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1.
Pan Li Cecilia Wai Ping Li-Tsang Xue Deng Xiaoyun Wang Hanjie Wang Yuting Zhang Ziming Tan Chengqi He 《Burns : journal of the International Society for Burn Injuries》2018,44(6):1451-1467
Introduction
Pressure therapy used to be considered as the mainstay non-invasive treatment of hypertrophic scar. However, the maturation process of hypertrophic scar during pressure therapy process has seldom be reported. Moreover, although early application of pressure therapy after burn injuries is reco6mmended, minimal evidence exists to support it. This study aimed to examine the maturation trajectory of post-burn hypertrophic scars in a 6-month monitored pressure therapy intervention programme and investigate the difference in the trajectory between patients receiving early intervention and patients receiving late intervention.Methods
Thirty-four patients with sixty-five post-burn hypertrophic scar samples were recruited for the study. All the subjects were treated with a 6-month pressure therapy programme with the pressure dosage regulated using a newly developed pressure therapy system, the Smart Pressure Monitored Suits. The selected scars were assessed with MiniScan XE Spectrocolorimeter on scar pigmentation, and Terason t3000 portable ultrasound imaging equipment on scar thickness. The Vancouver Scar Scale (VSS) was used to evaluate pigmentation, pliability, vascularity and height of the scars. Subjects’ report of pain and itch was documented. Assessments were conducted before treatment began and then monthly during the 6 month-intervention process. Patients were further divided into two groups according to the time of intervention post-burn injuries to review differences in the maturation trajectory between those who received early versus late treatment (early intervention group, prescribed within 60 days after injuries; late intervention group, prescribed after 61 days). The changes of scar features were recorded to formulate the recovery trajectory of scar, and the outcomes of intervention between the early and the late groups were compared.Results
Pre- and post-treatment comparison demonstrated significant improvement in scar pigmentation, thickness, VSS scores and scores of pain and itch (p < 0.01) for the early intervention group. For the later intervention, only scar lightness, yellowness, VSS scores and scores of pain and itch was found with significant improvement (p < 0.01). The improvement in these scar characteristics was sustained over time during the treatment process. The early group demonstrated superior effect in improving scar lightness, yellowness (p < 0.01), thickness (p < 0.01), pigmentation score (p < 0.05) and pain score (p < 0.01) than the late group in comparison between the two groups at similar post-burn timing.Conclusions
Hypertrophic scars appeared to undergo continuous improvement in the appearance, pain and itch over time during the process of a monitored pressure intervention programme. Early application of pressure therapy after burn injury may contribute to better outcomes as shown by their faster recovery than those with late intervention. In order to achieve the best outcomes, regular evaluation and adjustment for optimal interface pressure is necessary. 相似文献2.
Robabeh Abedini Pardis Sasani Hamid Reza Mahmoudi Maryam Nasimi Amir Teymourpour Zahra Shadlou 《Burns : journal of the International Society for Burn Injuries》2018,44(6):1482-1488
Background
Keloids and hypertrophic scars are due to overgrowth of dermal collagen following trauma to the skin that usually cause major physical, psychological and cosmetic problems.Methods
In this randomized controlled trial, with a paired design, 50 patients with 2 or more keloids were included. In the control group (50 lesions), intralesional triamcinolone acetonide (40 mg/mL) was injected at three-week intervals for a total of 18 weeks. In the other group (50 lesions), lesions were treated by verapamil (2.5 mg/mL) with the same therapeutic sessions. Scar evaluation at each stage and at the end of 3 months follow up was done by serial photographic records as well as by Vancouver Scar Scale (VSS).Results
Mean zero VSS scores were achieved with only triamcinolone in respect of scar height (week 15th) and pliability (week 15th). No therapeutic event (parameter = 0) or significant improvement was seen in verapamil group.Conclusion
Our results did not support verapamil’s capability in treatment of keloid nor hypertrophic scars. 相似文献3.
