Efficacy of combining erbium:YAG and fractional CO2 laser for the treatment of facial scarring

Background: Laser intervention is increasingly recognized as an effective approach to preventing scars, however, as lasers of different wavelengths reach different target tissues, an appropriate combination of laser treatment is required. Objectives: To evaluate the efficacy of combining erbium: yttrium aluminium garnet (Er:YAG) 2,940-nm laser and fractional carbon dioxide (CO2) 10,600-nm laser for the treatment of facial scarring. Materials & Methods: Medical records of 39 patients with facial scars were retrospectively reviewed. Treatments initiated within six months post-injury were defined as "early-intervention", whereas those initiated >six months post-injury were defined as "delayed-intervention". Patients' scores on the Vancouver Scar Scale (VSS) and Visual Analogue Scale (VAS) were collected and compared between different timepoints using the paired t-test. Improvement in pigmentation, height, vascularity and pliability was analysed between baseline and after final treatment. Results: Between March 2020 and March 2022, 39 patients underwent dual-laser therapy at our laser clinic. The average number of treatments was 4.69 1.54; 18 patients in the early-intervention and 21 patients in the delayedintervention group. Facial scars significantly improved after the first treatment in the delayed-intervention group (p < 0.001), however, there was no significant improvement until two sessions were completed in the early-intervention group (p < 0.001). In the delayed-intervention group, improvement in vascularity was insignificant (p = 0.083), however, improvement in height and flexibility was prominent (p < 0.001). In the early-intervention group, facial scars improved in all four dimensions of VSS (p < 0.05), with improvement of vascularity being the most significant. Side effects were self-limited, and complications were not noted. Conclusion: The combination of Er:YAG and fractional CO2 laser is a safe and effective therapeutic modality for facial scarring.

Perioperative Management of Spinal Tuberculosis in Patients with End-Stage Renal Disease: A Preliminary Report on A Patient Series.

OBJECTIVE: To present a preliminary experience of perioperative management for patients with spinal tuberculosis (STB) and end-stage renal disease (ESRD) and discuss strategic factors that should be considered. METHODS: A retrospective study of 6 patients with STB and ESRD who underwent spine surgeries in our hospital from January 2010 to May 2017 was carried out. Medical records were reviewed for clinical manifestations, laboratory examinations, radiologic findings, perioperative management, clinical outcomes, and complications. RESULTS: Except for 1 patient who died of cardiac arrest 5 days after surgery, this case series was followed with a mean follow-up period of 17.0 months (range, 9-23). There were no patients reporting major side effects related to an adjusted antituberculosis chemotherapy regimen. Postoperatively, surgical incision healed primarily, whereas delirium and pneumonia were noted in 2 patients. At final follow-ups, solid bony fusion was achieved in 4 patients, whereas fusion was indefinite in the patient who underwent surgery at L3/4 level. Visual analogue scale score improved from preoperative 5.2 ± 0.37 to 2.6 ± 0.55 at the final follow-ups. CONCLUSIONS: Perioperative management of patients with STB and ESRD is a complicated issue, with multiple factors to be considered. Spinal surgery can achieve acceptable outcomes in these patients if meticulous management is performed.

Could Allograft Bones Combined with Poly-Ether-Ether-Ketone Cages or Titanium Mesh Cages be an Alternative Grafting Method in the Management of Cervical Spinal Tuberculosis?

OBJECTIVE: To investigate the effectiveness of allograft bones combined with poly-ether-ether-ketone (PEEK) cages or titanium mesh cages (TMCs) in the management of cervical spinal tuberculosis. METHODS: A total of 16 patients with cervical spinal tuberculosis who underwent anterior debridement, reconstruction with allograft bones combined with PEEK cages or TMCs, and anterior plate fixation between 2013 and 2016 were retrospectively studied. Neck pain, neurologic status, operating time, intraoperative blood loss, cervical spine alignment, bony fusion, and self-reported clinical outcomes were reviewed. RESULTS: Six patients underwent 1 level reconstruction using PEEK cages and 10 patients received TMCs reconstruction. Patients received a mean follow-up time of 45.9 ± 13.1 months. Neck pain was greatly relieved, as visual analog scale scores decreased from 4.6 ± 1.3 preoperatively to 0.7 ± 0.5 at the final follow-up (P < 0.05). Neurologic status was improved in all patients with neurologic deficits, with 9 patients improving by 1 grade and 1 patient by 2 grades. Kyphosis angle was corrected from 1.3 ± 12.0 degrees preoperatively to -5.4 ± 10.2 degrees postoperatively (P < 0.05) and remained at -3.6 ± 9.6 degrees at the final follow-up (P < 0.05). Bony fusion was achieved in all patients, with a mean time to the fusion of 3.8 ± 1.3 months. There was no implant failure or signs of cervical spinal tuberculosis recurrence. Excellent results, good results, and fair results were reported in 37.5%, 56.25%, and 6.25% of patients, respectively. CONCLUSIONS: Allograft bone combined with PEEK cages and TMCs could bring about favorable clinical results in patients with cervical spinal tuberculosis. This method could be an alternative to autologous bone grafting method in the management of certain cases.