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Barone S, Bao E, Rothberg S, Palacios JF, Smith IT, Tanna N, Bastidas N. Scar Management in Pediatric Patients. MEDICINA (KAUNAS, LITHUANIA) 2025; 61:553. [PMID: 40282843 PMCID: PMC12028704 DOI: 10.3390/medicina61040553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2025] [Revised: 03/12/2025] [Accepted: 03/19/2025] [Indexed: 04/29/2025]
Abstract
Background and Objectives: Pediatric patients can acquire scars from both accidental injury and surgical procedures. While scars cannot be avoided if a full-thickness injury occurs, scar visibility may be minimized through a variety of approaches. In this narrative review, we evaluate the current evidence and propose an algorithm for scar management in pediatric patients. Materials and Methods: A review of the literature was performed for scar management techniques for pediatric patients. Management modalities based on the type of scar and dosing, treatment regimen, and safety profiles are described in this article and used to create a scar management algorithm. Results: The initial step to scar management in the pediatric population involves ensuring minimal wound tension, which can be achieved through making the incision along relaxed skin tension lines, and early, minimal tension wound closure. Subsequent treatments to optimize scar care should begin 2-3 weeks following wound closure and involve the application of silicone gel or sheets and scar massaging. When topical products are insufficient, laser therapy can be utilized for the management of immature erythematous or thick scars. When mature, pathological scars form such as atrophic scars, hyperpigmentation, hypertrophic scars, or keloids, a combination of modalities is recommended. These modalities vary by scar type and include retinoids and dermabrasion for atrophic scars; retinoids, hydroquinone, and laser therapy for hyperpigmentation; and pressure therapy, corticosteroids, and laser therapy for hypertrophic scars and keloids. When mature, pathological scars persist following 12 months of non-invasive therapies, surgical excision should be considered. Conclusions: Several treatment options are available to manage scars in the pediatric population depending on scar type.
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Affiliation(s)
- Sydney Barone
- Division of Plastic and Reconstructive Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, PA 19140, USA
| | - Eric Bao
- Division of Plastic and Reconstructive Surgery, Northwell Health, New York, NY 10022, USA; (E.B.); (I.T.S.)
| | - Stephanie Rothberg
- Division of Plastic and Reconstructive Surgery, Donald & Barbara Zucker School of Medicine, Hofstra University/Northwell, Hempstead, NY 11549, USA
| | - Jose F. Palacios
- Division of Plastic and Reconstructive Surgery, Northwell Health, New York, NY 10022, USA; (E.B.); (I.T.S.)
- Division of Plastic and Reconstructive Surgery, Donald & Barbara Zucker School of Medicine, Hofstra University/Northwell, Hempstead, NY 11549, USA
| | - Isabelle T. Smith
- Division of Plastic and Reconstructive Surgery, Northwell Health, New York, NY 10022, USA; (E.B.); (I.T.S.)
| | - Neil Tanna
- Division of Plastic and Reconstructive Surgery, Northwell Health, New York, NY 10022, USA; (E.B.); (I.T.S.)
| | - Nicholas Bastidas
- Division of Plastic and Reconstructive Surgery, Northwell Health, New York, NY 10022, USA; (E.B.); (I.T.S.)
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Betar N, Donovan M, Tyack Z, Warren J, McPhail SM, Vujcich E, Brown J. Recovery in patients undergoing ablative fractional carbon dioxide laser for adult hypertrophic burn scars: A longitudinal cohort study. Burns 2025; 51:107300. [PMID: 39549422 DOI: 10.1016/j.burns.2024.107300] [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: 01/21/2023] [Revised: 10/04/2024] [Accepted: 10/22/2024] [Indexed: 11/18/2024]
Abstract
INTRODUCTION Ablative fractional carbon dioxide laser (AFCO2L) is widely used as a treatment for hypertrophic burn scars. This study aimed to evaluate clinician and patient-reported outcomes after AFCO2L treatment, safety, and identify factors influencing outcomes. METHODS This longitudinal study recruited adult patients with hypertrophic burn scars treated with AFCO2L at a single Australian burn unit. Patients received up to four AFCO2L treatments over approximately 12 months. Outcomes were ultrasound scar thickness, the Patient and Observer Scar Assessment Scale (POSAS), and the Brisbane Burn Scar Impact Scale (BBSIP), measured at baseline and 3, 6, and 12 months after the first AFCO2L treatment. Analysis used mixed effects linear models. RESULTS 47 patients were included with median age 32 years (IQR: 24, 53) and median burn TBSA of 35 % (IQR: 7.5 %, 48 %). Statistically significant improvements between baseline and 12-month follow-up occurred in scar thickness, and all POSAS and BBSIP subscores. Most improvements remained when accounting for TBSA, Fitzpatrick skin type, scar maturity, and body area treated. Patients reported transient symptoms after 61 of 89 (69 %) AFCO2L treatments, but infection or delayed wound healing occurred after only 4 of 89 (4 %) treatments. CONCLUSION This study supports safety and improved clinician and patient-reported outcomes in patients undergoing AFCO2L for hypertrophic burn scars.
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Affiliation(s)
- Noah Betar
- Professor Stuart Pegg Adult Burns Centre, Level 4, Dr James Mayne Building, Royal Brisbane & Women's Hospital, Herston, Queensland 4029, Australia.
| | - Michelle Donovan
- Occupational Therapy Department, Level 2, Dr James Mayne Building, Royal Brisbane & Women's Hospital, Herston, Queensland 4029, Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, UQ-Child Health Research Centre Level 6, CCHR Building, The University of Queensland, St Lucia, Queensland 4067, Australia; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jacelle Warren
- Jamieson Trauma Institute, Metro North Health, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia; Digital Health and Informatics Directorate, Metro South Health, Brisbane, Queensland, Australia
| | - Elizabeth Vujcich
- Professor Stuart Pegg Adult Burns Centre, Level 4, Dr James Mayne Building, Royal Brisbane & Women's Hospital, Herston, Queensland 4029, Australia
| | - Jason Brown
- Professor Stuart Pegg Adult Burns Centre, Level 4, Dr James Mayne Building, Royal Brisbane & Women's Hospital, Herston, Queensland 4029, Australia
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Zilinskas K, Mittal R, Hollowed K, Kahn SA. Prophylactic Antibiotics Are Unnecessary for Routine CO2 Laser Burn Scar Treatment. J Burn Care Res 2025; 46:178-182. [PMID: 39087666 DOI: 10.1093/jbcr/irae146] [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: 03/30/2024] [Indexed: 08/02/2024]
Abstract
CO2 ablative fractional laser (CO2 AFL) therapy is a safe and effective procedure when used in the treatment of hypertrophic scars for burn patients. It has a high patient satisfaction rate and a minimal side effect profile, typically consisting of postoperative pain, irritation, surgical site inflammation, and, in rare cases, infection. Although prophylactic antibiotics have historically been recommended, there is a paucity of literature on the topic and recent studies indicate that they may be unnecessary in routine cases. In this retrospective, single-center descriptive study, 230 cases in patients with hypertrophic burn scars treated with CO2 AFL therapy were compared. 28 cases were with the use of prophylactic antibiotics and 201 cases were without the use of prophylactic antibiotics. We found that there was no significant association between the use of antibiotics and the prevention of topical skin infection in cases treated with CO2 AFL therapy (P = 1). Therefore, we conclude that the omission of prophylactic antibiotics is not associated with an increased risk of infection and recommend that prophylactic antibiotics should not be indicated in the setting of routine CO2 AFL therapy for patients with hypertrophic burn scars.
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Affiliation(s)
- Kasparas Zilinskas
- Department of Burn Surgery, Medical University of South Carolina, Charleston, SC 29403, USA
| | - Rohit Mittal
- Department of Burn Surgery, Medical University of South Carolina, Charleston, SC 29403, USA
| | - Kathleen Hollowed
- Department of Burn Surgery, Medical University of South Carolina, Charleston, SC 29403, USA
| | - Steven A Kahn
- Department of Burn Surgery, Medical University of South Carolina, Charleston, SC 29403, USA
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Park JH, Jeong JW, Park JU. Efficacy of Nd:YAG Laser and Intralesional Triamcinolone Injection Combination Therapy in the Postoperative Management of Keloids. Aesthetic Plast Surg 2025; 49:576-583. [PMID: 39373734 PMCID: PMC11814004 DOI: 10.1007/s00266-024-04433-z] [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: 05/08/2024] [Accepted: 09/26/2024] [Indexed: 10/08/2024]
Abstract
BACKGROUND Keloids, characterized by protruding scars that extend beyond the original skin damage site, cause significant emotional stress and reduced quality of life. Their exact pathogenesis remains unclear, with various hypotheses including growth factor imbalances and extracellular matrix changes. No single treatment is universally accepted, but multiple modalities like triamcinolone acetonide injection (TAC), laser therapies, and surgery are commonly used. METHODS This retrospective study involved East Asian patients who underwent keloid scar excision between March 2019 and June 2022. Patients were divided into two groups: one receiving only TAC injections and the other a combination of TAC and Nd:YAG laser therapy. The efficacy of treatments was evaluated using the modified Vancouver Scar Scale (mVSS) and the Patient and Observer Scar Assessment Scale (POSAS), with follow-ups at six and twelve months after operation. RESULTS The study involved 111 patients. Both treatment groups showed significant improvements in mVSS and POSAS scores, but the combination therapy group demonstrated a statistically significant improvement in POSAS scores and lower recurrence rates at 12 months compared to the TAC-only group. However, there was no significant difference in patient satisfaction between the groups. CONCLUSION Dual therapy involving TAC injection and Nd:YAG laser treatment was more effective than TAC injection alone for managing keloid scars after surgery. This combination therapy showed better outcomes in preventing keloid recurrence and improving scar status at 12 months after operation, along with significant improvements in patient-reported outcomes. LEVEL OF EVIDENCE II 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)
- Jun Ho Park
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, 07061, Republic of Korea
| | - Ji Won Jeong
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, 07061, Republic of Korea
| | - Ji-Ung Park
- Department of Plastic and Reconstructive Surgery, SMG-SNU Boramae Medical Center, Seoul National University College of Medicine, 20 Boramae-ro 5-gil, Dongjak-gu, 07061, Republic of Korea.
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Ku YC, Akhavan AA, Hultman CS. Surgical Management of Chronic Neuropathic Burn Pain. Clin Plast Surg 2024; 51:419-434. [PMID: 38789151 DOI: 10.1016/j.cps.2024.02.009] [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: 05/26/2024]
Abstract
Burn-related chronic neuropathic pain can contribute to a decreased quality of life. When medical and pharmacologic therapies prove ineffective, patients should undergo evaluation for surgical intervention, consisting of a detailed physical examination and elective diagnostic nerve block, to identify an anatomic cause of pain. Based on symptoms and physical examination findings, particularly Tinel's sign, treatments can vary, including a trial of laser therapies, fat grafting, or nerve surgeries (nerve decompression, neuroma excision, targeted muscle reinnervation, regenerative peripheral nerve interfaces, and vascularized denervated muscle targets). It is essential to counsel patients to establish appropriate expectations prior to treatment with a multidisciplinary team.
