Evaluating the efficacy of using a short-pulsed erbium:YAG laser for intraoperative resurfacing of surgical wounds.
OBJECTIVE
There are many studies demonstrating the aesthetic benefits of resurfacing a wound 4-8 weeks following surgical closure. Several anecdotal reports have been published stating that resurfacing a wound at the time of closure is also of cosmetic benefit. Our study was designed to evaluate the effects of resurfacing wound edges at the time of surgical closure.


METHODS
Ten patients with skin types I-III undergoing reconstruction on the head or neck using a complex linear closure of at least 4 cm in length were enrolled in the study. Following the placement of subcutaneous sutures and an intradermal running suture, a split scar study was designed. Half of the wound was left as a control and half of the wound was resurfaced with a short pulsed Erbium:YAG laser. Both sides were treated with a hydrogel dressing. Follow-up evaluations were performed 1 week, 1 month, and 3 months post-operatively. The wound was evaluated for any adverse reactions. The degree of erythema, textural misalignment or tissue mismatch, and overall aesthetic appearance of both sides of the scar were evaluated and scored.


RESULTS
There were no incidents of infection, dehiscence, hematoma, necrosis, or reaction to the dressing during the study. There was a trend towards greater erythema in the resurfaced half of the scar at the 1 week and 1 month evaluation. There was a trend towards less tissue mismatch and better overall aesthetic appearance of the side of the scar that had been resurfaced. The differences however were not statistically significant.


CONCLUSIONS
Given the time and resources necessary to perform an intraoperative resurfacing procedure on the wound edges, it may be more reasonable to withhold resurfacing procedures for those few cases that may require it postoperatively (patients with a history of poor healing, highly sebaceous areas, etc.). When good operative technique is used, most surgical wounds on the head and neck heal very well with excellent aesthetic outcomes without any additional intervention.
Rohrer
Thomas E
TE
Boston University Medical Center, Department of Dermatology, Boston University Center for Cosmetic and Laser Surgery, 609 Albany Street Boston, Massachusetts 02130, USA. RohrerT@BU.edu
Ugent
Steven J
SJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004871:Erbium / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D053685:Laser Therapy / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing; D014947:Wounds and Injuries / Q000601:surgery*
D004871:Erbium