Early use of CO2 lasers and silicone gel on surgical scars: Prospective study

Evaluating the combination and comparison of ablative fractional lasers (CO2, Erbium-YAG) with pulsed dye laser (PDL) for treating hypertrophic scars: a systematic review

The aim of this study is to compare pulsed dye laser (PDL) and ablative fractional lasers (CO2, Erbium-YAG) in the treatment of hypertrophic scars in a systematic review. Databases including Web of Science, Science Direct, Google Scholar and PubMed were searched for clinical trials up to December 1, 2022; focusing on the role of ablative fractional lasers and pulsed dye lasers in treating hypertrophic scars, using comprehensive keywords and search syntaxes. Key data extracted included type of scars, the assessment indexes, treatment modalities, side effects and the final conclusion of each article. We found no significant difference between the PDL and the ablative fractional laser in the treatment of hypertrophic scars, and both showed significant improvement. The average number of treatment sessions in the group receiving ablative fractional laser was 3.43 sessions, in the group receiving PDL, 3.68 sessions, and in the group receiving the combination of the two lasers, 1.5 sessions. Ablative fractional laser was 57.5% effective in VSS scoring and 40.4% effective in POSAS scoring, while PDL laser was 49.4% effective in VSS scoring and 35.5% effective in POSAS scoring, also the combination of both methods may lead to better results and higher efficacy with no severe adverse reactions noted. More high-quality trials are needed to fully confirm the effectiveness of laser therapy. Ablative fractional laser and PDL are both effective in treating hypertrophic scars and there was no significant difference between them. However, studies investigating the combination of these two lasers have reported greater effectiveness than each method alone.

Fractional CO2 Laser to Treat Surgical Scars: A System Review and Meta-Analysis on Optimal Timing

BACKGROUND

Surgical scars with textural changes can be disfiguring and uncomfortable for patients. Various laser therapies have shown promise in softening and flattening these scars. Therefore, the authors conducted a systematic review and meta-analysis on the efficacy of fractional CO2 laser in treating surgical scars.

OBJECTIVE

This study aims to present evidence from controlled trials investigating the efficacy of ablative carbon dioxide fractional laser in treating surgical scars.

MATERIALS AND METHODS

A literature search of Medline (via PubMed), Ovid, Web of Science, and Embase for relevant trials was conducted before March 2024. After assessing for inclusion, data extraction was performed using Population, Intervention, Comparison, Outcomes and Study criteria (PICOS). Quality, validity, and risk of bias were assessed using the RevMan5.3 risk of bias assessment tool.

RESULTS

A total of 14 controlled trials involving 492 participants or postsurgical scars were included in the system review and meta-analysis. Both in RCT and non-RCT settings, fractional CO2 laser therapy exhibited the same efficacious outcomes, with MD values of -0.63 (95% CI: -1.15 to -0.12; I2 = 70%; p = 0.02) and - 1.86 (95% CI: -2.65 to -1.07; I2 = 85%; p < 0.001), respectively. Moreover, furthermore analysis illustrated that initiating FRACTIONAL CO2 LASER treatment sessions at or within 1 month after surgery significantly reduced postoperative scars compared to control groups and groups on treatments initiated more than 3 months after surgery (MD: -1.66; 95% CI: -2.31 to -1.01; I2 = 89%; p < 0.001 and MD: -1.93; 95% CI: -2.24 to -1.62; I2 = 48%; p < 0.001). However, fractional CO2 laser treatment administered over 3 months after surgery did not significantly improve postoperative scars (MD: -0.17; 95% CI: -0.56 to 0.21; I2 = 37%; p = 0.37).

CONCLUSION

The systematic review and meta-analysis provide robust support for the efficacy of fractional CO2 laser in treating surgical scars, particularly when administered at or within 1 month after surgery. One treatment session within 1 month after surgery also can produce significant results, but most clinical trials support 2-3 treatment sessions or more.

