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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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Ultrapulse Fractional CO2 Laser With Different Fluences and Densities in the Prevention of Periorbital Laceration Scars: A Split-Scar, Evaluator-Blinded Study. J Craniofac Surg 2023:00001665-990000000-00602. [PMID: 36913549 DOI: 10.1097/scs.0000000000009244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 11/14/2022] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Periorbital laceration can result in complex, permanent scars, and even lead to serious complications such as cicatricial ectropion. Early intervention with laser devices has been suggested as a novel modality to reduce scar formation. However, no consensus exists regarding the optimal treatment parameters for scar management. This study evaluated the efficacy and safety of ultrapulse fractional CO2 laser (UFCL) with different fluences and densities in preventing periorbital surgical scars. OBJECTIVE To assess the efficacy and safety of UFCL with different fluences and densities in the prevention of periorbital laceration scars. METHODS A prospective, randomized, blinded study was conducted on 90 patients with periorbital laceration scars of 2 weeks old. Four treatment sessions of UFCL were administered to each half of the scar at 4-week intervals, with halves treated with high fluences with low density versus low fluences with low-density treatment. Vancouver Scar Scale was used to assess the 2 portions of each individual scar at baseline, final treatment, and 6 months. The patient's 4-point satisfaction scale was used to evaluate the patient's satisfaction at baseline and 6 months. Safety was evaluated by registration of adverse events. RESULTS Eighty-two of 90 patients completed the clinical trial and follow-up. There was no significant difference in Vancouver Scar Scale and satisfaction score between different laser settings between the two groups (P > 0.05). Adverse events were minor and no long-term side effects were noted. CONCLUSIONS Early application of UFCL is a safe, strategy to significantly improve the final traumatic periorbital scar appearance. Objective evaluation of scars did not identify differences in scar appearance between high fluences with low density versus low fluences with low density of UFCL treatment. LEVEL OF EVIDENCE Level III.
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Abd-Elsayed A, Pope J, Mundey DA, Slavin KV, Falowski S, Chitneni A, Popielarski SR, John J, Grodofsky S, Vanetesse T, Fishman MA, Kim P. Diagnosis, Treatment, and Management of Painful Scar: A Narrative Review. J Pain Res 2022; 15:925-937. [PMID: 35411187 PMCID: PMC8994628 DOI: 10.2147/jpr.s355096] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/29/2022] [Indexed: 12/26/2022] Open
Abstract
Painful scars can develop after surgery or trauma, with symptoms ranging from a minor itch to intractable allodynia. The problem of the painful scar may involve both intraneural and extraneural structures, requiring a systematic approach to diagnosis and treatment of this neuropathic pain condition that can impact quality of life and function profoundly. In this review, we outline the algorithm for the diagnosis, management, medical and surgical treatment of painful scars.
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Affiliation(s)
- Alaa Abd-Elsayed
- Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Correspondence: Alaa Abd-Elsayed, FASA Department of Anesthesia, Division of Pain Medicine, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, B6/319 CSC, Madison, WI, 53792-3272, USA, Tel +1 608-263-8100, Fax +1 608-263-0575, Email
| | - Jason Pope
- Evolve Restorative Center, Santa Rosa, CA, USA
| | | | - Konstantin V Slavin
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
- Neurology Service, Jesse Brown Veterans Administration Medical Center, Chicago, IL, USA
| | | | - Ahish Chitneni
- Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian Hospital - Columbia and Cornell, New York, NY, USA
| | | | - Jarod John
- Argires Marotti Neurosurgical Associates, Lancaster, PA, USA
| | | | - Tony Vanetesse
- Center for Interventional Pain Spine, LLC., Wilmington, DE, USA
| | | | - Philip Kim
- Center for Interventional Pain Spine, LLC., Wilmington, DE, USA
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Peng W, Zhang X, Kong X, Shi K. The efficacy and safety of fractional CO 2 laser therapy in the treatment of burn scars: A meta-analysis. Burns 2021; 47:1469-1477. [PMID: 34493423 DOI: 10.1016/j.burns.2021.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 04/14/2021] [Accepted: 08/16/2021] [Indexed: 01/19/2023]
Abstract
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.
