A controlled study of the effectiveness of spot dermabrasion ('scarabrasion') on the appearance of surgical scars

A Split-Scar Study Investigating the Effectiveness of Early Intervention With Electroabrasion on Improving the Cosmetic Appearance of Postsurgical Scars

BACKGROUND

Electroabrasion, which uses an in-office electrosurgical device, is a method of surgical planning that ablates the skin to the papillary dermis. Several reports demonstrate that intraoperative ablative interventions with lasers or dermabrasion can modulate scar formation more effectively. This investigation uses electroabrasion intraoperatively to mitigate scar formation.

OBJECTIVE

To evaluate the effectiveness of intraoperative electroabrasion for scar revision.

MATERIALS AND METHODS

This was a prospective, randomized, observer-blinded, split-scar study with 24 linear scar segments resulting from primary closures in patients undergoing Mohs micrographic surgery. After placement of dermal sutures, half of the wound was randomly treated with electroabrasion. The other half was used as the control. Scar appearance was assessed by a blinded observer and by the patient using the Patient and Observer Scar Assessment Scale at 1 to 2 weeks, 1 month, and 3 months after surgery.

RESULTS

At the 3-month follow-up, both patient and observer variables measuring scar contour improved on the treated side, whereas erythema was worse. Overall, no difference was seen in total scores between the 2 sides.

CONCLUSION

Based on this pilot study, scars treated with electroabrasion revealed improved surface topography but worsened erythema. Future studies with more refined electrosurgical settings are needed for further evaluation.

Comparative Evaluation of Clinical Outcomes of Laser Skin Resurfacing Using an Ultra-Pulse Carbon Dioxide Laser and Manual Dermabrasion Using a Medium-Grit Drywall Sand Screen for Scar Revision in Adults: A Split-Scar Prospective Study

PURPOSE

The purpose was to evaluate the clinical outcomes of laser skin resurfacing using an ultra-pulse carbon dioxide (CO₂) laser and manual dermabrasion with a medium-grit drywall sand screen for scar revision in adults with Fitzpatrick skin type III to V.

MATERIALS AND METHODS

A total of 20 postsurgical and post-traumatic scars in individuals with Fitzpatrick skin type III to V were included in this study. Preoperative evaluation of the scars was performed by 3 blinded observers using the Manchester scar rating scale. Each scar to be treated was divided into 2 equal halves, and each half was randomly allotted to either ultra-pulse CO₂ laser resurfacing (group A) or manual dermabrasion (group B). Postoperative clinical evaluation was performed by the same observers using the Manchester scar rating scale at the end of the first month, third month, and sixth month.

RESULTS

This study showed that both methods were effective in improving the appearance of the postsurgical and post-traumatic scars. No significant difference was found between them (P = .978). Hyperpigmentation occurred in 4 scars in both the half treated with manual dermabrasion and the half treated with laser resurfacing; however, it had resolved by the end of the sixth month in all 4 scars.

CONCLUSIONS

CO₂ laser resurfacing and manual dermabrasion are equally efficacious and safe methods for scar resurfacing in adults with Fitzpatrick skin type III to V.

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.

Treating Scars of the Cheek Region

Scars of the cheek resulting from all causes can extol significant psychological toll. The cheek is the largest facial subunit and visually and aesthetically prominent making scars in this region difficult to ignore. An approach to scar management that targets specific characteristics of a scar using a combination of surgical and nonsurgical modalities can significantly improve the appearance of most scars. The ideal time to revise a scar should be based on the extent of scar maturation and presence or absence of any functional distortion.

Use of lasers in acute management of surgical and traumatic incisions on the face

This article is a clinically practical review structured around the specific applications of laser technologies used in acute management of soft tissue injuries in surgical incisions and trauma. Surgical and traumatic incisions and injuries provide the clinician with the unique opportunity to follow the progression and maturation of the wound healing response from a very early stage. There has been a recent interest in early cosmetic optimization of surgical and traumatic wounds on the face using optical technologies. Early clinical results for acute laser intervention starting immediately after suture removal or the first several weeks after repair have been very promising.

