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Khalid S, Sanabria B, Tan I, Khan S, Khan H, Rao B. Treatment of postburn hypertrophic scaring in skin of color with fractional CO2 laser - A prospective cohort study. JAAD Int 2025; 19:35-42. [PMID: 39967763 PMCID: PMC11833642 DOI: 10.1016/j.jdin.2025.01.001] [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] [Accepted: 01/01/2025] [Indexed: 02/20/2025] Open
Abstract
Objective To evaluate the efficacy of fractional CO2 laser therapy in treating mature hypertrophic burn scars. Method A prospective cohort study enrolled burn patients with postburn hypertrophic scars undergoing fractional CO2 laser treatment in Rawalpindi, Pakistan. Patients aged 12 to 80 years were included, receiving 4 laser sessions every 4-6 weeks. Demographic data and scar assessments using the Vancouver Scar Scale and Patient Observer Scar Assessment Scale were collected. Results Twenty-five patients with hypertrophic scars received treatment. Vancouver Scar Scale scores showed significant reductions, with improvements in scar vascularity (pre: 0.85 ± 1.085, post: 0.10 ± 0.300, P < .001), pigmentation (pre: 2.44 ± 0.673, post: 2.12 ± 0.900, P = .008), and pliability (pre: 2.29 ± 1.078, post: 1.39 ± 0.997, P < .001). Patients with Fitzpatrick skin types III and IV had notable Vancouver Scar Scale score improvements (P = .013, P < .001). Patient Observer Scar Assessment Scale scores also decreased significantly post-treatment (P < .001). Conclusion Fractional CO2 laser therapy shows promise in managing mature hypertrophic burn scars, with improvement in scar appearance, functionality, and symptom relief. Stratification by Fitzpatrick skin type highlights the need for further research to optimize treatment strategies, particularly in populations with darker skin tones. This study underscores the importance of further longitudinal studies on burn scars to enhance outcomes for all burn survivors.
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Affiliation(s)
- Samman Khalid
- Department of Plastic and Reconstructive Surgery, Holy Family Hospital, Rawalpindi, Pakistan
| | - Bianca Sanabria
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Isabella Tan
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Samavia Khan
- Center for Dermatology, Rutgers Robert Wood Johnson Medical School, Somerset, New Jersey
- Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Husnain Khan
- Department of Plastic and Reconstructive Surgery, Holy Family Hospital, Rawalpindi, Pakistan
| | - Babar Rao
- Department of Dermatology, Weill Cornell Medicine, New York, New York
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Chen XJ, Wu D, Kang SX, Xing TJ, Yao Y, Yu L, Liang JQ. Assessment of ultra-pulse CO2 laser therapy in comparison to sequential laser and drug treatments for scar reduction. Medicine (Baltimore) 2025; 104:e41819. [PMID: 40101055 PMCID: PMC11922416 DOI: 10.1097/md.0000000000041819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2024] [Accepted: 02/21/2025] [Indexed: 03/20/2025] Open
Abstract
Scar management, particularly for early proliferative burn scars, remains a clinical challenge. This study assesses the efficacy of ultra-pulse carbon dioxide (CO2) laser therapy in comparison to sequential laser therapy and pharmacological interventions for scar reduction. A retrospective evaluation was conducted from January 2016 to March 2019 involving 200 patients with early proliferative burn scars treated at the Burn and Plastic Surgery Department of our institution. Participants were assigned to 4 groups: Group A received ultra-pulse CO2 laser therapy, Group B underwent sequential pulsed dye laser therapy, Group C received sequential laser therapy combined with pharmacological treatment, and a control group received no intervention. Clinical outcomes were assessed using the Vancouver Scar Scale (VSS) and the Numeric Pain Rating Scale. Efficacy was evaluated based on scar characteristics and pain scores. Demographic characteristics across all groups were comparable, with no significant differences noted (P > .05). The clinical efficacy assessment revealed that the overall effective rates for Group A, Group B, and Group C were 80.00%, 96.00%, and 98.00%, respectively. Groups B and C not only exhibited significantly higher effective rates but also demonstrated marked improvements in scar characteristics as measured by the VSS, including reduced erythema and thickness. Additionally, pain scores during treatment were lowest in Group C, indicating better tolerability compared to the other modalities (P < .05). Sequential laser therapy improves the clinical efficacy for early proliferative burn scars, enhancing scar characteristics overall. When combined with pretreatment pharmacotherapy, this approach also reduces patient pain during treatment. These results highlight the benefits of integrating sequential laser and drug therapies in scar management.
