Early intervention by Z-plasty combined with fractional CO2 laser therapy as a potential treatment for hypertrophic burn scars

The aim of this study is to determine whether Z-plasty combined with fractional CO₂ laser therapy can be a potential management option for hypertrophic burn scars in the proliferation stage. A total of 105 patients (46 male and 59 female patients) diagnosed with hypertrophic scars under tension but without any functional limitations were enrolled in this study. The Vancouver Scar Scale (VSS) score and scar height were analyzed and compared. The VSS scores for all scars were improved in all groups after treatment. The scar height was also significantly decreased in each group after treatment (P < 0.05). In the C group, the scar height decreased significantly to 2.62 ± 0.21 mm, which was the maximum extent at the ≦ 6 month time point compared to the decrease in the other groups. Compared to the > 12 month time point for the C group, there was a significant difference between the ≦ 6 month time point for the L group and the > 12 month time point for the Z group. The proportion of satisfied patients was highest at 89.47% at the ≦6 month time point in the C group and lowest at 65.52% at the > 12 month time point in the L group. Six representative cases are presented. Z-plasty can decrease the thickness of a hypertrophic burn scar, which not only reduces the scar tension but also makes it easy to treat the scar with a fractional CO₂ laser. Subsequent treatment with a fractional CO₂ laser can better improve the color and texture of the scar.     

Combination treatment utilizing fractional ablative and continuous wave CO2 lasers for hypertrophic burn scars

BackgroundHypertrophic scars are devastating outcomes of severe burn injuries, producing physical and mental burdens. Adequate treatment is of benefit to relieve these burdens. Laser therapy has shown scar reducing effects. In this study, we compared outcomes after combination of two different lasers or single laser treatment to treat severe hypertrophic burn scars.MethodsForty patients with hypertrophic burn scars were included in one of two therapeutic groups: continuous wave CO₂ laser and fractional ablative CO₂ laser group (group 1, n = 20) or fractional ablative CO₂ laser alone group (group 2, n = 20). Hypertrophic scars were evaluated by the observer-rated Vancouver Scar Scale (VSS) before and after treatment and by patient-completed questionnaires after treatment. Comparative analyses were performed before and after treatment, and time-dependent improvement was also analyzed.ResultsForty patients (54 hypertrophic scars) completed the laser treatment protocols. Group 1 exhibited significantly more improvement in VSS vascularity, pliability, and height indices than group 2 (p < 0.05). Time-dependent analysis of total VSS scores suggested that group 1 experienced more improvement during a shorter treatment period (p < 0.05). For patient-reported outcomes, group 1 noted better grades than group 2 in four indices, namely scar appearance, scar thickness, pain, and pruritus (p < 0.05).ConclusionEffective scar reduction was achieved using combination laser treatment, with significant improvement in multiple observer- and patient-reported outcomes. The shorter treatment period of the combination method can be a merit, as prolonged hypertrophic scars may increase morbidity. Nonetheless, cautious treatment protocols are necessary to avoid undesirable sequelae related to laser application.     

Microcirculation in hypertrophic burn scars

Using the technique of capillary microscopy the microcirculation of post burn hypertrophic scars and grafts, at varying stages of maturity, have been documented. Sympathetic innervation of larger vessels beneath and within the scarred tissues could be found only in fully-matured scars, suggesting a link between the processes of scar reinnervation and maturation.     

The efficacy and safety of fractional CO2 laser therapy in the treatment of burn scars: A meta-analysis

Although we have numerous publications about the effect of fractional CO₂ laser therapy for burn scars, quantitative data about its efficacy and safety are sparse. The purpose of this meta-analysis was to assess the efficacy and safety of fractional CO₂ laser therapy for the treatment of burn scars. Pertinent studies were identified by a search of PubMed, Embase and Web of Science up to 20 September 2020. Weighted mean difference (WMD) was conducted to combine the results, and a random-effect model was used to pool the results. Publication bias was estimated using Begg and Egger’s regression asymmetry test. Twenty articles were included. Our pooled results suggested that fractional CO₂ laser therapy significantly improved the Vancouver Scar Scale (VSS) score (WMD = −3.24, 95%CI: −4.30, −2.18; P < 0.001). Moreover, the Patient and Observer Scar Assessment Scale (POSAS)-patient (WMD = −14.05, 95%CI: −22.44, −5.65; P = 0.001) and Observer (WMD = −6.31, 95%CI: −8.48, −4.15; P < 0.001) also showed significant improvements with the treatment of fractional CO₂ laser therapy. Fractional CO₂ laser significantly reduced scar thickness measured with ultrasonography (WMD = −0.54, 95%CI: −0.97, −0.10; P < 0.001). For other outcomes, including pigmentation, vascularity, pliability, and height of scar, vascularity and relief, laser therapy was associated with significant improvements. However, only the cutometer measure R2 (scar elasticity) (WMD = −0.06, 95%CI: −0.10, −0.01; P = 0.023) was significantly improved with the laser therapy, but cutometer measures R0 (scar firmness) (WMD = 0.03, 95%CI: −0.04, 0.09; P = 0.482) was not. Side effects and complications induced by fractional CO₂ laser were mild and tolerable. Fractional CO₂ laser therapy significantly improved both the signs and symptoms of burn scars. Considering potential limitations, more large-scale, well-designed RCTs are needed to verify our findings.     

