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Abstract: After laparoscopic surgery, a 35-year-old male presented with a well-defined, irregularly shaped dark red protrusion at the original surgical site, which was slightly sharp and hard to the touch, not painful or itchy, but the overall shape was obvious and affected the appearance, so he came to the clinic and was diagnosed with scar-like changes, which is also known as scars in daily life.
Basic information】Male, 35 years old
Disease Type】Scars
Hospital】Harbin Hospital of Traditional Chinese Medicine
Date of consultation】May 2022
Treatment plan】Topical anesthesia (lidocaine hydrochloride gel) + surgical treatment (CO2 fractional laser)
Treatment period】6 months of regular outpatient treatment
【Treatment effect】The irregular red hyperplastic scars on the skin surface gradually faded away
I. Initial consultation
Patient Li, a 35-year-old male, reported that he underwent hernia surgery at a local hospital in April 2021. After the disease was cured by laparoscopy, the local suture wound gradually formed a well-defined but irregularly shaped hyperplastic change with red color, but it was not painful or itchy and only affected the appearance. On examination, a dark red scar tissue was seen 0.5 cm above the umbilicus of the patient, which was slightly raised by hand and had a nodule-like touch on the surface. 10 cm outside the belly button of the right abdomen, a dark red altered border was visible, clear and level with the skin, but slightly hard to the touch. A dark red hyperplastic mass that was flat against the skin was seen 10 cm outside the navel on the left lower abdomen of the patient. The patient’s medical history was clear, and no additional ancillary tests were needed. The diagnosis of scarring was made based on clinical examination.
II. Treatment history
The patient’s scar had formed on the surface of the body for one year, with no spreading of the edges and no tendency to turn into a keloid. After communicating with the patient about the occurrence and development of the disease, it was decided to choose to use carbon dioxide fractional laser for treatment. The fractional CO2 laser is used to gradually regenerate the skin through the exfoliative regenerative principle of the laser in order to achieve scar removal.
We apply topical lidocaine hydrochloride gel to the patient’s local skin surface for local anesthesia, remove the anesthetic after 30 minutes, then disinfect the local skin and select the CO2 fractional laser to perform fractional treatment on the local scars. After one treatment, the patient will have a red, fractional burn mark on the local scar. At this time, sterile gauze was applied to the area to prevent friction, and the patient was instructed to undergo the second cycle of treatment after 2 months.
III. Treatment effect
One month after the patient’s return home, a telephone call was made to the patient. The patient indicated that after removing the gauze to prevent friction, the local skin felt slightly burning. After 7 days of treatment, the dark red color gradually faded. After 15 days of treatment, the local fractional laser marks disappeared completely. As of the date of the callback, the abdominal scars had slightly faded in color, the structures raised above the skin had slightly flattened, and the overall tendency of the scars to improve was visible. After regular application of fractional laser treatment for 3 times, i.e. 6 months, the patient’s scars were basically smoothed out in their raised structure, and the color of their appearance was no different from normal skin, and no local itching or pain occurred.
IV. Notes
Happily, after a series of treatments, the patient’s scars gradually faded and had a tendency to get better. However, since the carbon dioxide fractional laser treatment of scars will result in the formation of burning burn-like changes on the skin surface, patients are advised to pay attention to reducing the friction on the scars in their daily life to prevent the formation of local breakage due to repeated friction, which will lead to the breeding of bacteria and is not conducive to the fading of scars.
In addition, patients are advised to avoid drinking alcohol and eating less spicy and stimulating food within 7 days of CO2 fractional laser treatment to avoid triggering improper local wound repair.
V. Personal insight
Scars are mainly secondary to skin tissue irritation on the skin surface after trauma, mostly due to fresh connective tissue constituting connective tissue replacing missing tissue in the dermis and deeper areas. The types of scars are relatively diverse and can be easily confused with lichen planus and lupus erythematosus. However, scars are not incurable, and the patient in this article developed a scar after laparoscopy but was able to gradually lighten it with aggressive treatment. However, it should be noted that the patient’s scars are not able to disappear completely, so we should also clarify with the patient in advance, their treatment expectations to prevent dissatisfaction after treatment.