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Affiliation(s)
- Xiang-Jun Chen
- Department of Plastic and Reconstructive Surgery, Peking University Cancer Hospital Inner Mongolia Hospital, Hohhot, China
| | - Di Wu
- Department of Plastic and Reconstructive Surgery, Peking University Cancer Hospital Inner Mongolia Hospital, Hohhot, China
| | - Shu-Xia Kang
- Department of Dermatology and Venereology, Peking University Cancer Hospital Inner Mongolia Hospital, Hohhot, China
| | - Tian-Jiao Xing
- Department of Dermatology and Venereology, Peking University Cancer Hospital Inner Mongolia Hospital, Hohhot, China
| | - Yao Yao
- Department of Dermatology and Venereology, Peking University Cancer Hospital Inner Mongolia Hospital, Hohhot, China
| | - Li Yu
- Department of Intensive Care Medicine, PLA Joint Logistics Support Force 969th Hospital, Hohhot, China
| | - Jun-Qing Liang
- Breast Tumor Center, Peking University Cancer Hospital Inner Mongolia Hospital, Hohhot, China
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Alomari O, Mokresh ME, Hamam M, Teker AU, Caliskan CS, Sadigova S, Ertan SN, Wojtara M, Filinte G. Combined Stromal Vascular Fraction and Fractional CO2 Laser Therapy for Hypertrophic Scar Treatment: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2025; 49:885-896. [PMID: 39333369 DOI: 10.1007/s00266-024-04359-6] [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: 05/10/2024] [Accepted: 09/03/2024] [Indexed: 09/29/2024]
Abstract
BACKGROUND Hypertrophic scars (HTSs) result from aberrant wound healing processes, leading to raised, thickened tissue with functional discomfort and cosmetic concerns. Current treatments, including corticosteroid injections and laser therapy, have limitations. Stromal vascular fraction (SVF) therapy and CO2 laser treatment offer promising avenues, with SVF therapy showing regenerative potential and CO2 laser therapy promoting precise tissue removal and wound healing. This study aims to investigate the combined application of SVF therapy and CO2 laser treatment for HTS, aiming to enhance treatment efficacy, tissue remodeling, and aesthetic outcomes, ultimately improving patient satisfaction in HTS management. METHOD PubMed, Scopus, Embase, and Web of Science databases have been searched for relevant studies. The "R" software (version 4.3.1) along with the "tidyverse" and "meta" statistical packages utilized to analyze data related to the efficiency of this combined method. A random-effects model was fitted to the data. For each study, continuous outcomes were pooled by calculating the standardized mean difference, along with their 95% confidence intervals. The assessment of heterogeneity utilized the I2 and chi-squared tests, applying the random effect model. RESULTS Six articles fulfilled our inclusion criteria and were included in our review. Results from the pooled analysis of Vancouver Scar Scale (VSS) scores across three included studies indicated a significant impact of the SVF+CO2 method on VSS scores post-treatment (SMD=-3.0144; 95% CI:-4.3706 to -1.6583, p<0.0001). However, analysis of transepidermal water loss levels before and after treatment showed no significant difference (SMD=-2.7603; 95% CI: -6.8729 to 1.3522; p=0.1883). Comparatively, in a pooled analysis of two studies, the combined SVF+CO2 method demonstrated superior efficacy in VSS scores compared to other methods (SMD= -1.3573; 95% CI: -2.2475 to -0.4672, p = 0.0028), with moderate heterogeneity across studies (I^2=23.0%, p = 0.2545). CONCLUSION The combined application of SVF and CO2 laser treatment shows significant promise in improving hypertrophic scars' appearance and texture. The SVF+CO2 method demonstrates superior efficacy compared to other modalities, suggesting its potential as a valuable therapeutic approach for hypertrophic scar management. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Omar Alomari
- Hamidiye International Faculty of Medicines, Hamidiye International School of Medicine, University of Health Sciences, 3400, 34668, Istanbul, Turkey.
| | - Muhammed Edib Mokresh
- Hamidiye International Faculty of Medicines, Hamidiye International School of Medicine, University of Health Sciences, 3400, 34668, Istanbul, Turkey
| | - Meryem Hamam
- Hamidiye International Faculty of Medicines, Hamidiye International School of Medicine, University of Health Sciences, 3400, 34668, Istanbul, Turkey
| | - Asude Ukba Teker
- Hamidiye International Faculty of Medicines, Hamidiye International School of Medicine, University of Health Sciences, 3400, 34668, Istanbul, Turkey
| | - Cagla Sumeyye Caliskan
- Hamidiye International Faculty of Medicines, Hamidiye International School of Medicine, University of Health Sciences, 3400, 34668, Istanbul, Turkey
| | - Seljan Sadigova
- Hamidiye International Faculty of Medicines, Hamidiye International School of Medicine, University of Health Sciences, 3400, 34668, Istanbul, Turkey
| | - Sinem Nur Ertan
- Hamidiye International Faculty of Medicines, Hamidiye International School of Medicine, University of Health Sciences, 3400, 34668, Istanbul, Turkey
| | - Magda Wojtara
- Department of Human Genetics, University of Michigan Medical School, Ann Arbor, USA
| | - Gaye Filinte
- Department of Plastic, Reconstructive and Aesthetic Surgery, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
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Chen L, Xu H, Wang QY, Chen P, Wang LQ, Qin XM. Treatment of Surgical Scars with Fractional Carbon Dioxide (CO 2) Laser: A Randomized Controlled Trial. Adv Wound Care (New Rochelle) 2025. [PMID: 39869009 DOI: 10.1089/wound.2024.0213] [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: 01/28/2025] Open
Abstract
Object: The aim of this study was to compare the long-term effects of fractional carbon dioxide (CO2) laser treatment with traditional therapy on surgical scars by analyzing and comparing observational indicators. Approach: A randomized controlled trial was conducted on 116 patients who received scar treatment in our hospital, of which 58 patients received fractional CO2 laser treatment, and 58 patients received injection treatment. The outcome measures comprised the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). The observation intervals occur at specific times. Evaluated at 6 months of follow-up, the outcome was blinded, on-site evaluation using the dermatological appearance scale (DAS) and visual analog scale (VAS). Results: Patients in the fractional carbon-dioxide laser (CO2FL) group rated better than those in the injection group in the POSAS, VSS, DAS, and VAS scores (p < 0.05). The therapeutic efficacy and patients' satisfaction of the research group were superior to those in the control group. Innovation: Scars following surgical procedures can be treated in a variety of methods, but there is no consensus on the best method. CO2FL has exhibited safety and is more effective than traditional injection treatments for surgical scars. It is a worthwhile approach to consider in clinical treatment. Conclusions: This study demonstrates that CO2FL achieves more significant long-term results in surgical scars, including improved scar appearance, safety, and patient satisfaction.
