Abstract
Introduction
Minor burn scar contractures can be successfully treated with conservative approaches including Carbon Dioxide (CO2) laser therapy. While previous research has mainly focused on using the CO2 laser in a fractional mode to create a stamped pattern of holes (Figure A), less is known about how altering this pattern may affect the overall outcome of the contracture. Given this knowledge gap, our research group sought to investigate a new laser technique in which a series of lines, referred to as “laser surgical cuts,” are created across the length of the scar (Figure B). Thus, the aim of this pilot study was to evaluate the effectiveness of using this novel, laser surgical cuts technique to treat minor burn scar contractures in pediatric patients.
Methods
This prospective pilot study was carried out in the outpatient setting at our pediatric hospital. Only patients that had a minor burn scar contracture that crossed a joint on their palm and/or digits and who had consented to receive treatment with laser therapy were eligible to participate. Prior to treatment, a trained occupational and/or physiotherapist assessed each participant’s contracture by examining at least one of the following characteristics depending on the contracture’s location and extent of involvement: 1) range of motion (ROM), 2) digit length, 3) hand-span. Treatment consisted of one session of laser therapy during which surgical cuts were created across the length of the contracture followed by casting for approximately one week. Following cast removal, the initial contracture assessment was repeated and pre-post measures were compared.
Results
Seven patients participated in this study. All injuries were the result of contact burns and the mean age at assessment was 5.1 years. Overall, patients with flexion contractures (n = 4) experienced a mean improvement in ROM by 22.5° (SD 14.4). Patients with discrepancies in digit length (n = 4) experienced a mean improvement of 9.4% (pre = 5.3 cm, SD 1.6; post = 5.8 cm, SD 1.6) while those with discrepancies in hand-span (n = 3) experienced a mean improvement of 13.7% (pre = 14.6 cm, SD 3.4, post = 16.6 cm, SD 3.0).
Conclusions
We have shown that using the CO2 laser to create surgical cuts can improve minor contractures in burn-injured children. Further, we hypothesize that improvements in ROM, digit length, and hand-span are the result of a decrease in the mechanical tension across the contracture following treatment. Based on the positive findings obtained from this pilot study, a larger study with long-term follow-up is needed to determine if treatment with laser surgical cuts is more effective than using traditional, fractional CO2 laser settings.
Applicability of Research to Practice
Ultimately, if this novel laser technique is proven to be highly effective, the need for future contracture release surgeries may be reduced.
Burn scar contracture release surgery effectively improves functional range of motion, disability and quality of life: A pre/post cohort study with long-term follow-up in a Low- and Middle-Income Country
