Treatment of keloid sternotomy scars with 585 nm flashlamp-pumped pulsed-dye laser

Despite increasing knowledge of wound healing and collagen metabolism, hypertrophic scars and keloid scars are difficult to eradicate. Median sternotomy scars are often hypertrophic or keloidal. We treated them with a 585 nm flashlamp-pumped pulsed-dye laser, which selectively injures cutaneous microvessels without inducing scars. 16 adult patients with hypertrophic or keloidal median sternotomy scars after heart surgery received two treatments to one half of their previously untreated scars every 6-8 weeks and were reviewed at 6 months. Symptoms and clinical, histological, photographic, and surface texture assessments were obtained for treated and untreated areas of scar and evaluated independently by two observers blind to the treatment and by digital image analysis of skin surface casts. There was a significant improvement in erythema, scar height, skin surface texture, and pruritus in laser-treated scar areas; this improvement persisted for at least 6 months.