Laser Modulation of Hypertrophic Scars

Issler‐Fisher, Andrea C.; Waibel, Jill; Donelan, Matthias B.

doi:10.1016/j.cps.2017.05.007

Cited by 64 publications

(46 citation statements)

References 41 publications

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“…Eine Reihe von Studien haben belegt, dass mit dem bei Verbrennungsnarben häufig eingesetzten fraktionierten CO 2 -Laser eine Reduktion der Narbendicke, eine verbesserte Elastizität, ein verbessertes Oberflächenrelief sowie Verbesserung der (Hyper-und Hypo-) Pigmentation erzielt werden können. Lasertherapie führt zu dermaler Restrukturierung mit einer erwünschten Verdickung der Dermis und kann auch Schmerz und Juckreiz positiv beeinflussen [59][60][61][62]. Verbesserungen des Narbenbildes treten schon nach einer einzelnen Anwendung auf [63], jedoch erfolgen zumeist mehrere Sitzungen im Intervall von einem bis drei Monaten, um gute Resultate zu erzielen [64,65].…”

Section: Laser Zur Behandlung Von Hypertrophen Verbrennungsnarbenunclassified

Die Verbrannte Hand – Neuheiten und aktuelle Forschung

Popp

Tapking

Branski

2019

Handchir Mikrochir plast Chir

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ZusammenfassungEine funktionierende Handmotorik ist im täglichen Leben und in der Arbeitswelt unverzichtbar. Selbst kleinere Verbrennungen können selbige entweder direkt oder durch Narbenbildung wesentlich einschränken. Erhalt und Wiederherstellung der Handfunktion sind essenziell für das körperliche und seelische Wohlbefinden von Verbrennungspatienten, zumal eine Einschränkung zu sozialer Isolation und Berufsunfähigkeit führen kann. Obwohl eine Hand nur 3 % der gesamten Körperoberfläche repräsentiert, werden Handverbrennungen als schwere Verbrennung eingestuft und zählen zu den primären Indikationen zur Behandlung in einem Verbrennungszentrum. Bei mehr als 80 % aller schweren Verbrennungen sind die Hände beteiligt und zählen somit zu den am häufigsten betroffenen Körperregionen. Unabhängig von der Schwere der gesamten Verbrennung ist den Händen höchste Priorität beizumessen.Weiterentwicklungen in der Akut- und Langzeitbehandlung von Brandverletzungen der Hand sollten zum Ziel haben, eine langfristige Verbesserung der funktionellen und ästhetischen Ergebnisse zu erlangen. Zudem soll auch bei schwerer Handverbrennung die Wiedereingliederung in Alltag und Berufsleben angestrebt werden. Der Zweck dieser Übersichtsarbeit ist es, die aktuelle Forschung auf dem Gebiet der Handverbrennung aufzuzeigen und Teilbereiche zu identifizieren, in denen in Zukunft intensivere Forschung betrieben werden sollte. Wir fassen in dieser Arbeit relevante Original- und Übersichtsarbeiten der letzten Jahre auf dem Gebiet der Handverbrennung zusammen. Neuheiten zu Akutbehandlung, Nachbehandlung, Rekonstruktion, der Verletzung durch E-Zigaretten sowie zur Funktionsbeurteilung werden vorgestellt und in Kontext zu bewährten Methoden gestellt. Die Problematik mangelnder Forschungsprojekte und potenzielle Forschungsideen werden aufgezeigt.

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Section: Laser Zur Behandlung Von Hypertrophen Verbrennungsnarbenunclassified

Die Verbrannte Hand – Neuheiten und aktuelle Forschung

Popp

Tapking

Branski

2019

Handchir Mikrochir plast Chir

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“…Laser therapies have also demonstrated benefit in addressing the symptomatic complaints associated with scar tissue. Pulsed-dye laser (PDL) and other hemoglobintargeted devices demonstrate benefit in treating the erythema and pruritus [1]; IPL has been used to treat the hyperpigmentation and dyschromia; and both ablative and non-ablative lasers, by the process of fractional photothermolysis, have revolutionized the non-surgical revision of scar hypertrophy [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

“…Algorithmic approaches to laser scar management have been proposed, with a consensus that treatment should address erythema with a vascular laser in the first sessions, followed by management of contour and texture abnormalities with either ablative or non-ablative fractional lasers at future sessions [2][3][4][5][6][7][8][9][10]. While both therapeutic avenues address scar erythema and thickness, they may not effectively treat the melanin dyspigmentation seen with many hypertrophic scars.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Combined Intense Pulsed Light (IPL) With Fractional CO₂‐Laser Ablation in the Treatment of Large Hypertrophic Scars: A Prospective, Randomized Control Trial

