Department of Plastic and Reconstructive Surgery, Xijing Hospital, Forth Military Medical University, Xi'an, Shaanxi, China.
Lasers Surg Med. 2024 Nov;56(9):770-775. doi: 10.1002/lsm.23846. Epub 2024 Sep 22.
Scars resulting from injuries or surgical procedures often present both physical and aesthetic challenges. Recent studies have indicated promising results in improving postoperative scar outcomes through the combined use of specific laser technologies. Nevertheless, there remains a crucial need for further exploration to ascertain the optimal timing for initiating such treatments.
In this retrospective investigation, a cohort of 47 adult patients who did not require hospitalization was analyzed. These patients were divided into two distinct groups: Group A, which received intervention beginning 2 weeks after their respective operations, and Group B, which commenced intervention 4 weeks postoperation. Each group underwent a comprehensive treatment protocol consisting of five laser sessions. Initially, patients underwent three sessions of V-beam pulsed-dye laser (PDL) therapy followed by two sessions of ablative fractional CO laser (AFL) therapy. Evaluation of outcomes was conducted using advanced imaging techniques such as Antera 3D imaging, in conjunction with established scar assessment tools including the Vancouver Scar Scale (VSS) and the University of North Carolina "4P" Scar Scale (UNC4P).
All patients successfully completed the full course of five treatment sessions, with no dropouts and no reported adverse events. Baseline cosmetic assessments of scars were equivalent across both groups. In Group A, the mean VSS scores decreased from 7.04 before treatment to 5.29 at 3 months posttreatment and further to 4.33 at 6 months posttreatment. Meanwhile, in Group B, scores decreased from 7.52 to 6.83 at 3 months and 6.17 at 6 months. There were no statistically significant differences in baseline VSS scores between the two groups (p = 0.34). At both the 3- and 6-month follow-up points, mean VSS scores were significantly lower in Group A compared to Group B (p < 0.05). Similar trends were observed in UNC4P scores. Statistically significant differences were noted across all time points (baseline, 3 months, and 6 months posttreatment) for both VSS and UNC4P scores (p < 0.05). Subset analysis revealed greater improvements in texture and depression volume at 3 months posttreatment, while improvements in depression area, depth, elevation variation, and area were more pronounced at the 6-month mark.
Early intervention using the combined 595-nm pulse dye laser and CO ablative fractional laser (AFL) 2- and 4-weeks post-surgery proves to be an effective and safe method for improving scar outcomes, particularly for facial surgical scars when treatment starts 2 weeks after surgery. However, further research is needed to refine our understanding and address potential study limitations.
受伤或手术导致的疤痕会带来身体和美观方面的双重挑战。最近的研究表明，特定的激光技术联合应用在改善术后疤痕效果方面具有良好的前景。然而，仍需要进一步探索以确定开始此类治疗的最佳时机。
在这项回顾性研究中，分析了一组 47 名无需住院的成年患者。这些患者分为两组：A 组在术后 2 周开始干预，B 组在术后 4 周开始干预。两组均接受了包括 5 次激光治疗在内的综合治疗方案。首先，患者接受 3 次 V 型脉冲染料激光（PDL）治疗，然后进行 2 次剥脱性分数 CO2 激光（AFL）治疗。使用先进的成像技术，如 Antera 3D 成像，以及公认的疤痕评估工具，包括温哥华疤痕量表（VSS）和北卡罗来纳大学“4P”疤痕量表（UNC4P），对治疗结果进行评估。
所有患者均成功完成了 5 次治疗的全部疗程，无脱落病例，无不良事件报告。两组患者的疤痕基线美容评估相当。A 组 VSS 评分从治疗前的 7.04 分降至治疗后 3 个月的 5.29 分，再降至 6 个月的 4.33 分。与此同时，B 组的评分从 7.52 分降至 3 个月的 6.83 分和 6 个月的 6.17 分。两组间 VSS 评分的基线差异无统计学意义（p=0.34）。在 3 个月和 6 个月的随访时，A 组的平均 VSS 评分均显著低于 B 组（p<0.05）。UNC4P 评分也呈现出相似的趋势。VSS 和 UNC4P 评分在所有时间点（基线、3 个月和 6 个月）均存在显著差异（p<0.05）。亚组分析显示，在治疗后 3 个月时，纹理和凹陷容积的改善更为明显，而在 6 个月时，凹陷面积、深度、隆起变化和面积的改善更为显著。
在术后 2 至 4 周内使用 595nm 脉冲染料激光联合 CO 剥脱性分数激光进行早期干预是改善疤痕效果的有效且安全的方法，尤其适用于面部手术疤痕。然而，仍需要进一步的研究来深化我们的认识并解决潜在的研究局限性。
