Maximal respiratory pressure and pliability of the body wall of the Japanese ama.
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Abdomen↗
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Skin elasticity meter or subjective evaluation in scars: a reliability assessment.
UNLABELLED: Various methods are available for evaluating the elasticity of scars. However, the reliability and validity of these methods have been sparsely examined. The aim of this study was to examine the reliability of the subjective evaluation of scar pliability, while at the same time testing the reliability of the measurements of a non-invasive suction device (Cutometer Skin Elasticity Meter 575) on scars. Four observers assessed 49 scar areas of 20 patients with a subjective assessment of pliability. Subsequently, each observer measured the scar areas with the Cutometer. The intraclass correlation coefficients (ICC) of the elasticity (Ue) and extension (Uf) parameters of the Cutometer were acceptable (r = 0.76 and 0.74, respectively) when a single observer carried out the measurements. The subjective assessment of pliability needs to be completed by two or more observers to make the evaluation reliable (r = 0.79). The concurrent validities between the subjective pliability-assessment and each of the Cutometer parameters were statistically significant and ranged from r = 0.29-0.53. The correlations between each of the Cutometer parameters were high and statistically significant (r > or = 0.71). CONCLUSION: A single observer can reliably use the Cutometer for the elasticity measurements of scars. Furthermore, either Ue or Uf, instead of all five elasticity values provided by the Cutometer, can be adequately used for the elasticity measurements of scars. The subjective assessment of pliability of scars can only be assessed reliably when completed by two or more observers. The concurrent validity showed that all Cutometer parameters, except for visco-elasticity (Uv), and the subjective assessment of pliability measured the same characteristic of a scar.
Adolescent↗
Objective measurement of scarring by multiple assessors: is the tissue tonometer a reliable option?
Depending on the patient population, the incidence of scarring is as great as 75% after burns. Skin pliability and functional recovery are affected negatively by hypertrophic scarring. Therapists use various treatment strategies to improve scar outcomes. However, a simple, objective, clinically useful method of measuring scar response to treatment eludes us. This study examines the inter-rater reliability and validity of scar pliability measures using the modified tissue tonometer (MTT). Twenty-four patients were tested by two blinded, randomly allocated raters. The MTT was used to assess scar pliability with a standardized, repeated-measures design. One normal and up to three scar points were assessed for each subject. One subject was excluded from the data analyses. Concerning inter-rater reliability, the intraclass correlation coefficient for averaged measures between measurers was 0.957, and the standard error of measurement was 0.025 mm. For validity, a significant difference (P = .0000) between scar (2.64 +/- 0.5 mm) and normal tissue (3.23 +/- 0.46 mm) measurements was demonstrated. Scar pliability scores between raters are extremely reliable and reproducible using the MTT. It can differentiate between injured and uninjured tissue. Hence, it provides clinicians with a reliable, transportable, and objective tool to document scar outcomes. The MTT provides a standardized method to longitudinally measure scar tissue pliability after burn injury.
Adolescent↗
Comparing the Vancouver Scar Scale with the cutometer in the assessment of donor site wounds treated with various dressings in a randomized trial.
Cutaneous scarring observed in wounds is, to a significant degree, dependent upon the time it takes for the wounds to heal. Various topical dressings are proposed to influence healing time in donor sites. In this prospective randomized study, we examined the effect of Vaseline gauze (VD; Branolind, Paul Hartmann AG, Germany), Biobrane (BD; Bertek Pharmaceuticals, Inc., Morgantown, WV), an occlusive film dressing Barrier Flex (OD; Moelnlycke Health Care GmbH, Germany), and an equine collagen foil, Tissu Foil E (CD; Baxter, Heidelberg, Germany), on re-epithelialization and scarring in standardized donor site wounds. At 6 months after surgery, donor site scars and normal uninjured mirror sided skin were evaluated in 33 patients using both the Vancouver Scar Scale (VSS) and the cutometer SEM 575 (Courage and Khazaka). The median healing time for OD was 14 days, BD 16 days, CD 19 days, and VD 19 days. The single parameter pliability of the VSS was not significantly different from uninjured skin when all donor site scars were pooled. No difference was found between the four groups. Viscoelastic analysis of all pooled patient data showed a significant difference for Uf (total deformation), Ua (total recovery), Ur (immediate retraction), Ue (immediate distension), Ur/Ue, and Ur/Uf, indicating that donor sites significantly differed from normal uninjured skin. No significant correlation between objective viscoelastic measurements and the subjective pliability assessment of the VSS was found. Viscoelastic differences were greatest in the VD and BD groups. Viscolelastic differences did not significantly correlate with healing time. Various wound dressings had minimal yet significant influence on healing time and scarring. In contrast to the VSS, viscoelastic measurements of skin pliability can objectify scarring when few differences are anticipated.