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Affiliation(s)
- Weihai Peng
- Department of Plastic Surgery, The First Hospital of Jilin University, Chang Chun 130021, PR China
| | - Xi Zhang
- Department of Burns and Plastic Surgery, The First Hospital of Jilin University, Chang Chun 130021, PR China
| | - Xiangli Kong
- Department of Burns and Plastic Surgery, The First Hospital of Jilin University, Chang Chun 130021, PR China
| | - Kai Shi
- Department of Burns and Plastic Surgery, The First Hospital of Jilin University, Chang Chun 130021, PR China.
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A Call to Action: Using Current Procedural Terminology Category III Codes for Laser Fenestration of Burn and Traumatic Scars for Functional Improvement. Dermatol Surg 2020; 46:1430-1432. [PMID: 33108128 DOI: 10.1097/dss.0000000000002586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rasheed AI, Shawki SR, Mostafa RG, Sharara MA. A comparative clinical and histopathological pilot study of different fractional CO 2 laser parameters in treatment of atrophic linear scars. J Cosmet Dermatol 2020; 20:116-123. [PMID: 32416611 DOI: 10.1111/jocd.13489] [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: 01/25/2020] [Revised: 04/22/2020] [Accepted: 05/07/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atrophic scars cause significant patient morbidity. Fractional photothermolysis is one of the most effective treatment options used to resurface scars of different etiologies. AIMS To assess the efficacy and safety of different fractional ablative CO2 laser parameters in treatment of linear atrophic depressed post-traumatic facial scars in adult male patients. METHODS A prospective pilot study of 20 adult male patients (skin types Π- Ⅳ, aged 18-45) with post-traumatic atrophic linear scars were divided into 2 groups each comprising 10 patients receiving different fractional CO2 laser parameters. Both groups received 3 laser sessions, one month apart, and were followed for 2 months after the last treatment session. Clinical and histological assessments were done to all patients before treatment and 2 months after the last treatment session. Also, patient satisfaction and side effects were recorded. RESULTS The study showed statistically significant reduction in average scar volume in both groups (P < .01), with reduction in depth more obvious than reduction in width or length in both groups. There was a highly significant difference in overall scar improvement represented by scar volume between both groups (P < .01) with an average reduction in scar volume of 42.85% in group (a) compared with 35.29% in group (b). Also, there was a highly statistically significant increase in both epidermal and papillary and reticular dermis thickness in both groups after treatment. However, the difference between both groups was nonsignificant. Side effects were mild, well tolerated, and transient. CONCLUSION Fractional CO2 laser can be utilized as a safe and effective modality in treatment of post-traumatic linear atrophic scars of the face. Adjusting parameters toward increasing depth of penetration and decreasing thermal coagulative effect gives better results.
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Affiliation(s)
- Ahmad I Rasheed
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | | | - Rabab G Mostafa
- Department of Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Manal A Sharara
- Department of Dermatology, Venereology and Andrology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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New Developments for Fractional CO2 Resurfacing for Skin Rejuvenation and Scar Reduction. Facial Plast Surg Clin North Am 2020; 28:17-28. [DOI: 10.1016/j.fsc.2019.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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8
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Ablative fractional resurfacing for burn scar management affects the number and type of elective surgical reconstructive procedures, hospital admission patterns as well as length of stay. Burns 2020; 46:65-74. [DOI: 10.1016/j.burns.2019.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 09/21/2018] [Accepted: 01/01/2019] [Indexed: 11/20/2022]
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Klifto KM, Asif M, Hultman CS. Laser management of hypertrophic burn scars: a comprehensive review. BURNS & TRAUMA 2020; 8:tkz002. [PMID: 32346540 PMCID: PMC7175764 DOI: 10.1093/burnst/tkz002] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/28/2019] [Indexed: 12/15/2022]
Abstract
Hypertrophic scars often develop following burn-related injuries. These scars can be cosmetically unappealing, but associated symptoms of pruritus, pain and restricted range of motion can impair a person’s quality of life. Laser and light therapies offer a minimally invasive, low-risk approach to treatment, with a short postoperative recovery period. As laser technology developed, studies have shown decreased scar thickness, neuropathic pain and need for surgical excision, as well as improved scar pigmentation, erythema, pliability, texture, height and pruritus. In this review, we present the evolution of laser therapy for hypertrophic burn scars, how different types of lasers work, indications, perioperative considerations and guidelines for practice management.
