Minimally invasive technologies for treatment of HTS and keloids : fractional laser

Hypertrophic fractional laser and keloid scars present a spectrum of disorders that are difficult to treat. Multiple treatments have been tried, to ameliorate the clinical sequelae of scarring, such as erythema, pruritus, functional limitation, reduced range of movement, dyschromias, hyper and/or hypopigmentation. Early international clinical recommendations on scar management first recognized the importance of laser therapy in this armamentarium [1]. Within the years that followed, laser technology and the understanding of how it modulates the underlying processes that leads to hypertrophic and keloid scarring have experienced a quantum leap [2] and are still evolving. Lasers also present a considerable financial commitent, and it is possible, in the authors’ experience, that limited early results partially stemmed from limited availability of multiple lasers with consequent attempts to overstretch the indications for what was available. This chapter presents a state-of-the-art insight into the use of fractional laser for the management of this complex problem. In particular, we focus on the management of complex scars such as those occurring post-burn injury and split-thickness skin grafting.peer-reviewe

Specific attention areas in scar management : management of atrophic scars

Atrophic scars represent some of the most difficult and insidious pathologies confronting the reconstructive surgeon. Deriving from the ancient Greek “a-trophos” (wasted), the term presents a vivid representation of the clinical picture and an area of scar management particularly worthy of specific attention. The atrophic scars typically develop as a result of an intracutaneous inflammatory process. Rather than exuberant inflammation, the process results in reduced matrix regeneration and focally reduced collagen production. Focal contraction of the scar tissue will result in uneven soft tissue defects. Clinically, these result in contour defects on the surface of the skin [1]. Several pathologies may result in atrophic scars [2], This chapter is intended for the experienced laser practitioner tackling three clinical conditions presenting to the reconstructive specialties, often as a last resort after exhaustive traditional management: acne, striae albae, and burns. It explores common principles, followed by state-of-the-art management and evaluation of the senior author’s experience.peer-reviewe