Bandages↗
A prospective randomized clinical trial to investigate the effect of silicone gel sheeting (Cica-Care) on post-traumatic hypertrophic scar among the Chinese population.
BACKGROUND: This study aimed to determine the efficacy of silicone gel (Cica-Care) on severe post-traumatic hypertophic scars among the Chinese population. METHOD AND MATERIALS: A randomized clinical trial (RCT) was conducted on 45 Chinese patients with post-traumatic hypertrophic scars. Twenty-two subjects were placed in the experimental group with silicone gel sheeting (SGS) applied 24h per day for 6 months while all subjects were taught to massage the scar daily for 15 min serving as the control intervention. Scar assessments were conducted regularly to measure the changes in thickness, pigmentation, vascularity, pliability, itchiness and pain. RESULTS: Two-way repeated ANOVA showed a significant difference between MT group and SGS group on scar thickness. The post hoc comparison analysis showed that the difference was significant at the post-2-month (p=0.008) and post-6-month (p<0.001) intervention. The SGS group also showed changes in pigmentation which resembled normal skin but no statistical significance was found. Pain, itchiness and pliability were also improved after intervention. CONCLUSION: This study indicated that silicone gel sheeting (Cica-Care) was effective to reduce thickness, pain, itchiness and pliability of the severe hypertrophic scar among the Chinese population. The moisturization effect of the tough and hard scar might contribute to the reduction of the skin thickness after 6 month's intervention.
Adult↗
The effects of soft tissue mobilization on the immature burn scar: results of a pilot study.
The purpose of this pilot study was determine the effects of soft tissue mobilization (STM) on range of motion (ROM), scar pliability, and vascularity. Patients received either one treatment session of standard physical therapy or standard physical therapy plus 10 to 15 minutes of STM. Before and after ROM, scar pliability and vascularity measurements were obtained. The student's t test was used to compare measurements and revealed the STM group (n = 5) had significant (p < 0.10) gains in wrist extension and radial deviation, and the control group (n = 5) had significant gains in wrist extension and ulnar deviation. No significant difference was found in ROM, scar pliability, and vascularity when the STM group was compared to the control group. Further study of a larger sample over multiple treatment sessions is necessary to determine the true efficacy of STM.
Adult↗
Pulsed dye laser treatment of hypertrophic burn scars.
Hypertrophic burn scars are notoriously difficult to treat because of their extensive tissue involvement and tendency to worsen with hypertrophy and contracture formation. Various therapies have been advocated in the past, including surgical excision and grafting, dermabrasion, and corticosteroids, with distinct cosmetic limitations. The 585-nm pulsed dye laser has been shown previously to be effective in the treatment of a variety of traumatic and surgical scars with improvement in scar texture, color, and pliability with minimal side effects. Sixteen patients with 40 hypertrophic burn scars resulting from chemical peels, carbon dioxide laser procedures, and accidental thermal injury were treated with a 585-nm pulsed dye laser. Sequential photographic and clinical assessments were recorded in all patients. Histologic evaluations of skin punch biopsies before and after laser irradiation were performed when possible. Symptomatic improvement of scars was reported after one treatment. Decreased scar erythema with improved texture and pliability was observed after an average of 2.5 treatments. No correlation was found between scar duration, location, or etiology and response to treatment. Normal number of dermal fibroblasts with decreased sclerosis was observed on histologic examination of laser-irradiated scars. The 585-nm pulsed dye laser irradiation of hypertrophic burn scars can effectively improve scar pliability and texture and decrease erythema and associated symptoms yielding cosmetically and functionally acceptable clinical results.
Adult↗
Implantation of esterified hyaluronic acid in microdissected Reinke's space after vocal fold microsurgery: first clinical experiences.