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Affiliation(s)
- Liang Chen
- Department of Dermatology, The Second Affiliated Hospital of Wannan Medic-al College, Wuhu, Anhui, China
| | - Han Xu
- Department of Oncology, Bengbu Third People's Hospital Affiliated to Beng-bu Medical University, Bengbu, Anhui, China
| | - Qiu Yu Wang
- Department of Electrocardiology, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Peng Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Wanna-n Medical College, Wuhu, Anhui, China
| | - Lin Qi Wang
- Department of Thoracic Surgery, The Second Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Xiao Ming Qin
- Department of Dermatology, The Second Affiliated Hospital of Wannan Medic-al College, Wuhu, Anhui, China
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Heron MJ, Reinoso TR, Dane JM, Rezwan SK, Mack S, Broderick KP, Cooney CM, Caffrey JA. The Fractured Insurance Landscape of Laser Therapy for Scar Revision. J Burn Care Res 2025; 46:14-21. [PMID: 39269322 DOI: 10.1093/jbcr/irae173] [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: 03/26/2024] [Indexed: 09/15/2024]
Abstract
Fractional laser therapy improves skin texture, range of motion, and quality of life for patients with traumatic scars. Nevertheless, anecdotal evidence suggests declining insurance coverage for laser therapy. We aimed to characterize the landscape of insurance coverage for fractional laser therapy present our 6 year reimbursement trends. We cross-sectionally analyzed the 60 largest American health insurers by enrollee size and market share. For each, we identified their laser therapy policy for scar revision and extracted their documentation, prior and continuing authorization requirements and treatment guidelines. We also collected retrospective institutional claims data from 2017 to 2022 to investigate trends in reimbursement. Of the 60 largest health insurers, we identified 11 (18.3%) policies on scar revision and 40 policies (66.7%) on reconstructive surgery, including scar revision. Nineteen policies considered laser therapy medically necessary with evidence of functional impairment refractory to prior treatment. Three insurers denied laser coverage under any circumstance. Of the 1,531 claims submitted by our institution for burn scar laser therapy, 13.8% were denied. Patients with Medicare (ORadj, 3.78) or Medicaid (ORadj, 2.80) had significantly greater odds of coverage than privately insured patients (P < .01). There was a 14.5% annual reduction in the odds of reimbursement during the study period (ORadj, 0.86, P < .01). Laser therapy is a powerful treatment that is not widely available to patients with traumatic scars. Our institutional data suggest this access may be further eclipsed by decreasing trends in coverage since 2017. Strategies are needed to protect patient access to this life-changing treatment.
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Affiliation(s)
- Matthew J Heron
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Tyler R Reinoso
- Drexel University College of Medicine, Philadelphia, PA 19129, USA
| | - Julia M Dane
- DeBusk College of Osteopathic Medicine, Lincoln Memorial University, Harrogate, TN 37752, USA
| | - Siam K Rezwan
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Sylvia Mack
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Kristen P Broderick
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Carisa M Cooney
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
| | - Julie A Caffrey
- Department of Plastic & Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA
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Pham VX, Pousti BT, Gauglitz G, Shumaker PR. Impact of Fractional Ablative Laser Therapy on Function, Symptoms, and Quality of Life in the Management of Traumatic Scars: A Review. Lasers Surg Med 2025; 57:8-14. [PMID: 39523456 DOI: 10.1002/lsm.23858] [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: 06/06/2024] [Revised: 09/09/2024] [Accepted: 10/18/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVES A substantial and expanding body of literature addresses the safety and efficacy of fractional ablative laser therapy for traumatic scarring resulting from burns and other trauma. However, available scar research commonly employs standardized assessment scales that generally do not directly address the impact on function and overall quality of life. Unlike past reviews, this manuscript will explore available evidence with a focus explicitly on function and quality of life (QoL) outcomes and de-emphasize surrogate outcome measures that rely primarily on visual characteristics. METHODS Through literature review conducted up to January 2024, the authors examined relevant studies focusing on function and quality of life outcomes in traumatic and burn scar management with fractional ablative laser therapy. PubMed, EMBASE, MEDLINE, and Cochrane Library were utilized as primary databases. Reference lists were secondarily reviewed to supplement the literature review process. Studies that did not highlight functional or QoL endpoints or were not in the English language were excluded. RESULTS The reviewed studies demonstrated that fractional ablative therapy led to consistent significant and meaningful improvements in functional outcomes, relief from pruritus and pain, and overall enhancements in quality of life for patients with traumatic scarring. Adverse events associated with fractional ablative therapy were infrequent and generally of mild severity, indicating a favorable safety profile. CONCLUSIONS The findings from this literature review document ample existing evidence supporting the efficacy and safety of fractional ablative therapy to enhance function, mobility, reduce pruritus and pain, and improve overall QoL. Fractional ablative laser therapy should be integrated more widely into standard management protocols. Given the previous reliance on standardized scar assessment tools that heavily integrate visual characteristics, future studies should prioritize functional and QoL outcomes to further advance scar management protocols and optimize patient care.
