RELEASe Q Chile: primer programa de rehabilitación de cicatrices de quemaduras con láser CO2 ablativo fraccionado en paciente gran quemado en el Sistema de Salud Pública de Chile.

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Title:	RELEASe Q Chile: primer programa de rehabilitación de cicatrices de quemaduras con láser CO2 ablativo fraccionado en paciente gran quemado en el Sistema de Salud Pública de Chile.
Alternate Title:	RELEASe Q Chile: first burn scar rehabilitation program with ablative fractional CO2 laser in severely burned patient in the Chilean Public Health System.
Authors:	SOTO DIEZ, Carolina¹ carola.sotodiez@gmail.com, MONTERO PEÑALOZA, Cristina², RIVERA RIVERA, Carolina³, TRONCOSO OLCHEVSKAIA, Ekaterina¹, DÍAZ FLORES, Gabriel¹, VALDÉS RUBILAR, Consuelo¹, GONZÁLEZ MANZANO, Diego⁴
Source:	Cirugía Plástica Ibero-Latinoamericana. ene-mar2025, Vol. 51 Issue 1, p75-85. 11p.
Subjects:	HYPERTROPHIC scars, MINIMALLY invasive procedures, JOINTS (Anatomy), BURN patients, BURN care units
Abstract (English):	Background and objective. Burn injuries are common worldwide and pose significant challenges due to their prolonged recovery, need for specialized care, and the prevalence of aesthetic and functional sequelae. In Chile, the management of acute adult major burns is guaranteed by the National GES Law, surgical management is technically standardized, with a mortality rate close to 10%. Regarding the sequelae of major adult burns, we do not have statistics on the prevalence and associated morbidity, nor were there guaranteed access to surgery for sequelae until the date of this study. With the goal of improving the functional prognosis of our patients without resorting to surgery, we incorporated fractional ablative CO2 laser combined with topical corticosteroid therapy into the existing noninvasive multimodal management (pharmacotherapy, compression suit, splints, and motor physical therapy) as a minimally invasive procedure, performed on an outpatient basis. We present our model using an outpatient care model in the Chilean Public Health Service. Methods. A prospective study was conducted in severely burned patients at the National Burn Reference Center (NRC) Hospital de Urgencia Asistencia Publica (HUAP), Santiago, Chile, between 2019-2020, who required laser treatment for scars. Inclusion criteria included time since the accident a minimum of 6 months (2 months in face, hands and joints), and a treatment area of no more than 5% TBSA per session. Case documentation was performed with photographs, scar evaluation using the POSAS patient and observer survey, and symptom assessment using the 5D itch & pain scale at baseline and during each session. Under topical anesthesia, the fractional ablative CO2 laser session was performed according to established parameters, and laser-assisted triamcinolone was administered. Results. In the follow-up of 16 patients/33 scars, a significant decrease in the POSAS scores was observed between the observer and the patient over the 7 sessions, with a statistically signi- ficant decrease between sessions 1-4, with a p-value of <0.05. No post-laser complications were reported. During this experience, the Spanish translation of the 5D itch & pain scale was also validated, which also showed a significant decrease in symptoms. Conclusions. In our experience, in adult major burn patients, fractional ablative CO2 laser therapy, as part of a multimodal rehabilitation program scheduled in sessions (3 to 6 sessions), achieved significant improvement in hypertrophic scars, mild linear contractures, and relief of associated symptoms, with good tolerance to the procedure, very low associated morbidity, and no down time. Our study was conducted in patients with more than 6 months post-injury history, shifting the start time to half of the existing publications. Considering these results, we recommend early intervention, always based on multimodal strategies, highlighting the long-term benefits of avoiding disabling sequelae or complex surgical resolution with higher costs. We believe that this early and even prophylactic approach, could be a global model for treating hypertrophic scars, especially in developing countries where prevention must be strengthened. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Introducción y objetivo. Las quemaduras son comunes en todo el mundo y plantean importantes desafíos debido a su recuperación prolongada, necesidad de atención especializada y prevalencia de secuelas estético-funcionales de distinta severidad. En Chile, el manejo del gran quemado adulto en etapa aguda está asegurado por la Ley Nacional GES y técnicamente estandarizado el manejo médico-quirúrgico, con una mortalidad cercana al 10%. En relación con las secuelas en grandes quemados adultos, no contamos con estadística de prevalencia y morbilidad asociada, ni garantías de acceso a cirugía de secuelas hasta la fecha del presente estudio. Con el objetivo de mejorar el pronóstico funcional de nuestros pacientes sin recurrir a cirugías, incorporamos al manejo multimodal no invasivo existente (farmacoterapia, traje compresivo, férulas y kinesiterapia motora), el láser CO2 ablativo fraccionado asociado a corticoterapia tópica, como procediendo mínimamente invasivo ambulatorio. Presentamos nuestro modelo de atención ambulatoria en el Servicio Público de Salud en Chile. Material y método. Estudio prospectivo en grandes quemados manejados en Centro de Referencia