Bispebjerg University Hospital, Copenhagen, Denmark.
Department of Dermatology, Venereology and Allergology, University of Leipzig, Leipzig, Germany.
Br J Dermatol. 2018 Dec;179(6):1307-1314. doi: 10.1111/bjd.17076. Epub 2018 Sep 30.
In recent years, various lasers have increasingly been applied during wound healing to minimize scar formation. However, no consensus regarding treatment procedures exists.
To assess scar formation clinically after three nonablative fractional laser (NAFL) exposures, targeting the inflammation, proliferation and remodelling wound healing phases in patients vs. untreated controls.
A randomized controlled trial was performed using a split-wound design to assess excisional wound halves treated with 1540-nm NAFL vs. no laser treatment. Three NAFL exposures were provided: immediately before surgery, at suture removal and 6 weeks after surgery. NAFL exposures were applied using two handpieces, sequentially distributing energy deeply and more superficially in the skin (40-50 mJ per microbeam). Evaluated at 3 months of follow-up, the primary outcome was blinded, on-site evaluation using the Patient Observer Scar Assessment Scale (POSAS total; range from 6, normal skin to 60, worst imaginable scar). Secondary outcomes comprised blinded evaluation on the Vancouver Scar Scale (VSS) and standardized assessment comparing scar sides, carried out by blinded on-site, photo and patient assessments. This trial was registered with ClinicalTrials.gov (NCT03253484).
Thirty of 32 patients completed the trial. At the 3-month follow-up, the NAFL-treated scar halves showed improvement compared with the untreated control halves on POSAS total: NAFL treated, median 11, interquartile range (IQR) 9-12 vs. control, median 12, IQR 10-16; P = 0·001. The POSAS subitems showed that the NAFL-treated halves were significantly less red and more pliable, and presented with smoother relief than the untreated controls. VSS total correspondingly revealed enhanced appearance in the NAFL-treated halves: median 2, IQR 1-2·5 vs. control, median 2, IQR 1·75-3, P = 0·007. The standardized assessment comparing appearance of scar halves demonstrated a low degree of correspondence between on-site, photo and patient assessments. NAFL-treated scars were rated as superior to untreated scars by 21 of 29 patients.
NAFL-treated scars showed subtle improvement compared with untreated control scars.
近年来，各种激光在伤口愈合过程中被越来越多地应用，以尽量减少瘢痕形成。然而，关于治疗程序尚未达成共识。
评估 3 次非剥脱性点阵激光（NAFL）治疗与未治疗对照组患者炎症、增殖和重塑伤口愈合阶段的临床瘢痕形成情况。
采用切开伤口设计进行随机对照试验，评估 1540nm NAFL 治疗的切除伤口半侧与无激光治疗的半侧。给予 3 次 NAFL 治疗：手术前、拆线时和手术后 6 周。使用两个手柄进行 NAFL 治疗，依次在皮肤深处和更浅层分布能量（每个微束 40-50mJ）。在 3 个月的随访时，主要结局是使用患者观察者瘢痕评估量表（POSAS 总分；范围从 6，正常皮肤到 60，最想象不到的瘢痕）进行盲法、现场评估。次要结局包括使用温哥华瘢痕量表（VSS）进行盲法评估和比较瘢痕侧的标准化评估，由盲法现场、照片和患者评估进行。该试验在 ClinicalTrials.gov（NCT03253484）注册。
32 例患者中有 30 例完成了试验。在 3 个月的随访时，与未治疗对照组相比，NAFL 治疗的瘢痕半侧在 POSAS 总分上有所改善：NAFL 治疗，中位数 11，四分位距（IQR）9-12 vs. 对照组，中位数 12，IQR 10-16；P=0.001。POSAS 各分项表明，NAFL 治疗的半侧明显颜色更浅，更柔韧，且较未治疗的对照组更平滑。VSS 总分相应显示 NAFL 治疗的半侧外观改善：中位数 2，IQR 1-2.5 vs. 对照组，中位数 2，IQR 1.75-3，P=0.007。比较瘢痕半侧外观的标准化评估表明，现场、照片和患者评估之间的一致性程度较低。29 例患者中有 21 例认为 NAFL 治疗的瘢痕优于未治疗的瘢痕。
与未治疗对照组相比，NAFL 治疗的瘢痕有轻微改善。
