Erickson Taylor, Gray Jayla, Tayebi Bailey, Tung Rebecca
Division of Dermatology, Loyola University Medical Center, Chicago, IL, USA.
Forefront Dermatology, Carmel, IN, USA.
Scars Burn Heal. 2018 Dec 19;4:2059513118818997. doi: 10.1177/2059513118818997. eCollection 2018 Jan-Dec.
Hypertrophic scars and keloids are challenging to manage due to recurrence and often sub-optimal response to treatment. There is a lack of both definitive treatment standards and randomised controlled trials comparing therapeutic options. While a wide array of procedures has been utilised to improve traumatic burn scars, such interventions have been used with varying degrees of success. Some reported methods include intralesional injections of anti-inflammatory and anti-mitotic medications, laser-based therapy, topical therapies, cryotherapy, silicone gel sheeting, pressure therapy, radiotherapy and reconstructive surgery.
We report a case of extensive traumatic burn scarring on the head and neck successfully treated with a multimodal approach comprised of an infrequently used modified subcision technique to deliver alternating intralesional injections of anti-inflammatory (high-dose steroid) and anti-metabolite (5-flurouracil) concurrently with a series of laser (epilatory, vascular and fractional) treatments.
Our treatment modality utilised a subcisional technique to deliver intralesional steroid and anti-metabolite medications directly into scar tissue to downregulate inflammation and inhibit collagen synthesis. Alexandrite, fractional and pulsed dye laser therapy was employed to improve skin texture, reduce dyschromia and reduce tissue burden of hypertrophic scar and keloid tissue, resulting in improved mobility and skin elasticity.
Our case supports a combined medical and procedural, subcisional, approach to successfully treat a patient with extensive hypertrophic scarring and keloid formation with associated hair entrapment after a head and neck burn.
肥厚性瘢痕和瘢痕疙瘩由于容易复发且对治疗的反应往往不尽人意，因此治疗颇具挑战性。目前既缺乏明确的治疗标准，也缺乏比较各种治疗方案的随机对照试验。虽然已经采用了各种各样的方法来改善创伤性烧伤瘢痕，但这些干预措施的成功率各不相同。一些报道的方法包括病灶内注射抗炎和抗有丝分裂药物、激光治疗、局部治疗、冷冻治疗、硅胶片、压力治疗、放射治疗和重建手术。
我们报告了一例头颈部广泛创伤性烧伤瘢痕的病例，采用了一种多模式方法成功治疗，该方法包括一种较少使用的改良皮下分离技术，同时交替进行病灶内注射抗炎药（高剂量类固醇）和抗代谢药（5-氟尿嘧啶），并结合一系列激光（脱毛、血管和分次）治疗。
我们的治疗方式采用皮下分离技术，将病灶内类固醇和抗代谢药物直接注入瘢痕组织，以减轻炎症并抑制胶原蛋白合成。使用翠绿宝石激光、分次激光和脉冲染料激光治疗来改善皮肤质地、减轻色素沉着异常，并减轻肥厚性瘢痕和瘢痕疙瘩组织的组织负担，从而提高活动度和皮肤弹性。
我们的病例支持采用一种联合药物和手术的皮下分离方法，成功治疗一名头颈部烧伤后出现广泛肥厚性瘢痕和瘢痕疙瘩形成并伴有毛发嵌入的患者。
