Ablative fractional CO2 laser surgery improving sleep quality, pain and pruritus in adult hypertrophic scar patients: a prospective cohort study
- Burns & Trauma Vol. 9, Issue 1, (2021)
- 作者机构：
1. Department of Plastic Surgery
2. Shanghai Jiao Tong University School of Medicine
3. Department of Burn Surgery, the First affiliated Hospital to Naval Medical University
4. Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong University
5. Department of Plastic Surgery, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University,Wenzhou
6. Shanghai Institute of Laser Technology
- 作者简介：
- 基金信息：
DOI：10.1093/burnst/tkab023
CLC：Published：2021，
Published Online：27 July 2021，
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Kaiyang Lv, Huazhen Liu, Haiting Xu, Caixia Wang, Shihui Zhu, Xiaozhen Lou, Pengfei Luo, Shichu Xiao, Zhaofan Xia, Ablative fractional CO2 laser surgery improving sleep quality, pain and pruritus in adult hypertrophic scar patients: a prospective cohort study, Burns & Trauma, Volume 9, 2021, tkab023, https://doi.org/10.1093/burnst/tkab023
Kaiyang Lv, Huazhen Liu, Haiting Xu, Caixia Wang, Shihui Zhu, Xiaozhen Lou, Pengfei Luo, Shichu Xiao, Zhaofan Xia, Ablative fractional CO2 laser surgery improving sleep quality, pain and pruritus in adult hypertrophic scar patients: a prospective cohort study, Burns & Trauma, Volume 9, 2021, tkab023, https://doi.org/10.1093/burnst/tkab023 DOI：
摘要
Abstract
BackgroundPoor sleep quality is associated with a decrease in quality of life in patients with major burn scars
combined with pruritus and pain. Few interventions have been reported to improve the sleep quality of patients with scars. In the current prospective cohort study
we investigated the efficacy of CO2-ablative fractional laser (AFL) surgery vs conventional surgery in post-burn patients with hypertrophic scars with sleep quality as the primary study outcome.MethodsIn total 68 consecutive patients undergoing scar surgical treatment were recruited
including a CO2-AFL surgery cohort (n = 35) and a conventional surgery cohort (n = 33). A subgroup from the AFL cohort was selected. Sleep quality
pain and pruritus were evaluated. Multiple linear regression analyses were performed to reveal the effect of CO2-AFL surgery.ResultsThe CO2-AFL surgery cohort had significantly lower Pittsburgh sleep quality index (PSQI) global scores than the conventional surgery cohort after the last surgical treatment. In the subgroup of patients receiving hardware sleep monitoring
CO2-AFL markedly increased deep sleep time
deep sleep efficiency and reduced initial sleep latency. Compared to the conventional surgery cohort
the CO2-AFL cohort presented significantly lower pain and pruritus scores. Correlation analysis showed pain and pruritus were significantly associated with PSQI scores
and there were also significant correlations between pain and pruritus scores. Multiple linear regression analysis showed that surgery method was negatively linearly correlated with visual analog scale (VAS) pain score
brief pain inventory (BPI) total
VAS pruritus score
5-D itch scale total
four-item itch questionnaire (FIIQ) total and PSQI total.ConclusionsCO2-AFL surgery significantly improved sleep quality and reduced pain and pruritus of hypertrophic scar patients. The alleviation of sleep disorder was associated with improvement of deep sleep quality including deep sleep time and deep sleep deficiency.Trial registrationThe Chinese Clinical Trial Registry (ChiCTR200035268) approved retrospectively registration on 5 Aug 2020.
关键词
Keywords
Burn scarAblative CO2 fractional laserCardiopulmonary couplingSleep qualityPainPruritus
references
1.Tredget EE, Shupp JW, Schneider JC. Scar management following burn injury. J Burn Care Res. 2017;38:146–7.
2.Berman B, Maderal A, Raphael B. Keloids and hypertrophic scars: pathophysiology, classification, and treatment. Dermatol Surg. 2017;43:3–18.
