Post-Surgical Repair of Cleft Scar Using Fractional CO2 Laser
BACKGROUND: Postoperative scarring is a common cause of patients dissatisfaction. Several modalities have been developed to overcome such a problem following surgical repair. Despite precise surgical technique, still, some scars would remain over the time, mostly due to the weak formation or inadequately replaced collagen fibres in the underneath dermis especially those following unilateral or bilateral cleft lip repair surgery.
AIM: of this study is to evaluate whether a 10,600 nm fractional ablative carbon dioxide (CO2) used early during the healing period would result in better postoperative scars.
METHODS: In the present study six patients complained from cleft lip scars resulting from lip revision surgery. Each patient had six fractional ablative CO2 laser sessions for treatment along six months to obtain a complete collagen cycle. Vancouver Scar Scale VSS was used as a method of evaluation of the scar using 4 points scale evaluating vascularity, pliability, thickness & colour of the skin and Visual Analogue Scale VAS from (0-10) was used to assess the severity of pain as well as a survey questionnaire for the rate of patientâ€™s satisfaction. Also, digital clinical photos assessment before&after were compared.
RESULTS: Patients expressed a significantly greater degree of satisfaction with the treatment using a subjective 4-point scale. All patients observed dramatic improvement in their lip scars after FCO2 laser sessions following their surgeries with the better psychological state. The assessment was done by clinical observation according to VSS before (9.17 Â± 2.2) while after (3.33 Â± 1.9) with a highly significant P value <0.001 and VAS for the rate of pain & satisfaction that ranged from (8.0 Â± 0.9) as well as series of photos taken before and after the procedure. No long-term complications were noted however patients complained of annoying pain during the session as well as crust formation that lasted up to 5 days after surgery. In the present study, we introduce the effectiveness of ablative fractional 10,600 nm CO2 laser for treatment of postoperative cleft lip scar after secondary surgical cleft repair rather than ablative CO2 due to its reported complications such as postoperative infection, erythema and pigmentary changes along with prolonged downtime healing. In the current study, we chose early laser treatment within the first six months before complete collagen organisation which will be easier to manage the older scars. Patients mostly complained about the pain during the session as well as dark-coloured crust formation post session that stayed from 3-5 days however they all observed a massive improvement of their scars following treatment protocol.CONCLUSION: Facial wounds sutured in layers heal in a good manner. Patients prefer early treatment with a fractional CO2 ablative laser for postoperative surgical scars. The use of a CO2 fractional laser is safe and effective also causes high patients satisfaction.
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Lee SH, Zheng Z, Roh R. Early postoperative treatment of surgical scars using a fractional carbon dioxide laser: a split-scar, evaluator-blinded study. J Dermatol Surg. 2013; 8:1190-6. https://doi.org/10.1111/dsu.12228 PMid:23631513
Sobanko JF, Vachiramon V, Rattanaumpawan P, Miller CJ. Early postoperative single treatment ablative fractional lasing of Mohs micrographic surgery facial scars: a split scar evaluator blinded study. 2015; 47(1):1-5.
Gotkin RH, Sarnoff DS, Cannarozo G, Sadik NS, Alexiades Armenakas M. Ablative skin resurfacing with a novel microablative CO2 laser. J Drugs Dermatol 2009; 8(2):138-44. PMid:19213229
Buelens S, Van Hove AS, Ongeane K, Lapeere H, Huvenne W, Vermeersch H, Verhaeghe E, Boone B. Fractional Carbon Dioxide Laser of Recent Surgical Scars in the Head and Neck Region: A Split-Scar, Evaluator-Blinded Study. 2017; 43:75-84. https://doi.org/10.1097/DSS.0000000000000963
Shin JU, Gantsetseg D, Jung JY, Jung I, Shin S, Lee JH. Comparison of non-ablative and ablative fractional laser treatments in a postoperative scar study. 2014; 46(10):741-9.
Waibel JS, Wulkan AJ, Shumaker PR. Treatment of hypertrophic scars using laser and laser assisted corticosteroid delvery. 2013; 45(3): 135-40.
Trelles MA, Shohat M, Urdiales F. Safe and effective one-session fractional skin resurfacing using a carbon dioxide laser device in super-pulse mode: a clinical and histologic study. 2011; 35(1): 31-42.
Weiss ET, Chapas A, Brightman L, Hunzeker C, Hale EK, Karen JK, Bernestein L, Gernonemus RG. Successful treatment of atrophic postoperative and traumatic scarring with carbon dioxide ablative fractional resurfacing. Arch Dermatol. 2010; 146(2):133-40. https://doi.org/10.1001/archdermatol.2009.358 PMid:20157023
Naeman KC, Baca ME, Piazza RC, WanderWoude DL, Renucci JD. Outcomes of fractional CO2 laser application in aesthetic surgery: a retrospective review. Aesth Surg J. 2010; 30(6):845-52. https://doi.org/10.1177/1090820X10386930 PMid:21131460
Ali Asilian, Elias Salimi, Gita Faghihi, Farideh Dehghani, Nabet Tajmirriahi and Sayed Mohsen Hosseini. Comparison of Q-Switched 1064-nm Nd:YAG laser and fractional CO2 laser efficacies on improvement of atrophic facial acne scar. J Res Med Sci. 2011; 16(9):1189-1195. PMid:22973388 PMCid:PMC3430044
Nilfourashzadeh MA, Minaravesh S, Jaffary F, Siadat AH, Haftbaradaran E. Comparison the efficacy of ablative CO2 laser and fractional CO2 laser on the healing of cutaneous leishmaniasis scars. Adv Biomed Res. 2014; 31(3):259.
Choi JE, Oh GN, Kim JY, Seo SH, Ahh HH, Kye YC. Ablative fractional laser treatment for hypertrophic scars: comparison between Er:YAG and CO2 fractional lasers. J Dermatol Treat. 2014; 25(4):299-303. https://doi.org/10.3109/09546634.2013.782090 PMid:23621348
Eiler RE jr, Ross EV, Cohen JL, Ortiz AE. A Combination approach to surgical scars. Dermatol Surg. 2016; 42:150-6. https://doi.org/10.1097/DSS.0000000000000750 PMid:27128241
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