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• W4220997038 abstract "To the Editor: It has been estimated that 5.4 million new cases of nonmelanoma skin cancer are diagnosed each year,1Rogers H.W. Weinstock M.A. Feldman S.R. Coldiron B.M. Incidence estimate of nonmelanoma skin cancer (keratinocyte carcinomas) in the US population, 2012.JAMA Dermatol. 2015; 151: 1081-1086https://doi.org/10.1001/jamadermatol.2015.1187Crossref PubMed Scopus (1012) Google Scholar with up to 10% of basal cell carcinomas and 20% of squamous cell carcinomas occurring on the lower extremities.2Subramaniam P. Olsen C.M. Thompson B.S. Whiteman D.C. Neale R.E. Anatomical distributions of basal cell carcinoma and squamous cell carcinoma in a population-based study in Queensland, Australia.JAMA Dermatol. 2017; 153: 175-182https://doi.org/10.1001/jamadermatol.2016.4070Crossref PubMed Scopus (46) Google Scholar The treatment for nonmelanoma skin cancer is often destructive or surgical, with Mohs micrographic surgery frequently used for skin cancers below the knee. This increase in the incidence of skin cancer on the lower extremities results in an increase in the number of postoperative lower extremity wounds. Carbon dioxide ablative fractionated laser (CO2AFL) is a Food and Drug Administration-approved device with proven efficacy in chronic, postsurgical scar treatment.3Lee S.H. Zheng Z. Roh M.R. Early postoperative treatment of surgical scars using a fractional carbon dioxide laser: a split-scar, evaluator-blinded study.Dermatol Surg. 2013; 39: 1190-1196https://doi.org/10.1111/dsu.12228Crossref PubMed Scopus (35) Google Scholar CO2AFL offers a multidepth pulse technology that delivers a fractionated beam pattern to treat the epidermis and dermis simultaneously while sparing healthy tissue in the vicinity. In histopathologic and 3-dimensional, human organotypic, full-thickness skin models, CO2AFL induced the expression of matrix metalloproteinases and the downregulation of proinflammatory cytokines.4Schmitt L. Huth S. Amann P.M. et al.Direct biological effects of fractional ultrapulsed CO2 laser irradiation on keratinocytes and fibroblasts in human organotypic full-thickness 3D skin models.Lasers Med Sci. 2018; 33: 765-772https://doi.org/10.1007/s10103-017-2409-1Crossref PubMed Scopus (23) Google Scholar Therefore, CO2AFL can offer significant advantages over traditional lasers and low-level lights in treating ulcers, although it has not been studied for the treatment of acute, lower extremity wounds. Therefore, this study sought to define the safety and efficacy of CO2AFL in healing acute, lower extremity wounds following Mohs micrographic surgery. This prospective, double-blinded, randomized, placebo-controlled trial consisted of 48 patients who received either sham laser (n = 24) or CO2AFL therapy (n = 24) on their lower extremity, postsurgical wound following Mohs micrographic surgery (Table I). Uncontrolled diabetics, minors, and those with venous insufficiency or peripheral vascular disease were excluded.Table IParticipant demographicsDemographic categoryTreatment groupControl groupP valueLaserShamSex.162 Male, %2912.5 Female, %7187.5Age (mean, SD)70, 1272, 12.563Ethnicity (% Hispanic)8.30.155Current smoker (%)4.220.8.084 Open table in a new tab The laser energy setting was 70 milli-Joules, corresponding to a power density of 360,000 W/cm2. The treatment area was 7.1 × 8.1 mm2, with a coverage density of 5%. The patients received 2 passes. The spot size, with a silver lens, was 150 μm. The pulse duration was 1.166 milliseconds. To assess the efficacy of CO2AFL, the following data points were assessed at each time point (4, 8, and 12 weeks): mean time to complete wound healing, the number of wounds completely healed, wound surface area, and wound temperature. These were analyzed using the 2-sided t test. To assess the safety of CO2AFL, we collected data on the incidence of posttreatment infection, self-reported pain, and the quality of life. These variables were analyzed for statistical significance using the Fisher exact χ2 test. The analyses employed α = 0.10 and β = 0.20. There was no statistically significant difference between CO2AFL and the control in terms of wound healing, percent change in surface area, the quality of life, or adverse events at weeks 4, 8, or 12 (Table II). All infections resolved with antibiotics.Table IIResultsDemographic categoryBaselineWeek 4Week 8Week 12TreatmentControlTreatmentControlTreatmentControlTreatmentControln2424222422202321Completely healed (n, %)N/AN/A3, 14%0, 0%13, 59%13, 65%20, 87%18, 86%Average wound surface area (cm2)3.563.222.431.841.610.90.630.81Average wound temperature, °C25.6025.5330.3530.1731.0231.2632.4131.76Adverse events (n, %)0, 0%0, 0%4, 18%2, 8%0, 0%0, 0%0, 0%0, 0%EQ-5D, mean score87.585.688.982.592.187.190.787.5EQ-5D, EuroQol-5Dimensional; N/A, not applicable. Open table in a new tab EQ-5D, EuroQol-5Dimensional; N/A, not applicable. The limitations of our study include its single-center design and protocol of monthly follow-up visits. Further studies examining the role of CO2AFL at an earlier time point after surgery may unmask true differences between the groups. Additionally, differences in carbon dioxide lasers cannot be overlooked. The longer pulse width of the laser used in this study may have altered the healing characteristics of the wounds in our patients, although the power density may have somewhat mitigated this effect. Although a safe modality, our study suggests that CO2AFL is not a useful modality for healing acute, lower extremity wounds. Further prospective studies are needed to definitively evaluate its efficacy. None disclosed." @default.
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• W4220997038 date "2022-11-01" @default.
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• W4220997038 title "Management of acute, lower extremity surgical wounds using an ablative fractional laser: A single-center, randomized, double-blinded controlled trial" @default.
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• W4220997038 doi "https://doi.org/10.1016/j.jaad.2021.10.067" @default.
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