P. Ault A. Plaza J. Paratz 《Burns : journal of the International Society for Burn Injuries》2018,44(1):24-38
Background
Scar massage is used in burn units globally to improve functional and cosmetic outcomes of hypertrophic scarring following a burn, however, the evidence to support this therapy is unknown.Objective
To review the literature and assess the efficacy of scar massage in hypertrophic burn scars.Methods
MEDLINE, PubMed, Embase, CINAHL and the Cochrane Library were searched using the key words “burn”, “burn injury”, “thermal injury” and “scar”, “hypertrophic scar” and “massage”, “manipulation”, “soft tissue mobilisation”, “soft tissue manipulation”. The articles were scored by the assessors using the Physiotherapy Evidence Database (PEDro) scale and outcome measures on range of motion (ROM), cosmesis (vascularity, pliability, height), pain scores, pruritus, and psychological measures of depression and anxiety were extracted.Results
Eight publications were included in the review with 258 human participants and 15 animal subjects who received scar massage following a thermal injury resulting in hypertrophic scarring. Outcome measures that demonstrated that scar massage was effective included scar thickness as measured with ultrasonography (p = 0.001; g = ?0.512); depression (Centre for Epidemiologic Studies — Depression [CES-D]) (p = 0.031; g = ?0.555); pain as measured with Visual Analogue Scale (VAS) (p = 0.000; g = ?1.133) and scar characteristics including vascularity (p = 0.000; g = ?1.837), pliability (p = 0.000; g = ?1.270) and scar height (p = 0.000; g = ?2.054). Outcome measures that trended towards significance included a decrease in pruritus (p = 0.095; g = ?1.157).Conclusions
It appears that there is preliminary evidence to suggest that scar massage may be effective to decrease scar height, vascularity, pliability, pain, pruritus and depression in hypertrophic burns scaring. This review reflects the poor quality of evidence and lack of consistent and valid scar assessment tools. Controlled, clinical trials are needed to develop evidence-based guidelines for scar massage in hypertrophic burns scarring. 相似文献4.
5.
Patient satisfaction after fractional ablation of burn scar with 2940 nm wavelength Erbium-Yag laser
Tarik D. Madni Paul A. Nakonezny Jonathan B. Imran Audra T. Clark Holly B. Cunningham John E. Hoopman Brett D. Arnoldo Steven E. Wolf Jeffrey M. Kenkel Herb A. Phelan 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1100-1105
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 + 326 cm2; 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. 相似文献6.
Mieke Anthonissen Jill Meirte Peter Moortgat Koen Maertens Daniel Daly Steffen Fieuws Cindy Lafaire Lieve De Cuyper Eric Van den Kerckhove 《Burns : journal of the International Society for Burn Injuries》2018,44(4):877-885
Objective
Depressomassage is a non-invasive massage technique using a mechanical suction device that is used in the treatment of traumatic or burn scars. Since color and transepidermal water loss (TEWL) are respectively the most important physical and physiological characteristic of hypertrophic scar formation, we wanted to investigate the effects of depressomassage on the recovery of color and TEWL in burn scars compared to the traditional physiotherapy.Methods
In this pilot comparative controlled study a total 43 burn patients were included and allocated into 2 groups. All patients received standard physical therapy, and the test group received additional depressomassage during 6 months. Color was assessed using the POSAS questionnaire (for color, vascularity and pigmentation) and the Minolta Chromameter. TEWL was measured using DermaLab.Results
Patients of both groups were evaluated at baseline, after 1, 3 and 6 months and after 1 year. The evidence for a difference in evolution of color and TEWL between both groups in our study was minimal.Conclusions
In practice, precise indications to begin depressomassage have to be kept in mind. Perhaps other scar abnormalities such as decreased elasticity, increased thickness, excessive pain or itching could be sufficient reasons to begin depressomassage and should be assessed. 相似文献7.