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Affiliation(s)
- Kevin M Klifto
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, Maryland, USA, 21205.,Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, Maryland, USA, 21224
| | - Mohammed Asif
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, Maryland, USA, 21205.,Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, Maryland, USA, 21224
| | - C Scott Hultman
- Department of Plastic and Reconstructive Surgery, The Johns Hopkins University School of Medicine, 733 North Broadway, Baltimore, Maryland, USA, 21205.,Johns Hopkins Burn Center, The Johns Hopkins University School of Medicine, 4940 Eastern Ave, Baltimore, Maryland, USA, 21224
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10
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Zhang C, Yin K, Shen YM. Efficacy of fractional carbon dioxide laser therapy for burn scars: a meta-analysis. J DERMATOL TREAT 2019; 32:845-850. [PMID: 31865824 DOI: 10.1080/09546634.2019.1704679] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Cong Zhang
- Department of Burn, Beijing Jishuitan Hospital, Beijing, China
| | - Kai Yin
- Department of Burn, Beijing Jishuitan Hospital, Beijing, China
| | - Yu-ming Shen
- Department of Burn, Beijing Jishuitan Hospital, Beijing, China
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11
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The Efficacy of Combining Fractional Carbon Dioxide Laser With Verapamil Hydrochloride or 5-Fluorouracil in the Treatment of Hypertrophic Scars and Keloids: A Clinical and Immunohistochemical Study. Dermatol Surg 2019; 45:536-546. [DOI: 10.1097/dss.0000000000001726] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Tawfik AA, Fathy M, Badawi A, Abdallah N, Shokeir H. Topical 5 fluorouracil cream vs combined 5 fluorouracil and fractional erbium YAG laser for treatment of severe hypertrophic scars. Clin Cosmet Investig Dermatol 2019; 12:173-180. [PMID: 30936735 PMCID: PMC6421878 DOI: 10.2147/ccid.s191137] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Topical 5 fluorouracil (5-FU) has been reported as one of the standard treatments for hypertrophic scars (HTS). Ablative fractional laser was found to have promising results in the delivery of topical drugs into the skin by creating vertical channels through which the drugs can penetrate the skin. So far there have been no comparative studies performed to compare both modalities in the same patient and same anatomical region, especially in severe HTS. Objective The aim of this study was to compare the effectiveness of topical 5-FU and combined topical 5-FU and laser in treating severe HTS. Patients and methods Twenty-four severe HTS lesions were treated by 5-FU monotherapy and 5-FU combined with ablative fractional erbium YAG laser. Each lesion was divided into two parts. One part was treated with topical 5-FU twice weekly for 8 months. The other part was treated with combined topical 5-FU and ablative fractional erbium YAG laser once per month for 8 months. The scars’ improvement was evaluated by Vancouver scar scale (VSS) and skin analysis camera. Results The assessment by VSS showed a significant reduction in the mean height, pliability, and vascularity of the lesions which were treated with combined approaches compared to 5-FU monotherapy. Pain and ulceration occurred at a higher rate in the combination therapy group. Conclusion Treatment of severe HTS with combined 5-FU and ablative fractional erbium YAG laser is more effective than 5-FU alone.
