tian Q, Zhang YX, Wang JJ, Huang GB. Advances in Photoelectric Therapy for the Early Intervention and Treatment of Traumatic Scars. Clin Cosmet Investig Dermatol 2023; 16:869-877. [PMID: 37038450 PMCID: PMC10082596 DOI: 10.2147/ccid.s407361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/28/2023] [Indexed: 04/05/2023]
Abstract
Traumatic scar is a disease that affected approximately tens of millions of patients worldwide. According to the histological and morphological properties of scars, the traumatic scar typically includes superficial scar, atrophic scar, hypertrophic scar, and keloid. Its formation is a natural consequence of wound healing, regardless of whether the wound was caused by trauma or surgery. However, the production of scars has considerable impacts on the physical and mental health of patients, even causing substantial aesthetic and functional impairments. Prevention or early treatment of scars is the most suitable therapeutic method, including surgical and non-surgical procedures; nevertheless, the benefits of non-operative therapies for scars are quite limited, and surgical treatments are always hard to achieve satisfying outcomes. Through the application of innovative technologies such as lasers, intense pulsed light, and radiofrequency, significant progress has been made in the treatment of traumatic scars. This review highlights the current advancements of photoelectric therapy for the prevention and treatment of various traumatic scars, which may throw light on innovative therapeutic options for scar therapies.
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Affiliation(s)
- Qi Tian
- Department of Clinical Medicine, Weifang Medical University, Weifang, People’s Republic of China
- Department of Burns and Reconstructive Surgery, Central Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Yi-Xin Zhang
- Centre for Translational Medicine, Institute of Precision Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China
| | - Jin-Jing Wang
- Department of Surgery, Central Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
| | - Guo-Bao Huang
- Department of Burns and Reconstructive Surgery, Central Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China
- Correspondence: Guo-Bao Huang, Department of Burns and Reconstructive Surgery, Central Hospital Affiliated to Shandong First Medical University, No. 105, Jiefang Road, Lixia District, Jinan, Shandong Province, 250013, People’s Republic of China, Tel +86 531-55865707, Email
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12
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Shen JC, Liang YY, Li W. Quantitative simulation of photothermal effect in laser therapy of hypertrophic scar. Skin Res Technol 2023; 29:e13305. [PMID: 36973985 PMCID: PMC10155850 DOI: 10.1111/srt.13305] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 02/25/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Laser technology has been widely used in the treatment of hypertrophic scar (HPS). Due to the lack of effective quantitative relationship between laser doses and thermal effect of lesion tissue, the selection of laser doses in clinical laser treatment of HPS is blind, which cannot guarantee the best treatment effect. MATERIALS AND METHODS The photothermal model of HPS was established by using finite element method. The effects of laser dose parameters such as laser energy density, pulse width, and spot diameter on the thermal effects of laser treatment were analyzed. According to tissue temperature threshold and thermal damage degree of the simulation results, the optimal laser doses of HPS were selected for the laser treatment experiments of rabbit ear HPSs to verify the rationality of the quantitative photothermal model. RESULTS The temperature rise and thermal damage degree of HPS following laser treatment were directly correlated to the laser doses, which grew with the increase of energy density and laser pulse width. For the different spot diameters, the temperature rise decreased with the increase of spot diameter, whereas the thermal damage degree worsened with the increase of spot diameter. Both simulation and experimental results show that the optimal treatment parameters of HPS were as follows: The laser energy density was 7.5 J/cm3 , the pulse width was 4 ms, and the spot diameter was 7 mm. CONCLUSION The laser dose parameters optimized by the photothermal model have achieved good therapeutic effects in the rabbit ear HPS, indicating that the model can be used for quantitative evaluation of laser doses before clinical treatment.
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Affiliation(s)
- Jin Cui Shen
- Department of DermatologyChengdu Second People's HospitalChengduSichuanChina
| | - Ya Ya Liang
- Tribology Research InstituteKey Laboratory for Advanced Technology of Materials of Ministry of EducationSouthwest Jiaotong UniversityChengduChina
| | - Wei Li
- Tribology Research InstituteKey Laboratory for Advanced Technology of Materials of Ministry of EducationSouthwest Jiaotong UniversityChengduChina
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13
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Nobari NN, Tabavar A, Sadeghi S, Dehghani A, Kalantari Y, Ghassemi M, Atefi N, Goodarzi A. A systematic review of the comparison between needling (RF-needling, meso-needling, and micro-needling) and ablative fractional lasers (CO 2, erbium YAG) in the treatment of atrophic and hypertrophic scars. Lasers Med Sci 2023; 38:67. [PMID: 36749436 DOI: 10.1007/s10103-022-03694-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/08/2022] [Indexed: 02/08/2023]
Abstract
The aim of this study is to compare needling (RF-needling, meso-needling, micro-needling) and ablative fractional lasers (CO2, erbium-YAG) in the treatment of atrophic and hypertrophic scars in a systematic review. The database was searched, and 10 articles were selected that were relevant in terms of content, topic, and purpose and met the inclusion criteria. Of all the articles reviewed in this study, there were 2 randomized split-face trials (20%), 1 controlled nonrandomized trial (10%), 1 controlled randomized phase III clinical trial (10%), 1 prospective trial (10%), 1 prospective nonrandomized open-label trial (10%), and 1 randomized comparative trial (10%), with the type of study not reported in 3 articles. We used Endnote X8 to review the articles and extract data. After review, the studies were analyzed and categorized. No statistically significant difference was found between the two methods, laser and micro-needling, in the treatment of atrophic and hypertrophic scars in 60% of the articles studied, and both showed significant improvement (70% or more improvement to complete response). Significant improvement was noted in 20% of the studies reviewed for the laser and micro-needling treatment methods. The results of this study show that needling and ablative fractional lasers are tolerable and safe procedures with no significant difference in the treatment of skin scars in sixty percent of the studies.
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Affiliation(s)
- Niloufar Najar Nobari
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Anahita Tabavar
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Sara Sadeghi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Division of Dermatology, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Abbas Dehghani
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Yasamin Kalantari
- Department of Dermatology, Razi Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Ghassemi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Najmolsadat Atefi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
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14
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Haik J, Segalovich M, Visentin D, Lepselter J, Cleary M, Kornhaber R, Harats M. Comparison of stationary and dynamic fractional CO2 laser modalities of large burns treatment: Experimental laboratory model. Burns 2023; 49:162-168. [PMID: 35248429 DOI: 10.1016/j.burns.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 11/28/2021] [Accepted: 11/29/2021] [Indexed: 01/06/2023]
Abstract
OBJECTIVES To experimentally compare two fractional ablative CO2 laser handpieces intended for the treatment of large area burn scars. Each handpiece coverage rate, depth of penetration and application time were measured and compared in a simulation model of large area burns scars using a dynamic/roller handpiece (small footprint) and a stationary/stamping handpiece (large footprint). METHODS A 30 W fractional ablative CO2 laser was applied using 2 different handpieces and footprints on a A4 size paper stack. The handpieces were a stationary (stamping) handpiece with 7 × 7 (49 pixels/square shape) and dynamic (roller) handpiece with 7 × 1 (7 pixels/single row shape). For both handpieces the laser settings were fixed at "High" power (30 W), providing an energy level of 100 mJ/pixel. Both handpieces were applied perpendicular to the surface, with the process repeated for the dynamic handpiece with an angled operation. The depth of laser penetration was assessed by the number of pages of paper having visible holes and burn area coverage time measured under each handpiece/condition. RESULTS The application time was faster and the penetration deeper for the dynamic handpiece compared to the stationary handpiece in both the perpendicular and angled conditions. This study has practical implications for lasers operators to improve time efficacy in large area scars with improved clinical endpoints. CONCLUSION The fractional ablative dynamic handpiece demonstrated superior application efficiency compared to the stationary handpiece in the simulated treatment of large surface area burn scars, reducing treatment time with improved depth of penetration.
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Affiliation(s)
- Josef Haik
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel; Institute for Health Research, University of Notre Dame, Western Australia, Australia; College of Health and Medicine, University of Tasmania, Australia
| | - Matan Segalovich
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Denis Visentin
- College of Health and Medicine, University of Tasmania, Australia
| | | | - Michelle Cleary
- School of Nursing, Midwifery & Social Sciences. Central Queensland University, Israel
| | - Rachel Kornhaber
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel; College of Health and Medicine, University of Tasmania, Australia
| | - Moti Harats
- Department of Plastic and Reconstructive Surgery, Sheba Medical Center, Tel Hashomer, Israel; Sackler Faculty of Medicine, Tel Aviv University, Israel; Institute for Health Research, University of Notre Dame, Western Australia, Australia.
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15
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Nunez JH, Strong AL, Comish P, Hespe GE, Harvey J, Sorkin M, Levi B. A Review of Laser Therapies for the Treatment of Scarring and Vascular Anomalies. Adv Wound Care (New Rochelle) 2023; 12:68-84. [PMID: 35951024 DOI: 10.1089/wound.2021.0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Significance: Laser use has become part of the gold standard of treatment as an effective adjuvant in multimodal therapy for pathologic scarring caused by burns, trauma, acne, and surgery, as well as vascular anomalies. Understanding indications and applications for laser therapy is essential for physicians to improve patient outcomes. Recent Advances: Since the 1980s, the medical use of lasers has continuously evolved with improvements in technology. Novel lasers and fractionated technologies are currently being studied in the hopes to improve treatment efficacy, while reducing complications. Recent advancements include acne treatment with novel picosecond lasers, new hypertrophic scar therapies with simultaneous laser and intense pulsed light use, and novel systems such as lasers with intralesional optical fiber delivery devices. In addition, optimizing the timing of laser therapy and its use in multimodal treatments continue to advance the field of photothermolysis. Critical Issues: Selecting the correct laser for a given indication is the fundamental decision when choosing a laser balancing effective treatment with minimal complications. This article covers the principles of laser therapy, the preferred lasers used for the treatment of scarring and vascular anomalies, and discusses the current evidence behind these laser choices. Future Directions: To optimize laser therapy, larger randomized control trials and split scar studies are needed. Continued advancement through better randomized controlled studies will help to improve patient outcomes on a broader scale.
