Scar Prevention by Laser‐Assisted Scar Healing (LASH): A pilot study using an 810‐nm diode‐laser system

Abstract

Normal wound healing of the skin results in a flat and flexible scar. The ideal end point would be total regeneration, with the new tissue having the same structural, aesthetic, and functional attributes as the original uninjured skin. Scars are often considered trivial, but they can be disfiguring and aesthetically unpleasant and cause severe itching, tenderness, pain, sleep disturbance, anxiety, and depression [1]. Cosmetic results obtained after skin surgery are a key component of patient satisfaction. Surgical skin scars are a type of scar that can benefit from laser therapy. Redness and telangiectasia developing in such scars usually spontaneously remit, but often slowly and incompletely. Laser can not only accelerate this decolorizing process, it can also advance the end point closer to the complete absence of redness with improvement in scar texture and pliability with minimal side effects [2]. Recently, Capon et al. [3] showed the ability of a 815-nm diode-laser system to assist wound closure leading to an acceleration and an improvement of wound healing with indiscernible resulting scar in hairless rats. The purpose of this study was to improve the appearance of scars, by improving through a thermal action the wound healing process. This thermal action was generated by an 810-nm laser source. This specific wavelength choice ensured a minimal epidermal damage as neither blood nor water can absorb at this wavelength. This pilot study aimed at evaluating the 810-nm diode-laser system to accelerate and improve the healing process in surgical scars, immediately after skin closure, of patients with Fitzpatrick skin type I–IV. Five patients (five females) with Fitzpatrick skin types I–IV and fresh surgical scars of greater than 2 cm (i.e., horizontal scars from abdominoplasty) were enrolled in this prospective pilot study (Table 1). This clinical trial has been approved by the Ethics Committee (Comite Consultatif de Protection des Personnes en Recherche Biomedicale (CCPPRB) de la region Nord Pas-de-Calais). Patients under 18 years of age, with dark skin (phototypes V or VI), pregnant women, and patients with a history of malignant tumor skin disease, bacterial or viral infectious skin disease, immunosuppression and treated by a longterm corticosteroids treatment were excluded. Patients were treated with fluence comprised between 80 and 120 J/ cm, in order to evaluate safety and performance of the 810-nm diode-laser system. Each surgical incision was divided into two fields, with 8 cm receiving an 810-nm diode-laser treatment (4 mm diameter beam, continuous wave, total exposure duration: 3–4 seconds). The other part was not treated. Treated and untreated portions were selected randomly. Scars were evaluated for pigmentation, vascularity, pliability, and height by surgeon and patient at 10 days, 3 months, and 12 months. A comparative scar evaluation based on cosmetic appearance using a visual analog scale from 5 (worst) to 5 (best) was performed by surgeon and patients. Overall appearance ratings ranging from an optimum of 1 to a minimum of 4 (11⁄4 excellent, 21⁄4 good,