Advertisement

Surgical Scars

  • Shilpi Khetarpal
  • Jeffrey S. Dover
  • Kenneth Arndt
Chapter

Abstract

The realm of scar therapeutics is constantly changing. Several factors need to be considered when developing a comprehensive treatment plan for scar rehabilitation, including those related to the patient and the nature of the scar. Scar characteristics can be divided by color, scar type and thickness, and body location. Many agents including topical, intralesional, light and laser-based treatment modalities can be used to revitalize and restore damaged skin. The most commonly used lasers are the pulsed-dye laser (PDL) and either fractional ablative or fractional non-ablative devices. Ideally, a combination approach using topical and intralesional medications along with PDL and a fractional laser should be considered in all patients wishing to undergo treatment of their scars.

Keywords

Scars Hypertrophic scars Keloids Pulsed-dye laser Fractional resurfacing Microneedling 

References

  1. 1.
    Alster T, Scanion LZ. Laser scar revision: a review. Dermatol Surg. 2007;33:131–40.PubMedGoogle Scholar
  2. 2.
    Eilers RE, Ross EV, Cohen JL, Ortiz AE. A combination approach to surgical scars. Dermatol Surg. 2016;42:S150–6.CrossRefGoogle Scholar
  3. 3.
    Tredget EE, Levi B, Donelan MB. Biology and principles of scar management and burn reconstruction. Surg Clin North Am. 2014;94(4):793–815.CrossRefGoogle Scholar
  4. 4.
    Chan KY, Lau CL, Adeeb SM, Somasundaram S, Nasir-Zahari M. A randomized, placebo-controlled, double-blind, prospective clinical trial of silicone gel in prevention of hypertrophic scar development in median sternotomy wound. Plast Reconstr Surg. 2005;116:1013–20.CrossRefGoogle Scholar
  5. 5.
    Fitzpatrick RE. Treatment of inflamed hypertrophic scars using intralesional 5-FU. Dermatol Surg. 1999;25:224–32.CrossRefGoogle Scholar
  6. 6.
    Surowitz JB, Shockley WW. Enhancement of facial scars with dermabrasion. Facial Plast Surg Clin North Am. 2011;19:517–25.CrossRefGoogle Scholar
  7. 7.
    Alster TS, Williams CM. Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser. Lancet. 1995;345(8959):1198–200.CrossRefGoogle Scholar
  8. 8.
    Anderson RR, Donelan MB, Hivnor C, Greeson E, Ross EV, Shumaker PR, et al. Laser treatment of traumatic scars with an emphasis on ablative fractional laser resurfacing: consensus report. JAMA Dermatol. 2014;150(2):187–93.CrossRefGoogle Scholar
  9. 9.
    Balaraman B, Geddes ER, Friedman PM. Best reconstructive techniques: improving the final scar. Dermatol Surg. 2015;41(Suppl 10):S265–75.CrossRefGoogle Scholar
  10. 10.
    Anderson RR, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science. 1983;220:524–7.CrossRefGoogle Scholar
  11. 11.
    Keany TC, Tanzi E, Alster T. Comparison of 532 nm potassium titanyl phosphate laser and 595 nm pulsed dye laser in the treatment of erythematous surgical scars: a randomized, controlled, open-label study. Dermatol Surg. 2016;42:70–6.CrossRefGoogle Scholar
  12. 12.
    Alam M, Pon K, Laborde V. Clinical effect of a single pulsed dye laser treatment of fresh surgical scars: randomized controlled trial. Dermatol Surg. 2006;32:21–5.CrossRefGoogle Scholar
  13. 13.
    Martinez OV, EIchelmann K, Melendez MG, Miranda I, Lozano AA, Vega D, Candiai JO. Pulsed dye laser for early treatment of scars after dermatological surgery. J Drugs Dermatol. 2015;14(11):1209–12.Google Scholar
  14. 14.
    Baca ME, Neaman KC, Rapp DA, Burton ME, Mann RJ, Renucci JD. Reduction of post-surgical scarring with the use of ablative fractional CO2 lasers: a pilot study using a porcine model. Lasers Surg Med. 2016.  https://doi.org/10.1002/lsm.22521. [Epub ahead of print].
  15. 15.
    Uebelhoer NS, Ross EV, Shumaker PR. Ablative fractional resurfacing for the treatment of traumatic scars and contractures. Semin Cutan Med Surg. 2012;31:110–2.CrossRefGoogle Scholar
  16. 16.
    Carniol PJ, Hamilton MM, Carniol ET. Current status of fractional laser resurfacing. JAMA Facial Plast Surg. 2015;17(5):360–6.CrossRefGoogle Scholar
  17. 17.
    Laubach HJ, Tannous Z, Anderson RR, Manstein D. Skin responses to fractional photothermolysis. Lasers Surg Med. 2006;38:142–9.CrossRefGoogle Scholar