Acne vulgaris

Acne vulgaris is a common inflammatory skin condition that presents management difficulties to cosmetic surgeons. Acute management and treatment focuses on early diagnosis as well as treatment with topical agents, oral antibiotics, hormonal therapy,and nonablative chemical peel and laser applications. The treatment of postinflammatory scarring must be individualized to address potential macular dyschromia, cystic lesions,epithelial bridges, or deep pitted scars. A review of interventional options is presented to apply to the spectrum of acne scarring as well as a review of the literature to address objectively published reports on efficacy.

Post acne scarring: a review

Historically, post acne scarring has not been well treated. New techniques have been added and older ones modified to manage this hitherto refractory problem. The patient, his or her expectations and overall appearance as well as the morphology of each scar must be assessed and treatment designed accordingly. Upon reaching an understanding of what the pathology of the scar is and where it resides in the skin, the most pertinent treatment for that scar may be devised. Post acne scars are polymorphous and include superficial macules, dermal troughs, ice picks, multi-channelled fistulous tracts and subcutaneous atrophy. The wide variety of new methods includes the latest resurfacing tools such as CO(2) and erbium infrared lasers, dermasanding and possibly some future techniques such as non-ablative and radiofrequency resurfacing. Dermal and subcutaneous augmentation with autologous (including fat and blood transfer) and non-autologous tissue augmentation and the advent of tissue undermining has greatly improved the treatment of atrophic scars. Use of punch techniques for sharply marginated scars (such as ice picks) is necessary if this scar morphology is to be treated well. One should attempt to match each scar against an available treatment as far as possible. Many of these techniques may be performed in a single treatment session but repeat treatments are often necessary. The treatment of hypertrophic acne scarring remains difficult, but silastic sheeting, vascular laser and intralesional cytotoxics are interesting developments. Most often occurring extra-facially and in males, these distressing scars often require multiple treatments and modalities before adequate improvement is achieved.

Effectiveness of dermasanding (manual dermabrasion) on the appearance of surgical scars: a prospective, randomized, blinded study

BACKGROUND

Dermasanding using sterile sandpaper has been described as a simple treatment for scars but has not been evaluated in a prospective randomized fashion. It could provide a safe, simple, and cost-effective option for the treatment of scars.

OBJECTIVE

Our purpose was to assess the effectiveness of dermasanding on the appearance of surgical scars of the face.

METHODS

We evaluated 15 patients using a blinded, split-scar model. Each scar was divided into 2 equal portions, and half of the scar was treated according to randomized assignment. Scars were treated with dermasanding 6 to 8 weeks after operation. The treatment half was compared with the control half by blinded observers at 3 time points.

RESULTS

Improvement in the treated half of scars was seen in 80% of patients at 6 months (95% confidence interval, 60%-100%), and 47% had an excellent response. In 20% of patients the unsanded side was better.

CONCLUSIONS

Dermasanding is an effective procedure in the treatment of surgical scars.

585-nm pulsed dye laser in the treatment of surgical scars starting on the suture removal day

BACKGROUND

The optimal time frame to improve the quality and cosmetic appearance of scars by laser therapy has not been clearly elucidated by prior controlled clinical trials.

OBJECTIVE

To determine the efficacy of the 585-nm pulsed dye laser (PDL) in the treatment of surgical scars starting on the day of suture removal.

METHODS

Eleven patients (skin types I-IV) with 12 postoperative linear scars that were greater than 2 cm were treated three times on monthly intervals with the 585-nm PDL (450 micro s, 10-mm spot size, 3.5 J/cm2 with 10% overlap) on one scar half, whereas the other half received no treatment. Scars were later evaluated by a blinded examiner using the Vancouver Scar Scale (VSS) for pigmentation, vascularity, pliability, and height. Scars were then blindly examined for cosmetic appearance using a visual analog scale.

RESULTS

One month after the last treatment, final scar analysis by the blinded examiner revealed a significant difference between treated and untreated sites, with the treated halves scoring better in all scar parameters in the VSS and in cosmetic appearance. The treated halves demonstrated an overall average improvement in the VSS between the first treatment score and the final score of 54% versus 10% in the controls (P=0.0002). The cosmetic appearance score (0=worst; 10=best) at final assessment was significantly better for the treated scars, scoring 7.3 versus the averaged control score of 5.2 (P=0.016).

CONCLUSION

The 585-nm PDL is effective and safe in improving the quality and cosmetic appearance of surgical scars in skin types I-IV starting on the day of suture removal.