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Affiliation(s)
- Abeer Attia Tawfik
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
| | - Maha Fathy
- Al-Houd Al Marsoud Hospital, Cairo, Egypt,
| | - Ashraf Badawi
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt, .,Dermatology and Allergology Department, University of Szeged, Szeged, Hungary
| | - Noha Abdallah
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
| | - Hisham Shokeir
- Dermatology Unit, Department of Medical Applications of Lasers (MAL), National Institute of Laser Enhanced Sciences, Cairo University, Giza, Egypt,
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Clayton NA, Haertsch PA, Maitz PK, Issler-Fisher AC. Ablative Fractional Resurfacing in Acute Care Management of Facial Burns: A New Approach to Minimize the Need for Acute Surgical Reconstruction. J Burn Care Res 2019; 40:368-372. [DOI: 10.1093/jbcr/irz030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Nicola A Clayton
- Speech Pathology Department, Concord Repatriation General Hospital, Sydney, Australia
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia
- School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Peter A Haertsch
- Speech Pathology Department, Concord Repatriation General Hospital, Sydney, Australia
| | - Peter K Maitz
- Speech Pathology Department, Concord Repatriation General Hospital, Sydney, Australia
- Faculty of Medicine, University of Sydney, Australia
| | - Andrea C Issler-Fisher
- Speech Pathology Department, Concord Repatriation General Hospital, Sydney, Australia
- Faculty of Medicine, University of Sydney, Australia
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Fu X, Dong J, Wang S, Yan M, Yao M. Advances in the treatment of traumatic scars with laser, intense pulsed light, radiofrequency, and ultrasound. BURNS & TRAUMA 2019; 7:1. [PMID: 30723753 PMCID: PMC6350396 DOI: 10.1186/s41038-018-0141-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 12/25/2018] [Indexed: 12/21/2022]
Abstract
Traumatic scarring is one of the most common complications after soft tissue injury caused by burns and trauma, which affects tens of millions of people worldwide every year. Traumatic scars diminish the quality of life due to disfigurement, symptoms of pain and itch, and restricted motion. The pathogenesis and pathophysiology of traumatic scar remain elusive. The management for traumatic scars is comprised of surgical and non-surgical interventions such as pressure therapy, silicone, corticosteroid, and radiotherapy, which are chosen by clinicians based on the physical examinations of scars. Recently, great progress in treating traumatic scars has been achieved by the development of novel technologies including laser, intense pulsed light (IPL), radiofrequency, and ultrasound. The aim of this review article was to summarize the advances of these technologies for traumatic scars intervention.
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Affiliation(s)
- Xiujun Fu
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Jiying Dong
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Shen Wang
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Min Yan
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China
| | - Min Yao
- Department of Plastic Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011 China
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15
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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: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Keen A, Sheikh G, Hassan I, Jabeen Y, Rather S, Mubashir S, Latif I, Zeerak S, Ahmad M, Hassan A, Ashraf P, Younis F, Saqib N. Treatment of post-burn and post-traumatic atrophic scars with fractional CO 2 laser: experience at a tertiary care centre. Lasers Med Sci 2018; 33:1039-1046. [PMID: 29473114 DOI: 10.1007/s10103-018-2469-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/13/2018] [Indexed: 11/24/2022]
Abstract
Scars are abnormal wound responses in predisposed individuals. They occur after any kind of wound and skin inflammation in predisposed individuals. Despite their benign nature, they can be aesthetically disabling. Although several approaches have been tried in their management, most of them have produced poor results. This study aims to assess the efficacy and safety of fractional CO2 laser treatment in the management of post-burn and post-traumatic scars. One hundred consecutive patients (77 females and 23 males) affected by post-burn scars as well as post-traumatic atrophic scars were treated with monthly sessions of fractional CO2 laser treatment. Patient's response to treatment was assessed clinically as well as improvement of scars by comparing the photographs taken before treatment with those taken 6 months after the last treatment session. Changes in skin texture, surface irregularity and pigmentation were assessed on a quartile grading scale and scored individually from 0 to 4. A mean of the three individual scores was calculated and the response was labelled as 'excellent' if the mean score achieved was > 3. A score of 2-3 was labelled as good response while a score below 1 was labelled as 'poor' response. A mean of six treatments per scar were required and all patients, followed up for 1 year after the last treatment, had optimum results and no recurrence. Response to treatment was excellent in 53.75%, good in 16.25% patients, and poor in 30% patients. Fractional CO2 laser gives a very good result in the management of patients with post-burn scars as well as post-traumatic scars with minimal adverse effects.
