| Part ?Effective treatment for hypertrophic scar with dual-wave-length PDL and Nd:YAG laser in Chinese patientsBackgroundAbnormal wound healing as observed in burns,trauma,surgery,and abrasions usually cause hypertrophic scars.It is very common in clinic.The common symptoms of hypertrophic scars are pain,itching,red,and raised.Most patients seek treatment because of being uncomfortable with cosmetic defects.Patients with severe scarring may have functional problems.Hypertrophic scars can be treated through various methods,such as silica gel treatment,drug injections,local pressure,micro-plasma radio frequency,laser treatment,and surgical scar revision.Each method is useful,as well as comes with its own limitations.In recent years,the effectiveness and safety of laser therapy have been more and more recognized,so laser therapy is widely used in treating scars.Several physicians have reported a positive response among hypertrophic scar patients treated with various forms of phototherapy,such as exposure to Pulsed Dye Laser(PDL),Intense Pulsed Laser(IPL),and fractional laser.For example,PDL and IPL can accelerate mutation of scar,whereas non-ablative and ablative fractional laser can improve scar's texture.ObjectiveThe sequential combined PDL/Nd:YAG laser treatment that combines 585/1064 nm lasers has been found to be useful in improving acne vulgaris and leg veins;however,it is less reported for hypertrophic scar treatment.In our study,we have evaluated the effectiveness and safety of dual-wave-length laser in the management of hypertrophic scars.Materials and methodsTwenty-five Chinese patients who clinically diagnosed as having hypertrophic scars participated in this study.Before laser treatment,all patient scars were evaluated using the Patient Scar Assessment Scale(PSAS).It contains six items that are scored numerically(1-10 for each item).The patients scored the characteristics of scar color,pliability,thickness,relief,itching,and pain.Two observers,who were plastic surgeons but did not participate in the research,scored patients' scars by using the Observer Scar Assessment Scale(OSAS)which contains five items:vascularization,pigmentation,pliability,thickness,and relief.The treatment was terminated,when the color and thickness of the scar were obviously improved or patient achieved satisfactory results.All patients were treated with combined PDL/Nd:YAG laser at 4-6 weeks intervals.The patients and observers evaluated scars again by using the Patient and Observer Scar Assessment Scales.A 3-grade scale(poor,good,and excellent)was used to evaluate patient and observer satisfaction,at the end of laser treatment.We compared the changes in the various parameters before and after treatment.Statistical analyses were performed using GraphPad Prism 7.0.ResultsSixteen female and nine male subjects,aged 7-35 years,were enrolled in our study,with a median age of 23 years.The total number of treatment sessions was determined by the response and satisfaction of the patient.The mean number of treatments was 5.3(range:2-11).We used pair t-test to compare the changes in each index before and after final treatment.The results showed that hypertrophic scar was significantly improved after several laser treatments.No severe adverse effects were observed.Most of patients and observers were satisfied.The observers' satisfaction was slightly higher than that of the patients.ConclusionsThe hypertrophic scar was significantly improved after several laser treatments and severe adverse effects were not observed.Considering the safety and satisfactory effects of dual-wave-length laser treatment,it can be regarded as a good method for treating hypertrophic scars.This study clearly demonstrates that combined PDL/Nd:YAG laser treatment is an effective,safe and well-tolerated treatment option for hypertrophic scars.Part ?Combination of sclerotherapy and dual-wavelength laser in the management of infantile hemangiomas in Chinese infantsBackgroundInfantile hemangiomas(IHs)are the most common benign vascular tumor,occurring in 4%to 10%of all children.Some cases of IH have a tendency toward regression,with treatment only required for complicated cases and IHs located in facial and other cosmetic positions.Since 2008,oral propranolol has become a first-line treatment for IH.But some patients respond poorly to oral therapy.There are also some complications with oral propranolol,such as sleep disturbance,diarrhea,bronchiolitis,hypoglycemia,and hypotension,etc.Oral propranolol therapy is not suitable for every patient.Combining dual-wavelength laser treatment and sclerotherapy of IH allows the different components of the treatment to play to their individual strengths,complementing each other so that a satisfactory result can be achieved.ObjectiveTo evaluate the efficacy and safety of combination therapy with sclerotherapy and dual wavelength pulsed dye laser(PDL)&Nd:YAG for infantile hemangiomas(IHs).Patients and methodsFifty-nine patients with IH were recruited from the plastic surgery department of Shandong Provincial Hospital Affiliated to Shandong University.All IHs which were diagnosed as mixed hemangioma had both superficial and deep components.All patients with IH received treatment with sclerotherapy and dual wavelength PDL&Nd:YAG treatment at 4-week intervals.The general situations of hemangioma before and after treatment were recorded.B-ultrasound examination results of hemangioma before and after treatment(changes in tumor thickness and blood flow signal)were recorded.Adverse reactions occurred during treatment were recorded.Observers assessed the size and color of IH using a size rating scale and color rating scale before and after treatments.ResultsTwenty-three male and 36 female subjects,aged between 3 and 12 months,were enrolled in the study,with a median age of 4.9 months.There were 5 cases of multifocal IH,48 cases of focal IH,and 6 of segmental IH,representing 69 lesions in the 59 patients.Surface areas of the lesions ranged from 2 to 55 cm2,with a mean of 11.2 cm2.All IHs had both superficial and deep components.The study showed that IH improved significantly after several sessions of treatment.Sclerotherapy reduced the size of IH,whereas dual-wavelength laser lightened the color of IH.Size of IHs evidently improved after 1 to 5 treatment sessions,with a mean of 2.4 sessions,Infantile hemangioma color was clearly less intense after 2 to 7 treatment sessions,with a mean of 4.3 sessions.The data were also normally distributed.Estimates using the SRS indicated that sclerotherapy completely resolved the IHs in close to half(49.2%,29)of the patients,mostly resolved in 33.9%(20),and a moderate decrease in size in 16.9%(10).Evaluation of the effect of the dual-wavelength laser treatment on the IHs using the CRS indicated that 45.8%(27)of patients experienced complete reduction in coloration,40.7%(24)with color mostly resolved,and 13.6%(8)with an intermediate change.Four cases of transient hyperpigmentation and 2 cases of ulceration were observed in our study.The ulcerations healed in about 2 weeks using standard wound dressings.No other adverse effects occurred.ConclusionCombined sclerotherapy and dual-wavelength laser treatment is an effective and safe option for IH.It is an important supplement to oral propranolol in the treatment of infantile hemangioma. |
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