Ablative <scp>CO</scp><sub>2</sub> fractional resurfacing in treatment of thermal burn scars: an open‐label controlled clinical and histopathological study

El-Zawahry, Bakr Mohamed; Sobhi, Rehab Mohamed; Bassiouny, Dalia Ahmed; Tabak, Sahar A.

doi:10.1111/jocd.12163

Cited by 83 publications

(64 citation statements)

References 20 publications

(29 reference statements)

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“…Wound repair in skin epithelium is a well‐defined process characterized by inflammation, proliferation leading to tissue restoration, and tissue remodeling . LASER is believed to normalize the cycle of collagenesis and collagenolysis by inducing break down of disorganized collagen fibrils, creating more organized collagen bundles, and decreasing collagen bundle thickness and density …”

Section: Basic Science Evidencementioning

confidence: 99%

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document

Preti¹,

Vieira‐Baptista

Digesu³

et al. 2019

Neurourology and Urodynamics

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BACKGROUND The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology is controversial. AIMS In this best practice document, we propose recommendations for the use of LASER for gynecologic and urologic conditions such as vulvovaginal atrophy, urinary incontinence, vulvodynia, and lichen sclerosus based on a thorough literature review. MATERIALS & METHODS This project was developed between January and September 2018. The development of this document followed the ICS White Paper Standard Operating Procedures. RESULTS Most of the available studies are limited by their design; for example they lack a control group, patients are not randomized, follow up is short term, series are small, LASER is not compared with standard treatments, and studies are industry sponsored. Due to these limitations, the level of evidence for the use of LASER in the treatment of these conditions remains low and does not allow for definitive recommendations for its use in routine clinical practice. Histological evidence is commonly reported as proof of tissue regeneration following LASER treatment. However, the histological changes noted can also be consistent with reparative changes after a thermal injury rather than necessarily representing regeneration or restoration of function. The use of LASER in women with vulvodynia or lichen sclerosus should not be recommended in routine clinical practice. There is no biological plausibility or safety data on its use on this population of women. DISCUSSION The available clinical studies do not present convincing data regarding the efficacy of LASER for the treatment of vaginal atrophy or urinary incontinence. Also, while short‐term complications seem to be uncommon, data concerning long‐term outcomes are lacking. CONCLUSION At this point, LASER is not recommended for routine treatment of the aforementioned conditions unless part of well‐designed clinical trials or with special arrangements for clinical governance, consent, and audit.

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Section: Basic Science Evidencementioning

confidence: 99%

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document

Preti¹,

Vieira‐Baptista

Digesu³

et al. 2019

Neurourology and Urodynamics

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“…Most recently, fractional laser ablation has been proposed to treat scars (Choi et al 2014). The results from the clinical trials with this technology in burn patients are encouraging and report on textural improvement and a significant decrease of Vancouver, POSAS observer, and patient scores (El-Zawahry et al 2015; Levi et al 2016). However, therapy depth in skin is limited due to high scattering of light in skin, causing a fundamental impediment for this technology (Preissig et al 2012).…”

Section: Discussionmentioning

confidence: 91%

Preventing Scars after Injury with Partial Irreversible Electroporation

Golberg

Villiger

Khan

et al. 2016

Journal of Investigative Dermatology

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Preventing the formation of hypertrophic scars, especially those that are a result of major trauma or burns, would have enormous impact in the fields of regenerative and trauma medicine. In this report, we introduce a non-invasive method to prevent scarring based on non-thermal partial irreversible electroporation. Contact burn injuries in rats were treated with varying treatment parameters to optimize the treatment protocol. Scar surface area and structural properties of the scar were assessed with histology and non-invasive, longitudinal imaging with polarization-sensitive optical coherence tomography. We found that partial irreversible electroporation using 200 pulses of 250 V and 70 μs duration, delivered at 3 Hz every 20 days during a total of five therapy sessions after the initial burn injury resulted in a 57.9% reduction of the scar area in comparison with untreated scars and structural features approaching those of normal skin. Noteworthy, unlike humans, rats do not develop hypertrophic scars. Therefore, the use of a rat animal model is the limiting factor of this work.