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Affiliation(s)
- Abid Keen
- Postgraduate Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, Srinagar, India
| | - Gousia Sheikh
- Postgraduate Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, Srinagar, India
| | - Iffat Hassan
- Postgraduate Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, Srinagar, India. .,Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, University of Kashmir, Srinagar, Jammu and Kashmir, 190010, India.
| | - Yasmeen Jabeen
- Postgraduate Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, Srinagar, India
| | - Shagufta Rather
- Postgraduate Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, Srinagar, India
| | - Syed Mubashir
- Postgraduate Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, Srinagar, India
| | - Insha Latif
- Postgraduate Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, Srinagar, India
| | - Sumaya Zeerak
- Postgraduate Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, Srinagar, India
| | - Muzafar Ahmad
- Postgraduate Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, Srinagar, India
| | - Aqib Hassan
- Postgraduate Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, Srinagar, India
| | - Peerzada Ashraf
- Postgraduate Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, Srinagar, India
| | - Faizan Younis
- Postgraduate Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, Srinagar, India
| | - Najamul Saqib
- Postgraduate Department of Dermatology, Sexually Transmitted Diseases and Leprosy, Government Medical College Srinagar, Srinagar, India
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Abstract
Laser treatment for posttraumatic injury offers the clinician the unique opportunity for early intervention in mediating early scar formation, or for reducing the appearance of scars after maturation. In this review, the authors focus on the mechanisms by which lasers exert their therapeutic effects, highlighting several popular lasers and dosimetry used, and underscoring the power of combined surgical scar revision in managing posttraumatic facial scars.
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Burn injury: Challenges and advances in burn wound healing, infection, pain and scarring. Adv Drug Deliv Rev 2018; 123:3-17. [PMID: 28941987 DOI: 10.1016/j.addr.2017.09.018] [Citation(s) in RCA: 291] [Impact Index Per Article: 48.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/15/2017] [Accepted: 09/18/2017] [Indexed: 12/18/2022]
Abstract
Severe burn injuries are the most traumatic and physically debilitating injuries affecting nearly every organ system and leading to significant morbidity and mortality. Early burn wound excision and skin grafting are common clinical practices that have significantly improved the outcomes for severe burn injured patients by reducing mortality rate and days of hospital stay. However, slow wound healing, infection, pain, and hypertrophic scarring continue to remain a major challenge in burn research and management. In the present article, we review and discuss issues in the current treatment of burn injuries; the advances and novel strategies developed in the past decade that have improved burn management; and also, pioneer ideas and studies in burn research which aims to enhance burn wound care with a focus on burn wound infection, pain management, treatments for scarring and skin tissue engineering.
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19
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Issler-Fisher AC, Waibel JS, Donelan MB. Laser Modulation of Hypertrophic Scars. Clin Plast Surg 2017; 44:757-766. [DOI: 10.1016/j.cps.2017.05.007] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Gokalp H. Evaluation of nonablative fractional laser treatment in scar reduction. Lasers Med Sci 2017; 32:1629-1635. [DOI: 10.1007/s10103-017-2303-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 08/06/2017] [Indexed: 10/19/2022]
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Issler-Fisher AC, Fisher OM, Smialkowski AO, Li F, van Schalkwyk CP, Haertsch P, Maitz PKM. Ablative fractional CO 2 laser for burn scar reconstruction: An extensive subjective and objective short-term outcome analysis of a prospective treatment cohort. Burns 2016; 43:573-582. [PMID: 27707636 DOI: 10.1016/j.burns.2016.09.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Revised: 09/13/2016] [Accepted: 09/13/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The introduction of ablative fractional CO2 lasers (CO2-AFL) for burn scar management shows promising results. Whilst recent studies have focused on objective scar outcomes following CO2-AFL treatment, to date no data on patient subjective factors such as quality of life are available. METHODS A prospective study was initiated to analyze the safety and efficacy of the CO2-AFL. Various objective and subjective outcome parameters were prospectively collected from the date of first consultation and follow-up following treatment. Objective factors include the Vancouver Scar Scale (VSS), the Patient and Observer Scar Assessment Scale (POSAS), and ultrasound measurements of the thickness of the scar. Subjective parameters included the assessment of neuropathic pain and pruritus, as well as the evaluation of improvement of quality of life following CO2-AFL with the Burns Specific