Treatment of a Full-thickness Laceration Scar on the Forehead Using a 1,064-nm Fractional Picosecond Laser and Polynucleotide Gel Injection

1. Medical Lasers; Engineering, Basic Research, and Clinical Application
88
Treatment of a Full-thickness Laceration Scar on the Forehead
Using a 1,064-nm Fractional Picosecond Laser and
Polynucleotide Gel Injection
A 72-year-old Korean male with an atrophic surgical scar on the
forehead was treated using a combination of picosecond-domain, 1,064-
nm neodymium-doped yttrium-aluminum-garnet laser with a
fractionated beam profile and an intradermal injection of polynucleotide
gel. At the follow-up 2 months after the sixth treatment, a significant
improvement in the scar was observed. We suggest that the use of
fractional picosecond-domain lasers in combination with injectable
wound healing accelerators can be a safe and effective treatment for
atrophic surgical scars.
Key words
Fractional laser; Picosecond-domain laser; Scar revision; Wound healing
Nark-Kyoung Rho
Sung Tae Chung
Cheongdam Leaders Dermatology Clinic, Seoul,
Korea
Received November 15, 2018
Accepted November 21, 2018
Correspondence
Nark-Kyoung Rho
Cheongdam Leaders Dermatology Clinic, 409
Dosan-daero, Gangnam-gu, Seoul 06014, Korea
Tel.: +82-2-2088-7828
Fax: +82-2-2088-7829
E-mail: rhonark@hanmail.net
C KoreanSocietyforLaserMedicineandSurgery
CC Thisisanopenaccessarticledistributedunderthe
termsoftheCreativeCommonsAttributionNon-
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Med Laser 2018;7(2):88-90
https://doi.org/10.25289/ML.2018.7.2.88
pISSN 2287-8300ㆍeISSN 2288-0224
Case Report

2. Scar Treatment Using a Fractional Picosecond Laser and Polynucleotide Gel
Nark-Kyoung Rho and Sung Tae Chung
VOLUME 7 NUMBER 2 DECEMBER 2018 89
Case
Report
INTRODUCTION
The use of picosecond-domain pulses is considered to
offer qualitatively different tissue effects than earlier-gen-
eration lasers for scar treatment. In contrast to conven-
tional fractional photothermolysis which aims to produce
thermal coagulation columns in the skin, a picosecond-
domain laser using a fractionated beam profile creates
numerous microscopic cavitations in the skin without
significant thermal injury.1
Recently, various wound
healing accelerators such as stem cell culture media,
platelet-rich plasma, and polynucleotide are getting more
popularity in wound and scar management although their
efficacy and safety have not been fully evaluated.2
We re-
port a case of a Korean male patient with deep atrophic
scarring of the forehead successfully treated with a six
treatment of fractional picosecond laser and intralesional
injection of polynucleotide gel.
CASE REPORT
A 72-year-old Korean male patient presented with
scarring to the right side of the forehead and the scalp
(Fig. 1A), which had resulted from surgical repair of a
traumatic full-thickness laceration 10 weeks prior to
presentation. The linear scar, extending from the right
eyebrow to the scalp, was linear 7.5 cm long, atrophic,
and slightly erythematous. The patient had no history of
any active management of the scar. The treatment area
was anesthetized using a eutectic mixture of local anaes-
thetic cream (EMLATM
, Astra-Zeneca AB, Södertälje, Swe-
den) for 30 minutes and cleansed with 5% chlorhexidine
gluconate antiseptics. A treatment with a picosecond-
domain (450 picosecond) 1,064-nm neodymium-doped
yttrium-aluminum-garnet (Nd:YAG) laser (Discovery
PicoTM
; Quanta System, Varese, Italy) was started. Laser
irradiation was performed using a round, 8 mm fractional
microlens array handpiece at a fluence of 0.7 J/cm2
. Mul-
tiple passes were applied on the lesion until the endpoint
of significant petechiae. Immediately after laser irradia-
tion, long-chain polynucleotide gel (RejuranTM
; Pharmar-
easearch Products, Seongnam, Korea) at a concentra-
tion of 20 mg/mL was injected at the base of the scar.
Injections were performed with a 33-gauge needle and
a serial intradermal puncture technique. About 0.05 mL
of material was injected in each point and total 10 points
were injected into the entire lesion. After wet dressing
with physiologic saline, a hydrocolloid dressing (Duoderm
Extra ThinTM
; ConvaTec, Deeside, UK) was applied to the
treatment area for 5 days. Petechiae were significant but
disappeared spontaneously within a week. Mild, transient
pruritus was noted 3 days after the procedure. The treat-
ment was repeated at 3-week intervals for six sessions
(Fig. 1B). No significant adverse effects were reported
throughout the treatment period. A 2-months follow- up
visit after the sixth treatment revealed a significant clinical
improvement (Fig. 1C).
DISCUSSION
Traumatic lacerations occur most often on the face
and scalp and more than 50 percent of all lacerations are
caused by blunt injury.3
Although most traumatic lacera-
tion wounds are caused by shear forces, compressive
forces cause more devitalization of tissue, and therefore
crush wounds are more susceptible to infection and
unacceptable scarring.3
For atrophic scars, fractional
lasers, which create noncontiguous columns of thermal
A B C
Fig. 1. (A) A linear, atrophic surgical
scar on the right forehead of a 72-
year-old Korean male, (B) the patient’s
scar after 3 treatments of a picosec­
ond-domain 1,064-nm neo­
dymium-
doped yttrium-aluminum-garnet
with a fractional beam profile
follow­
ed by intradermal injection of
poly­
nu­
cleotide gel, (C) a 2-months
follow-up visit after the sixth treat­
ment revealing a significant impro­
ve­
ment of the patient’s surgical scar.

3. Medical Lasers; Engineering, Basic Research, and Clinical Application
90
injury surrounded by zones of viable tissue that allow re-
sidual epidermal and dermal cells to contribute to rapid
healing, are more frequently used than the traditionally
used lasers such as carbon dioxide and erbium:yttrium-
aluminum-garnet lasers currently. Recently an innovative
fractional lens array, which helps deliver laser energy into
highly focused areas in a grid pattern, has been applied
for picosecond-domain lasers to produce very high beam
energies. This approach exploits laser-induced optical
breakdown of skin tissue to achieve fast and efficient skin
remodeling.1
Efficacy and safety of fractional picosecond
laser treatment of atrophic acne scars have been report-
ed under the wavelength of either 755 nm or 1,064 nm.4,5
Because the surgical scar of our case was more fibrotic
and more extensive than atrophic acne scars, we used
intralesional injection of polynucleotide gel in conjunc-
tion with the use of fractional picosecond laser, given that
adjuvant administration of polynucleotide gel along with
conventional fractional laser treatment has been found
to lead to more favorable effect in wound healing and
post-operative scar prevention after thyroidectomy.2
In
our patient, a good result was found by combined use of
picosecond-domain laser pulses and polynucleotide gel
for atrophic surgical scars. We think that this case report
adds to the literature on the efficacy of fractional picosec-
ond Nd:YAG laser in treating atrophic scars. The authors
also suggest that the adjunctive use of polynucleotide gel
may further facilitate dermal remodeling after laser scar
revision procedures.
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