临床和实验室研究年鉴

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Quantitative Assessment of Pulse Dye Laser Therapy in the Management of Hypertrophic Burn Scars

David I. Tucker, Brandon Stanley, Wanda Segroves, James Aden, Evan M. Renz, Booker T. King and Rodney K. Chan

Background: Several studies have reported the utility of Pulse Dye Laser (PDL) therapy in the management of hypertrophic burn scars. Among the potential benefits including improvement in pruritis, pain, stiffness and surface irregularities, its effect on erythema reduction has been most frequently reported. However, few studies have used quantitative methods to document the degree of erythema reduction in hypertrophic burn scars.

Methods: A retrospective review of patients who received PDL therapy at our burn center was performed. The anatomic area, date, settings and number of treatments were tabulated as were the skin type, and the erythema measurements of the treated areas.

Results: 61 patients received PDL therapy from a period of Mar 2012 to Jul 2013. Among them, 45 patients had enough data for analysis. The average age was 33 (range 18-66) with a 2:1 female to male ratio. The most common mechanism of injury was flame (55%) followed by blast (17.7%). The average TBSA was 16.55% (range 1-65%). The mean fluences used were 7.3 J/cm2 (range 6-9 J/cm2) and 5.1 J/cm2 (range 3.75-6.5 J/cm2) for the 7 mm and 10 mm spot sizes respectively. An average of 10.7 months elapsed (range 0.75-81 months) prior to treatment initiation. An average of 2.2 treatments were rendered (range 1-5). The average follow up period was 4.6 months with a range of 1 – 14.2 months. Erythema reduction of 5.8% percent (p=0.045) was observed. Subgroup analysis based on Fitzpatrick skin types revealed a 15.3% reduction in type I skin (p=0.047), 7.4% reduction in type II skin (p= 0.036), -5.5% reduction in type III skin (p=0.081) and -2.2% reduction type IV skin (p=0.084).

Conclusion: Pulse dye laser treatment for the management of hypertrophic burn scars resulted in a modest decrease in erythema, with the greatest degree of erythema reduction observed in patients with Fitzpatrick skin types I and II.