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Case Reports
. 2022 Dec;54(10):1251-1260.
doi: 10.1002/lsm.23596. Epub 2022 Sep 7.

Long-term improvement in the appearance of hypertrophic scars following a single treatment with acoustic subcision-A single center proof-of-concept study

Brenda LaTowsky  1 , David W Robertson  2 , Christopher C Capelli  3
Affiliations
Case Reports

Long-term improvement in the appearance of hypertrophic scars following a single treatment with acoustic subcision-A single center proof-of-concept study

Brenda LaTowsky et al. Lasers Surg Med. 2022 Dec.

Abstract

Introduction and objectives: Fibrosis, including hypertrophic scar formation, is a pathological condition characterized by excessive production and accumulation of collagen, and loss of tissue architecture, in response to wound healing. Alterations in the extracellular matrix (ECM) biomechanical properties may be important in modulating myofibroblasts and fibrosis formation. The acoustic subcision device uses rapid acoustic pulse technology to noninvasively improve the appearance of hypertrophic scars through both microdisruption of scar tissue matrix and downregulation of fibrotic fibroblasts leading to scar remodeling. The objective of this single-site proof-of-concept IRB-approved human clinical study was to evaluate the efficacy of acoustic subcision device for the improvement in the appearance of hypertrophic scars.

Method: Eleven hypertrophic scars in 10 participants were treated with a single 6-minute acoustic subcision application without anesthesia. Posttreatment adverse events (AEs) and tolerability were recorded. At 12 and 89 weeks posttreatment, scar heights and volumes were measured, and participant satisfaction questionnaires were completed. Finally, at the last visit the scar appearance was assessed by the Principal Investigator (PI) using the Mecott Modified Scar Scale (MMSS).

Results: Immediately following the acoustic subcision treatment, only mild, moderate erythema or pinpoint bleeding were noted. The treatment sessions were considered tolerable by all participants with an average pain score of 2.2 (on a 0-10 pain score with 10 being the worse possible pain). The 12- and 89-week assessments demonstrated mean height reductions of 46.3% and 56.8%, respectively from baseline. The differences in scar height were statistically significant (p < 0.01). The 12- and 89-week assessments demonstrated a mean volume reduction of 63.2% and 58.1% respectively from baseline. The differences in the scar volume were statistically significant (p < 0.001). The PI graded an average improvement of 33.7% in scar appearance using the MMSS, a statistically significant change (p < 0.001). Finally, >90% of participants reported satisfaction with the improvement in their scar.

Conclusion: This proof-of-concept study showed that a single noninvasive acoustic subcision treatment session can safely provide statistically significant improvement in the appearance of hypertrophic scars with minimal treatment pain and meaningful participant satisfaction. More work is needed on a larger number of scars to verify this finding. Further improvement in appearance is expected with multiple acoustic subcision treatments and/or treatments in combination with currently available options. Additional trials to verify this are planned.

Keywords: acoustic subcision; fibrosis; hypertrophic scar; improvement in appearance; noninvasive; rapid acoustic pulse.

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Figures

Figure 1
Figure 1
Fibrous septa disruption time‐dose response. This series histological images of porcine subcutaneous tissue treated with an acoustic subcision device demonstrating increase disruption of fibrous septa with increase 1‐minute rapid acoustic pulse doses.
Figure 2
Figure 2
Acoustic subcision device
Figure 3
Figure 3
Mecott Modified Scar Scale 10
Figure 4
Figure 4
Scar height at baseline (Week 0), 12 and 89
Figure 5
Figure 5
Scar volume at baseline (Week 0), 12 and 89
Figure 6
Figure 6
Images of Participant 1 showing (left to right) the scar at baseline, 12‐ and 89‐week following a single 6‐minute acoustic subcision treatment
Figure 7
Figure 7
Images of Participant 2 showing (left to right) the scar at baseline, 12‐ and 89‐week following a single 6‐minute acoustic subcision treatment
Figure 8
Figure 8
Images of Participant 7 showing (left to right) the scar at baseline, 12‐ and 89‐week following a single 6‐minute acoustic subcision treatment
Figure 9
Figure 9
Images of Participant 4 showing (left to right) the scar at baseline, 12‐ and 89‐week following a single 6‐minute acoustic subcision treatment
See this image and copyright information in PMC

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