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Affiliation(s)
- Johanna H Nunez
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amy L Strong
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Paul Comish
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Geoffrey E Hespe
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Jalen Harvey
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Michael Sorkin
- Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Benjamin Levi
- Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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16
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Tawfic SO, Hassan AS, El-Zahraa Sh Aly F, Elbendary A, Shaker OG, AlOrbani AM. Fractional microneedle radiofrequency versus fractional carbon dioxide laser in the treatment of postburn hypertrophic scars. Lasers Surg Med 2022; 54:1089-1098. [PMID: 35900305 DOI: 10.1002/lsm.23589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/01/2022] [Accepted: 07/15/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE New and improved treatment modalities, including lasers and energy-based devices, are promising treatment options for hypertrophic scars. This study aimed to assess the efficacy and safety of fractional microneedle radiofrequency (FMR) compared with fractional carbon dioxide (CO2 ) laser in the treatment of postburn hypertrophic scars. PATIENTS AND METHODS Twenty patients with hypertrophic scars were enrolled in the study. Two areas in each patient were randomly assigned to fractional CO2 laser or FMR. Four sessions, 6-8 weeks apart were performed. The Patient and Observer Scar Assessment Scale (POSAS) was used for clinical evaluation, H & E and orcein-stained samples were examined for histopathological assessment, and tissue transforming growth factor beta 1 (TGFβ1 ) levels were measured for biochemical evaluation. RESULTS Both fractional CO2 and FMR-treated areas showed significant improvement in all parameters 1 month after treatment. Fractional CO2-treated areas showed a higher degree of improvement compared with FMR in OSAS (p = 0.025), elastin grading (p = 0.004), and TGFβ1 levels (p = 0.000). Patients reported less downtime and showed less postinflammatory hyperpigmentation with FMR compared with fractional CO2, but this did not reach statistical significance (p = 0.327, p = 0.231; respectively). CONCLUSION Our results demonstrate the value of FMR as an effective alternative to fractional CO2 in the treatment of hypertrophic scars, with a potentially favorable safety profile.
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Affiliation(s)
- Shereen O Tawfic
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Akmal S Hassan
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | | | - Amira Elbendary
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Olfat G Shaker
- Medical Biochemistry and Molecular Biology Department, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Aya M AlOrbani
- Dermatology Department, Faculty of Medicine, Cairo University, Giza, Egypt
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17
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Liu H, Shu F, Xu H, Ji C, Wang Y, Lou X, Luo P, Xiao S, Xia Z, Lv K. Ablative fractional carbon dioxide laser improves quality of life in patients with extensive burn scars: A nested case-control study. Lasers Surg Med Suppl 2022; 54:1207-1216. [PMID: 36116066 DOI: 10.1002/lsm.23603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 07/11/2022] [Accepted: 09/06/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVES Ablative fractional carbon dioxide laser (CO2 -AFL) for small-area burn scar management shows encouraging outcomes. Few studies, however, focused on comprehensive outcomes following CO2 -AFL treatment for extensive burn scars. This study evaluated whether CO2 -AFL surgery improved the quality of life (QoL) for burn survivors with extensive hypertrophic scars. METHODS A retrospective nested case-control study was initiated to analyze the efficacy of CO2 -AFL treatment for patients with large-area burn scars. Patients with extensive burn scars (≥30% total body surface area [TBSA]) were registered in our hospital from March 2016 to October 2018. Patients undergoing CO2 -AFL surgery were divided into CO2 -AFL group, and patients undergoing conventional surgery were matched in a 1:1 ratio as the conventional surgery group according to the burned area. The questionnaires were collected and followed up. The 36-Item Short Form Health Survey (SF-36) and Burns Specific Health Scale-Brief (BSHS-B) were the primary parameters. Secondary parameters included the Pittsburgh Sleep Quality Index (PSQI), University of North Carolina "4P" Scars Scale (UNC4P), Patient Scars Assessment Scale for Patient (POSAS-P), and Douleur Neuropathique 4 questions (DN4). RESULTS 23 patients (55.96 ± 21.59% TBSA) were included in CO2 -AFL group and 23 patients (57.87 ± 18.21% TBSA) in conventional surgery group. Both the BSHS-B total score (CO2 -AFL vs. conventional surgery: 115.35 ± 29.24 vs. 85.43 ± 33.19, p = 0.002) and the SF-36 total score (CO2 -AFL vs. conventional surgery: 427.79 ± 118.27 vs. 265.65 ± 81.66, p < 0.001) for the CO2 -AFL group were higher than those for the conventional surgery group. Parameters for the CO2 -AFL group were lower than those for the conventional surgery group in all of the following comparisons: PSQI total score (CO2 -AFL vs. conventional surgery: 7.70 ± 3.74 vs. 12.26 ± 4.61, p = 0.001), POSAS-P total score (CO2 -AFL vs. conventional surgery: 26.48 ± 6.60 vs. 33.04 ± 4.56, p < 0.001), UNC4P total score (CO2 -AFL vs. conventional surgery: 5.57 ± 1.97 vs. 7.26 ± 1.81, p = 0.004), and DN4 score (CO2 -AFL vs. conventional surgery: 3 [2-5] vs. 5 [4-8], p = 0.004). CONCLUSIONS Compared to conventional surgery, whole scar CO2 -AFL surgery dramatically improved physical and mental health as well as QoL for people with extensive burn scars. Additionally, CO2 -AFL enhanced the evaluation of scars including their appearance, pain, itching, and a host of other symptoms.
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Affiliation(s)
- Huazhen Liu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China.,Department of Plastic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
| | - Futing Shu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Haiting Xu
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, People's Republic of China.,Department of Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
| | - Chao Ji
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Yuxiang Wang
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Xiaozhen Lou
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Pengfei Luo
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Shichu Xiao
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Zhaofan Xia
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, People's Republic of China
| | - Kaiyang Lv
- Department of Plastic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People's Republic of China
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18
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Khatery BHM, Hussein HA, Abd‐el‐Raheem TA, hanbuli HME, Yassen NN. Assessment of intralesional injection of botulinum toxin type A in hypertrophic scars and keloids: Clinical and pathological study. Dermatol Ther 2022; 35:e15748. [DOI: 10.1111/dth.15748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/07/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Basma H. M. Khatery
- Department of Dermatology, STDs and Andrology, Faculty of Medicine Fayoum University Egypt
| | - Heba A. Hussein
- Department of Dermatology, STDs and Andrology, Faculty of Medicine Fayoum University Egypt
| | - Talal A. Abd‐el‐Raheem
- Department of Dermatology, STDs and Andrology, Faculty of Medicine Fayoum University Egypt
- Pathology department, Faculty of Medicine Fayoum University, Egypt, Keman Fares, Fayoum Governorate Egypt
| | - Hala M. El hanbuli
- Pathology department, Faculty of Medicine Fayoum University, Egypt, Keman Fares, Fayoum Governorate Egypt
| | - Noha N. Yassen
- Pathology Department Medical Research Institute, National Research Center Egypt
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THE IMPORTANCE OF BIOMECHANICS AND THE KINETIC CHAINS OF HUMAN MOVEMENT IN THE DEVELOPMENT AND TREATMENT OF BURN SCARS – A NARRATIVE REVIEW WITH ILLUSTRATIVE CASES. Burns 2022; 49:707-715. [PMID: 36127224 DOI: 10.1016/j.burns.2022.08.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 08/11/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Burn scars are a major clinical sequelae of severe burn wound healing. To effectively establish a successful treatment plan and achieve durable results, understanding the pathophysiology of scar development is of utmost importance. METHODS A narrative review of the principles of the kinematic chain of movement and the hypothesised effect on burn scar development based on properties of burn scars was performed. An examination of the literature supporting these concepts is presented in conjunction with illustrative cases, with a particular focus on the effect of combination treatments that include ablative fractional resurfacing with surgical contracture releases. DISCUSSION Ablative fractional resurfacing combined with the surgical release of contractures are an effective treatment modality for burn scar reconstruction. This treatment approach seems particularly effective because it is one of the only approaches where the principles of functional kinematics can be addressed when tailoring a reconstructive approach to an individual burn patient. The presented cases illustrate the importance of recognising and including the principles of functional kinematic chains in any reconstructive treatment approach for burn scars. Further, epifascial contracture bands are cord like structures which can be found underneath the subcutaneous fat of scar contractures which follow the principles of functional kinematics. Contractures can be more efficiently released if these structures are divided as well. CONCLUSION Ablative fractional resurfacing combined with local tissue re-arrangements is a promising approach to address the underlying forces leading to hypertrophic burn scarring. To achieve an optimal outcome, it is essential to recognise and address the origin of the pathology when treating burn scars. Ablative fractional laser resurfacing allows a different scar approach as it is not limited to one surgical site and thus enables for effective treatment at the cause of the pathology.