  18. 18.
    Waibel JS, Rudnick A. Current trends and future considerations in scar treatment. Semin Cutan Med Surg. 2015;34(1):13–6.CrossRefGoogle Scholar
  19. 19.
    Ozog DM, Moy RL. A randomized split-scar study of intraoperative treatment of surgical wound edges to minimize scarring. Arch Dermatol. 2011;147:1109–10.CrossRefGoogle Scholar
  20. 20.
    Waibel JS, Wulkan AJ, Shumaker PR. Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery. Lasers Surg Med. 2013;45:135–40.CrossRefGoogle Scholar
  21. 21.
    Rkein A, Ozog D, Waibel JS. Treatment of atrophic scars with fractionated CO2 laser facilitating delivery of topically applied poly-L-lactic acid. Dermatol Surg. 2014;40:624–31.PubMedGoogle Scholar
  22. 22.
    Chuang GS, Manstein D, Tannous Z, Avram MM. Ulceration of mature surgical scars following nonablative fractional photothermolysis associated with intralesional lidocaine injections. Dermatol Surg. 2012;38:1879–81.CrossRefGoogle Scholar
  23. 23.
    Tidwell WJ, Owen CE, Shorten CK, Maity A, McCall M, Brown TS. Fractionated Er:YAG laser versus fully ablative Er:YAG laser for scar revision: results of a split scar, double blinded, prospective trial. Lasers Surg Med. 2016;48:837–43.CrossRefGoogle Scholar
  24. 24.
    Reish RG, Eriksoon E. Scar treatments: preclinical and clinical studies. J Am Coll Surg. 2008;206:719–30.CrossRefGoogle Scholar
  25. 25.
    Shin JU, Gantseteg D, Jung JY, Jung I, Shin S, Lee JH. Comparison of non-ablative and ablative fractional laser treatments in a postoperative scar study. Lasers Surg Med. 2014;46(10):741–9.CrossRefGoogle Scholar
  26. 26.
    Carniol PJ, Meshkov L, Grunebaum LD. Laser treatment of facial scars. Curr Opin Otolaryngol Head Neck Surg. 2011;19(4):283–8.CrossRefGoogle Scholar
  27. 27.
    Tenzel PA, Patel K, Erickson BP, Shriver EM, Grunebaum LD, Alabiad CR, Lee WW, Wester ST. Split face evaluation of long-pulsed non-ablative 1,064nm Nd:YAG laser for treatment of direct browplasty scars. Lasers Surg Med. 2016;48:742–7.CrossRefGoogle Scholar
  28. 28.
    Ezra N, Arshanapalli A, Bednarek R, Akaishi S, Somani AK. The microsecond 1064 nm Nd:YAG laser as an adjunct to improving surgical scars following Mohs micrographic surgery. J Cosmet Laser Ther. 2016;18(4):225–9.CrossRefGoogle Scholar
  29. 29.
    Castro DJ, Abergel RP, Meeker C, Dwyer RM, LEsavoy MA, Uitto J. Effects of the Nd:YAG laser on DNA synthesis and collagen production in human skin fibroblast cultures. Ann Plast Surg. 1983;11:214–22.CrossRefGoogle Scholar
  30. 30.
    Davison SP, Dayan JH, Clemens MW, Sonni S, et al. Efficacy of intralesional 5-fluorouracil and triamcinolone in the treatment of keloids. Aesthet Surg J. 2009;29:40–6.CrossRefGoogle Scholar
  31. 31.
    Goldman MP, Alster TS, Weiss R. A randomized trial to determine the influence of laser therapy, monopolar radiofrequency treatment, and intense pulsed light therapy administered immediately after hyaluronic acid gel implantation. Dermatol Surg. 2007;33:535–42.PubMedGoogle Scholar
  32. 32.
    Kasper DA, Cohen JL, Saxena A, Morganroth GS. Fillers for postsurgical depressed scars after skin cancer reconstruction. J Drugs Dermatol. 2008;7:486–7.PubMedGoogle Scholar
  33. 33.
    Massaki AB, Fabi SG, Fitzpatrick R. Repigmentation of hypopigmented scars using an erbium-doped 1,550 nm fractionated laser and topical bimatoprost. Dermatol Surg. 2012;38:995–1001.CrossRefGoogle Scholar
  34. 34.
    Singh A, Yadav S. Microneedling: advances and widening horizons. Indian Dermatol Online J. 2016;7:244–54.CrossRefGoogle Scholar
  35. 35.
    Nair PA, Arora TH. Microneedling using dermaroller: a means of collagen induction therapy. GMJ. 2014;69:24–7.Google Scholar
  36. 36.
    El-Domyati M, Barakat M, Awad S, Medhat W, et al. Microneedling therapy for atrophic acne scars: an objective evaluation. J Clin Aesthet Dermatol. 2015;8:36–42.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Shilpi Khetarpal
    • 1
  • Jeffrey S. Dover
    • 2
  • Kenneth Arndt
    • 2
  1. 1.Department of DermatologyCleveland Clinic FoundationClevelandUSA
  2. 2.SkinCare PhysiciansChestnut HillUSA

Personalised recommendations