Ablative fractional CO_(2)laser surgery improving sleep quality,pain and pruritus in adult hypertrophic scar patients:a prospective cohort study

Background:Poor sleep quality is associated with a decrease in quality of life in patients with major burn scars,combined with pruritus and pain.Few interventions have been reported to improve the sleep quality of patients with scars.In the current prospective cohort study,we investigated the efficacy of CO_(2)-ablative fractional laser(AFL)surgery vs conventional surgery in post-burn patients with hypertrophic scars with sleep quality as the primary study outcome.Methods:In total 68 consecutive patients undergoing scar surgical treatment were recruited,including a CO_(2)-AFL surgery cohort(n=35)and a conventional surgery cohort(n=33).A subgroup from the AFL cohort was selected.Sleep quality,pain and pruritus were evaluated.Multiple linear regression analyses were performed to reveal the effect of CO_(2)-AFL surgery.Results:The CO_(2)-AFL surgery cohort had significantly lower Pittsburgh sleep quality index(PSQI)global scores than the conventional surgery cohort after the last surgical treatment.In the subgroup of patients receiving hardware sleep monitoring,CO_(2)-AFL markedly increased deep sleep time,deep sleep efficiency and reduced initial sleep latency.Compared to the conventional surgery cohort,the CO_(2)-AFL cohort presented significantly lower pain and pruritus scores.Correlation analysis showed pain and pruritus were significantly associated with PSQI scores,and there were also significant correlations between pain and pruritus scores.Multiple linear regression analysis showed that surgery method was negatively linearly correlated with visual analog scale(VAS)pain score,brief pain inventory(BPI)total,VAS pruritus score,5-D itch scale total,four-item itch questionnaire(FIIQ)total and PSQI total.Conclusions:CO_(2)-AFL surgery significantly improved sleep quality and reduced pain and pruritus of hypertrophic scar patients.The alleviation of sleep disorder was associated with improvement of deep sleep quality including deep sleep time and deep sleep deficiency.Trial registration:The Chinese Clinical Trial Registry(ChiCTR200035268)approved retrospectively registration on 5 Aug 2020.

Combination of ablative fractional carbon dioxide laser and platelet-rich plasma treatment to improve hypertrophic scars:a retrospective clinical observational study

Background:Hypertrophic scars are one of the main complications that affect the quality of life of patients after burns.Many methods have been shown to be effective in the treatment of hypertrophic scars,such as ablative fractional CO_(2) laser(AFCL)and platelet-rich plasma(PRP).However,there are few studies on the effect of the combined application of these measures.The purpose of this study was to explore the therapeutic effect of AFCL combined with PRP on hypertrophic burn scars.Methods:A retrospective clinical observation study was conducted on 50 patients with hypertrophic burn scars.The AFCL+PRP group included 31 patients who received AFCL combined with PRP treatment;the AFCL group included 19 patients who received AFCL treatment only.The University of North Carolina 4P Scar Scale(UNC4P)and the Vancouver Scar Scale(VSS)scores that were collected before each treatment were used as indicators of the effectiveness of the previous treatment.The scores recorded at the second,fourth and seventh months were analysed.Results:The demographic data of the 2 groups were not significantly different.Before treatment,therewas no difference in the UNC4P and VSS scores between the 2 groups.Therewas a significant decline in the UNC4P and VSS total scores over 6 months in both groups(p<0.05)and scores in the 2 groups were comparable after 3 and 6 months(p<0.05).UNC4P scores in the AFCL+PRP group decreased from a mean of 8.26 to 2.61(p<0.05)with a concomitant drop in VSS scores from a mean of 11.74 to 6.06(p<0.01).In the AFCL group UNC4P and VSS scores decreased from 7.68 to 4.63(p<0.05)and from 10.89 to 8.16(p<0.05),respectively.The sub-items of these 2 assessments were analysed and the results suggest that AFCL combined with PRP can comprehensively improve scarring.Conclusions:This study shows that PRP is an effective adjunct for AFCL in the treatment of hypertrophic burn scars and that the combination of PRP and AFCL proved to be more useful than AFCL alone.This combination may be a new and effective clinical practice for the treatment of scars.However,larger and higher-level clinical studies are still needed to determine its efficacy and possible mechanisms.