Focus of Report: The focus of this Health Technology Assessment is to evaluate the effectiveness and safety of fractional laser treatment (FLT) for functional improvement in patients with hypertrophic and keloid burn and traumatic scars.
Technology Description: Laser therapy can be used to improve the appearance, texture, pliability, pain, and functional impairment associated with hypertrophic and keloid scars caused by trauma and burns. Conventional laser therapy is associated with prolonged recovery times and high rates of complications. FLT is less invasive than some surgical scar revision procedures, is more precise than topical treatments, and may be associated with fewer adverse effects compared with conventional laser therapy. The most commonly used media for FLT for hypertrophic scars are carbon dioxide (CO2) and erbium-doped yttrium aluminum garnet (Er:YAG, nanosecond modality)
Controversy: It is unclear whether FLT for burn and traumatic scars provides additional functional benefit beyond conventional scar care. Additionally, the effectiveness of FLT on specific scar types (e.g., hypertrophic and keloid) is not certain and there is limited evidence on the effectiveness of specific types of fractional laser media. The effectiveness of various FLTs on different skin types and pigmentations is not clear. Finally, the optimal timing of administration of FLT in the course of scar formation is unclear.
Key Questions:
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Is FLT effective for functional improvement in patients with impaired function caused by burn and traumatic scars?
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How does FLT compare with conservative treatment for functional improvement in patients with impaired function caused by burn and traumatic scars?
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Is FLT in patients with functional impairment caused by burn and traumatic scars safe?
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Have definitive patient selection criteria been identified for FLT for functional improvement in patients with impaired function caused by burn and traumatic scars?