Effect of Laser and Energy-based Device Therapies to Minimize Surgical Scar Formation: A Systematic Review and Network Meta-analysis

Utilization of lasers and energy-based devices for surgical scar minimization has been substantially evaluated in placebo-controlled trials. The aim of this study was to compare reported measures of efficacy of lasers and energy-based devices in clinical trials in preventing surgical scar formation in a systematic review and network meta-analyses. Five electronic databases, PubMed, Scopus, Embase, ClinicalTrials.gov, and the Cochrane Library, were searched to retrieve relevant articles. The search was limited to randomized controlled trials that reported on clinical outcomes of surgical scars with treatment initiation no later than 6 months after surgery and a follow-up period of at least 3 months. A total of 18 randomized controlled trials involving 482 participants and 671 postsurgical wounds were included in the network meta-analyses. The results showed that the most efficacious treatments were achieved using low-level laser therapy) (weighted mean difference -3.78; 95% confidence interval (95% CI) -6.32, -1.24) and pulsed dye laser (weighted mean difference -2.46; 95% CI -4.53, -0.38). Nevertheless, low-level laser therapy and pulsed dye laser demonstrated comparable outcomes in surgical scar minimization (weighted mean difference -1.32, 95% CI -3.53, 0.89). The findings of this network meta-analyses suggest that low-level laser therapy and pulsed dye laser are both effective treatments for minimization of scar formation following primary closure of surgical wounds with comparable treatment outcomes.

Safety and Effectiveness of Laser or Intense Pulsed Light Treatment for Early Surgical Scar: A Systematic Review and Meta-analysis

OBJECTIVE

We aimed to investigate the safety and efficacy of laser or intense pulsed light therapy for early treatment of surgical scar.

METHODS

A literature search was conducted for relevant prospective, randomized controlled trials published in PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang Database, and VTTMS between January 2006 and January 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to extract literature data. The risk of bias was assessed by RevMan. Safety was assessed based on the presence of serious adverse reactions (blisters, infections, burns above the second degree), while effectiveness was assessed using the Vancouver Score Scale.

RESULTS

1512 related articles were preliminarily retrieved, including 1211 English articles and 301 Chinese articles. According to the inclusion criteria and exclusion criteria, 12 articles were selected for this analysis. In total, 475 patients were included (laser group, 238; control group, 236). All studies confirmed that the laser group was superior to the control group. In the subgroup analysis of 7 articles, the standardized mean difference was 1.99 (P = 0.0001).

CONCLUSIONS

This meta-analysis demonstrates that laser or intense pulsed light therapy is a safe and effective approach for early surgical scar treatment, resulting in improved scar appearance and minimal adverse reactions.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Efficacy of Fractional Carbon Dioxide Laser in Surgical Scars Treatment: A system Review and Meta-analysis

BACKGROUND

Surgical scars seriously affect a patient's quality of life, and they have a strong impact on individuals. Many studies have reported the results of using fractional carbon dioxide (CO₂) laser to treat surgical scars and have generally found it to be effective.

OBJECTIVES

We conducted a meta-analysis with the objective of evaluating and proving the efficacy of fractional CO₂ laser therapy for surgical scars.

METHODS

We performed a search of databases including PubMed, Web of Science, Embase and the Cochrane Library. The outcomes of the meta-analysis were overall scores on the Vancouver Scar Scale (VSS) and its four dimensions (pigmentation, vascularity, pliability and height). Statistical analysis was performed using RevMan 5.4 software.

RESULTS

A total of ten studies were included in this meta-analysis, including six randomized controlled trials (RCTs) and four nonrandomized controlled trials (N-RCTs). In the meta-analysis of RCTs and N-RCTs, similar results were obtained, and fractional CO₂ laser irradiation significantly decreased VSS scores (P < 0.00001). In addition, fractional CO₂ laser irradiation also had a significant effect on scores on the pigmentation (P = 0.08), vascularity (P = 0.001), flexibility (P = 0.005) and height (P = 0.008) dimensions. Except for mild pain during treatment and temporary erythema after treatment, most patients had no obvious adverse reactions.