Effectiveness and safety of ablative fractional CO2 laser for the treatment of burn scars: A case-control study

BackgroundBurn scars are a major clinical challenge. The aim of this study was to determine the effectiveness and safety of one treatment with the ablative fractional CO₂ laser (AFL-CO₂) compared to standard burn scar treatment.MethodFrom December 2014 to October 2018 patients were prospectively recruited and treatment effects analyzed by assessing various outcome parameters from the date of first consultation and after treatment. A case control study was conducted looking at the impact of one AFL-CO₂ treatment compared to a cohort subjected to conventional conservative treatment. Adverse effects were noted at follow up.Results187 patients were included, with 167 in the AFL-CO₂, and 20 in the control cohort. Baseline demographics and scar characteristics showed no significant differences. Ultrasound measured scar thickness as well as the Vancouver Scar Scale (VSS) revealed a significant reduction in the treatment cohort, but no significant improvement in the control group. The POSAS-O was significantly improved in both cohorts. Subjective parameters (POSAS-P, DN4-Pain, and modified D4Pruritus scores) decreased significantly in the AFL-CO₂ cohort but remained unchanged in the control group. The BSHS-B quality of life score increased significantly in the AFL-CO₂ group, but worsened at the follow up of the untreated patients. Sub-domain analyses found the biggest differences in Affect, Body Image, Heat Sensitivity, Treatment and Work. Complications occurred in 5 patients (2.9%).ConclusionsThis study demonstrates that AFL-CO₂ is an effective and safe treatment modality for burn scars improving thickness, symptoms and quality of life of burn survivors when compared to conventional scar treatment.     

超脉冲CO2激光联合点阵铒激光治疗痤疮凹陷性瘢痕的疗效及影响疗效的因素分析

目的 探讨使用超脉冲CO2激光联合点阵铒激光治疗痤疮凹陷性瘢痕的疗效及影响疗效的因素.方法 对我科自2007年3月至2010年1月收治的33例痤疮凹陷性瘢痕患者的治疗情况进行回顾性分析,结合临床特点分析治疗失败的原因并找出危险因素.结果 本组超脉冲CO2激光联合点阵铒激光治疗痤疮凹陷性瘢痕有效率达87.9%,临床疗效与患者的病史时间(P =0.038)、是否患有其他皮肤病(P =0.002)有关;而本研究中患者性别、病变程度、病损程度与临床预后间无统计学意义.结论 超脉冲CO2激光联合点阵铒激光是治疗痤疮凹陷性瘢痕的有效方法.伴有其他皮肤疾病、病程较长的患者预后可能较差.     

1565 nm非剥脱点阵激光治疗瘢痕疙瘩与增生性瘢痕

增生性瘢痕以及瘢痕疙瘩的治疗是亟待解决的医学难题。1565 nm非剥脱点阵激光是瘢痕治疗全新的治疗方法,临床尝试使用1565 nm非剥脱点阵激光来治疗增生期的增生性瘢痕以及瘢痕疙瘩的确有明显的治疗作用。非剥脱性点阵激光造成瘢痕组织局部的热效应,这种热效应,在不破坏组织胶原支架结构,不引起较强炎症反应基础上,能够导致瘢痕局部的成纤维细胞增殖受到抑制,甚至能够促进成纤维细胞的凋亡,瘢痕逐渐萎缩,达到治疗目的。     

可调脉宽倍频Nd：YAG激光和点阵CO_2激光综合治疗瘢痕的临床应用

目的：探讨综合应用可调脉宽倍频Nd：YAG532nm激光和点阵CO2激光分别治疗面颈部早期红色瘢痕和晚期浅表性瘢痕的临床效果。方法：采用可调脉宽倍频Nd：YAG 532nm波长激光治疗面颈部红色增生期瘢痕,采用点阵CO2激光治疗面颈部浅表性瘢痕,并且根据疗效评定标准对治疗效果进行评价。结果：98个早期红色增生期瘢痕每次经激光治疗后症状和体征都减轻,4次治疗后手术切口条形瘢痕的总有效率为100%,显效率为96%,挫伤及烧烫伤后片状瘢痕的总有效率为91%,显效率为70%。80例浅表性瘢痕一次治疗后的总显效率为65%。结论：综合应用可调脉宽倍频Nd：YAG532nm激光和点阵CO2激光分别治疗面颈部早期增生性瘢痕和晚期浅表性瘢痕的治疗方案可行,值得临床推广应用。     