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Affiliation(s)
- Ying C Ku
- Department of Surgery, Campbell University School of Osteopathic Medicine, 4350 US Highway 421 South, Lillington, NC 27546, USA
| | - Arya Andre Akhavan
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Rutgers New Jersey Medical School, 90 Bergen St., Newark, NJ 07103
| | - Charles Scott Hultman
- Department of Plastic and Reconstructive Surgery, WPP Plastic and Reconstructive Surgery, WakeMed Health and Hospitals, 3000 New Bern Avenue, Raleigh, NC 27610, USA.
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Sinha S, Gabriel VA, Arora RK, Shin W, Scott J, Bharadia SK, Verly M, Rahmani WM, Nickerson DA, Fraulin FO, Chatterjee P, Ahuja RB, Biernaskie JA. Interventions for postburn pruritus. Cochrane Database Syst Rev 2024; 6:CD013468. [PMID: 38837237 PMCID: PMC11152192 DOI: 10.1002/14651858.cd013468.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
BACKGROUND Postburn pruritus (itch) is a common and distressing symptom experienced on healing or healed burn or donor site wounds. Topical, systemic, and physical treatments are available to control postburn pruritus; however, it remains unclear how effective these are. OBJECTIVES To assess the effects of interventions for treating postburn pruritus in any care setting. SEARCH METHODS In September 2022, we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE (including In-Process & Other Non-Indexed Citations), Ovid Embase, and EBSCO CINAHL Plus. We also searched clinical trials registries and scanned references of relevant publications to identify eligible trials. There were no restrictions with respect to language, publication date, or study setting. SELECTION CRITERIA Randomised controlled trials (RCTs) that enrolled people with postburn pruritus to compare an intervention for postburn pruritus with any other intervention, placebo or sham intervention, or no intervention. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence. MAIN RESULTS We included 25 RCTs assessing 21 interventions with 1166 randomised participants. These 21 interventions can be grouped into six categories: neuromodulatory agents (such as doxepin, gabapentin, pregabalin, ondansetron), topical therapies (such as CQ-01 hydrogel, silicone gel, enalapril ointment, Provase moisturiser, beeswax and herbal oil cream), physical modalities (such as massage therapy, therapeutic touch, extracorporeal shock wave therapy, enhanced education about silicone gel sheeting), laser scar revision (pulsed dye laser, pulsed high-intensity laser, fractional CO2 laser), electrical stimulation (transcutaneous electrical nerve stimulation, transcranial direct current stimulation), and other therapies (cetirizine/cimetidine combination, lemon balm tea). Most RCTs were conducted at academic hospitals and were at a high risk of performance, attrition, and detection bias. While 24 out of 25 included studies reported change in burn-related pruritus, secondary outcomes such as cost-effectiveness, pain, patient perception, wound healing, and participant health-related quality of life were not reported or were reported incompletely. Neuromodulatory agents versus antihistamines or placebo There is low-certainty evidence that doxepin cream may reduce burn-related pruritus compared with oral antihistamine (mean difference (MD) -2.60 on a 0 to 10 visual analogue scale (VAS), 95% confidence interval (CI) -3.79 to -1.42; 2 studies, 49 participants). A change of 2 points represents a minimal clinically important difference (MCID). Due to very low-certainty evidence, it is uncertain whether doxepin cream impacts the incidence of somnolence as an adverse event compared to oral antihistamine (risk ratio (RR) 0.64, 95% CI 0.32 to 1.25; 1 study, 24 participants). No data were reported on pain in the included study. There is low-certainty evidence that gabapentin may reduce burn-related pruritus compared with cetirizine (MD -2.40 VAS, 95% CI -4.14 to -0.66; 1 study, 40 participants). A change of 2 points represents a MCID. There is low-certainty evidence that gabapentin reduces the incidence of somnolence compared to cetirizine (RR 0.02, 95% CI 0.00 to 0.38; 1 study, 40 participants). No data were reported on pain in the included study. There is low-certainty evidence that pregabalin may result in a reduction in burn-related pruritus intensity compared with cetirizine with pheniramine maleate (MD -0.80 VAS, 95% CI -1.24 to -0.36; 1 study, 40 participants). A change of 2 points represents a MCID. There is low-certainty evidence that pregabalin reduces the incidence of somnolence compared to cetirizine (RR 0.04, 95% CI 0.00 to 0.69; 1 study, 40 participants). No data were reported on pain in the included study. There is moderate-certainty evidence that ondansetron probably results in a reduction in burn-related pruritus intensity compared with diphenhydramine (MD -0.76 on a 0 to 10 numeric analogue scale (NAS), 95% CI -1.50 to -0.02; 1 study, 38 participants). A change of 2 points represents a MCID. No data were reported on pain and adverse events in the included study. Topical therapies versus relevant comparators There is moderate-certainty evidence that enalapril ointment probably decreases mean burn-related pruritus compared with placebo control (MD -0.70 on a 0 to 4 scoring table for itching, 95% CI -1.04 to -0.36; 1 study, 60 participants). No data were reported on pain and adverse events in the included study. Physical modalities versus relevant comparators Compared with standard care, there is low-certainty evidence that massage may reduce burn-related pruritus (standardised mean difference (SMD) -0.86, 95% CI -1.45 to -0.27; 2 studies, 166 participants) and pain (SMD -1.32, 95% CI -1.66 to -0.98). These SMDs equate to a 4.60-point reduction in pruritus and a 3.74-point reduction in pain on a 10-point VAS. A change of 2 VAS points in itch represents a MCID. No data were reported on adverse events in the included studies. There is low-certainty evidence that extracorporeal shock wave therapy (ESWT) may reduce burn-related pruritus compared with sham stimulation (SMD -1.20, 95% CI -1.65 to -0.75; 2 studies, 91 participants). This equates to a 5.93-point reduction in pruritus on a 22-point 12-item Pruritus Severity Scale. There is low-certainty evidence that ESWT may reduce pain compared with sham stimulation (MD 2.96 on a 0 to 25 pressure pain threshold (PPT), 95% CI 1.76 to 4.16; 1 study, 45 participants). No data were reported on adverse events in the included studies. Laser scar revision versus untreated or placebo controls There is moderate-certainty evidence that pulsed high-intensity laser probably results in a reduction in burn-related pruritus intensity compared with placebo laser (MD -0.51 on a 0 to 1 Itch Severity Scale (ISS), 95% CI -0.64 to -0.38; 1 study, 49 participants). There is moderate-certainty evidence that pulsed high-intensity laser probably reduces pain compared with placebo laser (MD -3.23 VAS, 95% CI -5.41 to -1.05; 1 study, 49 participants). No data were reported on adverse events in the included studies. AUTHORS' CONCLUSIONS There is moderate to low-certainty evidence on the effects of 21 interventions. Most studies were small and at a high risk of bias related to blinding and incomplete outcome data. Where there is moderate-certainty evidence, practitioners should consider the applicability of the evidence for their patients.
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Affiliation(s)
- Sarthak Sinha
- Department of Comparative Biology and Experimental Medicine, University of Calgary, Calgary, Canada
| | - Vincent A Gabriel
- Departments of Clinical Neurosciences, Pediatrics and Surgery, University of Calgary, Calgary Firefighters' Burn Treatment Centre, Calgary, Canada
| | - Rohit K Arora
- Department of Comparative Biology and Experimental Medicine, University of Calgary, Calgary, Canada
| | - Wisoo Shin
- Department of Comparative Biology and Experimental Medicine, University of Calgary, Calgary, Canada
| | - Janis Scott
- Calgary Firefighters' Burn Treatment Centre, Calgary, Canada
| | - Shyla K Bharadia
- Departments of Clinical Neurosciences, Pediatrics and Surgery, University of Calgary, Calgary Firefighters' Burn Treatment Centre, Calgary, Canada
| | - Myriam Verly
- Division of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Canada
| | - Waleed M Rahmani
- Department of Comparative Biology and Experimental Medicine, University of Calgary, Calgary, Canada
| | - Duncan A Nickerson
- Department of Plastic, Burn and Wound Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Frankie Og Fraulin
- Division of Plastic and Reconstructive Surgery, University of Calgary, Calgary, Canada
- Department of Surgery, Alberta Health Services, Alberta Children's Hospital, Calgary, Canada
| | - Pallab Chatterjee
- Department of Plastic Surgery, Surgical Division, Command Hospital Air Force, Bengaluru, India
| | - Rajeev B Ahuja
- Department of Plastic Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Jeff A Biernaskie
- Department of Comparative Biology and Experimental Medicine, University of Calgary, Calgary, Canada
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Mota WM, Salles AG, Remigio AFDN, Gemperli R, Alonso N. Microneedling in the Treatment of Post-burn Hypertrophic Scars. Aesthetic Plast Surg 2024; 48:2321-2329. [PMID: 38238571 DOI: 10.1007/s00266-023-03820-2] [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: 09/04/2023] [Accepted: 12/14/2023] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Post-burn hypertrophic scars are an important cause of physical discomfort, limitation of movements, psychological disorders, low self-esteem and reduced quality of life. Treatment for this condition is complex and involves several options. Microneedling, also known as minimally invasive percutaneous collagen induction, is an affordable minimally invasive option that can be combined with other treatments, including ablative ones. OBJECTIVE The goal of this study was to present our microneedling approach for the treatment of hypertrophic scars after burns. METHOD A prospective study of 15 patients with post-burn hypertrophic scars was conducted between October 2016 and June 2022. All patients were treated with microneedling and drug delivery of triamcinolone. Scars were evaluated using Vancouver Scar Scale (VSS), Burn Scar Assessment Scale (BSAS) and angle measurement for amplitude of movement evaluation of joints. RESULTS A significant improvement in the VSS score was obtained after microneedling (8.8 ± 0.44 to 4.1 ± 0.98; p = 0.012), especially in the acute group (less than 1 year after burns): 9.3 ± 0.49 to 3.5 ± 1.36; p = 0.041. There was a significant and progressive improvement of the scars throughout the treatment sessions in all criteria evaluated and in the ranges of joint movement (p = 0.012). CONCLUSION Our microneedling protocol promoted a significant improvement of post-burn scars, especially in acute hypertrophic scars, and in the amplitude of joint motion. Sequential treatments provided progressive improvement. 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)
- Wellington Menezes Mota
- Division of Plastic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil
- Sociedade Brasileira de Cirurgia Plástica (SBCP), São Paulo, Brazil
| | - Alessandra Grassi Salles
- Division of Plastic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil.
