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

Rohrer, Thomas E.; Ugent, Steven J.

doi:10.1002/lsm.10035

Cited by 16 publications

(7 citation statements)

References 10 publications

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“…The body of evidence on early laser intervention comprises less than 30 studies applying laser within 3 months after injury. Thirteen of these studies were randomized controlled trials [7,24,25]. Sixteen studies applied laser in the proliferation phase of wound healing (4-21 days post-injury), generally performed at the point of suture removal using PDL, NAFL, and AFL.…”

Section: Discussionmentioning

confidence: 99%

Early intervention with non‐ablative fractional laser to improve cutaneous scarring—A randomized controlled trial on the impact of intervention time and fluence levels

et al. 2017

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Background and Objectives: Laser treatment in the early phases of wound healing may reduce scar formation. However, little is known on when in the early wound healing phases laser exposure most optimally should be provided and at which fluence levels. This study investigates the clinical effect of non-ablative-fractional-laser (NAFL) performed at three early time points at a range of fluence levels versus untreated control scars. Materials and Methods: A randomized, controlled, intraindividual trial with erbium-glass 1,540 nm NAFL versus no laser treatment on sixteen subjects receiving 10 standardized full-thickness punch-biopsy wounds. A single NAFL-exposure was applied to test-wounds 1 day before, immediately after, or 2 weeks after wounding. Three fluence levels provided deep and superficial energy depositions (range 30-70 mJ/microbeam). Primary outcome comprised the total-score of the observer part of PatientObserver-Scar-Assessment-Scale (POSAS), performed by blinded on-site assessment at 3 months follow-up. Secondary outcomes were clinical evaluation on visual-analoguescale (VAS), reflectance measurements, and histology. Results: NAFL-treatment applied 1 day before, immediately after or 2 weeks after wounding had the potential to offer subtle but detectable improvement in clinical scar appearance compared to untreated controls. Thus, NAFL-exposure 1 day before wounding (POSAS-total: median of 15 vs. controlmedian of 16, P ¼ 0.03, VAS: median 4.1 vs. control-median 5.5, P ¼ 0.03, medium-fluence), as well as immediately-, and 2 weeks after wounding (POSAS-total: P 0.05, low-fluence) induced improvement compared to untreated controls. No significant differences in dyschromia were detected between NAFL-treated and control scars. Histology showed subtle changes towards more mature interwoven bundles of collagen in NAFL-treated scars as compared to controls. Conclusions: This study indicates that a single NAFLtreatment at low to medium fluence performed 1 day prior, or in the early phases of wound healing, may have the potential to optimize scar formation in full thickness wounds. Lasers Surg. Med. 50:28-36, 2018.

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Section: Discussionmentioning

confidence: 99%

Early intervention with non‐ablative fractional laser to improve cutaneous scarring—A randomized controlled trial on the impact of intervention time and fluence levels

et al. 2017

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“…The evaluation of the methodological quality revealed generally high risk of bias according to random sequence generation and allocation concealment. Four studies 16,25,30,33 provided a clear and adequate randomization procedure. None of the trials described allocation concealment.…”

Section: Methodological Quality Of Included Studiesmentioning

confidence: 99%

“…Rohrer applied full-ablative Er:YAG immediately after intracutaneous suturing and found at 3 months follow-up improvement in overall cosmetic appearance of scars from treated lesions compared to untreated, though not significant. 30 Capon introduced the laser-assisted skin healing (LASH) procedure and performed two split scar studies using an 810-nm diode laser immediately after skin closure on surgical scars. The first study 31 showed improvement on treated scar side after 12 months on overall appearance rating.…”

Section: Laser Intervention In the Inflammation Phasementioning

confidence: 99%

Early laser intervention to reduce scar formation – a systematic review

Karmisholt

Hærskjold

Karlsmark

et al. 2018

Acad Dermatol Venereol

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The ability of laser treatment to affect wound healing and subsequently minimize scar formation has been investigated in recent years. However, no systematic review links these clinical trials. The aim of this study was to systematically review and evaluate clinical evidence for early laser intervention to reduce scar formation in studies where laser treatment was introduced less than 3 months after wounding. We searched PubMed using relevant keywords in June 2017. Titles, abstracts and articles were sorted according to inclusion and exclusion criteria. Methodological quality was evaluated according to Cochrane Collaborations risk-of-bias assessment guideline by two independent authors. Twenty-five articles met the inclusion criteria. In total, 22 of 25 studies were controlled studies, and 17 of 25 studies compared laser treatment vs. untreated control scars. The following laser devices have been investigated: pulsed dye laser (PDL), potassium-titanyl-phosphate (KTP) laser, fractional erbium:glass 1540 nm/1550 nm, fractional/full ablation erbium-doped yttrium aluminium garnet (Er:YAG) laser or fractional CO laser. Eighteen studies applied laser treatments 2-4 times with 2- to 8-week intervals, while seven studies applied only one laser treatment. Follow-up time ranged from 1 to 12 months with 18 studies using a follow-up time ≤3 months. In general, laser-treated wounds and scars showed benefit from laser intervention, though not always reaching significance. Significant scar improvement was found in three of four studies using laser treatment in inflammation phase, in six of 16 studies with laser initiated in the proliferation phase and in two of five studies in the remodelling phase. High risk of bias was found in randomization and allocation concealment, and low risk of bias with regard to blinding of outcome assessment and lost to follow-up. In conclusion, laser intervention when introduced in inflammation, proliferation or remodelling phase has the potential to reduce cutaneous scar formation. Further, high-quality studies are needed before standard protocols can be implemented in clinical practice.

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“…In recent years, 2 studies using ablative laser resurfacing of wounds at the time of closure have shown promising trends. 4,5 Ablative fractional resurfacing has been shown to quantitatively improve atrophic surgical and traumatic scars. 6 The improved safety profile of fractional carbon dioxide lasers vs their fully ablative counterparts and the ability to treat nonfacial sites makes them well suited for scar treatments.…”

Section: A Randomized Split-scar Study Of Intraoperative Treatment Ofmentioning

confidence: 99%

A Randomized Split-Scar Study of Intraoperative Treatment of Surgical Wound Edges to Minimize Scarring

Ozog¹,

Moy²

2011

Arch Dermatol

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

Cited by 16 publications

References 10 publications

Early intervention with non‐ablative fractional laser to improve cutaneous scarring—A randomized controlled trial on the impact of intervention time and fluence levels

Early intervention with non‐ablative fractional laser to improve cutaneous scarring—A randomized controlled trial on the impact of intervention time and fluence levels

Early laser intervention to reduce scar formation – a systematic review

A Randomized Split-Scar Study of Intraoperative Treatment of Surgical Wound Edges to Minimize Scarring

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