Post-Surgical Repair of Cleft Scar Using Fractional CO2 Laser

Abstract

BACKGROUND: Postoperative scarring is a common cause of patients dissatisfaction. Several modalities have been developed to overcome such a problem following surgical repair. Despite precise surgical technique, still, some scars would remain over the time, mostly due to the weak formation or inadequately replaced collagen fibres in the underneath dermis especially those following unilateral or bilateral cleft lip repair surgery.

AIM: of this study is to evaluate whether a 10,600 nm fractional ablative carbon dioxide (CO₂) used early during the healing period would result in better postoperative scars.

METHODS: In the present study six patients complained from cleft lip scars resulting from lip revision surgery. Each patient had six fractional ablative CO₂ laser sessions for treatment along six months to obtain a complete collagen cycle. Vancouver Scar Scale VSS was used as a method of evaluation of the scar using 4 points scale evaluating vascularity, pliability, thickness & colour of the skin and Visual Analogue Scale VAS from (0-10) was used to assess the severity of pain as well as a survey questionnaire for the rate of patient’s satisfaction. Also, digital clinical photos assessment before&after were compared.

RESULTS: Patients expressed a significantly greater degree of satisfaction with the treatment using a subjective 4-point scale. All patients observed dramatic improvement in their lip scars after FCO₂ laser sessions following their surgeries with the better psychological state. The assessment was done by clinical observation according to VSS before (9.17 ± 2.2) while after (3.33 ± 1.9) with a highly significant P value <0.001 and VAS for the rate of pain & satisfaction that ranged from (8.0 ± 0.9) as well as series of photos taken before and after the procedure. No long-term complications were noted however patients complained of annoying pain during the session as well as crust formation that lasted up to 5 days after surgery. In the present study, we introduce the effectiveness of ablative fractional 10,600 nm CO₂ laser for treatment of postoperative cleft lip scar after secondary surgical cleft repair rather than ablative CO₂ due to its reported complications such as postoperative infection, erythema and pigmentary changes along with prolonged downtime healing. In the current study, we chose early laser treatment within the first six months before complete collagen organisation which will be easier to manage the older scars. Patients mostly complained about the pain during the session as well as dark-coloured crust formation post session that stayed from 3-5 days however they all observed a massive improvement of their scars following treatment protocol.

CONCLUSION: Facial wounds sutured in layers heal in a good manner. Patients prefer early treatment with a fractional CO₂ ablative laser for postoperative surgical scars. The use of a CO₂ fractional laser is safe and effective also causes high patients satisfaction.