Non-Ablative Fractional Resurfacing of Total Knee Replacement Scars

Patients undergoing unilateral, primary total knee replacement will be enrolled in the study in the treating surgeon's office at the time surgery is indicated and scheduled. Patient's will be asked to enroll in the study if they are indicated by the treating surgeon for primary total knee replacement, are 18 years of age or older, and, if they have no history of wound healing problems, chronic infection or connective tissue disorder and if they have a Fitzpatrick skin type between I and VI. Patients will be excluded from the study if they: have any prior history of surgery on the indicated knee; have a mental or psychological illness that prohibits them from consenting or completing the necessary forms; if they refuse to consent to be in the study; or, if they have a history of wound healing problems, or a diagnosed skin or connective tissue disease. Standard baseline health information and demographics will be collected at the time of enrollment (gender, age, co-morbidities, etc.).

On the day of surgery, patients will be randomized to have their surgical incision treated with the non-ablative fractional laser or treated with the placebo laser. Randomization will be computer-generated and stored in opaque sealed envelopes. For each patient, randomization will take place prior to surgery in the holding area on the day of surgery. At discharge, the laser technician will open the sealed envelope to reveal the allocation into control or experimental groups. The technician will then treat the patient appropriately as per the protocol. Proper randomization will be ensured by the technician, principal investigator and co-investigators. The patients, principal investigator and co-investigators collecting the data will be blinded to the randomization. The technician providing the laser therapy will not be blinded.

The incisional length will be determined by the treating surgeon at the time of surgery based on what he deems will be adequate given the patient's body habitus and the technical demands of the surgery. The skin incision will always be made with a new, sharp, sterile 10 blade. Subcutaneous dissection will be done with the scalpel as well.

Closure of the wound will be done with 0-vicryl sutures for the arthrotomy and deep subcutaneous tissue. The sutures will be tied in an interrupted simple pattern. The superficial subcutaneous tissue layer will be closed with interrupted buried 2.0-vicryl sutures. The skin will be closed with a 4.0 monocryl running subcuticular stitch. The wound will be dressed with a sterile dressing that will come off on post operative day two.

After the primary dressing is taken down, the wound will be left open to air unless there is active drainage. If active drainage is present, sterile gauze will be kept on the wound until it is dry.