1
|
Yenyuwadee S, Achavanuntakul P, Phisalprapa P, Levin M, Saokaew S, Kanchanasurakit S, Manuskiatti W. Effect of Laser and Energy-based Device Therapies to Minimize Surgical Scar Formation: A Systematic Review and Network Meta-analysis. Acta Derm Venereol 2024; 104:adv18477. [PMID: 38189223 PMCID: PMC10789167 DOI: 10.2340/actadv.v104.18477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/17/2023] [Indexed: 01/09/2024] Open
Abstract
Utilization of lasers and energy-based devices for surgical scar minimization has been substantially evaluated in placebo-controlled trials. The aim of this study was to compare reported measures of efficacy of lasers and energy-based devices in clinical trials in preventing surgical scar formation in a systematic review and network meta-analyses. Five electronic databases, PubMed, Scopus, Embase, ClinicalTrials.gov, and the Cochrane Library, were searched to retrieve relevant articles. The search was limited to randomized controlled trials that reported on clinical outcomes of surgical scars with treatment initiation no later than 6 months after surgery and a follow-up period of at least 3 months. A total of 18 randomized controlled trials involving 482 participants and 671 postsurgical wounds were included in the network meta-analyses. The results showed that the most efficacious treatments were achieved using low-level laser therapy) (weighted mean difference -3.78; 95% confidence interval (95% CI) -6.32, -1.24) and pulsed dye laser (weighted mean difference -2.46; 95% CI -4.53, -0.38). Nevertheless, low-level laser therapy and pulsed dye laser demonstrated comparable outcomes in surgical scar minimization (weighted mean difference -1.32, 95% CI -3.53, 0.89). The findings of this network meta-analyses suggest that low-level laser therapy and pulsed dye laser are both effective treatments for minimization of scar formation following primary closure of surgical wounds with comparable treatment outcomes.
Collapse
Affiliation(s)
- Sasitorn Yenyuwadee
- Departments of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Petchlada Achavanuntakul
- Department of Medicine, College of Medicine and Public Health, Ubonratchathani University, Ubonratchathani, Thailand
| | - Pochamana Phisalprapa
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Surasak Saokaew
- Division of Social and Administration Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Unit of Excellence on Clinical Outcomes Research and Integration (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Unit of Excellence on Herbal Medicine, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bander Sunway, Malaysia; Biofunctional Molecule Exploratory Research Group, Biomedicine Research Advancement Centre, School of Pharmacy, Monash University Malaysia, Bander Sunway, Malaysia
| | - Sukrit Kanchanasurakit
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Unit of Excellence on Herbal Medicine, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Division of Clinical Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Division of Pharmaceutical care, Department of Pharmacy, Phrae Hospital, Phrae, Thailand.
| | - Woraphong Manuskiatti
- Departments of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
2
|
Kim BR, Kwon SH, Kim JW, Jeong WJ, Cha W, Jung YH, Na JI, Huh CH, Shin JW. Early Postoperative Polydeoxyribonucleotide Injections Prevent Hypertrophic Scarring after Thyroidectomy: A Randomized Controlled Trial. Adv Wound Care (New Rochelle) 2022; 12:361-370. [PMID: 35713247 DOI: 10.1089/wound.2022.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Bo Ri Kim
- Seoul National University Bundang Hospital, 65462, Department of Dermatology, 82 Gumi-Ro 173 Beon-Gil, Seongnam, Korea (the Republic of), 13620;
| | - Soon Hyo Kwon
- Seoul National University Bundang Hospital, 65462, Department of Dermatology, Seongnam, Korea (the Republic of);
| | - Jee Woo Kim
- Seoul National University Bundang Hospital, 65462, Seongnam, Korea (the Republic of);
| | - Woo-Jin Jeong
- Seoul National University Bundang Hospital, 65462, Seongnam, Korea (the Republic of);
| | - Wonjae Cha
- Seoul National University Bundang Hospital, 65462, Seongnam, Korea (the Republic of);
| | - Young Ho Jung
- Seoul National University Bundang Hospital, 65462, Seongnam, Korea (the Republic of);
| | - Jung Im Na
- Seoul National University Bundang Hospital, 65462, Seongnam, Korea (the Republic of);
| | - Chang Hun Huh
- Seoul National University Bundang Hospital, 65462, Seongnam, Korea (the Republic of);
| | - Jung Won Shin
- Seoul National University Bundang Hospital, 65462, Seongnam, Korea (the Republic of);
| |
Collapse
|
3
|
Brewin M, Docherty S, Heaslip V, Breheny K, Pleat J, Rhodes S. Early Laser for Burn Scars (ELABS): protocol for a multi-centre randomised, controlled trial of both the effectiveness and cost-effectiveness of the treatment of hypertrophic burn scars with Pulsed Dye Laser and standard care compared to standard care alone [version 1; peer review: 2 approved]. NIHR OPEN RESEARCH 2022; 2:1. [PMID: 35392303 PMCID: PMC7612584 DOI: 10.3310/nihropenres.13234.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 11/22/2022]
Abstract
This paper outlines the protocol for a study that is being carried out at multiple centres across the UK in the next three years. It is a Research for Patient Benefit (RfPB) study funded by the National Institute for Healthcare Research (NIHR). The aim is to assess the effectiveness of treating hypertrophic burns scars with pulsed dye laser (PDL) at an early stage of scar formation. The objective is to improve Quality of Life for the patient by improving both the appearance and quality of burn scarring, as well as reducing its psychological impact. This is a parallel-arm randomised, controlled trial to compare PDL and standard care against standard care alone. The difference is measured between baseline and six-month follow-up. Recruits are within three months of healing from a burn injury; with wounds showing a defined potential for hypertrophic scarring. A total of 120 patients are recruited in a multi-centre study; with randomisation in a 1:1 allocation to each arm. The treatment arm receives 3 PDL treatments at six-week intervals in addition to standard care, whereas the control arm receives standard care alone. The primary outcome is the patient-rated part of the Patient and Observer Scar Scale (POSAS). Psychological and psycho-social impact is evaluated using the CARe burn scale (UWE, Bristol) and Quality Adjusted Life Years (QALY) is determined using the Short-Form Health Survey (SF-12). The study evaluates both the cost-effectiveness through an economic analysis and the patient-reported experience of the treatment by phone interviews.
Collapse
Affiliation(s)
- Mark Brewin
- Burns & Plastics, Salisbury NHS Foundation Trust, Salisbury, Wiltshire, SP2 8BJ, UK
| | | | | | | | - Jonathon Pleat
- Burns & Plastics, North Bristol NHS Trust, Bristol, BS10 5NB, UK
| | - Shelley Rhodes
- Exeter Clinical Trials Unit, University of Exeter, Exeter, EX4 4SB, UK
| |
Collapse
|
4
|
Peinemann F, Behrouz-Pirnia A. Quality issues identified in systematic reviews on early laser intervention to reduce scar formation in wound healing. J Plast Reconstr Aesthet Surg 2020; 73:1357-1404. [PMID: 32241740 DOI: 10.1016/j.bjps.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/21/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Frank Peinemann
- Children's Hospital, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; FOM University of Applied Science for Economics & Management, Essen, Germany.
| | - Armin Behrouz-Pirnia
- Children's Hospital, University of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| |
Collapse
|