Fractional Laser With Transdermal Delivery Of Triamcinolone Acetonide In The Treatment Of Hypertrophic Scars In Children

Objective:This article aims to explore the effectiveness and safety of ablative CO2 fractional laser combined with transdermal delivery of triamcinolone acetonide in the treatment of hypertrophic scars in children,and to scientifically compare,observe and discuss with the current clinical mainstream treatment methods of ablative CO2 fractional laser combined with local injection of triamcinolone acetonide.It is expected to provide new options and directions for the clinical treatment of hypertrophic scars in children.Methods:From January 2021 to January 2022,children diagnosed as hypertrophic scars and treated with ablative CO2 fractional laser were collected,who presented to the Burn and Plastic Surgery Clinic of Children’s Hospital Affiliated to Soochow University.According to whether to apply triamcinolone acetonide and different ways of using triamcinolone acetonide in the treatment plan,they were divided into treatment group A:simple ablative CO2 fractional laser treatment,treatment group B:ablative CO2 fractional laser combined with transdermal delivery of triamcinolone acetonide,and treatment group C:ablative CO2 fractional laser treatment combined with local injection of triamcinolone acetonide.The status of hypertrophic scars at different treatment stages was scored using the Vancouver Scar Scale,and the degree of pain during treatment was scored using the Visual Analogue Scale.Statistical analysis of the three distinct groups was conducted on the general situation(gender,age,etiology,course of disease,location),VSS score,VAS score,treatment response rate,treatment satisfaction of parents,and adverse reactions during treatment.Results:(1)Finally,120 children with hypertrophic scars were included.Group A:40 cases(male/female,20/20);Age:1.6-17.2 years(7.77±2.61 years);The course of disease is 1.5-23 months(9.41 ±3.95 months);Etiology(26 cases of burns,5 cases of surgery,9 cases of trauma);Location(face and neck 12 cases,trunk 12 cases,limbs 16 cases);VSS score before treatment(9.33±1.94).Group B:40 cases(male/female,18/22);Age:1.5-16.8 years old(7.72±2.61 years);The course of disease is 1.2-22 months(9.14±3.45 months);Etiology(26 cases of burns,4 cases of surgery,10 cases of trauma);Location(face and neck 10 cases,trunk 9 cases,limbs 21 cases);VSS score before treatment(9.21±2.46).Group C:40 cases(male/female,21/19),aged 1.2-17.5 years(8.00±2.45 years);The course of disease is 1.8-24 months(9.37±3.39 months);Etiology(28 cases of burns,4 cases of surgery,8 cases of trauma);Location(face and neck 10 cases,trunk 12 cases,limbs 18 cases);VSS score before treatment(9.09±2.38).There was no significant difference in general information(gender,age,course of disease,etiology,location)and VSS scores before treatment among the three groups of children(P>0.05),which was comparable.(2)In terms of VSS scores:During the treatment period,except for the decrease in VSS scores in Group A after the first treatment,there was no statistically significant difference compared to before treatment(P>0.05).VSS scores in Group A after the second and third treatment,as well as the decrease in VSS scores in Group B and Group C after each treatment,were statistically significant compared to before treatment(P<0.05).Six months after treatment,the VSS score after treatment in Group A was 6.87±1.64.the VSS score after treatment in Group B was 5.02± 1.32,and the VSS score after treatment in Group C was 4.84±1.75.Compared with the VSS score before treatment,the VSS score in each group decreased significantly after treatment(P<0.05).The decrease in VSS scores after treatment in Group B and Group C was statistically significant compared to the decrease in VSS scores after treatment in Group A(P<0.05),but there was no statistically significant decrease in VSS scores between Group B and Group C(P>0.05).In terms of scar softness,thickness,vascular distribution,and color,the VSS scores of the three groups decreased significantly after treatment compared to those before treatment(P<0.05).The VSS scores of Group B and Group C decreased significantly compared to those of Group A(P<0.05),while the VSS scores of Group B and Group C decreased without statistical significance(P>0.05).(3)In terms of pain treatment,the VAS scores of the three groups were 3.70±1.79 for Group A,3.78± 1.53 for Group B,and 5.65±1.78 for Group C.There were statistically significant differences in VAS scores between Group A,Group B,and Group C(P<0.05);There was no statistically significant difference in VAS scores between Group A and Group B(P>0.05).(4)The effective rates after scar treatment in the three groups were 77.5%in Group A,92.5%in Group B,and 90%in Group C,respectively,with no statistically significant difference(χ2=4.47,P>0.05).The parents satisfaction scores of the three groups of children were 3.70± 1.79 in Group A,3.70± 1.07 in Group B,and 3.60±0.98 in Group C.The percentage of satisfaction(≥3 points)was 72.5%,82.5%,and 85%,respectively,with no statistically significant difference(χ2=2.19,P>0.05).It indicates that all of them have good therapeutic effects and high treatment satisfaction.(5)In terms of adverse reactions:During the treatment of the three groups,in Group A,there was 1 case of hyperplasia aggravation(person time),1 case of pigmentation(person time),and 1 case of blister(person time),with an adverse reaction rate of 7.5%;In Group B,there was 1 case of pigmentation and 1 case of blister,with an adverse reaction rate of 5%;Group C had pigmentation in 1 case(person time)and peripheral tissue atrophy in 1 case(person time),with an adverse reaction rate of 5%.There was no significant difference in the incidence of adverse reactions among the three groups(P>0.05).Conclusion:(1)Simple ablative CO2 fractional laser,ablative CO2 fractional laser with transdermal delivery of triamcinolone acetonide,and ablative CO2 fractional laser combined with local injection of triamcinolone acetonide have certain therapeutic effects on hypertrophic scars in children.Moreover,ablative CO2 fractional laser combined with triamcinolone acetonide has better therapeutic effects,which is worthy of clinical recommendation.(2)Ablative CO2 fractional laser with transdermal delivery of triamcinolone acetonide has a better therapeutic effect in the treatment of hypertrophic scars in children,with fewer adverse reactions,mild treatment pain,and high patient satisfaction.It is a more suitable treatment method for treating hypertrophic scars in children and is worthy of clinical recommendation.