RESUMO
BACKGROUND: Whatever the technique of the surgical repair, the scar remains and it is the most common cause for parent's and patient's dissatisfaction. We aimed in this work to evaluate the efficacy of the fractional CO2 (FCO2) laser on the later appearance of cleft lip scars in general and to compare between the early and late use of this tool to know its ideal application time in particular. To our knowledge, there are no published reports about this objective with regard to the number of patients and the concerned designated study. PATIENTS AND METHODS: One hundred twenty patients complaining of cleft lip scar were divided into 3 groups. Group 1 started FCO2 application 3 weeks postoperatively, group 2 started it 3 months postoperatively, and group 3 applied local creams only as a control group. Fractional CO2 laser had been applied for 5 to 7 sessions. Vancouver scar scale was used for scar evaluation determining vascularity, pigmentation, pliability, and height. Visual analog scale was also used depending on 5 independent physicians and nonmedical personnel to rate results on a graded scale from 0 to 10. Moreover, the scar width had been assessed through studying the final images by Photoshop CS5 Extended Version, in 2 fixed points of the scar width. RESULTS: Patients showed a great degree of improvement in their lip scar after FCO2 laser sessions. Vancouver Scar Scale score had insignificant differences between studied groups at the baseline before applying either FCO2 or local cream, whereas after their applications, it was significantly lower in group 1 (1.92 ± 0.88) in comparison with group 2 (3.70 ± 1.11) and group 3 (4.05 ± 1.29). Regarding scar width assessment, it was significantly lower in group 1 (2.51 ± 0.64) in comparison with groups 2 (3.17 ± 0.54) and 3 (3.27 ± 0.48). The visual analog scale by the participating medical personnel indicated that the FCO2-induced improvement in the lip scar appearance in group 1 more than groups 2 and 3 with a mean score of 44.17 ± 3.45, 36.53 ± 4.43, and 30.40 ± 5.22, respectively. The same assessment by the participating nonmedical personnel was significantly higher in group 1 (43.52 ± 4.20) in comparison with group 2 (37.52 ± 4.73) and group 3 (33.55 ± 4.85). CONCLUSIONS: We proved that using FCO2 is significantly better than using local creams in the postoperative management of cleft lip scars. More in depth, the early application of this tool is also significantly better than its delayed use.Clinical Trials Registration Name: Assessment of Fractional CO2 Laser in Treatment of Post-surgical Scarring of Cleft LipURL:https://clinicaltrials.gov/ct2/show/NCT03277287?cond=Assessment+of+Fractional+CO2+Laser+in+Treatment+of+Post-surgical+Scarring+of+Cleft+Lip&draw=2&rank=1Clinical Trials ID: NCT03277287Registration Date: June 9, 2017, retrospectively registered.