[Effect analysis of sequential laser application in treating the hypertrophic scars of burn children at early stage]

Zhonghua Shao Shang Za Zhi. 2021 Apr 20;37(4):327-332. doi: 10.3760/cma.j.cn501120-20201214-00526.
[Article in Chinese]


Objective: To explore the effects of sequential application of intensive pulsed light and carbon dioxide laser in treating the hypertrophic scars of burn children at early stage. Methods: A retrospective cohort before-after control study in the same patients was conducted. From January 2016 to December 2018, 145 burn children with hypertrophic scar at the early stage who met the inclusion criteria were admitted to the First Hospital of Jilin University, including 82 males and 63 females, aged 1 to 12 (3 (2, 6)) years. All the children were firstly treated with intense pulsed light therapy (no anesthesia or intravenous-inhalation combined anesthesia) at an interval of once per month, and then changed to carbon dioxide laser therapy (topical anesthesia or intravenous-inhalation combined anesthesia) when the degree of scar hyperemia was reduced, at an interval of once every 3 months, for a total of 3 times. Before the first intense pulsed light treatment (hereinafter referred to as before the first treatment) and 3 months after the last carbon dioxide laser treatment (hereinafter referred to as after the last treatment), scar scoring was evaluated by Vancouver Scar Scale (VSS), and scar hyperemia (denoted as hemoglobin level) was measured with Antera 3D® camera. The times of intense pulsed light, the time of single treatment, the anesthesia method, and the time of intravenous-inhalation combined anesthesia of intense pulsed light and carbon dioxide laser treatment were analyzed. After the last treatment, Likert Scale was used to evaluate the efficacy satisfaction of both doctors and patients. Adverse reactions were recorded during the treatment. Data were statistically analyzed with Wilcoxon signed rank sum test, and paired sample t test. Results: The color, vascular distribution, thickness, and softness scores, and total score in VSS scoring of scars of children after the last treatment were significantly lower than those before the first treatment (Z=-6.05, -10.34, -9.84, -9.28, -10.43, P<0.01). The hemoglobin level of scar of children after the last treatment was 1.86±0.24, significantly lower than 2.27±0.32 before the first treatment (t=17.65, P<0.01). A total of 411 times of intense pulsed light therapy were performed, (2.8±0.6) times per person, and the single treatment time was 35 (20, 45) s. There were 392 times (95.38%) without anesthesia, and 19 times (4.62%) with intravenous-inhalation combined anesthesia with time of 6 (5, 8) min. The single treatment time of carbon dioxide laser therapy was 5 (3, 10) min. There were 364 times (83.68%) of topical anesthesia and 71 times (16.32%) of intravenous-inhalation combined anesthesia with time of 10 (8, 15) min. After the last treatment, the efficacy satisfaction scores of doctors and patients were (4.3±0.7) and (3.8±1.0) points, respectively. Blisters occurred in 5 cases after intense pulsed light treatment, which were healed naturally after drainage. One child developed local skin infection, skin redness and swelling accompanied by purulent exudate after carbon dioxide laser treatment, which was improved after skin disinfection and external use of mupirocin ointment. No inflammatory pigmentation, worsening of hyperplasia of scar, erythema, or other skin adverse reactions or anesthetics-related adverse reactions occurred in any child. Conclusions: Sequential application of intense pulsed light and carbon dioxide laser to treat the hypertrophic scars of burn children at early stage can obviously improve the appearance and texture of scar, with higher satisfaction of doctors and patients and fewer adverse reactions.

目的: 探讨应用强脉冲光与二氧化碳激光序贯治疗烧伤患儿早期增生性瘢痕的效果。 方法: 采用回顾性队列研究及自身前后对照方法。2016年1月—2018年12月,吉林大学第一医院收治145例符合入选标准的烧伤后早期增生性瘢痕患儿,其中男82例、女63例,年龄1~12[3(2,6)]岁。患儿均首先采用强脉冲光治疗(无麻醉/静脉-吸入复合麻醉),间隔1个月治疗1次;至瘢痕充血程度减轻时改行二氧化碳激光治疗(表面麻醉/静脉-吸入复合麻醉),间隔3个月治疗1次,共治疗3次。首次强脉冲光治疗前(以下称首次治疗前)及末次二氧化碳激光治疗后3个月(以下称末次治疗后),采用温哥华瘢痕量表(VSS)行瘢痕评分,采用Antera 3D®相机测量瘢痕充血程度(以血红蛋白水平表示)。统计本组患儿强脉冲光治疗次数,强脉冲光和二氧化碳激光单次治疗时间、采用的麻醉方式及静脉-吸入复合麻醉时间。末次治疗后,采用李克特量表标准评定医患双方疗效满意度。记录治疗期间患儿的不良反应。对数据行Wilcoxon符号秩和检验、配对样本t检验。 结果: 本组患儿末次治疗后的瘢痕VSS评分中的色泽、血管分布、厚度、柔软度评分及总分均明显低于首次治疗前(Z=-6.05、-10.34、-9.84、-9.28、-10.43,P<0.01)。本组患儿末次治疗后瘢痕血红蛋白水平为1.86±0.24,明显低于首次治疗前的2.27±0.32(t=17.65,P<0.01)。本组患儿共行强脉冲光治疗411次,每人(2.8±0.6)次,单次治疗时间35(20,45)s,无麻醉治疗392次(95.38%)、静脉-吸入复合麻醉治疗19次(4.62%),静脉-吸入复合麻醉时间6(5,8)min;二氧化碳激光单次治疗时间5(3,10)min,表面麻醉治疗364次(83.68%)、静脉-吸入复合麻醉治疗71次(16.32%),静脉-吸入复合麻醉时间10(8,15)min。末次治疗后,医方和患方的疗效满意度评分分别为(4.3±0.7)、(3.8±1.0)分。5例患儿强脉冲光治疗后发生水疱,水疱液引流后自然愈合;1例患儿二氧化碳激光治疗后皮肤局部发生感染,皮肤红肿伴脓性渗出物,经皮肤消毒+外用莫匹罗星软膏后好转。所有患儿均无炎症性色素沉着、瘢痕增生加重、红疹等皮肤不良反应或麻醉相关不良反应发生。 结论: 应用强脉冲光与二氧化碳激光序贯治疗烧伤患儿早期增生性瘢痕可明显改善瘢痕外观和质地,医患双方满意度较高,不良反应少。.

MeSH terms

  • Burns* / complications
  • Child
  • Cicatrix, Hypertrophic* / pathology
  • Female
  • Humans
  • Lasers, Gas*
  • Male
  • Retrospective Studies
  • Treatment Outcome