Clayton Nicola A, Haertsch Peter A, Maitz Peter K, Issler-Fisher Andrea C
Speech Pathology Department, Concord Repatriation General Hospital, Sydney, Australia.
Burns Unit, Concord Repatriation General Hospital, Sydney, Australia.
J Burn Care Res. 2019 Apr 26;40(3):368-372. doi: 10.1093/jbcr/irz030.
Current evidence suggests awaiting for scars to fully mature before engaging surgical reconstruction unless acute indications to prevent secondary damage, such as microstomia and eyelid ectropion are apparent. To evaluate the efficacy of ablative fractional CO2 laser intervention early in the acute treatment of panfacial burn injury. A 39-year-old Asian male with 60% TBSA flame burns including panfacial involvement was developing microstomia and upper and lower eyelid ectropion early proceeding epithelialization. At 6-weeks postinjury, ablative fractional CO2 laser treatment was commenced while still in the intensive care unit, and subsequently delivered at regular intervals. Nonsurgical scar contracture management was provided concurrently as per site specific standard protocols. Measurements and photographic data relative to deficits in eye and mouth competence were obtained at rest, as well as maximal opening at baseline and routinely until scar stabilization was reached. The outcomes were subsequently compared with facial burn patient historical data within our facility. No significant difference was identified in the functional ROM for mouth and eye regions; treatment duration was, however, shorter and aesthetic outcomes were considered superior to their surgical reconstruction counterparts in the historical cohort. This case report reveals that early ablative fractional CO2 resurfacing treatment, coalesced with nonsurgical scar management is an efficacious interventional approach to abate contractures to the face, accelerates and enhances scar maturation processes and may alleviate the need for surgical scar reconstructions. Moreover, optimal aesthetic outcomes may be achieved compared with traditional reconstructive methods.
目前的证据表明,除非有明显的急性指征(如小口畸形和眼睑外翻)以防止继发性损伤,否则应等待瘢痕完全成熟后再进行手术重建。为了评估剥脱性分次二氧化碳激光干预在全颜面烧伤急性治疗早期的疗效。一名39岁的亚洲男性,60%体表面积火焰烧伤,包括全颜面烧伤,在早期上皮化过程中出现了小口畸形以及上下眼睑外翻。受伤6周后,在重症监护病房时开始进行剥脱性分次二氧化碳激光治疗,并随后定期进行。同时按照特定部位的标准方案进行非手术瘢痕挛缩处理。在静息状态下获取与眼口功能缺陷相关的测量数据和照片资料,以及在基线时和常规情况下直至瘢痕稳定时的最大开口度。随后将结果与我们机构内颜面烧伤患者的历史数据进行比较。在口部和眼部区域的功能活动度方面未发现显著差异;然而,治疗持续时间较短,并且美学效果在历史队列中被认为优于手术重建。本病例报告表明,早期剥脱性分次二氧化碳激光表面重塑治疗与非手术瘢痕处理相结合,是一种有效的干预方法,可减轻面部挛缩,加速并促进瘢痕成熟过程,且可能减少手术瘢痕重建的需求。此外,与传统重建方法相比,可实现更佳的美学效果。
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