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Schaffrick L, Ding J, Kwan P, Tredget EE. Molecular Features of Hypertrophic Scars After Thermal Injury: Is There a Biologic Basis for Laser Therapy? Adv Wound Care (New Rochelle) 2022; 11:163-178. [PMID: 34663086 DOI: 10.1089/wound.2021.0060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Significance: Hypertrophic scars (HTS) and keloids are common after thermal injuries and other trauma to deep regions of dermis of the skin. These abnormal scars can cause contractures and the thick masses of scar tissue that result in functional and cosmetic impairment. Management of these dermal fibrotic conditions includes a wide range of medical and surgical treatments, which can be time consuming, only partially effective, and often uncomfortable for patients. Recent Advances: The molecular pathophysiology of HTS has become more understood over the past two decades, where thermal injury to the reticular dermis results in an inflammatory response, fibrogenic growth factor release, and the formation of a dermal scar with increased collagen and proteoglycan composition in an abnormal morphology. Lasers are becoming a widely used form of treatment for these types of scars; however, the evidence for the beneficial effects of laser treatments and the understanding of their mechanism of action are still evolving. Critical Issues: Paradoxically, laser delivery of thermal energy to the skin is suggested to improve scar remodeling and wound healing, yet HTS is a well-recognized complication of excessive thermal energy delivered by laser treatments. This review aims to examine the current evidence for the use of lasers for HTS, and to investigate the molecular mechanisms where re-injury of a burn scar from laser treatment could result in overall improvements in scar quality. Future Directions: Improved design of clinical trials for the treatment of scarring in the future will evolve from new methodology and models of HTS in animals and humans.
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Affiliation(s)
- Lindy Schaffrick
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Jie Ding
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Peter Kwan
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
| | - Edward E. Tredget
- Wound Healing Research Group, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Alberta, Edmonton, Canada
- Department of Surgery, Division of Critical Care, University of Alberta, Edmonton, Canada
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21
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Li J, Ng SKH, Xi W, Zhang Z, Wang X, Li H, Su W, Wang J, Zhang Y. Efficacy and safety of a dual-scan protocol for carbon dioxide laser in the treatment of split-thickness skin graft contraction in a red Duroc pig model. BURNS & TRAUMA 2022; 9:tkab048. [PMID: 34988232 PMCID: PMC8720306 DOI: 10.1093/burnst/tkab048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 10/29/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Fractional CO2 laser plays an important role in scar management post split-thickness skin graft by loosening the graft contracture and restoring the smoothness of the surface. However, the optimal treatment protocol remains unknown. This study applied a dual-scan protocol to achieve both releasing and ablation of contracted skin graft. We comprehensively describe this treatment method and compare the efficacy and safety between this dual-scan method and the conventional mono-scan mode. METHODS A hypercontracted scar model after split-thickness skin grafting in red Duroc pigs was established. All scars meeting the inclusion criteria were randomly divided into four groups: high fluence-low density (HF-LD), low fluence-high density (LF-HD), combined group and control group. The energy per unit area was similar in the HF-LD and LF-HD groups. Two laser interventions were performed at a 6-week interval. The efficacy of the treatment was evaluated by objective measures of scar area, release rate, elasticity, thickness and flatness, while the safety was evaluated based on adverse reactions and melanin index. Collagen structure was observed histologically. The animals were followed up for a maximum of 126 days after modeling. RESULTS A total of 28 contracted scars were included, 7 in each group. At 18 weeks postoperatively, the HF-LD and the combined groups showed significantly increased scar release rate (p = 0.000) and elasticity (p = 0.036) and decreased type I/III collagen ratio (p = 0.002) compared with the control and LF-HD groups. In terms of flatness, the combined group was significantly better than the HF-LD group for elevations <1 mm (p = 0.019). No significant skin side effects, pigmentation or scar thickness changes were observed at 18 weeks. CONCLUSIONS Dual-scan protocol could achieve superficial ablation and deep release of contracted split-thickness skin graft in a single treatment, with similar contraction release and texture improvement compared to a single deep scan. Its main advantage is to restore a smoother scar appearance. Adequate laser penetration was necessary for the release of contracted scars.
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Affiliation(s)
- Jie Li
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Sally Kiu-Huen Ng
- Department of Plastic Surgery, Austin Health, Melbourne 3084, Australia.,Victorian Adult Burns Service, Alfred Health, Melbourne 3181, Australia
| | - Wenjing Xi
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Zheng Zhang
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Xiaodian Wang
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Hua Li
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Weijie Su
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Jingyan Wang
- Department of Plastic and Reconstructive Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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22
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Manuskiatti W, Yan C, Artzi O, Gervasio MKR, Wanitphakdeedecha R. Efficacy and safety of thermomechanical fractional injury-assisted corticosteroid delivery versus intralesional corticosteroid injection for the treatment of hypertrophic scars: A randomized split-scar trial. Lasers Surg Med 2021; 54:483-489. [PMID: 34913497 DOI: 10.1002/lsm.23511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/28/2021] [Accepted: 12/04/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Disruption of the natural skin barrier in a controlled manner may be used to deliver drugs that enhance scar resolution. OBJECTIVE To compare the efficacy and safety of thermomechanical fractional injury (TMFI)-assisted topical corticosteroid delivery with corticosteroid injection in the treatment of hypertrophic scar (HTS). MATERIALS AND METHODS This was a randomized, split-scar, double-blinded study. Twenty-one subjects with HTS on the abdomen received five split-scar treatments of TMFI + Steroid and steroid injection alone. Changes in scar thickness, scar volume, and Vancouver Scar Scale (VSS) were analyzed. Patient self-assessment, VAS scores, and adverse effects were also evaluated. RESULTS Scar thickness, volume, and VSS scores of both segments improved significantly compared to baseline. On every follow-up visit, there were no significant differences in mean scar thickness reduction between the two treatment groups except at the 6-month follow-up where the mean scar thickness reduction of the steroid injection segment was significantly lower than that of the TMFI + Steroid segment (95% confidence interval [CI], 0.09-0.35; p = 0.002). Scar volume, VSS scores, and patient self-assessment also showed no significant differences between both segments on all visits. The steroid injection segment was significantly more painful than the TMFI + Steroid segment (95% CI, -2.16 to -1.29; p < 0.001). Adverse effects of skin atrophy, telangiectasia, and post-inflammatory hyperpigmentation were noted in the steroid injection segment, while no adverse effects were observed at the TMFI + Steroid segment. CONCLUSIONS TMFI-assisted topical corticosteroid delivery is an effective treatment for HTS with a lower risk of adverse effects compared with corticosteroid injection.
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Affiliation(s)
- Woraphong Manuskiatti
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chadakan Yan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Mia Katrina R Gervasio
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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23
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Alhamzawi NK. Efficacy of Fractional Carbon Dioxide Laser (FCO 2) with Intralesional 5-Fluorouracil (5-FU) in the Treatment of Keloids. J Cutan Aesthet Surg 2021; 14:323-329. [PMID: 34908775 PMCID: PMC8611703 DOI: 10.4103/jcas.jcas_153_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Context: Managing keloids remains a challenge in clinical practice. Many therapeutic options are available, but none is universally accepted or without recurrence. Therefore, an effort is required to choose the treatment with maximal outcomes. Aims: To evaluate the effectiveness of combining fractional carbon dioxide (FCO2) laser and intralesional 5-fluorouracil (5-FU) for the treatment of keloids. Materials and Methods: In this prospective open-label study, 24 patients received FCO2 laser treatment, started at baseline, for a total of six sittings. The patients also received 1 mL/cm2/keloid of 5-FU (50 mg/mL) intralesionally, following irradiation, at identical time points. The primary outcome evaluated was the clinical response concerning height, pliability, vascularity, and pigmentation, using the Vancouver Score Scale (VSS). Adverse reactions and recurrences were recorded as secondary outcomes. Results: A significant reduction was observed in the VSS in terms of pliability and height after three treatment sessions. The mean VSS reduction was 65%, from 8.45 ± SD 0.93 at baseline to 3 ± SD 1.8 one month after the last treatment (P < 0.05). Most patients (79.1%; n = 19) showed a satisfactory response to treatment, with 57.8% (n = 11) achieving an excellent result. Adverse reactions included post-inflammatory hyperpigmentation in four patients and ulceration in two. Recurrences were reported in 21% of the patients who responded well. Conclusions: Combination therapy with FCO2 laser and intralesional 5-FU showed a promising effect in the treatment of resistant keloids, with an acceptable safety profile and low recurrence rate.
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24
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Nisticò SP, Bennardo L, Sannino M, Negosanti F, Tamburi F, Del Duca E, Giudice A, Cannarozzo G. Combined CO 2 and dye laser technique in the treatment of outcomes due to flap necrosis after surgery for basal cell carcinoma on the nose. Lasers Surg Med 2021; 54:523-529. [PMID: 34837404 DOI: 10.1002/lsm.23502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Basal cell carcinoma (BCC) is the most frequent cutaneous cancer worldwide, and the nasal area is the most commonly affected region. Skin flaps are usually performed to achieve radical results, but various adverse events often occur. The necrosis of the skin flap is one of the most frequently observed, resulting in scars and anti-aesthetic outcomes. Ablative and non-ablative lasers have been proposed to improve scars resulting from surgical failure and skin flap necrosis. STUDY DESIGN/MATERIALS AND METHODS This study aims to evaluate a new laser protocol combining ablative CO2 -laser with flashlamp pulsed dye laser for the treatment of nasal scars resulting from the necrosis of flap that occurred after surgery. Twelve patients were enrolled in the study, and a total of five laser sessions were planned, spaced from 14 days to 1 month apart. RESULTS Seven out of 12 patients underwent all the five laser sessions planned, while 5/12 patients achieved optimal cosmetic results within the fourth session. Eighty percent of the patients reported good/optimal cosmetic results, and no significant side effects were observed during the study. CONCLUSION Combining fractionated CO2 laser with flashlamp pulsed dye laser represents a new effective modality for treating skin flap necrosis after BBC removal, representing a valid alternative to other surgical procedures.
