Karmisholt Katrine E, Wenande Emily, Thaysen-Petersen Daniel, Philipsen Peter A, Paasch Uwe, Haedersdal Merete
Bispebjerg University Hospital, Copenhagen, Denmark.
University of Leipzig, Leipzig, Germany.
Lasers Surg Med. 2018 Jan;50(1):28-36. doi: 10.1002/lsm.22707. Epub 2017 Aug 16.
Laser treatment in the early phases of wound healing may reduce scar formation. However, little is known on when in the early wound healing phases laser exposure most optimally should be provided and at which fluence levels. This study investigates the clinical effect of non-ablative-fractional-laser (NAFL) performed at three early time points at a range of fluence levels versus untreated control scars.
A randomized, controlled, intra-individual trial with erbium-glass 1,540 nm NAFL versus no laser treatment on sixteen subjects receiving 10 standardized full-thickness punch-biopsy wounds. A single NAFL-exposure was applied to test-wounds 1 day before, immediately after, or 2 weeks after wounding. Three fluence levels provided deep and superficial energy depositions (range 30-70 mJ/microbeam). Primary outcome comprised the total-score of the observer part of Patient-Observer-Scar-Assessment-Scale (POSAS), performed by blinded on-site assessment at 3 months follow-up. Secondary outcomes were clinical evaluation on visual-analogue-scale (VAS), reflectance measurements, and histology.
NAFL-treatment applied 1 day before, immediately after or 2 weeks after wounding had the potential to offer subtle but detectable improvement in clinical scar appearance compared to untreated controls. Thus, NAFL-exposure 1 day before wounding (POSAS-total: median of 15 vs. control-median of 16, P = 0.03, VAS: median 4.1 vs. control-median 5.5, P = 0.03, medium-fluence), as well as immediately-, and 2 weeks after wounding (POSAS-total: P ≤ 0.05, low-fluence) induced improvement compared to untreated controls. No significant differences in dyschromia were detected between NAFL-treated and control scars. Histology showed subtle changes towards more mature interwoven bundles of collagen in NAFL-treated scars as compared to controls.
This study indicates that a single NAFL-treatment at low to medium fluence performed 1 day prior, or in the early phases of wound healing, may have the potential to optimize scar formation in full thickness wounds. Lasers Surg. Med. 50:28-36, 2018. © 2017 Wiley Periodicals, Inc.
在伤口愈合早期进行激光治疗可能会减少瘢痕形成。然而，对于在伤口愈合早期的何时进行激光照射最为理想以及使用何种能量密度水平，人们了解甚少。本研究调查了在三个早期时间点、一系列能量密度水平下进行非剥脱性分数激光（NAFL）治疗与未治疗的对照瘢痕相比的临床效果。
一项随机、对照、个体内试验，对16名接受10个标准化全层打孔活检伤口的受试者，使用掺铒玻璃1540nm的NAFL治疗与不进行激光治疗进行对比。在伤口形成前1天、伤口形成后立即或伤口形成后2周对测试伤口进行单次NAFL照射。三种能量密度水平提供了深部和浅表能量沉积（范围为30 - 70mJ/微束）。主要结局包括患者 - 观察者瘢痕评估量表（POSAS）观察者部分的总分，在3个月随访时由盲法现场评估得出。次要结局包括视觉模拟量表（VAS）临床评估、反射率测量和组织学检查。
与未治疗的对照相比，在伤口形成前1天、伤口形成后立即或伤口形成后2周进行NAFL治疗有可能在临床瘢痕外观上带来细微但可检测到的改善。因此，伤口形成前1天进行NAFL照射（POSAS总分：中位数为15，对照中位数为16，P = 0.03，VAS：中位数4.1，对照中位数5.5，中等能量密度），以及伤口形成后立即和2周进行照射（POSAS总分：P≤0.05，低能量密度）与未治疗的对照相比均有改善。在NAFL治疗的瘢痕与对照瘢痕之间未检测到色素沉着异常的显著差异。组织学显示，与对照相比，NAFL治疗的瘢痕中胶原束向更成熟的交织状态有细微变化。
本研究表明，在伤口形成前1天或伤口愈合早期进行单次低至中等能量密度的NAFL治疗，可能有潜力优化全层伤口的瘢痕形成。《激光外科与医学》50:28 - 36，2018。©2017威利期刊公司