- Sociedade Brasileira de Cirurgia Plástica (SBCP), São Paulo, Brazil.
| | - Adelina Fátima do Nascimento Remigio
- Division of Plastic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil
- Sociedade Brasileira de Cirurgia Plástica (SBCP), São Paulo, Brazil
| | - Rolf Gemperli
- Division of Plastic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil
- Sociedade Brasileira de Cirurgia Plástica (SBCP), São Paulo, Brazil
| | - Nivaldo Alonso
- Division of Plastic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil
- Sociedade Brasileira de Cirurgia Plástica (SBCP), São Paulo, Brazil
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Molina EA, Travis TE, Hussein L, Oliver MA, Keyloun JW, Moffatt LT, Shupp JW, Carney BC. Treatment of hypopigmented burn hypertrophic scars with short-term topical tacrolimus does not lead to repigmentation. Lasers Surg Med 2024; 56:175-185. [PMID: 38225772 DOI: 10.1002/lsm.23754] [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: 10/17/2023] [Revised: 12/18/2023] [Accepted: 12/28/2023] [Indexed: 01/17/2024]
Abstract
OBJECTIVES Dyschromia is an understudied aspect of hypertrophic scar (HTS). The use of topical tacrolimus has successfully shown repigmentation in vitiligo patients through promotion of melanogenesis and melanocyte proliferation. It was hypothesized that HTSs treated with topical tacrolimus would have increased repigmentation compared to controls. METHODOLOGY Full-thickness burns in red Duroc pigs were either treated with excision and meshed split-thickness skin grafting or excision and no grafting, and these wounds formed hypopigmented HTSs (n = 8). Half of the scars had 0.1% tacrolimus ointment applied to the scar twice a day for 21 days, while controls had no treatment. Further, each scar was bisected with half incurring fractional ablative CO2 laser treatment before topical tacrolimus application to induce laser-assisted drug delivery (LADD). Pigmentation was evaluated using a noninvasive probe to measure melanin index (MI) at Days 0 (pretreatment), 7, 14, and 21. At each timepoint, punch biopsies were obtained and fixed in formalin or were incubated in dispase. The formalin-fixed biopsies were used to evaluate melanin levels by H&E staining. The biopsies incubated in dispase were used to obtain epidermal sheets. The ESs were then flash frozen and RNA was isolated from them and used in quantitative reverse transcription polymerase chain reaction for melanogenesis-related genes: Tyrosinase (TYR), TYR-related protein-1 (TYRP1), and dopachrome tautomerase (DCT). Analysis of variance test with Šídák's multiple comparisons test was used to compare groups. RESULTS Over time, within the grafted HTS and the NS group, there were no significant changes in MI, except for Week 3 in the -Tacro group. (+Tacro HTS= pre = 685.1 ± 42.0, w1 = 741.0 ± 54.16, w2 = 750.8 ± 59.0, w3 = 760.9 ± 49.8) (-Tacro HTS= pre = 700.4 ± 54.3, w1 = 722.3 ± 50.7, w2 = 739.6 ± 53.2, w3 = 722.7 ± 50.5). Over time, within the ungrafted HTS and the NS group, there were no significant changes in MI. (+Tacro HTS= pre = 644.9 ± 6.9, w1 = 661.6 ± 3.3, w2 = 650.3 ± 6.2, w3 = 636.3 ± 7.4) (-Tacro HTS= pre = 696.8 ± 8.0, w1 = 695.8 ± 12.3, w2 = 678.9 ± 14.0, w3 = 731.2 ± 50.3). LADD did not lead to any differential change in pigmentation compared to the non-LADD group. There was no evidence of increased melanogenesis within the tissue punch biopsies at any timepoint. There were no changes in TYR, TYRP1, or DCT gene expression after treatment. CONCLUSION Hypopigmented HTSs treated with 0.1% tacrolimus ointment with or without LADD did not show significantly increased repigmentation. This study was limited by a shorter treatment interval than what is known to be required in vitiligo patients for repigmentation. The use of noninvasive, topical treatments to promote repigmentation are an appealing strategy to relieve morbidity associated with dyschromic burn scars and requires further investigation.
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Affiliation(s)
- Esteban A Molina
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Taryn E Travis
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Lou'ay Hussein
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - Mary A Oliver
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
| | - John W Keyloun
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
| | - Lauren T Moffatt
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Biochemistry and Molecular Biology, Georgetown University School 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
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Biochemistry and Molecular Biology, 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
- The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Biochemistry and Molecular Biology, Georgetown University School of Medicine, Washington, District of Columbia, USA
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Raborn LN, Janis JE. Prevention and Treatment of Burn Scar Contracture: A Practical Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5333. [PMID: 38250207 PMCID: PMC10798744 DOI: 10.1097/gox.0000000000005333] [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: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 01/23/2024]
Abstract
Burn contracture affects close to one-third of all burn patients, leading to significant functional impairment and costs. Effective prevention and treatment strategies are necessary to decrease morbidity and unnecessary costs. This scoping review aimed to summarize prevention and treatment strategies used for management of burn scar contractures published in the literature since 2000. A comprehensive PubMed review was performed in October 2022 to identify methods of burn contracture prevention and treatments. Non-English, duplicate, and unavailable articles were excluded. Data were extracted including publication year, techniques, and outcomes. A total of 327 publications met criteria for inclusion. Most articles were published in 2011 (n = 22). Treatment strategies were discussed in 82.9% of studies, prevention in 16.5%, and both in 0.6%. The most common areas discussed included the upper extremity (n = 127) and neck (n = 102). Flaps were the most frequently used method (n = 208), followed by autografts (n = 89). Most preventative therapies were still in early stages of development. Burn contracture management requires a highly individualized approach with many available reconstructive techniques available. Further research is needed to improve prevention techniques and decrease morbidity and cost to patients.
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Affiliation(s)
- Layne N. Raborn
- From the Division of Plastic Surgery, University of Rochester Medical Center, Rochester, N.Y
| | - Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, Ohio State University, Wexner Medical Center Columbus, Ohio
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10
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Bai Y, Zhang Y, Ni W, Yao M. Laser, Intense Pulsed Light, and Radiofrequency for the Treatment of Burn Scarring: A Systematic Review and Meta-Analysis. EUROPEAN BURN JOURNAL 2023; 4:142-162. [PMID: 39599923 PMCID: PMC11571841 DOI: 10.3390/ebj4020013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 11/29/2024]
Abstract
Burns and scarring are considered some of the greatest problems in public health because of their frequent occurrence. Today, photo-electric technology shows promising results in the treatment of burn scars. Over the years, more clinical trials and more technologies for scarring have emerged. The aim of this study was to determine better timing and methods of photo-electric therapy for burn scars. This study was registered in PROSPERO (CRD42023397244), following the PRISMA statement, and was carried out in concordance with the PRISMA checklist. In October 2022, we searched PubMed.gov, Embase, and the Cochrane library (1980-present) for published studies related to the photo-electric treatment of burn scars. Two review authors independently selected the studies, extracted the data, assessed the risk of bias among the studies included, and carried out NIH assessments to assess the certainty of the evidence. A third review author arbitrated any disagreements. Our research included 39 studies. We found evidence suggesting that photo-electric therapy between six months and one year offers significantly better outcomes than treatment of scarring after one year. The evidence also suggests the use of IPL for the treatment of early burn scarring. However, it is important to emphasize that the scientific evidence remains insufficient. We need more clinical trials of higher quality and with less heterogeneity to confirm our results.
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Affiliation(s)
- Yubing Bai
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Yiqiu Zhang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Wei Ni
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430000, China
| | - Min Yao
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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11
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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: 0.3] [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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12
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Analysis of the Utility of CO2 and Pulse-Dye Lasers Together and Separately in the Treatment of Hypertrophic Burn Scars. Ann Plast Surg 2022; 89:166-172. [PMID: 35943226 DOI: 10.1097/sap.0000000000003240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Hypertrophic burn scars (HTBSs) remain a significant source of morbidity. Contemporary treatment has evolved to use CO2 lasers and/or pulse-dye lasers (PDLs) to reduce scar thickness (ST) and erythema. This study seeks to compare treatment efficacy with CO2 or PDL individually and in combination. METHODS Patients undergoing laser treatments for HTBSs were enrolled. Three 3 × 3 cm squares of HTBSs were randomized to receive treatment with CO2 laser, PDL or CO2 + PDL. Patients underwent 3 treatments, 4 to 6 weeks apart and were followed up over 3 to 6 months. Scar assessments occurred at each visit before treatment and consisted of photographs, ultrasound, colorimetry, and the Patient and Observer Scar Assessment Score. RESULTS Twenty-five patients were enrolled. Twenty completed 2 treatments (80%) and 11 completed all 3 treatments (44%). Median initial ST was 0.3 cm. Median time since injury was 8 months. Hypertrophic burn scars treated with CO2 or PDL showed a significant decrease in Patient and Observer Scar Assessment Scale score from visit 1 to 3 (P = 0.01 and 0.01, respectively). When separated by ST, thick scars (≥0.3 cm) showed a significant decrease in thickness between visit 1 and 2 using all laser modalities (CO2 + PDL, P = 0.01; CO2, P = 0.02; PDL, P = 0.03). Thin scars (<0.3 cm) showed a reduction in thickness by visit 3 after CO2 + PDL or PDL alone (P = 0.01 and 0.04, respectively). Separating scars by age, younger scars (<9 months) showed a significant reduction in thickness between visit 1 and 2 for CO2 treatment (P = 0.04), and between visit 2 and 3 for CO2 + PDL treatment (P = 0.04). Hypertrophic burn scars treated with PDL did not demonstrate a significant reduction in thickness until visit 3 (P = 0.002). Older scars (≥9 months) showed a significant reduction in thickness between visit 1 and 2 only after CO2 + PDL (P = 0.01). CONCLUSIONS Hypertrophic burn scars of varying ages, etiologies, and thicknesses were examined in this study with greater degree of early reduction seen in thicker scars using all laser modalities of CO2, PDL or in combination. However, there was no clinically meaningful benefit found with combination as compared with individual treatment. These data support the use of laser to improve HTBS but does not support one modality or combination of modalities over another.
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13
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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: 5] [Impact Index Per Article: 1.7] [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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14
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Xu H, Li J, Zhou Z, Bi J, Li X, Huo R. Skin Wound Tension Reduction Device Combined with Ablative Fractional Carbon Dioxide Laser to Reduce Scar Formation After Excision of Pediatric Facial Skin Lesions: A Prospective Cohort Study. CLINICAL, COSMETIC AND INVESTIGATIONAL DERMATOLOGY 2022; 15:283-292. [PMID: 35228810 PMCID: PMC8881920 DOI: 10.2147/ccid.s347065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/16/2022] [Indexed: 11/23/2022]
Abstract
Purpose To investigate the efficacy of skin wound tension reduction device (SWTRD) combined with ablative fractional carbon dioxide laser (CO2-AFL) for the prevention of scar formation following the excision of facial cutaneous lesions in children. Methods Patients undergoing surgical excision of facial cutaneous lesions in our hospital between May 2019 and April 2021 were enrolled. After the excision of facial cutaneous lesions and based on the personal intents and conditions, patients were assigned to undergo SWTRD combined with CO2-AFL. Outcome evaluations were as follows: defect size, incision width, scar width, the Vancouver Scar Scale (VSS) and University of North Carolina 4P Scar Scale (UNC4P). Results A total of 25 pediatric patients (mean age, 9.88 years) were enrolled in the study. Following the treatment of SWTRD+CO2-AFL, scar widths were relatively narrow and the appearance of the incision scars was significantly improved. A significant reduction in the patient-reported UNC4P scores at 6 months (3, 1–4) was observed when compared with that at 2 months (0, 0–1) after surgery (p<0.001). A similar reduction in the VSS scar scale was also evident (6 months: 1, 0.75–2.5 vs 2 months: 6.5–8.5; p<0.001). Conclusion Combined SWTRD and CO2-AFL treatment effectively modulates the scar formation after the incision is healed and resulting in preventing scar widening, leading to the improvement of scar appearance, reduction in wound pain and pruritus and its overall prognosis.
