From the Skin and Laser Center.
Division of Trauma, Acute Care Surgery, and Burns.
Ann Plast Surg. 2023 May 1;90(5):444-446. doi: 10.1097/SAP.0000000000003526. Epub 2023 Mar 8.
The necessity of treating hypertrophic burn scars has expanded significantly with increased burn survivorship. Ablative lasers, such as carbon dioxide (CO 2 ) lasers, have been the most common nonoperative option for improving functional outcomes in severe recalcitrant hypertrophic burn scars. However, the overwhelming majority of ablative lasers used for this indication require a combination of systemic analgesia, sedation, and/or general anesthesia due to the painful nature of the procedure. More recently, the technology of ablative lasers has advanced and is more tolerable than their first-generation counterparts. Herein, we hypothesized that refractory hypertrophic burn scars can be treated by a CO 2 laser in an outpatient clinic.
We enrolled 17 consecutive patients with chronic hypertrophic burn scars that were treated with a CO 2 laser. All patients were treated in the outpatient clinic with a combination of a topical solution (23% lidocaine and 7% tetracaine) applied to the scar 30 minutes before the procedure, Cryo 6 air chiller by Zimmer, and some patients received a mixture of N 2 O/O 2 . Laser treatments were repeated every 4 to 8 weeks until the patient's goals were met. Each patient completed a standardized questionnaire to assess tolerability and patient satisfaction of functional results.
All patients tolerated the laser well in the outpatient clinic setting, with 0% indicating "not tolerable," 70.6% "tolerable," and 29.4% "very tolerable." Each patient received more than 1 laser treatment for the following complaints: decreased range of motion (n = 16, 94.1%), pain (n = 11, 64.7%), or pruritis (n = 12, 70.6%). Patients were also satisfied with the results of the laser treatments ("no improvement or worsened" = 0%, "improved" = 47.1%, and "significant improvement" = 52.9%). The age of patient, type of burn, location of burn, presence of skin graft, or age of scar did not significantly affect the tolerability of treatment or satisfaction of outcome.
The treatment of chronic hypertrophic burn scars with a CO 2 laser is well tolerated in an outpatient clinic setting in select patients. Patients reported a high level of satisfaction with notable improvement in functional and cosmetic outcomes.
随着烧伤存活率的提高，治疗增生性烧伤瘢痕的必要性显著增加。二氧化碳（CO 2 ）激光等烧蚀性激光已成为改善严重难治性增生性烧伤瘢痕功能结局的最常用非手术选择。然而，由于该治疗过程具有疼痛性质，绝大多数用于该适应症的烧蚀性激光需要联合全身镇痛、镇静和/或全身麻醉。最近，烧蚀性激光技术已经发展，比第一代产品更具耐受性。在此，我们假设可以在门诊诊所通过 CO 2 激光治疗难治性增生性烧伤瘢痕。
我们纳入了 17 例慢性增生性烧伤瘢痕患者，他们接受了 CO 2 激光治疗。所有患者均在门诊接受治疗，在治疗前 30 分钟在瘢痕上涂抹一种包含 23%利多卡因和 7%丁卡因的溶液，使用 Zimmer 生产的 Cryo 6 空气冷却器，部分患者接受 N 2 O/O 2 混合物。激光治疗每 4 至 8 周重复一次，直到患者达到治疗目标。每位患者完成一份标准化问卷，以评估对功能结果的耐受性和患者满意度。
所有患者均能在门诊环境中耐受激光治疗，0%表示“不能耐受”，70.6%表示“可耐受”，29.4%表示“非常耐受”。每位患者接受了多次激光治疗，以下为主要治疗诉求：活动度受限（n = 16，94.1%）、疼痛（n = 11，64.7%）或瘙痒（n = 12，70.6%）。患者对激光治疗的效果也非常满意（“无改善或恶化”= 0%，“改善”= 47.1%，“显著改善”= 52.9%）。患者的年龄、烧伤类型、烧伤位置、是否存在皮瓣或瘢痕年龄均不会显著影响治疗的耐受性或结果的满意度。
在选择的患者中，CO 2 激光治疗慢性增生性烧伤瘢痕在门诊环境中耐受性良好。患者报告对功能和美容结果有显著改善，满意度较高。
