Treatment of hypertrophic scars in children with triamcinolone acetonide acetate injection combined with ultra-pulsed CO 2 fractional laser
10.3760/cma.j.cn114453-20240902-00226
- VernacularTitle:醋酸曲安奈德注射联合超脉冲CO 2点阵激光治疗儿童增生性瘢痕
- Author:
Jingjing XU
1
;
Jie ZHENG
1
;
Lingdong ZHU
1
;
Beibei NIU
1
Author Information
1. 山东大学附属儿童医院（济南市儿童医院）整形烧伤外科，济南 250022
- Publication Type:Journal Article
- Keywords:
Cicatrix, hypertrophic;
Lasers, gas;
Ultra-pulsed CO 2 fractional laser;
Triamcinolone acetonide acetate;
Combined therapy
- From:
Chinese Journal of Plastic Surgery
2025;41(3):231-239
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical effect of local injection of triamcinolone acetonide acetate combined with ultra-pulsed CO 2 fractional laser in the treatment of hypertrophic scars in children. Methods:A randomized controlled study method was used. According to the inclusion and exclusion criteria, the subjects were selected from children with hypertrophic scars admitted to the Children’s Hospital Affiliated to Shandong University from January 2022 to September 2023, and were divided into control group and experimental group using random number table method. The control group was treated with ultra-pulsed CO 2 fractional laser. The experimental group was injected with triamcinolone acetonide acetate injection at multiple points into the scar (the ratio of triamcinolone acetonide acetate injection to 2% lidocoin hydrochloride injection was 1∶1), with a distance between the points as 1 cm, and the injection dose was about 0.1 to 0.2 ml/cm 2 according to the degree of scar protrusion. The maximum dose each time was ≤40 mg. CO 2 fractional laser treatment was performed after 10 minutes of cold compress with ice bag. Scars in both groups were treated 3 times, with an interval of 2 to 3 months. Before the treatment and 6 months after the last treatment, the Vancouver scar scale (VSS) was performed on both groups of scars score, the total score was 0 - 15. The higher the score, the more serious the scar hyperplasia was. Six months after the last treatment, the scar treatment effects of the two groups were comprehensively evaluated and divided into 3 levels: markedly effective, effective and ineffective. The total effective rate =(markedly effective + effective) number of cases/total number of cases ×100%. Patient satisfaction was investigated 6 months after the last treatment and divided into 5 levels: very satisfied, satisfied, average, dissatisfied, and very dissatisfied. Satisfaction rate =(very satisfied + satisfied) number of cases/total number of cases ×100%. The occurrence of adverse reactions was recorded throughout the treatment process. Analysis was performed using SPSS 19.0 software. Measurement data were expressed as Mean±SD, inter-group comparisons were performed using independent samples t-test, intra-group comparisons were performed using paired t-test, counting data were expressed as examples and percentages, and comparisons between the two groups were performed using χ2 test. P<0.05 indicated that the difference was statistically significant. Results:A total of 82 children with hypertrophic scars were included, 33 males and 49 females, aged 1 to 15 years old, with an area of 5 to 45 cm 2. The pathogenic factors were trauma, burns, and surgery. The course of disease was 2 to 30 months. Among them, 41 patients in the control group, 16 males and 25 females; the age was (5.8±1.6) years; 41 patients in the experimental group, 17 males and 24 females, the age was (5.6±1.5) years. There were no significant differences in age, gender, scar area, pathogenic factors and course of disease between the two groups ( P>0.05). There was no significant difference in VSS scores between the experimental group and the control group before the treatment [(9.42±1.35) points vs. (9.06±1.57) points, P>0.05]. Six months after the last treatment, there was a significant difference in VSS scores between the experimental group and the control group [(4.12±0.56) points vs. (5.50±0.75) points, P<0.01]. The VSS scores of children in both groups were significantly lower than those before the treatment ( P<0.01). Six months after the last treatment, the comprehensive evaluation result showed that the total effective rate in the experimental group was higher than that in the control group [92.7%(38/41) vs. 75.6%(31/41), P<0.05]. Six months after the last treatment, the patient satisfaction survey showed that the satisfaction rate in the experimental group was higher than that in the control group [87.8%(36/41) vs. 58.5%(24/41), P<0.01]. The main adverse reactions during treatment included edema erythema, skin ruptures, skin atrophy, and vigorous hair growth. There was no significant difference in the incidence of adverse reactions between the experimental group and the control group [12.2%(5/41) vs. 7.3%(3/41), P>0.05]. Conclusion:Local injection of triamcinolone acetonide acetate combined with ultra-pulsed CO 2 fractional laser is more effective in treating children’s hypertrophic scars. It can significantly improve the appearance of scars, reduce clinical symptoms, with fewer adverse reactions, and high patient satisfaction.
