Walia S, Alster T S
Washington Institute of Dermatologic Laser Surgery, Washington, DC, USA.
Dermatol Surg. 1999 Dec;25(12):926-30. doi: 10.1046/j.1524-4725.1999.99115.x.
The recent development of high-energy pulsed CO2 lasers that minimize thermal injury to uninvolved adjacent structures has revolutionized the manner in which atrophic facial scars are recontoured. Significant improvement of atrophic scars with laser resurfacing has clearly been demonstrated; however, the exact timing for assessment of skin for further treatment has varied due to the unknown amount of time needed after laser scar resurfacing to effect maximal collagen formation and remodeling.
The aim of this study was to determine the immediate and long-term (12-18 months) histologic and clinical effects of atrophic acne scars after CO2 laser resurfacing in order to provide physician guidelines for postoperative clinical assessment for retreatment.
Sixty patients (50 women, 10 men, mean age 38 years, skin types I-V) with moderate to severe atrophic facial scars were evaluated. Nineteen patients received regional cheek treatment and 41 patients received full-face resurfacing with a high-energy pulsed CO2 laser. Independent clinical assessments of treated scars were performed at 1, 6, 12, and 18 months and blinded histologic analyses were made of skin biopsies immediately prior to and after laser resurfacing, and at 1, 6, 12, and 18 months postoperatively in six patients.
Significant immediate and prolonged clinical improvement in skin tone, texture, and appearance of CO2 laser-irradiated scars was seen in all patients. Average clinical improvement scores were 2.22 (69%) at 1 month, 2.1 (67%) at 6 months, 2.37 (73%) at 12 months, and 2.5 (75%) at 18 months. Continued collagenesis and subsequent dermal remodeling were observed on histologic examination of biopsied tissue up to 18 months after surgery.
Continued clinical improvement was observed as long as 18 months after CO2 laser resurfacing of atrophic scars, with an 11% increase in improvement observed between 6 and 18 months postoperatively. We propose that a longer postoperative interval (12-18 months) prior to assessment for re-treatment be advocated in order to permit optimal tissue recovery and an opportunity for collagen remodeling.
近期高能脉冲二氧化碳激光的发展使对未受累相邻结构的热损伤降至最低，彻底改变了萎缩性面部瘢痕重塑的方式。激光换肤术对萎缩性瘢痕有显著改善已得到明确证实；然而，由于激光瘢痕重塑后实现最大程度的胶原蛋白形成和重塑所需的时间未知，进一步治疗的皮肤评估的确切时机各不相同。
本研究的目的是确定二氧化碳激光换肤术后萎缩性痤疮瘢痕的即时和长期（12 - 18个月）组织学和临床效果，以便为再次治疗的术后临床评估提供医生指导。
评估了60例（50名女性，10名男性，平均年龄38岁，皮肤类型I - V）中度至重度萎缩性面部瘢痕患者。19例患者接受局部脸颊治疗，41例患者接受高能脉冲二氧化碳激光全脸换肤。在1、6、12和18个月时对治疗后的瘢痕进行独立临床评估，并对6例患者在激光换肤术前、术后即刻以及术后1、6、12和18个月时的皮肤活检进行盲法组织学分析。
所有患者的二氧化碳激光照射瘢痕在肤色、质地和外观方面均有显著的即时和长期临床改善。平均临床改善评分在1个月时为2.22（69%），6个月时为2.1（67%），12个月时为2.37（73%），18个月时为2.5（75%）。术后长达18个月的活检组织组织学检查显示持续的胶原形成和随后的真皮重塑。
萎缩性瘢痕二氧化碳激光换肤术后长达18个月仍观察到临床持续改善，术后6至18个月改善率增加了11%。我们建议提倡在评估再次治疗前延长术后间隔时间（12 - 18个月），以便实现最佳组织恢复并为胶原蛋白重塑提供机会。
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