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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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Thank You!