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“…One study of 15 raised burn scars (11 HTS, 4 keloids, mean scar age 8.1 years) showed that fractional CO2 improved the Patient and Observer Scar Assessment Scale (POSAS) and the VSS for HTS but not for thicker keloids after 3 treatment sessions every 4 to 6 weeks. 14,15 HTS on the limbs responded better than those on the face or trunk. Authors purported that the dermal penetration depth of the laser light (400 to 1,000 μm) was insufficient to reach the depth of the scar tissue in the treated keloids, leaving deeper fibrosis untreated.…”

Section: ■ Abstractmentioning

confidence: 81%

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects

2017

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I n recent decades, there has been a revolution in energy-based treatment options for skin scarring, rejuvenation, and tightening. One of the most promising developments has been the introduction of fractional photothermolysis, developed by Anderson and Manstein in 2004. Fractionated systems deliver laser energy in a grid-like pattern, creating microscopic columns of ablative and/or coagulative damage termed microthermal zones (MTZs), which stimulate collagen remodeling.1 The incorporation of fractional photothermolysis into energy-based devices has allowed less destruction to surrounding tissue, leading to desired results with the minimization of unwanted side effects, leading to both ablative and nonablative laser devices becoming desirable treatment options for cutaneous scarring and rejuvenation. Given their impressive results, newer fractional laser treatment options, including picosecond lasers, quality-switched (QS) lasers, and combined ablative and nonablative lasers, are being investigated for the treatment of these common skin conditions.The following review addresses the current and emerging topics on fractional laser treatment of skin scarring and rejuvenation based on the device type, including ablative, nonablative, QS, picosecond, and hybrid fractional lasers (HFLs). Additionally, newer energy-based fractional devices, such as radiofrequency (RF) with and without microneedling and the use of fractionated technology for drug delivery, are discussed in the context of these common skin conditions. Fractionated lasersTreatment options for cutaneous scars and skin rejuvenation have evolved significantly since the rise in popularity of ablative lasers in the 1990s. Newer treatment options, including ablative fractional lasers (AFL) and nonablative fractional lasers (NAFL), have garnered favor, given the milder side effect profile in comparison with traditional fully ablative lasers. Ablative fractional lasersAcne scarring AFLs were developed in an attempt to achieve the efficacy of traditional ablative lasers with the milder side effect profile of fractional technology. Although a single treatment produces less dramatic, albeit noticeable, results than traditional fully ablative lasers can, multiple treatments result in greater clinical improvement.2 Currently, there are 3 types of AFLs available for scar treatment: the 10600-nm carbon dioxide (CO2), the 2940-nm erbium:yttrium aluminum garnet (Er:YAG), and the 2740-nm yttrium scandium gallium garnet (YSGG) lasers. AFL is associated with the increased risk of both protracted erythema and postinflammatory hyperpigmentation (PIH) in darker skin types, which has led many clinicians to prefer a longer series of NAFL treatments over AFL treatments to achieve similar results with a lower risk of side effects.Multiple studies support the efficacy of the fractional CO2 laser in acne scars. The overwhelming majority of these studies investigate the utility of these lasers in atrophic facial scars. While NAFLs typically require multiple sessions to achieve modest ...

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Ablative CO₂ fractional resurfacing in treatment of thermal burn scars: an open‐label controlled clinical and histopathological study

Abstract: Fractional CO2 laser is a possible safe and effective modality for the treatment of hypertrophic burn scars with improvement achieved both clinically and histopathologically.

Cited by 83 publications

References 20 publications

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document

Preventing Scars after Injury with Partial Irreversible Electroporation

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects

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Ablative CO2 fractional resurfacing in treatment of thermal burn scars: an open‐label controlled clinical and histopathological study

Abstract: Fractional CO2 laser is a possible safe and effective modality for the treatment of hypertrophic burn scars with improvement achieved both clinically and histopathologically.

Cited by 83 publications

References 20 publications

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document

The clinical role of LASER for vulvar and vaginal treatments in gynecology and female urology: An ICS/ISSVD best practice consensus document

Preventing Scars after Injury with Partial Irreversible Electroporation

Advances in fractional technology for skin rejuvenation, skin tightening, drug delivery, and treating scars and skin defects

Contact Info

Product

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Ablative CO₂ fractional resurfacing in treatment of thermal burn scars: an open‐label controlled clinical and histopathological study