Email Alerts
RSS
Volume 37 Issue 8
Aug.  2021
Turn off MathJax
Article Contents
Article Navigation >  CHINESE JOURNAL OF BURNS AND WOUNDS  > 2021  >  37(8): 711-717
Xi WJ,Zhang Z,Li J,et al.Clinical effect of fractional carbon dioxide laser in the treatment of contracture scars[J].Chin J Burns,2021,37(8):711-717.DOI: 10.3760/cma.j.cn501120-20210624-00225.
Citation: Xi WJ,Zhang Z,Li J,et al.Clinical effect of fractional carbon dioxide laser in the treatment of contracture scars[J].Chin J Burns,2021,37(8):711-717.DOI: 10.3760/cma.j.cn501120-20210624-00225.
shu

Clinical effect of fractional carbon dioxide laser in the treatment of contracture scars

doi: 10.3760/cma.j.cn501120-20210624-00225

  • Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China

Funds:

General Program of National Natural Science Foundation of China 81772098

Youth Program of National Natural Science Foundation of China 81801918, 82000456, 82002064, 81801917

Shanghai Hospital Development Center Three-year Program of China SHDC2020CR2045B

Excellent Technology Leader Plan of Shanghai Science and Technology Commission of China 18XD1423700

Scientific Research Project of Shanghai Municipal Commission of Health and Family Planning of China 20154Y0023

Peak Plateau Plan of Shanghai Education Commission "Research Doctors" Project of China 20152227

Industry Supporting Foundation of Huangpu District of Shanghai XK2020008

Interdisciplinary Program between Medicine and Engineering of Shanghai Jiao Tong University YG2019QNB09

Construction Project of Clinical Research Multidisciplinary Diagnosis and Treatment Team of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine 2017-1-007

Clinical Research Booster Program of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine JYLJ027

Interdisciplinary Foundation of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine JYJC202009

More Information
    Abstract
  •   Objective  To explore the clinical effect of the fractional carbon dioxide laser in the treatment of contracture scars.  Methods  A retrospective before-after self-control study was conducted. From December 2016 to April 2021, 16 patients (7 males and 9 females, aged 3-49 years) with contracture scars causing impaired function of the adjacent joint were admitted to Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. Eighteen joint scars of 16 patients were treated with fractional carbon dioxide laser every 2-3 months until the joint retained its normal range of motion or the effect plateaued. The treatment times of each patient were recorded. Before the first treatment and 6 months after the last treatment, the ranges of motion of the affected joint were measured in each patient, and the difference was calculated, meanwhile, the Vancouver Scar Scale (VSS) was used to evaluate the scar of each patient. In the treatment of 1 joint scar in each of 6 patients (totally 6 times of treatments), the ranges of motion of the affected joint before the current treatment, immediately after the treatment, and at the first follow-up after the treatment were documented, and the differences between the ranges before and immediately after the treatment as well as between the ranges before and at the first follow-up after the treatment were calculated. Adverse effects after the treatment in the treatment area were documented. At the last follow-up, a self-made questionnaire was used to collect the implementation status of the physical therapy and other scar management modalities during the treatment interval and follow-up period. Data were statistically analyzed with Wilcoxon rank sum test.  Results  Eighteen joint scars in 16 patients received 2 (1, 3) times of fractional carbon dioxide laser treatment. The range of motion of the affected joint of 16 patients 6 months after the last treatment was 56.5 (39.0, 128.8)°, notably higher than 38.4 (22.9, 116.3)° before the first treatment (Z=-3.724, P<0.01), showing a remarkable improvement by 17.4 (8.0, 24.1)°. The vascular distribution, softness, and thickness scores, and total score in VSS scoring of scars of 16 patients 6 months after the last treatment were significantly lower than those before the first treatment (Z=-2.989, -3.762, -2.814, -3.739, P<0.01), with the most obvious improvement in softness. In 6 times of treatments, the range of motion of the affected joint immediately after treatment and at the first follow-up of (2.5±0.6) months after treatment were 156.2 (148.0, 164.2)° and 160.2 (156.7, 166.4)°, both notably higher than 151.4 (145.7, 155.3)° before treatment (Z=-2.201, -2.201, P<0.05), showing a remarkable improvement by 9.1 (4.4, 13.0)° and 13.1 (8.0, 15.7)°, respectively. No adverse effects such as blisters, infection, or hypertrophic scar formation were observed in the treatment area of 16 patients after treatment. Most patients adopted physical therapy, compression, silicone gel or sheets, and braces during the treatment interval and follow-up period.  Conclusions  The fractional carbon dioxide laser can soften the scar and increase the range of motion of the affected joint, which is suitable for the clinical treatment of mild contracture scars.