Health Scale (BSHS-B). For treatment effect analysis, patients were stratified according to scar maturation status (> or <2 years after injury). RESULTS 47 patients with 118 burn scars completed at least one treatment cycle. At a median of 55 days (IQR 32-74) after CO2-AFL treatment all analyzed objective parameters decreased significantly: intra-patient normalized scar thickness decreased from a median of 2.4mm to 1.9mm (p<0.001) with a concomitant VSS-drop from a median of 7 to 6 (p<0.001). The overall POSAS patient scale decreased from a median of 9 to 5 (p<0.001) with similar effects documented in POSAS observer scales. Both pain and pruritus showed significant reduction. Quality of life increased significantly by 15 points (median 120 to 135; p<0.001). All of the identified changes following CO2-AFL were equally significant irrespective of scar maturation status. CONCLUSION Our preliminary results confirm significant improvement in thickness, texture, colour, and symptoms following treatment with CO2-AFL. Foremost, quality of life of patients with both immature and mature scars (up to 23 years after injury) improved significantly after just one treatment session. To our knowledge, this is the first study to document such holistic treatment effects in burn patients treated by CO2-AFL.
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Affiliation(s)
| | - Oliver M Fisher
- St. Vincent's Centre for Applied Medical Research, Sydney, Australia
| | | | - Frank Li
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia
| | | | - Peter Haertsch
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia
| | - Peter K M Maitz
- Burns Unit, Concord Repatriation General Hospital, Sydney, Australia; ANZAC Research Institute, Concord Repatriation General Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
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22
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Lee SJ, Suh DH, Lee JM, Song KY, Ryu HJ. Dermal Remodeling of Burn Scar by Fractional CO2 Laser. Aesthetic Plast Surg 2016; 40:761-8. [PMID: 27519176 DOI: 10.1007/s00266-016-0686-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/29/2016] [Indexed: 02/05/2023]
Abstract
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 AND 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. 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)
- Sang-Jun Lee
- Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Korea
| | - Dong-Hye Suh
- Dermatology, Arumdaun Nara Dermatologic Clinic, Seoul, Korea
| | - Ji Min Lee
- Department of Dermatology, Korea University College of Medicine, Inchon-ro 73(Anam-dong 5ga), Seongbuk-gu, Seoul, 136-705, Korea
| | - Kye-Yong Song
- Department of Pathology, College of Medicine Chung-Ang University, Seoul, Korea
| | - Hwa Jung Ryu
- Department of Dermatology, Korea University College of Medicine, Inchon-ro 73(Anam-dong 5ga), Seongbuk-gu, Seoul, 136-705, Korea.
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Żądkowski T, Nachulewicz P, Mazgaj M, Woźniak M, Cielecki C, Wieczorek AP, Beń-Skowronek I. A new CO2 laser technique for the treatment of pediatric hypertrophic burn scars: An observational study. Medicine (Baltimore) 2016; 95:e5168. [PMID: 27759650 PMCID: PMC5079334 DOI: 10.1097/md.0000000000005168] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Treatment of hypertrophic scars arising as a result of thermal burns in children is still a big problem. The results of the treatment are not satisfactory for patients and parents, and new methods of treatment are still investigated.We present the use of one of the most modern carbon dioxide (CO2) lasers (Lumenis Encore laser equipped with a Synergistic Coagulation and Ablation for Advanced Resurfacing module) in the treatment of hypertrophic scars in children after burns.From March to April of 2013, a group of 47 patients aged 6 to 16 years underwent 57 laser surgery treatments. The average time from accident was 7.5 years. The results of treatment were investigated in 114 areas. The assessed areas were divided into 2 groups: 9-cm area 1, where the thickness of the scar measured by physician was the lowest and 9-cm area 2, where the thickness of the scar was the biggest. The results were considered on the Vancouver Scar Scale (VSS) independently by the surgeon and by parents 1, 4, and 8 months after the procedure. In addition, ultrasound evaluation of the scar thickness before and after laser procedure was made.VSS total score improved in all areas assessed by both the physician and parents. The biggest change in total VSS score in area 1 in the evaluation of the investigator was obtained at follow-up after the 1st month of treatment (average 7.23 points before and 5.18 points after the 1st month after surgery-a difference of 2.05 points). Scar ratings by parents and the physician did not differ statistically (P < 0.05). In the ultrasound assessment, the improvement was statistically significant, more frequently for both minimum and maximum thickness of the scars (B-mode measures) (P < 0.05).The use of a CO2 laser in the treatment of hypertrophic scars in children is an effective and safe method. The use of a CO2 laser improves the appearance and morphology of scarring assessed using the VSS by both the parents and the physician. The treatment also reduced the thickness of scars evaluated by ultrasound.
