Laser treatments in early wound healing improve scar appearance: a randomized split‐wound trial with nonablative fractional laser exposures vs. untreated controls3. (30th September 2018)

• Record Type: Journal Article
• Authors: Karmisholt, K.E.; Banzhaf, C.A.; Glud, M.; Yeung, K.; Paasch, U.; Nast, A.; Haedersdal, M.
• Is Part Of: British journal of dermatology. Volume 179:Number 6(2018)
• Page Start: 1307
• Page End: 1314
• Publication Date: 2018-09-30
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.17076
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background: In recent years, various lasers have increasingly been applied during wound healing to minimize scar formation. However, no consensus regarding treatment procedures exists. Objectives: To assess scar formation clinically after three nonablative fractional laser (NAFL) exposures, targeting the inflammation, proliferation and remodelling wound healing phases in patients vs. untreated controls. Methods: A randomized controlled trial was performed using a split‐wound design to assess excisional wound halves treated with 1540‐nm NAFL vs. no laser treatment. Three NAFL exposures were provided: immediately before surgery, at suture removal and 6 weeks after surgery. NAFL exposures were applied using two handpieces, sequentially distributing energy deeply and more superficially in the skin (40–50 mJ per microbeam). Evaluated at 3 months of follow‐up, the primary outcome was blinded, on‐site evaluation using the Patient Observer Scar Assessment Scale (POSAS total; range from 6, normal skin to 60, worst imaginable scar). Secondary outcomes comprised blinded evaluation on the Vancouver Scar Scale (VSS) and standardized assessment comparing scar sides, carried out by blinded on‐site, photo and patient assessments. This trial was registered with ClinicalTrials.gov (NCT03253484). Results: Thirty of 32 patients completed the trial. At the 3‐month follow‐up, the NAFL‐treated scar halves showed improvement compared with the untreated control halves on POSAS total: NAFL treated, median 11, interquartile range (IQR) 9–12 vs. control, median 12, IQR 10–16; P = 0·001. The POSAS subitems showed that the NAFL‐treated halves were significantly less red and more pliable, and presented with smoother relief than the untreated controls. VSS total correspondingly revealed enhanced appearance in the NAFL‐treated halves: median 2, IQR 1–2·5 vs. control, median 2, IQR 1·75–3, P = 0·007. The standardized assessment comparing appearance of scar halves demonstrated a low degree of correspondence between on‐site, photo and patient assessments. NAFL‐treated scars were rated as superior to untreated scars by 21 of 29 patients. Conclusions: NAFL‐treated scars showed subtle improvement compared with untreated control scars. Abstract : What's already known about this topic? There are indications that early laser treatment may reduce scar formation during wound healing. No consensus exists regarding the optimal treatment procedure for early laser treatment to reduce scar formation. What does this study add? This is the first trial investigating the clinical effect of three nonablative fractional laser (NAFL) treatments, initiated as early as immediately before surgery and repeated throughout the wound healing phases. NAFL‐treated scars showed subtle superiority over untreated control scars. NAFL may be promising as an integrated part of surgical procedures and postsurgical care to reduce scar formation. Plain language summary available online Respond to this article