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Affiliation(s)
- Haiting Xu
- Department of Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.,Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Jing Li
- Department of Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Zifu Zhou
- Department of Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Jianhai Bi
- Department of Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Xiaoyang Li
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China
| | - Ran Huo
- Department of Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China.,Department of Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People's Republic of China
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15
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Pan L, Qin H, Li C, Zhang G, Yang L, Zhang L. Efficacy of the Neodymium-Doped Yttrium Aluminum Garnet Laser in the Treatment of Keloid and Hypertrophic Scars: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2022; 46:1997-2005. [PMID: 35059813 DOI: 10.1007/s00266-021-02716-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/06/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Keloid and hypertrophic scars are the most common types of pathological scars. They can cause itching, pain, erythema, and psychological stress due to cosmetic problems, decreasing the quality of life for affected individuals. The neodymium-doped yttrium aluminum garnet (Nd:YAG) multipurpose laser is used to treat pathological scars, and studies have shown that the Nd:YAG laser can markedly improve scarring. AIMS We performed a meta-analysis to evaluate the efficacy of the Nd:YAG laser in the treatment of keloid and hypertrophic scars. METHODS A literature search of PubMed, Web of Science, Scopus, Cochrane, Embase, CNKI, and Wanfang was performed between January 1st, 2010, and July 14th, 2021. The Vancouver Scar Scale (VSS) was used to evaluate treatment outcomes. We used the R version 4.0.0 software for statistical analysis. RESULTS The Nd:YAG laser improved the condition of keloid and hypertrophic scars and reduced VSS score (mean difference [MD]: 2.96, 95% confidence interval [CI]: 2.08-3.84, p < 0.01). There was no obvious difference in the results between regions. A subgroup analysis by scar type revealed that the curative effect of the Nd:YAG laser on keloid scars (MD: 2.02, 95% CI: 0.58-4.63, p = 0.10) was less marked compared with that on hypertrophic scars (MD: 3.05, 95% CI: 1.58-4.52, p < 0.01). With the combined use of the Nd:YAG laser and other treatment methods, a more significant change in VSS score was noted (MD: 4.28, 95% CI: 2.07-6.49). CONCLUSIONS This meta-analysis showed that the Nd:YAG laser can improve the condition of keloid and hypertrophic scars and effectively reduce VSS score. Moreover, the curative effect of this approach on keloid scars is less marked compared with that on hypertrophic scars. 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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Brewin M, Docherty S, Heaslip V, Breheny K, Pleat J, Rhodes S. Early Laser for Burn Scars (ELABS): protocol for a multi-centre randomised, controlled trial of both the effectiveness and cost-effectiveness of the treatment of hypertrophic burn scars with Pulsed Dye Laser and standard care compared to standard care alone [version 1; peer review: 2 approved]. NIHR OPEN RESEARCH 2022; 2:1. [PMID: 35392303 PMCID: PMC7612584 DOI: 10.3310/nihropenres.13234.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/22/2022]
Abstract
This paper outlines the protocol for a study that is being carried out at multiple centres across the UK in the next three years. It is a Research for Patient Benefit (RfPB) study funded by the National Institute for Healthcare Research (NIHR). The aim is to assess the effectiveness of treating hypertrophic burns scars with pulsed dye laser (PDL) at an early stage of scar formation. The objective is to improve Quality of Life for the patient by improving both the appearance and quality of burn scarring, as well as reducing its psychological impact. This is a parallel-arm randomised, controlled trial to compare PDL and standard care against standard care alone. The difference is measured between baseline and six-month follow-up. Recruits are within three months of healing from a burn injury; with wounds showing a defined potential for hypertrophic scarring. A total of 120 patients are recruited in a multi-centre study; with randomisation in a 1:1 allocation to each arm. The treatment arm receives 3 PDL treatments at six-week intervals in addition to standard care, whereas the control arm receives standard care alone. The primary outcome is the patient-rated part of the Patient and Observer Scar Scale (POSAS). Psychological and psycho-social impact is evaluated using the CARe burn scale (UWE, Bristol) and Quality Adjusted Life Years (QALY) is determined using the Short-Form Health Survey (SF-12). The study evaluates both the cost-effectiveness through an economic analysis and the patient-reported experience of the treatment by phone interviews.
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Affiliation(s)
- Mark Brewin
- Burns & Plastics, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, SP2 8BJ, UK
| | | | | | | | - Jonathon Pleat
- Burns & Plastics, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Shelley Rhodes
- Exeter Clinical Trials Unit, University of Exeter, Exeter, EX4 4SB, UK
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Tsai HH, Hsieh CH, Lin CH, Tsai YJ, Chi SY, Hsieh MH, Lin KC, Lin HP, Hsu SY. Facilitated delivery of topical steroids after fractional ablative carbon dioxide laser benefits postthyroidectomy hypertrophic scar. DERMATOL SIN 2022. [DOI: 10.4103/ds.ds_54_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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18
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Lin CH, Tsai YJ, Lin KC, Hsieh MH, Lin HP, Hsu SY, Tsai HH, Hsieh CH. Laser-Assisted Drug Delivery of Tranexamic Acid by Picosecond Laser in Postinflammatory Hyperpigmentation: A Split-Area Double Blind Randomized Prospective Study. PHOTOBIOMODULATION PHOTOMEDICINE AND LASER SURGERY 2021; 39:711-715. [PMID: 34762534 DOI: 10.1089/photob.2021.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Tranexamic acid has been reported to benefit the treatment of postinflammatory hyperpigmentation (PIH). Laser-assisted drug delivery (LADD) could facilitate the efficacy of topically applied drugs into the dermis. This split-area randomized prospective study aims to assess whether early utilization of the LADD procedure with tranexamic acid delivery followed by picosecond lasers can attenuate the PIH better than the utilization of picosecond lasers alone. Patients and methods: Ten post-traumatic cases of PIH in 10 patients (8 female and 2 male) with an average age of 34.2 ± 11.2 years were included in this clinical trial. Using block randomization to determine the treatment side, one side of each area of the PIH was separated from the midline into two halves belonging to the control and tranexamic acid groups. The half area of the tranexamic acid group was further topically applied with 10% tranexamic acid solution. This procedure was repeated every 6 weeks, four times in total. Results: The self-assessment of the hyperpigmentation and overall satisfaction of the treatment outcome were not significantly different between the treatment and control sides. Conclusions: This split-area study revealed that, compared with picosecond alone, there was no significant difference adopting tranexamic acid in LADD after nonablative fractional picosecond laser for PIH.
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Affiliation(s)
- Cen-Hung Lin
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Yueh-Ju Tsai
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Ko-Chien Lin
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Mu-Han Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Hui-Ping Lin
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
| | | | - Ching-Hua Hsieh
- Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University and College of Medicine, Kaohsiung, Taiwan
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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: 11] [Impact Index Per Article: 2.8] [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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Elgarhy LH, El-Tatawy RA, Abdelaziz D, Dogheim NN. Pulsed dye laser versus ablative fractional CO 2 laser in treatment of old hypertrophic scars: Clinicopathological study. Wound Repair Regen 2021; 29:417-424. [PMID: 33599018 DOI: 10.1111/wrr.12904] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/29/2021] [Accepted: 02/04/2021] [Indexed: 12/14/2022]
Abstract
There is a continuous need to find out the best treatment for old hypertrophic scars (OHSs). Thirty patients with OHSs were included. Each scar was divided into right half treated with PDL (handpiece with a 7-mm spot, pulse duration of 1.5 ms and fluence of 6 J/cm2 ) and left half treated with FrCo2 laser (15 W, spacing 800 μm, dwelling time 600 μs and stack 3) once every month for three sessions. Scars were assessed before and after treatment clinically by Vancouver Scar Scale (VSS) and histologically using hematoxylin and eosin (H&E), Masson trichrome and orcein stains. Both halves showed statistically significant improvement after treatment. However, there was no statistically significant difference in VSS between them (P = 0.176). FrCo2 laser showed more significant improvement in pliability and height (Pp = 0.017, Ph = 0,011), while, PDL showed more significant improvement in vascularity (P = 0.039) of OHSs. Both PDL and ablative FrCo2 laser were effective in the treatment of OHSs, however, FrCo2 laser was more effective in improving OHSs pliability, and height which are the main concern in OHSs.
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Affiliation(s)
- Lamia Hamouda Elgarhy
- Department of Dermatology & Venereology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Rania Ahmed El-Tatawy
- Department of Dermatology & Venereology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Dareen Abdelaziz
- Department of Dermatology & Venereology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Noha Nabil Dogheim
- Department of Dermatology & Venereology, Faculty of Medicine, Tanta University, Tanta, Egypt
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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: 0.5] [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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22
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Dai Z, Lou X, Shen T, Sun Y, Xiao Y, Zheng X, Wang X, Peng Y, Guo Y, Guo Y, Wen J, Fang H, Ma B, Xia Z. Combination of ablative fractional carbon dioxide laser and platelet-rich plasma treatment to improve hypertrophic scars: a retrospective clinical observational study. BURNS & TRAUMA 2021; 9:tkab016. [PMID: 34337088 PMCID: PMC8316760 DOI: 10.1093/burnst/tkab016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/20/2021] [Accepted: 04/16/2021] [Indexed: 04/28/2023]
Abstract
BACKGROUND Hypertrophic scars are one of the main complications that affect the quality of life of patients after burns. Many methods have been shown to be effective in the treatment of hypertrophic scars, such as ablative fractional CO2 laser (AFCL) and platelet-rich plasma (PRP). However, there are few studies on the effect of the combined application of these measures. The purpose of this study was to explore the therapeutic effect of AFCL combined with PRP on hypertrophic burn scars. METHODS A retrospective clinical observation study was conducted on 50 patients with hypertrophic burn scars. The AFCL+PRP group included 31 patients who received AFCL combined with PRP treatment; the AFCL group included 19 patients who received AFCL treatment only. The University of North Carolina 4P Scar Scale (UNC4P) and the Vancouver Scar Scale (VSS) scores that were collected before each treatment were used as indicators of the effectiveness of the previous treatment. The scores recorded at the second, fourth and seventh months were analysed. RESULTS The demographic data of the 2 groups were not significantly different. Before treatment, there was no difference in the UNC4P and VSS scores between the 2 groups. There was a significant decline in the UNC4P and VSS total scores over 6 months in both groups (p < 0.05) and scores in the 2 groups were comparable after 3 and 6 months (p < 0.05). UNC4P scores in the AFCL+PRP group decreased from a mean of 8.26 to 2.61 (p < 0.05) with a concomitant drop in VSS scores from a mean of 11.74 to 6.06 (p < 0.01). In the AFCL group UNC4P and VSS scores decreased from 7.68 to 4.63 (p < 0.05) and from 10.89 to 8.16 (p < 0.05), respectively. The sub-items of these 2 assessments were analysed and the results suggest that AFCL combined with PRP can comprehensively improve scarring. CONCLUSIONS This study shows that PRP is an effective adjunct for AFCL in the treatment of hypertrophic burn scars and that the combination of PRP and AFCL proved to be more useful than AFCL alone. This combination may be a new and effective clinical practice for the treatment of scars. However, larger and higher-level clinical studies are still needed to determine its efficacy and possible mechanisms.
