Synergistic Sequential Emission of Fractional 1540 nm and 10 600 Lasers for Abdominal Postsurgical Scar Management: A Clinical Case Report

Background

The number of abdominoplasty surgeries performed has been steadily rising during the past 10 years [1]. Abdominoplasty complications include hematoma, infection, seroma, skin necrosis, hypertrophic scars, neurological symptoms, suture extrusions, umbilical anomalies, pulmonary thromboembolism/deep venous thrombosis, respiratory disorders, and death [2]. Among these, depending on the degree of distortion, abdominal hypertrophic scars have a significant psychological and social impact [3]. Management strategies for abdominoplasty scars include punch grafts, postsurgical scar revision/excision, steroid applications/injections, and laser treatment. However, most of them, particularly surgery management, must be done under local anesthesia and with outpatient procedures resulting in a slow return to work. The availability of more recent and sophisticated technologies, such as lasers, has all but eliminated the need for surgery. With the introduction of more ablative and non-ablative photothermolysis technologies and apparatus, doctors and patients now have more alternatives, but the complexity of the system utilized and the methods to improve the outcomes have also increased [4,5]. By promoting collagen and fibroblasts, fractional ablative CO2 lasers have been demonstrated to be a promising and prospective treatment for enhancing burn scar function/appearance and skin regeneration [6–9]. Moreover, 1540 nm non-ablative fractional lasers can be used to flatten the scar through the delivery of light in an array of narrow, focused micro-beams to create coagulation columns within the skin. This produces an improvement in the skin’s appearance without the risk of inflammation [10–12]. Recent scientific findings demonstrated that the simultaneous combination of the CO2 laser wavelengths of 10 600 nm and 1540 nm non-ablative laser is a valid treatment choice for skin remodeling. In addition, to reduce downtime and pain for patients during treatments, the combination of ablative and non-ablative fractional CO2 lasers produced better skin remodeling results than either laser used alone [13–16]. Based on the existing literature, the purpose of the current study was to assess the volumetric action of the 1540 wavelength, and the efficacy and safety of the synergistic sequential application of a new fractional ablative 10 600 nm CO2 and non-ablative 1540 nm lasers on abdominal postsurgical scar management.

Case Report

Our patient was a 45-year-old woman, in general good health, with a body mass index (BMI) of 22.3 Kg/m2, a Fitzpatrick skin grade of III, and a history of abdominoplasty. Following surgery, the patient had a noticeable extensive suprapubic scar. She did not have any history of keloid formation following prior surgeries.

After 12 months, the scar was not healing, so the patient decided to undergo laser treatment. The following conditions were excluded in the patient: systemic dermatologic conditions (eg, eczema), autoimmune disorders, uncontrolled diabetes, pregnancy, and pigmentary disorders. Informed consent was obtained regarding the risks, advantages, and treatment options. For the abdominal scar removal, the patient underwent 3 treatment sessions with a dual-wavelength system (DuoGlide, DEKA M.e.l.a Srl, Florence, Italy). To work with the fractioned scanning units (μScan DOT), the system creates a multi-technology that includes a 10 600 nm CO2 laser device (60 W) and a 1540 nm diode laser (10 W). A tunable balance between ablation and coagulation depths is possible, with the scanner able to deliver 1 or both wavelengths (1540 nm and 10 600 nm) in sequential emission mode on the same DOT, which is the area that includes both the microscopic ablative zones (MAZs) and microscopic thermal zones (MTZs) in the tissue. This enables the delivery of new and more effective treatments. Utilizing the 1540+CO2 sequence, 1 pass across the whole suprapubic region is made, and both wavelengths simultaneously affect the skin. For the 10600 nm wavelength, power of 16 W, pulse width of 1 millisecond, and stack 2 and 500 µm of spacing were used, whereas for the 1540 wavelength, power of 3 W and pulse width of 5 milliseconds with stack 2 was used. The treatment sessions were performed once every 50 days. The protocol was in conformity with the ethics guidelines of the Helsinki Declaration (1975). A local cream and/or subcutaneous anesthesia were applied before each treatment session. A thermal water-based lotion, cold compression, and sun protection were used for postoperative care (sun exposure avoidance for at least 2 weeks). It is suggested to wait for 1 day before having a shower (hot water avoidance on the treated area until healing is complete). The use of moisturizing and emollient lotions is suggested without any time limitation, which helps to maintain a uniform and compact aspect of the new skin. We monitored for possible adverse effects such as dyschromia, burning sensation, bleeding, and mild to moderate post-treatment erythema, itching, crusting, and edema. Photographic evaluation of the suprapubic scar was performed to monitor the treatment’s effect on aesthetic appearance. Sixty days after the last treatment session, the photographic assessment showed a significant improvement in scar texture and color, as clearly shown in Figure 1. The patient reported no pain or discomfort, and no complications or adverse effects were observed either during treatment or in the follow-up period.

Discussion

STUDY LIMITATIONS:

Our future goal will be to increase the of number cases and make a scale with a significance score range for the evaluation of scars. Further studies involving more patients are needed to confirm the effectiveness of treatment.

Conclusions

This case report describes the possibility of effectively treating abdominal suprapubic scars following abdominoplasty surgery with a simultaneous and combined irradiation of the 2 wavelengths 10 600 nm and 1540 nm.