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Burn Center and Plastic Surgery Department- S. Eugenio Hospital - Rome
Chief: Prof. P. Palombo
M. Palombo - S. Moroni – A....
NEW PROTOCOL
GOALS
Evolution of the scar from a functional and aesthetic point of view depending on
the method used ( lipo...
Hematoxylin-
Eosin Pre-
Treatment
Chaotic organization of the basal layer of epidermis
Small number of spinous layer cells...
After lipofilling +
Ablative Fractional Laser
CO2
More compact connective tissue
Epidermis is not very celluleted
After li...
Average number of sessions required to switch
from a subjective test of 30 to 110, with Non
Ablative Fractional Laser with...
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EWMA 2014 - EP437 BURN AND POST TRAUMATIC SCARS TREATMENT

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Palombo Marco, Fasciani L., Bruno A., delli Santi G., Pagliarini T., Schirosi M., Moroni S., Palombo P.

Veröffentlicht in: Gesundheit & Medizin
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EWMA 2014 - EP437 BURN AND POST TRAUMATIC SCARS TREATMENT

  1. 1. 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
  2. 2. 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
  3. 3. 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 vesselsFirmer 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
  4. 4. 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
  5. 5. 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

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