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Utilizing the CROSS Technique for
Post-operative Scars
Travis Hamblin, DO
Oakwood Hospital
Trenton, MI
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Objectives
Discuss the impact of scarring on quality
of life
Review scar revision options
Review history of CROSS technique
Discuss our study
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Conflicts of Interest
I have no conflicts of interest to declare.
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Skin Cancer Surgery in 2013
Over 5 million skin
cancers diagnosed
each year
Dermatologists
perform over 3 million
of these treatments
Up 13% from previous
year
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Effects of Scarring
Anxiety
Self-consciousness
Social stigma
Perceive physician as
unempathetic
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The Nose
Centrally located
Prominent during face
to face encounters
Difficult reconstruction
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Tethering Effect
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Bulbous sebaceous
skin emphasizes scar
More prominent and
atrophic in
appearance
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Resurfacing Methods
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Chemical Skin Resurfacing
Collagen remodeling
Reepithelialization
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C.R.O.S.S. Technique
• Published in 2002.
• Use of highly potent
trichloroacetic acid placed
within the scar
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C.R.O.S.S. Technique
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Hematoxylin/eosin-stained sections (original magnification, 100) of acne scars before (left) and at 1-year follow-up (right) after therapy with 95% trichloroacetic acid. Note overall increased hyalinization of dermal collagenous tissue, with focal knobby collagen fibers visible in bottom left corner.
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Masson trichrome special-stained sections (original magnification, 100) of acne scars before (left) and at 1-year follow-up (right) after therapy with 95% trichloroacetic acid. Note overall increased hyalinization of dermal collagenous tissue (blue).
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Our Study
Post-surgical scarring
on nose following
Mohs
Applied 50% TCA to
scarring 6-12 weeks
following surgery
Evaluated 3 months
later
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Visual Analogue Scale
2 independent
evaluators
Scores given for
Atrophy, Skin
Texture, and Overall
Improvement
Scale Change in Scar
Appearance
0 Worsening or no
improvement
1 1-25% Improvement
2 26-50% Improvement
3 51-75% Improvement
4 76-100%
Improvement
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Investigator 1Atrophy Textur
e
Overall
Patient #1 4 4 4
Patient #2 4 4 3
Patient #3 4 4 4
Patient #4 1 1 1
Patient #5 2 3 2
Patient #6 2 3 2
Patient #7 1 1 1
Patient #8 4 4 4
Patient #9 1 3 3
Atrophy Textur
e
Overall
Patient #1 4 4 4
Patient #2 3 2 3
Patient #3 4 3 4
Patient #4 3 2 2
Patient #5 2 3 2
Patient #6 2 4 2
Patient #7 1 1 1
Patient #8 3 4 3
Patient #9 3 4 4
Investigator 2
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Average Investigator Scores of
Improvement on Quartile Scale
Atrophy
Mean 2.67 (± 1.1)
Texture
Mean 3 (± 1.1)
Overall
Mean 2.72 (± 1.1)
2 out of 3 patients
had a good or
excellent response to
treatment (>50%
improvement)
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Before and After
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Adverse Events
All patients experienced mild
discomfort/burning with TCA application
No significant complications at the
treatment sites such as persistent
erythema, hyper/hypopigmentation, HSV
flare, scarring, or keloids
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Conclusion
CROSS technique is a safe and very
effective modality for treatment of post-
operative scarring with no significant
complications.
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Conclusion
Inexpensive
Simple application
Minimal pain or discomfort
As effective as other resurfacing methods
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