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Affiliation(s)
- Zhanzhan Dai
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University; Burn Institute of PLA; 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, 168 Changhai Road, Yangpu District, Shanghai 200433, China
| | - Xiaozhen Lou
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University; Burn Institute of PLA; 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, 168 Changhai Road, Yangpu District, Shanghai 200433, China
| | - Tuo Shen
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University; Burn Institute of PLA; 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, 168 Changhai Road, Yangpu District, Shanghai 200433, China
| | - Yu Sun
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University; Burn Institute of PLA; 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, 168 Changhai Road, Yangpu District, Shanghai 200433, China
| | - Yongqiang Xiao
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University; Burn Institute of PLA; 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Department of Burn and Plastic Surgery, the 970th Hospital of People's Liberation Army, 7 Zhichunan Road, Zhifu District, Yantai, Shandong, 264000, China
| | - Xingfeng Zheng
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University; Burn Institute of PLA; 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, 168 Changhai Road, Yangpu District, Shanghai 200433, China
| | - Xuexin Wang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University; Burn Institute of PLA; 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, 168 Changhai Road, Yangpu District, Shanghai 200433, China
| | - Yu Peng
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University; Burn Institute of PLA; 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, 168 Changhai Road, Yangpu District, Shanghai 200433, China
| | - Yukun Guo
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University; Burn Institute of PLA; 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, 168 Changhai Road, Yangpu District, Shanghai 200433, China
| | - Yibin Guo
- Department of Health Statistics, the Naval Medical University, 800 Xiangyin Road, Yangpu District, Shanghai 200433, China
| | - Jiannan Wen
- First Resident Outpatient Department of Northern Theater General Hospital, 22 Beiwu Road, Heping District, Shenyang, Liaoning Province, 110001, China
| | - He Fang
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University; Burn Institute of PLA; 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Correspondence. He Fang, ; Bing Ma, ; Zhaofan Xia,
| | - Bing Ma
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University; Burn Institute of PLA; 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Correspondence. He Fang, ; Bing Ma, ; Zhaofan Xia,
| | - Zhaofan Xia
- Department of Burn Surgery, the First Affiliated Hospital of Naval Medical University; Burn Institute of PLA; 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Research Unit of key techniques for treatment of burns and combined burns and trauma injury, Chinese Academy of Medical Sciences, 168 Changhai Road, Yangpu District, Shanghai 200433, China
- Correspondence. He Fang, ; Bing Ma, ; Zhaofan Xia,
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Liu H, Chen S, Zhu X, Zhou Z, Zhang J, Xu H. Before-after cohort study to assess the efficacy of fractional ablative carbon dioxide laser treatment of pediatric hand scars. Lasers Med Sci 2020; 36:1455-1460. [PMID: 33169274 DOI: 10.1007/s10103-020-03186-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 11/03/2020] [Indexed: 11/26/2022]
Abstract
The purpose of this study is to investigate the efficacy of fractional ablative carbon dioxide laser (AFXL) surgery in patients with pediatric hand scars. This study enrolled hand scar patients who received treatment in our hospital between May 2018 and April 2019. Patients were assigned to undergo AFXL surgery based on their personal intents and condition, whereas the fractional laser was used for stiffness and abnormal texture. Outcomes were as follows: hand function was evaluated using the Michigan hand outcomes questionnaire; scar condition was evaluated using the Vancouver scar scale and UNC4P scar scale. Total 30 pediatric patients (mean age, 11.4 years) were eligible for the study and laser-treated scars were significantly improved in Michigan hand outcomes questionnaire from 52.30 ± 6.14 to 66.91 ± 6.43 (p < 0.001). Provider-rated Vancouver scar scale dropped from 8.80 ± 2.75 to 6.73 ± 2.52 (p < 0.001). Patient-reported UNC4P scar scale declined from7.07 ± 2.02 to 4.73 ± 1.31 (p < 0.001). AFXL surgery can significantly improve hand function and appearance of pediatric hand scars, suggesting its advantages over traditional methods of operative intervention.
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Affiliation(s)
- Huazhen Liu
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People's Republic of China
| | - Shisheng Chen
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People's Republic of China
| | - Xuwei Zhu
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People's Republic of China
| | - Zifu Zhou
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People's Republic of China
| | - Jin Zhang
- Department of Aesthetic, Plastic and Burn Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People's Republic of China
| | - Haiting Xu
- Department of Hand and Plastic Surgery, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, 325027, People's Republic of China.
- Department of Aesthetic, Plastic and Burn Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, 250021, People's Republic of China.
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24
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Madni TD, Lu K, Nakonezny PA, Imran JB, Cunningham HB, Clark AT, Taveras L, Hoopman JE, Wolf SE, Kenkel JM, Phelan HA. Treating Hypertrophic Burn Scar With 2940-nm Er:YAG Laser Fractional Ablation Improves Scar Characteristics as Measured by Noninvasive Technology. J Burn Care Res 2020; 40:416-421. [PMID: 31046088 DOI: 10.1093/jbcr/irz056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Their group previously demonstrated high-patient satisfaction for the treatment of hypertrophic burn scar (HBS) with the erbium: yttrium aluminum garnet (Er:YAG) laser, but this and other literature supporting the practice suffer from a common weakness of a reliance on subjective assessments by patients or providers. Herein, they sought to prospectively study the effects of Er:YAG fractional ablation on HBS using noninvasive, objective technologies to measure outcomes. Patients with HBS had identical regions of scar designated for treatment by the Er:YAG laser (TREAT) or to be left untreated (CONTROL). They prospectively collected scar measurements of TREAT and CONTROL regions preoperatively, 3 weeks, and 3 months after Er:YAG treatment. Scar measurements included viscoelastometry, transepidermal water loss, optical coherent tomography, and high-frequency ultrasound. Outcomes were measured for the aggregate difference between the TREAT group vs the CONTROL group, as well as within each group in isolation. Seventeen patients were seen preoperatively, followed by n = 15 at 3 weeks and n = 11 at 3 months. A mixed-model repeated measures analysis showed no significant effect of fractional ablation when comparing the overall TREAT group measurements with those of the CONTROL group. However, when considered as within-group measurements, TREAT scars showed significant improvement in viscoelastic deformity (P = .03), elastic deformity (P = .004), skin roughness (P = .05), and wrinkle depth (P = .04) after fractional ablation, whereas CONTROL scars showed no such within-group changes. HBS treated by the Er:YAG laser showed objective improvements, whereas no such changes were seen within the untreated scars over the same time frame.
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Affiliation(s)
- Tarik D Madni
- UT Southwestern Department of Surgery, Division of Biostatistics Dallas, Texas
| | - Karen Lu
- UT Southwestern Department of Plastic Surgery, Division of Biostatistics Dallas, Texas
| | - Paul A Nakonezny
- UT Southwestern Department of Clinical Sciences, Division of Biostatistics, Dallas, Texas
| | - Jonathan B Imran
- UT Southwestern Department of Surgery, Division of Biostatistics Dallas, Texas
| | - Holly B Cunningham
- UT Southwestern Department of Surgery, Division of Biostatistics Dallas, Texas
| | - Audra T Clark
- UT Southwestern Department of Surgery, Division of Biostatistics Dallas, Texas
| | - Luis Taveras
- UT Southwestern Department of Surgery, Division of Biostatistics Dallas, Texas
| | | | | | - Jeffrey M Kenkel
- UT Southwestern Department of Plastic Surgery, Division of Biostatistics Dallas, Texas
| | - Herb A Phelan
- UT Southwestern Division of Burns/Trauma/Critical Care, Dallas, Texas
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Wang J, Wu J, Xu M, Gao Q, Chen B, Wang F, Song H. Combination therapy of refractory keloid with ultrapulse fractional carbon dioxide (CO 2 ) laser and topical triamcinolone in Asians-long-term prevention of keloid recurrence. Dermatol Ther 2020; 33:e14359. [PMID: 33002270 DOI: 10.1111/dth.14359] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/03/2020] [Accepted: 09/12/2020] [Indexed: 11/30/2022]
Abstract
Keloid often recur after treatment, and recent studies in keloid management favor the combination therapy of laser-assisted drug delivery over monotherapy. Unfortunately, the previous researches lack long-term follow-up. In this prospective study, 41 individuals with refractory keloids underwent eight treatment sessions at 4 weeks intervals consisting of ultrapulse fractional carbon dioxide laser (UFCL), followed by postoperative application topical triamcinolone acetonide (40 mg/ml). Four follow-up moments were chosen, with follow-up of 24 months. The effects of combination therapy on scar pliability, thickness, relief, vascularization, surface area, pain, and itchiness were examined by means of the Patient and Observer Scar Assessment Scale (POSAS). 38 patients completed the full 24 months of follow-up after the whole treatment. The results reveal a fast and abiding improvement of keloid scars after the combination therapy. The mean keloid POSAS scores showed a decreasing trend in subsequent times. All POSAS components improved significantly between baseline and 24 months after start of therapy (P < .05). Long-term follow-up results demonstrate that combination keloid therapy using UFCL and tropical triamcinolone has overall significant improvement and low recurrence rate with a long-term stable results.
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Affiliation(s)
- Jue Wang
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Jiang Wu
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Minghuo Xu
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Quanwen Gao
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Baoguo Chen
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Fang Wang
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, Beijing, China
| | - Huifeng Song
- Department of Burn and Plastic Surgery, Fourth Center of Chinese People's Liberation Army General Hospital, Beijing, China
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Oosterhoff TCH, Beekman VK, van der List JP, Niessen FB. Laser treatment of specific scar characteristics in hypertrophic scars and keloid: A systematic review. J Plast Reconstr Aesthet Surg 2020; 74:48-64. [PMID: 33645505 DOI: 10.1016/j.bjps.2020.08.108] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/14/2020] [Accepted: 08/20/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hypertrophic scarring and keloid can cause significant emotional and physical discomfort. Cosmetic appearance, functional limitations, pain and pruritus form a degree of impairment. While the etiology is not fully known, there is a wide array of treatment options, which include excision, radiation, cryotherapy, silicone gel sheeting, and intralesional injections. A relatively new modality is laser therapy. While results are promising, the number of different laser systems is substantial. This review evaluates the available evidence regarding outcomes on specific objective characteristics (i.e., erythema, pigmentation, height, and pliability) of the different laser systems. METHODS A systematic literature review was performed using MEDLINE, Cochrane Library, and EMBASE. Data on scar characteristics were extracted from scar scales Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS), and from objective measurement tools. RESULTS Heterogeneity was seen in a lot of aspects: maturity of scar, origin of scar, follow-up, and number of treatments. The fractional ablative lasers CO2 10,600 nm and Er:YAG 2940 nm were found to produce the best results regarding erythema, height, and pliability, while the flash lamp-pumped pulsed dye laser (PDL) 585 nm scored slightly below that. CONCLUSIONS Laser systems, and specifically the fractional ablative lasers CO2 and Er:YAG, improved various characteristics of excessive scarring. An overview of preferred laser modality per scar characteristic is presented. Accounting for the methodological quality and the level of evidence of the data, future research in the form of randomized trials with comparable standardized scar scales is needed to confirm these results.
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Affiliation(s)
- Thijs C H Oosterhoff
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands
| | - Vivian K Beekman
- Department of Plastic, Reconstructive and Hand Surgery, Onze Lieve Vrouwe Gasthuis, Oosterpark 9, 1091 AC Amsterdam, the Netherlands
| | - Jelle P van der List
- Department of Orthopaedic Surgery, Amsterdam UMC, Location AMC, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Frank B Niessen
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Location VUMC, De Boelelaan 1117, 1081 HV Amsterdam, the Netherlands.
