Objective: To explore the effects of early application of sequential treatment of intensive pulsed light and carbon dioxide laser on burn children. Methods: The retrospective cohort before-after study in the same patient was conducted. From January 2016 to December 2018, 145 burn children with hypertrophic scar in the early stage and met the inclusion criteria were admitted to the First Hospital of Jilin University. There were 82 males and 63 females with age of 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) once an interval of one month, and then changed to carbon dioxide laser therapy (topical anesthesia or intravenous-inhalation combined anesthesia) when the degree of scar hyperemia was reduced, once an interval of 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 (hemoglobin level) was measured with Antera 3D® camera. The times of intense pulsed light and carbon dioxide laser treatment, the time of single treatment, the anesthesia method and the time of anesthesia were analyzed. After the last treatment, Likert scale was used to evaluate the satisfaction of both doctors and patients. Adverse reactions were recorded during the treatment. Data were stastically analyzed with Wilcoxon signed rank sum test and paired sample t test. Results: The color, vascular distribution, thickness, and softness and total VSS score 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 without anesthesia, and 19 times with intravenous-inhalation combined anesthesia with time of 6 (5,8) min. A total of 435 times of carbon dioxide laser therapy were performed, 3 times per person, and the single treatment time was 5 (3, 10) min. There were 364 times of topical anesthesia and 71 times of intravenous-inhalation combined anesthesia with time of 10 (8, 15) min. After the last treatment, the 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 with mupiroxin ointment. No inflammatory pigmentation, hyperplasia of scar, erythema and other skin adverse reactions or anestheties-related adverse reactions occurred in all the children. Conclusions: Early application of intense pulsed light and carbon dioxide laser in sequential treatment of hypertrophic scar in burn children has obvious curative effect, higher satisfaction and less adverse reactions.
Objective: To explore the effects of early application of sequential treatment of intensive pulsed light and carbon dioxide laser on burn children. Methods: The retrospective cohort before-after study in the same patient was conducted. From January 2016 to December 2018, 145 burn children with hypertrophic scar in the early stage and met the inclusion criteria were admitted to the First Hospital of Jilin University. There were 82 males and 63 females with age of 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) once an interval of one month, and then changed to carbon dioxide laser therapy (topical anesthesia or intravenous-inhalation combined anesthesia) when the degree of scar hyperemia was reduced, once an interval of 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 (hemoglobin level) was measured with Antera 3D® camera. The times of intense pulsed light and carbon dioxide laser treatment, the time of single treatment, the anesthesia method and the time of anesthesia were analyzed. After the last treatment, Likert scale was used to evaluate the satisfaction of both doctors and patients. Adverse reactions were recorded during the treatment. Data were stastically analyzed with Wilcoxon signed rank sum test and paired sample t test. Results: The color, vascular distribution, thickness, and softness and total VSS score 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 without anesthesia, and 19 times with intravenous-inhalation combined anesthesia with time of 6 (5,8) min. A total of 435 times of carbon dioxide laser therapy were performed, 3 times per person, and the single treatment time was 5 (3, 10) min. There were 364 times of topical anesthesia and 71 times of intravenous-inhalation combined anesthesia with time of 10 (8, 15) min. After the last treatment, the 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 with mupiroxin ointment. No inflammatory pigmentation, hyperplasia of scar, erythema and other skin adverse reactions or anestheties-related adverse reactions occurred in all the children. Conclusions: Early application of intense pulsed light and carbon dioxide laser in sequential treatment of hypertrophic scar in burn children has obvious curative effect, higher satisfaction and less adverse reactions.