Clinical Observation Of Fractional CO2 Laser Combined With Subcutaneous Thinning Of Scar On Hypertrophic Scar

Objective:In this study,we observed the clinical treatment effect of hypertrophic scar by fractionalCO2 laser combined with subcutaneous thinning of scar,and explored a new method for the treatment of hypertrophic scar.Methods:This study included 20 patients who met the inclusion criteria,all of whom were hypertrophic scars in patients who were seen in our outpatient clinic from February to October 2018.Twenty patients were divided into 10 patients with a skin plane greater than 10 mm by palpation scar thickness.The patients with scars protruding the skin plane but less than or equal to 4 mm were divided into laser-only control groups.Pre-operative photographs were taken before treatment for all enrolled patients.A doctor with clinical experience and not participating in the study used the Vancouver Scar Rating Scale(VSS)for color,thickness,blood vessel distribution,and softness of the scar before treatment.Score scores in four aspects.In the first trial,the patients underwent subcutaneous thinning of the scar,and the scar tissue specimens were removed during the operation.Each patient was given plastic surgeryroutine after surgery,and the VSS score was recorded again one week after the scar was completely epithelialized in the surgical site.And in the thinned area row dot matrix CO2 laser multi-mode combined treatment.The second laser treatment was performed for 3 months,followed by two laser treatments and followed for 3 months.The control patients underwent a single-dot CO2 laser multi-mode combination therapy.The laser treatment interval was also 3 months,and the patients were followed up for 3 months.All laser wounds were treated with MEBO MEBO wet wounds.All patients were photographed again after two laser treatments,and the same doctor again recorded VSS scores on the scars in the treatment area to obtain scars in the treatment area.Organize specimens.The histological changes of scar were observed by HE staining in the preoperative and postoperative specimens of the two groups.The Vancouver scar scores before and after treatment were statistically analyzed in the two groups.The clinical efficacy of the two groups was compared.Results:1.Compare the VSS scores of the experimental group and the control group separately:1.1 Control group: the scar VSS score of the control group after two laser treatments,the color,blood vessel distribution,thickness,softness and total score of the scar were significantly lower than before treatment.The mean and standard deviation of the data before and after treatmentwere tested by t test.For the analysis,the differences were statistically significant(P<0.05).1.2 Test group: 1.VSS score before and after surgery: the thickness,softness and total score of scar after operation were significantly lower than before treatment,the difference was statistically significant(P<0.05).The color and blood vessel distribution were not significantly lower than before treatment,and the difference was not statistically significant(P<0.05).2.VSS score after surgery and two laser treatments: the color,blood vessel distribution,softness and total score of scar after laser treatment were significantly lower than those before laser treatment,and the difference was statistically significant.The thickness of the scar was not significantly lower than that before treatment,and the difference was not statistically significant.1.3 Comparison of VSS total scores before and after treatment between the experimental group and the control group: The difference between the two groups was significant.After statistical analysis,the difference was statistically significant(P<0.05).2.1 Pathological section observation: There were no significant differences between the two groups of scar tissue before treatment,and a large number of proliferating fibroblasts and neovascularization were observed.The collagen fibers were densely arranged and accompanied by obvious inflammatory cell infiltration.The HE staining of theexperimental group showed that compared with the preoperative section,the whole layer of collagen fibers in the scar was loose and tend to be ordered,the collagen fibers were arranged in a network,and the infiltration of inflammatory cells was reduced compared with preoperative.After treatment,the sections were treated with a small amount of fibroblasts and neovascularization.The arrangement of superficial collagen fibers tends to be orderly and sparse.The deeper layers of collagen can still show dense and disordered collagen fibers and more neovascularization.No significant difference.Conclusion:1.Simple dot-matrix CO2 laser treatment of hypertrophic scar has certain curative effect on improving color,blood vessel distribution,reducing thickness and increasing softness.2.Simple scar thinning is effective in reducing the thickness of hypertrophic scar and increasing the softness,but it is not effective in the color and blood vessel distribution of scar.After combined with CO2 laser treatment,the effect on color and blood vessel distribution can be significantly improved.3.The overall effect of dot-matrix CO2 laser combined with scar subcutaneous thinning on hypertrophic scar is better than pure dot-matrix CO2 laser.4.The clinical effect of dot-matrix CO2 laser combined with scarsubcutaneous thinning on hypertrophic scar is definite and worthy of clinical promotion.