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Affiliation(s)
- Vy X Pham
- University of California San Diego School of Medicine, La Jolla, USA
| | - Bobak T Pousti
- Department of Dermatology, University of California San Diego, La Jolla, USA
| | - Gerd Gauglitz
- Department of Dermatology and Allergy, Ludwig Maximilian University, Munich, Germany
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7
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Xue P, Yang Q, Guo L, Yin Y, Dou W, Li T, Zeng X, Song B, Fan X. Follicular unit extraction combined with fractional carbon dioxide laser therapy for post-traumatic eyebrow scar with defects: A prospective and comparative study. J Cosmet Dermatol 2024; 23:4146-4152. [PMID: 39129177 PMCID: PMC11626299 DOI: 10.1111/jocd.16518] [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: 06/07/2024] [Revised: 07/16/2024] [Accepted: 07/29/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Eyebrows play a crucial role in the human body. While Follicular Unit Extraction (FUE) is a widely utilized and highly effective treatment for typical eyebrow deficiencies, it may not yield satisfactory outcomes for patients with post-traumatic eyebrow scars and defects. OBJECTIVE A prospective comparative clinical study was conducted to explore the treatment outcomes of post-traumatic eyebrow scars accompanied by defects using a combination of ablative fractional CO2 laser therapy with FUE. METHOD Between January 2019 and January 2023, we enrolled 30 patients with post-traumatic eyebrow scars and accompanying eyebrow defects, randomly assigning them to experimental and control groups. Patients in the control group received FUE treatment exclusively, whereas patients in the experimental group underwent CO2 fractional laser therapy on the eyebrow scars prior to FUE treatment. Alongside the patients' baseline data and the quantity of transplanted follicular units during surgery, we will compare the follicular survival rates between the two groups at 6 and 12 months post-treatment. RESULTS Prior to FUE, there were no notable variances in baseline data between the two-patient groups. At 6 and 12 months postoperatively, the follicular survival rate in the experimental group was significantly higher compared to the control group. Additionally, patients in the control group were more prone to experiencing postoperative asymmetry between their eyebrows and developing curly hair. CONCLUSION For patients with post-traumatic eyebrow scars accompanied by eyebrow defects, we applied ablative fractional CO2 laser therapy in combination with FUE treatment. This approach not only resulted in a higher follicular survival rate postoperatively but also led to the achievement of a well-defined eyebrow shape.
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Affiliation(s)
- Ping Xue
- Department of Plastic and Reconstructive Surgery, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Qing Yang
- Department of Plastic and Reconstructive Surgery, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Lei Guo
- Department of Plastic and Reconstructive Surgery, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Yue Yin
- Department of Plastic and Reconstructive Surgery, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Wenjie Dou
- Department of Plastic and Reconstructive Surgery, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Tong Li
- Department of Plastic and Reconstructive Surgery, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Xianhui Zeng
- Department of Plastic and Reconstructive Surgery, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Baoqiang Song
- Department of Plastic and Reconstructive Surgery, Xijing HospitalFourth Military Medical UniversityXi'anChina
| | - Xing Fan
- Department of Plastic and Reconstructive Surgery, Xijing HospitalFourth Military Medical UniversityXi'anChina
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Neema S, Vendhan S, Vasudevan B, K L, Dakshinamurthy S. Efficacy of fractional carbon dioxide laser-assisted drug delivery in the management of post-burn scars - A prospective study. J Cutan Aesthet Surg 2024; 17:219-226. [PMID: 39483650 PMCID: PMC11497552 DOI: 10.25259/jcas_181_23] [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: 10/19/2023] [Accepted: 05/11/2024] [Indexed: 11/03/2024] Open
Abstract
Objectives The objective of our study is to assess the efficacy of fractional carbon dioxide (CO2) laser-assisted drug delivery (LADD) in the management of post-burn scars. Material and Methods It is a prospective study conducted from March 2021 to February 2022, with 32 patients ranging in age from 9 to 52 years. The scars lasted anywhere from 6 months to 18 years. The ethical clearance of the Institutional Ethics Committee was obtained. The patient's median age was 22 (range, 09-52). Patients were assessed using a modified Vancouver scar scale (mVSS) score before and after receiving fractional CO2 laser at monthly intervals. Results After one treatment, statistically significant improvements in pigment, thickness, and pliability were seen according to the mVSS scores, and these improvements persisted through the final laser session. Conclusion Our study has demonstrated that fractional CO2 LADD seems to be an encouraging approach in the management of post-burn scars with good patient satisfaction.
