Background:Hypertrophic scars are one of the main complications that affect the quality of life of patients after burns.Many methods have been shown to be effective in the treatment of hypertrophic scars,such as ablat...Background:Hypertrophic scars are one of the main complications that affect the quality of life of patients after burns.Many methods have been shown to be effective in the treatment of hypertrophic scars,such as ablative fractional CO_(2) laser(AFCL)and platelet-rich plasma(PRP).However,there are few studies on the effect of the combined application of these measures.The purpose of this study was to explore the therapeutic effect of AFCL combined with PRP on hypertrophic burn scars.Methods:A retrospective clinical observation study was conducted on 50 patients with hypertrophic burn scars.The AFCL+PRP group included 31 patients who received AFCL combined with PRP treatment;the AFCL group included 19 patients who received AFCL treatment only.The University of North Carolina 4P Scar Scale(UNC4P)and the Vancouver Scar Scale(VSS)scores that were collected before each treatment were used as indicators of the effectiveness of the previous treatment.The scores recorded at the second,fourth and seventh months were analysed.Results:The demographic data of the 2 groups were not significantly different.Before treatment,therewas no difference in the UNC4P and VSS scores between the 2 groups.Therewas a significant decline in the UNC4P and VSS total scores over 6 months in both groups(p<0.05)and scores in the 2 groups were comparable after 3 and 6 months(p<0.05).UNC4P scores in the AFCL+PRP group decreased from a mean of 8.26 to 2.61(p<0.05)with a concomitant drop in VSS scores from a mean of 11.74 to 6.06(p<0.01).In the AFCL group UNC4P and VSS scores decreased from 7.68 to 4.63(p<0.05)and from 10.89 to 8.16(p<0.05),respectively.The sub-items of these 2 assessments were analysed and the results suggest that AFCL combined with PRP can comprehensively improve scarring.Conclusions:This study shows that PRP is an effective adjunct for AFCL in the treatment of hypertrophic burn scars and that the combination of PRP and AFCL proved to be more useful than AFCL alone.This combination may be a new and effective clinical practice for the treatment of scars.However,larger and higher-level clinical studies are still needed to determine its efficacy and possible mechanisms.展开更多
Background:Fractional CO_(2) laser plays an important role in scar management post split-thickness skin graft by loosening the graft contracture and restoring the smoothness of the surface.However,the optimal treatmen...Background:Fractional CO_(2) laser plays an important role in scar management post split-thickness skin graft by loosening the graft contracture and restoring the smoothness of the surface.However,the optimal treatment protocol remains unknown.This study applied a dual-scan protocol to achieve both releasing and ablation of contracted skin graft.We comprehensively describe this treatment method and compare the efficacy and safety between this dual-scan method and the conventional mono-scan mode.Methods:A hypercontracted scar model after split-thickness skin grafting in red Duroc pigs was established.All scars meeting the inclusion criteria were randomly divided into four groups:high fluence–low density(HF–LD),low fluence–high density(LF–HD),combined group and control group.The energy per unit areawas similar in the HF–LD and LF–HD groups.Two laser interventions were performed at a 6-week interval.The efficacy of the treatment was evaluated by objective measures of scar area,release rate,elasticity,thickness and flatness,while the safetywas evaluated based on adverse reactions and melanin index.Collagen structurewas observed histologically.The animals were followed up for a maximum of 126 days after modeling.Results:A total of 28 contracted scars were included,7 in each group.At 18 weeks postoperatively,the HF–LD and the combined groups showed significantly increased scar release rate(p=0.000)and elasticity(p=0.036)and decreased type I/III collagen ratio(p=0.002)compared with the control and LF–HD groups.In terms of flatness,the combined group was significantly better than the HF–LD group for elevations<1mm(p=0.019).No significant skin side effects,pigmentation or scar thickness changes were observed at 18 weeks.Conclusions:Dual-scan protocol could achieve superficial ablation and deep release of contracted split-thickness skin graft in a single treatment,with similar contraction release and texture improvement compared to a single deep scan.Its main advantage is to restore a smoother scar appearance.Adequate laser penetration was necessary for the release of contracted scars.展开更多
基金supported by the National Nature Science Foundation of China(81701899)the Youth Incubation Plan of the Military Medical Science and Technology(16QNP091)+1 种基金the CAMS Innovation Fund for Medical Sciences(2019-I2M-5-076)the high level achievement cultivation plan of the Naval Medical University(2018-CGPZ-B03).
