Laser Resurfacing and Remodeling of Hypertrophic Burn Scars The Results of a Large, Prospective, Before-After Cohort Study, With Long-term Follow-up
Laser Resurfacing and Remodeling of Hypertrophic Burn Scars The Results of a Large, Prospective, Before-After Cohort Study, With Long-term Follow-up
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DOI：
10.1097/sla.0000000000000893
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发表时间：
2014-09-01
影响因子：
9
通讯作者：
Meyer, Anthony A.
中科院分区：
文献类型：
--
作者：
Hultman, C. Scott;Friedstat, Jonathan S.;Meyer, Anthony A.
目的：增生性烧伤瘢痕会导致严重的并发症，包括瘙痒、疼痛、僵硬和痉挛，但最佳的治疗方法尚不清楚。我们提出了迄今为止最大的一项研究，考察了激光疗法对瘢痕重塑的长期影响，这是一种潜在的变革性技术。方法：我们对烧伤患者进行了一项前后前瞻性的队列研究。用脉冲染料激光治疗瘙痒和红斑，用分数CO2激光治疗僵硬和质地异常。结果：147名烧伤患者(平均年龄26.9岁，总体表面积16.1%)在伤后16个月(中位数)接受了415次激光治疗，其中包括脉冲染料激光(327次)和二氧化碳(139次)。激光治疗对增生性瘢痕产生了快速、显著和持久的改善。治疗结束时，提供者评定的VSS从10.43[标准差(SD)2.37]降至5.16(SD 1.92)，随后在25个月的随访中降至3.29(SD 1.24)。第一年后，患者报告的UNC4P从5.40(SD 2.54)下降到2.05(SD 1.67)，并在研究结束时进一步下降到1.74(SD 1.72)。结论：首次在一项大型前瞻性研究中，通过客观和主观工具的测量，激光治疗显著改善了肥厚性烧伤瘢痕的体征和症状。激光治疗烧伤疤痕是一项颠覆性的创新，可以产生以前不可能实现的结果，并可能取代传统的手术干预方法。
Objectives: Hypertrophic burn scars produce significant morbidity, including itching, pain, stiffness, and contracture, but best management practices remain unclear. We present the largest study to date that examines long-term impact of laser therapies, a potentially transformative technology, on scar remodeling.Methods: We conducted a prospective, before-after cohort study in burn patients with hypertrophic scars. Pulsed-dye laser was used for pruritus and erythema; fractional CO2 laser was used for stiffness and abnormal texture. Outcomes included (1) Vancouver Scar Scale (VSS), which documents pigmentation, erythema, pliability, and height, and (2) University of North Carolina "4P" Scar Scale (UNC4P), which rates pain, pruritus, paresthesias, and pliability.Results: A total of 147 burn patients (mean age, 26.9 years; total body surface area, 16.1%) received 415 laser sessions (2.8 sessions/patient), 16 months (median) after injury, including pulsed dye laser (n = 327) and CO2 (n = 139). Laser treatments produced rapid, significant, and lasting improvements in hypertrophic scar. Provider-rated VSS dropped from 10.43 [ standard deviation (SD) 2.37] to 5.16 (SD 1.92), by the end of treatments, and subsequently decreased to 3.29 (SD 1.24), at a follow-up of 25 months. Patient-reported UNC4P fell from 5.40 (SD 2.54) to 2.05 (SD 1.67), after the first year, and further decreased to 1.74 (SD 1.72), by the end of the study period.Conclusions: For the first time, ever, in a large prospective study, laser therapies have been shown to dramatically improve both the signs and symptoms of hypertrophic burn scars, as measured by objective and subjective instruments. Laser treatment of burn scars represents a disruptive innovation that can yield results not previously possible and may displace traditional methods of operative intervention.