3.Lv K, Xia Z. Chinese expert consensus on clinical prevention and treatment of scar. Burns & trauma. 2018;6:27.
4.Gangemi EN, Gregori D, Berchialla P, Zingarelli E, Cairo M, Bollero D, et al. Epidemiology and risk factors for pathologic scarring after burn wounds. Arch Facial Plast S. 2008;10:93–102.
5.Hultman CS, Edkins RE, Lee CN, Calvert CT, Cairns BA. Shine on: review of laser- and light-based therapies for the treatment of burn scars. Dermatol Res Pract. 2012;6:243651.
6.Boeve SA, Aaron LA, Martin-Herz SP, Peterson A, Cain V, Heimbach DM, et al. Sleep disturbance after burn injury. J Burn Care Rehabil. 2002;23:32–8.
7.Kwak IS, Choi YH, Jang YC, Lee YK. Immunohistochemical analysis of neuropeptides (protein gene product 9.5, substance P and calcitonin gene-related peptide) in hypertrophic burn scar with pain and itching. Burns. 2014;40:1661–7.
8.Forbes-Duchart L, Cooper J, Nedelec B, Ross L, Quanbury A. Burn therapists' opinion on the application and essential characteristics of a burn scar outcome measure. J Burn Care Res. 2009;30:792–800.
9.Pilcher JJ, Ginter DR, Sadowsky B. Sleep quality versus sleep quantity: relationships between sleep and measures of health, well-being and sleepiness in college students. J Psychosom Res. 1997;42:583–96.
10.Berman B, Viera MH, Amini S, Huo R, Jones IS. Prevention and management of hypertrophic scars and keloids after burns in children. J Craniofac Surg. 2008;19:989–1006.
11.Vinci V, Klinger M, Klinger FM, Forcellini D, Borbon G, Caviggioli F. Treatment outcomes for keloid scar management in the pediatric burn population. Burns. 2013;39:1321–32.
12.Steinstraesser L, Flak E, Witte B, Ring A, Tilkorn D, Hauser J, et al. Pressure garment therapy alone and in combination with silicone for the prevention of hypertrophic scarring: randomized controlled trial with intraindividual comparison. Plast Reconstr Surg. 2011;128:306–13.
13.Wiseman J, Simons M, Kimble R, Ware R, McPhail S, Tyack Z. Effectiveness of topical silicone gel and pressure garment therapy for burn scar prevention and management in children: study protocol for a randomised controlled trial. Trials. 2017;18:72.
14.Klinger M, Marazzi M, Vigo D, Torre M. Fat injection for cases of severe burn outcomes: a new perspective of scar remodeling and reduction. Aesthetic Plastic Surg. 2008;32:465–9.
15.Anderson RR, Donelan MB, Hivnor C, Greeson E, Ross EV, Shumaker PR, et al. Laser treatment of traumatic scars with an emphasis on ablative fractional laser resurfacing: consensus report. JAMA dermatology. 2014;150:187–93.
16.Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: a new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med. 2004;34:426–38.
17.Helbig D, Bodendorf MO, Grunewald S, Kendler M, Simon JC, Paasch U. Immunohistochemical investigation of wound healing in response to fractional photothermolysis. J Biomed Opt. 2009;14:064044.
18.Prignano F, Campolmi P, Bonan P, Ricceri F, Cannarozzo G, Troiano M, et al. Fractional CO2 laser: a novel therapeutic device upon photobiomodulation of tissue remodeling and cytokine pathway of tissue repair. Dermatologic Ther. 2009;22:8–15.
19.Ozog DM, Liu A, Chaffins ML, Ormsby AH, Fincher EF, Chipps LK, et al. Evaluation of clinical results, histological architecture, and collagen expression following treatment of mature burn scars with a fractional carbon dioxide laser. JAMA dermatology. 2013;149:50–7.
20.Omi T, Numano K. The role of the CO2 laser and fractional CO2 laser in dermatology. Laser Therapy. 2014;23:49–60.
21.Oh BH, Hwang YJ, Lee YW, Choe YB, Ahn KJ. Skin characteristics after fractional photothermolysis. Ann Dermatol. 2011;23:448–54.
