Palombo Marco, Fasciani L., Bruno A., delli Santi G., Pagliarini T., Schirosi M., Moroni S., Palombo P.

1. Burn Center and Plastic Surgery Department- S. Eugenio Hospital - Rome
Chief: Prof. P. Palombo
M. Palombo - S. Moroni – A.Bruno – L.Fasciani
G. delli Santi- F De Vita- T Anniboletti- P. Palombo
Burn scars
?Represent an entity on its
own
Traditionally
considered as
hypertrophic
scars
Due to their
tendency to
overcome the
limits of the lesion
and not to regress
by themselves
Keloids (clinical
behavior)
Al-Attar Ali et al. Keloid Pathogenesis and Treatment. Plastic
& Reconstructive Surgery. January 2006 – Vol. 117 - Issue 1 -
pp 286-300

2. NEW PROTOCOL
GOALS
Evolution of the scar from a functional and aesthetic point of view depending on
the method used ( lipofilling alone, lipofilling and non ablative fractional laser
Er:Glass Lux1540 nm, lipofilling and Fractional Ablative CO2 );
Evaluation of the optimal time in which to work in order to obtain the most
satisfactory aesthetic and functional result
THREE PHASES
I PHASE: TIME 0
Subjective and objective tests
Scar of at least 300 cm2 divided in three areas of about 100 cm2:
1.Lipofilling;
2.Lipofilling + Non ablative Er:Glass Fractional Laser Lux1540TM;
3.Lipofilling + Ablative CO2 Fractional Laser
Biopsies of the three areas pre treatment
After 30-45 days….II phase
II PHASE:
1.Observation
2.Second treatment Non Ablative Lux 1540 Fractional Laser;
3.Second treatment Ablative Fractional CO2 Laser
After 30-45 days …
III PHASE:
1.Observation
2.third treatment Non Ablative Fractional Laser ;
3.third treatment Ablative Fractional Laser
After 3-4 months….
EVALUATION:
1.Final Subjective and objective test
2. New Biopsy of the three regions
Eventual new cycle of lipofilling and laser

3. Hematoxylin-
Eosin Pre-
Treatment
Chaotic organization of the basal layer of epidermis
Small number of spinous layer cells, arranged in a chaotic way
Collagen fibers arranged in an anarchic way, fragmented and in low density
Small number of blood vessels
After lipofilling + Non
Ablative Fractional
Laser Lux1540TM
Higher Collagen density
Increased number of blood vesselsFirmer skin, more cellularity
Increase number of spinous layer cells
Presence of cell polarity
Collagen fibers arranged in parallel
mode
After lipofilling + Non
Ablative Fractional
Laser Lux1540TM

4. After lipofilling +
Ablative Fractional Laser
CO2
More compact connective tissue
Epidermis is not very celluleted
After lipofilling
More homogeneous connective tissue, but not thick
Increased blood vessel number
CONCLUSIONS
We conducted a retrospective study on 854
patients treated for burn scars, from 2010,
with laser alone
854 patients
736 treated with
fractional non
ablative laser
118 treated with
fractional
ablative laser
NO LIPOFILLING

5. Average number of sessions required to switch
from a subjective test of 30 to 110, with Non
Ablative Fractional Laser without lipofilling
9,4 12 months
Average number of sessions required to switch
from a subjective test of 30 to 110, with Fractional
Ablative Laser without lipofilling
8,9 13 months
Average number of sessions required to switch
from a subjective test of 30 to 110, with lipofilling +
Non Ablative and Ablative Fractional Lasers
3 4 months
We have shown a significant reduction of time required for functional and
aesthetic improvement of the treated areas. The areas subjected to lipofilling
alone have a functional and aesthetic improvement, anyway. The combined
use of laser and lipofilling allows a further improvement, histologically
documented