Usuwanie blizn pooparzeniowych laserem CO2 - badania

Effects of Multiple Modes of UltraPulse Fractional CO2 Laser Treatment on Extensive Scarring: A Retrospective Study

Authors: Xiaojing Ge, Yute Sun, Jing Lin, Fang Zhou, Gang Yao, Xin Su

Research Sites: Department of Plastic and Burn Surgery, The First Afliated Hospital of Nanjing Medical University, 300

Guangzhou Rd, Nanjing 210029, Jiangsu Province, China

Publication: Lasers in Medical Science

The main therapeutic options for extensive scarring (e.g.,>20% of the total body surface area, or TBSA) after burns and trauma have focused on conservative treatments, such as compression, moisturization, and topical agent application. However, these treatments may not achieve optimal effects due to the large size and complexity of the scars. UltraPulse fractional CO2 laser treatment is a novel approach that is currently a subject of intense interest; this treatment is most widely used to improve texture, pliability, and pigmentation in all types of scars. However, no studies on the independent use of UltraPulse fractional CO2 laser treatment for extensive scars have been reported. This retrospective study evaluated a total of 21 patients, whose scars covered 20 to 65% TBSA. Scar thickness was measured by ultrasonography before treatment. Personalized treatment modalities and parameters were set according to the scar type and thickness. Scar formation and treatment effects were evaluated by photography, the Patient and Observer Scar Assessment Scale (POSAS), and patients’ judgment of effectiveness. Where the scars covered joints, joint function was assessed by measuring the maximum range of motion (ROM). With laser therapy, scars became fatter and lighter; furthermore, pruritus, pain, and discomfort decreased significantly. POSAS scores significantly decreased after laser therapy, including the item scores for pain and pruritus. There were no instances of joint contracture, ROM reduction, apparent functional impairment, serious adverse events, or comorbidities. This study demonstrates the safety and efficiency of UltraPulse fractional CO2 laser treatment for extensive scarring.

Fractional Ablative Laser Therapy is an Effective Treatment for Hypertrophic Burn Scars: A Prospective Study of Objective and Subjective Outcomes

Authors: Nathanial Miletta, Katherine Siwy, Chad Hivnor, Jason Clark, Joshua Shofner, David Zurakowski, R Rox Anderson, Kachiu Lee, Matthias Donelan

Research Sites: San Antonio Military Health System, Laser Surgery and Scar Center, San Antonio, TX; Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA; Shriner's Hospital for Children- Boston, Boston, MA; dermatology Associates of San Antonio, San Antonio, TX.Emory University School of Medicine, Department of Dermatology, Atlanta GA; Dermatology Associates of Winchester, Winchester, MA; Boston Children's Hospital, Departments of Anesthesiology & Surgery, Boston, MA; Brown University,Department of Dermatology, Providence, RI

Publication: Ann Surg. 2021 Dec 1;274(6):e574-e580

Objectives: The aim of this study is to determine objective and subjective changes in mature hypertrophic burn scars treated with a fractional ablative carbon dioxide (CO2) laser.

Background: Fractional CO2 laser treatment has been reported to improve burn scars, with increasing clinical use despite a paucity of controlled, prospective clinical studies using objective measures of improvement.

Methods: A multicenter, site-controlled, prospective open-label study was conducted from 2013 to 2016. Objective and patient-reported outcome measures were documented at baseline, at each monthly laser treatment, and 6 months after treatment. Objective measurements employed were: mechanical skin torque to measure viscoelastic properties; ultrasonic imaging to measure scar thickness; and reflectometry to measure erythema and pigmentation. Subjective measures included health-related quality of life, patient and investigator scar assessment scales, and blinded scoring of before and after photographs. Subjects aged 11 years or older with hypertrophic burn scars were recruited. Each subject received 3 monthly treatment sessions with an ablative fractionated CO2 laser.

Results: Twenty-nine subjects were enrolled, of whom 26 received at least 1 fractional CO2 laser treatment and 22 received 3 treatments. Mean age of those completing all 3 treatments was 28 years. Statistically significant objective improvements in elastic stretch (P < 0.01), elastic recovery (P < 0.01), extensibility (P < 0.01), and thickness (P < 0.01) were noted. Patient- and physician-reported scar appearance and pain/pruritus were significantly improved (P < 0.01). There was no regression of improvement for at least 6 months after treatment.

Conclusion: Fractional ablative laser treatment provides significant, sustained improvement of elasticity, thickness, appearance, and symptoms of mature hypertrophic burn scars.

Randomized, Controlled Early Intervention of Dynamic Mode Fractional Ablative CO2 Laser on Acute Burn Injuries for Prevention of Pathological Scarring

Authors: Jill S Waibel, Chloe Gianatasio, Ashley Rudnick

Research Sites: Department of Research, Miami Dermatology and Laser Institute, Miami, Florida.

Publication: Lasers Surg Med. 2020 Feb;52(2):117-124

Background & objectives: This study challenges the currently accepted treatment parameters of waiting 1 year following burn injury to treat the resultant scarring. It assesses the impact of treating burn and trauma wounds at less than 3 months of injury on scar formation, providing a new temporal paradigm to patients in the prevention and minimization of scar formation.