A new modality for fractional CO2 laser resurfacing for acne scars in Asians

Since fractional photothermolysis was first introduced in 2004, it has become a very popular procedure, especially with more and more ablative fractional laser systems and treatments. Fractional ablative laser has been shown to be very effective; however, it does not reach the efficacy of conventional ablative laser treatments in most instances. In an attempt order to make the fractional CO₂ laser treatment more efficacious and safe, we combined both the conventional CO₂ laser and the fractional CO₂ laser to treat acne scars. We report our experience with this new modality. A total of 44 Chinese patients with facial acne scars and skin type IV were included in this study. Each patient received a minimum of two treatment sessions. For each laser session, both the conventional CO₂ laser treatment and the DeepFX laser treatment were focused on treating the scar areas only. Following this technique, the more superficialf ActiveFX fractional CO₂ laser was performed to the entire face. The efficacy of the procedure was evaluated 3 months after the final laser treatment. The improvement in acne scars and the overall skin texture change were assessed by photographic evaluation using the following scales: ≤25 % (mild), 26–50 % (moderate), 51–75 % (marked), and >75 % (excellent). Side effects from this therapy were mild to moderate. Two cases of HSV outbreak were noted; they were treated and resolved without adverse sequelae. Post-laser erythema was resolved within 1 month in one half of the patients. Prolonged erythema (≤3 months) was noted in 12(27 %) cases. Temporary post-inflammatory hyperpigmentation (PIH; ≤1 month) was seen in approximately 50 % of the patients. PIH (≤3 months) was noted in four cases (9 %). Sixty-four percent of the patients (28/44) had an improvement of between 51 and 75 % after more than two sessions of the combination of laser treatments. The average overall improvement was 52.50 % (±12.25 %). Three patients achieved improvement of >75 %. This new modality of ablative conventional CO₂ laser therapy with fractional CO₂ laser resurfacing was shown to be safe and efficacious in the treatment of acne scars in Asian patients. It did not increase the risk of PIH compared to other reports of laser therapy and PIH. It is the hope that future study with combination therapy will further enhance the clinical results and thus lessen potential adverse events.     

二氧化碳点阵激光治疗烧伤瘢痕的研究进展

This paper reviews the new progress in the research of fractional carbon dioxide laser in treating hypertrophic scar after bum injury,which remains a challenging problem for burn care surgeons.There have been many traditional therapeutic approaches,such as compression remedy,operation,and so on.However,a satisfactory method is lacking to date.In recent years,the newly developed fractional carbon dioxide laser has been employed to treat different kinds of scars,and it has been proved to be effective in terms of an improvement of scar color,texture,and rigidity.It seems to be a promising method for scar treatment in future.     

Laser in the treatment of hypertrophic burn scars

This prospective study looked at the outcome of laser (light amplification by stimulated emission of radiation) treatment for hypertrophic scarring. Dermatrade mark K laser (a set of combined lasers erbium:yttrium aluminium garnet/carbon dioxide, qualified as a class IV laser) was used. Between 21 June 2000 and 19 November 2002, at the Siemianowice Burn Center, Poland, 592 interventions, using laser, were performed on N= 327 patients (220 women and 107 men, aged between 3 and 80 years). The majority of cases [N= 223 (68.9%)] were patients with post-burn hypertrophic scars, and 104 cases (31.8%) had various types of hypertrophic scars. Evaluation took place using an adapted Vancouver Scar Scale and digital photographs as well as the patient's opinion. It was noted that after laser treatment, satisfactory results were achieved in 72% of cases. The scars had become less red (192/327 scored no redness at the end of the study versus 92/327 upon initial), less raised (272/327 scored a flat scar versus 72/327 upon initial) and demonstrated an improved viscoelasticity (192/327 scored a soft skin versus 62/327 upon initial). Laser treatment did not improve contractures in post-burn hypertrophic scars. Results were not confirmed using objective measurement tools, as these were not available to us.     