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Affiliation(s)
- Tomasz Żądkowski
- Department of Paediatric Surgery
- Correspondence: Tomasz Żądkowski, Medical University of Poland, Lublin, Poland (e-mail: )
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Khetarpal S, Dover JS, Arndt K. The Evolution and Current Best Treatments for Traumatic, Surgical, and Burn Scars. CURRENT DERMATOLOGY REPORTS 2016. [DOI: 10.1007/s13671-016-0146-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Jeffery S. Fractional CO 2 laser therapy: A paradigm shift in managing burns and scarring. TRAUMA-ENGLAND 2015. [DOI: 10.1177/1460408615580204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bleasdale B, Finnegan S, Murray K, Kelly S, Percival SL. The Use of Silicone Adhesives for Scar Reduction. Adv Wound Care (New Rochelle) 2015; 4:422-430. [PMID: 26155385 DOI: 10.1089/wound.2015.0625] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 03/12/2015] [Indexed: 01/31/2023] Open
Abstract
Significance: This article discusses the history and developments of silicone gel sheeting (SGS) scar therapy. Furthermore, we review a breadth of literature to gain an insight into how and why topical silicone gels remain the favored treatment of medical experts in scar management. We also analyze an ever increasing number of alternative therapies claiming to provide enhanced scar reduction performance. Recent Advances: Topical silicone gel treatments seem to remain the first point of clinical recommendation in scar management. SGS has been used in scar therapy for over 30 years, during which its efficacy has been the subject of numerous clinical evaluations. Critical Issues: While the exact mechanisms by which SGS improves hypertrophic scars, keloid development and recovery are yet to be fully agreed upon, its ability to do so remains largely undisputed at present. However, there still is ongoing deliberation over the exact mechanism of action of silicone in improving a scar. At present it is likely that through occlusion of the scar site and hydration of the wound bed, the overactivity of scar-related cells is suppressed, and their activity normalized. Future Direction: The clinical support of topical silicone gel products, relative to all alternative scar therapies, is considered the internationally recommended first-line form of scar management, and favored by consensus among healthcare professionals. However, there still remains the need for further clinical evidence and a better understanding of the mechanism behind the benefit of silicone gel for use in the prevention of abnormal scarring.