Nacional (CRN) de Hospital de Urgencia y Asistencia Publica (HUAP) de Santiago, Chile, entre 2019-2020, que requirieron tratamiento láser para cicatrices. Criterio de inclusión: tiempo de evolución desde el accidente, mínimo 6 meses (2 meses en cara, manos, articulaciones), área a tratar menor de 5% SCT por sesión. Documentamos los casos con fotografías, evaluación de cicatriz con encuesta POSAS paciente y observador y evaluación de síntomas con escala 5D itch & pain basal y en cada sesión. La sesión de láser CO2 ablativo fraccionado se realizó bajo anestesia tópica según parámetros fijados y administración de triamcinolona asistida por láser. Resultados. En el seguimiento a 16 pacientes / 33 cicatrices, observamos disminución significativa en los valores de la escala POSAS observador y paciente a lo largo de las 7 sesiones realizadas, con disminución estadísticamente significativa entre las sesiones 1-4 con valores de p <0.05. No hubo complicaciones postláser. Durante la experiencia validamos la traducción al español de la escala 5D itch & pain, que también mostró disminución significativa de los síntomas. Conclusiones. En nuestra experiencia, la terapia con láser CO2 ablativo fraccionado como parte de un programa multimodal de rehabilitación de secuelas en grandes quemados, programada en sesiones (3 a 6 sesiones), logró mejoría significativa de las cicatrices hipertróficas, contracturas lineales leves y alivio de los síntomas asociados, con buena tolerancia, muy baja morbilidad y sin reposo añadido. Nuestro estudio, en pacientes con más de 6 meses de evolución del accidente, desplaza el tiempo de inicio a la mitad de las publicaciones existentes. En vista de los resultados, recomendamos intervención temprana, siempre basada en estrategias multimodales, con los bene- ficios a largo plazo de evitar secuelas invalidantes o de resolución quirúrgica compleja con costos mayores. Creemos que este enfoque de manejo precoz y hasta profiláctico podría ser un modelo global para tratar cicatrices hipertróficas, particularmente en países en vías de desarrollo donde debemos potenciar la prevención. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Background and objective. Burn injuries are common worldwide and pose significant challenges due to their prolonged recovery, need for specialized care, and the prevalence of aesthetic and functional sequelae. In Chile, the management of acute adult major burns is guaranteed by the National GES Law, surgical management is technically standardized, with a mortality rate close to 10%. Regarding the sequelae of major adult burns, we do not have statistics on the prevalence and associated morbidity, nor were there guaranteed access to surgery for sequelae until the date of this study. With the goal of improving the functional prognosis of our patients without resorting to surgery, we incorporated fractional ablative CO2 laser combined with topical corticosteroid therapy into the existing noninvasive multimodal management (pharmacotherapy, compression suit, splints, and motor physical therapy) as a minimally invasive procedure, performed on an outpatient basis. We present our model using an outpatient care model in the Chilean Public Health Service. Methods. A prospective study was conducted in severely burned patients at the National Burn Reference Center (NRC) Hospital de Urgencia Asistencia Publica (HUAP), Santiago, Chile, between 2019-2020, who required laser treatment for scars. Inclusion criteria included time since the accident a minimum of 6 months (2 months in face, hands and joints), and a treatment area of no more than 5% TBSA per session. Case documentation was performed with photographs, scar evaluation using the POSAS patient and observer survey, and symptom assessment using the 5D itch & pain scale at baseline and during each session. Under topical anesthesia, the fractional ablative CO2 laser session was performed according to established parameters, and laser-assisted triamcinolone was administered. Results. In the follow-up of 16 patients/33 scars, a significant decrease in the POSAS scores was observed between the observer and the patient over the 7 sessions, with a statistically signi- ficant decrease between sessions 1-4, with a p-value of <0.05. No post-laser complications were reported. During this experience, the Spanish translation of the 5D itch & pain scale was also validated, which also showed a significant decrease in symptoms. Conclusions. In our experience, in adult major burn patients, fractional ablative CO2 laser therapy, as part of a multimodal rehabilitation program scheduled in sessions (3 to 6 sessions), achieved significant improvement in hypertrophic scars, mild linear contractures, and relief of associated symptoms, with good tolerance to the procedure, very low associated morbidity, and no down time. Our study was conducted in patients with more than 6 months post-injury history, shifting the start time to half of the existing publications. Considering these results, we recommend early intervention, always based on multimodal strategies, highlighting the long-term benefits of avoiding disabling sequelae or complex surgical resolution with higher costs. We believe that this early and even prophylactic approach, could be a global model for treating hypertrophic scars, especially in developing countries where prevention must be strengthened. [ABSTRACT FROM AUTHOR]
ISSN:	03767892
DOI:	10.4321/S0376-78922025000100011