Evaluating the efficacy of using a short-pulsed erbium:YAG laser for intraoperative resurfacing of surgical wounds

BACKGROUND AND OBJECTIVE

There are many studies demonstrating the aesthetic benefits of resurfacing a wound 4-8 weeks following surgical closure. Several anecdotal reports have been published stating that resurfacing a wound at the time of closure is also of cosmetic benefit. Our study was designed to evaluate the effects of resurfacing wound edges at the time of surgical closure.

STUDY DESIGN/MATERIALS AND METHODS

Ten patients with skin types I-III undergoing reconstruction on the head or neck using a complex linear closure of at least 4 cm in length were enrolled in the study. Following the placement of subcutaneous sutures and an intradermal running suture, a split scar study was designed. Half of the wound was left as a control and half of the wound was resurfaced with a short pulsed Erbium:YAG laser. Both sides were treated with a hydrogel dressing. Follow-up evaluations were performed 1 week, 1 month, and 3 months post-operatively. The wound was evaluated for any adverse reactions. The degree of erythema, textural misalignment or tissue mismatch, and overall aesthetic appearance of both sides of the scar were evaluated and scored.

RESULTS

There were no incidents of infection, dehiscence, hematoma, necrosis, or reaction to the dressing during the study. There was a trend towards greater erythema in the resurfaced half of the scar at the 1 week and 1 month evaluation. There was a trend towards less tissue mismatch and better overall aesthetic appearance of the side of the scar that had been resurfaced. The differences however were not statistically significant.

CONCLUSION

Given the time and resources necessary to perform an intraoperative resurfacing procedure on the wound edges, it may be more reasonable to withhold resurfacing procedures for those few cases that may require it postoperatively (patients with a history of poor healing, highly sebaceous areas, etc.). When good operative technique is used, most surgical wounds on the head and neck heal very well with excellent aesthetic outcomes without any additional intervention.

Postacne scarring: a review of its pathophysiology and treatment

BACKGROUND

There has been a largely unheralded revolution in the number of techniques that can now be used in the treatment of atrophic postacne scarring. Atrophic scarring is the more common type of scarring encountered after acne.

OBJECTIVE

To illustrate the range of techniques useful in the therapy of postacne scarring, their relative advantages and disadvantages, and their place in treatment.

METHOD

A review of available techniques is used to illustrate the treatment of indented or atrophic acne scars.

RESULTS

The individual architecture of the indented scar must be assessed so that treatment may be designed to maximize its improvement. A variety of new methods now exist, including newer resurfacing tools such as infrared lasers, dermasanding, and others in their infancy such as nonablative resurfacing and radiofrequency methods. A true explosion in autologous and nonautologous tissue augmentation and the advent of tissue undermining and the use of punch replacement techniques has added more precision and efficacy to the treatment of these scars.

CONCLUSION

Atrophic postacne scars may be satisfactorily treated in many patients, but multiple methods are often required to ensure the best results.

Treatment of scars with a pulsed Er:YAG laser

BACKGROUND

Numerous revision procedures such as surgical excision, intralesional steroid injection, cryotherapy, dermabrasion, soft tissue augmentation, chemical peeling and laser therapy are available for the correction of various types of scars. Recently, Er:YAG laser resurfacing has proved to be a useful and safe means for several kinds of scars.

OBJECTIVE

The purpose of this study was to assess the efficacy and safety of pulsed Er:YAG laser scar resurfacing for the various types of scars induced by trauma, burns, or surgery.

METHODS

This study included 36 patients with various types of scars resulting from picking, scratching, knife injury, laceration, car accident, simple surgical excision, focal burn and focal inflammation. Twelve of these patients were treated for hypertrophic scars, 20 for depressed scars, and four for burn scars. The pulsed Er:YAG laser with a 2-mm handpiece at the setting of 500-1200 mJ/pulse at 3.5-9 W was used. Photographs were obtained at baseline and 2-week intervals postoperatively. The results of laser treatment were assessed by two independent physicians and the surgeon according to contour, skin texture and color.

RESULTS

In all, 9 of 12 hypertrophic scars, 17 of 20 depressed scars, and two of four burn scars were improved more than 50%. In one patient who had a depressed scar, minimal postinflammatory hyperpigmentation was observed 3 months after laser treatment. Mild erythema was sustained 4 months after laser treatment in one patient with a depressed scar and in all patients with burn scars. No other side effects were observed.

