San Antonio Military Health System, Laser Surgery and Scar Center, San Antonio, TX 78234.
Wellman Center for Photomedicine, Massachusetts General Hospital, Boston, MA 02114.
Ann Surg. 2021 Dec 1;274(6):e574-e580. doi: 10.1097/SLA.0000000000003576.
The aim of this study is to determine objective and subjective changes in mature hypertrophic burn scars treated with a fractional ablative carbon dioxide (CO2) laser.
Fractional CO2 laser treatment has been reported to improve burn scars, with increasing clinical use despite a paucity of controlled, prospective clinical studies using objective measures of improvement.
A multicenter, site-controlled, prospective open-label study was conducted from 2013 to 2016. Objective and patient-reported outcome measures were documented at baseline, at each monthly laser treatment, and 6 months after treatment. Objective measurements employed were: mechanical skin torque to measure viscoelastic properties; ultrasonic imaging to measure scar thickness; and reflectometry to measure erythema and pigmentation. Subjective measures included health-related quality of life, patient and investigator scar assessment scales, and blinded scoring of before and after photographs. Subjects aged 11 years or older with hypertrophic burn scars were recruited. Each subject received 3 monthly treatment sessions with an ablative fractionated CO2 laser.
Twenty-nine subjects were enrolled, of whom 26 received at least 1 fractional CO2 laser treatment and 22 received 3 treatments. Mean age of those completing all 3 treatments was 28 years. Statistically significant objective improvements in elastic stretch (P < 0.01), elastic recovery (P < 0.01), extensibility (P < 0.01), and thickness (P < 0.01) were noted. Patient- and physician-reported scar appearance and pain/pruritus were significantly improved (P < 0.01). There was no regression of improvement for at least 6 months after treatment.
Fractional ablative laser treatment provides significant, sustained improvement of elasticity, thickness, appearance, and symptoms of mature hypertrophic burn scars.
本研究旨在确定接受分批次消融二氧化碳（CO2）激光治疗的成熟肥厚性烧伤瘢痕的客观和主观变化。
尽管缺乏使用客观改善措施的对照性、前瞻性临床研究，但分批次 CO2 激光治疗已被报道可改善烧伤瘢痕，且其临床应用日益广泛。
2013 年至 2016 年进行了一项多中心、站点对照、前瞻性开放标签研究。在基线、每月的激光治疗时和治疗后 6 个月记录客观和患者报告的结果测量。采用的客观测量包括：机械皮肤扭矩测量粘弹性；超声成像测量瘢痕厚度；反射计测量红斑和色素沉着。主观测量包括健康相关生活质量、患者和研究者瘢痕评估量表以及治疗前后照片的盲法评分。招募年龄在 11 岁或以上、有肥厚性烧伤瘢痕的患者。每位患者接受 3 次每月的消融性分批次 CO2 激光治疗。
共纳入 29 名受试者，其中 26 名接受了至少 1 次分批次 CO2 激光治疗，22 名接受了 3 次治疗。完成所有 3 次治疗的患者的平均年龄为 28 岁。弹性拉伸（P < 0.01）、弹性恢复（P < 0.01）、伸展性（P < 0.01）和厚度（P < 0.01）的客观改善均具有统计学意义。患者和医生报告的瘢痕外观和疼痛/瘙痒明显改善（P < 0.01）。治疗后至少 6 个月内没有改善的回退。
分批次消融激光治疗可显著、持续改善成熟肥厚性烧伤瘢痕的弹性、厚度、外观和症状。
