Intralesional Cryosurgery for the Treatment of Hypertrophic Scars and Keloids

Abstract

This chapter is aimed to describe in a comprehensive way the novel cryoneedle which is inserted into the hypertrophic scars and keloid (HSK). It is connected to a canister of liquid nitrogen, which causes the cryoprobe to freeze, thereby freezing the HSK from the inside out.

Following the cryotreatment, the histomorphometric analysis demonstrated rejuvenation of the treated scars. The collagen bundles became more compact. A clear distinct transition zone separated the treated from the unaffected area. The surface thermal history showed a slow cooling and thawing rates, and less pronounced end temperature, which is “friendly” to the melanocytes; thus, only minimal hypopigmentation was evident. A significant long hold time was documented. This allows time for solute effects, ice crystal formation, and recrystallization, which enhances and increases the rate of cell death. This long hold time, which is unique for the cryosurgery technology, might explain the superior clinical results which have been obtained.

An average of 51% of scar volume reduction was achieved following a single cryotreatment: for ear HSK, 67% reduction, and for the upper back and shoulders, 60%. Significant alleviation of objective and subjective clinical symptoms was achieved. During the follow-up period there was no worsening or infection of the HSK and only minimal hypopigmentation.

A pain control protocol has been applied which involved oral pain relief tablets and translesional local anesthesia. This protocol significantly reduced pain severity during the cryosurgery treatment to tolerable levels (VAS ≤ 3 cm).

The intralesional cryosurgery treatment is an evidence-based effective and safe technology, simple to operate which can be applied as an office procedure, is cost-effective, and possesses a short learning curve.