Introduction Despite advances in burn care, hypertrophic burn scars (HTBS) remain a significant source of morbidity. Treatment often involves use of CO2 lasers to reduce thickness and pulse-dye lasers (PDL) to reduce erythema. Despite frequent utilization, little quantitative data exists. This study seeks to objectively determine the effects of these laser treatments on burn scars. Methods Patients found to have HTBS undergoing laser treatments were approached for enrollment. Following enrollment, an area of HTBS outside of the treatment area was divided into 4 equal 3x3cm squares which were randomized to receive either CO2, PDL, CO2+PDL, or no treatment. Patients underwent a total of 3 treatments, 4–6 weeks apart, and were seen for follow-up over 3–6 months. Scar assessments occurred at each visit prior to treatment and consisted of digital photographs, ultrasound assessment for scar thickness, colorimetry, and the Patient and Observer Scar Assessment Score (POSAS). Results Twenty-five patients were enrolled at our institution. To date, 12 (48%) have completed all 3 treatments and the remainder are still in their follow-up period. Median initial scar thickness (ST) was 0.3cm. Mean time since injury was 9 months. Overall, there was a significant decrease in ST over time (p=0.0246) but not between treatment groups. There were no significant changes seen in melanin, erythema, or POSAS scores (p=0.9030, 0.6470, and 0.1495, respectively). When separated by ST before initiation of treatment, thin scars (< 3cm) appeared to be overall less erythematous in groups treated with PDL and CO2+PDL and untreated groups (p=0.0358, 0.0027. 0.0118, respectively) as compared to thick scars (≥3cm). Thin scars treated with PDL and CO2+PDL were also less pigmented than thick scars (p=0.0127, 0.0213, respectively). Erythema significantly decreased between the last treatment and the final visit for PDL and CO2+PDL groups (p< 0.0001). Older scars (≥9 months prior to treatment) tended to have a greater reduction in thickness as compared to newer scars but the difference was not significant to date. Conclusions Laser therapy is often employed in the treatment of HTBS. However, few studies have determined their objective benefits. Based on a preliminary analysis of our data, we have shown an overall decrease in scar thickness, less pigmentation, and less erythema in thin scars treated with PDL or CO2+PDL. Further analysis will be performed after additional follow-up information is collected.
Background: Autologous fat transfer—also referred to as fat grafting—has been reported to provide beneficial effects to overlying scar and skin. Despite procedural frequency, there is a paucity of high-level evidence guiding the surgeon in technique, patient selection, and efficacy. Methods: A multicenter, double-blinded, randomized, internally placebo-controlled trial was performed with an aim to qualitatively and quantitatively evaluate the impact of autologous fat transfer on the quality of overlying scar tissue. Fat-grafted scars were evaluated and compared with paired, saline-injected “control” scars. Subjective and objective metrics were evaluated in treated sites for 12 months after treatment. Results: Blinded qualitative results demonstrated a statistically significant improvement in scar quality over time in fat-grafted scars. However, these improvements were not found to be statistically different from changes noted in scars treated with saline. In addition, objective metrics did not statistically differ between saline-injected and autologous fat-grafted scars. Conclusions: Our results demonstrate that autologous fat grafting can improve the qualitative profile of a scar from both the patient and observer perspectives. However, there was no difference in improvement when compared with scars that were treated with saline in a randomized and blinded fashion. These results demonstrate that any improvements in scar quality related to fat grafting are also achieved using saline and suggest that mechanisms other than cell activity may be at play. Additional randomized, blinded, placebo-controlled trials are required to either corroborate or contest the putative beneficial effect(s) of adipose tissue on scar remodeling.
Vascularized composite allotransplantation (VCA) is the most advanced reconstructive technique available to patients who suffer devastating burns to the limbs or face. However, VCA requires donor–recipient matching. Burn patients have been reported to experience sensitization, or the development of anti-human leukocyte antigen antibodies, during resuscitation and wound coverage, potentially precluding them from future VCA. This study sought to investigate the contributions of both blood and allograft to sensitization in burn patients. Four groups were compared: burn patients who received blood products and allograft (group 1), burn patients who received blood products only (group 2), trauma patients who received blood products only (group 3), and healthy volunteer controls (group 4). The average calculated panel-reactive antibody (indicating sensitization) was higher in group 1 compared to group 4 (P = .035). Additionally, the incidence of severe sensitization was higher in group 1 relative to the other groups (P = .049). When comparing groups of patients who had no sensitization, mild sensitization, moderate sensitization, and severe sensitization, there were no significant differences in age, sex, blood products received, total body surface area burned, or allograft used between groups, though severely sensitized patients tended to have greater total body surface area involvement and received more units of packed red blood cells and allograft (P = .079, P = .196, and P = .072, respectively). We therefore conclude that while burn patients who received allograft and blood demonstrated a higher incidence of anti-human leukocyte antigen sensitization relative to healthy controls, this difference cannot solely be attributed to either allograft use or transfusion.
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