Presidential Greeting - American Society for Laser Medicine and ...

#53
NON-ABLATIVE FRACTIONAL LASER
RESURFACING FOR THE TREATMENT OF SCARS
AND GRAFTS AFTER MOHS MICROGRAPHIC
SURGERY: A RANDOMIZED CONTROLLED TRIAL
Evelien Verhaeghe, Katia Ongenae, Jessica
Bostoen, Jo Lambert
University Hospital Ghent, Gent, Belgium
Background: Mohs micrographic surgery is a tissue sparing
surgical technique for removal of skin cancer in the head and neck
region. To optimize the cosmetic result of the scars and skin grafts
after surgery non-invasive procedures as non ablative fractional
laser resurfacing are a treatment of choice. The objective of this
study was to evaluate the efficacy and safety of 1,540 nm nonablative
fractional laser (NAFL) in the treatment of scars and full
thickness grafts after Mohs surgery.
Study: Intra-individual randomized controlled trial (RCT) with
split lesion design and single blinded outcome evaluations.
Patients receive four treatments at monthly interval with NAFL
(Starlux-300 with Lux 1,540 nm fractional hand piece (Palomar
Technologies)). Patients are evaluated 1 and 3 months after the
last treatment. Primary outcome measures are clinical efficacy
(assessed by blinded on site visual and palpable Physician Global
Assessment (PhGA)), adverse effects and pain (assessed by a
visual analogue scale (VAS)). Patients Global Assessment (PGA)
was also measured.
Results: Preliminary results based on 18 patients show a
significant difference of the PhGA comparing the laser treated
parts to the untreated control side 1 (P ¼ 0.04) and 3 months
(P ¼ 0.007) after treatment (Wilcoxon signed rank test). Patients
experienced mild to moderate pain (median VAS score 3.1) during
the treatment. Four days after treatment patients reported
erythema (69%), edema (38%), crusts (17%), burning sensation
(13%), purpura (6%) and vesicles (3%). No long-term adverse
effects were seen 3 months after the last treatment. There is also a
significant difference of the PGA 1 (P ¼ 0.02) and 3 months
(P ¼ 0.01) after the last treatment (Wilcoxon signed rank test).
Conclusion: Based on these preliminary results non-ablative
1,540 nm fractional laser seems to be a safe and effective treatment
for the improvement of scars and grafts after Mohs surgery.
#54
American Society for Laser Medicine and Surgery Abstracts 17
HISTOLOGIC CHARACTERISTICS OF MATURE
BURN SCARS BEFORE AND AFTER THREE
TREATMENTS WITH FRACTIONAL CO2 LASER
David Ozog, Marsha Chaffins, Ronald Moy,
Elizabeth Farhat
Henry Ford Hospital Detroit, MI; UCLA, Los Angeles, CA
Background: Treatment of mature burn scars (greater than 1
year since injury) have been reported to show clinical
improvement after treatment with fractional CO2 lasers in noncontrolled
studies and case reports. Currently, there are no
prospective reports showing the histological and gene expression
changes after treatments. Additionally, little is known about the
remodeling of collagen by subtype after treatment. This
prospective study intended to quantify the changes to collagen
gross structure as well as changes in type I and type III collagen
after treatment. Additional gene parameters were also examined.
Study: Ten patients with mature burn scars were recruited from
the Grossman Burn Center in Sherman Oaks California. The
average age was 35 years old, average body surface area was 35%,
and the average treatment area was 280 cm 2 . Patients were
treated were biopsied prior to treatment with fractional CO 2
Ultrapulse laser (Lumenis Corp). The area was marked and
photographed. Over a 6-month timeframe, three treatments were
performed on subjects. A follow-up biopsy was performed on all
subjects 1 month after final treatment. Biopsies were stained with
collagen stains and reviewed by dermatopathologists.
Results: Patients had significant improvement in gross
histological appearance of hypertrophic burn scars. Collagen
subtype profiles returned toward normal ratios.
Conclusion: Treatment with fractional CO2 lasers of mature
burn scars improves the histological gross appearance of these
scars. Additionally, the type of collagen produced trends toward
normal ratios.
#55
SUCCESSFUL TREATMENT OF POST BURN
SCARS WITH FRACTIONAL CO2 LASER IN INDIAN
SKIN
Niteen Dhepe, Ashok Naik, Sahil Dhavan, Shilpa
Shah
Pune, India
Background: There are no reports from India of treatment of
post burn scars with lasers. We present a report of successful
treatment of post burn scars with a novel fractional CO2 laser
delivery system.
Study: Patients (24) with post-burn scars of average 6-year
duration were treated with Ultrapulse Deep FX fractional CO2
laser. Typical protocol is three treatments at an interval of 2–3
months in between and used 0.12 mm spots with density 5%,
single stacking and pulse fluence of 20 mJ to 35 mJ/pulse as per
thickness of scar with topical tetracaine 7% and lignocaine 7%.
The scars are assessed for thickness, surface wrinkling, color
match with surrounding at the time of each treatment, 1, 2, and 3
months post-operatively after last sitting by two independent
dermatologists on VAS of 4. Pain during treatment is scored by
patient on a VAS of 4.
Results: Three months after three sessions of fractional CO2 treatment reduced the scar thickness to a mean VAS score of 3.47
out of 4. The score increased from 2.14 before second sitting to 3.47
at 3rd month follow-up of last sitting. Reduction in scar surface
wrinkling was 3.85, and color match to surrounding was 2.89 on a
VAS scale of 4. Pain during procedure scored by patient was 1.12
on scale of 4 using topical anesthesia.
Conclusion: Fractional CO2 laser with DeepFx scanner is a well
tolerated and effective treatment of hypertrophic post-burn scars
in Indian patients.
#56
TREATMENT OF SCARS WITH A NEW HANDHELD
810 NM LASER
Nathalie Fournier
Clapiers, France
Background: Previous evaluations have demonstrated that a
novel 810 nm diode laser system could improve skin healing
leading to a scar reduction 1,2 . This technique named Laser
Assisted Skin Healing (LASH) has demonstrated its efficacy in
plastic surgery. This study aimed to demonstrate the interest of
that laser for another application: patients with hypertrophic
scars or cheloids.