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Introduction: Burn scars can be extensive and require a number of features to present improvements. We developed a treatment protocol for extensive hypertrophic scars involving microneedling, application of platelet-rich fibrin, injections of botulinum toxin type A and triancinolone and Intensed Pulsed Light(IPL). Combined therapies seem to lead to faster and more effective results. A case-control study would be needed to define the efficacy of each separate therapy, but patient satisfaction with the procedures association encouraged us to develop a protocol for faster and more effective outcomes. Microneedling has multiple advantages such as cost effectiveness, availability of triacinolone drug delivery and platelet-rich fibrin and stimulation of neo collagenesis. Its association with platelet-rich fibrin allows a restructuring of the dermis in addition to promoting early epithelization of the lesions. Botulinum toxin acts on the expression of TGF beta 1 and reduces the formation of myofibroblasts in addition to reducing tension on the edges of the scars. Finally, the Intensed Pulsed Light reduces the excess of neovascularization that causes excessive hyperemia of the scar. We therefore believe that combination therapies are an excellent form of treatment for extensive burn scars

Objective: To define a treatment protocol for extensive burn scars using combination therapies.

Methods: Patients underwent treatment every 4 weeks under sedation in the Surgical Center to perform the microneedle procedure where we used 3.0mm rollers, and 30 ml of blood were collected for centrifugation at 1800 rpm for 2 min to obtain platelet-rich fibrin. Fibrin was injected and applied to the skin after microagglutination for drug delivery. Botulinum toxin type A injections were performed on the edges of the scar 2 to 4 units not exceeding 20 U per session. In the 15-day postoperative period, the patient received a Pulsed Intense Light session of 10 ms 16 J / cm2 followed by drug delivery with triamcinolone 40 mg / ml, also with monthly intervals. A total of 10 treatments were totaled: 5 treatments in the surgical center and 5 treatments in the LIP and triamcinolone sessions.

Results: The 5 patients submitted to this protocol presented rapid evolution within the Vancouver scale of scars. Even in anterior chest injuries and upper limbs where there was a probability of repairing surgeries we do not need to undergo surgical treatment. Patients were followed up for 2 years with a significant reduction in the Vancouver scale score without resection of scars or flanges.

Conclusion: Combination therapies seem to be a pathway for the faster and more effective treatment of extensive burn scars. The accomplishment of 5 alternate sessions totaling 10 treatments, has already promoted in less than 12 months a great improvement in the final appearance of the scars confirmed by the application of the Vancouver scale.

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