Ablative fractional laser treatment of hypertrophic burn and traumatic scars: a systematic review of the literature
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REVIEW
Ablative fractional laser treatment of hypertrophic burn and traumatic scars: a systematic review of the literature Brittany Buhalog1 · Farah Moustafa2 · Lisa Arkin3 · Kachiu Lee4 · Katherine Siwy5 · Matthias Donelan6 · C. Scott Hultman7 · Peter R. Shumaker8 Received: 4 June 2020 / Revised: 13 August 2020 / Accepted: 26 August 2020 © This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2020
Abstract Hypertrophic scars (HTS) following burns and other trauma and are associated with significant functional and psychosocial impairment. Ablative fractional lasers (AFLs) are increasingly being applied in the treatment of HTS supported by a rapidly expanding multidisciplinary base of literature. The multidisciplinary authors sought to evaluate existing literature, provide context and identify gaps, and make recommendations for a path forward. A systematic review was conducted to identify literature pertinent literature through September 2019. Retrospective cohort, randomized controlled trials, quasi-randomized controlled trials, observational prospective cohort, or case series with five or more subjects with hypertrophic scars incurred from burns and related trauma were considered. Twenty-two of the 23 evaluated studies documented statistically significant and/or meaningful qualitative improvements in nearly all outcome measures. Adverse events were generally infrequent and minor. Significant heterogeneity was observed among the studies included in this systematic review, precluding metaanalysis of pooled data. There is abundant existing literature on the use of AFLs in the management of HTS but study heterogeneity limits generalizability. Future studies should prioritize standardized protocols including assessments of function and quality of life. Keywords Laser · Scar · Hypertrophic · Fractional · Treatment · Review
Disclaimers The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of Veterans Affairs or the United States Government. Brittany Buhalog and Farah Moustafa are co-first authors. * Peter R. Shumaker [email protected] 1
University of California, San Francisco, USA
2
SkinCare Physicians, Chestnut Hill, MA, USA
3
University of Wisconsin School of Medicine, Madison, WI, USA
4
Temple University, Philadelphia, PA, USA
5
Shriners Hospital for Children-Boston, Boston, MA, USA
6
Harvard Medical School and Shriners Hospital for Children-Boston, Boston, MA, USA
7
Johns Hopkins University, Baltimore, MD, USA
8
VA San Diego Healthcare System and University of California, San Diego, CA, USA
Abbreviations HTS Hypertrophic scars AFL Ablative fractional lasers CPT Current Procedural Technology POSAS Patient and Observer Scar Assessment Scale VSS Vancouver Scar Scale LADD Laser-assisted drug delivery PDL Pulsed Dye Laser CO2 Carbon dioxide W Watts mJ Millijoules Hz Hertz TPIS Toronto Pediatric Itch Scale WA Weeks Apart H&
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