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IMCAS Asia 2019
Programa

FOCO EN S031

Complication & management of post surgical scars

Sala: Room 3B
Fecha: viernes 5 julio 2019 de 16:30 a 17:30
Formato: SESIÓN ENFOCADA > presentación que cubre una temática principal del congreso
Objetivos: 1. Compare and discuss treatment methods for surgical scars 2. Explore combined treatment options for scars 3. Apply scar management strategies based on patient morphology

Moderadores

Dr Maria Agnes ESPINOZA THAEBTHARM

Cirujano Cosmético

Filipinas

Dr Wichai HONGCHARU

Dermatólogo

Tailandia

Las presentaciones

Horas	Oradores	Título de la presentación	Resumen	Número
16:30	Dr Michael BENZAQUEN	Combined treatment of hypertrophic scars with intralesional injection of corticosteroids and laser-assisted delivery	Ver	84745
16:42	Dr Nariaki MIYATA	Full ablation vs fractional ablation for scar	Ver	86283
16:54	Dr Maria Agnes ESPINOZA THAEBTHARM	Microfocused ultrasound in the treatment of hypertrophic scars	Ver	86517
17:06	Dr Daniel CATALDO	Scars surgical treatment	Ver	84669
17:18		Questions and answers		88273

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Ultrasonido

Láseres

Dr Michael BENZAQUEN

Dermatólogo

Suiza

Otro(s) autor(es) :

Combined treatment of hypertrophic scars with intralesional injection of corticosteroids and laser-assisted delivery

Objectives: To describe a combined treatment of hypertrophic and keloid scars with intra-lesional injection of corticosteroids and laser-assisted corticosteroid delivery

Introduction: Hypertrophic and keloid scars result from an abnormal hyperproliferation of dermal fibroblasts with increased depositions of collagen in the wound. Injected or topical corticosteroids are one of the best treatment options despite a limited effectiveness and a high recurrence rate.
Ablative fractional lasers (AFL) can create vertical channels to enhance topical drug delivery deep into the dermis. In this way, laser-assisted corticosteroid delivery (LACD) can be an alternative or a complementary treatment to intra-lesional injections of steroids (ILIS).

Materials / method: The concept of LACD has been first developed in 2013 by Waibel et al. on 15 subjects undergoing 10600 nm CO2 AFL followed by application of triamcinolone acetonide, with an overall improvement after 3 to 5 sessions. This idea was later developed with a longer protocol (median of nine sessions) combining 2940 nm erbium AFL followed by betamethasone cream b.i.d., with poor results on ear and neck keloids and 22% of recurrence. Park et al. compared ILIS and topical application of corticosteroids after erbium AFL on the same keloid, with no significant difference between the two techniques.

Results: We developed a new protocol combining 10600 nm CO2 AFL (10 Watts, density 5%, index 8) followed by the application of triamcinolone acetonide 40 mg/mL, delivered in the deep dermis through the vertical channels. The originality of our protocol was to combine LACD to ILIS of a minimal amount of triamcinolone acetonide 40 mg/mL on the thickest parts of the scar. This protocol was performed on 15 hypertrophic and keloid scars with resolution of symptoms and complete flattening of the scars after only 1 to 3 sessions at 6-weeks interval, and no recurrence after 6-months follow-up.

Conclusion: This association allows faster improvement of scars than LACD used alone, with significant results after only 2-3 sessions. Limiting the amount of injected steroids leads to reduce the risk of fat atrophy and telangiectasias, reduce the pain, and improve the uniformity of steroids into the scar. Finally, the collagen remodeling role of AFL is an additional explanation for the better results of this association. Combining LACD and ILIS is an interesting protocol, not reported so far. Further prospective studies are needed to confirm the results and the settings of our protocol.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Dr Nariaki MIYATA

Cirujano Plástico

Japón

Otro(s) autor(es) :

Full ablation vs fractional ablation for scar

Objectives: About scar treatment, ablative laser treatment is one of effective non-surgical procedures. There are two approaches. One is fully ablative and another is fractional ablative procedure. Which is better to get good result? It’s very difficult to answer. We cannot erase scar perfectly. Therefore, we should compare the detail of each procedure.

