The Efficacy of Low Energy Fractional Carbon Dioxide Laser Therapy in Management of Post-Surgical Hypertrophic Scars

Al-Marzouqi, Hamda; Nagy, Eman; Sair, Mohamed; Mabrouk, Amr

doi:10.21608/ejprs.2022.254701

The Efficacy of Low Energy Fractional Carbon Dioxide Laser Therapy in Management of Post-Surgical Hypertrophic Scars

Document Type : Research article

Authors

The Department of Plastic Surgery, Burns and Maxillo-Facial Surgery, Faculty of Medicine, Ain Shams University

10.21608/ejprs.2022.254701

Abstract

Background: Hypertrophic Scars result from abnormal
wound healing due to an inflammatory process within the
wound and are mainly constituted of fibroblasts formation,
neoangiogensis and substantial deposition of collagen. HS
likely arise during a few months in high tension area and can
persist along the margins of the original wound. Hypertrophic
scars arise after various injury mechanisms such as traumatic
skin injury, skin burns, surgical wounds, skin injections and
dermatitis. Among which, surgeries are considered to be one
of the major causes of Hypertrophic Scars.
Aim of Study: The aim of this study was to evaluate the
efficacy of low energy carbon dioxide laser therapy in management
of hypertrophic surgical scars in comparison to the
standardized high energy modes in regards of scar ablation
and patient satisfaction.
Patients and Methods: This study is a prospective and a
comparative that compared traditional High energy with Low
Energy fractional CO2 laser in treatment of Hypertrophic
post-surgical scars. This study was conducted between April
2021 to March 2022 at the Laser Unit attached to plastic,
Burn and Maxillofacial Surgery Department at Faculty of
Medicine, Ain Shams University. The study included 40
patients (N=40), all of which were complaining of post
Abdominoplasty Hypertrophic scars and were divided blindly
into 2 groups. In group I (n=20), they were treated by standard
high energy fractional CO2 laser therapy Light FX: Energy
(70-150mJ), density (5-10%), and frequency (150-250Hz),
Deep FX: Energy (15.5-25.5mJ), density (5-15%) and frequency
(300-600Hz), Active FX: Energy (100-150mJ), density
(5%) and frequency (200-250Hz). In group II (n=20), they
were treated by lower energy modes than group I, Light FX:
Energy (50-120mJ), density (5%), and frequency (100-200Hz),
Deep FX: Energy (12.5-22.5mJ), density (3-10%) and frequency
(200-400Hz), Active FX: (80-125mJ), density (3%)
and frequency (100-150Hz). Both groups were treated by
Syneron/CANDELA CO2RE® laser machine and both groups
were evaluated by, 3 different observers using the VSS score
once before starting sessions and twice on two separate
occasions after completion of sessions. Patients in both groups
also evaluated themselves using the POSAS score. Results of
231
both groups were compared in regards to mean age, history
of Abdominoplasty, history of massive weight loss, post
session complication, skin quality, mean POSAS score before
and after, and mean VSS before and after.
Conclusion: After review of both groups; we have concluded
that high frequency fractional CO2 laser offers greater
results in regards to scar ablation which could be notably
measured by the VSS variables at the cost of longer recovery
times and potentially more irritation to the patients. On the
other hand, the low frequency fractional CO2 laser scar
ablation is likely to offer moderate results, and an easier and
shorter recovery times thus may contribute to greater patient
satisfaction. Overall, this selection of frequencies allows the
physician options to customize the appropriate care for their
patients according to their patient's needs and circumstances.

Keywords

Main Subjects

Aesthetics

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