Mine Seyyah Saadet Ufuk Yurdalan 《Burns : journal of the International Society for Burn Injuries》2018,44(5):1352-1356
Background
This study aimed to evaluate cross-cultural adaptation, validation, and reliability of Patient and Observer Scar Assessment Scale (POSAS) for its Turkish use.Method
This study included 50 burn patients with hypertrophic scars who were aged 18–65 years (mean, 37.5 ± 1.4 years) and were admitted to Wound and Burn Treatment Center from February 2014 to April 2014. With regard to the cultural adaptation of POSAS from English to Turkish, the scale was translated by two people who worked in different health fields. POSAS was administered to the patients with a 1-week interval to evaluate the validity and reliability of the scale. Internal consistency of the scale was tested using the Cronbach alphamethod.Results
The Cronbach alpha value for the observer measurements was found to be 0.93 (excellent), and that for patient measurements was found to be 0.77 (good). Accordingly, the internal consistency of the scale was established.Conclusion
The Turkish version of POSAS is a valid, reliable and culturally appropriate survey for evaluating hypertrophic scars. We believe that the Turkish version of POSAS will be an important clinical/scientific tool in the field of burn physiotherapy in Turkey, which will lead to new researches in this field. 相似文献8.
Farrukh Aslam Khalid Muhammad Younas Mehrose Muhammad Saleem Muhammad Amin Yousaf Abdul Malik Mujahid Saif Ur Rehman Sania Ahmad Moazzam Nazeer Tarar 《Burns : journal of the International Society for Burn Injuries》2019,45(1):69-75
The treatment of keloid and hypertrophic scar is challenging with no universally accepted mode for permanent ablation. Conventional therapies yield unpredictable results, significant complications and require elaborate hardware.
Objective
The objective was to establish the safety and efficacy of intralesional 5-fluorouracil (5-FU) for the treatment of keloids and hypertrophic scars.Study design
Randomized controlled trial (RCT).Place and duration
It was conducted at the Jinnah Burn and Reconstructive Surgery Center/Allama Iqbal Medical College, Lahore, Pakistan from May 2012 to March 2013.Subjects and methods
We included 120 patients divided in two groups. The group A patients received intralesional triamcinolone acetonide (TAC) and the group B patients received both 5-FU and TAC. 8 injections at a week interval were given and patients were evaluated at the start of treatment and then at 4th and at 8th week during the treatment and then 4 weeks after the end of treatment. Patents were assessed for mean reduction in scar height, efficacy and complications.Results
Total of 108 patients completed the study. The mean reduction in the scar height in group B (5-FU + TAC) 1.144 + .4717 was markedly better than that of group A (TAC alone) 1.894 + 1.0751 (t = 4.781, p = .000). The efficacy (defined previously as >50% reduction in initial scar height) was superior in group B 44 (77.2%) than that of group A 25 (49.0% (X2 = 9.260, p = .002). Recurrence was seen in 39.2% (20) of patients of the group A while in only 17.5% (10) of the cases of group B (P = 0.012). Mean follow up was of 22 months.Conclusion
5-FU + TAC is safe, easy to administer and effective treatment for problematic scars and has the lower rate of recurrence on larger follow up. 相似文献9.
Vu Quang Vinh Tran Van Anh Nguyen Gia Tiên Hiko Hyakusoku Rei Ogawa 《Burns : journal of the International Society for Burn Injuries》2018,44(2):462-467
Background
The concept of the “super-thin flap” (also known as the subdermal vascular network flap) was introduced in Japan in 1994. Its distinctive characteristic is its extreme thinness: it is thinned to the point that the subdermal vascular network (subdermal plexus) can be seen through the minimal fat layer. Since 2006 in Vietnam, we have used circumflex scapular artery-supercharged occipito-cervico-dorsal (OCD) super-thin flaps to reconstruct cases of neck and face scar contracture.Materials and methods
This case series comprised all 82 patients with neck and face scar contracture who underwent reconstruction with an OCD supercharged super-thin flap from 2006–2015 at the Vietnam National Institute of Burns. The flap was thinned and anastomosed at the distal area after elevation. All patients received one flap.Results
Of the 82 flaps, 77 survived completely. The remaining five developed distal superficial necrosis (n = 3) and interruption of the sutures due to infection; these required resuturing (n = 2). In two of the three necrosis cases, the necrotic area affected 50% of the flap. Eighty of the eighty-two patients were satisfied with both the functional and aesthetic results.Conclusions
The OCD super-thin flap has clear benefits, and although it is thin, its vasculature is reliable. Thus, it may be one of the best choices for reconstruction of neck and face scar contractures. 相似文献10.
A. Abdulkadir M. Ahmed U.M. Tela A. Ismail B.M. Abubakar 《The African Journal of Urology》2017,23(1):20-23