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

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 receive...

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Veröffentlicht in:Lasers in surgery and medicine 2020-02, Vol.52 (2), p.149-158
Hauptverfasser: Issler‐Fisher, Andrea C., Fisher, Oliver M., Haertsch, Peter, Li, Zhe, Maitz, Peter K.M.
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container_issue 2
container_start_page 149
container_title Lasers in surgery and medicine
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creator Issler‐Fisher, Andrea C.
Fisher, Oliver M.
Haertsch, Peter
Li, Zhe
Maitz, Peter K.M.
description 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 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.
doi_str_mv 10.1002/lsm.23166
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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), &gt;100% (n = 3) of scar thickness. The median reduction in maximum scar thickness was 800 μm following one treatment (P &lt; 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 &gt;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.</description><identifier>ISSN: 0196-8092</identifier><identifier>EISSN: 1096-9101</identifier><identifier>DOI: 10.1002/lsm.23166</identifier><identifier>PMID: 31571242</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Ablation ; ablative fractional CO2 laser ; burn scars ; Carbon dioxide ; Carbon dioxide lasers ; depth of laser penetration ; Ions ; Lasers ; Neuralgia ; Pain ; Parameters ; Patients ; Penetration depth ; Pruritus ; Reduction ; Resurfacing ; scar assessment scores ; scar thickness ; Scars ; Steroids ; Surfacing ; Thickness ; Ultrasound</subject><ispartof>Lasers in surgery and medicine, 2020-02, Vol.52 (2), p.149-158</ispartof><rights>2019 Wiley Periodicals, Inc.</rights><rights>2020 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3536-407f498496911eee7af06f3f86050f5d1d6782cacab73a7c075f27d7c9543b4b3</citedby><cites>FETCH-LOGICAL-c3536-407f498496911eee7af06f3f86050f5d1d6782cacab73a7c075f27d7c9543b4b3</cites><orcidid>0000-0002-7453-1248</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Flsm.23166$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Flsm.23166$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31571242$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Issler‐Fisher, Andrea C.</creatorcontrib><creatorcontrib>Fisher, Oliver M.</creatorcontrib><creatorcontrib>Haertsch, Peter</creatorcontrib><creatorcontrib>Li, Zhe</creatorcontrib><creatorcontrib>Maitz, Peter K.M.</creatorcontrib><title>Ablative fractional resurfacing with laser‐facilitated steroid delivery for burn scar management: Does the depth of laser penetration matter?</title><title>Lasers in surgery and medicine</title><addtitle>Lasers Surg Med</addtitle><description>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), &gt;100% (n = 3) of scar thickness. The median reduction in maximum scar thickness was 800 μm following one treatment (P &lt; 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 &gt;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.</description><subject>Ablation</subject><subject>ablative fractional CO2 laser</subject><subject>burn scars</subject><subject>Carbon dioxide</subject><subject>Carbon dioxide lasers</subject><subject>depth of laser penetration</subject><subject>Ions</subject><subject>Lasers</subject><subject>Neuralgia</subject><subject>Pain</subject><subject>Parameters</subject><subject>Patients</subject><subject>Penetration depth</subject><subject>Pruritus</subject><subject>Reduction</subject><subject>Resurfacing</subject><subject>scar assessment scores</subject><subject>scar thickness</subject><subject>Scars</subject><subject>Steroids</subject><subject>Surfacing</subject><subject>Thickness</subject><subject>Ultrasound</subject><issn>0196-8092</issn><issn>1096-9101</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><recordid>eNp1kc1uFSEYhomxscfqwhswJG50cVp-ZmBw0zRVq8kxLtQ1YZiPloYZjsDYnJ13oNfYK5HTqS5MXH3ky8PDS16EnlFyTAlhJyGPx4xTIR6gFSVKrBUl9CFaEVrPHVHsED3O-ZoQwhmRj9Ahp62krGEr9POsD6b474BdMrb4OJmAE-Q5OWP9dIlvfLnCwWRItz9-7XfBF1NgwLlAin7AA4R6Pe2wiwn3c5pwtibh0UzmEkaYymv8JkLG5Qoqu6226BYh3sIEJZn9q5UvVXj6BB04EzI8vZ9H6Ou7t1_O3683ny4-nJ9t1pa3XKwbIl2jukYJRSkASOOIcNx1grTEtQMdhOyYNdb0khtpiWwdk4O0qm143_T8CL1cvNsUv82Qix59thCCmSDOWTOmlJSsI7SiL_5Br2P9Zk2nGW-bVjQ1SaVeLZRNMecETm-TH03aaUr0viVdW9J3LVX2-b1x7kcY_pJ_aqnAyQLc-AC7_5v05vPHRfkbJXWeug</recordid><startdate>202002</startdate><enddate>202002</enddate><creator>Issler‐Fisher, Andrea C.