Laser Treatment of Traumatic Scars and Contractures: 2020 International Consensus Recommendations.
burn scar
fractional
laser
scar
traumatic scar
vascular
Journal
Lasers in surgery and medicine
ISSN: 1096-9101
Titre abrégé: Lasers Surg Med
Pays: United States
ID NLM: 8007168
Informations de publication
Date de publication:
02 2020
02 2020
Historique:
accepted:
27
11
2019
pubmed:
11
12
2019
medline:
31
8
2021
entrez:
11
12
2019
Statut:
ppublish
Résumé
There is currently intense multidisciplinary interest and a maturing body of literature regarding laser treatments for traumatic scars, but international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the tremendous potential of laser techniques, offer recommendations for safe and efficacious treatment, and promote wider patient access guided by future high-quality research. An international panel of 26 dermatologists and plastic and reconstructive surgeons from 13 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the laser treatment of traumatic scars. A three-step modified Delphi method took place between March 2018 and March 2019 consisting of two rounds of emailed questionnaires and supplementary face-to-face meetings. The panel members approved the final manuscript via email correspondence, and the threshold for consensus was at least 80% concurrence among the panel members. The manuscript includes extensive detailed discussion regarding a variety of laser platforms commonly used for traumatic scar management such as vascular lasers and ablative and non-ablative fractional lasers, special considerations such as coding and laser treatments in skin of color, and 25 summary consensus recommendations. Lasers are a first-line therapy in the management of traumatic scars and contractures, and patients without access to these treatments may not be receiving the best available care after injury. Updated international treatment guidelines and reimbursement schemes, additional high-quality research, and patient access should reflect this status. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
Sections du résumé
BACKGROUND AND OBJECTIVES
There is currently intense multidisciplinary interest and a maturing body of literature regarding laser treatments for traumatic scars, but international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the tremendous potential of laser techniques, offer recommendations for safe and efficacious treatment, and promote wider patient access guided by future high-quality research.
STUDY DESIGN/MATERIALS AND METHODS
An international panel of 26 dermatologists and plastic and reconstructive surgeons from 13 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the laser treatment of traumatic scars. A three-step modified Delphi method took place between March 2018 and March 2019 consisting of two rounds of emailed questionnaires and supplementary face-to-face meetings. The panel members approved the final manuscript via email correspondence, and the threshold for consensus was at least 80% concurrence among the panel members.
RESULTS
The manuscript includes extensive detailed discussion regarding a variety of laser platforms commonly used for traumatic scar management such as vascular lasers and ablative and non-ablative fractional lasers, special considerations such as coding and laser treatments in skin of color, and 25 summary consensus recommendations.
CONCLUSIONS
Lasers are a first-line therapy in the management of traumatic scars and contractures, and patients without access to these treatments may not be receiving the best available care after injury. Updated international treatment guidelines and reimbursement schemes, additional high-quality research, and patient access should reflect this status. Lasers Surg. Med. © 2019 Wiley Periodicals, Inc.
Types de publication
Consensus Development Conference
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
96-116Commentaires et corrections
Type : CommentIn
Informations de copyright
Published 2019. This article is a U.S. Government work and is in the public domain in the USA.
Références
Nguyen TA, Feldstein SI, Shumaker PR, Krakowski AC. A review of scar assessment scales. Semin Cutan Med Surg 2015;34(1):28-36.
Dalkey N. The Delphi Method: An experimental study of group opinion. Futures 1969;1:408-426.
Gustafson D, Shukla R, Delbecq A, Walster G. A comparative study of differences in subjective likelihood estimates made by individuals, interacting groups, Delphi groups, and nominal groups. Organ Behav Hum Perf 1973;9:280-291.
Wood F. An approach to scar mitigation. In: Krakowski A, Shumaker P, editors. The Scar Book. Philadelphia, PA: Wolters Kluwer; 2017.
Tredget E, Ding J. The cellular and molecular basis of scarring: The paradigm of hypertrophic scarring after thermal injury. In: Krakowski A, Shumaker P, editors. The Scar Book. Philadelphia, PA: Wolters Kluwer; 2017.
Carlavan I, Bertino B, Rivier M, et al. Atrophic scar formation in patients with acne involves long-acting immune responses with plasma cells and alteration of sebaceous glands. Br J Dermatol 2018;179(4):906-917.
Ansari F, Sadeghi-Ghyassi F, Yaaghoobian B. The clinical effectiveness and cost-effectiveness of fractional CO2 laser in acne scars and skin rejuvenation: A meta-analysis and economic evaluation. J Cosmet Laser Ther 2018;20(4):248-251.
