剥脱性分数二氧化碳激光换肤术后颈部增生性瘢痕形成。
Hypertrophic scarring of the neck following ablative fractional carbon dioxide laser resurfacing.
作者信息
Avram Mathew M, Tope Whitney D, Yu Thomas, Szachowicz Edward, Nelson J Stuart
机构信息
Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
出版信息
Lasers Surg Med. 2009 Mar;41(3):185-8. doi: 10.1002/lsm.20755.
BACKGROUND
Ablative fractional carbon dioxide (CO(2)) laser treatments have gained popularity due to their efficacy, shortened downtime, and decreased potential for scarring in comparison to traditional ablative CO(2) resurfacing. To date, scarring with fractional CO(2) lasers has not been reported.
OBJECTIVE
Five patients treated with the same fractional CO(2) laser technology for photodamage of the neck were referred to our practices 1-3 months after treatment. Each patient developed scarring. Of the five cases, two are discussed in detail. The first was treated under general anesthesia on the face and anterior neck at a pulse energy of 30 mJ (859 microm depth) with 25% coverage. Eleven days after treatment, three non-healing areas along the horizontal skin folds of the anterior neck were noted. At 2 weeks after CO(2) ablative fractional resurfacing, these areas had become thickened. These raised areas were treated with a non-ablative fractionated 1,550 nm laser to modify the wound healing milieu. One week later, distinct firm pale papules in linear arrays with mild hypopigmentation had developed along involved neck skin folds. Skin biopsy was performed. For the second patient, the neck was treated at a pulse energy of 20 mJ (630 microm depth) with 30% coverage of the exposed skin, with a total treatment energy of 5.0 kJ. Minimal crusting was noted on the neck throughout the initial healing phase of 2 weeks. She then experienced tightness on her neck. Approximately 3 weeks after treatment, she developed multiple vertical and horizontal hypertrophic scars (HS).
RESULTS
Histopathology for the first case confirmed the presence of a hypertrophic scar. The papules in this case completely resolved with mild residual hypopigmentation after treatment with topical corticosteroids. HS failed to resolve in the second case to date after 1 month.
CONCLUSION
As with traditional ablative CO(2) laser resurfacing, HS is a potential complication of ablative fractional CO(2) laser resurfacing, particularly on the neck. With early diagnosis and appropriate treatment HS of neck skin may be reversible. We urge caution when treating the neck with this device and close attention to wound care in the post-operative period.
背景
与传统的剥脱性二氧化碳（CO₂）激光换肤术相比，剥脱性分次二氧化碳（CO₂）激光治疗因其疗效显著、停工期缩短以及瘢痕形成可能性降低而受到欢迎。迄今为止，尚未有关于分次CO₂激光治疗后瘢痕形成的报道。
目的
5例接受相同分次CO₂激光技术治疗颈部光损伤的患者在治疗后1至3个月转诊至我们的科室。每位患者均出现了瘢痕形成。在这5例病例中，详细讨论了其中2例。第一例患者在全身麻醉下对面部和颈部前方进行治疗，脉冲能量为30 mJ（深度859微米），覆盖率为25%。治疗11天后，在前颈部水平皮肤褶皱处发现3个未愈合区域。在CO₂剥脱性分次换肤术后2周，这些区域变得增厚。使用非剥脱性分次1550纳米激光对这些隆起区域进行治疗，以改变伤口愈合环境。1周后，在前颈部受累皮肤褶皱处出现了呈线性排列的明显坚实淡色丘疹，并伴有轻度色素减退。进行了皮肤活检。第二例患者颈部治疗的脉冲能量为20 mJ（深度630微米），暴露皮肤的覆盖率为30%，总治疗能量为5.0 kJ。在最初2周愈合阶段，颈部仅出现轻微结痂。随后她感到颈部紧绷。治疗后约3周，她出现了多处垂直和水平方向的增生性瘢痕（HS）。
结果
第一例病例的组织病理学检查证实存在增生性瘢痕。该病例中的丘疹在局部使用皮质类固醇治疗后完全消退，仅遗留轻度色素减退。第二例病例的增生性瘢痕在1个月后仍未消退。
结论
与传统剥脱性CO₂激光换肤术一样，增生性瘢痕是剥脱性分次CO₂激光换肤术的一种潜在并发症，尤其是在颈部。早期诊断并进行适当治疗后，颈部皮肤的增生性瘢痕可能是可逆的。我们在使用该设备治疗颈部时敦促谨慎操作，并在术后密切关注伤口护理。
Zotero 插件