{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:55:23Z","timestamp":1760057723918,"version":"build-2065373602"},"reference-count":41,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T00:00:00Z","timestamp":1740009600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Alberta Children\u2019s Hospital Foundation (ACHF) Child Health Grant Program"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["EBJ"],"abstract":"<jats:p>Background: Assessing hypertrophic scar (HTS) interventions is challenging because scars continue to undergo dynamic changes. A split-scar design can distinguish treatment effects from natural HTS evolution. Despite promising reports of ablative fractional CO2 lasers (AFCO2Ls) for HTS, split-scar evidence, particularly in pediatric scars, remains limited. Objective: To explore the feasibility of a split-scar design in assessing AFCO2L\u2019s impact on pediatric HTS and to identify potential trends in treatment outcomes. Methods: Initially designed as a prospective single-center split-scar randomized controlled trial, our study transitioned to a feasibility trial due to recruitment challenges. Pediatric patients aged 1\u201317 years with HTS suitable for split-scar evaluation received three AFCO2L treatments at 6\u20138-week intervals, with outcomes assessed using the Vancouver Scar Scale (VSS), SCAR-Q, and Cutometer. Results: Recruitment was limited by COVID-19 restrictions, concerns about general anesthesia for split-scar treatment, and low interest in divided-scar interventions, resulting in only 6 participants with 9 scars enrolled, far below the target sample size of 44. This small heterogeneous sample precluded meaningful clinical outcome analysis. Conclusions: Our feasibility trial highlights challenges in conducting rigorous pediatric HTS studies and the need for careful interpretation of evidence due to potential publication bias. Future trials should focus on tailored recruitment and comprehensive reporting to improve feasibility and reliability.<\/jats:p>","DOI":"10.3390\/ebj6010010","type":"journal-article","created":{"date-parts":[[2025,2,20]],"date-time":"2025-02-20T11:03:37Z","timestamp":1740049417000},"page":"10","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Fractional CO2 Laser for Pediatric Hypertrophic Scars: Lessons Learned from a Prematurely Terminated Split-Scar Trial"],"prefix":"10.3390","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0770-3150","authenticated-orcid":false,"given":"Sarthak","family":"Sinha","sequence":"first","affiliation":[{"name":"Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Altay","family":"Baykan","sequence":"additional","affiliation":[{"name":"Section of Pediatric Surgery, Department of Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada"},{"name":"Section of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen","family":"Hulin","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Alberta Children\u2019s Hospital, Calgary, AB T3B 6A8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Doug","family":"Baron","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Alberta Children\u2019s Hospital, Calgary, AB T3B 6A8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0844-8953","authenticated-orcid":false,"given":"Vincent","family":"Gabriel","sequence":"additional","affiliation":[{"name":"Section of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada"},{"name":"Department of Clinical Neurosciences, University of Calgary, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8295-7794","authenticated-orcid":false,"given":"Frankie O. G.","family":"Fraulin","sequence":"additional","affiliation":[{"name":"Section of Pediatric Surgery, Department of Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada"},{"name":"Section of Plastic Surgery, Department of Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1016\/j.pmr.2011.02.002","article-title":"Hypertrophic scar","volume":"22","author":"Gabriel","year":"2011","journal-title":"Phys. Med. Rehabil. Clin."},{"key":"ref_2","first-page":"CD013468","article-title":"Interventions for postburn pruritus","volume":"6","author":"Sinha","year":"2024","journal-title":"Cochrane Database Syst. 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