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Affiliation(s)
| | - Luigi Bennardo
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Mario Sannino
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Federica Tamburi
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Ester Del Duca
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Amerigo Giudice
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
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25
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Guan H, Zhang D, Ma X, Lu Y, Dong J, Niu Y, Liu Y, Lu S, Xu J, Tang J. Efficacy and safety of CO 2 laser in the treatment of chronic wounds: A Retrospective Matched Cohort Trial. Lasers Surg Med 2021; 54:490-501. [PMID: 34778981 DOI: 10.1002/lsm.23490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/27/2021] [Accepted: 11/01/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Treating chronic cutaneous wounds is challenging, and debridement is a central concept in treating them. Studies have shown that CO2 laser debridement can control local infection and promote the wound healing process. The present study aimed to investigate the efficacy and safety of fully ablative CO2 laser debridement compared to routine surgical debridement in the treatment of chronic wounds. METHODS The retrospective cohort study was conducted on patients with chronic (>1 month) cutaneous wounds (≥1 cm2 ) between December 1, 2017, and December 1, 2020, in the Wound Healing Center at Shanghai Ruijin Hospital, China. Patients treated with CO2 laser debridement with a DEKA SmartXide2 C80 (DEKA) (the CO2 laser group) were compared with matched control patients with similar baseline characteristics who had undergone routine surgical debridement (the routine group). The primary outcome was time-to-heal (days) for chronic wounds in two groups, and secondary outcomes included the wound area and BWAT (Bates-Jensen wound assessment tool) score before treatment, and at 1, 2, 3, and 4 weeks after treatment. RESULTS The study included 164 patients (82 in the CO2 laser group and 82 matched in the routine group). The time-to-heal for patients in the CO2 laser group (41.30 ± 17.11) was significantly shorter than that of the patients in the routine group (48.51 ± 24.32) (p = 0.015). At 3 and 4 weeks after treatment, the absolute wound area of the CO2 laser group was significantly smaller than that of the routine group. Also, the CO2 laser group exhibited a significantly lower relative area at 2, 3, and 4 weeks after treatment. The CO2 laser group yielded significantly lower BWAT scores at 2, 3, and 4 weeks after treatment. Additionally, the relative BWAT score was significantly lower in the CO2 laser group than the relative scores in the routine group at 2, 3, and 4 weeks after treatment. No adverse events related to the treatments were observed in either group during the study period. CONCLUSIONS The present study has shown that fully ablative CO2 laser debridement has several advantages over routine sharp surgical debridement. It is superior at ameliorating wound status and reducing wound area, and it also significantly reduces the time-to-heal for chronic wounds, without causing any adverse events.
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Affiliation(s)
- Haonan Guan
- Department of Burn, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Wound Healing Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Di Zhang
- Department of Burn, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Wound Healing Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xian Ma
- Department of Burn, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Wound Healing Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yechen Lu
- Department of Burn, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Wound Healing Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiaoyun Dong
- Department of Burn, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Wound Healing Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yiwen Niu
- Department of Burn, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Wound Healing Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yingkai Liu
- Department of Burn, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Wound Healing Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Shuliang Lu
- Department of Burn, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Wound Healing Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiping Xu
- Department of Orthopaedics, Shanghai Fengxian District Center Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Jiajun Tang
- Department of Burn, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.,Wound Healing Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
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26
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Esmat S, Shokeir HA, Samy NA, Mahmoud SB, Sayed SSED, Shaker E, Hilal RF. Automated Microneedling Versus Fractional CO2 Laser in Treatment of Traumatic Scars: A Clinical and Histochemical Study. Dermatol Surg 2021; 47:1480-1485. [PMID: 34468410 DOI: 10.1097/dss.0000000000003227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND/OBJECTIVES Microneedling has shown satisfactory effects in scar rejuvenation. Comparisons of its results with fractional laser are limited. This study aims to compare the efficacy and safety of automated microneedling versus fractional carbon dioxide (CO2) laser in treatment of traumatic scars on clinical and histochemical bases. MATERIALS AND METHODS Thirty patients with traumatic facial scars were randomized to treatment with 4 monthly sessions of either automated microneedling or fractional CO2 laser. Assessment of scars was performed at baseline and 3 months after the last treatment session, clinically by the modified Vancouver Scar Scale (mVSS) and histochemically by quantitative assessment of collagen and elastic fibers. RESULTS Both groups showed improvement in mVSS, collagen, and elastin contents after treatment. Percentage improvement of collagen and elastin content was higher after treatment by a laser compared with microneedling, in case of the collagen content. Percentage increase in the collagen content after treatment was higher in atrophic scars of the laser group than those of the microneedling group. CONCLUSION In this small study, microneedling was as safe as fractional CO2 laser for rejuvenation of traumatic scars with comparable clinical effects. Fractional CO2 laser is more powerful in stimulating neocollagenesis. Automated microneedling is effective for treatment of hypertrophic scars.
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Affiliation(s)
- Samia Esmat
- Department of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Cairo, Egypt
| | - Hisham Ali Shokeir
- Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences, Cairo University, Cairo, Egypt
| | - Nevien Ahmed Samy
- Department of Medical Applications of Laser, National Institute of Laser Enhanced Sciences, Cairo University, Cairo, Egypt
| | - Sara Bahaa Mahmoud
- Department of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Cairo, Egypt
| | - Safinaz Salah El Din Sayed
- Department of Histology, Cairo University, Cairo, Egypt; Department of Dermatology, Students' Hospital, Cairo University, Cairo, Egypt
| | - Enas Shaker
- Department of Histology, Cairo University, Cairo, Egypt; Department of Dermatology, Students' Hospital, Cairo University, Cairo, Egypt
| | - Rana Fathy Hilal
- Department of Dermatology, Kasr Al Ainy Teaching Hospital, Cairo University, Cairo, Egypt
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27
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Liang YY, Shen JC, Li W. Evolution of compressive mechanical properties of early hypertrophic scar during laser treatment. J Biomech 2021; 129:110783. [PMID: 34662757 DOI: 10.1016/j.jbiomech.2021.110783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 11/27/2022]
Abstract
Laser therapy has been widely used in the treatment of hypertrophic scars (HPS), but whether the mechanical properties of HPS tissue after laser treatment can be restored to those of normal skin remains unclear. In this paper, the relationship between the evolution of compressive mechanical properties and histological changes of HPS tissues following three successive combined pulsed dye laser (PDL) and fractional CO2 laser (CO2) treatments was investigated by compression tests and histological analysis. The early HPS model of rabbit ear was established by CO2 laser ablation. The loading-unloading tests and strain creep tests under the compression forces of 1 N, 2 N, and 3 N were carried out for normal skin, untreated HPS and HPS after different treatment times, respectively. The results showed that the compression ratio λ of all tissues revealed force dependence and rose with the increasing compression force, which was similar to the trend of most biological soft tissues. The histological changes of HPSs following laser treatment have a significant influence on the compressive mechanical response. Compared with the normal skin, the toughness and anti-deformation ability of HPS reduced due to the proliferation of collagen fibers and the destruction of elastic fibers, resulting in higher energy dissipation, compression ratio λ, and stable creep rate D, and lower elastic modulus. After three successive combined PDL/ CO2 laser treatments, the compressive mechanical properties and creep properties of HPS gradually approached that of the normal skin owing to the gradual restoration of the amount and distribution of collagen and elastic fibers in HPS. The results provide a new method for evaluating the clinical efficacy of laser therapy for treatment of HPS tissue.
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Affiliation(s)
- Y Y Liang
- Tribology Research Institute, Key Laboratory for Advanced Technology of Materials of Ministry of Education, Southwest Jiaotong University, Chengdu 610031, China
| | - J C Shen
- Department of Dermatology, The Second People's Hospital of Chengdu, Chengdu, Sichuan Province 610017, China
| | - W Li
- Tribology Research Institute, Key Laboratory for Advanced Technology of Materials of Ministry of Education, Southwest Jiaotong University, Chengdu 610031, China.
