Burns Service of Western Australia, WA Department of Health, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Western Australia 6150.
Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, Western Australia 6009; School of Postgraduate Studies, Royal College of Surgeons in Ireland, 123 St Stephen's Green, Dublin, Ireland D02 YN77.
J Plast Reconstr Aesthet Surg. 2019 Jun;72(6):863-870. doi: 10.1016/j.bjps.2019.01.027. Epub 2019 Feb 10.
To investigate the effect of ablative fractional CO laser (AFCOL) on burns scar appearance and dermal architecture at 6 weeks and up to 3-years post-treatment.
Twenty adult patients with a burn-related scar were recruited. Inclusion criteria were a minimum scar area of 10 × 10 cm and Vancouver scar scale (VSS) score of >5 and ≥6 months since the time of injury. The region of scar was randomised to treatment/control zones. Treatment zones received 3 standardised laser treatments at 4- to 6-week intervals. All areas of scar received standard scar care. Outcome measures were recorded at baseline, 6-weeks post final treatment and up to 3 years post-treatment. Measures included blinded assessor VSS, Patient Scar Assessment Scale and histological tissue analysis.
Nineteen and nine patients completed the short- and long-term studies, respectively. Clinical results revealed improvement in all scar areas over time. There was a statistically significant improvement in pain and itch in the treatment zone compared to the control zone at 6 weeks. Histological data revealed a significant increase in medium-sized collagen fibres at 6 weeks relative to the control site. Sub-group analysis according to scar age revealed greater histological improvement following laser treatment in immature scars relative to more mature scar.
Results demonstrate that 3 treatments of AFCOL significantly improve scar pain, itch and dermal architecture at 6 weeks post-treatment. Histological results suggest greater potential in treating immature scar. Further investigation into the timing of laser treatment could help assist treatment protocols.
研究消融性分数 CO2 激光（AFCOL）对烧伤后瘢痕外观和真皮结构的影响，治疗后 6 周及长达 3 年的随访结果。
纳入 20 名烧伤相关瘢痕患者，纳入标准为瘢痕面积至少 10×10cm，温哥华瘢痕量表（VSS）评分＞5 分，且损伤后至少 6 个月。瘢痕区域随机分为治疗区/对照区。治疗区接受 3 次标准化激光治疗，间隔 4-6 周。所有瘢痕区域均接受标准瘢痕护理。在基线、末次治疗后 6 周及治疗后 3 年内记录结局指标。评估指标包括盲法评估者 VSS、患者瘢痕评估量表和组织学分析。
19 名患者完成了短期研究，9 名患者完成了长期研究。临床结果显示，所有瘢痕区域随时间推移均有改善。治疗区与对照区相比，治疗后 6 周时疼痛和瘙痒有统计学显著改善。组织学数据显示，与对照区相比，治疗后 6 周时中号胶原纤维显著增加。根据瘢痕年龄的亚组分析显示，与成熟瘢痕相比，激光治疗对未成熟瘢痕的组织学改善更大。
结果表明，3 次 AFCOL 治疗可显著改善治疗后 6 周时的瘢痕疼痛、瘙痒和真皮结构。组织学结果提示其对未成熟瘢痕有更大的治疗潜力。进一步研究激光治疗的时机可能有助于制定治疗方案。
