Li Jie, Ng Sally Kiu-Huen, Xi Wenjing, Zhang Zheng, Wang Xiaodian, Li Hua, Su Weijie, Wang Jingyan, Zhang Yixin
Department of Plastic and Reconstructive Surgery, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
Department of Plastic Surgery, Austin Health, Melbourne 3084, Australia.
Burns Trauma. 2021 Dec 31;9:tkab048. doi: 10.1093/burnst/tkab048. eCollection 2021.
Fractional CO laser plays an important role in scar management post split-thickness skin graft by loosening the graft contracture and restoring the smoothness of the surface. However, the optimal treatment protocol remains unknown. This study applied a dual-scan protocol to achieve both releasing and ablation of contracted skin graft. We comprehensively describe this treatment method and compare the efficacy and safety between this dual-scan method and the conventional mono-scan mode.
A hypercontracted scar model after split-thickness skin grafting in red Duroc pigs was established. All scars meeting the inclusion criteria were randomly divided into four groups: high fluence-low density (HF-LD), low fluence-high density (LF-HD), combined group and control group. The energy per unit area was similar in the HF-LD and LF-HD groups. Two laser interventions were performed at a 6-week interval. The efficacy of the treatment was evaluated by objective measures of scar area, release rate, elasticity, thickness and flatness, while the safety was evaluated based on adverse reactions and melanin index. Collagen structure was observed histologically. The animals were followed up for a maximum of 126 days after modeling.
A total of 28 contracted scars were included, 7 in each group. At 18 weeks postoperatively, the HF-LD and the combined groups showed significantly increased scar release rate ( = 0.000) and elasticity ( = 0.036) and decreased type I/III collagen ratio ( = 0.002) compared with the control and LF-HD groups. In terms of flatness, the combined group was significantly better than the HF-LD group for elevations <1 mm ( = 0.019). No significant skin side effects, pigmentation or scar thickness changes were observed at 18 weeks.
Dual-scan protocol could achieve superficial ablation and deep release of contracted split-thickness skin graft in a single treatment, with similar contraction release and texture improvement compared to a single deep scan. Its main advantage is to restore a smoother scar appearance. Adequate laser penetration was necessary for the release of contracted scars.
分次二氧化碳激光在中厚皮片移植后瘢痕处理中发挥着重要作用，可松解移植皮片挛缩并恢复表面平整度。然而，最佳治疗方案仍不明确。本研究应用双扫描方案实现挛缩皮片的松解和消融。我们全面描述了这种治疗方法，并比较了这种双扫描方法与传统单扫描模式的疗效和安全性。
建立红色杜洛克猪中厚皮片移植后高度挛缩瘢痕模型。所有符合纳入标准的瘢痕随机分为四组：高能量密度-低扫描密度（HF-LD）组、低能量密度-高扫描密度（LF-HD）组、联合组和对照组。HF-LD组和LF-HD组的单位面积能量相似。每隔6周进行两次激光干预。通过瘢痕面积、松解率、弹性、厚度和平整度的客观测量评估治疗效果，同时基于不良反应和黑色素指数评估安全性。组织学观察胶原结构。建模后对动物进行最长126天的随访。
共纳入28个挛缩瘢痕，每组7个。术后18周，与对照组和LF-HD组相比，HF-LD组和联合组的瘢痕松解率（P = 0.000）和弹性（P = 0.036）显著增加，I/III型胶原比率降低（P = 0.002）。在平整度方面，对于隆起<1 mm的情况，联合组明显优于HF-LD组（P = 0.019）。在18周时未观察到明显的皮肤副作用、色素沉着或瘢痕厚度变化。
双扫描方案可在单次治疗中实现挛缩中厚皮片的浅表消融和深部松解，与单次深度扫描相比，挛缩松解和质地改善效果相似。其主要优势是恢复更平滑的瘢痕外观。充分的激光穿透对于挛缩瘢痕的松解是必要的。