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28
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Peng W, Zhang X, Kong X, Shi K. The efficacy and safety of fractional CO 2 laser therapy in the treatment of burn scars: A meta-analysis. Burns 2021; 47:1469-1477. [PMID: 34493423 DOI: 10.1016/j.burns.2021.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 04/14/2021] [Accepted: 08/16/2021] [Indexed: 01/19/2023]
Abstract
Although we have numerous publications about the effect of fractional CO2 laser therapy for burn scars, quantitative data about its efficacy and safety are sparse. The purpose of this meta-analysis was to assess the efficacy and safety of fractional CO2 laser therapy for the treatment of burn scars. Pertinent studies were identified by a search of PubMed, Embase and Web of Science up to 20 September 2020. Weighted mean difference (WMD) was conducted to combine the results, and a random-effect model was used to pool the results. Publication bias was estimated using Begg and Egger's regression asymmetry test. Twenty articles were included. Our pooled results suggested that fractional CO2 laser therapy significantly improved the Vancouver Scar Scale (VSS) score (WMD = -3.24, 95%CI: -4.30, -2.18; P < 0.001). Moreover, the Patient and Observer Scar Assessment Scale (POSAS)-patient (WMD = -14.05, 95%CI: -22.44, -5.65; P = 0.001) and Observer (WMD = -6.31, 95%CI: -8.48, -4.15; P < 0.001) also showed significant improvements with the treatment of fractional CO2 laser therapy. Fractional CO2 laser significantly reduced scar thickness measured with ultrasonography (WMD = -0.54, 95%CI: -0.97, -0.10; P < 0.001). For other outcomes, including pigmentation, vascularity, pliability, and height of scar, vascularity and relief, laser therapy was associated with significant improvements. However, only the cutometer measure R2 (scar elasticity) (WMD = -0.06, 95%CI: -0.10, -0.01; P = 0.023) was significantly improved with the laser therapy, but cutometer measures R0 (scar firmness) (WMD = 0.03, 95%CI: -0.04, 0.09; P = 0.482) was not. Side effects and complications induced by fractional CO2 laser were mild and tolerable. Fractional CO2 laser therapy significantly improved both the signs and symptoms of burn scars. Considering potential limitations, more large-scale, well-designed RCTs are needed to verify our findings.
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Affiliation(s)
- Weihai Peng
- Department of Plastic Surgery, The First Hospital of Jilin University, Chang Chun 130021, PR China
| | - Xi Zhang
- Department of Burns and Plastic Surgery, The First Hospital of Jilin University, Chang Chun 130021, PR China
| | - Xiangli Kong
- Department of Burns and Plastic Surgery, The First Hospital of Jilin University, Chang Chun 130021, PR China
| | - Kai Shi
- Department of Burns and Plastic Surgery, The First Hospital of Jilin University, Chang Chun 130021, PR China.
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29
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Ge X, Sun Y, Lin J, Zhou F, Yao G, Su X. Effects of multiple modes of UltraPulse fractional CO 2 laser treatment on extensive scarring: a retrospective study. Lasers Med Sci 2021; 37:1575-1582. [PMID: 34436696 PMCID: PMC8971167 DOI: 10.1007/s10103-021-03406-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 08/18/2021] [Indexed: 12/03/2022]
Abstract
The main therapeutic options for extensive scarring (e.g., > 20% of the total body surface area, or TBSA) after burns and trauma have focused on conservative treatments, such as compression, moisturization, and topical agent application. However, these treatments may not achieve optimal effects due to the large size and complexity of the scars. UltraPulse fractional CO2 laser treatment is a novel approach that is currently a subject of intense interest; this treatment is most widely used to improve texture, pliability, and pigmentation in all types of scars. However, no studies on the independent use of UltraPulse fractional CO2 laser treatment for extensive scars have been reported. This retrospective study evaluated a total of 21 patients, whose scars covered 20 to 65% TBSA. Scar thickness was measured by ultrasonography before treatment. Personalized treatment modalities and parameters were set according to the scar type and thickness. Scar formation and treatment effects were evaluated by photography, the Patient and Observer Scar Assessment Scale (POSAS), and patients’ judgment of effectiveness. Where the scars covered joints, joint function was assessed by measuring the maximum range of motion (ROM). With laser therapy, scars became flatter and lighter; furthermore, pruritus, pain, and discomfort decreased significantly. POSAS scores significantly decreased after laser therapy, including the item scores for pain and pruritus. There were no instances of joint contracture, ROM reduction, apparent functional impairment, serious adverse events, or comorbidities. This study demonstrates the safety and efficiency of UltraPulse fractional CO2 laser treatment for extensive scarring.
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Affiliation(s)
- Xiaojing Ge
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Yute Sun
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Jing Lin
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Fang Zhou
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Gang Yao
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China
| | - Xin Su
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Rd, Nanjing, 210029, Jiangsu Province, China.
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30
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Lv K, Liu H, Xu H, Wang C, Zhu S, Lou X, Luo P, Xiao S, Xia Z. Ablative fractional CO 2 laser surgery improving sleep quality, pain and pruritus in adult hypertrophic scar patients: a prospective cohort study. BURNS & TRAUMA 2021; 9:tkab023. [PMID: 34322556 PMCID: PMC8314205 DOI: 10.1093/burnst/tkab023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/20/2020] [Indexed: 11/28/2022]
Abstract
Background Poor sleep quality is associated with a decrease in quality of life in patients with major burn scars, combined with pruritus and pain. Few interventions have been reported to improve the sleep quality of patients with scars. In the current prospective cohort study, we investigated the efficacy of CO2-ablative fractional laser (AFL) surgery vs conventional surgery in post-burn patients with hypertrophic scars with sleep quality as the primary study outcome. Methods In total 68 consecutive patients undergoing scar surgical treatment were recruited, including a CO2-AFL surgery cohort (n = 35) and a conventional surgery cohort (n = 33). A subgroup from the AFL cohort was selected. Sleep quality, pain and pruritus were evaluated. Multiple linear regression analyses were performed to reveal the effect of CO2-AFL surgery. Results The CO2-AFL surgery cohort had significantly lower Pittsburgh sleep quality index (PSQI) global scores than the conventional surgery cohort after the last surgical treatment. In the subgroup of patients receiving hardware sleep monitoring, CO2-AFL markedly increased deep sleep time, deep sleep efficiency and reduced initial sleep latency. Compared to the conventional surgery cohort, the CO2-AFL cohort presented significantly lower pain and pruritus scores. Correlation analysis showed pain and pruritus were significantly associated with PSQI scores, and there were also significant correlations between pain and pruritus scores. Multiple linear regression analysis showed that surgery method was negatively linearly correlated with visual analog scale (VAS) pain score, brief pain inventory (BPI) total, VAS pruritus score, 5-D itch scale total, four-item itch questionnaire (FIIQ) total and PSQI total. Conclusions CO2-AFL surgery significantly improved sleep quality and reduced pain and pruritus of hypertrophic scar patients. The alleviation of sleep disorder was associated with improvement of deep sleep quality including deep sleep time and deep sleep deficiency. Trial registration The Chinese Clinical Trial Registry (ChiCTR200035268) approved retrospectively registration on 5 Aug 2020.
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Affiliation(s)
- Kaiyang Lv
- Department of Plastic Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092; People's Republic of China.,Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China
| | - Huazhen Liu
- Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China
| | - Haiting Xu
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, People's Republic of China.,Department of Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, People's Republic of China
| | - Caixia Wang
- Shanghai Institute of Laser Technology, Shanghai 200233, People's Republic of China
| | - Shihui Zhu
- Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China
| | - Xiaozhen Lou
- Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China
| | - Pengfei Luo
- Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China
| | - Shichu Xiao
- Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China
| | - Zhaofan Xia
- Department of Burn Surgery, the First affiliated Hospital to Naval Medical University, Shanghai 200433, People's Republic of China
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31
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Issler-Fisher AC, Fisher OM, Haertsch PA, Li Z, Maitz PKM. Effectiveness and safety of ablative fractional CO 2 laser for the treatment of burn scars: A case-control study. Burns 2021; 47:785-795. [PMID: 33121852 DOI: 10.1016/j.burns.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/14/2020] [Accepted: 10/02/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Burn scars are a major clinical challenge. The aim of this study was to determine the effectiveness and safety of one treatment with the ablative fractional CO2 laser (AFL-CO2) compared to standard burn scar treatment. METHOD From December 2014 to October 2018 patients were prospectively recruited and treatment effects analyzed by assessing various outcome parameters from the date of first consultation and after treatment. A case control study was conducted looking at the impact of one AFL-CO2 treatment compared to a cohort subjected to conventional conservative treatment. Adverse effects were noted at follow up. RESULTS 187 patients were included, with 167 in the AFL-CO2, and 20 in the control cohort. Baseline demographics and scar characteristics showed no significant differences. Ultrasound measured scar thickness as well as the Vancouver Scar Scale (VSS) revealed a significant reduction in the treatment cohort, but no significant improvement in the control group. The POSAS-O was significantly improved in both cohorts. Subjective parameters (POSAS-P, DN4-Pain, and modified D4Pruritus scores) decreased significantly in the AFL-CO2 cohort but remained unchanged in the control group. The BSHS-B quality of life score increased significantly in the AFL-CO2 group, but worsened at the follow up of the untreated patients. Sub-domain analyses found the biggest differences in Affect, Body Image, Heat Sensitivity, Treatment and Work. Complications occurred in 5 patients (2.9%). CONCLUSIONS This study demonstrates that AFL-CO2 is an effective and safe treatment modality for burn scars improving thickness, symptoms and quality of life of burn survivors when compared to conventional scar treatment.