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Affiliation(s)
| | - Simon Finnegan
- Department of Chemistry, University of Sheffield, Sheffield, United Kingdom
| | - Kathyryn Murray
- Department of Chemistry, University of Sheffield, Sheffield, United Kingdom
| | - Sean Kelly
- Scapa Healthcare, Manchester, United Kingdom
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Perry A, Elston J, Reynolds H, Hawley L, Kroonen L, Uebelhoer NS, Shumaker PR. Ablative fractional photothermolysis in the treatment of scar contractures of the wrists and forearms: A retrospective data analysis. J Am Acad Dermatol 2014; 71:841-2. [DOI: 10.1016/j.jaad.2014.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 05/27/2014] [Accepted: 06/02/2014] [Indexed: 11/29/2022]
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Abstract
OBJECTIVE Excessive collagen deposition causes hypertrophic scarring after dermal wound repair. It can be functionally and cosmetically debilitating to many patients. A direct approach to the control of scar tissue formation is pharmacological regulation of collagen synthesis and deposition. Some studies reported that hepatocyte growth factor (HGF) plays an important role in scar formation. Hepatocyte growth factor can improve tissue fibrosis and reverse the imbalance of collagen metabolism. However, an in vivo study has not been reported concerning the use of HGF in controlling hypertrophy of skin scar until now. METHODS The authors tested the ability of HGF to reduce hypertrophic scar formation in a rabbit ear model. After the placement of three 5-mm dermal wounds on each ear, New Zealand white rabbits received HGF subcutaneously in the left ear at 4 time points on postwounding days 15, 30, 45, and 90. The left ear of each animal served as a control without HGF treatment. Scars were harvested at postoperative 6 months and scar hypertrophy quantified by measurement of the scar elevation index. RESULTS The experimental data showed that treatment of scars with HGF decreased scar formation. The HGF treatment resulted in a statistically significant reduction in the scar elevation index (P < .01). CONCLUSION The authors' results indicate the potential use of HGF to treat hypertrophic scarring, which shows important significance for antiscarring therapy.
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29
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Cho S, Jung JY, Shin JU, Lee JH. Non-Ablative 1550 nm Erbium-Glass and Ablative 10,600 nm Carbon Dioxide Fractional Lasers for Various Types of Scars in Asian People: Evaluation of 100 Patients. Photomed Laser Surg 2014; 32:42-6. [DOI: 10.1089/pho.2013.3608] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Suhyun Cho
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Young Jung
- Yeouido Oracle Cosmetic Dermatosurgery Clinic, Seoul, Korea
| | - Jung U. Shin
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Hee Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
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30
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Kroonen L, Shumaker PR, Kwan JM, Uebelhoer N, Hofmeister E. Treatment of split-thickness skin graft-related forearm scar contractures with a carbon dioxide laser protocol: 3 case reports. J Hand Surg Am 2013; 38:2164-8. [PMID: 24021742 DOI: 10.1016/j.jhsa.2013.06.036] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 06/19/2013] [Accepted: 06/21/2013] [Indexed: 02/02/2023]
Abstract
Split-thickness skin grafts in the forearm can lead to motion restriction and disability through the dense scarring of the skin and formation of graft-tendon adhesions. Three patients were referred for laser treatment of motion-limiting scar-associated split-thickness skin grafts to the forearm. All patients had reached a plateau in range of motion despite aggressive hand therapy and underwent serial laser scar treatments at 6- to 8-week intervals. Treatments were performed in a clinic setting and were initiated 2 to 5 months after reconstructive surgery. Rapid subjective functional and objective improvements in range of motion were noted after laser therapy. Results were cumulative and durable at final follow-up ranging from 10 to 15 months after the initial treatment. No complications were noted. Fractionated carbon dioxide laser therapy is a promising adjunct to hand therapy when the main restraint to motion is superficial skin scarring and skin-tendon adhesions.
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Affiliation(s)
- Leo Kroonen
- Departments of Orthopedics and Dermatology, Naval Medical Center San Diego, San Diego, California.
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31
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Shumaker PR, Dela Rosa KM, Krakowski AC. Treatment of lymphangioma circumscriptum using fractional carbon dioxide laser ablation. Pediatr Dermatol 2013; 30:584-6. [PMID: 23758048 DOI: 10.1111/pde.12165] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Lymphangioma circumscriptum remains a challenging entity to treat given anatomic considerations and a significant tendency for recurrence regardless of the modality selected. Surgical excision offers the greatest potential for definitive management but is often beset by procedural morbidity and suboptimal cosmetic outcomes. A range of palliative options have been reported for the treatment of lymphangioma circumscriptum, with varying degrees of associated efficacy and morbidity. This report describes the novel use of fractional carbon dioxide laser ablation for the treatment of lymphangioma circumscriptum, with promising cosmetic results and durable symptomatic relief.
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Affiliation(s)
- Peter R Shumaker
- Department of Dermatology, Naval Medical Center, San Diego, California
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