Structural Assessment of Scars Using Optical Techniques

Abstract

The evaluation of scar treatment benefits from exact structural measurements. Accurate assessment of thickness, surface area, and relief is crucial in routine clinical follow-up. From an experimental perspective, precise visualization of the microstructural organization is necessary for a better understanding of the mechanisms underlying pathological scarring. Structural proteins in scars differ from healthy skin in terms of amount, type, and importantly, organization. The precise quantification of this extracellular matrix (ECM) organization was, until recently, limited to two-dimensional images from fixated and stained tissue. Advances in optical techniques now allow high-resolution imaging of these structures, in some cases in vivo. The enormous potential of these techniques as objective assessment tools is illustrated by a substantial increase in available devices. This chapter describes currently used devices and techniques used in the clinical follow-up of scar progression from a volumetric standpoint. Furthermore, some of the most powerful techniques for microstructural research are described including optical coherence tomography, nonlinear optical techniques such as second harmonic generation microscopy, and confocal microscopy.

The use of carbon dioxide and intense pulsed light laser for the treatment of hypertrophic burn scars: A case series

“…25 Newer technologies and devices such as optical coherence tomography, non-linear technique such as second harmonic generation microscopy, confocal microscopy, as well as colourimeter devices can be used to provide better structural, vascular and pigmentation assessment of the scar. 33 This will allow clinicians to better understand and measure how various treatments alter the scar characteristics. While there is no current gold standard assessment of burn scars, 41,42 a more objective assessment of the scar will also help to separate patients into different cohorts based on the scar characteristic, and therefore develop more transferable and reproducible clinical results.…”

“…For the assessment of the CO 2 laser, the thickness of the scar determined the depth of treatment required and this was assessed by clinical measurement in our study. While there are newer devices such as optical coherence tomography and confocal microscopy that can offer a more objective assessment, 33 we did not have access to these technologies for our study. For the majority of hypertrophic burns scars, the deep mode and the fusion mode are preferred due to the depth of penetration.…”