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Affiliation(s)
- Andrea C Issler-Fisher
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia.
| | - Oliver M Fisher
- School of Medicine, University of Notre Dame, Sydney, NSW 2010, Australia; University of New South Wales Department of Surgery, St George Hospital, Kogarah, Australia
| | - Peter A Haertsch
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
| | - Zhe Li
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
| | - Peter K M Maitz
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; Concord Clinical School, University of Sydney, Sydney, Australia
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Comparison of Nd: YAG Laser and Combined Intense Pulsed Light and Radiofrequency in the Treatment of Hypertrophic Scars: A Prospective Clinico-Histopathological Study. Ann Plast Surg 2021; 84:518-524. [PMID: 31800559 DOI: 10.1097/sap.0000000000002086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hypertrophic scars are fibroproliferative disorders, seen after burn, trauma, and/or surgery. We aimed to compare the clinical and histopathological results of 1064-nm Nd:YAG laser and combined intense pulsed light and radiofrequency in the treatment of hypertrophic scars. METHODS Fifty patients with hypertrophic scars were included in this prospective, randomized study. Twenty-five patients were treated with Nd:YAG laser and 25 patients with combined intense pulsed light and radiofrequency (E-light). The scars were evaluated at baseline, during and at 3 months after the final treatment session using the Vancouver scar scale. Biopsy specimens from scars were obtained before, during, and 3 months after the final treatment session and were stained with hematoxylin and eosin stain, Masson's trichrome stain, and immunostaining procedures for collagen I, collagen III, and TGF-β1. RESULTS Significant improvements in the total Vancouver scar scale scores before and after the treatment in both groups (P < 0.001); however, a significant difference between both groups (P < 0.001), regarding the E-light, which showed better response than Nd:YAG laser. Hematoxylin and eosin and Masson's trichrome staining showed arrangement and thinning of collagen bundles and reduction in collagen density by in both groups, but the collagen bundles thinning and parallelism were more obvious in the E-light group. Significant decrease in the concentration of collagen I, collagen III, and TGF-β1 in the E-light group as compared with the laser group (P = 0.005, P = 0.003 and P < 0.001, respectively). CONCLUSIONS Both modalities were successful in the treatment of hypertrophic scars; however, a significant improvement in the clinical and histopathological findings was detected with the E-light method.
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Motta MM, Stelini RF, Calderoni DR, Gilioli R, Damiani GV, César CL, Kharmandayan P. Effects of the lower energy and pulse stacking in carbon dioxide laser skin treatment: an objective analysis using second harmonic generation. Acta Cir Bras 2021; 36:e360304. [PMID: 33978061 PMCID: PMC8112111 DOI: 10.1590/acb360304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 03/11/2021] [Indexed: 01/31/2023] Open
Abstract
PURPOSE To evaluate the effect of fractional carbon dioxide (CO2) laser treatment using lower power associated with pulse stacking within collagen fibers, using second harmonic generation microscopy and computerized image analysis. METHODS Twenty male Wistar rats aging eight weeks were used. Each treatment area received a single-pass CO2 fractional laser with different parameters. The 20 animals were divided into two groups and euthanized after 30 and 60 days. Second harmonic generation images were obtained and program ImageJ was utilized to evaluate the collagen organization within all areas. Collagen anisotropy, entropy and optical density were quantified. RESULTS Increased anisotropy over time was observed in all four areas, but only reached statistical significance (p = 0.0305) when the mildest parameters were used (area four). Entropy decreased over time in all areas, but without significance(p = 0.1779) in area four. Density showed an overtime increase only in area four, but no statistical significance was reached (p = 0.6534). CONCLUSIONS When combined, the results obtained in this study regarding anisotropy, entropy and density tend to demonstrate that it is possible to achieve collagen remodeling with the use of lower power levels associated with stacked pulses.
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Asuku M, Yu TC, Yan Q, Böing E, Hahn H, Hovland S, Donelan MB. Split-thickness skin graft donor-site morbidity: A systematic literature review. Burns 2021; 47:1525-1546. [PMID: 33781633 DOI: 10.1016/j.burns.2021.02.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 12/08/2020] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
The purpose of this systematic literature review is to critically evaluate split-thickness skin graft (STSG) donor-site morbidities. The search of peer-reviewed articles in three databases from January 2009 to July 2019 identified 4271 English-language publications reporting STSG donor-site clinical outcomes, complications, or quality of life. Of these studies, 77 met inclusion criteria for analysis. Mean time to donor-site epithelialization ranged from 4.7 to 35.0 days. Mean pain scores (0-10 scale) ranged from 1.24 to 6.38 on postoperative Day 3. Mean scar scores (0-13 scale) ranged from 0 to 10.9 at Year 1. One study reported 28% of patients had donor-site scar hypertrophy at 8 years. Infection rates were generally low but ranged from 0 to 56%. Less frequently reported outcomes included pruritus, wound exudation, and esthetic dissatisfaction. Donor-site wounds underwent days of wound care and were frequently associated with pain and scarring. Widespread variations were noted in STSG donor-site outcomes likely due to inconsistencies in the definition of outcomes and utilization of various assessment tools. Understanding the true burden of donor sites may drive innovative treatments that would reduce the use of STSGs and address the associated morbidities.
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Affiliation(s)
- Malachy Asuku
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Tzy-Chyi Yu
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA.
| | - Qi Yan
- Oxford PharmaGenesis Inc., 4 Caufield Place, Suite 201, Newtown, PA, 18940, USA
| | - Elaine Böing
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Helen Hahn
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Sara Hovland
- Mallinckrodt Pharmaceuticals, Shelbourne Building, 53 Frontage Rd Suite 300, Hampton, NJ, 08827, USA
| | - Matthias B Donelan
- Shriners Hospital for Children-Boston, 51 Blossom Street, Suite 930, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02114, USA; Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA
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Zhang CQ, Gogal C, Gaugler T, Blome-Eberwein S. A 6-Year Experience of Laser Treatments for Burn Scars in a Regional Burn Center-Safety, Efficacy, and Quality Improvement. J Burn Care Res 2021; 42:74-81. [PMID: 32681723 DOI: 10.1093/jbcr/iraa118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Laser treatments have long been used as a treatment method for burn scars. Since 2012, more than 1800 laser treatments were performed at Lehigh Valley Health Network Burn Center, far exceeding any previous cohort in studies exploring laser treatments for burn scars. Although previous research has looked at improving scar appearance and physiology with laser treatments, very few have focused on safety. The purpose of the study was to determine whether laser treatments are a safe treatment option for burn scars. Four hundred and fourteen patients who had undergone at least one laser treatment in the outpatient burn center since 2012 were analyzed. Electronic medical records (EPIC) were reviewed. The data were entered in REDCap and later exported to Microsoft Excel and R Studio for statistical analysis. Most of the complications found were related to the moderate sedation during the procedures and were mild, ie, nausea. The most common adverse effect was prolonged recovery time, which can affect practice flow. The overall postoperative complication rate for laser treatments with and without moderate sedation was minimal at 2.2% and 1.4%, respectively. Pain during and after the procedure averaged 3.9 and 1.7, respectively, on a 1 to 10 scale. The Vancouver Scar Scale showed modest improvement in scar appearance over time with an average improvement of 1.4. The high variability of the Vancouver Scar Scale observed in this series underlines its lack of sensitivity. The study results show that laser treatments for burn scars in the outpatient setting generally are safe for patients in need of burn scar intervention. Some practice flow adjustments need to be taken into consideration when offering these procedures in an outpatient setting.
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Li N, Yang L, Cheng J, Han J, Yang X, Zheng Z, Guan H, Hu D. A retrospective study to identify the optimal parameters for pulsed dye laser in the treatment of hypertrophic burn scars in Chinese children with Fitzpatrick skin types III and IV. Lasers Med Sci 2021; 36:1671-1679. [PMID: 33486651 DOI: 10.1007/s10103-021-03252-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
For over several decades, 595-nm pulsed dye laser (PDL) has been used effectively, reducing erythema and improving the pliability and texture of burn scars. Children usually tolerate PDL treatment as it is non-invasive and causes only mild pain compared to other laser treatments. However, currently, there are limited data on scar management in children who underwent PDL treatment, especially for Fitzpatrick skin types III and IV. The objective of the study was to identify the optimal parameters for the PDL treatment that induce inhibitory effects on scar tissue in children with Fitzpatrick skin types III and IV. Besides, the study assessed the usefulness of high-frequency ultrasound (20 MHz) and laser Doppler flowmetry in assessing these lesions. A total of 165 (79 males and 86 females) children with hypertrophic scars treated by PDL were assessed by the Vancouver scar scale (VSS), high-frequency ultrasound (20 MHz), and laser Doppler flowmetry. The parameters used for the 595-nm PDL treatment were pulse duration of 0.45 ms, fluence between 5 and 9 J/cm2, a spot size of 7 mm, and treatment intervals from 3 to 8 weeks. There were no significant differences between pretreatment and post-treatment in terms of the distribution of sex, type of skin color, and low and high fluences. While the mean scores of all scar parameters based on VSS, except thickness and pliability between pre and post-treatment, showed significant differences in ≤3-year-old children vs. to >3-year-old children, except for the subscore, a significant improvement was observed when PDL was initiated within 4 to 6 months of the scar age. In Chinese children with Fitzpatrick skin types III and IV, early intervention, appropriate treatment intervals, and low fluence of PDL were optimal parameters in treating hypertrophic burn scars. The combined high-frequency ultrasound and laser Doppler flowmetry assessment of scars helped assess these lesions and compare the efficacy of different treatment modalities.