Xu Y, Deng Y. Ablative fractional CO2 laser for facial atrophic acne scars. Facial Plast Surg 2018;34(2):205-219.
Dai R, Xie H, Hua W, Li XH, Li L. The efficacy and safety of the fractional radiofrequency technique for the treatment of atrophic acne scar in Asians: A meta-analysis. J Cosmet Laser Ther 2017;19(6):337-344.
Ozog DM, Liu A, Chaffins ML, et al. Evaluation of clinical results, histological architecture, and collagen expression following treatment of mature burn scars with a fractional carbon dioxide laser. JAMA Dermatol 2013;149(1):50-57.
Connolly KL, Chaffins M, Ozog D. Vascular patterns in mature hypertrophic burn scars treated with fractional CO2 laser. Lasers Surg Med 2014;46(8):597-600.
Qu L, Liu A, Zhou L, et al. Clinical and molecular effects on mature burn scars after treatment with a fractional CO(2) laser. Lasers Surg Med 2012;44(7):517-524.
Onur Erol O, Atabay K. The treatment of burn scar hypopigmentation and surface irregularity by dermabrasion and thin skin grafting. Plast Reconstr Surg 1990;85(5):754-758.
Waibel JS, Wulkan AJ, Shumaker PR. Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery. Lasers Surg Med 2013;45(3):135-140.
Waibel J, Wulkan AJ, Lupo M, Beer K, Anderson RR. Treatment of burn scars with the 1,550 nm nonablative fractional Erbium Laser. Lasers Surg Med 2012;44(6):441-446.
Bowes LE, Nouri K, Berman B, et al. Treatment of pigmented hypertrophic scars with the 585 nm pulsed dye laser and the 532 nm frequency-doubled Nd:YAG laser in the Q-switched and variable pulse modes: a comparative study. Dermatol Surg 2002;28(8):714-719.
Hultman CS, Friedstat JS, Edkins RE. Efficacy of intense pulsed light for the treatment of burn scar dyschromias: a pilot study to assess patient satisfaction, safety, and willingness to pay. Ann Plast Surg 2015;74(Suppl 4):S204-S208.
Massaki AB, Fabi SG, Fitzpatrick R. Repigmentation of hypopigmented scars using an erbium-doped 1,550-nm fractionated laser and topical bimatoprost. Dermatol Surg 2012;38(7 Pt 1):995-1001.
Goodman GJ. An automated autologous cell transplantation method for the treatment of hypopigmented scarring. Dermatol Surg 2008;34(4):578-581.
Jin R, Huang X, Li H, et al. Laser therapy for prevention and treatment of pathologic excessive scars. Plast Reconstr Surg 2013;132(6):1747-1758.
Al-Mohamady Al-S, Ibrahim SM, Muhammad MM. Pulsed dye laser versus long-pulsed Nd:YAG laser in the treatment of hypertrophic scars and keloid: A comparative randomized split-scar trial. J Cosmet Laser Ther 2016;18(4):208-212.
Keaney TC, Tanzi E, Alster T. Comparison of 532 nm potassium titanyl phosphate laser and 595 nm pulsed dye laser in the treatment of erythematous surgical scars: A randomized, controlled, open-label study. Dermatol Surg 2016;42(1):70-76.
Kuo YR, Jeng SF, Wang FS, et al. Flashlamp pulsed dye laser (PDL) suppression of keloid proliferation through down-regulation of TGF-beta1 expression and extracellular matrix expression. Lasers Surg Med 2004;34(2):104-108.
Draaijers LJ, Tempelman FRH, Botman YAM, et al. The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 2004;113(7):1960-1965. discussion 1966-1967.
Guertler A, Reinholz M, Poetschke J, Steckmeier S, Schwaiger H, Gauglitz GG. Objective evaluation of the efficacy of a non-ablative fractional 1565 nm laser for the treatment of deliberate self-harm scars. Lasers Med Sci 2017.
Lee Y. Combination treatment of surgical, post-traumatic and post-herpetic scars with ablative lasers followed by fractional laser and non-ablative laser in Asians. Lasers Surg Med 2009;41(2):131-140.
Blome-Eberwein S, Gogal C, Weiss MJ, Boorse D, Pagella P. Prospective evaluation of fractional CO2 laser treatment of mature burn scars. J Burn Care Res 2016;37(6):379-387.
Shumaker PR, Kwan JM, Landers JT, Uebelhoer NS. Functional improvements in traumatic scars and scar contractures using an ablative fractional laser protocol. J Trauma Acute Care Surg 2012;73(2 Suppl 1):S116-S121.