OBJECTIVE: In this pilot study are presented the first clinical experiences of the use of a resorbable bioimplant made of esterified hyaluronic acid inserted in the microdissected superficial layer of the lamina propria (SLLP), also called Reinke's space, after a flap excision procedure for a benign vocal fold lesion. Laryngeal and vocal evolution of implanted patients are depicted and discussed. STUDY DESIGN: Eleven bio-implants have been inserted in microdissected SLLP of 11 cases presenting with benign vocal fold lesions. The surgical procedure consisted of the excision of primary lesion by a microflap technique immediately followed by implantation of esterified hyaluronic acid in Reinke's space. METHODS: All patients underwent rigid laryngoscopy and a microsurgical procedure under general anesthesia. The cordal lesion was treated with cold instrumentation of Bouchayer (7 cases) or with a mixed technique using CO(2) laser (4 cases). After the classical freeing-up of Reinke's space and the creation of a mucosal flap, a few fibers of esterified hyaluronic bioimplant are gently arranged in Reinke's space before redraping the ligament and closing the cordal incision with a few drops of fibrin glue. Laryngeal and vocal assessments were performed pre- and postoperatively in all patients using videostroboscopy as well as perceptual and objective voice evaluation. All patients were followed in a longitudinal manner: between two and five postoperative evaluations were performed. The longest follow-up was 19 months and the shortest 2 months. RESULTS: All cases exhibited postsurgical improvement of the pliability of the SLLP. None of them developed an adverse scarring process. Improvement of SLLP's pliability was maintained in time in all cases. Vocal improvement was observed in all. Temporary inflammation was noted in one case. There were no serious adverse effects apparent during the follow-up period. CONCLUSION: Bio-implantation of esterified hyaluronic acid in Reinke's space is technically easy and well tolerated. All treated cases exhibited postoperative good pliability of the SLLP compared with their preoperative evaluation.
Absorbable Implants↗
Standardized assessment of breast cancer surgical scars integrating the Vancouver Scar Scale, Short-Form McGill Pain Questionnaire, and patients' perspectives.
BACKGROUND: Currently, there is no standardized, comprehensive method to assess surgical scars after breast cancer surgery. This article evaluates the application of the Vancouver Scar Scale, in conjunction with patients' scar self-rating and scar-related pain, in a cohort of breast cancer patients. METHODS: Data were prospectively collected in 59 women with breast cancer. Scar assessment comprised: 1. objective rating by pairs of independent observers using the Vancouver Scar Scale; 2. patient's ratings of the scar's physical parameters and overall satisfaction; and 3. pain assessment using the Short-Form McGill Pain Questionnaire. A total of 212 scar scores (59 pairs of breast/chest wall and 47 pairs of axillary scar scores) were generated by 13 observers: three physicians, five radiation therapists, and five nurses. Internal consistency was tested using Cronbach's alpha statistics. Interobserver reliability was evaluated with Spearman's rho and intraclass correlation coefficient computations. Convergent validity of the observer and patient ratings was examined with Spearman's correlation statistics. Linear regression analysis was performed to identify significant factors associated with Vancouver Scar Scale scores and patient satisfaction. RESULTS: The Vancouver Scar Scale, patient self-rating scale, and Short-Form McGill Pain Questionnaire had acceptable internal consistency (Cronbach's alpha 0.79, 0.64, and 0.72 respectively). Interobserver reliability using the Vancouver Scar Scale was significant with Spearman's correlation coefficients of 0.53 for pliability, 0.47 for scar height, 0.49 for vascularity, 0.54 for pigmentation, and 0.66 for overall score (all p values < 0.001). Significant agreement between observer and patient ratings of scar pliability (p = 0.01) and color (p = 0.001) was demonstrated. Mild to moderate pain was reported by more than 40 percent of patients. Patient satisfaction was significantly associated with self-rating of scar pliability and pain, but not Vancouver Scar Scale scores. CONCLUSIONS: The Vancouver Scar Scale is a reliable and valid tool to objectively evaluate scars after breast cancer surgery. Evaluation of scar-related pain and patients' scar rating and satisfaction provide additional information relevant to scar assessment. This integrated approach is feasible in a busy clinical setting to advance care and research in scar management for breast cancer patients.
Adult↗
Treatment of keloids and hypertrophic scars with dermojet injections of bleomycin: a preliminary study.
