This article discusses use of laser technologies in acute management of soft tissue injuries in surgical incisions and trauma. To minimize scar formation, current standard of care in acute management of surgical incisions includes irrigation and cleansing, multilayered, tension-free closure with precise approximation and eversion of wound edges, judicious use of suture material, use of postoperative moisture barrier or dressing, and early removal of surgical sutures. Traumatic soft tissue injury involving the skin can be more challenging to manage acutely due to frequent presence of crushed, macerated, or otherwise devitalized tissues. Additional steps are often warranted in that setting including removal of foreign bodies, copious irrigation of the wound, removal of clearly devitalized tissues, and use of antibiotics to cover polymicrobial flora. Despite these measures, poor cosmetic outcome is frequent after surgical procedures and traumatic skin injuries.

Numerous adjunctive measures have been proposed to optimize wound healing and obviate the need for operative scar revision, many of which are discussed in this volume. These include use of steroids, post-treatment dressings, avoidance of sunlight, dermabrasion, and laser treatment. In classic dermabrasion, mechanical debridement of the superficial papillary dermis leads to re-epithelialization via the adnexal structures, resulting in improved texture and color of the skin. This is an excellent method for smoothing an irregular surface or correcting pigmentary discrepancy between adjacent skin edges, which alters how light creates shadows across the surface. Dermabrasion is recommended 6 to 8 weeks after injury/surgical procedure. More substantial improvements are reported during this period, as the immature scar is still undergoing remodeling, rather than during the mature phase. Proposed mechanism of action for this modality has been described by Harmon and colleagues as reorganization of connective tissue ultrastructure and epithelial cell–cell interactions with an increase in collagen bundle density and size with a tendency toward unidirectional orientation of fibers parallel to the epidermal surface. Although excellent outcomes have been described with this technique, it does require a fair level of operator experience and learning curve for manual control of the depth of dermabrasion and feathering of the edges. Additionally, this technique can be complicated with excessive bleeding and tearing of tissues at the treatment margin. Laser scar revision is a competing technology that has gained increasing popularity due to the potential for excellent hemostasis, ease of use, and precise control over depth of penetration and extent of treatment.

Since the introduction of laser skin resurfacing for aesthetic surgery in the mid-1990s, the technology has worked its way into broad use in scar revision. Laser and optical methods for management of acute injury have very vital roles in postsurgical and traumatic wound therapeutic outcome. With advances in this technology a clinician may arrive at a crossroads in the decision to treat a scar with surgical revision versus dermabrasion or various laser technologies. The authors present and review their experience herein to help with this decision-making process in the acute setting. This article discusses indications and strengths of available optical modalities with a focus on acute and subacute skin injuries. The discussion is practically oriented and structured around the specific applications of each technology.