Abstract
Introduction
Fractional ablative laser therapy use is increasing for treating burn hypertrophic scar (HTS). However, standard components of a routine HTS evaluation prior to starting laser scar revision (LSR) and after each intervention have yet to be determined, and metrics for effective treatment have not been established.
Methods
Patients who entered a LSR program between September 2018 and September 2019, underwent at least two LSR treatments, and completed post-LSR scar evaluations for each of these treatments were included in the studied sample. Patients were treated with a fractional ablative CO2 laser. A single burn rehabilitation therapist conducted all pre- and post-procedure scar evaluations, which included the Patient and Observer Scar Assessment Scale (POSAS), Vancouver Scar Scale (VSS), Institutional Scar Comparison Scale (SCS), durometry, and active range of motion (AROM) measurements.
Results
From 9/2018 to 9/2019, 25 patients began the LSR program and underwent at least two treatments with post-laser scar assessments for each intervention. Patients underwent an average of 3±1 LSR sessions during the time period for a total of 84 sessions amongst the group. Patients averaged 51±14 years old (range 26–80), with all Fitzpatrick skin types represented (mode type 5). Average HTS age was 14±19 months post-injury (range 3–98 months post injury).
After one session of LSR, 91% of patients improved in at least one scar assessment metric (average 3±1.4 areas). After two sessions, all patients showed improvement in at least one metric (average 3.6±1.2 areas). One LSR session was associated with a 10.8±31.9% improvement in AROM of a HTS-affected joint, and this increased to 38.1±41.4% after five LSR treatments (p=0.0002). Durometry readings demonstrated decreasing scar hardness compared to adjacent uninjured skin in 90% of patients, and 96% of patients experienced improvements in POSAS, VSS, and SCS scores during a treatment course.
Conclusions
Improvements in burn HTS can be achieved with fractional ablative laser therapy in a wide range of scar ages and skin types, as early as the first LSR session. These continue to increase as additional sessions are performed.
Applicability of Research to Practice
This work suggests necessary baseline evaluation components for patients undergoing LSR, as well as a timeline for expected clinical improvements. This data may inform conversations with burn survivors and providers when considering laser therapy for symptomatic HTS.
In Vivo Histopathologic Comparison of the Acute Injury Following Treatment With Five Fractional Ablative Laser Devices
