Before overseas travel came to a standstill due to COVID-19, Sydney ENT & facial plastic surgeon Dr Alan Evans visited the Burns Unit at Shriners Hospital for Children in Galveston, Texas to further advance his understanding and management of hypertrophic and keloid scar treatments.
The Shriners Hospital for Children (Galveston) is a 30-bed non-profit paediatric burn hospital, research and teaching centre located on the campus of the University of Texas Medical Branch in Galveston, Texas, USA. Part of a 22-hospital system, it is one of the three Shriner’s Hospitals that specialise exclusively in burn care and consists of an intensive care unit with 15 acute beds and a reconstruction and plastic surgery unit with 15 reconstruction beds along with three operating rooms.
The hospital is verified as a burn centre by the American Burn Association and accredited by the Joint Commission on Accreditation of Healthcare Organizations. In 2012, the hospital joined the University of Texas Medical Centre as its 50th member institution.
Dr Alan Evans visited the centre in April 2018, with the specific intention of gaining expert guidance and knowledge from Prof Norbury and his staff in order to optimise his own management of hypertrophic and keloid scars as well as reducing contractures related to these scars. His clinics in Sydney operate both Lumenis Ultrapulse Fractionated ScaarFX lasers and Lumenis M22 IPL platforms necessary to augment the management of scarring.
Prof Norbury and his team treated 5 patients under general anaesthesia during the visit. Some of these patients had already undergone 3 or more treatments at approximately 6-12 monthly intervals for extensive scarring following intensive acute medical and surgical treatment for large surface area burns.
Patients were treated from Texas as well as Mexico and as far abroad as Nicaragua.
Patients treated for cosmetic purposes were self funded (personal or through their private insurances) whereas those who had functional disability were funded by the Shriners Hospital charitable fund, including those flying in from abroad.
Patients treated for cosmetic purposes were self funded (personal or through their private insurances) whereas those who had functional disability were funded by the Shriners Hospital charitable fund, including those flying in from abroad.
Prof Norbury stated that almost all patients undergoing treatment were very excited and appreciative of their treatments as their results were so satisfying. Healing was quick, with minimal pain and most were treated as day surgery patients, discharged with their postoperative regime to return to their state of residence the same or the following day.
The 2 most important advances that Dr Evans learnt were:
- The timing and indications of surgical care and ScaarFX deep fractionated laser treatments to optimise patient outcomes for hypertrophic scarring. Interestingly, Prof Norbury uses Lumenis Ultrapulse ScaarFX exclusively for hypertrophic scarring as he does not believe that other forms of fractionated lasers are as effective. Other forms of ablative and non-ablative lasers may be useful for atrophic scars, stria and stretch marks.
- The role of non-ablative lasers in the management of acute injuries and burns. Prof Norbury utilises the Lumenis M22 Platform for this purpose but Intense Pulsed Light (IPL), Pulse Dye and KTP lasers may be effective.
Dr Alan Evans has years of experience in the management of scars and has a well-trained team with a structured approach in the management of problematical postoperative, traumatic and miscellaneous scars. Modalities of treatment used in his clinics include Lumenis Ultrapulse CO2 ScaarFX laser, Lumenis M22 IPL, and Cutera Excel V+ 532nm (KTP) and 1064nm (frequency doubled) lasers.
For any further information regarding the management and laser treatments of problematical skin scars, contact Dr Evans and his team at Miranda, Sydney (info@dralanevans.com.au) or at Refine Cosmetic Clinic, Bondi Junction, Sydney (info@refineclinic.com).
