Department of Surgery, Center for Organogenesis Research and Trauma, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA.
Adv Wound Care (New Rochelle). 2023 Feb;12(2):68-84. doi: 10.1089/wound.2021.0045. Epub 2022 Aug 11.
Laser use has become part of the gold standard of treatment as an effective adjuvant in multimodal therapy for pathologic scarring caused by burns, trauma, acne, and surgery, as well as vascular anomalies. Understanding indications and applications for laser therapy is essential for physicians to improve patient outcomes. Since the 1980s, the medical use of lasers has continuously evolved with improvements in technology. Novel lasers and fractionated technologies are currently being studied in the hopes to improve treatment efficacy, while reducing complications. Recent advancements include acne treatment with novel picosecond lasers, new hypertrophic scar therapies with simultaneous laser and intense pulsed light use, and novel systems such as lasers with intralesional optical fiber delivery devices. In addition, optimizing the timing of laser therapy and its use in multimodal treatments continue to advance the field of photothermolysis. Selecting the correct laser for a given indication is the fundamental decision when choosing a laser balancing effective treatment with minimal complications. This article covers the principles of laser therapy, the preferred lasers used for the treatment of scarring and vascular anomalies, and discusses the current evidence behind these laser choices. To optimize laser therapy, larger randomized control trials and split scar studies are needed. Continued advancement through better randomized controlled studies will help to improve patient outcomes on a broader scale.
激光的应用已经成为治疗病理性瘢痕的金标准的一部分，这些病理性瘢痕可由烧伤、创伤、痤疮和手术以及血管畸形引起。了解激光治疗的适应证和应用对于提高患者的治疗效果至关重要。自 20 世纪 80 年代以来，随着技术的不断进步，激光在医学上的应用也在不断发展。目前正在研究新型激光器和分割技术，以期提高治疗效果，同时减少并发症。最近的进展包括使用新型皮秒激光器治疗痤疮、同时使用激光和强脉冲光治疗增生性瘢痕的新疗法，以及新型系统，如带有瘤内光纤输送装置的激光器。此外，优化激光治疗的时机及其在多模态治疗中的应用也在不断推进光热解领域的发展。在选择激光时，为特定适应证选择正确的激光是平衡有效治疗和最小化并发症的基本决策。本文介绍了激光治疗的原理、治疗瘢痕和血管畸形的首选激光器，并讨论了这些激光选择背后的现有证据。为了优化激光治疗，需要进行更大规模的随机对照试验和瘢痕分割研究。通过更好的随机对照研究继续取得进展，将有助于更广泛地改善患者的治疗效果。