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Affiliation(s)
- Na Li
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China
| | - Li Yang
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China
| | - Jing Cheng
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China
| | - Juntao Han
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China.
| | - Xuekang Yang
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China
| | - Zhao Zheng
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China
| | - Hao Guan
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China
| | - Dahai Hu
- Burns and Cutaneous Surgery, Xijing Hospital, Air force Military Medical University, Xi'an, Shaanxi Province, China
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Fractionally Ablative Er: YAG Laser Resurfacing for Thermal Burn Scars: a Split-Scar, Controlled, Prospective Cohort Study. Dermatol Surg 2021; 46:1577-1582. [PMID: 32740214 DOI: 10.1097/dss.0000000000002650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Thermal burn scars can have catastrophic impact on the quality of life and personal image, and over time can lead to profound physical and psychological debilitation. There are no established treatments to significantly improve burn scars. OBJECTIVE To demonstrate the safety, efficacy, and tolerability of fractionally ablative Er:YAG resurfacing of mature burn scars. METHODS Sixteen subjects were enrolled and received 3 treatments of fractionally ablative Er:YAG resurfacing at monthly intervals. Twelve completed the study. Scars were scored with the Vancouver Scar Scale (VSS) by the patient and physician before and after treatment. Blinded photographic analysis (Visual Analog Scale [VAS]) and blinded histologic analysis of tissue before and after treatment was also performed. RESULTS Significant Improvement in VSS scores were seen in all 12 patients, reported by patients and the evaluating physician alike. Photographic analysis demonstrated subjective improvement in all 12 patients. Histologically, there was significant improvement in collagen architecture and the number of vessels per high-power field. The treatments were tolerated well by patients, and 1 superficial skin infection occurred. CONCLUSION Fractionally ablative Er:YAG laser resurfacing is a safe and effective modality in the treatment of thermal burn scars with subjective and objective improvement as seen from the patient and physician.
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High- Versus Low-Density Fractional Laser in the Treatment of Hypertrophic Postburn Scars: A Randomized Clinical Trial. Dermatol Surg 2021; 46:e38-e44. [PMID: 31851017 DOI: 10.1097/dss.0000000000002293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Fractional CO2 laser has been shown effective in improving pigmentation, pruritus, and tightness of hypertrophic burn scars. However, there is no consensus on the optimal treatment parameters. OBJECTIVE To compare effectiveness of different densities of fractional CO2 laser in the treatment of mature hypertrophic burn scars. MATERIALS AND METHODS The study included 25 patients, each with 3 or more mature hypertrophic burn scars. Scars were randomly assigned to treatment with low-, medium-, and high-density fractional CO2 laser. Each scar received 3 sessions of laser at 1-month interval. The degree of improvement was assessed clinically using Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) scores, and histologically through evaluation of collagen (Masson's Trichrome stain) before and 1 month after end of therapy. RESULTS High-density parameters showed significant higher improvement in VSS and POSAS assessment scores (p-value < .001). Pliability and relief are the most improved parameters. Histopathological evaluation revealed a significant drop in the mean area percent of collagen in the 3 used parameters, with highest improvement with high-density laser treatment (p-value < .001). CONCLUSION High-density fractional CO2 laser treatment provides more improvement in burn scars both clinically and histopathologically.
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Rivers JK, Zarbafian M. Improvement of Dupuytren Disease After Treatment With a Fractionated CO2 Laser. Dermatol Surg 2021; 47:153-154. [PMID: 31567489 DOI: 10.1097/dss.0000000000002159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jason K Rivers
- Pacific DermVancouver, British Columbia, Canada.,Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Misha Zarbafian
- Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
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Matuszczak E, Weremijewicz A, Koper-Lenkiewicz OM, Kamińska J, Hermanowicz A, Dębek W, Komarowska M, Tylicka M. Effects of combined Pulsed Dye Laser and Fractional CO 2 Laser treatment of burn scars and correlation with plasma levels of collagen type I, MMP-2 and TIMP-1. Burns 2020; 47:1342-1351. [PMID: 33358398 DOI: 10.1016/j.burns.2020.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/13/2020] [Accepted: 12/07/2020] [Indexed: 12/13/2022]
Abstract
Hypertrophic burn scars remain a significant burden for patients and a challenge for clinicians. THE AIM Assessement of the efficacy of combined Pulsed Dye Laser and Ablative Fractional CO2 Laser therapy on hyperthophic scars and correlation with plasma levels of MMP-2, TIMP-1 and alpha-1 type I collagen. PATIENTS AND METHODS Twenty five pediatric subjects were enrolled into the study. Control group consisted of age-matched subjects admitted for surgical repair of inguinal hernia. For the assessment of the results of laser treatment we used the Vancouver scar scale (VSS), and Patient-Observer Scar Assessment Scale (POSAS). We also correlated clinical results with plasma levels of MMP-2, TIMP-1 and alpha-1 type I collagen. RESULTS All subjects reported the laser treatment resulted in improvement and were somewhat satisfied or very satisfied with their experience. No adverse events were reported. The levels of MMP-2, TIMP-1 and alpha-1 type I collagen in our patients with scars before laser threatment were higher in comparison to controls. We also found statistically significant decrease in the levels of MMP-2, TIMP-1 and alpha-1 type I collagen after laser treatment of burn scars CONCLUSIONS: Our study clearly shows that combined CO2-AFL treatment for burn scars improve texture, colour, function and alleviate pruritus. We believe that decrease in the levels of MMP-2, TIMP-1 and alpha-1 type I collagen after laser treatment of burn scars, reflects reduced dynamic of scar.
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Affiliation(s)
- Ewa Matuszczak
- Pediatric Surgery Department, Medical University of Bialystok, Poland; Biophysics Department, Medical University of Bialystok, Poland.
| | | | | | - Joanna Kamińska
- Department of Clinical Laboratory Diagnostics, Medical University of Białystok, Poland
| | - Adam Hermanowicz
- Pediatric Surgery Department, Medical University of Bialystok, Poland
| | - Wojciech Dębek
- Pediatric Surgery Department, Medical University of Bialystok, Poland
| | - Marta Komarowska
- Pediatric Surgery Department, Medical University of Bialystok, Poland
| | - Marzena Tylicka
- Biophysics Department, Medical University of Bialystok, Poland
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Marvin K, Schwartz I, Utz E, Wilson J, Johnson C, Gaudreau P. Effects of Fractional CO 2 Laser Treatment on Subglottic Scar in a Rabbit Model. Otolaryngol Head Neck Surg 2020; 165:137-141. [PMID: 33287672 DOI: 10.1177/0194599820978256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to investigate the effects of fractional CO2 laser on subglottic scar. STUDY DESIGN Randomized controlled animal study. SETTING Academic medical center. METHODS Subglottic scar was induced in 12 New Zealand white rabbits via an endoscopic brush technique. This was followed by an open airway surgery that included vertical division of the cricoid and proximal trachea. Eight rabbits underwent fractional CO2 laser treatment of the scar via a Lumenis Ultrapulse Deep FX handpiece. Four rabbits underwent the open surgical approach without laser treatment. Bronchoscopy was performed at weeks 1, 2, 4, and 8. The animals were euthanized and laryngotracheal complexes harvested 12 weeks postsurgery. Immunohistochemistry was performed to determine the collagen composition of treated and untreated scars. RESULTS All 12 subjects survived to the study endpoint with no significant respiratory complications, despite 10 of 12 developing some degree of lateral tracheal narrowing. The median ratio of type I collagen to type III collagen in the laser group (1.57) was significantly more favorable than that of the untreated group (2.84; P = .03). CONCLUSION Treatment with fractional CO2 laser appears to have similar effects on subglottic scars as with cutaneous scars, improving the ratio of type I to type III collagen. Additionally, we developed an open airway approach in the rabbit model to deliver fractional CO2 laser treatment to the subglottis without introducing respiratory complications or compromising survival.
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Affiliation(s)
- Kastley Marvin
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Isaac Schwartz
- Department of Otolaryngology-Head and Neck Surgery, Naval Hospital Naples, Naples, Italy
| | - Edward Utz
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Justin Wilson
- Department of Otolaryngology-Head and Neck Surgery, Naval Hospital Okinawa, Okinawa, Japan
| | - Christopher Johnson
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
| | - Philip Gaudreau
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California, USA
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Commentary on Treatment of Hypertrophic Burn and Traumatic Scars With 2940 mm Fractional Ablative Er: YAG. Dermatol Surg 2020; 46:794-795. [PMID: 32452977 DOI: 10.1097/dss.0000000000002194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fractional CO 2 laser treatment for burn scar improvement: A systematic review and meta-analysis. Burns 2020; 47:259-269. [PMID: 33288326 DOI: 10.1016/j.burns.2020.10.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/20/2020] [Indexed: 12/26/2022]
Abstract
Burn injury can cause abnormal healing and pathologic scar formation that significantly impairs patients' ability to return to baseline levels of functioning. Quality of life can be significantly diminished due to pain, stiffness, contracture, and the psychological burden of disfigurement. Traditional scar therapies such as silicone sheeting and compression garments are highly reliant on patient compliance, and have not demonstrated satisfactory efficacy. Even more invasive therapies such as intralesional medication delivery or surgical contracture release have high recurrence rates. Recently, fractional CO2 laser therapy has emerged as a promising treatment modality for burn scars, but there is a lack of recent studies that aggregates extant data to demonstrate outcomes after laser therapy. To address this, we conducted a systematic review and meta-analysis to determine the efficacy of fractional CO2 lasers in treating burn scars, and found that laser therapy alone yielded statistically significant improvements in scar profiles. There were very few reports of adverse effects, most treatments were provided as outpatient, and both patient and burn practitioners reported high satisfaction. By sharing our findings, we hope that more burn practitioners will consider adopting laser therapy as a safe and cost-effective first-line therapy for burn scar management.
