7. Needle-free jet Injector-assisted triamcinolone treatment of keloids and hypertrophic scars is effective and well tolerated in children. 182 pain scores with CN (>VAS 4) OR had needle-phobia OR had a therapeutic history with suboptimal results using CN. A local standard operating procedure for EPI-assisted treatment in children was followed. Prior to the first full treatment, an optional test treatment was performed where intralesional TCA with respectively a CN (27 gauge) and EPI was administered in two similar HTS or keloid scars (±1 cm2) in a random order. Treatment-related pain scores (VAS: range 0–10) with both injection techniques were evaluated.18 Intralesional triamcinolone 10–40 mg/mL (Kenacort; Bristol Myers Squibb, New York, NY, USA) was administered using the Enerjet 2.0 device (Enerjet 2.0; Sinclair, Rehovot, Israel) on every subsequent visit, and repeated every 4–6 weeks. The TCA concentration used for the treatment was based on scar severity and the judgment of the treating physician. The need for subsequent treatments was discussed between the treating physician, child, and their parents every visit. An injection volume of 100 μL (device range: 50–130 μL) was administered in every squared centimeter of the scar, with a maximum treatment surface of 20 cm2 per session. A pressure setting of 2 Bar (device range: 2–6 Bar) was selected, and was increased by 10% until the clinical endpoint (papule or blanching) was observed (Electronic Supplementary Material [ESM]). A follow-up was scheduled 4–6 weeks after the last treatment for scoring of the final POSAS and GAIS scores. A standardized form was utilized to extract data from the electronic patient files. Data were analyzed using SPSS version 28 (IBM, Armonk, NY, USA) and were presented as medians with interquartile ranges (IQRs). Hereafter, ordinal data (POSAS, GAIS, and VAS) were analyzed using a Wilcoxon signed-rank test. P < 0.05 was considered as statistically significant.
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