7. Needle-free jet Injector-assisted triamcinolone treatment of keloids and hypertrophic scars is effective and well tolerated in children. 188 DISCUSSION In this retrospective cohort study, we evaluated the effectiveness, tolerability, and treatment satisfaction of needle-free EPI-assisted intralesional TCA injections in children with HTS and keloids. We found a significant reduction of 28.9% and 23.8% in the POSASobserver and POSAS-patient scores, respectively. Importantly, EPI resulted in significantly lower procedure-related pain scores compared with CN [3 (IQR: 3–4) vs 7 (IQR: 6–8), respectively (p = 0.027)]. This difference in scores markedly surpasses the minimal clinical important difference threshold of 1 point.18 Furthermore, all children preferred needlefree EPI treatment over CN. Electronic pneumatic jet injector-assisted intralesional treatment offers a standardized, accurate, and reproducible treatment with the possibility to repetitively deliver volumes up to 0.1 mL of therapeutic drugs to the skin.19 In our experience, EPI-assisted treatments are also less time consuming than CN-assisted treatments. This is especially important to take into account when aiming to provide non-traumatic care in children with multiple keloids and HTS requiring frequent and repetitive treatment. Although our findings are promising, there are also some potential drawbacks of EPIassisted TCA treatment that need to be considered. First, 2 out of 11 children reported that they experienced the noise of the EPI as mildly disturbing. However, it was noted that these children were able to manage the discomfort by using an iPad and headphones to distract themselves. Therefore, it is recommended to prepare children for the noise that the EPI generates, to reduce anxiety associated with the treatment. Additionally, to further improve non-traumatic care, it is important to proactively involve children in their disease, treatment, and prognosis.20 Another drawback may lie in the relatively high costs of the EPI device and disposables needed for every treatment. However, we previously treated these severely affected children with multiple keloids or HTS with conventional needles under general anesthesia. Therefore, it is worth noting that although the costs of an EPI device are
RkJQdWJsaXNoZXIy MTk4NDMw