     

    • FullText(HTML)
  • loading
    • References(38)
  • [1]
    KhansaI,HarrisonB,JanisJE.Evidence-based scar management: how to improve results with technique and technology[J].Plast Reconstr Surg,2016,138(3 Suppl):S165-178.DOI: 10.1097/PRS.0000000000002647.
    [2]
    KafkaM,CollinsV,KamolzLP,et al.Evidence of invasive and noninvasive treatment modalities for hypertrophic scars: a systematic review[J].Wound Repair Regen,2017,25(1):139-144.DOI: 10.1111/wrr.12507.
    [3]
    RobsonMC,BarnettRA,LeitchIO,et al.Prevention and treatment of postburn scars and contracture[J].World J Surg,1992,16(1):87-96.DOI: 10.1007/BF02067119.
    [4]
    ThorneCH. Grabb and Smith's plastic surgery[M].7th ed. Philadelphia:Lippincott Williams & Wilkins, 2013.
    [5]
    MathesSJ, NahaiF. Clinical atlas of muscle and musculocutaneous flaps[M]. St. Louis: Mosby, 1979.
    [6]
    MaxeyL, MagnussonJ. Rehabilitation for the postsurgical orthopedic patient[M].3rd ed. St.Louis: Elsevier Health Sciences,2013.
    [7]
    Issler-FisherAC,WaibelJS,DonelanMB.Laser modulation of hypertrophic scars: technique and practice[J].Clin Plast Surg,2017,44(4):757-766.DOI: 10.1016/j.cps.2017.05.007.
    [8]
    PoetschkeJ,DornseiferU,ClementoniMT,et al.Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars: evaluation of an in-patient controlled, standardized treatment approach[J].Lasers Med Sci,2017,32(5):1031-1040.DOI: 10.1007/s10103-017-2204-z.
    [9]
    ZuccaroJ,MuserI,SinghM,et al.Laser therapy for pediatric burn scars: focusing on a combined treatment approach[J].J Burn Care Res,2018,39(3):457-462.DOI: 10.1093/jbcr/irx008.
    [10]
    OuyangHW,LiGF,LeiY,et al.Comparison of the effectiveness of pulsed dye laser vs pulsed dye laser combined with ultrapulse fractional CO2 laser in the treatment of immature red hypertrophic scars[J].J Cosmet Dermatol,2018,17(1):54-60.DOI: 10.1111/jocd.12487.
    [11]
    ŻądkowskiT,NachulewiczP,MazgajM,et al.A new CO2 laser technique for the treatment of pediatric hypertrophic burn scars: an observational study[J].Medicine (Baltimore),2016,95(42):e5168.DOI: 10.1097/MD.0000000000005168.
    [12]
    HultmanCS,FriedstatJS,EdkinsRE,et al.Laser resurfacing and remodeling of hypertrophic burn scars: the results of a large, prospective, before-after cohort study, with long-term follow-up[J].Ann Surg,2014,260(3):519-529; discussion 529-532.DOI: 10.1097/SLA.0000000000000893.
    [13]
    HultmanCS,EdkinsRE,LeeCN,et al.Shine on: review of laser- and light-based therapies for the treatment of burn scars[J].Dermatol Res Pract,2012,2012:243651.DOI: 10.1155/2012/243651.
    [14]
    KrakowskiAC,GoldenbergA,EichenfieldLF,et al.Ablative fractional laser resurfacing helps treat restrictive pediatric scar contractures[J].Pediatrics,2014,134(6):e1700-1705.DOI: 10.1542/peds.2014-1586.
    [15]
    SeagoM,ShumakerPR,SpringLK,et al.Laser treatment of traumatic scars and contractures: 2020 international consensus recommendations[J].Lasers Surg Med,2020,52(2):96-116.DOI: 10.1002/lsm.23201.
    [16]
    WaibelJS,GianatasioC,A.RandomizedRudnick, controlled early intervention of dynamic mode fractional ablative CO2 laser on acute burn injuries for prevention of pathological scarring[J].Lasers Surg Med,2020,52(2):117-124.DOI: 10.1002/lsm.23170.
    [17]
    KauvarA,KubickiSL,SuggsAK,et al.Laser therapy of traumatic and surgical scars and an algorithm for their treatment[J].Lasers Surg Med,2020,52(2):125-136.DOI: 10.1002/lsm.23171.
    [18]
    LeviB,IbrahimA,MathewsK,et al.The use of CO2 fractional photothermolysis for the treatment of burn scars[J].J Burn Care Res,2016,37(2):106-114.DOI: 10.1097/BCR.0000000000000285.
    [19]
    HaedersdalM.Fractional ablative CO2 laser resurfacing improves a thermal burn scar[J].J Eur Acad Dermatol Venereol,2009,23(11):1340-1341.DOI: 10.1111/j.1468-3083.2009.03215.x.
    [20]
    HurlimanE,ZelicksonB,KenkelJ.In-vivo histological analysis of a fractional CO2 laser system intended for treatment of soft tissue[J].J Drugs Dermatol,2017,16(11):1085-1090.
    [21]
    HantashBM,BediVP,KapadiaB,et al.In vivo histological evaluation of a novel ablative fractional resurfacing device[J].Lasers Surg Med,2007,39(2):96-107.DOI: 10.1002/lsm.20468.
