Effects of the combined PDL/Nd:YAG laser on surgical scars: vascularity and collagen changes evaluated by in vivo confocal microscopy

Abstract

The aim of this study was to investigate the efficacy of the sequential combined 585 nm PDL and the 1064 nm neodymium:yttrium-aluminium-garnet laser (PDL/Nd:YAG) in the treatment of surgical scars and to evaluate the short-term effects by in vivo confocal microscopy (RCM) and the long-term effects by clinical assessment of the scars. Twenty-five patients were enrolled with 39 postoperative linear scars; each scar was divided into two fields. One half was treated with the combined PDL/Nd:YAG laser, whereas the other half remained untreated. Each scar was treated three times at monthly intervals. Scars were evaluated by an independent examiner, using the Vancouver Scar Scale. The combined PDL/Nd:YAG laser significantly improved the appearance of the scars. In order to study the short-term effects of combined laser treatment, six additional patients were enrolled with 7 postoperative linear scars. One half of scars was treated once with the combined PDL/Nd:YAG laser. One week after this laser treatment, both the treated and the nontreated parts of the scars were examined by dermoscopy and RCM. The dermoscopic pictures revealed improvements even in treated areas. In conclusion, the combined PDL/Nd:YAG laser was found to be effective in improving the quality and appearance of the surgical scars.

Figure 1

Effects of combined 585/1064 nm laser treatment on the clinical appearance of the scar back of in the patient number 16 (Fitzpatrick skin type IV) on the day of suture removal (a), 1 month after the first treatment (b), 1 month after the second treatment (c), and at the final assessment (d). The treated half (Treated) and the control half (Control) of the scar are indicated.

Figure 2

Effects of combined 585/1064 nm laser treatment on the clinical appearance of the scar waist of in the patient number 10 (Fitzpatrick skin types I) on the day of suture removal (a), 1 month after the first treatment (b), 1 month after the second treatment (c), and at the final assessment (d). The treated half (Treated) and the control half (Control) of the scar are indicated.

Figure 3

VSS score 1 month after final treatment and final evaluation (n = 25); P < 0.05 was regarded as a significant change.

Figure 4

Improvement in individual VSS parameters 1 month after the final combined PDL/Nd:YAG laser treatment (n = 25); *P < 0.05 was regarded as a significant change.

Figure 5

Effects of a single combined 585/1064 nm laser treatment on the blood vessels and collagen fibers (abdomen). The untreated areas ((a), (b), (c), and (d)) and treated areas ((e), (f), (g), and (h)) are indicated. Control area: the dermatoscopic picture revealed high vascularity in the scar tissue ((a) Bar = 92.96 μm). The RCM picture of the scar and its surroundings indicated that the scar is only slightly depressed ((b) Bar = 132.59 μm); there are numerous, parallel collagen fibers with numerous dilated vessels (arrows) among them (c) and numerous parallel collagen fibers ((d) Bar = 132.59 μm). Treated area: the dermatoscopic picture shows low vascularity in the scar tissue (e). The RCM picture of the scar and its surroundings demonstrated that the scar is depressed relative to the normal skin ((f) Bar = 70.10 μm); there were collagen fibers regular and elongated and a few narrow vessels (arrows) among them ((g) Bar = 138.68 μm) and regular and elongated collagen fibers ((h) Bar = 129.54 μm).