Methods: This randomized clinical trial included 19 patients with moderate-to-severe acute burn injuries less than 3 months from injury. The treatment areas underwent three fractional ablative CO2 laser treatments at 8-week intervals. The primary outcomes were improvement in the Manchester Scar Scale (MSS) and photography. Secondary outcomes were optical coherence tomography (OCT), treatment time, immediate post-treatment response, and histology.

Results: Upon blinded evaluation, 100% of treatment areas were correctly identified when compared with control. MSS scores before and after treatment were totaled with an averaged sum of 13.33 per scar at baseline to 8.39 aftertreatment, a 63% average improvement versus control (P < 0.001). Histology and OCT demonstrated a re-organization of the underlying skin structure. The average treatment time was 18 minutes. Immediate post-treatment responses were limited to mild-to-moderate erythema.

Conclusion: Early intervention with ablative fractional laser on acute traumatic wounds resulted in significant decrease of scar formation compared with untreated

Ultrapulsed Fractional Ablative Carbon Dioxide Laser Treatment of Hypertrophic Burn Scars: Evaluation of an In-Patient Controlled, Standardized Treatment Approach

Authors: Poetschke, Julian; Dornseifer, Ulf; Clementoni, Matteo Tretti; Reinholz, Markus; Schwaiger, Hannah; Steckmeier, Stephanie; Ruzicka, Thomas; Gauglitz, Gerd G

Research Sites: Department of Dermatology and Allergy, Ludwig-Maximilian-University Munich, Frauenlobstr. 9-11, 80337 Munich, Germany; Department of Plastic, Reconstructive, Hand, and Burn Surgery, Bogenhausen Academic Hospital, Munich, Germany; Skin House, Milan, Italy

Publication: Lasers in Medical Science

In this study, we aimed to quantify the effects of fractional ablative carbon dioxide laser therapy in the treatment of widespread hypertrophic burn scars. While many different pilot studies have described the potential of the technology and expert groups and current guidelines, alike, recommend its use, the level of evidence for the efficacy of fractional CO2-laser treatment for burn scars is currently very low. Ten patients (three male, seven female) with hypertrophic burn scars were treated with a single course of fractional CO2-laser therapy in an in-patient controlled setup, using a standardized treatment paradigm. Documentation was based on modern scar scales and questionnaires, like the Vancouver Scar Scale (VSS), Patient and Observer Scar Assessment Scale (POSAS), and Dermatology Life Quality Index (DLQI), as well as state of the art clinical measurements (PRIMOS, Cutometer). Over the course of 6 months after treatment, VSS and POSAS scores showed significant improvement in the rating of scar parameters, as did the quality of life rating according to the DLQI. In the treated scars, surface relief improved significantly, as S max decreased by 1893 μm (-36.92%) (p = 0.0273) and S z by 1615 μm (-36.37%) (p = 0.0488). Scar firmness in treated scars could be reduced by 30% after one treatment session, as R 0 improved by 0.0797 mm (+30.38%) (p = 0.0212). Fractional ablative CO2-laser treatment is a safe and efficacious option for the treatment of hypertrophic burn scars. While more treatment sessions are required for satisfying results, significant improvement is already apparent after a single course of treatment.

Dermal Remodeling of Burn Scar by Fractional CO2 Laser

Authors: Sang-Jun Lee, Dong-Hye Suh, Ji Min Lee, Kye-Yong Song, Hwa Jung Ryu

Research Sites: Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Korea; Department of Dermatology, Korea University College of Medicine, Inchon-ro 73(Anam-dong 5ga), Seongbuk-gu, Seoul 136-705, Korea; Department of Pathology, College of Medicine Chung-Ang University, Seoul, Korea

Publication: Aesthetic Plastic Surgery

Background: Ablative CO2 fractional lasers have recently been introduced for burn scar treatment because of pronounced clinical outcomes with fewer treatment sessions than nonablative fractional laser.

Objective: This study was conducted to observe clinical as well as histologic changes of burn scars after treatment with CO2 fractional laser.

Materials & Methods: Eleven patients (one female and 10 males, aged 31–59 years) with skin phototypes III to V with burn scars received 10 sessions of fractional CO2 laser treatments (UltraPulse. Encore; Lumenis, Santa Clara, CA, USA) over an average 5-week interval. Two passes were performed using the following parameters: deep FX mode, 12.5–30 mJ, with a density setting of 5–10 %. Clinical evaluations by three blinded dermatologists were obtained at baseline and at 6 months after the final treatment via photographs using the Vancouver scar scale (VSS). Skin biopsies were done on four patients before and after treatment.

Results: All patients showed clinical improvement in their scars with significant decrease in VSS. Histologic findings showed the changes in the upper dermis with newly formed dermal papilla. This characteristic upper dermis change was presented as improvement in surface smoothness and skin tension clinically. Postinflammatory hyperpigmentation and itching sensation were the most common adverse effects.

Conclusion: Burn scar treatment by fractional CO2 laser is effective by forming new collagen fibers mainly in the upper dermis