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Affiliation(s)
- Shekhar Neema
- Department of Dermatology, Command Hospital, Lucknow, Uttar Pradesh, India
| | - Senkadhir Vendhan
- Department of Dermatology, Dr. Babasaheb Ambedekar Memorial Hospital Central Railways Hospital, Mumbai, Maharashtra, India
| | - Biju Vasudevan
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Lekshmipriya K
- Department of Dermatology, Armed Forces Medical College, Pune, Maharashtra, India
| | - Senkadhirdasan Dakshinamurthy
- Department of Community and Family Medicine, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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Alessandri Bonetti M, Arellano JA, Scarabosio A, Liu HY, Giorgino R, Ejaz A, Rubin JP, Egro FM. The Effect of Fat Grafting on Scars Hyperpigmentation: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2024; 48:989-998. [PMID: 38286897 DOI: 10.1007/s00266-023-03828-8] [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: 10/13/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Hyperpigmented scars, particularly in exposed body areas, can be difficult to conceal and may evoke psychological distress. While the precise causes of scar dyschromia are not fully understood, alterations in melanogenic activity appear to hold more significance than changes in melanocyte quantity. Current treatments encompass laser interventions. However, it is essential to consider their costs and potential complications in relation to their limited proven effectiveness. Fat grafting has gained interest as a scar modulation technique due to its regenerative properties, and its efficacy in reducing scar hyperpigmentation is currently under investigation. METHODS A systematic review and meta-analysis was reported according to PRISMA guidelines. PubMed, Embase, and Cochrane Library databases were accessed. PROSPERO registration number is CRD42023457778. The primary outcome was a change in scar pigmentation after fat grafting. Pigmentation changes after fat grafting were calculated using the standardized mean difference (SMD) between baseline and postoperative scores according to POSAS and VSS scales. Bias assessment was conducted according to the National Institute for Health and Clinical Excellence quality assessment tool. RESULTS A total of 8 articles meeting inclusion and exclusion criteria were identified, involving 323 patients with hyperpigmented scars treated with fat grafting. A significant difference in scar pigmentation was noted after treatment with fat grafting according to observers' ratings, with a SMD of - 1.09 [95% CI: - 1.32; - 0.85], p<0.01. The SMD for patient-reported scar pigmentation after treatment with fat grafting was - 0.99 [96% CI: - 1.31; - 0.66], p<0.01. Four studies provided objective measurements of melanin changes after fat grafting and revealed inconsistent findings compared to subjective observations. CONCLUSIONS Fat grafting shows promise in ameliorating hyperpigmented scars based on subjective assessments, but further corroborating evidence from objective measures is required. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Jose Antonio Arellano
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Anna Scarabosio
- Department of Plastic Surgery, Ospedale Santa Maria della Misericordia, 33100, Udine, Italy
| | - Hilary Y Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, 20141, Milan, Italy
| | - Asim Ejaz
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA.
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10
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Ma Y, Barnes SP, Chen YY, Moiemen N, Lord JM, Sardeli AV. Influence of scar age, laser type and laser treatment intervals on paediatric burn scars: a systematic review and meta-analysis. BURNS & TRAUMA 2024; 12:tkad046. [PMID: 38312741 PMCID: PMC10838059 DOI: 10.1093/burnst/tkad046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/24/2023] [Indexed: 02/06/2024]
Abstract
Background Laser therapy has emerged to play a valuable role in the treatment of paediatric burn scars; however, there is heterogeneity in the literature, particularly concerning optimal timing for initiation of laser therapy. This study aims to investigate the effect of factors such as scar age, type of laser and laser treatment interval on burn scar outcomes in children by meta-analysis of previous studies. Methods A literature search was conducted across seven databases in May 2022 to understand the effects of laser therapy on burn scar outcomes in paediatric patients by metanalysis of standardized mean difference (SMD) between pre- and post-laser intervention. Meta-analyses were performed using the Comprehensive Meta-Analysis software version 4.0. Fixed models were selected when there was no significant heterogeneity, and the random effects model was selected for analysis when significant heterogeneity was identified. For all analyses, a p-value < 0.05 was considered significant. Results Seven studies were included in the meta-analysis with a total of 467 patients. Laser therapy significantly improved Vancouver Scar Scale (VSS)/Total Patient and Observer Scar Assessment Scale (Total POSAS), vascularity, pliability, pigmentation and scar height of burn scars. Significant heterogeneity was found between the studies and thus subgroup analyses were performed. Early laser therapy (<12 months post-injury) significantly improved VSS/POSAS scores compared to latent therapy (>12 months post-injury) {SMD -1.97 [95% confidence interval (CI) = -3.08; -0.87], p < 0.001 vs -0.59 [95%CI = -1.10; -0.07], p = 0.03} as well as vascularity {SMD -3.95 [95%CI = -4.38; -3.53], p < 0.001 vs -0.48 [95%CI = -0.66; -0.30], p < 0.001}. Non-ablative laser was most effective, significantly reducing VSS/POSAS, vascularity, pliability and scar height outcomes compared to ablative, pulse dye laser and a combination of ablative and pulse dye laser. Shorter treatment intervals of <4 weeks significantly reduced VSS/POSAS and scar height outcomes compared to intervals of 4 to 6 weeks. Conclusions Efficacy of laser therapy in the paediatric population is influenced by scar age, type of laser and interval between laser therapy application. The result of this study particularly challenges the currently accepted initiation time for laser treatment. Significant heterogeneity was observed within the studies, which suggests the need to explore other confounding factors influencing burn scar outcomes after laser therapy.
