MULTIMODAL RECONSTRUCTIVE AND PLASTIC SURGERY METHODS FOR POST-BURN SCAR TREATMENT

Hypertrophic scars and keloids represent pathological outcomes of impaired skin regeneration, defined by excessive fibroblast proliferation, upregulated collagen synthesis, and sustained inflammatory response. Given that these conditions predominantly arise in the setting of deep thermal burns, trauma, and surgical procedures, they constitute a problem of considerable clinical significance in burn and reconstructive surgery. Objective. To evaluate the efficacy of reconstructive plastic surgery techniques in the management of hypertrophic and keloid scars. Materials and Methods. A total of 84 patients with hypertrophic and keloid scars were enrolled. The mean age was 37.8 ± 12.6 years (range 18–62 years); 60.8% of participants were male and 39.2% were female. The minimum interval from scar formation to treatment initiation was 1 year, and the mean interval between scar formation and presentation for specialized care was 14.5 ± 6.3 years. Prior to referral, the predominant management approach had consisted of watchful waiting and conservative home-based treatment. As a consequence, a substantial proportion of patients presented at an advanced stage with scar contractures involving the face, chin, and periorbital region. All procedures were conducted in accordance with the Declaration of Helsinki of the World Medical Association (2000 revision). Statistical analysis was performed using SPSS 26.0. Data are expressed as the arithmetic mean (M) ± standard deviation (SD) or standard error of the mean (m). Between-group differences were assessed using Student's t-test and the Mann–Whitney U-test; a p-value of < 0.05 was considered statistically significant. The study was conducted in accordance with the research plan of Bukhara State Medical Institute, entitled "Early Detection, Diagnosis, and Novel Treatment and Prevention Strategies for Pathological Factors Affecting Population Health in the Bukhara Region During the Post-COVID-19 Pandemic Period (2022–2026)." Results. The study demonstrated that combined surgical and laser treatment of hypertrophic and keloid scars resulted in a statistically significant reduction in scar thickness by a mean of 27–28% (p < 0.05), a decrease in vascularisation and erythema index by 22–33%, and an improvement in scar tissue elasticity. Objective assessment methods, including ultrasonography, PeriCam, and photoindexing, together with subjective evaluation using the Vancouver Scar Scale (VSS), revealed substantial reductions in the vascular component, scar height, and scar density, yielding an overall VSS score reduction of 42% for hypertrophic scars and 37.9% for keloid scars. Pigmentation changes were moderate; however, marked improvement was observed in the keloid scar group. Adverse effects were transient, no recurrences or serious complications were recorded during the 6–12-month follow-up period, and patient satisfaction exceeded 85%. Conclusions. The 10,600 nm wavelength laser was shown to substantially reduce the inflammatory response and tissue perfusion, thereby preventing pathological scar formation. Laser therapy resulted in a reduction of scar thickness by approximately 30% and a significant improvement in scar tissue elasticity (p < 0.05), demonstrating both tissue softening and the clinical efficacy of the method.

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