title: Fractional CO2laser treatment of caesarean section scars-A randomized controlled split-scar trial with long term follow-up assessment.
abstract: Caesarean section (c-section) scars can be pose functional and cosmetic challenges and ablative fractional laser (AFXL) treatment may offer benefit to patients. We evaluated textural and color changes over time in AFXL-treated versus untreated control scars.
  
  
  
  A randomized, controlled, intra-individual split-scar trial with three sessions of AFXL-treatments for mature c-section scars. Settings of AFXL were adjusted to each individual scar. End-points were blinded on-site clinical evaluations at 1, 3, and 6 months follow-up (Patient and Observer Scar Assessment Scale [POSAS] and Vancouver Scar Scale [VSS]), blinded photo-evaluations, reflectance measurements, tissue histology, and patients satisfaction.
  
  
  
  Eleven of 12 patients completed the study. At 1 month follow-up, AFXL-treated scars were significantly improved in pliability (POSAS P = 0.01 VSS P = 0.02) and smoother in surface relief (POSAS P = 0.03) compared to control scars. At 1-3 months, overall scar appearance was dominated by transient erythema and hyperpigmentation, confirmed by reflectance measurements (erythema% and pigmentation% peaked at 1 and 3 month follow-up, respectively). At 6 months follow-up, AFXL-treated scars improved on POSAS-total score though not significantly (P = 0.06). Correspondingly, blinded photo-evaluation found AFXL-treated scars significantly improved compared to controls (VAS P = 0.02). Histology indicated new dermal collagen and elastic fibers on AFXL-treated scars. At 6 months follow-up, a majority of patients (64%) favored subsequent AFXL-treatment of their untreated control scar tissue.
  
  
  
  Scar remodeling is initiated 1 month after AFXL treatment, but overall scar improvement is concealed until laser-induced color changes resolve. At 6 months follow-up, the benefit of AFXL treatment on c-section scars emerges. Lasers Surg. Med. 49:189-197, 2017. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Katrine E
authors.initials: KE
authors.lastname: Karmisholt
authors.affiliation: Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Elisabeth H
authors.initials: EH
authors.lastname: Taudorf
authors.affiliation: Department of Obstetrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Camilla B
authors.initials: CB
authors.lastname: Wulff
authors.affiliation: Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Emily
authors.initials: E
authors.lastname: Wenande
authors.affiliation: Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Philipsen
authors.affiliation: Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Merete
authors.initials: M
authors.lastname: Haedersdal
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D054020:Lasers, Gas / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: POSAS; Vancouver scar scale; ablative fractional laser; caesarean section scar; fractional CO2-laser; scar; scar remodulation; scar treatment; surgical scar