Donelan MB, Parrett BM, Sheridan RL. Pulsed dye laser therapy and z-plasty for facial burn scars: the alternative to excision. Ann Plast Surg 2008;60(5):480-486.
Alster TS, Nanni CA. Pulsed dye laser treatment of hypertrophic burn scars. Plast Reconstr Surg 1998;102(6):2190-2195.
Bailey JK, Burkes SA, Visscher MO, et al. Multimodal quantitative analysis of early pulsed-dye laser treatment of scars at a pediatric burn hospital. Dermatol Surg 2012;38(9):1490-1496.
Levi B, Ibrahim A, Mathews K, et al. The use of CO2 fractional photothermolysis for the treatment of burn scars. J Burn Care Res 2016;37(2):106-114.
Issler-Fisher AC, Fisher OM, Smialkowski AO, et al. Ablative fractional CO2 laser for burn scar reconstruction: An extensive subjective and objective short-term outcome analysis of a prospective treatment cohort. Burns 2017;43(3):573-582.
Hultman CS, Edkins RE, Wu C, Calvert CT, Cairns BA. Prospective, before-after cohort study to assess the efficacy of laser therapy on hypertrophic burn scars. Ann Plast Surg 2013;70(5):521-526.
Alster TS. Improvement of erythematous and hypertrophic scars by the 585-nm flashlamp-pumped pulsed dye laser. Ann Plast Surg 1994;32(2):186-190.
Manuskiatti W, Fitzpatrick RE. Treatment response of keloidal and hypertrophic sternotomy scars: comparison among intralesional corticosteroid, 5-fluorouracil, and 585-nm flashlamp-pumped pulsed-dye laser treatments. Arch Dermatol 2002;138(9):1149-1155.
Karmisholt KE, Haerskjold A, Karlsmark T, Waibel J, Paasch U, Haedersdal M. Early laser intervention to reduce scar formation-A systematic review. J Eur Acad Dermatol Venereol 2018;32(7):1099-1110.
de las Alas JM, Siripunvarapon AH, Dofitas BL. Pulsed dye laser for the treatment of keloid and hypertrophic scars: A systematic review. Expert Rev Med Devices 2012;9(6):641-650.
Anderson RR, Donelan MB, Hivnor C, et al. Laser treatment of traumatic scars with an emphasis on ablative fractional laser resurfacing: consensus report. JAMA Dermatol 2014;150(2):187-193.
Admani S, Gertner JW, Grosman A, Shumaker PR, Uebelhoer NS, Krakowski AC. Multidisciplinary, multimodal approach for a child with a traumatic facial scar. Semin Cutan Med Surg 2015;34(1):24-27.
Cassuto D, Emanuelli G. Non-ablative scar revision using a long pulsed frequency doubled Nd:YAG laser. J Cosmet Laser Ther 2003;5(3-4):135-139.
Cassuto DA, Scrimali L, Siragò P. Treatment of hypertrophic scars and keloids with an LBO laser (532 nm) and silicone gel sheeting. J Cosmet Laser Ther 2010;12(1):32-37.
Koike S, Akaishi S, Nagashima Y, Dohi T, Hyakusoku H, Ogawa R. Nd:YAG laser treatment for keloids and hypertrophic scars: An analysis of 102 cases. Plast Reconstr Surg Glob Open 2014;2(12):e272.
Manstein D, Herron GS, Sink RK, Tanner H, Anderson RR. Fractional photothermolysis: A new concept for cutaneous remodeling using microscopic patterns of thermal injury. Lasers Surg Med 2004;34(5):426-438.
Hantash BM, Bedi VP, Chan KF, Zachary CB. Ex vivo histological characterization of a novel ablative fractional resurfacing device. Lasers Surg Med 2007;39(2):87-95.
Douglas H, Lynch J, Harms KA, et al. Carbon dioxide laser treatment in burn-related scarring: A prospective randomised controlled trial. J Plast Reconstr Aesthet Surg 2019;72(6):863-870.
Miletta N, Siwy K, Hivnor C, et al. Fractional ablative laser therapy is an effective treatment for hypertrophic burn scars: A prospective study of objective and subjective outcomes. Ann Surg 2019. [published online ahead of print August 28, 2019].
Patel SP, Nguyen HV, Mannschreck D, Redett RJ, Puttgen KB, Stewart FD. Fractional CO2 laser treatment outcomes for pediatric hypertrophic burn scars. Ann Surg 2019;40(4):386-391.
