Prevention of Scarring With Intraoperative Erbium: YAG Laser Treatment

November 2020 | Volume 19 | Issue 11 | Original Article | 1040 | Copyright © November 2020


Published online October 16, 2020

doi:10.36849/JDD.2020.5244

Hiren Kolli BS,a,b Ronald L. Moy MDb

aVirginia Commonwealth University School of Medicine, Richmond, VA 
bResearch Department, Moy-Fincher-Chipps Facial Plastics/Dermatology, Beverly Hills, CA

Abstract
Background: Scars can develop as a result of surgical incisions and pose psychological, cosmetic, and physical stress to the patients affected. Lasers have been used for scar revision, but little information exists regarding intraoperative use and efficacy.
Objective: To evaluate a 2,940-nm fractional erbium:YAG laser to improve scar appearance when used immediately after skin closure. Methods and Materials: Patients undergoing complex closures of at least 1.5 cm in length were recruited. Half of the wound received treatment with 2,940 erbium:YAG laser immediately after skin closure. Follow up occurred at 1 week and 12 weeks, postoperatively. Patient self-assessment was performed at the final visit. Photographs were evaluated by three blinded dermatologic surgeons.
Results: 18 patients completed the treatment protocol and follow-up. 61.1% of patients reported that the treated side was cosmetically superior to the control side. A majority of patients said the treated side was superior in elevation, erythema, and similarity to normal skin. Physician evaluation showed that the treated half was cosmetically superior in 12 of 18 patients (66.7%).
Conclusions: This study demonstrates that a 2,940-nm erbium:YAG laser treatment, performed immediately after surgery, can improve the appearance of a surgical scar.

J Drugs Dermatol. 2020;19(11): 1040-1043. doi:10.36849/JDD.2020.5244

INTRODUCTION

Scarring is an inevitable consequence of surgical incision. While physicians strive to employ excellent surgical technique, the outcome of a surgical scar is often unpredictable. There are a number of therapeutic strategies used for the reduction and prevention of scars. Nonsurgical options include corticosteroids, fluorouracil, and pressure therapy while more aggressive options include various surgical techniques and dermabrasion. In particular, laser technology has become the treatment of choice for many types of scars and has shown both clinical and cosmetic benefits for the patient.1

Though the initial scar after surgery can be expected to change over time, a 6 to12-month delay before revision is recommended, with a 2-month delay for more unfavorable scars.2 However, recent studies have emphasized the importance of early laser resurfacing to minimize scar formation. Capon et al evaluated the immediate post-surgical wound closure use of an 810-nm diode laser treatment.3 At 12 months, the treated portion scored significantly better compared with controls. Ozog and Moy reported that 1–2 passes of a fractional carbon dioxide laser to half of a surgical wound immediately following subcutaneous sutures significantly improved the appearance and texture of scars.4 In 2018, Du et al observed an apparent aesthetic scar improvement in Asian patients treated with intraoperative fractional CO2, but did not have controls for comparison.5

In 2002, Rohrer and Ugent conducted a study on 10 patients with use of a short-pulsed Erbium:YAG laser intraoperatively.6 Though there was no significant difference, there was a better overall aesthetic appearance of the side of the scar that had been resurfaced.

Our study aims to quantify the improvement resulting from fractional Erbium:YAG laser treatment. To our knowledge, no report on fractional Erbium:YAG laser intervention on the same day of skin suture has been published thus far.

MATERIALS AND METHODS

The procedures followed were in accordance with the Helsinki Declaration of 1975, as revised in 1983. Patients undergoing a complex linear closure of at least 1.5 cm in length after excisional surgery were asked to voluntarily participate in the trial and were enrolled after written informed consent was obtained. To be enrolled, the patients had to be 18 years of age or older with a wound length of 1.5 cm or greater, willing to comply with the protocol of standard postoperative care and be able to attend the postoperative visits. Patients on systemic immunosuppressants or with a dermatologic disease in the target site that may interfere with examination were excluded from the study.