CONCLUSION

A pulsed erbium:YAG laser is an effective and safe treatment modality for scar revision.

Management of post-acne scarring. What are the options for treatment?

Post-acne scarring is a very distressing and difficult problem for physician and patient alike. Recently, newer techniques and modifications to older ones may make this hitherto refractory problem more manageable. Options for dealing with post-acne scarring are explored. The patient, his or her overall appearance and the morphology of each scar must be assessed and treatment designed accordingly. To adequately address the patient with scarring, a thorough knowledge of the pathophysiology and anatomy of the different types of scars should be sought. Once an understanding of what the pathology is and where it is occurring is attained, the most pertinent treatment for that scar may be devised. A variety of post-acne scars is produced including superficial macules, dermal troughs, ice picks, multi-channelled fistulous tracts and subcutaneous atrophy. The wide variety of new treatment methods for post-acne scarring includes newer resurfacing tools such as CO2 and erbium infrared lasers, dermasanding and possibly some future techniques such as non-ablative and radiofrequency resurfacing. Dermal and subcutaneous augmentation with autologous and nonautologous tissue augmentation and the advent of tissue undermining have greatly improved treatment of atrophic scars. Use of punch techniques for sharply marginated scars (such as ice picks) is necessary if this scar morphology is to be treated well. One should attempt to match each scar against an available treatment as far as possible. Many of these techniques may be performed in a single treatment session but repeat treatments are often necessary. The treatment of hypertrophic acne scarring remains difficult, but silastic sheeting, vascular laser, and intralesional cytotoxics are interesting developments. Most often occurring extra-facially and in males these distressing scars often require multiple treatments and modalities before adequate improvement is achieved.

Electrosurgical skin resurfacing: a new bipolar instrument

BACKGROUND

Numerous modalities may be used for skin resurfacing, including chemical peels, dermabrasion, and lasers. Each of these methods is associated with significant disadvantages.

OBJECTIVE

The purpose of these initial studies was to determine the efficacy and safety of a new electrosurgical resurfacing system. Depth of cutaneous injury was also evaluated.

METHODS

Postoperative scar resurfacing was performed on six patients in the initial feasibility study. Patients were evaluated with questionnaires, physician observations, and photographs. The histologic investigation evaluated depth of injury after resurfacing at various power settings and number of passes.

RESULTS

Appearance of postoperative scars in all 6 patients was improved by electrosurgical resurfacing. The overall injury, residual thermal damage plus ablation, for all power levels and passes was 114.1 micrometer (mean) with a standard deviation of 60.7 micrometer.

CONCLUSION

Electrosurgical resurfacing may become an effective and safe alternative to current resurfacing modalities.

Comparison of high-energy pulsed carbon dioxide laser resurfacing and dermabrasion in the revision of surgical scars

BACKGROUND

Both dermabrasion and high-energy pulsed carbon dioxide (CO2) laser resurfacing can improve the appearance of surgical scars. Although the results of these two procedures have been compared using historical data, a prospective evaluation has never been performed in humans.

OBJECTIVE

To prospectively compare the clinical effects of dermabrasion and high-energy pulsed CO2 laser resurfacing in the revision of surgical scars.

METHODS

Facial surgical scars in four patients were prospectively revised using a split scar model. One half of the scar was dermabraded and the other half was resurfaced with the high-energy pulsed CO2 laser. Comparisons of the two treatment modalities were performed through clinical assessment, photographic evaluation, and textural analysis of the scars.

RESULTS

The high-energy pulsed CO2 laser-resurfaced halves of the scar were bloodless with less postoperative crusting in comparison with the dermabraded halves. Reepithelialization time and degree and duration of postoperative erythema were similar for both treatment halves. Photographic evaluation and textural analysis showed comparable improvement in the clinical appearance and surface texture of the scars with both treatment modalities.

CONCLUSIONS

Both the high-energy pulsed CO2 laser and dermabrasion can achieve comparable clinical improvement in the revision of surgical scars. The high-energy pulsed CO2 laser offers the advantage of a bloodless field and a more precise method of tissue ablation. Postoperative erythema, however, is an expected finding with both treatment modalities.

Concurrent use of laser skin resurfacing and punch excision in the treatment of facial acne scarring

BACKGROUND

Laser skin resurfacing has added to the numerous treatment options available for acne scarring. Adjunct modalities such as punch excision should be considered to enhance treatment outcomes. Traditionally, punch excision and grafting have been performed, followed 1-2 months later by dermabrasion.

