Combination laser treatment for immediate post-surgical scars: a retrospective analysis of 33 immature scars

Very Early Pulsed Dye Laser Intervention for Optimal Cosmetic Outcome in Post-Thyroidectomy Scars

Purpose

Early intervention of surgical scars with a pulsed dye laser is known to effectively prevent pathologic scars. Despite multiple reports on the effectiveness of the treatment, very few studies have demonstrated its appropriate initiation timing. In this study, our objective was to determine the optimal timing for initiating laser treatment following thyroidectomy.

Methods

This study retrospectively analyzed 91 patients undergoing pulsed dye laser treatment post-thyroidectomy, grouping them by treatment initiation timing. The patients underwent treatment at intervals of 3-4 weeks with at least five sessions. Those with a high pliability score were injected with intralesional corticosteroids. The Antera 3D® skin imaging analyzer was used to assess biophysical parameters.

Results

The total Vancouver Scar Scale score significantly reduced after treatment in all groups. The Vancouver Scar Scale score reduction rate was significantly higher after treatment in the group for which the treatment was initiated within 3 weeks of surgery. The pigmentation and erythema score analyzed by Antera 3D® was also lower in this group.

Conclusion

Early intervention using a pulsed dye laser within 3 weeks of thyroidectomy can substantially inhibit pathological scar development, providing physicians with a guide for optimal treatment commencement.

Early Postoperative Polydeoxyribonucleotide Injections Prevent Hypertrophic Scarring after Thyroidectomy: A Randomized Controlled Trial

OBJECTIVE

Polydeoxyribonucleotide (PDRN) is known to enhance wound healing, but there has been no clinical trial investigating the effect of PDRN on scar prevention in surgical wounds. This study aimed to evaluate the efficacy of PDRN administration in preventing postoperative scars.

APPROACH

In this randomized controlled trial (NCT05149118), 44 patients who underwent open thyroidectomy were randomly assigned to the PDRN treatment or untreated control group. Only patients in the treatment group received two consecutive injections of PDRN one and two days after surgery. The modified Vancouver Scar Scale (mVSS), patients' subjective symptoms, erythema index (EI), melanin index (MI), and scar height were assessed three months after surgery.

RESULTS

Patients in the treatment group had lower mVSS scores (1.619 ± 1.244 vs. 2.500 ± 1.540, respectively; P = 0.059) and a significantly lower vascularity subscore (0.476 ± 0.512 vs. 0.900 ± 0.447, respectively; P = 0.010) than those in the control group at the 3-month follow-up. Compared with the control group, the level of subjective symptoms, EI, and scar height were all significantly lowered in the PDRN injection group. No specific side effects related to PDRN injection were observed.

INNOVATION

This is the first clinical study which demonstrated that PDRN injections rapidly decreased postsurgical wound erythema and as a result, significantly reduced both excessive scar formation and accompanying symptoms.

CONCLUSION

Early postoperative injection of PDRN is an effective and safe treatment to prevent hypertrophic scars and improve scar outcomes.

Mitigation of Postsurgical Scars Using Lasers: A Review

Background:

Most postsurgical scars are considered esthetically and functionally acceptable. Currently, there is no definite consensus treatment for postsurgical scarring. The purpose of this review is to shed some light on the value of scar mitigation and the efficacy of different lasers employed on postsurgical wounds.

Methods:

A systematic literature review and computational analysis were conducted to identify relevant clinical articles that pertained to the use of lasers for mitigating postsurgical scars. Articles included the National Institutes of Health–National Center for Biotechnology Information–PubMed search and sources cited from relevant studies after 1995. Trials that attributed pre- and posttreatment scores of scar severity based on a verified scar evaluation scale (eg, Patient and Observer Scar Assessment Scale, Vancouver Scar Scale, Global Assessment Scale) were chosen. Clinical assessments varied for each study. To adequately assess the efficacy of the modalities, the final scaled scar appearance scores were realigned and normalized to a standard scale for unbiased comparison.

Results:

After filtering through a total of 124 studies, 14 relevant studies were isolated and thus included in the review. Studied lasers were as follows: Pulsed dye laser (PDL), carbon dioxide, diode, potassium titanyl phosphate (KTP), and erbium glass (Er-Glass) lasers.

Conclusion:

Treatment with lasers in the postsurgical wound healing phase is safe, effective, and advised in mitigation of pathologic scar formation.

Microdermal Grafting for Color Regeneration of White Scars

White scars are defined in this study as mature hypopigmented surgical or traumatic scars whose color is much lighter than surrounding skin, to the extent that they appear white. These scars are often obvious and very difficult to treat or mask. This 3-year retrospective study reports the outcomes from 38 recipients of a new microdermal grafting surgery we developed, which introduces melanocytes into the white scar lesion to regenerate skin color. The study shares 18 years of experience with this procedure, describes the surgical steps, offers videos of the procedures, and presents 4 cases. Between September 2013 and December 2016, 38 patients (30 females; 8 males) underwent microdermal grafting for color regeneration of white scars in our plastic surgery clinic. Most patients, 78.9%, received 1 treatment, 15.8% received 2 treatments, and 5.3% received 3 treatments. Three lay judges were asked to assess percentage pigmentation recovery by comparing photographic images of patients' preoperative and postoperative scars. Patients were also asked to assess, via a questionnaire, satisfaction and percentage improvement 1 year after surgical treatment. Lay judges found an average of 49% improvement after 1 session, 75% after 2 sessions, and 90% after 3 sessions. In total, 71.1% of the patients completed the questionnaire 1 year after the surgery. Average subjective improvement was 55% after 1 session, 88% after 2 sessions, and 95% after 3 sessions. The patient satisfaction rate was high. Microdermal grafting provides adequate treatment of white scars by regenerating melanocytes, although more than 1 session treatment may be needed.