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Consensus Statement |

Laser Treatment of Traumatic Scars With an Emphasis on Ablative Fractional Laser Resurfacing:  Consensus Report

R. Rox Anderson, MD1; Matthias B. Donelan, MD2; Chad Hivnor, MD3; Eric Greeson, MD3; E. Victor Ross, MD4; Peter R. Shumaker, MD5; Nathan S. Uebelhoer, DO5; Jill S. Waibel, MD6
[+] Author Affiliations
1Wellman Center for Photomedicine, Massachusetts General Hospital, Boston
2Department of Plastic Surgery, Shriner’s Hospital for Children, Boston, Massachusetts
3San Antonio Uniformed Health Education Consortium, Lackland Air Force Base, Texas
4Scripps Clinic Laser and Cosmetic Dermatology Center, San Diego, California
5Department of Dermatology, Naval Medical Center, San Diego, California
6Miami Dermatology and Laser Institute, Miami, Florida
JAMA Dermatol. 2014;150(2):187-193. doi:10.1001/jamadermatol.2013.7761.
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Importance  Despite expert wound care and assiduous management with traditional therapy, poor cosmetic outcomes, restricted motion, and symptoms such as pain and itch are a pervasive problem of disfiguring and debilitating scars. The advent of ablative fractional photothermolysis within the past decade and its application to the treatment of traumatic scars represents a breakthrough in the restoration of function and cosmetic appearance for injured patients, but the procedure is not widely used.

Objective  To provide a synthesis of our current clinical experience and available literature regarding the laser treatment of traumatic scars with an emphasis on fractional resurfacing.

Evidence Review  Eight independent, self-selected academic and military dermatology and plastic surgery physicians with extensive experience in the use of lasers for scar treatment assembled for a 2-day ad hoc meeting on January 19 and 20, 2012. Consensus was based largely on expert opinion, but relevant literature was cited where it exists.

Findings  After consensus was appraised, we drafted the manuscript in sections during the course of several months. The draft was then circulated among all panel members for final review and comment. Our consensus is that laser treatment, particularly ablative fractional resurfacing, deserves a prominent role in future scar treatment paradigms, with the possible inclusion of early intervention for contracture avoidance and assistance with wound healing.

Conclusions and Relevance  Laser scar therapy, particularly fractional ablative laser resurfacing, represents a promising and vastly underused tool in the multidisciplinary treatment of traumatic scars. Changes to existing scar treatment paradigms should include extensive integration of fractional resurfacing and other combination therapies guided by future research.

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Figure 1.
Laser Scar Treatment Algorithm

Fractional laser treatment may be combined with vascular laser treatment in alternating or combined sessions. AFL indicates ablative fractionated laser; KTP, potassium titanyl phosphate; NAFL, nonablative fractionated laser; PDL, pulsed-dye laser.

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Figure 2.
Treatment of a 25-Year-Old Man After an Injury Due to an Improvised Explosive Device

A, Split-thickness skin graft on the left arm at presentation (Supplement [eAppendix 4]). Six months after injury, erythema, cobblestone texture, and decreased range of motion at the wrist associated with the graft are evident. B, Split-thickness graft after ablative fractional laser (AFL) treatment in the left arm 7 months after starting a series of 4 fractional carbon dioxide (CO2) laser treatments. Interval improvements in erythema and texture are evident. C, Range of motion in the left wrist at presentation is decreased at maximum wrist extension. D, Seven months after initiating a series of 4 AFL CO2 laser treatments, significantly increased range of motion at maximum wrist extension is evident.

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Figure 3.
Treatment of a 22-Month-Old Girl With a Scalding Injury

A, Hypertrophic scar at initial presentation (Supplement [eAppendix 4]). An erythematous, hypertrophic burn scar is evident 6 months after injury. B, Hypertrophic scar after 2 combination pulsed-dye and fractional carbon dioxide laser treatments, 7 months after her initial treatment. A significant interval improvement of hypertrophy, erythema, dyschromia, texture, and range of motion is evident.

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