๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Comparative Trials
Comparative Trials
Recently, randomized controlled studies have been conducted to compare the efficacy of dermabrasion versus other approaches to scar treatment, such as manual dermabrasion, electrobrasion, chemical peels, and laser. Some have also advocated a combination approach to the treatment of facial scarring.
Dermabrasion versus manual dermabrasion Using a split scar study, Gillard et al. randomly assigned 21 patients to receive traditional dermabrasion with diamond fraise to one-half of the scar and manual dermabrasion with drywall sanding screen to the other half.25 All scars were on the face and a majority (18/21) were on the nose. Repairs included scars healing via secondary intention, complex linear closures, full-thickness skin grafts, and flap closures. Patients were evaluated at 1, 2, 3, and 4 weeks, and 3 and 6 months to assess for percentage of skin reepithelialization, skin erythema, presence of milia, scar-line visibility, contour, presence of infection, pain score, and presence of hypertrophic scar. No differences were found between the two treatment modalities overall or at any of the time points.
Electrobrasion versus manual dermabrasion Kleinerman et al. evaluated electrobrasion using a monopolar electrosurgical device versus manual dermabrasion using medium grit drywall cement paper in a split scar study enrolling 33 patients.26 Scars were assessed at 3 months following treatment using the Manchester Scar Scale, a validated scar assessment instrument.27 Significant improvement in scar outcome from baseline was reported for both techniques, with no significant difference seen between electrobrasion and manual dermabrasion.
Chemical peel versus dermabrasion Several groups have studied the histologic and immunohistochemical changes between the use of chemical peels and dermabrasion. El-domyati et al. treated the faces of four patients with trichloroacetic acid peel (TCA 10%, 20%, and 30%) and five patients with dermabrasion.28 Biopsies were taken at 3 months post procedure for examination under electron microscopy, H&E staining, and immunohistochemical staining. They found that while both techniques produced increased collagen deposition and normalization of elastic tissues, changes were more prominent in patients treated with dermabrasion.
Giese et al. used a porcine model to examine differences between dermabrasion and TCA 25%, TCA 50%, and Phenol peels.29 At 6 months, no significant difference in elastic tissue volume was found in the dermabrasion and TCA groups. However, the phenol peel group demonstrated a decrease in elastic tissue volume, which the authors concluded was an unintended but potential risk of deeper peels.
Laser versus dermabrasion In 1998, Nehal et al. compared the efficacy of unfractionated CO2 laser to dermabrasion in resurfacing facial scars in a split scar study of four patients.30 At 8 weeks following treatment, there was no significant difference between the treatment sides. Nehal reported that the side treated with CO2 laser had the advantage of being bloodless and resulted in less crusting postoperatively, although both sides had the same outcome.
Christophel et al. also utilized a split scar study to compare fractionated CO2 laser to dermabrasion in 6 patients with 12 scars.31 There were no long-term differences at 3 months, although the CO2 laser group demonstrated less erythema, bleeding, and edema in the period immediately following treatment.