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27
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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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28
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Madni TD, Hoopman JE, Li X, Imran JB, Clark AT, Cunningham HB, Wolf SE, Kenkel JM, Phelan HA. Impact of a Laser Service Line for Burn Scar on a Dedicated Burn OR's Flow and Productivity. J Burn Care Res 2020; 39:811-814. [PMID: 29789856 DOI: 10.1093/jbcr/irx056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Our group began performing erbium-YAG 2940 wavelength fractional resurfacing of burn scar in our burn center's dedicated burn operating room (OR) in January 2016. The impact of these procedures on the performance of a mature, dedicated burn OR is unknown. All burn OR cases performed between January 1, 2015 and December 31, 2015 served as a pre-laser (PRE-LSR) historical control. A postintervention cohort of laser-only cases (LSR) performed between January 1, 2016 and August 17, 2016 was then identified. PRE-LSR and LSR cases were retrospectively reviewed for OR component times, and work relative value units (wRVU) billed. A total of 628 burn OR cases were done in 2015 (PRE-LSR), while 488 burn OR cases were done between January 1 and August 17, 2016. Of these 488, 59 cases were LSR (12.1%). Calculated on a monthly basis, significantly more cases were done per day in the LSR era (2.2 ± 0.4 cases/d) than PRE-LSR (1.6 ± 2.0 cases/d; P < .0001). The LSR group was significantly shorter than the PRE-LSR group for all OR component times (induction, prep, and procedure all P < .0001; transport out, P = .01; room turnover, P = .004). Aggregate OR component time was 79.2 ± 33.4 minutes for LSR and 157.5 ± 65.0 minutes for PRE-LSR (P < .0001). LSR yielded 6.9 ± 3.2 wRVU/h, while PRE-LSR generated 12.2 ± 8.9 wRVU/h (P < .0001). Despite significantly shorter OR component times and more cases being done per day, laser treatment of burn scar using a single 17108 Current Procedural Terminology code cuts wRVUs generated per hour in a mature burn OR roughly in half.
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Affiliation(s)
- Tarik D Madni
- UT Southwestern Department of Surgery, Dallas, Texas
| | | | - Xingchen Li
- UT Southwestern Department of Plastic Surgery, Dallas, Texas
| | | | - Audra T Clark
- UT Southwestern Department of Surgery, Dallas, Texas
| | | | - Steven E Wolf
- UT Southwestern Division of Burns/Trauma/Critical Care, Dallas
| | | | - Herb A Phelan
- UT Southwestern Division of Burns/Trauma/Critical Care, Dallas
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Seago M, Shumaker PR, Spring LK, Alam M, Al-Niaimi F, Rox Anderson R, Artzi O, Bayat A, Cassuto D, Chan HH, Dierickx C, Donelan M, Gauglitz GG, Leo Goo B, Goodman GJ, Gurtner G, Haedersdal M, Krakowski AC, Manuskiatti W, Norbury WB, Ogawa R, Ozog DM, Paasch U, Victor Ross E, Tretti Clementoni M, Waibel J. Laser Treatment of Traumatic Scars and Contractures: 2020 International Consensus Recommendations. Lasers Surg Med 2020; 52:96-116. [PMID: 31820478 DOI: 10.1002/lsm.23201] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES There is currently intense multidisciplinary interest and a maturing body of literature regarding laser treatments for traumatic scars, but international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the tremendous potential of laser techniques, offer recommendations for safe and efficacious treatment, and promote wider patient access guided by future high-quality research. STUDY DESIGN/MATERIALS AND METHODS An international panel of 26 dermatologists and plastic and reconstructive surgeons from 13 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the laser treatment of traumatic scars. A three-step modified Delphi method took place between March 2018 and March 2019 consisting of two rounds of emailed questionnaires and supplementary face-to-face meetings. The panel members approved the final manuscript via email correspondence, and the threshold for consensus was at least 80% concurrence among the panel members. RESULTS The manuscript includes extensive detailed discussion regarding a variety of laser platforms commonly used for traumatic scar management such as vascular lasers and ablative and non-ablative fractional lasers, special considerations such as coding and laser treatments in skin of color, and 25 summary consensus recommendations. CONCLUSIONS Lasers are a first-line therapy in the management of traumatic scars and contractures, and patients without access to these treatments may not be receiving the best available care after injury. Updated international treatment guidelines and reimbursement schemes, additional high-quality research, and patient access should reflect this status. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Meghan Seago
- Department of Dermatology, Naval Medical Center, San Diego, California, 92134
- Fellow, Micrographic Surgery and Surgical Oncology, Scripps Clinic, La Jolla, California, 92037
| | - Peter R Shumaker
- Department of Dermatology, Naval Medical Center, San Diego, California, 92134
| | - Leah K Spring
- Fellow, Micrographic Surgery and Surgical Oncology, SkinCare Physicians, Chestnut Hill, Massachusetts, 02467
| | - Murad Alam
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, 60611
| | | | - R Rox Anderson
- Department of Dermatology, Harvard Medical School, and Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, Massachusetts, 02114
| | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ardeshir Bayat
- Division of Dermatology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | | | - Henry Hl Chan
- Private Practice and Department of Medicine (Dermatology), University of Hong Kong, People's Republic of China
| | | | - Matthias Donelan
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children-Boston, Harvard Medical School, Boston, Massachusetts, 02114
| | - Gerd G Gauglitz
- Department of Dermatology and Allergy, Ludwig Maximillian University, Munich, Germany
| | - Boncheol Leo Goo
- Naeum Dermatology and Aesthetic Clinic/Skin Rehabilitation Center, Seoul, Korea
| | - Greg J Goodman
- Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Geoffrey Gurtner
- Department of Surgery, Stanford University School of Medicine, Stanford, California, 94305
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrew C Krakowski
- Division of Dermatology, St. Luke's University Health Network, Bethlehem, Pennsylvania, 18015
| | | | - William B Norbury
- Department of Surgery, University of Texas Medical Branch, Shriners Hospital for Children-Galveston, Galveston, Texas, 77550
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, 48202
| | - Uwe Paasch
- Department of Dermatology, Venereology, and Allergy, University of Leipzig, Leipzig, Germany
| | | | | | - Jill Waibel
- Miami Dermatology and Laser Institute, Miami, Florida, 33173
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Baumann ME, Blackstone BN, Malara MM, Clairmonte IA, Supp DM, Bailey JK, Powell HM. Fractional CO 2 laser ablation of porcine burn scars after grafting: Is deeper better? Burns 2019; 46:937-948. [PMID: 31767253 DOI: 10.1016/j.burns.2019.10.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 10/01/2019] [Accepted: 10/04/2019] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Fractional CO2 lasers have been used in clinical settings to improve scarring following burn injury. Though used with increasing frequency, the appropriate laser settings are not well defined and overall efficacy of this therapy has not been definitively established. As it has been proposed that for thick hypertrophic scars proportionally greater fluence and thus deeper ablation into the scar tissue would be most effective, the goal of this study was to examine the role of ablation depth on scar outcomes in a highly-controlled porcine model for burn scars-after grafting. METHODS Properties of laser ablated wells were quantified on ex vivo pig skin as a function of laser energy (20, 70 or 150mJ). Full-thickness burn wounds were created on the dorsum of red Duroc pigs with the eschar excised and grafted with a split-thickness autograft meshed and expanded 1.5:1. After four weeks of healing, sites were treated with either 20, 70, or 150mJ pulse energy from a fractional CO2 laser at 5% density or left untreated as a control. Sites were treated every four weeks with three total sessions. Scar area, pigmentation, erythema, roughness, histology, and biomechanics were evaluated prior to each laser treatment at day 28, 56, and 83, as well as four weeks after the final laser treatment, day 112. Additional biopsies were collected at day 112 for gene expression analysis. RESULTS The depth of the laser ablated wells increased with increasing pulse energy while the width of the wells was smaller in the 20mJ group and not significantly different in the 70 and 150mJ groups. Scar properties (area, color, biomechanics) were not significantly altered by laser therapy at any of the laser energies tested versus controls. Average scar roughness was improved by laser therapy in a dose dependent manner with scars treated with 150mJ of energy having the smoothest surface; however, these changes were not statistically significant. Assessment of matrix metalloproteinase 9 gene expression showed a slight upregulation in scars treated with 70 or 150mJ versus control scars and scars treated with 20mJ pulse energy. CONCLUSION The current study demonstrated that the properties of the ablative well (depth and width) are not linearly correlated with laser pulse energy, with only a small increase in well depth at energies between 70 and 150mJ. Overall, the study suggests that there is little difference in outcomes as a function of laser energy. Fractional CO2 laser therapy did not result in any statistically significant benefit to scar properties assessed by quantitative, objective measures, thus highlighting the need for additional clinical investigation of laser therapy efficacy with non-treated controls and objective measures of outcome.
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Affiliation(s)
- Molly E Baumann
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Britani N Blackstone
- Department of Materials Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Megan M Malara
- Department of Materials Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Isabelle A Clairmonte
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Dorothy M Supp
- Research Department, Shriners Hospitals for Children, Cincinnati, OH, United States; Department of Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - J Kevin Bailey
- Research Department, Shriners Hospitals for Children, Cincinnati, OH, United States; Department of Surgery, Division of Critical Care, Trauma and Burns, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Heather M Powell
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States; Department of Materials Science and Engineering, The Ohio State University, Columbus, OH, United States; Research Department, Shriners Hospitals for Children, Cincinnati, OH, United States.
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Systematic Review on the Content of Outcome Measurement Instruments on Scar Quality. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2424. [PMID: 31741815 PMCID: PMC6799398 DOI: 10.1097/gox.0000000000002424] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/09/2019] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is available in the text. Measurements of scar quality are essential to evaluate the effectiveness of scar treatments and to monitor scars. A large number of scar scales and measurement devices have been developed, which makes instrument selection challenging. The aim of this study was to provide an overview of the content (ie, included items) of all outcome measurement instruments that measure scar quality in different types of scars (burn, surgical, keloid, and necrotizing fasciitis), and the frequency at which the instruments and included items are used.
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Kant SB, Colla C, van den Kerckhove E, Piatkowski de Grzymala A. Clinical effects of transparent facial pressure masks: A literature review. Prosthet Orthot Int 2019; 43:349-355. [PMID: 30860443 PMCID: PMC6557006 DOI: 10.1177/0309364619836023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Severe facial hypertrophic scars are known to severely impact emotional well-being. Pressure therapy by means of transparent face masks has been used for almost 40 years, but evidence about the clinical effects remains sparse. OBJECTIVES To provide a summary on the efficacy of transparent face masks in the treatment of facial hypertrophic scars. METHODS A literature search was conducted in PubMed, MEDLINE, and Cochrane databases through 1 January 2018. Articles describing the clinical effects of facial pressure therapy for remodeling the face after trauma or surgery with a validated tool were included. This review included studies of participants treated with facial hypertrophic scars, both minors and adults. RESULTS Three articles involving 33 patients were selected for inclusion. Two studies described statistically significant improvement in facial scars measured by durometer, ultrasound, and the Patient and Observer Scar Assessment Scale (POSAS). CONCLUSIONS Facial pressure masks have been shown to deliver significant improvement in facial scars, measured by both subjective and objective tools. However, only three studies could be included in this literature review. Also, because of considerable limitations of the studies, it remains difficult to draw substantial conclusions about the efficacy of transparent face masks. CLINICAL RELEVANCE This literature review provides a summary of the current evidence on the subjectively and objectively measured clinical effects of transparent face masks in the treatment of facial scars, highlighting the need for further research on this topic.