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Combination treatment utilizing fractional ablative and continuous wave CO 2 lasers for hypertrophic burn scars. Burns 2020; 47:1084-1093. [PMID: 33199081 DOI: 10.1016/j.burns.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 10/18/2020] [Accepted: 10/29/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hypertrophic scars are devastating outcomes of severe burn injuries, producing physical and mental burdens. Adequate treatment is of benefit to relieve these burdens. Laser therapy has shown scar reducing effects. In this study, we compared outcomes after combination of two different lasers or single laser treatment to treat severe hypertrophic burn scars. METHODS Forty patients with hypertrophic burn scars were included in one of two therapeutic groups: continuous wave CO2 laser and fractional ablative CO2 laser group (group 1, n = 20) or fractional ablative CO2 laser alone group (group 2, n = 20). Hypertrophic scars were evaluated by the observer-rated Vancouver Scar Scale (VSS) before and after treatment and by patient-completed questionnaires after treatment. Comparative analyses were performed before and after treatment, and time-dependent improvement was also analyzed. RESULTS Forty patients (54 hypertrophic scars) completed the laser treatment protocols. Group 1 exhibited significantly more improvement in VSS vascularity, pliability, and height indices than group 2 (p < 0.05). Time-dependent analysis of total VSS scores suggested that group 1 experienced more improvement during a shorter treatment period (p < 0.05). For patient-reported outcomes, group 1 noted better grades than group 2 in four indices, namely scar appearance, scar thickness, pain, and pruritus (p < 0.05). CONCLUSION Effective scar reduction was achieved using combination laser treatment, with significant improvement in multiple observer- and patient-reported outcomes. The shorter treatment period of the combination method can be a merit, as prolonged hypertrophic scars may increase morbidity. Nonetheless, cautious treatment protocols are necessary to avoid undesirable sequelae related to laser application.
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Ablative fractional laser treatment of hypertrophic burn and traumatic scars: a systematic review of the literature. Arch Dermatol Res 2020; 313:301-317. [PMID: 32926192 DOI: 10.1007/s00403-020-02135-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/13/2020] [Accepted: 08/26/2020] [Indexed: 10/23/2022]
Abstract
Hypertrophic scars (HTS) following burns and other trauma and are associated with significant functional and psychosocial impairment. Ablative fractional lasers (AFLs) are increasingly being applied in the treatment of HTS supported by a rapidly expanding multidisciplinary base of literature. The multidisciplinary authors sought to evaluate existing literature, provide context and identify gaps, and make recommendations for a path forward. A systematic review was conducted to identify literature pertinent literature through September 2019. Retrospective cohort, randomized controlled trials, quasi-randomized controlled trials, observational prospective cohort, or case series with five or more subjects with hypertrophic scars incurred from burns and related trauma were considered. Twenty-two of the 23 evaluated studies documented statistically significant and/or meaningful qualitative improvements in nearly all outcome measures. Adverse events were generally infrequent and minor. Significant heterogeneity was observed among the studies included in this systematic review, precluding metaanalysis of pooled data. There is abundant existing literature on the use of AFLs in the management of HTS but study heterogeneity limits generalizability. Future studies should prioritize standardized protocols including assessments of function and quality of life.
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Letter to the Editor: Fractional CO2 laser ablation of porcine burn scars after grafting. Burns 2020; 47:492-493. [PMID: 32900548 DOI: 10.1016/j.burns.2020.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 11/23/2022]
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Chen B, Hou J, Song H, Gao Q, Xu M, Wang F, Wang J, Wu J, Chai J. Using rational strategies for children's scars based on more than 5 years assessment after burn. Burns 2020; 47:190-197. [PMID: 32713827 DOI: 10.1016/j.burns.2020.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 06/18/2020] [Accepted: 06/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Paediatric patients with scars after burn are regularly encountered. Discussion of rational strategies for management are of value. The objective of the study was to describe development and utilisation of strategies for paediatric burn scars up to five years after injury. METHODS We included 164 cases aged from 5 to 8 years old in our study; all had burn scar deformities. RESULTS Assessments were made up to December 31, 2019. The following strategies were used: sequential treatment, reconstruction based on facial aesthetic units, predicting the effect of surgery on development, releasing skin tension and application of photoelectric technology or other non-surgical measures. CONCLUSIONS Using rational strategies for paediatric burn scars is very important.
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Affiliation(s)
- Baoguo Chen
- The Fourth Medical Center of Chinese People's Liberation Army General Hospital, China.
| | - Jian Hou
- The Fourth Medical Center of Chinese People's Liberation Army General Hospital, China
| | - Huifeng Song
- The Fourth Medical Center of Chinese People's Liberation Army General Hospital, China.
| | - Quanwen Gao
- The Fourth Medical Center of Chinese People's Liberation Army General Hospital, China
| | - Minghuo Xu
- The Fourth Medical Center of Chinese People's Liberation Army General Hospital, China
| | - Fang Wang
- The Fourth Medical Center of Chinese People's Liberation Army General Hospital, China
| | - Jue Wang
- The Fourth Medical Center of Chinese People's Liberation Army General Hospital, China
| | - Jiang Wu
- The Fourth Medical Center of Chinese People's Liberation Army General Hospital, China
| | - Jiake Chai
- The Fourth Medical Center of Chinese People's Liberation Army General Hospital, China
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Xi W, Xie Y, Zhang Z, Li K, Wang J, Li J, Feng S, Hultman CS, Liu Y, Zhang Y. 3D Mesh Releasing Method: A Retrospective Analysis of Fractional CO 2 Treatment on Contracture Scars. Lasers Surg Med 2020; 53:227-235. [PMID: 32432374 DOI: 10.1002/lsm.23262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 05/08/2020] [Accepted: 05/09/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES There has been reports on fractional CO2 laser successfully improving contracture scars that impair the function of a joint. It seems that certain contracture problems could be solved by laser instead of surgery. However, the clinical application could be difficult when the efficacy of the method remains unknown. The purpose of this study is to report the releasing capacity of the fractional CO2 laser on contracture scars based on a defined treatment method. STUDY DESIGN/MATERIALS AND METHODS We conducted a retrospective study in patients with limited function in joints caused by contracture scars. Fractional CO2 laser and our "3D mesh releasing" protocol were applied. The primary outcome was the improvement measured in range of motion (ROM) of the relevant joint before all intervention and 6 months after the last treatment. RESULT From November 2016 to January 2018, 11 joints of 10 cases were treated by the fractional CO2 laser. Patients went through 2.27 (standard deviation [SD] 1.42, 1-5) sessions. The average progress of ROM before and 6 months after all treatments was 19.13° (SD 10.25, P < 0.02). In six cases, we recorded that there was an 8.53° (SD 5.81, P < 0.02) of increase in ROM immediately after the laser session, and the average improvement reached up to 13.58° (SD 8.15, P < 0.02) after 2-3 months during the next follow-up. CONCLUSION The fractional CO2 laser could achieve functional improvement in contracture scars and it maintained its effect for at least 6 months. The "3D Mesh Releasing" protocol would help to standardize the treatment procedure. This modality has minimal-invasiveness and potentially could become a supplement to the current treatment choices for mild contracture scars. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.
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Affiliation(s)
- Wenjing Xi
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yixin Xie
- Department of Burns Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Zheng Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Ke Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jingyan Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Jie Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Shaoqing Feng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Ying Liu
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yixin Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.,Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
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49
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Weshahy RH, Aly DG, Shalaby S, Mohammed FN, Sayed KS. Clinical and Histological Assessment of Combined Fractional CO
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Laser and Growth Factors Versus Fractional CO
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Laser Alone in the Treatment of Facial Mature Burn Scars: A Pilot Split‐Face Study. Lasers Surg Med 2020; 52:952-958. [DOI: 10.1002/lsm.23252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/09/2020] [Accepted: 04/10/2020] [Indexed: 01/13/2023]
Affiliation(s)
- Ragia H. Weshahy
- Department of Dermatology and Venereology National Research Centre Giza Egypt
| | - Dalia G. Aly
- Department of Dermatology and Venereology National Research Centre Giza Egypt
| | - Suzan Shalaby
- Department of Dermatology, Faculty of medicine Cairo University Cairo Egypt
| | - Faisal N. Mohammed
- Department of Dermatology and Venereology National Research Centre Giza Egypt
| | - Khadiga S. Sayed
- Department of Dermatology, Faculty of medicine Cairo University Cairo Egypt
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50
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Tawfic SO, El‐Tawdy A, Shalaby S, Foad A, Shaker O, Sayed SS, Metwally D. Evaluation of Fractional CO
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Versus Long Pulsed Nd:YAG Lasers in Treatment of Hypertrophic Scars and Keloids: A Randomized Clinical Trial. Lasers Surg Med 2020; 52:959-965. [DOI: 10.1002/lsm.23249] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 01/01/2023]
Affiliation(s)
| | - Amira El‐Tawdy
- Department of Dermatology Cairo University Cairo 11562 Egypt
| | - Suzan Shalaby
- Department of Dermatology Cairo University Cairo 11562 Egypt
| | - Ahmed Foad
- Department of Dermatology Cairo University Cairo 11562 Egypt
| | - Olfat Shaker
- Department of Biochemistry Cairo University Cairo 11562 Egypt
| | | | - Dina Metwally
- Department of Dermatology Cairo University Cairo 11562 Egypt
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