    [22]
    MansteinD,HerronGS,SinkRK,et al.Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury[J].Lasers Surg Med,2004,34(5):426-438.DOI: 10.1002/lsm.20048.
    [23]
    ZhangZ,ChenJ,HuangJ,et al.Experimental study of 5-fluorouracil encapsulated ethosomes combined with CO2 fractional laser to treat hypertrophic scar[J].Nanoscale Res Lett,2018,13(1):26.DOI: 10.1186/s11671-017-2425-x.
    [24]
    DeBrulerDM,BlackstoneBN,BaumannME,et al.Inflammatory responses, matrix remodeling, and re-epithelialization after fractional CO2 laser treatment of scars[J].Lasers Surg Med,2017,49(7):675-685.DOI: 10.1002/lsm.22666.
    [25]
    OzogDM,LiuA,ChaffinsML,et al.Evaluation of clinical results, histological architecture, and collagen expression following treatment of mature burn scars with a fractional carbon dioxide laser[J].JAMA Dermatol,2013,149(1):50-57.DOI: 10.1001/2013.jamadermatol.668.
    [26]
    QuL,LiuA,ZhouL,et al.Clinical and molecular effects on mature burn scars after treatment with a fractional CO2 laser[J].Lasers Surg Med,2012,44(7):517-524.DOI: 10.1002/lsm.22055.
    [27]
    MakboulM,MakboulR,AbdelhafezAH,et al.Evaluation of the effect of fractional CO2 laser on histopathological picture and TGF-β1 expression in hypertrophic scar[J].J Cosmet Dermatol,2014,13(3):169-179.DOI: 10.1111/jocd.12099.
    [28]
    LeeSJ,SuhDH,LeeJM,et al.Dermal remodeling of burn scar by fractional CO2 laser[J].Aesthetic Plast Surg,2016,40(5):761-768.DOI: 10.1007/s00266-016-0686-x.
    [29]
    El-HoshyK,Abdel-HalimMRE,DorghamD,et al.Efficacy of fractional carbon dioxide laser in the treatment of mature burn scars: a clinical, histopathological, and histochemical study[J].J Clin Aesthet Dermatol,2017,10(12):36-43.
    [30]
    NaouriM,AtlanM,PerrodeauE,et al.High-resolution ultrasound imaging to demonstrate and predict efficacy of carbon dioxide fractional resurfacing laser treatment[J].Dermatol Surg,2011,37(5):596-603.DOI: 10.1111/j.1524-4725.2011.01943.x.
    [31]
    BaryzaMJ,BaryzaGA.The Vancouver Scar Scale: an administration tool and its interrater reliability[J].J Burn Care Rehabil,1995,16(5):535-538.DOI: 10.1097/00004630-199509000-00013.
    [32]
    ZuccaroJ,ZiolkowskiN,FishJ.A systematic review of the effectiveness of laser therapy for hypertrophic burn scars[J].Clin Plast Surg,2017,44(4):767-779.DOI: 10.1016/j.cps.2017.05.008.
    [33]
    KarmisholtKE,HaerskjoldA,KarlsmarkT,et al.Early laser intervention to reduce scar formation-a systematic review[J].J Eur Acad Dermatol Venereol,2018,32(7):1099-1110.DOI: 10.1111/jdv.14856.
    [34]
    WillowsBM,IlyasM,SharmaA.Laser in the management of burn scars[J]. Burns,2017,43(7):1379-1389. DOI: 10.1016/j.burns.2017.07.001.
    [35]
    GiordanoCN,OzogD.Microstructural and molecular considerations in the treatment of scars with ablative fractional lasers[J].Semin Cutan Med Surg,2015,34(1):7-12.DOI: 10.12788/j.sder.2015.0124.
    [36]
    AndersonRR,DonelanMB,HivnorC,et al.Laser treatment of traumatic scars with an emphasis on ablative fractional laser resurfacing: consensus report[J].JAMA Dermatol,2014,150(2):187-193.DOI: 10.1001/jamadermatol.2013.7761.
    [37]
    Issler-FisherAC,FisherOM,HaertschP,et al.Ablative fractional resurfacing with laser-facilitated steroid delivery for burn scar management: does the depth of laser penetration matter?[J].Lasers Surg Med,2020,52(2):149-158.DOI: 10.1002/lsm.23166.
    [38]
    LvKY,XiaZF, Chinese consensus panel on the prevention and treatment of scars. Chinese expert consensus on clinical prevention and treatment of scar[J/OL].Burns Trauma,2018,6:27[2021-06-24]. https://pubmed.ncbi.nlm.nih.gov/30263894/.DOI: 10.1186/s41038-018-0129-9.
    • Relative Articles
    • Supplements(0)
    • Cited By
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(3)

    Get Citation
    PDF
    XML

    Article Metrics

    Article views (2290) PDF downloads(59) Cited by()
    Proportional views
    Related

    Copyright © Chinese Journal of Burns京ICP备07035254号-14

    E-mail：shaoshangzazhi@163.com

    Website：https://zhsszz.xml-journal.net/

    Supported by: Beijing Renhe Information Technology Co. Ltd    

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return