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Affiliation(s)
- Yangmyung Ma
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Sabrina P Barnes
- Hull York Medical School, University Rd, Heslington, York YO10 5DD, United Kingdom
| | - Yung-Yi Chen
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
| | - Naiem Moiemen
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
- Department of Burns and Plastic Surgery, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
- Scar Free Foundation Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
| | - Janet M Lord
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
- Scar Free Foundation Centre for Burns Research, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, United Kingdom
| | - Amanda V Sardeli
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT, United Kingdom
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11
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Daigo Y, Daigo E, Fukuoka H, Fukuoka N, Idogaki J, Taniguchi Y, Tsutsumi T, Ishikawa M, Takahashi K. CO 2 Laser for Esthetic Healing of Injuries and Surgical Wounds with Small Parenchymal Defects in Oral Soft Tissues. Diseases 2023; 11:172. [PMID: 38131978 PMCID: PMC10742548 DOI: 10.3390/diseases11040172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 11/22/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023] Open
Abstract
A number of studies have recently demonstrated the effectiveness of CO2 laser irradiation for the repair and regeneration of scar tissue from injuries or surgical wounds. However, such studies of the oral mucosa are highly limited. Previous studies using CO2 laser irradiation have indicated that two factors contribute to esthetic healing, namely, artificial scabs, which are a coagulated and carbonized blood layer formed on the wound surface, and photobiomodulation therapy (PBMT) for suppressing wound scarring and promoting wound healing. This review outlines basic research and clinical studies of esthetic healing with the use of a CO2 laser for both artificial scab formation by high-intensity laser therapy and PBMT in the treatment of injuries and surgical wounds with small parenchymal defects in oral soft tissues. The results showed that the wound surface was covered by an artificial scab, enabling the accumulation of blood and the perfusion necessary for tissue regeneration and repair. Subsequent PBMT also downregulated the expression of transformation growth factor-b1, which is involved in tissue scarring, and decreased the appearance of myofibroblasts. Taken together, artificial scabs and PBMT using CO2 lasers contribute to the suppression of scarring in the tissue repair process, leading to favorable esthetic and functional outcomes of wound healing.
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Affiliation(s)
- Yuki Daigo
- Department of Geriatric Dentistry, Osaka Dental University, 2-2-14 Higashitanabe, Higashisumiyoshi-ku, Osaka 546-0032, Japan; (J.I.); (K.T.)
- Nogami Dental Office, 4-22-18 Nishiimagawa, Higashisumiyoshi-ku, Osaka 546-0042, Japan;
| | - Erina Daigo
- Nogami Dental Office, 4-22-18 Nishiimagawa, Higashisumiyoshi-ku, Osaka 546-0042, Japan;
| | - Hiroshi Fukuoka
- Fukuoka Dental Office, 704-4 Torai, Satsuma-gun, Kagoshima 895-1811, Japan; (H.F.); (N.F.)
| | - Nobuko Fukuoka
- Fukuoka Dental Office, 704-4 Torai, Satsuma-gun, Kagoshima 895-1811, Japan; (H.F.); (N.F.)
| | - Jun Idogaki
- Department of Geriatric Dentistry, Osaka Dental University, 2-2-14 Higashitanabe, Higashisumiyoshi-ku, Osaka 546-0032, Japan; (J.I.); (K.T.)
| | - Yusuke Taniguchi
- Section of Oral Implantology, Department of Oral Rehabilitation, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka 814-0193, Japan;
| | - Takashi Tsutsumi
- The Center for Visiting Dental Service, Department of General Dentistry, Fukuoka Dental College, 2-15-1 Tamura, Sawara-ku, Fukuoka 814-0193, Japan;
| | - Masatsugu Ishikawa
- Bees Dental Office, 6-904 Befudanchi, Jyonan-ku, Fukuoka 814-0106, Japan;
| | - Kazuya Takahashi
- Department of Geriatric Dentistry, Osaka Dental University, 2-2-14 Higashitanabe, Higashisumiyoshi-ku, Osaka 546-0032, Japan; (J.I.); (K.T.)
