Mitigation of Postsurgical Scars Using Lasers: A Review

Ofir Artzi, MD; Or Friedman, MD, MD; Firas Al-niaimi, MD; Yoram Wolf, MD; Joseph N. Mehrabi, MD

Disclosures

Plast Reconstr Surg Glob Open. 2020;8(4):e2746 

In This Article

Methods

Search Strategy

Studies were identified through the search strategy by 2 independent reviewers.

A systematic National Institutes of Health–National Center for Biotechnology Information–PubMed search was conducted to identify relevant clinical articles that pertained to the use of lasers to mitigate postsurgical scars. Message-Subject-Headings were applied. The search algorithm used was (cicatrix OR cicatrix treatment OR scar OR scars) AND (laser OR laser treatment OR laser therapy OR fractional laser OR ablative fractional laser OR nonablative fractional laser OR dye laser OR diode laser) AND (prevention OR minimizing OR early intervention OR treatment outcome). Additional studies were acquired from review articles that appeared in the search. Only human trials that attributed pre- and posttreatment scores of scar severity based on a verified scar evaluation scale [eg, Patient and Observer Scar Assessment Scale, Vancouver Scar Scale (VSS), Global Assessment Scale], published in English, after January 1, 1995, were finally included.

The final studies that fit the inclusion criteria were identified using a 2-step process. First, the titles and abstracts of acquired articles were screened. Next, the complete text was reviewed. The inclusion and exclusion criteria are shown in Figure 1.

Figure 1.

Inclusion and exclusion criteria. POSAS, Patient and Observer Scar Assessment Scale.

Data Extraction

Standardized extraction of data was compiled and consolidated in a Microsoft Excel (Microsoft, Redmond, Wash., USA) spreadsheet. Acquired data included the name of the first author, year of publication, type of surgical wound, time of first treatment relative to operation date, device(s) and medications used, number of compared treatments, number of raters, number of patients subject to each treatment arm, parameters and settings on the device, number of treatments, time interval between treatments, study design, scar evaluation scale, statistical test used, P value, results, comments, and clarifications for future considerations.

Outcome Measures, Data Normalization, and Analysis

Different studies use different clinical assessment scores. To adequately assess the efficacy of the modalities, the final scaled scar appearance scores were realigned and normalized to a standard scale for unbiased comparison. This excluded studies that only reported improvement of scars and studies that did not adequately report their final results. Scales such as the VSS, the Global Assessment Scale, the Patient and Observer Scar Assessment Scale, Visual Analog Scale, and 4- and 5-level Likert scales were normalized to a standard 0–100 scale depicting 100 as healthy skin (= best esthetic outcome) and 0 as the worst possible scar (= worst esthetic outcome). Objective scar scores were defined as those determined by physicians, and subjective scar scores were those determined by patients.

The aligned scores were then compared: treatment versus control to calculate standard score, or z score, as it pertains to a single measurement, whereas standard mean difference (SMD) compares 2 groups of measurements: treatment versus control. The SMD was calculated for both objective and subjective ratings. Studies that employed more patients were weighted heavier against studies that employed fewer patients.

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