et al. 2019

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Background and Objectives: Scar rehabilitation is a complex process that incorporates medical, surgical, and physical therapeutic measures to best restore function and visual normalcy. Lasers have emerged as essential tools in the management of scars, with devices available to address scar size, dyschromia, and contour irregularities. As different lasers treat these different features, multi-laser, same session therapeutic approaches may offer a more comprehensive approach to scar revision. In this study, we aim to demonstrate the effect of a combinatorial, same session treatment with intense pulsed light (IPL) and fractional ablative CO 2 as compared to single laser treatment with fractional ablative CO 2 laser alone or control in the treatment of mature hypertrophic scars. Materials and Methods: This institutional review board-approved, randomized controlled trial, enrolled 23 healthy adults with large (>100 cm 2 ) hypertrophic scars who were randomized to one of three treatment arms: (i) IPL and CO 2 ablative fractional laser (AFL), (ii) CO 2 AFL alone, and (iii) control (no laser treatment). Subjects underwent a total of four treatment sessions at 6-8-week intervals with follow-up visits at 1, 3, and 6 months following the last treatment session. Primary endpoints included blinded scoring of before and after photographs via the Manchester Scar Scale (MSS). Secondary endpoints included the Patient-Observer Scar Assessment Scale (POSAS). Results: As compared to control and CO 2 AFL laser alone, the combination of CO 2 AFL and IPL demonstrated statistically significant improvement across a greater number of scar domains, as assessed by the MSS. 100% of subjects in both treatment groups showed a statistically significant decrease in the POSAS scale after the series of four treatment sessions. No adverse events were reported. Conclusion: Treatment with combined IPL and CO 2 AFL demonstrated higher average improvements across the majority of assessed scar domains, as compared to both control and CO 2 laser alone. The difference was not statistically significant in overall MSS score as expected due to the role of CO 2 as the main source of improvement. However, only the combination group had statistically significant improvement in both color and texture. These findings support the assertion that a multi-photo-thermolytic approach with combined IPL and CO 2 AFL can have a positive impact on the treatment of hypertrophic scars by using multiple wavelengths to maximize laser-skin interactions in targeting the different chromophores expressed in scar tissue. Lasers Surg. Med.

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“…On the basis of water absorption and bulk heating, epidermal and dermal structures are removed, resulting in microscopic ablative zones (MAZ) . High energy and a short pulse duration in CO 2 ‐AFL facilitate precise effects with minimal side effects so that islands of undamaged skin can serve as reservoirs to trigger small wound healing reactions and subsequent scar remodeling . CO 2 ‐AFL devices ablate micro‐columns vertically through epidermis and dermis .…”

Section: Introductionmentioning

confidence: 99%

Ablative fractional resurfacing with laser‐facilitated steroid delivery for burn scar management: Does the depth of laser penetration matter?

et al. 2019

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Background and Objective To investigate whether the depth of ablative fractional CO2 laser (CO2‐AFL) penetration of pathological burn scars influences clinical outcomes. Study Design/Materials and Methods All patients presenting to the Concord Repatriation General Hospital (CRGH) Scar Clinic received ultrasound measurement at the thickest point of their burn scars. Subsequently, the effect of various CO2‐AFL settings (energy which correlates to penetration depths) on different outcome parameters was analysed. Patients were divided into five groups depending on minimal scar penetration depth. Results Seventy‐eight patients (158 scars) had complete data allowing for analysis. Median scar thickness was 3,400 μm and median laser scar penetration depth was 900 μm. Scar penetration categories were as follows: 0–25% (n = 40), 25–50% (n = 67), 50–75% (n = 31), 75–100% (n = 8), >100% (n = 3) of scar thickness. The median reduction in maximum scar thickness was 800 μm following one treatment (P < 0.001). However, this effect depended on scar penetration depth, whereby scars that were penetrated ≥75% showed no significant improvement in scar thickness and those penetrated >100% indicated a tendency to become worse. Other assessed outcome parameters included: the Vancouver Scar Scale, the Patient and Observer Scar Assessment Scale, a neuropathic pain score (DN4 Pain Questionnaire), and a pruritus score (modified D4 Pruritus Score). All these factors showed significant improvement in the categories up to 75% scar penetration depth. Conclusions CO2‐AFL scar penetration depth significantly influences subjective and objective pathologic burn scar modulation. The penetration depth of 51–75% achieves the greatest reduction in scar thickness. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.

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Laser Modulation of Hypertrophic Scars

Cited by 64 publications

References 41 publications

Die Verbrannte Hand – Neuheiten und aktuelle Forschung

Die Verbrannte Hand – Neuheiten und aktuelle Forschung

Efficacy of Combined Intense Pulsed Light (IPL) With Fractional CO₂‐Laser Ablation in the Treatment of Large Hypertrophic Scars: A Prospective, Randomized Control Trial

Ablative fractional resurfacing with laser‐facilitated steroid delivery for burn scar management: Does the depth of laser penetration matter?

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Laser Modulation of Hypertrophic Scars

Cited by 64 publications

References 41 publications

Die Verbrannte Hand – Neuheiten und aktuelle Forschung

Die Verbrannte Hand – Neuheiten und aktuelle Forschung

Efficacy of Combined Intense Pulsed Light (IPL) With Fractional CO2‐Laser Ablation in the Treatment of Large Hypertrophic Scars: A Prospective, Randomized Control Trial

Ablative fractional resurfacing with laser‐facilitated steroid delivery for burn scar management: Does the depth of laser penetration matter?

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Product

Resources

About

Efficacy of Combined Intense Pulsed Light (IPL) With Fractional CO₂‐Laser Ablation in the Treatment of Large Hypertrophic Scars: A Prospective, Randomized Control Trial