Effectiveness of artesunate combined with fractional CO2 laser in a hypertrophic scar model with underlying mechanism

Background and objectivesBoth artesunate and fractional CO₂ laser have been proved effective in the treatment of hypertrophic scars, yet little data are available for the efficacy of artesunate combined with fractional CO2 laser. In order to assess the pre-clinical significance and the underlying mechanism of this combined treatment profile, we attempted to observe the effectiveness of this therapy in rabbit models through determining the expression of BMP-7 and Fas.Materials and methodsTwenty-Four New Zealand white rabbits with established hypertrophic scar samples were randomly divided into control group and three treatment groups. Artesunate (20 μl/cm²) was injected into the rat’s scar of artesunate and combination groups, while fractional CO2 laser (Combo mode, deep energy:10 mJ, super energy: 50 mJ) was applied to rats in fractional CO2 laser and combination groups at week 4 after model establishment. All rabbits underwent a total of 3 sessions of treatment once every 2 weeks. Histological and immunohistochemistry study, Western blot assay, cell viability, ELISA and RT-QPCR were performed at week 10 to observe the aspects of hypertrophic scar sample changes and expression of BMP-7 and Fas in the scar tissues.ResultsCompared with control group, hypertrophic scars and the collagen fibers were significantly inhibited after treatment, and higher inhibition was seen in the samples in combination group compared to that in artesunate and fractional CO2 laser groups (P < 0.01). Meanwhile, BMP-7 and Fas expressions were both notably increased in all treatment groups, and upregulation of the two proteins was dominant in combination group (P < 0.01).ConclusionsArtesunate combined with fractional CO2 laser is effective in hypertrophic scarring in this rabbit model. Our findings can serve as a potential alternative strategy to treatment of hypertrophic scar in clinical practice.     

CO2点阵激光治疗面部皮肤光老化的疗效观察

目的 探讨CO2点阵激光治疗面部皮肤光老化的临床疗效.方法 自2008年10月至2010年12月,应用CO2点阵激光技术治疗皮肤老化患者30例,治疗3次为一疗程,每次间隔3个月.治疗后观察并判定其疗效.结果 30例患者经一个疗程治疗后,13(43%)例患者皱纹得到明显改善,评为3～6分;12(40%)例患者皱纹得到改善,评为6～9分;5例(17%)患者皱纹改善不明显,评为3分以下.对所有患者随访6个月,有效率达83%.结论 CO2点阵激光能有效治疗面部皮肤光老化,且安全性高、不良反应少,可将其作为当前面部皮肤年轻化治疗的新方法.     

Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars: evaluation of an in-patient controlled,standardized treatment approach

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.     

CO2点阵激光治疗眶周皱纹的临床观察

目的 评价CO2点阵激光治疗眶周皱纹的疗效及安全性.方法 20例眶周皱纹患者,皱纹Ⅰ级16例,Ⅱ级4例,选取照射能量25～30mJ,密度10～15,单脉冲.评价皱纹改善率并分5个等级:1级(0)、2级(1%～25%)、3级(26%～50%)、4级(51%～75%)、5级(76%～100%),观察并发症.结果 本组20例患者获随访12个月,16例(80%)患者皱纹获得2级改善,4例(20%)患者皱纹获得3级改善.疼痛程度:轻度8例(40%)、中度12例(60%).治疗后点状结痂7～10d脱落,红斑2～4周消退,暂时性色素沉着1～3个月消退,无永久性色素改变和瘢痕形成..结论 CO2点阵激光能有效改善眶周皱纹,无永久性不良反应发生.     

点阵CO2激光治疗兔耳增生性瘢痕后成纤维细胞凋亡及VEGF变化规律的研究

目的:①通过点阵CO2激光对兔耳增生性瘢痕治疗的实验研究,验证其有效性;②观察点阵CO2激光治疗兔耳增生性瘢痕后治疗组与对照组成纤维细胞凋亡及VEGF表达情况的变化。方法:新西兰大白兔20只双侧耳制作兔耳增生性瘢痕的动物模型并分组,造模后三周治疗组行点阵CO2激光治疗,对照组无干预。两组切取治疗后1h、治疗后3天、7天、14天、28天瘢痕组织,TUNEL法检测成纤维细胞凋亡率变化,免疫组化检测VEGF的表达变化。结果:点阵CO2激光治疗组瘢痕软化、变平所需时间较对照组缩短,治疗后瘢痕组织中成纤维细胞凋亡增多、VEGF表达减少。结论:点阵CO2激光治疗可以促进兔耳增生性瘢痕软化、变平,瘢痕组织中成纤维细胞凋亡增加、VEGF的表达降低,其治疗增生性瘢痕的机理之一可能在于其启动了增生性瘢痕中过度增殖的成纤维细胞的凋亡程序,加速凋亡,进而影响VEGF的表达,促进瘢痕的萎缩。