BACKGROUND: Numerous treatment modalities have been used to treat keloids and hypertrophic scars, but the optimal treatment has not been established. OBJECTIVE: The aim of this study was to determine the efficacy and safety of intralesional jet injection of bleomycin as therapy for keloids and hypertrophic scars that are unresponsive to intralesional steroid injection. METHODS: The study included 14 patients with 15 keloids or hypertrophic scars that had not responded to a minimum of three intralesional injections of triamcinolone acetonide. Multiple jet injections of 0.1 ml of bleomycin (1.5 IU/ml) were administered to each lesion, with injection sites spaced 0.5 mm apart. Injections were repeated each month. Scar height was measured, and scar pliability and erythema were scored at baseline and then monthly during the treatment and follow-up periods. Patients' self-assessments of subjective symptoms (pruritus and pain) were also scored. Clinical improvement was defined primarily on the basis of scar height reduction (percentage reduction from baseline), and was classified using the following scale: complete flattening (100%), highly significant flattening (> 90%), significant flattening (75-90%), moderate flattening (50-75%), and minimal flattening (< 50%). Pre- and post-treatment mean values for scar height, scar pliability, erythema, pruritus and pain were statistically compared. RESULTS: The number of sessions required to successfully treat the lesions ranged from two to six. Eleven lesions (73.3%) showed complete flattening, one (6.7%) showed highly significant flattening, two (13.3%) showed significant flattening, and one scar (6.7%) showed moderate flattening. The mean scar height was significantly lower, and the mean scores for scar pliability and erythema were significantly better at the end of treatment (P < 0.001, P < 0.001 and P < 0.001, respectively). The mean scores for pruritus and pain also improved significantly (P < 0.001 and P = 0.01, respectively). The observed side-effects were hyperpigmentation (four lesions) and skin atrophy (three lesions). No recurrences were noted during follow up (mean duration of 19 months). CONCLUSIONS: Intralesional jet injection of bleomycin is an effective and safe method of treating keloids and hypertrophic scars that are unresponsive to intralesional steroid therapy.
Adolescent↗
Early experience with a new collagen-impregnated aortic graft.
Standard knitted Dacron prosthetic grafts in the aortic position have performed well in terms of patency and durability, but require preclotting and lose their pliability with use. In an effort to overcome these problems, a collagen-impregnated double-velour knitted Dacron graft has been developed. This graft is impervious to blood, does not require preclotting, and maintains its pliability. During a 2 and one half year period, 590 of these grafts have been used at our institution for abdominal aortic replacement in both emergent and elective cases. Indications have included aneurysmal disease (67%), occlusive disease (30%), and failed previous aortic graft (3%). A bifurcated graft has been used in most cases (68%). The patient population has included 449 men and 141 women. Their median age is 68 years, with a range from 15 to 91 years. Seventy nine per cent of the patients experienced no perioperative complications. The remaining twenty one per cent have had a variety of complications, most of them cardiac or pulmonary, but none related directly to the graft. Twenty nine patients died in the perioperative period, for a mortality of 4.9 per cent. Late complications have been infrequent and in no cases directly related to the graft. There have been no graft-related late deaths. It is concluded that, at least in this early experience, there are no problems inherent in the use of this graft. Its pliability and the fact that it does not require preclotting are distinct advantages over previous Dacron grafts.
Adolescent↗
[Progression of senile aortic valve calcification: echocardiographic and clinical assessment].
Factors involved in the progression of senile aortic valve calcification were evaluated by analyzing the clinical and echocardiographic characteristics of patients older than 69 years with senile aortic valve calcification. The patients were divided into three groups; group 1: 46 male and 40 female patients with calcification of one cusp and almost normal pliability of three cusps, group 2: 48 males and 55 female patients with calcification of two or three cusps, mildly reduced pliability of calcified cusps, and aortic valve area (AVA) > or = 2.0 cm2, group 3: 26 male and 31 female patients with calcification of two or three cusps, significantly reduced pliability of calcified cusps, and AVA < or = 1.5 cm2. There were no significant differences in age, weight, height, left ventricular dimension, or left ventricular wall thickness between these three groups. For male patients, the end-diastolic maximum left ventricular outflow tract dimensions (LVOT) in groups 1, 2, and 3 were 20 +/- 2 mm, 19 +/- 2 mm (p < 0.01 vs group 1), and 17 +/- 3 mm (p < 0.001 vs group 1, p < 0.01 vs group 2), respectively. For female patients, the LVOTs of groups 1, 2, and 3 were 18 +/- 2 mm, 16 +/- 2 mm (p < 0.001 vs group 1), and 16 +/- 2 mm (p < 0.001 vs group 1), respectively. Reduction in LVOT was not associated with left ventricular hypertrophy or decrease in dimension of aortic annulus. In female patients, the frequency of mitral annular calcification of group 3 was 61% [p < 0.05 vs group 1 (35%), p < 0.01 vs group 2 (25%)].(ABSTRACT TRUNCATED AT 250 WORDS)
Aged↗
The effect of stimulus form and dimensions on the oral size illusion in humans.