22.Hurliman E, Zelickson B, Kenkel J. In-vivo histological analysis of a fractional CO2 laser system intended for treatment of soft tissue. J Drugs Dermatol. 2017;16:1085–90.
23.Xiao Y, Sun Y, Zhu B, Wang K, Liang P, Liu W, et al. Risk factors for hypertrophic burn scar pain, pruritus, and paresthesia development. Wound Repair Regen. 2018;26:172–81.
24.Karmisholt KE, Taudorf EH, Wulff CB, Wenande E, Philipsen PA, Haedersdal M. Fractional CO2 laser treatment of caesarean section scars-a randomized controlled split-scar trial with long term follow-up assessment. Laser Surg Med. 2017;49:189–97.
25.Buysse DJ, Reynolds CF, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh sleep quality index: a new instrument for psychiatric practice and research. Psychiat Res. 1989;28:193–213.
26.Langley GB, Sheppeard H. The visual analogue scale: its use in pain measurement. Rheumatol Int. 1985;5:145–8.
27.Poquet N, Lin C. The brief pain inventory (BPI). J Physiother. 2016;62:52.
28.Furue M, Ebata T, Ikoma A, Takeuchi S, Kataoka Y, Takamori K, et al. Verbalizing extremes of the visual analogue scale for pruritus: a consensus statement. Acta Derm-Venereol. 2013;93:214–5.
29.Elman S, Hynan LS, Gabriel V, Mayo MJ. The 5-D itch scale: a new measure of pruritus. Brit J Dermatol. 2010;162:587–93.
30.Gunthert AR, Duclos K, Jahns BG, Krause E, Amann E, Limacher A, et al. Clinical scoring system for vulvar lichen sclerosus. Journal of Sexual Med. 2012;9:2342–50.
31.Yang AC, Yang CH, Hong CJ, Tsai S, Kuo C, Peng C, et al. Sleep state instabilities in major depressive disorder: detection and quantification with electrocardiogram-based cardiopulmonary coupling analysis. Psychophysiology. 2011;48:285–91.
32.Choi JH, Thomas RJ, Suh SY, Park IH, Kim TH, Lee SH, et al. Sleep quality change after upper airway surgery in obstructive sleep apnea: electrocardiogram-based cardiopulmonary coupling analysis. Laryngoscope. 2015;125:1737–42.
33.Thomas RJ, Mietus JE, Peng CK, Goldberger AL. An electrocardiogram-based technique to assess cardiopulmonary coupling during sleep. Sleep. 2005;28:1151–61.
34.Clayton JL, Edkins R, Cairns BA, Hultman CS. Incidence and management of adverse events after the use of laser therapies for the treatment of hypertrophic burn scars. Ann Plas Surg. 2013;70:500–5.
35.Gottschlich MM, Jenkins ME, Mayes T, Khoury J, Kramer M, Warden GD, et al. The 1994 clinical research award. A prospective clinical study of the polysomnographic stages of sleep after burn injury. J Burn Care Rehabil. 1994;15:486–92.
36.Bolton L. Evidence corner: taking itch seriously. Wounds. 2018;30:27–38.
37.Lee AF, Ryan CM, Schneider JC, Kazis LE, Li NC, Mary R, et al. Quantifying risk factors for long-term sleep problems after burn injury in young adults. J Burn Care Res. 2017;38:510–20.
38.Qu L, Liu A, Zhou L, He C, Grossman PH, Moy RL, et al. Clinical and molecular effects on mature burn scars after treatment with a fractional CO2 laser. Laser Surg Med. 2012;44:517–24.
39.Waibel JS, Wulkan AJ, Shumaker PR. Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery. Laser Surg Med. 2013;45:135–40.
40.Waibel JS, Wulkan AJ, Rudnick A, Daoud A. Treatment of hypertrophic scars using laser-assisted corticosteroid versus laser-assisted 5-fluorouracil delivery. Dermatol Surg. 2019;45:423–30.
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