Hultman CS, Friedstat JS, Edkins RE, Cairns BA, Meyer AA. Laser resurfacing and remodeling of hypertrophic burn scars: The results of a large, prospective, before-after cohort study, with long-term follow-up. Ann Surg 2014;260(3):519-529. discussion 529-532.
Żądkowski T, Nachulewicz P, Mazgaj M, et al. A new CO2 laser technique for the treatment of pediatric hypertrophic burn scars: An observational study. Medicine (Baltimore) 2016;95(42):e5168.
Poetschke J, Dornseifer U, Clementoni MT, et al. Ultrapulsed fractional ablative carbon dioxide laser treatment of hypertrophic burn scars: Evaluation of an in-patient controlled, standardized treatment approach. Lasers Med Sci 2017;32(5):1031-1040.
El-Zawahry BM, Sobhi RM, Bassiouny DA, Tabak SA. Ablative CO2 fractional resurfacing in treatment of thermal burn scars: An open-label controlled clinical and histopathological study. J Cosmet Dermatol 2015;14(4):324-331.
Choi JE, Oh GN, Kim JY, Seo SH, Ahn HH, Kye YC. Ablative fractional laser treatment for hypertrophic scars: Comparison between Er:YAG and CO2 fractional lasers. J Dermatolog Treat 2014;25(4):299-303.
Khatri KA, Ross V, Grevelink JM, Magro CM, Anderson RR. Comparison of erbium:YAG and carbon dioxide lasers in resurfacing of facial rhytides. Arch Dermatol 1999;135(4):391-397.
Bowen RE. A novel approach to ablative fractional treatment of mature thermal burn scars. J Drugs Dermatol 2010;9(4):389-392.
Issler-Fisher AC, Fisher OM, Haertsch P, Li Z, Maitz PKM. Ablative fractional resurfacing with laser-facilitated steroid delivery for burn scar management: Does the depth of laser penetration matter? Lasers Surg Med 2019. [published online ahead of print September 30, 2019].
Bedi VP, Chan KF, Sink RK, et al. The effects of pulse energy variations on the dimensions of microscopic thermal treatment zones in nonablative fractional resurfacing. Lasers Surg Med 2007;39(2):145-155.
Laubach HJ, Tannous Z, Anderson RR, Manstein D. Skin responses to fractional photothermolysis. Lasers Surg Med 2006;38(2):142-149.
Haedersdal M, Moreau KE, Beyer DM, Nymann P, Alsbjørn B. Fractional nonablative 1540 nm laser resurfacing for thermal burn scars: A randomized controlled trial. Lasers Surg Med 2009;41(3):189-195.
Taudorf EH, Danielsen PL, Paulsen IF, et al. Non-ablative fractional laser provides long-term improvement of mature burn scars-A randomized controlled trial with histological assessment. Lasers Surg Med 2015;47(2):141-147.
Karmisholt KE, Banzhaf CA, Glud M, et al. Laser treatments in early wound healing improve scar appearance: A randomized split-wound trial with nonablative fractional laser exposures vs. untreated controls. Br J Dermatol 2018;179(6):1307-1314.
Ibrahim SM, Saudi WM, Abozeid MF, Elsaie ML. Early fractional carbon dioxide laser intervention for postsurgical scars in skin of color. Clin Cosmet Investig Dermatol 2019;12:29-34.
Gold MH, McGuire M, Mustoe TA, et al. Updated international clinical recommendations on scar management: Part 2-Algorithms for scar prevention and treatment. Dermatol Surg 2014;40(8):825-831.
Shumaker PR, Kwan JM, Badiavas EV, Waibel J, Davis S, Uebelhoer NS. Rapid healing of scar-associated chronic wounds after ablative fractional resurfacing. Arch Dermatol 2012;148(11):1289-1293.
Diegidio P, Hultman CS. Clinical Scar Research: Quantitative and Qualitative Assessment of Hypertrophic Burn Scars. In: Krakowski AC, Shumaker PR, editors. The Scar Book. Philadelphia, PA: Wolters Kluwer; 2017. pp 369-381.
Sullivan T, Smith J, Kermode J, McIver E, Courtemanche DJ. Rating the burn scar. J Burn Care Rehabil 1990;11(3):256-260.
Poetschke J, Schwaiger H, Gauglitz GG. Current and emerging options for documenting scars and evaluating therapeutic progress. Dermatol Surg 2017;43(Suppl 1):S25-S36.
Fearmonti RM, Bond JE, Erdmann D, Levin LS, Pizzo SV, Levinson H. The modified Patient and Observer Scar Assessment Scale: a novel approach to defining pathologic and nonpathologic scarring. Plast Reconstr Surg 2011;127(1):242-247.
