Postoperative Treatment of Linear Thyroidectomy Scars with the Pinhole Method Using a 10600-nm Carbon Dioxide Laser

The formation of linear hypertrophic scars along suture lines is a frequent and undesired event after the conventional thy-roidectomy. 1 Previous reports have described good therapeutic results in minimizing the scars with fractional lasers and intralesional steroid injections. 1-4 However, in the cases of narrow linear scars, the fractional laser can damage the surrounding tissue despite using the smallest spot size. Intralesional ste-roid injections can also worsen scar appearance, causing atrophy and telangiectasia of the surrounding skin (Fig. 1A). Here, we describe the use of a pinhole method using a 10600-nm carbon dioxide (CO2) laser to treat linear thyroidectomy scars. Five female Korean patients, who developed linear hyper-trophic scars during the postoperative treatment of thyroidec-tomy scars, were included. All five patients had a linear thy-roidectomy scar on the anterior neck with a length of 6 cm to 8 cm. The mean patient age was 44.6±6.9 years (range, 39–52 years). We performed two to three CO2 laser (Spectra SP; Lu-tronic, Goyang, Korea) treatments using the pinhole method in 4-to 8-week intervals for each patient. Final treatment outcomes were evaluated after 8 weeks from the last CO2 laser treatment. All the participants provided written informed consent. Thirty minutes after applying topical anaesthesia (EMLA; AstraZeneca AB, Södertälje, Sweden), the treatment was performed using 300-mJ pulse energy and a 100-Hz frequency with a 1-mm spot diameter. The CO2 laser penetrated the skin depending on the scar thickness, creating multiple small holes 1-to 2-mm apart (Fig. 1B). Clinical photographs were taken, and the Vancouver Scar Scale (VSS) was graded at every visit to evaluate the treatment efficacy. 1 Two blinded physicians also evaluated the final outcomes using a four-point grading scale (grade 1, <25% improvement; grade 2, 26–50%; grade 3, 51–75%; grade 4, >75%). All five patients showed posttreatment improvement (Fig. 1C-F). Four of the five patients showed clinical improvement greater than grade 3 (three patients showed grade 4 improvement , one patient showed grade 3 improvement, and one patient showed grade 2 improvement). The mean total VSS scores decreased significantly: 10.2±1.3 pretreatment and 4.6±1.1 posttreatment. One patient developed persistent erythema after the first session; this complication continued for 3 weeks but spontaneously resolved. Ablative fractional lasers have been widely used to effectively minimize the appearance of thyroidectomy scars. 2,5 However, this laser has some limitations regarding the penetration depth and size of the focused beam. Fixed spot sizes and shapes in the commercially available …