Early Intervention Of Fractional Carbon Dioxide Laser On Fresh Traumatic Scar

Objective: To determine the combined therapeutic effect of fractional carbon dioxide laser and silicone gel on fresh traumatic scars using a rabbit ear hypertrophic scar(EHS)model,as well as on human subjects.Methods: The rabbit EHS model was established by punching 4 circular wounds in each ear,and respectively treated with carbon dioxide laser,silicone gel and the combination of both,while one wound was left untreated.In addition,a validation group of 5 rabbits was also included wherein the wounds were treated with triamcinolone,IFN-? and normal saline,with one untreated control.The gross hyperplasic changes and the histological features were analyzed,and the scar elevation index(SEI)was calculated for each treatment group.Thirty patients who underwent debridement and suturing in our department were also recruited and randomized into three treatment groups: carbon dioxide laser,silicone gel and the combination of both.The treatment regimens were begun on the day of suture removal,and the therapeutic effect of each method was evaluated once a month for 5 months using the Vancouver Scar Scale(VSS).Results: In the rabbit model,the untreated control wounds showed hypertrophic growth,whereas triamcinolone or IFN-? showed an inhibitory effect,similar to that on hypertrophic scars in humans,thereby proving the feasibility of our animal model.The SEI peaked 2 months after treatment,and was respectively 2.28±0.56,1.85±0.33,1.91±0.34 and 1.45±0.22 in the untreated control,and the silicone,laser and combined treatment groups,clearly indicating a significant therapeutic effect of the combined treatment modality(p<0.01).The fibroblast and microvascular counts also showed similar trends in each group.In the clinical study,all patients exhibited noticeableaesthetic improvements.While laser and silicone gel monotherapies had similar effects,their combination further improved scar healing and shortened the recovery time.