Previous work has shown that individuals overestimate the diameter of holes presented to the tongue when they use their fingers to select matching holes from a range of comparators. This disparity is known as the oral size illusion. The hypothesis that this illusion arises from the greater pliability of the tongue surface compared with that of the fingertip was tested here. Two experiments were carried out on 64 participants. In experiment 1 (n=32), the stimuli were two sets of holes, 1 and 5 mm deep and 2.4, 5.6, 8.2, 12 mm dia. , which were presented to the tongue. The comparator was a series of holes 5 mm deep and 0.8-15 mm dia., which were explored manually. Participants significantly overestimated all diameters of the 1- and 5-mm deep stimulus holes (p<0.05). Apart from the 2.4-mm dia. holes, there were no significant differences between the illusions produced with the holes 1 mm and 5 mm deep (p0.7). In experiment 2 (n=32) individuals were tested with small cylinders ('pegs') 1 mm high and 2.6, 5.2. 7.6, 12.6 mm dia. and also with the four 5-mm deep stimulus holes used in experiment 1. The 'peg' stimuli presented to the tongue were matched against a similar set of 1-mm pegs, 2-18 mm dia., explored with the fingers. The comparator series for the 5-mm deep holes was the same as for experiment 1. Participants consistently overestimated the size of the 5-mm holes (p<0.001). However, there was no illusion with the peg stimuli (p=0.08), except for the 7.6-mm dia. stimulus (p<0.05). The results of experiment 1 did not support the experimental hypothesis that the oral size illusion was due to the greater pliability of the tongue surface. The result of experiment 2 suggests that the oral size illusion does not occur when peg stimuli are used instead of holes. The form and diameter of the stimulus is thus important in determining the magnitude of the oral size illusion.
Adolescent↗
Flashlamp pulsed dye laser (PDL) suppression of keloid proliferation through down-regulation of TGF-beta1 expression and extracellular matrix expression.
BACKGROUND AND OBJECTIVES: Keloids have been treated with flashlamp pulsed dye lasers (PDLs) with good results. We investigated whether PDL treatments induced keloid regression by decreasing growth factor-beta(1) (TGF-beta(1)) induction, thereby reducing fibroblast proliferation and collagen deposition. STUDY DESIGN/MATERIALS AND METHODS: Clinical evaluation and photography documented keloid height/texture, erythema, and pliability before and after PDL treatments scheduled at 2-month intervals in 30 patients. Fluence per pulse was 10-18 J/cm(2) (mean 14.0 J/cm(2)). Immunohistochemical (IHC) staining of TGF-beta(1), proliferating cell nuclear antigen (PCNA), and collagen (types I and III) in extra-cellular matrix was performed on 10 intra-lesional or punch biopsies obtained before and 7 days after PDL treatments. RESULTS: Twelve months after final PDL treatments, keloid regression ( >/= 50%) had occurred in 26/30 patients in whom erythema and surface irregularities had been reduced and pliability had been increased. In 4/30 patients, no changes in keloids had occurred after 12 months. Multiple treatments ( > 6) yielded better results than fewer treatments: 79% versus 50%, respectively. Marked keloid regression ( >/= 90%) occurred in two patients who had received more than 10 treatments. IHC staining indicated that expression of TGF-beta(1), PCNA and collagen type III, but not type I, was significantly reduced in keloid fibroblasts after PDL irradiation. CONCLUSIONS: Keloids regressed following PDL-induced reduction in TGF-beta(1) expression, fibroblast proliferation, and collagen type III deposition. More than six PDL treatments at 2-month intervals provided the best results.
Adolescent↗
Rheumatic mitral stenosis:cross-sectional echocardiographic analysis.
Twenty-one patients with rheumatic mitral stenosis diagnosed by both M-mode echocardiography and hemodynamic findings were subjected to detailed cross-sectional echocardiographic studies. The age of the patients ranged from 27 to 79 years with 76% females. Left ventricular longitudinal, short axis, and apical four-chamber cross-sectional echocardiographic views were obtained in each patient. Three predominant patterns of anterior mitral leaflet motion on left ventricular longitudinal view were observed and correlated with the severity of mitral stenosis: Pattern A (eight patients) with diastolic leaflet doming and restricted leaflet tip motion. Pattern B (eight patients) tip and body leaflet motion, and Pattern C (five patients) with the entire leaflet motion restricted. Mitral valve prolapse as a rebound phenomenon was observed in three patients who had marked leaflet doming in Pattern A and two had severe obstruction. The longitudinal cross-sectional echocardiography was superior to the apical view in assessing the diastolic doming motion of the anterior mitral leaflet. Thus, longitudinal cross-sectional echocardiographic analysis of the pliability and degree of doming of the anterior of the pliability and degree of doming of the anterior mitral leaflet is valuable in estimating the severity of mitral stenosis.
