Fractional CO₂ Laser for Pediatric Hypertrophic Scars: Lessons Learned from a Prematurely Terminated Split-Scar Trial

Area of Science:

• Dermatology
• Plastic Surgery
• Pediatric Medicine

Background:

• Assessing hypertrophic scar (HTS) treatments is complex due to scar evolution.
• Split-scar designs can isolate treatment effects from natural scar changes.
• Evidence for ablative fractional CO2 lasers (AFCO2Ls) in pediatric HTS using split-scar methods is scarce.

Purpose of the Study:

• To evaluate the feasibility of a split-scar design for assessing AFCO2L treatment in pediatric HTS.
• To identify preliminary treatment outcome trends for pediatric HTS with AFCO2Ls.

Main Methods:

• A feasibility trial adapted from a prospective split-scar randomized controlled trial.
• Pediatric patients (1-17 years) with HTS received three AFCO2L treatments.
• Outcomes were measured using Vancouver Scar Scale (VSS), SCAR-Q, and Cutometer.

Main Results:

• Recruitment was significantly hindered by COVID-19, anesthesia concerns, and low interest in split-scar approaches.
• Only 6 participants (9 scars) were enrolled, falling short of the 44-scar target.
• The small, heterogeneous sample size prevented meaningful clinical outcome analysis.

Conclusions:

• This feasibility study underscores the difficulties in conducting rigorous pediatric HTS research.
• Challenges in recruitment and design necessitate careful interpretation of existing evidence, considering publication bias.
• Future pediatric HTS trials require optimized recruitment strategies and comprehensive reporting for improved feasibility and reliability.