</creator><creator>Fisher, Oliver M.</creator><creator>Haertsch, Peter</creator><creator>Li, Zhe</creator><creator>Maitz, Peter K.M.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>8FD</scope><scope>FR3</scope><scope>K9.</scope><scope>M7Z</scope><scope>P64</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-7453-1248</orcidid></search><sort><creationdate>202002</creationdate><title>Ablative fractional resurfacing with laser‐facilitated steroid delivery for burn scar management: Does the depth of laser penetration matter?</title><author>Issler‐Fisher, Andrea C. ; Fisher, Oliver M. ; Haertsch, Peter ; Li, Zhe ; Maitz, Peter K.M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3536-407f498496911eee7af06f3f86050f5d1d6782cacab73a7c075f27d7c9543b4b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Ablation</topic><topic>ablative fractional CO2 laser</topic><topic>burn scars</topic><topic>Carbon dioxide</topic><topic>Carbon dioxide lasers</topic><topic>depth of laser penetration</topic><topic>Ions</topic><topic>Lasers</topic><topic>Neuralgia</topic><topic>Pain</topic><topic>Parameters</topic><topic>Patients</topic><topic>Penetration depth</topic><topic>Pruritus</topic><topic>Reduction</topic><topic>Resurfacing</topic><topic>scar assessment scores</topic><topic>scar thickness</topic><topic>Scars</topic><topic>Steroids</topic><topic>Surfacing</topic><topic>Thickness</topic><topic>Ultrasound</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Issler‐Fisher, Andrea C.</creatorcontrib><creatorcontrib>Fisher, Oliver M.</creatorcontrib><creatorcontrib>Haertsch, Peter</creatorcontrib><creatorcontrib>Li, Zhe</creatorcontrib><creatorcontrib>Maitz, Peter K.M.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Lasers in surgery and medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Issler‐Fisher, Andrea C.</au><au>Fisher, Oliver M.</au><au>Haertsch, Peter</au><au>Li, Zhe</au><au>Maitz, Peter K.M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ablative fractional resurfacing with laser‐facilitated steroid delivery for burn scar management: Does the depth of laser penetration matter?</atitle><jtitle>Lasers in surgery and medicine</jtitle><addtitle>Lasers Surg Med</addtitle><date>2020-02</date><risdate>2020</risdate><volume>52</volume><issue>2</issue><spage>149</spage><epage>158</epage><pages>149-158</pages><issn>0196-8092</issn><eissn>1096-9101</eissn><abstract>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), &gt;100% (n = 3) of scar thickness. The median reduction in maximum scar thickness was 800 μm following one treatment (P &lt; 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 &gt;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.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>31571242</pmid><doi>10.1002/lsm.23166</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-7453-1248</orcidid></addata></record>
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subjects Ablation
ablative fractional CO2 laser
burn scars
Carbon dioxide
Carbon dioxide lasers
depth of laser penetration
Ions
Lasers
Neuralgia
Pain
Parameters
Patients
Penetration depth
Pruritus
Reduction
Resurfacing
scar assessment scores
scar thickness
Scars
Steroids
Surfacing
Thickness
Ultrasound
title Ablative fractional resurfacing with laser‐facilitated steroid delivery for burn scar management: Does the depth of laser penetration matter?
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