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BURNS AND SCARRING

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SUMMARY

  • The prevalence of hypertrophic scarring, much of it trauma-related, in the developed and developing world is currently at an all-time high.

  • Given the ubiquity of hypertrophic scarring and its potential impact on health-related quality of life, it is paramount that patients have access to safe and effective treatment.

image Beginner Pearls

  • The current literature suggests that 32% to 72% of burn patients will go on to develop hypertrophic scarring.

  • The physical impact of hypertrophic scarring varies widely and should not be assessed through visual inspection alone.

  • The pulsed dye laser (PDL) has proven to be a cornerstone in the treatment of erythematous hypertrophic scars.

image Expert Pearls

  • Ablative fractional laser (AFL) is primarily used for hypertrophic scars.

  • When using IPL, the 515- to 590-nm filters are commonly used with a pulse width of approximately 10 ms.

  • Often, the simplest approach is best, including Z- or W-plasty in conjunction with AFL, PDL, and other adjunctive therapies.

image Don’t Forget!

  • In general, NAFLs do not have a significant role in the management of hypertrophic scars at this time.

  • The use of combination intralesional corticosteroid/5-FU therapy has been associated with improved scar regression, reduced recurrence, and fewer side effects.

  • Z-plasty performed within scars is virtually undetectable, and the resulting decrease in tension helps scar maturation.

image Pitfalls and Cautions

  • To avoid unwanted atrophy, the concentration of triamcinolone is subsequently reduced as scars flatten.

  • A protocol that promotes the safety and well-being of the laser surgeon and the patient should be established in every practice.

image Patient Education Points

  • Given the complexity of hypertrophic scar management and the general lack of awareness of the available treatment options and associated outcomes by the patient, it is essential to incorporate this discussion during the clinical evaluation.

  • The understanding of the patient’s needs and expectations by the physician produces greater satisfaction of care, which has been correlated with greater adherence to therapy, less doctor shopping, and a lower propensity to sue for malpractice.

INTRODUCTION

The prevalence of hypertrophic scarring in the developed and developing world is currently at an all-time high. Modern advances in acute burn and trauma care have led to unprecedented survival rates, particularly in the most severely injured patients. As these patients transition from acute to chronic care, they are confronted with the long-term sequelae of hypertrophic scarring. Given the ubiquity of hypertrophic scarring and its potential impact on health-related quality of life, it is paramount that patients have access to safe and effective treatment. While the focus is on hypertrophic scarring, many of these techniques can be extended to keloid scars, recognizing that keloids often require more aggressive management and additional adjunctive therapies.1,2

BACKGROUND

Societal disease burden

Hypertrophic scarring secondary to trauma, burns, and surgical interventions ...

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