CONCLUSION

Our study found that fractional CO₂ laser exhibits excellent efficacy and safety in terms of surgical scar treatment. Thus, we hope it becomes more widely available to patients with surgical scars.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Efficacy of Early Application of 1540 nm Non-ablative Fractional Laser and Silicones to Improve Post-epicanthoplasty Scars

The combination of epicanthoplasty and blepharoplasty is a popular choice in Asians to acquire a pair of charming big eyes. However, the obvious scarring in the medial canthal area may result in unsatisfactory aesthetic outcomes. Recently, various laser treatments have been used to deal with scars had achieved detectable improvement, but only a few studies investigating the efficacy of lasers used in post-epicanthoplasty scarring were developed. A total of 70 participants who underwent Z-epicanthoplasty were enrolled in this prospective clinical trial and were randomly assigned to the groups of 1540nm non-ablative fractional laser (NAFL) combined with silicones treatment and silicones alone treatment. The NAFL-exposure in the treated group was additionally applied to the medial canthal area on day 21 postoperatively, compared with the participants in the control group who had only been treated with the daily usage of silicone sheets for 12 hours and silicone gels twice for 5 months after scab had fallen from the skin. Scar evolution was performed by patient and observer scar assessment Scales (POSAS) and visual analogue scale (VAS) for 21 days, and 6 months postoperatively. 64 participants have completed the entire follow-up process. The scar recovery was statistically detected in treated group compared with the control group at 6-month postoperatively assessed by POSAS, especially in pliability of scars. Furthermore, the VAS evaluations showed superior satisfaction in treated group. The early treatment of NAFL combined with silicones has improved scar formation in medial canthal region after epicantholplasties efficiently.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Early Laser for Burn Scars (ELABS): protocol for a multi-centre randomised, controlled trial of both the effectiveness and cost-effectiveness of the treatment of hypertrophic burn scars with Pulsed Dye Laser and standard care compared to standard care alone [version 1; peer review: 2 approved]

This paper outlines the protocol for a study that is being carried out at multiple centres across the UK in the next three years. It is a Research for Patient Benefit (RfPB) study funded by the National Institute for Healthcare Research (NIHR). The aim is to assess the effectiveness of treating hypertrophic burns scars with pulsed dye laser (PDL) at an early stage of scar formation. The objective is to improve Quality of Life for the patient by improving both the appearance and quality of burn scarring, as well as reducing its psychological impact. This is a parallel-arm randomised, controlled trial to compare PDL and standard care against standard care alone. The difference is measured between baseline and six-month follow-up. Recruits are within three months of healing from a burn injury; with wounds showing a defined potential for hypertrophic scarring. A total of 120 patients are recruited in a multi-centre study; with randomisation in a 1:1 allocation to each arm. The treatment arm receives 3 PDL treatments at six-week intervals in addition to standard care, whereas the control arm receives standard care alone. The primary outcome is the patient-rated part of the Patient and Observer Scar Scale (POSAS). Psychological and psycho-social impact is evaluated using the CARe burn scale (UWE, Bristol) and Quality Adjusted Life Years (QALY) is determined using the Short-Form Health Survey (SF-12). The study evaluates both the cost-effectiveness through an economic analysis and the patient-reported experience of the treatment by phone interviews.

Mitigation of Postsurgical Scars Using Lasers: A Review

Background:

Most postsurgical scars are considered esthetically and functionally acceptable. Currently, there is no definite consensus treatment for postsurgical scarring. The purpose of this review is to shed some light on the value of scar mitigation and the efficacy of different lasers employed on postsurgical wounds.

Methods:

A systematic literature review and computational analysis were conducted to identify relevant clinical articles that pertained to the use of lasers for mitigating postsurgical scars. Articles included the National Institutes of Health–National Center for Biotechnology Information–PubMed search and sources cited from relevant studies after 1995. Trials that attributed pre- and posttreatment scores of scar severity based on a verified scar evaluation scale (eg, Patient and Observer Scar Assessment Scale, Vancouver Scar Scale, Global Assessment Scale) were chosen. Clinical assessments varied for each study. To adequately assess the efficacy of the modalities, the final scaled scar appearance scores were realigned and normalized to a standard scale for unbiased comparison.

Results:

After filtering through a total of 124 studies, 14 relevant studies were isolated and thus included in the review. Studied lasers were as follows: Pulsed dye laser (PDL), carbon dioxide, diode, potassium titanyl phosphate (KTP), and erbium glass (Er-Glass) lasers.

Conclusion:

Treatment with lasers in the postsurgical wound healing phase is safe, effective, and advised in mitigation of pathologic scar formation.