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12
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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: 3] [Impact Index Per Article: 1.5] [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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13
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Roohaninasab M, Khodadad F, Sadeghzadeh-Bazargan A, Atefi N, Zare S, Jafarzadeh A, Rahimi ST, Nouri M, Nilforoushzadeh MA, Behrangi E, Goodarzi A. Efficacy of fractional CO 2 laser in combination with stromal vascular fraction (SVF) compared with fractional CO 2 laser alone in the treatment of burn scars: a randomized controlled clinical trial. Stem Cell Res Ther 2023; 14:269. [PMID: 37742019 PMCID: PMC10518108 DOI: 10.1186/s13287-023-03480-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/29/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND The appearance of skin scars is known as one of the main side effects of skin burns. Stromal vascular fraction (SVF), as a rich source of cell populations with tissue regeneration properties, plays an important role in the healing of skin lesions. Fractional CO2 lasers have occupied a special place in treating skin lesions, particularly skin scars, since their introduction. Our study aimed to compare the combination of SVF and fractional CO2 laser with fractional CO2 laser alone in the treatment of burn scars. METHOD This double-blind clinical trial study was conducted on ten patients with burn scars that were treated three times with a fractional CO2 laser at site of burn lesions, and one of the two areas studied was randomly injected with SVF. Two months after completion of the procedure, patients' scars were assessed using the Vancouver scar scale (VSS), biometric criteria, and physician and patient satisfaction ratings. RESULTS The results confirmed a significant improvement in VSS, cutometry, R7 criteria, complete density sonography, and skin density sonography in the fractional CO2 laser-treated group. The VSS criteria, epidermal thickness sonography, complete density sonography, and skin density sonography in the group treated with the combination of fractional CO2 laser and SVF also showed significant improvement. The VSS criteria and melanin index of Mexameter in the group treated with SVF in combination with fractional CO2 laser were significantly better than the group treated with fractional CO2 laser alone. Also, physician and patient satisfaction in the group treated with SVF injection in combination with fractional CO2 laser was significantly higher than the other group. CONCLUSION The results confirm the efficacy of SVF injection in combination with fractional CO2 laser in the treatment of burn scars and can be considered as a treatment option for better management of these lesions. TRIAL REGISTRATION The study protocol was retrospectively registered at Iranian Registry of Clinical Trials with code: IRCT20210515051307N1, Registration date: 2021-11-14, URL: https://www.irct.ir/trial/56337 .
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Affiliation(s)
- Masoumeh Roohaninasab
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Khodadad
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Sadeghzadeh-Bazargan
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, 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
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sona Zare
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Stem Cell and Regenerative Medicine Institute, Sharif University of Technology, Tehran, Iran
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Alireza Jafarzadeh
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Seyyedeh Tahereh Rahimi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maryam Nouri
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Nilforoushzadeh
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Skin Repair Research Center, Jordan Dermatology and Hair Transplantation Center, Tehran, Iran.
| | - Elham Behrangi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, 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
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
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14
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Wasson E, Thandi C, Hitchens E, Thomas K, Keith D. An audit of the use of fractional CO2 laser for hypertrophic burn scars: a real-life perspective. Lasers Med Sci 2023; 38:144. [PMID: 37347311 DOI: 10.1007/s10103-023-03814-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Elizabeth Wasson
- Foundation School, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
| | - Charankumal Thandi
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
| | - Emma Hitchens
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
| | - Kay Thomas
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
| | - Daniel Keith
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
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15
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Bryarly J, Kowalske K. Long-Term Outcomes in Burn Patients. Surg Clin North Am 2023; 103:505-513. [PMID: 37149386 DOI: 10.1016/j.suc.2023.02.004] [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: 05/08/2023]
Abstract
Better understanding of long-term outcomes after burn injury is essential for the burn clinician. Contractures are present in almost half of patients at discharge. Although less common, neuropathy and heterotopic ossification may be missed or go unaddressed. Close attention to psychological distress and to challenges with community reentry is essential. Obviously long-term problems with skin issues occur but other issues must be attended to maximize health and quality of life after injury. Facilitating access to community resources and providing long-term medical follow-up should be the standard of care.
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Affiliation(s)
- Julia Bryarly
- Physical Medicine and Rehabilitation, University of Texas, Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9055, USA
| | - Karen Kowalske
- Physical Medicine and Rehabilitation, University of Texas, Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9055, USA.
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16
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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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17
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Flores R, Valenzuela F. Cicatrices de quemaduras y la utilidad de la terapia láser en su manejo. REVISTA MÉDICA CLÍNICA LAS CONDES 2023. [DOI: 10.1016/j.rmclc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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18
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Ponomarenko GN. [High-intensity laser therapy in clinical medicine: scientometric analysis of evidence of effectiveness]. VOPROSY KURORTOLOGII, FIZIOTERAPII, I LECHEBNOI FIZICHESKOI KULTURY 2023; 100:18-26. [PMID: 36971668 DOI: 10.17116/kurort202310001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
INTRODUCTION High-intensity laser technologies are widely used in modern restorative medicine, and indications for their use are expanding annually. These technologies are effective, potentially safe methods of treating many diseases. with pronounced therapeutic effects. PURPOSE OF RESEARCH Analysis of scientific evidence of the effectiveness and safety of high-intensity laser therapy in patients with various diseases. MATERIAL AND METHODS A comprehensive scientometric analysis of evidence-based studies of the effectiveness and safety of high-intensity laser therapy methods was carried out according to electronic databases (Google scholar, PEDro, PubMed, Cochrane DATABASE) for the period from 2006 to 2021. RESULTS High-intensity laser therapy has a wide range of significantly pronounced therapeutic effects. and it is an effective method of treating patients with various diseases. Various technologies and methods of its application are widely used in various fields of clinical medicine. Individually developed therapy protocols are needed, with optimal exposure parameters for each patient, intervals between procedures. CONCLUSION It is advisable to develop more reliable and standard evaluation criteria, regular generalization and analysis of existing evidence, careful planning and implementation of further large-scale randomized controlled trials to study the effects of high-intensity laser radiation both as a single effect and as part of combinations with other treatment methods. The effectiveness of combination therapy requires further analysis in the course of conducting new benign clinical trials.
