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ABSTRACT

Each year in the developed world, over 100 million scars are acquired from elective surgery, trauma, keloids, and burn injuries. Across the United States and the EU, there are 44- and 42 million procedures conducted respectively to improve these scars due to their substantial impact on quality of life. As scar severity increase, so does the potential for functional and symptomatic sequelae such as burning, itching, pain, discomfort, disfigurement, contracture, stigma, and social isolation.

A variety of approaches are currently utilized in scar management including prevention, surgical correction, perioperative manipulation, and postoperative intervention. From these categories, lasers have emerged as a leading technology both in prevention and correction of scar formation. The flexibility of laser additionally lends itself to synergistic combination strategies. Ablative fractional lasers (AFL) in particular have been utilized for their ability to create microscopic channels in the skin that allow the delivery of drugs and other treatment enhancing agents directly into scar tissue. This technique is called laser-assisted drug delivery (LAD).

LAD is conducted through the vaporization of small ablative fractional laser zones (120 to 150 micrometers) of the stratum corneum, epidermis, and dermis to tunable depths of 20 to 4000 micrometers, facilitating increased penetration of a drug, device, or cell to its respective target. Traditional topical methods of drug application are limited in their potential due to the function of the skin as a barrier and its resulting impedance of bioavailability. By bypassing this natural shield, LAD overcomes this challenge and can dramatically enhance the impact of a utilized agent. As a precise and highly customizable therapeutic delivery mechanism, LAD is a rapidly evolving and its possible applications expanding. This comprehensive review will discuss the indications and techniques involved in LAD in order to optimize clinical results in scar rehabilitation.

HISTORY OF THE METHOD

Scarring is ubiquitous across the globe and its sequelae potentially detrimental to quality of life.1 As such, a wide variety of treatment modalities are in continuous development to improve and optimize scar rehabilitation. Of these modalities, laser-assisted drug delivery (LAD) has emerged as a powerful and promising tool in this endeavor.2,3 LAD is a novel delivery method first published in 2002. Its initial application in this report was a combination of full-field ablative traditional 2,940-nm erbium: yttrium aluminum garnet (Er:YAG) followed by topically applied lidocaine.4 It was then quickly realized that this technique is a unique way to circumvent one of the skin’s main functions, providing a protective barrier to prevent exogenous substances from penetration. Typically when a drug is applied topically, the stratum corneum is the rate-limiting step, impairing the ability of these drugs to enter the body. But the use of full-field ablation, while capable of removing this barrier on a broad scale, left substantial room for optimization. In 2007, a new tool entered the armamentarium through the emergence of fractional ablative lasers. These infrared lasers ...

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