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Affiliation(s)
- Sander B Kant
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, The Netherlands,Sander B Kant, Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, P Debyelaan 25, 6229 HX Maastricht, The Netherlands.
| | - Carlo Colla
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, The Netherlands
| | - Eric van den Kerckhove
- Department of Plastic, Reconstructive, and Hand Surgery, Maastricht University Medical Center, The Netherlands,Department of Rehabilitation Sciences (Faber), Universitaire Ziekenhuizen Leuven, KU Leuven, Leuven, Belgium,Department of Physical Medicine and Rehabilitation and Burns Center, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
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Carbon dioxide laser treatment in burn-related scarring: A prospective randomised controlled trial. J Plast Reconstr Aesthet Surg 2019; 72:863-870. [DOI: 10.1016/j.bjps.2019.01.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/19/2018] [Accepted: 01/18/2019] [Indexed: 11/21/2022]
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Patel SP, Nguyen HV, Mannschreck D, Redett RJ, Puttgen KB, Stewart FD. Fractional CO2 Laser Treatment Outcomes for Pediatric Hypertrophic Burn Scars. J Burn Care Res 2019; 40:386-391. [DOI: 10.1093/jbcr/irz046] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abstract
Carbon dioxide ablative fractional laser (CO2-AFL) therapy has not been widely adopted in pediatric burn care given limited outcomes literature and no established guidelines on laser treatment protocols. We present our experience to further elucidate the clinical role of CO2-AFL therapy for pediatric hypertrophic burn scars. We conducted a prospective cohort study of pediatric burn patients undergoing CO2-AFL treatment of hypertrophic, symptomatic burn scars at a tertiary care regional burn center during a 2-year period. Scars were assessed before each treatment using the Patient and Observer Scar Assessment Scale (POSAS), a validated, subjective, comprehensive scar assessment tool. We treated 49 pediatric patients for a total of 180 laser sessions. Burn severity was full thickness (63.6%) or deep partial thickness (47.7%). Observer-rated POSAS scores revealed statistically significant improvements in pigment, thickness, relief, pliability, and surface area after one treatment with continued improvement until the last laser session. Patient-rated POSAS revealed statistically significant improvements in color, stiffness, thickness, and irregularity after laser treatments. Total POSAS improved from 89.6 ± 17.5 to 76.6 ± 16.8 (P < .0001) after one treatment with further improvement to 69.2 ± 14.9 (P < .0001) at the final laser session. We found convincing evidence that CO2-AFL therapy improves hypertrophic burn scars on both patient- and observer-rated scales confirming statistical and clinical significance to both providers and families. These findings demonstrate that CO2-AFL can improve hypertrophic burn scars in pediatric patients providing a lower risk alternative to invasive therapies and a more immediate, efficacious alternative to more conservative scar treatments.
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Affiliation(s)
- Sagar P Patel
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ha Vi Nguyen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Diana Mannschreck
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Richard J Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine B Puttgen
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - F Dylan Stewart
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Treatment of Hypertrophic Scars Using Laser-Assisted Corticosteroid Versus Laser-Assisted 5-Fluorouracil Delivery. Dermatol Surg 2019; 45:423-430. [DOI: 10.1097/dss.0000000000001678] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Development of a Postburn Pruritus Relief Protocol. Rehabil Nurs 2018; 43:315-326. [PMID: 30395557 DOI: 10.1097/rnj.0000000000000095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Postburn pruritus is a syndrome of stressful symptoms that is pervasive and occurs in over 90% of burn patients and continues for years after the burn has healed. Postburn pruritus is experienced by burn survivors that may require medical management and effective interventions. PURPOSE This article shows how to effectively relieve postburn pruritus by developing a postburn pruritus relief protocol. DESIGN A descriptive literature review was conducted, and relevant empirical articles written during the years 2000-2014 were appraised to create a postburn pruritus relief protocol. Twenty-six of 79 articles were selected using preestablished inclusion criteria: any age group experiencing burn-related pruritus after second- or third-degree burns. Databases were Cochrane Central Register of Controlled Trials, CINAHL, EBSCO, PubMed, the National Guideline Clearinghouse, Google Scholar, and the American Burn Association website. CONCLUSIONS This protocol included both nonpharmacological and pharmacological interventions that have been delineated for use and was developed to apply based on the healing stage: prehealing, healing, and posthealing.
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Madni TD, Lu KB, Imran JB, Clark AT, Hoopman JE, Kenkel JM, Phelan HA. Chronic burn wound treatment by Erbium: YAG fractional ablation: First described report and literature review. Burns 2018; 45:256-258. [PMID: 30342793 DOI: 10.1016/j.burns.2018.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/04/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Tarik D Madni
- UT Southwestern Department of Surgery, Dallas, TX, United States.
| | - Karen B Lu
- UT Southwestern Medical Center, Dallas, TX, United States.
| | - Jonathan B Imran
- UT Southwestern Department of Surgery, Dallas, TX, United States.
| | - Audra T Clark
- UT Southwestern Department of Surgery, Dallas, TX, United States.
| | - John E Hoopman
- UT Southwestern Medical Center, Dallas, TX, United States.
| | - Jeffrey M Kenkel
- UT Southwestern Department of Plastic Surgery, Dallas, TX, United States.
| | - Herb A Phelan
- UT Southwestern Division of Burns/Trauma/Critical Care, Dallas, TX, United States.
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Fractional Carbon Dioxide Laser in Patients with Skin Phototypes III to VI and Facial Burn Sequelae. Plast Reconstr Surg 2018; 142:342e-350e. [DOI: 10.1097/prs.0000000000004688] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Treatment of Pediatric Treadmill Burn Contractures With Ablative Fractional Laser and Topical Triamcinolone Suspension. Dermatol Surg 2018; 44:1656-1659. [PMID: 29846345 DOI: 10.1097/dss.0000000000001553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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40
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Lee BW, Levitt AE, Erickson BP, Ko AC, Nikpoor N, Ezuddin N, Lee WW. Ablative Fractional Laser Resurfacing With Laser-Assisted Delivery of 5-Fluorouracil for the Treatment of Cicatricial Ectropion and Periocular Scarring. Ophthalmic Plast Reconstr Surg 2018; 34:274-279. [DOI: 10.1097/iop.0000000000000948] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Madni TD, Nakonezny PA, Imran JB, Clark AT, Cunningham HB, Hoopman JE, Arnoldo BD, Wolf SE, Kenkel JM, Phelan HA. Patient satisfaction after fractional ablation of burn scar with 2940nm wavelength Erbium-Yag laser. Burns 2018; 44:1100-1105. [PMID: 29627130 DOI: 10.1016/j.burns.2018.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/11/2017] [Accepted: 02/05/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Fractional laser therapy is a new treatment with potential benefit in the treatment of burn scars. We sought to determine patient satisfaction after burn scar treatment with the Erbium-Yag laser. METHODS We performed a telephone survey of all patients who underwent fractional resurfacing of burn scars with the Erbium-Yag 2940 wavelength laser at Parkland Hospital from 01/01/2016 to 05/01/2017. Subjects were asked to rate their satisfaction with their scars' after treatment characteristics on a scale from 1 (completely unsatisfied) to 10 (completely satisfied). Subjects were also asked to assess their treatment response using the UNC 4P Scar Scale before and after treatment. RESULTS Sixty-four patients underwent 156 treatments. A survey response rate of 77% (49/64) was seen (age: 36.8+21 years; surface area treated=435+326cm2; 35% of burn scars were >2 years old; mean scar age of 1.02+0.4 years). Overall, 46/49 (94%) of patients reported some degree of scar improvement after treatment. Patient satisfaction scores were 8.3+2.3. Number of laser treatments included: 1 (31%), 2 (33%), 3 (18%), 4(10%), >5 (8%). Treatment depth, scar age, and number of laser procedures were not significant predictors of satisfaction or UNC 4P Scar scores. The paired t-test showed a significant reduction on each of the UNC 4P Scar scale items (pain, pruritus, pliability, paresthesia). One subject reported that she felt that the laser treatment made her scar worse (2%). CONCLUSION Burn patients treated with the Erbium-Yag laser are highly satisfied with changes in their burn scars.
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Affiliation(s)
- Tarik D Madni
- UT Southwestern Department of Surgery, Dallas, TX, United States.
| | - Paul A Nakonezny
- UT Southwestern Department of Clinical Sciences, Division of Biostatistics, Dallas, TX, United States.
| | - Jonathan B Imran
- UT Southwestern Department of Surgery, Dallas, TX, United States.
| | - Audra T Clark
- UT Southwestern Department of Surgery, Dallas, TX, United States.
| | | | - John E Hoopman
- UT Southwestern Medical Center, Dallas, TX, United States.
| | - Brett D Arnoldo
- UT Southwestern Division of Burns/Trauma/Critical Care, Dallas, TX, United States.
| | - Steven E Wolf
- UT Southwestern Division of Burns/Trauma/Critical Care, Dallas, TX, United States.
| | - Jeffrey M Kenkel
- UT Southwestern Department of Plastic Surgery, Dallas, TX, United States.
| | - Herb A Phelan
- UT Southwestern Division of Burns/Trauma/Critical Care, Dallas, TX, United States.
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Hibbard JC, Friedstat JS, Thomas SM, Edkins RE, Hultman CS, Kosorok MR. LIBERTI: A SMART study in plastic surgery. Clin Trials 2018; 15:286-293. [PMID: 29577741 DOI: 10.1177/1740774518762435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Laser treatment of burns scars is considered by some providers to be standard of care. However, there is little evidence-based research as to the true benefit. A number of factors hinder evaluation of the benefit of laser treatment. These include significant heterogeneity in patient response and possible delayed effects from the laser treatment. Moreover, laser treatments are often provided sequentially using different types of equipment and settings, so there are effectively a large number of overall treatment options that need to be compared. We propose a trial capable of coping with these issues and that also attempts to take advantage of the heterogeneous response in order to estimate optimal treatment plans personalized to each individual patient. It will be the first large-scale randomized trial to compare the effectiveness of laser treatments for burns scars and, to our knowledge, the very first example of the utility of a Sequential Multiple Assignment Randomized Trial in plastic surgery. METHODS We propose using a Sequential Multiple Assignment Randomized Trial design to investigate the effect of various permutations of laser treatment on hypertrophic burn scars. We will compare and test hypotheses regarding laser treatment effects at a general population level. Simultaneously, we hope to use the data generated to discover possible beneficial personalized treatment plans, tailored to individual patient characteristics. RESULTS We show that the proposed trial has good power to detect laser treatment effect at the overall population level, despite comparing a large number of treatment combinations. The trial will simultaneously provide high-quality data appropriate for estimating precision-medicine treatment rules. We detail population-level comparisons of interest and corresponding sample size calculations. We provide simulations to suggest the power of the trial to detect laser effect and also the possible benefits of personalization of laser treatment to individual characteristics. CONCLUSION We propose, to our knowledge, the first use of a Sequential Multiple Assignment Randomized Trial in surgery. The trial is rigorously designed so that it is reasonably straightforward to implement and powered to answer general overall questions of interest. The trial is also designed to provide data that are suitable for the estimation of beneficial precision-medicine treatment rules that depend both on individual patient characteristics and on-going real-time patient response to treatment.
