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Innovative scar treatment

Innovative scar treatment

New technologies, remarkable results for scar treatment

The staff at Shriners Hospitals for Children — Boston is on the leading edge of burn care because of our pioneering efforts in modern scar treatment, which begins immediately after the wound heals. One of our most important treatment tools is the use of lasers to enhance healing. This improves both the appearance and symptoms of scars. Matthias B. Donelan, M.D., physician at Shriners Hospitals for Children — Boston, has worked for over 30 years on the latest innovations in scar treatment for his young patients. He and the team of plastic surgeons at the hospital are renowned for using state-of-the-art technologies to minimize scars – whether the scars were caused by new or old burns or injuries, or stem from congenital issues, such as port wine birthmarks.

A recent advancement in the treatment of scars is the use of lasers, an innovation that Shriners Hospitals for Children — Boston was one of the first to adopt. Dr. Donelan first used lasers to treat birthmarks, but has since found laser therapy to be extremely effective for burn scars.

The light energy of the pulsed dye laser (PDL) shrinks the abnormal excess of blood vessels that form red scars or birthmarks (particularly port wine stains) under the surface of the skin – resulting in a decreased appearance of redness.

This method of treatment was not widely considered for burn scars initially, since lasers use thermal energy to treat skin – in some ways similar to the thermal energy that creates burn injuries to begin with. The trick, says Dr. Donelan, is in the energy setting of the lasers. If set correctly, laser treatments will aid in the healing process.

A newer innovation, the fractional ablative laser (also known as the carbon dioxide or CO2 laser), allows plastic surgeons to target the thick, fibrous collagen of hypertrophic and contracted scars. This is achieved through the creation of thousands of tiny holes in the scar’s surface and substance while leaving adjacent areas untouched.

The fractional ablative laser can be used in two ways, both of them helping different characteristics of hypertrophic scars. Tiny, deep cores can be drilled into the scar which stimulates collagen remodeling. This softens, thins, and creates elasticity in the scar tissue. At different settings, tiny focal injuries to the epidermis and dermis of the scar can smooth the surface and correct abnormalities in pigmentation. Early results have demonstrated profound improvement in the quality and appearance of skin grafts and scars following burn injury.

Perhaps one of the best patient benefits of the innovative lasers treatments is the ease with which they are completed. Patients receive laser treatment for scarring on an outpatient basis – allowing treatment to be continuous without interfering with a child’s schoolwork or social life.

Preventing scar formation

Scars are a natural and essential part of the healing process. While they restore integrity to the skin they can cause symptoms and are often unsightly once a wound closes. Scars, including keloids, develop following burns, cuts and surgery, and as a result of diseases such as acne. After a wound closes, a scar is visibly noticeable because scar tissue, unlike natural skin tissue, does not regenerate all the components of normal skin and therefore has a different appearance.

When a child is severely burned, the epidermis and dermis of normal skin are destroyed. The wound closes by producing fibrous collagen which makes up a scar. Pressure garments help prevent the development of hypertrophic, or raised, scars and keep scar tissue soft by applying pressure to the wounded area. Since scar tissue is very responsive in the early stages of formation, it’s important to begin wearing pressure garments as soon as possible.

Using pressure to prevent scar formation can range from a full-cloth body suit to a pliable-plastic mask worn just over the face.

Wearing pressure garments

Proper fitting garments are critical to success, so each patient’s pressure garments will be measured individually. Garments that are too tight can cause numbness or tingling, or abrade the skin. Garments that are too large will not apply enough pressure to be effective.

Pressure garments may be worn from as little as a few months to as much as two or three years, depending on the severity of the burn and the area of the body that is affected. The garments are worn 23 hours a day, seven days a week, and are removed only for bathing and when they interfere with therapy. In most cases, it’s a good idea to have two sets of garments on hand so that a clean set is always available for wear.

When pressure garments are part of your child’s burn therapy, your doctor will give you specific and personalized instructions about how your child should wear them and how long they should do so.

Understanding hypertrophic scarring and keloid scars

Hypertrophic scars are disfiguring and can impair the quality of life of burn survivors. They frequently occur after burns, but can be very effectively treated with current surgery and technologies, including lasers. Unlike normal scars, keloids are abnormal overgrowths of scar tissue that spread to adjacent skin and resist treatment. It is not clear why some patients are at higher risk for keloid formation or why it is more prevalent among darker-skinned individuals.