Efficacy Evaluation Of Co₂ Fractional Laser Combined With Triamcinolone Acetonide Or Silicone Gel For The Treatment Of Burn Hypertrophic Scars

Objectives:1.To explore whether there is a differences in the color,thickness,vascular distribution and softness of scar in the treatment of CO₂fractional laser（CO₂FL）,CO₂FL combined with triamcinolone acetonide and combined with ultrasonic introduction of silicone gel.Methods:A total of 90 patients with early hypertrophic scar after burn wound healing who met the inclusion criteria in the Burn Department of the Second Affiliated Hospital of Kunming Medical University from September 2020 to December 2022 were collected and completed a 3-month treatment cycle,multiple group case-control studies were used to analyze the data retrospectively.According to the treatment method,the patients were divided into observation group（CO₂FL combined with triamcinolone acetonide treatment group,30 cases）,CO₂FL combined with ultrasonic introduction of silicone gel treatment group（30 cases）)and control group（CO₂FL treatment group,30 cases）.All patients were treated with CO₂FL once a month.In the observation group,CO₂FL combined with triamcinolone acetonide injection was used to apply triamcinolone acetonide to the wound or injected into the scar once a month.The total treatment period of treatment was 3 months.After 1 week,patients in the CO₂FL combined with ultrasonic introduction of silicone gel group were treated with ultrasonic introduction of silicone gel once a day.The total treatment period was 3months.Data collection,photos,Vancouver Scar Scale（VSS）score and the Patient Scar Assessment Scale（PSAS）score were performed at the first treatment and 3months after treatment.The scores of patients in the observation group and the control group before and after treatment were compared.To analyze whether there is a difference in the color,thickness,vascular distribution and softness of scar in the treatment of CO₂FL,CO₂FL combined with triamcinolone acetonide and combined with ultrasonic introduction of silicone gel.Statistical description counting data is expressed by example and constituent ratio n（%）;counting data are represented by chi-square test;paired measurement data that conform to normal distribution are expressed by paired t-test,expressed by mean±standard deviation（（?）±s）;data that do not conform to normal distribution are expressed by Wilcoxon symbolic rank sum test,expressed by median（quartile spacing）.The results of single factor analysis of variance of multiple groups of measurement data lines in accordance with normal distribution were expressed as mean±standard deviation（（?）±s）,and the row Kruskal-Wallis H test that did not accord with normal distribution was expressed as median（quartile interval）.The test levelαis 0.05.Results:1.There was no significant difference in the scores of VSS and PSAS between the observation group and the control group before treatment（P>0.05）.The VSS and PSAS scores of the three treatment methods were compared before and after treatment,and the results showed that there were significant differences（P>0.05）.2.There were significant differences in VSS and PSAS scores among the three treatment groups after treatment（P<0.05）.The curative effects of the three treatment methods were different.Further pairwise comparison of different treatment methods showed that there were significant differences in VSS and PSAS scores between the observation group and the control group（P<0.05）.There was no significant difference in VSS and PSAS scores between the two treatment groups in the observation group（P>0.05）.3.After treatment,the VSS indexes of the observation group and the control group were compared,and the results showed that there were significant differences in color,vascular distribution and thickness between the observation group and the control group（P<0.05）.There was significant difference in vascular distribution between CO₂FL combined with triamcinolone acetonide group and the other two treatments（P<0.05）,and there was significant difference in thickness between CO₂FL combined ultrasonic introduction of silicone gel group and the other two treatments（P<0.05）.4.After treatment,the PSAS indexes of the observation group and the control group were compared,the results showed that there were significant differences in color,hardness,thickness and flatness between the observation group and the control group（P<0.05）.Further more,the color differences between the CO₂FL combined triamcinolone acetonide treatment group and the other two groups were statistically significant（P<0.05）.There was significant difference in hardness between CO₂FL combined with triamcinolone acetonide group and CO₂FL group（P<0.05）,but there was no significant difference in other pairwise comparison（P>0.05）.There was a significant difference in thickness between the CO₂FL combined ultrasonic introduction of silicone gel group and the other two treatments（P<0.05）.There was significant difference in flatness between CO₂FL combined with triamcinolone acetonide group and CO₂FL alone group（P<0.05）,but there was no significant difference in other pairwise comparison（P>0.05）.Conclusions:1.CO₂FL combined with triamcinolone acetonide,and combined with ultrasonic introduction of silicone gel and simple CO₂FL are effective in the treatment of hypertrophic scar after burn wound healing.2.The clinical efficacy of CO₂FL combined with triamcinolone acetonide and combined with ultrasonic introduction of silicone gel was better than that of simple CO₂FL,but there was no significant difference between the two groups.3.The vascular improvement of hypertrophic scar treated by CO₂FL combined with triamcinolone acetonide is better than that of CO₂FL combined with ultrasonic introduction of silicone gel and simple CO₂FL,and CO₂FL combined with ultrasonic introduction of silicone gel is superior to CO₂FL combined with triamcinolone acetonide and simple CO₂FL in the improvement of hypertrophic scar thickness.