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Affiliation(s)
- Jonathan C Hibbard
- 1 Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,2 School of Mathematics, Institute for Advanced Study, Princeton, NJ, USA
| | - Jonathan S Friedstat
- 3 Division of Burns, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Renee E Edkins
- 5 Division of Plastic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C Scott Hultman
- 5 Division of Plastic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael R Kosorok
- 1 Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Lei Y, Li SF, Yu YL, Tan J, Gold MH. Clinical efficacy of utilizing Ultrapulse CO 2 combined with fractional CO 2 laser for the treatment of hypertrophic scars in Asians-A prospective clinical evaluation. J Cosmet Dermatol 2018; 16:210-216. [PMID: 29058830 DOI: 10.1111/jocd.12334] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE Hypertrophic scarring is seen regularly. Tissue penetration of laser energy into hypertrophic scars using computer defaults from some lasers may be insufficient and penetration not enough. We have developed a treatment with an interrupted laser "drilling" by the Ultrapulse CO2 (Manual Fractional Technology, MFT) and, a second pass, with fractional CO2 . The MFT with fractional CO2 lasers to treat hypertrophic scars is evaluated. STUDY DESIGN/MATERIALS AND METHODS A total of 158 patients with hypertrophic scars had three sessions of MFT with fractional CO2 laser at 3-month intervals. Evaluations made before and 6 months after the 3rd treatment: (1) the Vancouver Scar Scale (VSS), (2) the University of North Carolina (UNC) Scar Scale, and (3) a survey of patient satisfaction. RESULTS All data were analyzed using a t-test before and after treatment. The VSS score decreased from 9.35 to 3.12 (P<.0001), and the UNC Scar Scale score decreased from 8.03 to 1.62 (P<.0001). The overall satisfaction rate was 92%. No long-term complications occurred in the clinical trial. CONCLUSION The interrupted laser drilling by MFT and a fractional CO2 laser had profound effects on the hypertrophic scars treated. It works by increasing the penetration depth of the CO2 laser in the scar tissue, exerting more precise effects on the hypertrophic scars. MFT combined with fractional CO2 laser has the potential to be a major advance in the treatment of hypertrophic scars.
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Affiliation(s)
- Ying Lei
- Department of Plastic & Aesthetic Laser Surgery, The People's Hospital of Hunan Province, 1st Affiliated Hospital of Hunan Normal University, Chang-Sha, Hunan, China
| | - Shi Feng Li
- Department of Plastic and Cosmetic Surgery, The First People's Hospital of Chen-Zhou, Chen-Zhou, Hunan, China
| | - Yi Ling Yu
- Department of Plastic & Aesthetic Laser Surgery, The People's Hospital of Hunan Province, 1st Affiliated Hospital of Hunan Normal University, Chang-Sha, Hunan, China
| | - Jun Tan
- Department of Plastic & Aesthetic Laser Surgery, The People's Hospital of Hunan Province, 1st Affiliated Hospital of Hunan Normal University, Chang-Sha, Hunan, China
| | - Michael H Gold
- Department of Dermatology, Gold Skin Care Center, Nashville, TN, USA
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Erickson T, Gray J, Tayebi B, Tung R. A multimodal approach to the treatment of extensive burn scars: a modified subcision technique for intralesional delivery of corticosteroid and 5-fluorouracil in combination with several procedural laser therapies; a case report. Scars Burn Heal 2018; 4:2059513118818997. [PMID: 35154809 PMCID: PMC8832315 DOI: 10.1177/2059513118818997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Hypertrophic scars and keloids are challenging to manage due to recurrence and often sub-optimal response to treatment. There is a lack of both definitive treatment standards and randomised controlled trials comparing therapeutic options. While a wide array of procedures has been utilised to improve traumatic burn scars, such interventions have been used with varying degrees of success. Some reported methods include intralesional injections of anti-inflammatory and anti-mitotic medications, laser-based therapy, topical therapies, cryotherapy, silicone gel sheeting, pressure therapy, radiotherapy and reconstructive surgery. CASE We report a case of extensive traumatic burn scarring on the head and neck successfully treated with a multimodal approach comprised of an infrequently used modified subcision technique to deliver alternating intralesional injections of anti-inflammatory (high-dose steroid) and anti-metabolite (5-flurouracil) concurrently with a series of laser (epilatory, vascular and fractional) treatments. METHODS Our treatment modality utilised a subcisional technique to deliver intralesional steroid and anti-metabolite medications directly into scar tissue to downregulate inflammation and inhibit collagen synthesis. Alexandrite, fractional and pulsed dye laser therapy was employed to improve skin texture, reduce dyschromia and reduce tissue burden of hypertrophic scar and keloid tissue, resulting in improved mobility and skin elasticity. CONCLUSION Our case supports a combined medical and procedural, subcisional, approach to successfully treat a patient with extensive hypertrophic scarring and keloid formation with associated hair entrapment after a head and neck burn.
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Affiliation(s)
- Taylor Erickson
- Division of Dermatology, Loyola
University Medical Center, Chicago, IL, USA
| | - Jayla Gray
- Division of Dermatology, Loyola
University Medical Center, Chicago, IL, USA
| | | | - Rebecca Tung
- Division of Dermatology, Loyola
University Medical Center, Chicago, IL, USA
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de Oliveira RA, Boson LLB, Portela SMM, Filho ALMM, de Oliveira Santiago D. Low-intensity LED therapy (658 nm) on burn healing: a series of cases. Lasers Med Sci 2017; 33:729-735. [DOI: 10.1007/s10103-017-2399-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 11/21/2017] [Indexed: 12/14/2022]
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47
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Willows BM, Ilyas M, Sharma A. Laser in the management of burn scars. Burns 2017; 43:1379-1389. [PMID: 28784339 DOI: 10.1016/j.burns.2017.07.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 05/10/2017] [Accepted: 07/05/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Burn scars are associated with significant morbidity ranging from contractures, pruritus, and disfigurement to psychosocial impairment. Traditional therapies include silicone gel, compression garments, corticosteroid injections, massage therapy, and surgical procedures, however, newer and advanced therapies for the treatment of burn scars have been developed. Lasers, specifically ablative fractional lasers, show potential for the treatment of burn scars. METHODS Both MeSH and keyword searches of the PubMed, Medline and Embase databases were performed and relevant articles were read in full for the compilation of this review. RESULTS Fifty-one relevant observational studies, clinical trials, and systematic reviews published in English from 2006 to 2016 were reviewed and summarized. CONCLUSION Laser therapy is effective for the treatment of burn scar appearance, including measures such as pigmentation, vascularity, pliability, and thickness. Ablative fractional laser therapy, in particular, shows significant potential for the release of contractures allowing for improved range of motion of affected joints. Patients may benefit from the use of lasers in the treatment of burn scars, and the safety profile of lasers allows the benefits of treatment to outweigh the risks. Laser therapy should be included in burn scar treatment protocols as an adjuvant therapy to traditional interventions.
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Affiliation(s)
- Brooke M Willows
- School of Medicine, University of Arizona, Phoenix, AZ, United States
| | - Muneeb Ilyas
- Department of Dermatology, Mayo Clinic Arizona, 13400 E. Shea Blvd. Scottsdale, AZ 85259, United States.
| | - Amit Sharma
- Department of Dermatology, Mayo Clinic Arizona, 13400 E. Shea Blvd. Scottsdale, AZ 85259, United States
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Bailey JK, Blackstone BN, DeBruler DM, Kim JY, Baumann ME, McFarland KL, Imeokparia FO, Supp DM, Powell HM. Effects of early combinatorial treatment of autologous split-thickness skin grafts in red duroc pig model using pulsed dye laser and fractional CO2
laser. Lasers Surg Med 2017; 50:78-87. [DOI: 10.1002/lsm.22702] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2017] [Indexed: 01/05/2023]
Affiliation(s)
- J. Kevin Bailey
- Department of Surgery; The Ohio State University Medical Center; 410 W. 10th Avenue Columbus 43210 Ohio
| | - Britani N. Blackstone
- Department of Materials Science and Engineering; The Ohio State University; Columbus Ohio
| | - Danielle M. DeBruler
- Department of Materials Science and Engineering; The Ohio State University; Columbus Ohio
| | - Jayne Y. Kim
- Department of Biomedical Engineering; The Ohio State University; Columbus Ohio
| | - Molly E. Baumann
- Department of Biomedical Engineering; The Ohio State University; Columbus Ohio
| | | | - Folasade O. Imeokparia
- Department of Surgery; The Ohio State University Medical Center; 410 W. 10th Avenue Columbus 43210 Ohio
| | - Dorothy M. Supp
- Research Department; Shriners Hospital for Children; Cincinnati Ohio
- Department of Surgery; University of Cincinnati; Cincinnati Ohio
| | - Heather M. Powell
- Department of Materials Science and Engineering; The Ohio State University; Columbus Ohio
- Department of Biomedical Engineering; The Ohio State University; Columbus Ohio
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49
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Evidence-Based Scar Management: How to Improve Results with Technique and Technology. Plast Reconstr Surg 2017; 138:165S-178S. [PMID: 27556757 DOI: 10.1097/prs.0000000000002647] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Scars represent the visible sequelae of trauma, injury, burn, or surgery. They may induce distress in the patient because of their aesthetically unpleasant appearance, especially if they are excessively raised, depressed, wide, or erythematous. They may also cause the patient symptoms of pain, tightness, and pruritus. Numerous products are marketed for scar prevention or improvement, but their efficacy is unclear. METHODS A literature review of high-level studies analyzing methods to prevent or improve hypertrophic scars, keloids, and striae distensae was performed. The evidence from these articles was analyzed to generate recommendations. Each intervention's effectiveness at preventing or reducing scars was rated as none, low, or high, depending on the strength of the evidence for that intervention. RESULTS For the prevention of hypertrophic scars, silicone, tension reduction, and wound edge eversion seem to have high efficacy, whereas onion extract, pulsed-dye laser, pressure garments, and scar massage have low efficacy. For the treatment of existing hypertrophic scars, silicone, pulsed-dye laser, CO2 laser, corticosteroids, 5-fluorouracil, bleomycin, and scar massage have high efficacy, whereas onion extract and fat grafting seem to have low efficacy. For keloid scars, effective adjuncts to excision include corticosteroids, mitomycin C, bleomycin, and radiation therapy. No intervention seems to have significant efficacy in the prevention or treatment of striae distensae. CONCLUSION Although scars can never be completely eliminated in an adult, this article presents the most commonly used, evidence-based methods to improve the quality and symptoms of hypertrophic scars, as well as keloid scars and striae distensae.
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50
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Wong BM, Keilman J, Zuccaro J, Kelly C, Maynes JT, Fish JS. Anesthetic Practices for Laser Rehabilitation of Pediatric Hypertrophic Burn Scars. J Burn Care Res 2017; 38:e36-e41. [DOI: 10.1097/bcr.0000000000000427] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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