Burn Center and Plastic Surgery Department- S. Eugenio Hospital - Rome

Chief: Prof. P. Palombo

M. Palombo - S. Moroni – A.Bruno – L.Fasciani

G. delli Santi- F De Vita- T Anniboletti- P. Palombo

Burn scars

? Represent an entity on its own

Traditionally considered as hypertrophic

scars

Due to their tendency to overcome the limits of the lesion and not to regress by themselves

Keloids (clinical behavior)

Al-Attar Ali et al. Keloid Pathogenesis and Treatment. Plastic & Reconstructive Surgery. January 2006 – Vol. 117 - Issue 1 - pp 286-300

NEW PROTOCOL

GOALS Evolution of the scar from a functional and aesthetic point of view depending on the method used ( lipofilling alone, lipofilling and non ablative fractional laser Er:Glass Lux1540 nm, lipofilling and Fractional Ablative CO2 ); Evaluation of the optimal time in which to work in order to obtain the most satisfactory aesthetic and functional result

THREE PHASES

I PHASE: TIME 0

Subjective and objective tests Scar of at least 300 cm2 divided in three areas of about 100 cm2: 1.Lipofilling; 2.Lipofilling + Non ablative Er:Glass Fractional Laser Lux1540TM; 3.Lipofilling + Ablative CO2 Fractional Laser

Biopsies of the three areas pre treatment

After 30-45 days….II phase

II PHASE:

1.Observation 2.Second treatment Non Ablative Lux 1540 Fractional Laser; 3.Second treatment Ablative Fractional CO2 Laser

After 30-45 days …

III PHASE:

1.Observation 2.third treatment Non Ablative Fractional Laser ; 3.third treatment Ablative Fractional Laser

After 3-4 months….

EVALUATION:

1.Final Subjective and objective test 2. New Biopsy of the three regions

Eventual new cycle of lipofilling and laser

Hematoxylin- Eosin Pre-Treatment

Chaotic organization of the basal layer of epidermis

Small number of spinous layer cells, arranged in a chaotic way

Collagen fibers arranged in an anarchic way, fragmented and in low density

Small number of blood vessels

After lipofilling + Non Ablative Fractional Laser Lux1540TM

Higher Collagen density

Increased number of blood vessels Firmer skin, more cellularity Increase number of spinous layer cells Presence of cell polarity

Collagen fibers arranged in parallel mode

After lipofilling + Non Ablative Fractional Laser Lux1540TM

After lipofilling + Ablative Fractional Laser CO2

More compact connective tissue

Epidermis is not very celluleted

After lipofilling

More homogeneous connective tissue, but not thick

Increased blood vessel number

CONCLUSIONS

We conducted a retrospective study on 854 patients treated for burn scars, from 2010, with laser alone

854 patients

736 treated with fractional non ablative laser

118 treated with fractional ablative laser

NO LIPOFILLING

Average number of sessions required to switch from a subjective test of 30 to 110, with Non Ablative Fractional Laser without lipofilling

9,4 12 months

Average number of sessions required to switch from a subjective test of 30 to 110, with Fractional Ablative Laser without lipofilling

8,9 13 months

Average number of sessions required to switch from a subjective test of 30 to 110, with lipofilling + Non Ablative and Ablative Fractional Lasers

3 4 months

We have shown a significant reduction of time required for functional and aesthetic improvement of the treated areas. The areas subjected to lipofilling alone have a functional and aesthetic improvement, anyway. The combined use of laser and lipofilling allows a further improvement, histologically documented