Adult↗
Ghost cells as a cause of glaucoma.
Clinical and investigative evidence indicated a glaucoma caused mainly by degenerated red blood cells, or ghost cells. These ghost cells, with altered shape, color, and pliability, accumulated in the vitreous cavity after hemorrhage. Following disruption of the anterior hyaloid face, they passed into the anterior chamber and caused severe glaucoma. In the anterior chamber, the tiny, khakicolored cells, circulating slowly, were frequently mistaken for white blood cells. They covered the trabecular meshwork or filled the inferior angle with a pathognomonic khaki-colored layer. They were identified by phase-contrast microscopic examination of anterior chamber aspirates. The decreased pliability of these degenerated cells seemed to account for their inability to pass easily through the human trabecular meshwork and, therefore, to cause severe glaucoma.
Aged↗
Laser scar revision: comparison study of 585-nm pulsed dye laser with and without intralesional corticosteroids.
BACKGROUND: Hypertrophic scars affect 1.5% to 4.5% of the general population and remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with treatment. Pulsed dye laser (PDL) treatment and intralesional corticosteroids have individually been reported to be effective in reducing hypertrophic scar bulk and symptoms. OBJECTIVE: To determine whether combination PDL and intralesional corticosteroid treatment produces better hypertrophic scar improvement than PDL treatment alone. METHODS: Bilateral hypertrophic inframammary scars in 22 females were randomly assigned to receive treatment with 585-nm PDL alone or in combination with intralesional corticosteroid. Clinical evaluations and scar pliability scores were determined before each of the two treatment sessions and 6 weeks after the final treatment. Histologic evaluation of skin biopsies obtained before and after treatment was performed in four patients. RESULTS: All scars showed clinical improvement with increased pliability and decreased symptoms (pruritus) after each of the two treatments. Clinical improvement scores were not significantly better with the concomitant use of corticosteroids. Side effects were limited to mild purpura and transient hyperpigmentation. Decreased sclerosis was seen in scars after PDL treatment (with or without concomitant corticosteroids). CONCLUSIONS: Treatment of hypertrophic inframammary scars with 585-nm PDL irradiation alone effected substantial clinical and histologic improvement. The adjunctive use of intralesional corticosteroids did not significantly enhance clinical outcome except in those scars that were most symptomatic.
Adult↗
Energy density and numbers of treatment affect response of keloidal and hypertrophic sternotomy scars to the 585-nm flashlamp-pumped pulsed-dye laser.
BACKGROUND: The 585-nm flashlamp-pumped pulsed-dye laser (PDL) has proven to be the treatment of choice for certain keloids and hypertrophic scars, but the precise fluence, numbers of treatment, and treatment interval remain anecdotal. OBJECTIVE: This study was performed to determine whether the therapeutic outcome of the PDL varies with the energy density (fluence) of the laser pulses and numbers of treatment. METHOD: Ten previously untreated, erythematous, keloidal or hypertrophic median sternotomy scars of 10 patients were divided into 4 segments and were randomly treated with a 585-nm PDL at a fluence of 3, 5, and 7 J/cm(2) to 3 of 4 segments every 4 weeks for a total of 6 treatment sessions. One segment of each patient's scars was untreated and served as a control. Clinical improvement including scar height, erythema, and pliability was evaluated before treatment and every 8 weeks for a total period of 32 weeks. Self-assessment was also determined by patients on a 25% increment of improvement scale comparing week 0 and week 32. RESULTS: A significant improvement in scar height, erythema, and pliability was noted in all laser-treated scar areas. There was no significant difference in treatment outcome versus the fluence of the laser (3, 5, and 7 J/cm(2)), although there was a trend for lower fluences to show more improvement. Objective clinical improvement was seen as early as week 16, after more than two treatments were given. Multiple treatments (>2) appeared to provide a greater percentage of scar resolution. CONCLUSIONS: The clinical improvement of scars after PDL treatment demonstrates no statistically significant fluence dependence in this study, but a trend toward better response with lower fluences is seen. In addition, multiple treatment sessions are suggested for achieving greater response.
Adult↗