The commonly used lasers for scar treatment are pulsed dye laser, adjustable pulse width multiplier Nd:YAG laser, PhotoDerm intense light and ultra-pulsed CO2 laser. Good clinical results have been achieved.
Indications: 1. depressed keloid scars after chicken pox and acne; 2. superficial keloid scars affecting aesthetics; 3. mature proliferative keloid scars without dysfunction; 4. bridging keloid scars; 5. proliferative keloid scars and keloid scars in the proliferative phase must be combined with radiation therapy.
Contraindications: 1. active hyperplastic scars and keloids; 2. scars with dysfunction requiring surgery; 3. partial webbed scars; 4. patients with localized infections, adolescents or patients with recurrent facial acne that has not reached stability; 5. patients who have recently received radiation therapy, corticosteroid injection therapy, and oral retinoic acid should be treated at intervals; 6. abnormal liver and kidney function 7, scar body; 8, with obvious pigment metabolism disorders, such as endocrine disorders, Addison’s disease, progressive vitiligo, etc.; 9, mental abnormalities, unrealistic fantasies about treatment.
Treatment: Preoperative routine blood tests, blood clotting time, liver and kidney function, blood sugar and other laboratory tests, as well as chest X-ray and electrocardiogram are routinely performed. Anesthesia can be performed with EMLA surface anesthetic, local infiltration anesthesia and nerve block anesthesia if necessary. Basic anesthesia or general anesthesia can be used in children.
1. Depressed keloid scars are firstly smoothed out by smoothing the “can” of the edge of the depressed keloid scars that rises above the normal skin and then doing the overall grinding. After the newborn is repaired, the original “deep pits” will become “shallow pits”, making the skin smooth and even from the overall perspective. Those who are still not satisfied with the appearance can undergo grinding again after six months.
2. For small bridged scar, the skin bridge can be picked up, the skin and the base at both ends can be cut off with laser, and then the base can be ground and vaporized. For larger bridging scar, the skin bridge and the base at both ends can be cut off first, then the base, and then the base can be ground and gasified smooth. For larger bridged keloid scars, the basal base of one end of the skin bridge can be cut off first, the skin bridge can be lifted to grind and remove the scar under the bridge, then the basal base can be grinded and smoothed, then the skin tissue of the bridge can be affixed back to the trauma and pressure bandaged.
3. Mature hyperplastic keloid scars can be smoothed out with laser grinding. For proliferative keloid scars with obvious augmentation, the scar tissue can be cut down from the basal plane with continuous wave before grinding and smoothing.
4. After laser grinding of hyperplastic scars and keloids in the proliferative phase, once the wound is healed, corticosteroid injection, radiation therapy or treatment with pulsed dye laser, adjustable pulse width multiplier Nd:YAG laser, PhotoDerm intense light, etc. should be used immediately, otherwise the scar is likely to recur or even expand in scope.
Postoperative treatment: 1. After scar grinding, clean the wound with iodophor.
2. Post-operative medication (1) keloid: within one week of surgery, apply anti-inflammatory and wound healing medication; after one week of surgery, apply anti-scar medication (2) ordinary scar: after surgery, mainly apply anti-inflammatory and wound healing medication. 3. Number and frequency of medication changes: once a day within one week of scar surgery; after one week, the frequency of medication changes is once every other day.
4.Postoperative abnormal treatment (1) Scar regeneration: If new flesh teeth are found to grow on the trauma surface after scar surgery, immediately apply 3% hypertonic saline wet dressing and continue until the flesh teeth disappear.
(2) Excessive secretion: There is yellow secretion on the trauma surface after scar surgery, this is a normal phenomenon, just clean the trauma surface with antiseptic water.
Side effects: 1. Erythema is inevitable in the wound healing process, and the time required for erythema to subside usually lasts for several weeks; 2. The incidence of infection is low, mostly related to poor intraoperative aseptic operation, improper postoperative care and low patient resistance; 3. -12 months. Hypopigmentation is very rare; 4. Keloidal hyperplasia is an important complication after scar grinding. Combined with radionuclide irradiation can solve this problem. Treatment of keloid scars combined with radiotherapy can successfully inhibit fibroblast proliferation and effectively prevent recurrence.