Clinical Improvement and Safety of Ablative Fractional Laser Therapy for Post-Surgical Scars: A Systematic Review of Randomized Controlled Trials

November 2015 | Volume 14 | Issue 11 | Original Article | 1200 | Copyright © November 2015


Trenton Custis MDa,b and Daniel B. Eisen MDa

aUniversity of California-Davis School of Medicine, Sacramento, CA
bDallas Associated Dermatologists, Dallas, TX

Abstract
BACKGROUND: Ablative fractional laser (AFL) therapy for scars is an area of increasing interest. While the enthusiasm for these treatments is high, a systematic review of their use on surgical scars has not been done.
OBJECTIVE: To identify randomized trials that study the efficacy of ablative fractionated laser therapy for treatment of surgical scars.
METHODS AND MATERIALS: EMBASE, Web of Science, and Pubmed databases were searched for randomized trials with 10 or more surgical wounds. No restrictions were placed on the language of the publications.
RESULTS: Three randomized trials were identified that met the criteria for the review. One study found superior efficacy of ablative fractionated laser treatment of surgical scars compared to pulsed dye laser while the others found equivalent efficacy when compared to dermabrasion or pulsed dye laser. One study found a superior safety profile for ablative fractionated laser treatment over dermabrasion. No studies compared fractionated laser therapy to sham therapy or observation.
CONCLUSIONS: AFL compares well with the scar amelioration techniques of dermabrasion and pulsed dye laser. Additional studies are needed to further contrast AFL to these and other modalities as well as to observation alone.

J Drugs Dermatol. 2015;14(11):1200-1204.

INTRODUCTION

Each year in the developed world 100 million patients acquire scars, 55 million of those from elective surgery. Depending on the severity, scars may inflict significant burden for some patients.1 Ablative laser technology has been used in scar treatments in the past, although extended periods of downtime and possibilities for hypo- and hyperpigmentation have limited fully ablative CO2 laser use in scar treatment.2 Now, newer ablative fractional laser (AFL) technology has gained popularity for the treatment of scars. A recent consensus report by Anderson, et al suggested AFL resurfacing for traumatic scars is a promising and vastly underused tool.3
Though a recent 2011 systematic review suggested pulsed dye laser (PDL) to have moderate effectiveness for the treatment of hypertrophic scars, no systematic reviews or meta-analyses appear to have been undertaken for the use of ablative fractional resurfacing for scars acquired specifically from surgery.
This study details the findings of a systematic review to address the question: What randomized trial evidence is available for the use of fractionated ablative laser treatments for patients with surgical scars?

MATERIALS AND METHODS

This study is registered with the Prospero international prospective register of systematic reviews (http://www.crd.york.ac.uk/PROSPERO) with the registration number: CRD42014007356. Our objective was to ascertain information from studies with a randomized design in any population group where surgical scars were treated with a fractionated ablative laser. We restricted our study type in order to limit bias typically present in observational studies. Any comparator treatment including sham or observation was considered in order to best delineate the utility of AFL in terms of both efficacy and complications relative to other available therapies. We assumed that data would be too sparse to restrict types of outcomes measured, given AFL is a relatively new treatment.
A search of the literature was performed using the following electronic databases: EMBASE, Web of Science, and Pubmed. No restrictions were made on language. The query for all databases was “(fractionated laser OR fractional laser OR photothermolysis) AND (Cicatrix OR (scar OR scars OR scarring OR scaring)) AND (“Randomized Controlled Trial” OR clinical trial) AND (Dermabrasion OR resurfacing).” References of retrieved articles were scanned for additional studies. The latest search date was September 6, 2013. A 26-year date range (1996-2012) was reviewed. Restriction of search dates was
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