OBJECTIVE

To determine the effectiveness of laser skin resurfacing and the concurrent use of punch excision performed at the same treatment session in the treatment of acne scarring.

METHODS

Twenty-one patients with skin types I-III with mild to severe facial acne scarring were treated with a combination of laser skin resurfacing and punch excision of acne scars in the same treatment session. Baseline, postoperative, and follow-up photographs were taken and evaluated by an independent dermatologist and a laser nurse blinded to patient treatment. In addition, subjective patient assessments of improvement were obtained.

RESULTS

There was a range of clinical improvement by the independent assessor of 25-50% in skin type I, 50-75% in skin type II, and 50-75% in skin type III. There was a patient subjective improvement of 25-50% for skin type I, 50-75% for skin type II and 75-100% for skin type III. Postoperative hyperpigmentation was noted in five patients and postoperative hypopigmentation was not seen in any patients. There was no wound dehiscence, evidence of infection, or hypertrophic scarring of treated areas noted on follow-up.

CONCLUSION

Laser skin resurfacing with the concurrent use of punch excision improves facial acne scarring. This newly described method negates the need to delay additional resurfacing for a future visit.

Scar revision

Scar improvement is an age old endeavor. Multiple modalities exist for improving a scar's appearance. This article will review scar types and offer a brief overview of nonsurgical and surgical options for scar revision.

Scar resurfacing with high-energy, short-pulsed and flashscanning carbon dioxide lasers

BACKGROUND

Scars have a significant effect on a person's physical and social being. Many treatment modalities for scar improvement such as surgical scar revision, electrosurgical planing, chemical peeling, filler substance implantation, and dermabrasion have been developed. Recently, the resurfacing carbon dioxide (CO2) laser systems have proven to be a useful and safe treatment in the treatment of facial rhytides and acne scarring.

OBJECTIVE

The purpose of this study was to evaluate the resurfacing CO2 lasers in the treatment of various surgical, traumatic, acne, and varicella scars.

METHODS

Thirty subjects, aging between 14 and 84 years, with surgical, traumatic, acne, or varicella scars were evaluated. Two types of resurfacing laser systems were utilized in this study, a high-energy, short-pulsed CO2 laser and a continuous wave CO2 laser with an optico-mechanical computer flash-scanner. Post-surgical scars were treated with laser resurfacing between 4 and 6 weeks after scar formation. Traumatic, acne, and varicella scars were treated after scar maturation (range, 1-10 years). Scar improvement was evaluated by photographic analysis of before and after images by four independent health care workers using a quartile scale of improvement (< 25%, 25-49%, 50-74%, > 75%) as well as optical profilometry using silicone surface impressions in 12 scars.

RESULTS

Twenty of 24 surgical scars had greater than 75% improvement, and 24 of 24 had greater than 50% improvement by photographic analysis. All six traumatic, acne and varicella scars had greater than 50% improvement. Optical profilometry and surface topography maps reveal a significant flattening of related and depressed scars.

CONCLUSION

The high-energy, short-pulsed CO2 laser and the continuous wave CO2 laser with flash-scanning attachment are safe and effective as a treatment modality for scar revision. In general, elevated scars improve more dramatically than depressed scars.

Scar revision

BACKGROUND

Scars of cosmetic or functional importance may form following cutaneous surgery, trauma, or inflammation. Many factors interplay in the formation of these scars. Knowledge and proper planning can help eliminate these consequences. Various scar revision techniques, both surgical and nonsurgical, are now available for treating undesirable scarring.

OBJECTIVE

To review the various scar revision options for the various types of scars.

LEARNING OBJECTIVE

After reading this review the participant should have a better approach and understanding of the appropriate scar revision techniques.

Facial cutaneous reconstructive surgery: general aesthetic principles

The performance of cutaneous reconstructive surgery requires understanding and application of many important principles. This article reviews the critical factors to consider in the management of surgical wounds by second-intention healing, primary closure, skin grafting, and repair with local flaps. For certain defects, reconstruction with local flaps offers several advantages over other alternatives. Key concepts useful in flap choice and implementation are discussed, and surgical techniques that maximize the aesthetic outcome of reconstructive surgery are reviewed.