Introduction: Surgical treatments of scars are sometimes very difficult to get satisfactory results. Scar revision operation using the scalpel is the standard treatment of them, however the result shows that scar is still visible. Furthermore, there is no way to erase the multiple scars widespread.
In such scar management, fractional carbon dioxide laser became the most promising new method for safe and nonsurgical improvement. Fractional carbon dioxide laser resurfacing produces tissue contraction, collagen synthesis, and dermal remodeling. However fully ablation procedure is still also one of the effectiv

Materials / method: Carbon dioxide laser devices with or without fractional handpiece are used for scar treatments. The reasons of scar formation are ; accident, surgery, or self-harming .

Results: Patients’ satisfaction level is very high, and we found measurable change by clinical photos.

Conclusion: Fractional carbon dioxide laser resurfacing is considered as the one of option for scar managements. With proper technique, results can be achieved with a low risk. However, depending on the reason of scar, we should perform more aggressive procedure for patients’ satisfaction. The goal of the treatment is different. Some patients wish to improve scar appearance slightly, and other wish to replace scars to other scars like burn scar to conceal their past.
We should care the patients’ mental condition.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Dr Maria Agnes ESPINOZA THAEBTHARM

Cirujano Cosmético

Filipinas

Otro(s) autor(es) : Mark Gerald Serrano, M.D.

Microfocused ultrasound in the treatment of hypertrophic scars

Objectives: To determine the clinical efficacy, safety and tolerability of micro-focused ultrasound in the treatment of hypertrophic scars

Introduction: Hypertrophic scars (HTS) are visible and elevated scars that do not spread into surrounding tissues. Up to date, the optimal treatment method for HTS has not been established. Micro-focused Ultrasound (MFU) is a non-invasive, non-ionic technology that produces and delivers highly localized acoustic energy to its target tissues causing coagulative necrosis. It is on the basis of this principle that it has been used for the treatment of benign and malignant tumors.

Materials / method: An observational analytic cohort study was conducted to determine the efficacy, safety and tolerability of micro-focused ultrasound in the treatment of hypertrophic scars. The study was conducted at the Department of Dermatology, Jose R. Reyes Memorial Medical Centre, Manila, Philippines. MFU was delivered monthly for 3 doses. Outcome measures were scar thickness as determined by ultrasound, clinical evaluation and histopathology. Safety and tolerability were evaluated as well.

Results: There was a significant decrease in scar thickness before and after treatment, both clinically and by measurement on ultrasound. Histologically, there was a decrease in scar thickness, normalization of epidermis, and more organized collagen bundles in the upper dermis. Adverse events included erythema, burning and blistering. Overall tolerability and acceptability of MFU treatment using visual analog scale was 1.6/10 (0- very satisfied).

Conclusion: Micro-focused ultrasound is clinically efficacious, safe and tolerable in the treatment of hypertrophic scar. The MFU was able to decrease the size of HTS with minimal discomfort and adverse effects.

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

Dr Daniel CATALDO

Cirujano Plástico

Italia

Otro(s) autor(es) :

Scars surgical treatment

Objectives: How to treat scars, with different technics .
Tacking care the position and the size of the defects, to chose the right technic the results are excellents

Introduction: A- Sliding flaps
B-Z Plastic
C-Sliding / own cicatrization

Materials / method: Two hundred twenty four patients operated at Saint Louis hospital in Paris and Columbus Medical Center in Milan .
Patients after suffering trauma, reconstructive surgery, or just aesthetic purpose.

Results: When different technics are right employed, depend on the position and size of the defect to reconstruct, the results are often excellents.

Conclusion: Scars is a frequent demand in plastic surgery .
There are three approach we often used .
The indication must heed the position and side of the defect
When the indication is appropriate the results are excellents

Declaraciones

¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No

¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No

¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
No

¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No

Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.

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IMCAS Asia 2019 Programa

FOCO EN S031

Complication & management of post surgical scars

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IMCAS Asia 2019
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