Efficacy of topical silicone gel in scar management: A systematic review and meta-analysis of randomised controlled trials

To assess the efficacy of topical silicone gel in the management of scars, we conducted this meta-analysis. The systematic search was performed on PubMed, Web of Science and Embase, and six randomised controlled trials with a total of 375 patients were involved. The outcome data of Vancouver Scar Scale were extracted from the studies and their effect sizes were calculated using Review Manager 5.3. As a result, topical silicone gel significantly reduced pigmentation, height, and pliability scores postoperatively compared with placebos or no treatment (Pigmentation: standard mean difference [SMD] = -0.55 [-0.83 to -0.26], P = .0002; Height: SMD = -0.73 [-1.02 to -0.44], P < .00001; Pliability: SMD = -0.49 [-0.95 to -0.03], P = .04). Topical silicone gel and silicone gel sheet were comparably effective (P > .05). The performance of topical silicone gel and other non-silicone topical treatment was also similar (P > .05). In summary, topical silicone gel was effective in post-operative scar prevention.

Early laser intervention to reduce scar formation in wound healing by primary intention: A systematic review

BACKGROUND

Hypertrophic scars frequently follow primary closure of surgical wounds. Laser application at or shortly after suture may be associated with a reduction in scar formation, although the respective study results vary.

AIM

The objective was to evaluate the efficacy of early laser applied within the first six months after surgery to reduce scar formation compared to no treatment.

METHODS

We searched the databases MEDLINE and CENTRAL on 14 January 2019 and included randomized controlled trials (RCTs). Primary outcome was the Vancouver Scar Scale (VSS). Measure of treatment effect was the mean difference from baseline.

RESULTS

Seventeen relevant RCTs randomized 430 scars (413 assessed) and compared laser versus no treatment. Fourteen studies applied a split-scar and three applied a simple parallel design. Three studies with a split-scar design favored the laser group on VSS, and one study had indifferent findings. Considerable heterogeneity I² = 86% did not justify a meta-analysis. The remaining 13 studies did not report appropriate data.

CONCLUSION

On the basis of the currently available evidence, we are uncertain whether early laser can reduce scar formation, and more high-quality research is needed for a definitive conclusion.

[Secondary surgical and medical treatment of scars]

The authors, through their experience, take stock of current secondary management of scars whether they are pathological (hypertrophic, cheloid) or dystrophic (enlarged, hypo- or hyper-pigmented, adherent) by presenting surgical or medical solutions.

Approach to the Post Mohs Patient

This article discusses the often unique patient presentations and management challenges of the post Mohs resection surgical patient. This includes social, economic, and health issues. Anesthesia considerations and pre- and postoperative care are also discussed in this article.

Preventive effect of polynucleotide on post-thyroidectomy scars: A randomized, double-blinded, controlled trial

BACKGROUND AND OBJECTIVE

Polynucleotide (PN) provides a structural scaffold to induce anti-inflammatory and enhanced wound healing properties, and this study aimed to assess the efficacy of PN administration in the prevention of post-operative scars after conventional open total thyroidectomy.

STUDY DESIGN MATERIALS AND METHODS

Forty-two patients with thyroid carcinoma who underwent total thyroidectomy were randomly assigned to the study (PN administration) or control (normal saline) group. All patients underwent a single session of combined ablative and non-ablative fractional laser. The Vancouver Scar Scale (VSS), global photographic assessment, and objective scar were assessed using three-dimensional (3D) camera at baseline and at 2, 4, 8, and 16 weeks after surgery.

RESULTS

Patients who underwent PN injection demonstrated better surgical scar quality outcome. Participants in the PN administration group had lower VSS scores than the control group (2.09 ± 0.47 vs. 4.01 ± 0.55, respectively) and lower scar height (0.23 ± 0.03 vs. 0.29 ± 0.03, respectively), as measured using 3D imaging. Furthermore, in the PN injected group, the degree of erythema, and pigmentation of the scar were less prominent. No patient developed hypertrophic scar or keloids on the surgical site. No other adverse events, including post-inflammatory hyperpigmentation, scarring, or infection, were observed.

CONCLUSION

Adjuvant administration of PN along with conventional fractional laser treatment led to more favorable effect in wound healing and post-operative scar prevention after thyroidectomy. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.