Bailey J Kevin, Blackstone Britani N, DeBruler Danielle M, Kim Jayne Y, Baumann Molly E, McFarland Kevin L, Imeokparia Folasade O, Supp Dorothy M, Powell Heather M
Department of Surgery, The Ohio State University Medical Center, 410 W. 10th Avenue, Columbus 43210, Ohio.
Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio.
Lasers Surg Med. 2018 Jan;50(1):78-87. doi: 10.1002/lsm.22702. Epub 2017 Jul 31.
The use of pulsed dye laser (PDL) and fractional CO (FX CO ) laser therapy to treat and/or prevent scarring following burn injury is becoming more widespread with a number of studies reporting reduction in scar erythema and pruritus following treatment with lasers. While the majority of studies report positive outcomes following PDL or FX CO therapy, a number of studies have reported no benefit or worsening of the scar following treatment. The objective of this study was to directly compare the efficacy of PDL, FX CO , and PDL + FX CO laser therapy in reducing scarring post burn injury and autografting in a standardized animal model.
Eight female red Duroc pigs (FRDP) received 4 standardized, 1 in. x 1 in. third degree burns that were excised and autografted. Wound sites were treated with PDL, FX CO , or both at 4, 8, and 12 weeks post grafting. Grafts receiving no laser therapy served as controls. Scar appearance, morphology, size, and erythema were assessed and punch biopsies collected at weeks 4, 8, 12, and 16. At week 16, additional tissue was collected for biomechanical analyses and markers for inflammatory cytokines, extracellular matrix (ECM) proteins, re-epithelialization, pigmentation, and angiogenesis were quantified at all time points using qRT-PCR.
Treatment with PDL, FX CO , or PDL + FX CO resulted in significantly less contraction versus skin graft only controls with no statistically significant difference among laser therapy groups. Scars treated with both PDL and FX CO were visually more erythematous than other groups with a significant increase in redness between two and three standard deviations above normal skin redness. Scars treated with FX CO were visually smoother and contained significantly fewer wrinkles. In addition, hyperpigmentation was significantly reduced in scars treated with FX CO .
The use of fractional carbon dioxide or pulsed dye laser therapy within 1 month of autografting significantly reduced scar contraction versus control, though no statistically significant difference was detected between laser modalities or use of both modalities. Overall, FX CO therapy appears to be modestly more effective at reducing erythema, and improving scar texture and biomechanics. The current data adds to prior studies supporting the role of laser therapy in the treatment of burn scars and indicates more study is needed to optimize delivery protocols for maximum efficacy. Lasers Surg. Med. 50:78-87, 2018. © 2017 Wiley Periodicals, Inc.
脉冲染料激光（PDL）和剥脱性二氧化碳（FX CO₂）激光疗法用于治疗和/或预防烧伤后瘢痕形成的应用越来越广泛，多项研究报告称激光治疗后瘢痕红斑和瘙痒有所减轻。虽然大多数研究报告PDL或FX CO₂治疗后有积极效果，但也有一些研究报告称治疗后瘢痕无改善或恶化。本研究的目的是在标准化动物模型中直接比较PDL、FX CO₂以及PDL + FX CO₂激光疗法在减轻烧伤后瘢痕形成和自体移植方面的疗效。
八只雌性红色杜洛克猪（FRDP）接受4处标准化的1英寸×1英寸三度烧伤，烧伤部位切除后进行自体移植。在移植后4周、8周和12周，对伤口部位分别用PDL、FX CO₂或两者进行治疗。未接受激光治疗的移植部位作为对照。评估瘢痕外观、形态、大小和红斑情况，并在第4周、8周、12周和16周采集钻孔活检样本。在第16周，收集额外组织进行生物力学分析，并使用qRT-PCR在所有时间点对炎症细胞因子、细胞外基质（ECM）蛋白、再上皮化、色素沉着和血管生成的标志物进行定量分析。
与仅行皮肤移植的对照组相比，PDL、FX CO₂或PDL + FX CO₂治疗导致的瘢痕收缩明显更少，激光治疗组之间无统计学显著差异。同时接受PDL和FX CO₂治疗的瘢痕在视觉上比其他组更红，发红程度比正常皮肤发红高出两到三个标准差且有显著增加。接受FX CO₂治疗的瘢痕在视觉上更光滑，皱纹明显更少。此外，接受FX CO₂治疗的瘢痕色素沉着明显减轻。
自体移植后1个月内使用剥脱性二氧化碳或脉冲染料激光疗法与对照组相比显著减少了瘢痕收缩，尽管在激光治疗方式或两种方式联合使用之间未检测到统计学显著差异。总体而言，FX CO₂疗法在减轻红斑、改善瘢痕质地和生物力学方面似乎略更有效。当前数据补充了先前支持激光疗法在烧伤瘢痕治疗中作用的研究，并表明需要更多研究来优化治疗方案以实现最大疗效。《激光外科与医学》50:78 - 87, 2018。© 2017威利期刊公司
