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Scars are a very common complication of traumatic injuries affecting millions of people worldwide every year. Scars can be disfiguring, aesthetically unacceptable, and cause pruritis, tenderness, pain, sleep disturbance, anxiety, and depression in patients. In approximately 70% of medico legal instructions to plastic surgeons the expert is required to comment upon issues of scarring and provide a prognosis and recommend various treatment options.
Valuing claims for scarring is a complex issue given the nature of an individual claimant’s perception of the scarring and the effects that it has on their daily life. The optimal effect is to reduce the scar to a minimum which will naturally reduce the effect it has on an ongoing basis and assist with settlement of the claim. There is no general consensus as to what is the optimal treatment for reducing scarring, however, the last few decades has shown that the use of lasers as a treatment option has delivered clinical and cosmetic benefits for patients for many types of scars.
Timing of Treatment
The optimal time for treatment is during the premature phase of scar formation at approximately 6 to 8 weeks after injury. Newer non ablative, pulsed, or fractionated lasers place minimal mechanical stress on the tissues, making an argument for even earlier treatments. Earlier intervention can in theory alter the inflammatory phase of wound healing and change fibroblast migration, leading to a reduction in the appearance of scars. { Oliaei S, Nelson JS, Fitzpatrick R, Wong BJ. Use of Lasers in Acute Management of Surgical and Traumatic Incisions on the Face. Facial plastic surgery clinics of North America. 2011;19(3):543-550. doi:10.1016/j.fsc.2011.06.007.}
The proper classification of scars is essential in determining proper laser treatment choice and protocol. Scar type, texture, morphology, and colour will determine the choice of laser parameter and help predict the number of treatment sessions required. For the purpose of this article we discuss the use of Fractional laser treatment for the treatment of hypertrophic and keloid scars most commonly found in personal injury and clinical negligence cases.
Fractional Laser Treatment
Fractional Laser Treatment is the latest technology being utilised to treat scars. Minute sections of the skin are targeted with laser light, which penetrate into the dermis to stimulate significant collagen renewal. The laser targets specific chromophores in the skin; namely, hemoglobin and oxyhemoglobin, melanin and water. The surrounding non affected areas of skin aid the body’s natural recovery process.
Different scars may need a different length of course, or in combination with intralesional agents such as corticosteroids and antimetabolites, including 5-fluorouracil (5-FU) but almost all types of scar can be treated. Combating redness, uneven surface and tightness. Other benefits include a brighter more even skin tone and a smoother skin texture with improved skin elasticity.
Medical Reports Ltd is now able to offer solicitors access to a nationwide network of specialist clinics to provide laser treatment in cases involving scarring. In the first instance the claimant would attend a clinic and be examined and patch tested and a report on the recommended treatment profile prepared.
Provided the claimant suffered no adverse reactions to the patch test a bespoke treatment plan would be undertaken and following treatment a final report completed.
For more information or to obtain a quote please email general@medicalreportsltd.co.uk
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