Application of punch excision in the treatment of severe burn scars.

Abstract

This study aims to identify the therapeutic outcomes of punch excision in severe burn patients with extensive, excessive and long-lasting growth scars. A retrospective comparative clinical observational study was conducted on patients with burn hypertrophic scars who were treated at the Department of Burn and Skin Wound Repair, First Hospital of Jilin University, between October 2022 and October 2024. A total of 49 patients with severe burn scars were included. Of these, 20 received combined treatment with ablative fractional carbon dioxide laser (AFCL) and punch excision (PE), while 29 were treated with AFCL alone. The AFCL+PE group showed faster and more significant improvements in scar height, pliability, and paresthesias. At 1 week post-treatment, the University of North Carolina 4P Scar Scale (UNC4P) pliability score decreased from 2.7 ± 0.5-2.2 ± 0.6, and the paresthesias score improved from 2.5 ± 0.7-1.9 ± 0.9. The Vancouver Scar Scale (VSS) pliability score dropped from 4.1 ± 0.8-3.4 ± 0.9, and the height score improved from 3.0 ± 0.0-2.1 ± 0.6. Significant improvements in scar sensation were noted, with the Semmes-Weinstein monofilament test decreasing from 32.9 ± 27.2 g pre-treatment to 15.0 ± 10.3 g at 1 week, further improving to 9.5 ± 7.7 g at 1 month and 8.4 ± 7.6 g at 3 months. All 20 patients tolerated the AFCL+PE treatment well, with no complications. The average healing time for PE was 11.7 ± 2.2 days. Postoperative adverse effects included pigmentation (n = 5), which appeared 7 days post-treatment, and mild itching (n = 1). PE is a safe and effective method for scar management, with excellent suitability for hypertrophic burn scars. It can achieve significant rates of scar volume reduction, rapidly and extensively improve scar thickness, hardness, and scar sensation. As an emerging treatment, punch excision offers a distinct therapeutic mechanism and indications compared to existing methods. It holds the potential to become an integral part of current multi-modal scar management approaches. In the future, scar thickness and hardness may no longer be the primary concerns for patients with scars.