Low Level Laser Therapy--a conservative approach to the burn scar?

Burn scars are known to be difficult to treat because of their tendency to worsen with hypertrophy and contracture. Various experimental and clinical efforts have been made to alleviate their effects but the problem has not been solved. Since patients keep asking for Low Level Laser Therapy (LLLT) and believe in its effectiveness on burn scars, and since former studies show contradictory results of the influence of LLLT on wound healing, this prospective study was designed to objectify the effects of LLLT on burn scars. Nineteen patients with 19 burn scars were treated with a 400 mW 670 nm Softlaser twice a week over 8 weeks. In each patient a control area was defined, that was not irradiated. Parameters assessed were the Vancouver Scar Scale (VSS) for macroscopic evaluation and the Visual Analogue Scale (VAS) for pruritus and pain. Photographical and clinical assessments were recorded in all the patients. Seventeen out of 19 scars exhibited an improvement after treatment. The average rating on the VSS decreased from 7.10+/-2.13 to 4.68+/-2.05 points in the treated areas, whereas the VSS in the control areas decreased from 6.10+/-2.86 to 5.88+/-2.72. A correlation between scar duration and improvement through LLLT could be found. No negative effects of LLLT were reported. The present study shows that the 400 mW 670 nm softlaser has a positive, yet sometimes limited effect on burn scars concerning macroscopic appearance, pruritus, and pain.

Interdigitating fasciocutaneous gluteal V-Y advancement flaps for reconstruction of sacral defects.

The authors describe a modification of the classic gluteal bilateral V-Y advancement flap for sacral defect closure. After initial debridement, the V-Y design is marked on both sides of the defect. The incision is carried down to the fascia of the underlying gluteus maximus muscle. The upper and lower arms of the flaps are elevated and advanced on the gluteal muscle toward the midline, interdigitating each opposing arm. The overall result is a zigzag, broken midline suture. This procedure was carried out in 14 patients with sacral pressure sores and in 1 patient with a chronic pilonidal sinus. All flaps survived without major problems. There were no recurrences during the 6 to 16 months of follow-up. The interdigitating fasciocutaneous V-Y gluteal flap design is effective in breaking the midline vertical scar and preserving the gluteus maximus muscle.