Early Intervention with Pulse Dye and CO2 Ablative Fractional Lasers to Improve Cutaneous Scarring Post-Mastectomy - a Randomized Controlled Trial

Background - Breast cancer surgery and reconstruction is currently considered the "gold standard" of treatment. Therefore plastic surgery consultation has become an inherent part of the breast cancer patient management, significantly improving aesthetic and functional results. Non the less, Surgical scars may be aesthetically unpleasant, serve as a focus of pain, pruritis, and considerable psychological distress. The most effective method of scar treatment is early intervention. Current standard practice for abnormal scar formation consists of the frequent use of moisturizers, silicone gel, silicone sheet occlusion, pressure therapy and sun avoidance. Integration of various laser modalities into scar treatment and scar prevention methods are gaining popularity and show impressive results. Vascular lasers, mainly the pulsed dye laser (PDL, 585–595 nm), have been shown to affect angiogenesis, collagen synthesis, and inflammation. While
Fractional ablative CO2 LASER (FACL) have been shown to improve scar hight, texture, and pliability efficiently. We set out to study the safety and efficacy of combined PDL and CO2 LASER therapy on the pre-scar surgical site.

OBJECTIVE - This study investigates the clinical effect combined PDL and FACL in preventing aesthetically displeasing scarring as well as improving appearance and symptoms of surgical post-mastectomy surgical wounds.

METHODS - A prospective randomized, controlled split scar study of PDL and FACL versus non-laser treatment control. Eighteen subjects planned for lumpectomy were enrolled. On each patient, the surgical scar was randomly assigned to treatment and non-treatment halves. Treatment consisted of a unique protocol of PDL (Syneron Candela, V-beam, 7mm, 0.45 milliseconds, 5-6 J\c"m2) followed immediately by FACL (Lumenis, Encore, Deep Fx, line pattern, 15-20 milliseconds 5%) at a monthly interval for three consecutive treatments, starting 2-4 weeks following surgery. The treated and untreated scar segments were evaluated by three blinded investigators (two dermatologists and one plastic surgeon) and by the patients at six months post last treatment, utilizing the Patient and Observer Scar Assessment Scale (POSAS). The participants also rated overall satisfaction using a four-point scale.

RESULTS - The mean POSAS scores at six months post-treatment were significantly lower (better cosmesis) for the treated half compared with the untreated half (p<0.01). Satisfaction rates were significantly higher in the treated half (p=0.005).

Conclusion - This study indicates that combined PDL and FACL, performed in the early stage of wound healing may have the potential to optimize scar formation of surgical scars.