Elrod Julia, Schiestl Clemens, Neuhaus Diego, Mohr Christoph, Neuhaus Kathrin
Ann Plast Surg. 2020 Sep;85(3):237-244. doi: 10.1097/SAP.0000000000002377.
Hypertrophic scars are commonly seen in children and associated with pruritus, pain, functional impairment, and aesthetic disfigurement. Ablative fractional CO2 and pulse dye laser are emerging techniques to improve scar quality. Only limited data are available on children, nonburn scars, and patient-reported outcome. We aimed to investigate safety and outcome of repeated laser therapy for hypertrophic scars originating from burns and other conditions by means of patient- and physician-reported outcome measures.
This was a retrospective before-after analysis of laser treatments in children with hypertrophic scars. Outcome was measured using Patient and Observer Scar Assessment Scale, Vancouver Scar Scale and Itch Man Scale. With respect to safety, laser- and anesthesia-related complications were analyzed.
Seventeen patients, aged 11.37 ± 4.82 years with 27 scars, underwent 102 distinct laser treatments, mainly combined CO2 and pulse dye laser (94%), with few CO2 only (6%). Vancouver Scar Scale total score before the first and after the first session decreased significantly from 7.65 ± 2.12 to 4.88 ± 1.73; Patient and Observer Scar Assessment Scale observer overall opinion also dropped from 5.88 ± 1.57 to 4.25 ± 1.70. Pruritus improved significantly. Patient age and timing of laser intervention did not have an impact on treatment response. Complications related to laser treatment were seen in 2% (wound infection, n = 2) and to anesthesia in 4% (insignificant n = 2, minor n = 1).
Combined laser therapy significantly improves quality, pain, and pruritus of hypertrophic scars in children. When provided by experienced laser and anesthesia teams, it is safe with a low rate of complications.
肥厚性瘢痕在儿童中常见，与瘙痒、疼痛、功能障碍及美观受损相关。剥脱性分次二氧化碳激光和脉冲染料激光是改善瘢痕质量的新兴技术。关于儿童、非烧伤瘢痕及患者报告结局的可用数据有限。我们旨在通过患者和医生报告的结局指标，研究重复激光治疗烧伤及其他原因所致肥厚性瘢痕的安全性和结局。
这是一项对儿童肥厚性瘢痕激光治疗的回顾性前后分析。使用患者和观察者瘢痕评估量表、温哥华瘢痕量表及瘙痒量表测量结局。在安全性方面，分析了与激光和麻醉相关的并发症。
17例年龄为11.37±4.82岁的患者有27处瘢痕，接受了102次不同的激光治疗，主要是联合二氧化碳激光和脉冲染料激光（94%），仅少数为单纯二氧化碳激光（6%）。第一次治疗前和第一次治疗后温哥华瘢痕量表总分从7.65±2.12显著降至4.88±1.73；患者和观察者瘢痕评估量表观察者总体评价也从5.88±1.57降至4.25±1.70。瘙痒明显改善。患者年龄和激光干预时机对治疗反应无影响。激光治疗相关并发症发生率为2%（伤口感染，n = 2），麻醉相关并发症发生率为4%（不显著，n = 2；轻微，n = 1）。
联合激光治疗可显著改善儿童肥厚性瘢痕的质量、疼痛和瘙痒。由经验丰富的激光和麻醉团队实施时，治疗安全，并发症发生率低。
