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

TLDR

Poor cosmetic outcomes, limited motion, and pain or itch remain common problems despite standard wound care, highlighting the need for improved scar treatment. This review synthesizes current clinical experience and literature on laser treatment of traumatic scars, emphasizing ablative fractional resurfacing. An expert panel of eight dermatology and plastic surgery physicians convened a two‑day meeting, reached consensus through literature review and expert opinion, and drafted and reviewed the manuscript over several months. The consensus recommends that ablative fractional resurfacing play a central role in scar management, including early intervention for contracture prevention and enhanced wound healing, and calls for broader integration of this technique and combination therapies in future treatment protocols.

Abstract

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.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.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.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.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.