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Affiliation(s)
- G N Ponomarenko
- Albrecht Federal Scientific Centre of Rehabilitation of the Disabled, St. Petersburg, Russia
- North-Western State Medical University named after I. I. Mechnikov, St. Petersburg, Russia
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19
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Yang Q, Xue P, Fan X, Yin Y, Dang H, Li W, Song B. Lasers treatment for traumatic facial tattoo. Lasers Med Sci 2022; 38:28. [PMID: 36580127 PMCID: PMC9800346 DOI: 10.1007/s10103-022-03658-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/28/2022] [Indexed: 12/30/2022]
Abstract
Effective treatment for traumatic tattoo is lacking. We aimed to compare the effectiveness and safety between Q-1064 nm laser as monotherapy and alternating Q-1064 nm laser with CO2 AFL in treating traumatic facial tattoo (black or blue color) and accompanied scars. Clinical data of 98 patients were grouped and analyzed based on the different treatment lasers. Tattoo clearance was evaluated with a 4-point scale, and scar improvement was analyzed with modified VOSAS scores. Patient satisfaction of the tattoo clearance and scar improvement, and treatment-related complications were analyzed. Significant increased clinical effects with patient satisfaction and decreased worsened scar were confirmed with the two alternated lasers, relative to those with Q-1064 nm laser alone (P < 0.05). Consequently, alternating Q-1064 nm laser and CO2 AFL treatment could be used for traumatic facial tattoo with black or blue color removal safely and effectively.
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Affiliation(s)
- Qing Yang
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Ping Xue
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Xing Fan
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Yue Yin
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Hui Dang
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Wei Li
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China
| | - Baoqiang Song
- Department of Plastic and Reconstructive Surgery, The First Affiliated Hospital of Air Force Medical University (Xijing Hospital), Xi'an, 710032, China.
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20
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Veronese S, Brunetti B, Minichino AM, Sbarbati A. Vacuum and Electromagnetic Fields Treatment to Regenerate a Diffuse Mature Facial Scar Caused by Sulfuric Acid Assault. Bioengineering (Basel) 2022; 9:799. [PMID: 36551005 PMCID: PMC9774184 DOI: 10.3390/bioengineering9120799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 12/15/2022] Open
Abstract
Acid attacks are on the rise, and they cause extensive and deep burns, especially on the face. The treatments used to improve the aesthetic, functional and social impact of non-acid scars do not always prove useful for acid scars. This article reports the case of a woman with an extended, mature, acid facial scar, caused by sulfuric acid assault, treated with a recent new procedure that combines the application of vacuum and electromagnetic fields. Before and after the treatment, the aesthetic appearance, and motor function of the face and neck were evaluated, as well as the level of hydration, the amount of sebum, the elasticity, and the pH of the skin. The improvements highlighted after the treatment of the aesthetic and functional characteristics of the face and neck, and of the physical parameters of the skin seemed to indicate that this particular treatment induces tissue regeneration, even in the nerve component. However, it is evident that the rehabilitation pathways of facial wounds and scars must be personalized, and must include continuous psychological support for the patient.
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Affiliation(s)
- Sheila Veronese
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
| | | | | | - Andrea Sbarbati
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, 37134 Verona, Italy
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21
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Altemir A, Boixeda P. [Translated article] Laser Treatment of Burn Scars. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:T938-T944. [DOI: 10.1016/j.ad.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 06/20/2022] [Indexed: 11/07/2022] Open
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22
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Altemir A, Boixeda P. Tratamiento láser de cicatrices por quemaduras. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:938-944. [DOI: 10.1016/j.ad.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/31/2022] [Accepted: 06/20/2022] [Indexed: 10/15/2022] Open
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23
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Ji Q, Tang J, Hu H, Chen J, Cen Y. Botulinum toxin type A for preventing and treating cleft lip scarring—— A Systematic Review and Meta‐analysis. J Cosmet Dermatol 2022; 21:2331-2337. [PMID: 35347825 DOI: 10.1111/jocd.14941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/16/2022] [Accepted: 03/23/2022] [Indexed: 02/05/2023]
Affiliation(s)
- Qiang Ji
- Department of Burn and Plastic Surgery West China Hospital Sichuan University Guoxue Alley, Wuhou District Chengdu 610041 China
| | - Jun Tang
- Department of Burn and Plastic Surgery West China Hospital Sichuan University Guoxue Alley, Wuhou District Chengdu 610041 China
| | - Hua Hu
- Department of Burn and Plastic Surgery West China Hospital Sichuan University Guoxue Alley, Wuhou District Chengdu 610041 China
| | - Junjie Chen
- Department of Burn and Plastic Surgery West China Hospital Sichuan University Guoxue Alley, Wuhou District Chengdu 610041 China
| | - Ying Cen
- Department of Burn and Plastic Surgery West China Hospital Sichuan University Guoxue Alley, Wuhou District Chengdu 610041 China
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