Non‐ablative fractional laser provides long‐term improvement of mature burn scars–A randomized controlled trial with histological assessment

Taudorf, E.; Danielsen, Patricia L; Paulsen, Ida Felbo; Togsverd‐Bo, Katrine; Dierickx, Christine; Paasch, Uwe; Hædersdal, Merete

doi:10.1002/lsm.22289

Cited by 65 publications

(35 citation statements)

References 22 publications

(76 reference statements)

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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: 85%

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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Section: ■ Abstractmentioning

confidence: 85%

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

2017

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“…Recent studies focusing on non-ablative as well as ablative lasers have demonstrated significant improvements in scar texture, coloration, pain and pruritus and have even been shown to treat contractures [57, 58]. Several lasers are commonly employed and are distinguished by a specific energy wavelength that targets a certain chromophore in the skin.…”

Section: Managementmentioning

confidence: 99%

Heterotopic Ossification and Hypertrophic Scars

Agarwal

Sorkin

Lévi

2017

Clinics in Plastic Surgery

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Burns and trauma lead to extensive superficial and deep soft tissue wounds which are unable to heal perfectly to the pre-injury state. Typically wound healing requires proliferation of cells capable of differentiating into the injured tissue type. As part of the structural requirements for tissue, these cells lay down extracellular matrix (ECM) often in the form of collagens. However, dysregulated cellular proliferation and collagen deposition often leads to wound pathology. Two conditions – heterotopic ossification (HO) and hypertrophic scarring – present a substantial challenge in the management of patients with large surface-area burns. HO is the pathologic formation of ectopic osseous lesions causing severe pain, non-healing wounds, and restricted range of motion. Current treatment strategies aimed at HO include prophylactic radiation therapy, non-steroidal anti-inflammatory drugs (NSAIDs), and bisphosphonates; ultimately patients who have developed HO may require surgical excision followed by prophylactic measures to reduce recurrence risk. Hypertrophic scars in contrast are non-osseous lesions caused by excessive collagen deposition. Similar to HO, hypertrophic scars are often painful, functionally limiting, and aesthetically displeasing. Treatment strategies include CO2 laser application, steroid injections, and excision with skin grafting. Here we review the biology, diagnosis, and treatment and outcomes associated with both forms of pathologic wound healing.

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“…Over the past decade, different modalities of laser therapy have become a versatile and integral part of scar management. Utilizing selective photothermolysis and fractional ablation to target hyperthrophic scar tissue provides a novel method to modulate the composition of the scar and may even result in reduction of scar restriction and contracture release [37]. Overall, laser therapy is associated with a low complication risk profile [38].…”

Section: Treatment Of Hypertrophic Scarsmentioning

confidence: 99%

Scar Management of the Burned Hand

2017

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Unimpaired hand function is critical in almost all activities of daily living. Burn injury can result in hypertrophic scar formation that can lead to debilitating functional deficits and poor aesthetic outcomes. Initial algorithms of acute burn management involve early debridement and skin grafting and early mobilization to prevent formation of hypertrophic scarring and ultimately digit contractures. While non-operative modalities in the early phase of scar maturation are critical to minimize hypertrophic scar formation, surgical management is often indicated in order to restore hand function. The essential tenant of operative scar management is release of tension, which can often be achieved through local tissue rearrangement. Laser therapy has emerged as a central pillar of subsequent scar rehabilitation with several modalities that address scar texture, color, pruritis and thickness. These can be utilized in conjunction with local corticosteroid treatment and other emerging modalities to modulate the scar and achieve optimal hand function. These treatment tools provide an effective resource for the reconstructive surgeon to treat hypertrophic hand scars.

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Non‐ablative fractional laser provides long‐term improvement of mature burn scars–A randomized controlled trial with histological assessment

Abstract: Combined superficial and deep non-ablative fractional laser-treatments induce long-term clinical and histological improvement of mature burn scars.

Cited by 65 publications

References 22 publications

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

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

Heterotopic Ossification and Hypertrophic Scars

Scar Management of the Burned Hand

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