文摘Background:Hypertrophic scars are one of the main complications that affect the quality of life of patients after burns.Many methods have been shown to be effective in the treatment of hypertrophic scars,such as ablative fractional CO_(2) laser(AFCL)and platelet-rich plasma(PRP).However,there are few studies on the effect of the combined application of these measures.The purpose of this study was to explore the therapeutic effect of AFCL combined with PRP on hypertrophic burn scars.Methods:A retrospective clinical observation study was conducted on 50 patients with hypertrophic burn scars.The AFCL+PRP group included 31 patients who received AFCL combined with PRP treatment;the AFCL group included 19 patients who received AFCL treatment only.The University of North Carolina 4P Scar Scale(UNC4P)and the Vancouver Scar Scale(VSS)scores that were collected before each treatment were used as indicators of the effectiveness of the previous treatment.The scores recorded at the second,fourth and seventh months were analysed.Results:The demographic data of the 2 groups were not significantly different.Before treatment,therewas no difference in the UNC4P and VSS scores between the 2 groups.Therewas a significant decline in the UNC4P and VSS total scores over 6 months in both groups(p<0.05)and scores in the 2 groups were comparable after 3 and 6 months(p<0.05).UNC4P scores in the AFCL+PRP group decreased from a mean of 8.26 to 2.61(p<0.05)with a concomitant drop in VSS scores from a mean of 11.74 to 6.06(p<0.01).In the AFCL group UNC4P and VSS scores decreased from 7.68 to 4.63(p<0.05)and from 10.89 to 8.16(p<0.05),respectively.The sub-items of these 2 assessments were analysed and the results suggest that AFCL combined with PRP can comprehensively improve scarring.Conclusions:This study shows that PRP is an effective adjunct for AFCL in the treatment of hypertrophic burn scars and that the combination of PRP and AFCL proved to be more useful than AFCL alone.This combination may be a new and effective clinical practice for the treatment of scars.However,larger and higher-level clinical studies are still needed to determine its efficacy and possible mechanisms.
基金supported by Shanghai Municipal Education Commission Gaofeng Clinical Medicine Grant Support(20152227)The national natural science foundation of China(81772098)Scientific research foundation of Shanghai Municipal Commission of Health and Family Planning(20154Y0023).
文摘Background:Fractional CO_(2) laser plays an important role in scar management post split-thickness skin graft by loosening the graft contracture and restoring the smoothness of the surface.However,the optimal treatment protocol remains unknown.This study applied a dual-scan protocol to achieve both releasing and ablation of contracted skin graft.We comprehensively describe this treatment method and compare the efficacy and safety between this dual-scan method and the conventional mono-scan mode.Methods:A hypercontracted scar model after split-thickness skin grafting in red Duroc pigs was established.All scars meeting the inclusion criteria were randomly divided into four groups:high fluence–low density(HF–LD),low fluence–high density(LF–HD),combined group and control group.The energy per unit areawas similar in the HF–LD and LF–HD groups.Two laser interventions were performed at a 6-week interval.The efficacy of the treatment was evaluated by objective measures of scar area,release rate,elasticity,thickness and flatness,while the safetywas evaluated based on adverse reactions and melanin index.Collagen structurewas observed histologically.The animals were followed up for a maximum of 126 days after modeling.Results:A total of 28 contracted scars were included,7 in each group.At 18 weeks postoperatively,the HF–LD and the combined groups showed significantly increased scar release rate(p=0.000)and elasticity(p=0.036)and decreased type I/III collagen ratio(p=0.002)compared with the control and LF–HD groups.In terms of flatness,the combined group was significantly better than the HF–LD group for elevations<1mm(p=0.019).No significant skin side effects,pigmentation or scar thickness changes were observed at 18 weeks.Conclusions:Dual-scan protocol could achieve superficial ablation and deep release of contracted split-thickness skin graft in a single treatment,with similar contraction release and texture improvement compared to a single deep scan.Its main advantage is to restore a smoother scar appearance.Adequate laser penetration was necessary for the release of contracted scars.