Lee KC, Dretzke J, Grover L, Logan A, Moiemen N. A systematic review of objective burn scar measurements. Burns Trauma 2016;4:14.
Wanner M, Sakamoto FH, Avram MM, et al. Immediate skin responses to laser and light treatments: Therapeutic endpoints: How to obtain efficacy. J Am Acad Dermatol 2016;74(5):821-833. quiz 834, 833.
Zuccaro J, Ziolkowski N, Fish J. A systematic review of the effectiveness of laser therapy for hypertrophic burn scars. Clin Plast Surg 2017;44(4):767-779.
Bernstein LJ, Kauvar AN, Grossman MC, Geronemus RG. The short- and long-term side effects of carbon dioxide laser resurfacing. Dermatol Surg 1997;23(7):519-525.
Graber EM, Tanzi EL, Alster TS. Side effects and complications of fractional laser photothermolysis: Experience with 961 treatments. Dermatol Surg 2008;34(3):301-305. discussion 305-307.
Metelitsa AI, Alster TS. Fractionated laser skin resurfacing treatment complications: A review. Dermatol Surg 2010;36(3):299-306.
Xu LY, Kilmer SL, Ross EV, Avram MM. Bacterial infections following non-ablative fractional laser treatment: A case series and discussion. Lasers Surg Med 2015;47(2):128-132.
Sarnoff GH, Doerfler B, Hanke GJ. The safety of laser skin resurfacing with the microablative carbon dioxide laser and review of the literature. J Drugs Dermatol 2018;17(11):1157-1162.
Fisher GH, Geronemus RG. Short-term side effects of fractional photothermolysis. Dermatol Surg 2005;31(9 Pt 2):1245-1249. discussion 1249.
Duke D, Grevelink JM. Care before and after laser skin resurfacing. A survey and review of the literature. Dermatol Surg 1998;24(2):201-206.
Nanni CA, Alster TS. Complications of carbon dioxide laser resurfacing. An evaluation of 500 patients. Dermatol Surg 1998;24(3):315-320.
Setyadi HG, Jacobs AA, Markus RF. Infectious complications after nonablative fractional resurfacing treatment. Dermatol Surg 2008;34(11):1595-1598.
Anthonissen M, Daly D, Janssens T, Van den Kerckhove E. The effects of conservative treatments on burn scars: A systematic review. Burns 2016;42(3):508-518.
Mustoe TA, Cooter RD, Gold MH, et al. International clinical recommendations on scar management. Plast Reconstr Surg 2002;110(2):560-571.
Nanda S, Reddy BS. Intralesional 5-fluorouracil as a treatment modality of keloids. Dermatol Surg 2004;30(1):54-56. discussion 56-57.
Kouba DJ, LoPiccolo MC, Alam M, et al. Guidelines for the use of local anesthesia in office-based dermatologic surgery. J Am Acad Dermatol 2016;74(6):1201-1219.
Edkins RE, Hultman CS, Collins P, Cairns B, Hanson M, Carman M. Improving comfort and throughput for patients undergoing fractionated laser ablation of symptomatic burn scars. Ann Plast Surg 2015;74(3):293-299.
Alexis AF. Lasers and light-based therapies in ethnic skin: treatment options and recommendations for Fitzpatrick skin types V and VI. Br J Dermatol 2013;169(Suppl 3):91-97.
Lv K, Xia Z. Chinese expert consensus on clinical prevention and treatment of scar. Burns Trauma 2018;6:27.
Danielsen PL, Lerche CM, Wulf HC, et al. Acute ultraviolet radiation perturbs epithelialization but not the biomechanical strength of full-thickness cutaneous wounds. Photochem Photobiol 2016;92(1):187-192.
Due E, Rossen K, Sorensen LT, Kliem A, Karlsmark T, Haedersdal M. Effect of UV irradiation on cutaneous cicatrices: A randomized, controlled trial with clinical, skin reflectance, histological, immunohistochemical and biochemical evaluations. Acta Derm Venereol 2007;87(1):27-32.
Wanitphakdeedecha R, Phuardchantuk R, Manuskiatti W. The use of sunscreen starting on the first day after ablative fractional skin resurfacing. J Eur Acad Dermatol Venereol 2014;28(11):1522-1528.
Chandrashekar BS, Shenoy C, Madura C. Complications of laser and light-based devices therapy in patients with skin of color. Indian J Dermatol Venereol Leprol 2019;85(1):24-31.