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Laser Resurfacing and Remodeling of Hypertrophic Burn Scars: The Results of a Large, Prospective, Before-After Cohort Study, with Long Term Follow-Up
Charles S Hultman, Jon S Friedstat*, Renee E Edkins*, Bruce A Cairns, Anthony A Meyer
University of North Carolina, Chapel Hill, NC
Objectives: Hypertrophic burn scars produce significant morbidity (itching, pain, stiffness, contracture), but best practices for management remain unclear, with unknown long-term benefit. We present the largest study to date that examines long-term impact of laser therapies, a potentially transformative technology, on hypertrophic burn scars.
Methods: We conducted a prospective, before-after cohort study in burn patients with hypertrophic scars. Pulsed-dye laser was used for pruritis, erythema; fractional CO2 laser was used for stiffness, abnormal texture. Outcomes included: 1) Vancouver Scar Scale (VSS), which documents pigmentation, erythema, pliability, height; 2) 4P Scar Scale (4PSS), which rates pain, pruritis, paresthesias, pliability.
Results: 147 burn patients (mean age, 26.9 years; TBSA, 16.1%) received 415 laser sessions (2.8 sessions/patient), 16 months (median) after injury, including PDL (n=327) and CO2 (n=139), over a mean area of 83 cm2. Laser treatments produced rapid, significant, lasting improvements in hypertrophic scar (table/figure).
Conclusions: For the first time ever, in a large prospective study, laser therapies have been shown to dramatically improve both the signs and symptoms of hypertrophic burn scars, as measured by objective/subjective instruments. Laser treatment of burn scars represents a disruptive innovation that can yield results not previously possible and may displace traditional methods of operative intervention.
| SCALE | PREOP Baseline | 1 Session | All Sessions | FINAL Result (2 Year F/U) | p value |
| VSS, range 0-15 | 10.43, sd 2.37 | 6.67, sd 2.11 | 5.16, sd 1.92 | 3.29, sd 1.24 | <0.001 |
| 4PSS, range 0-12 | 5.40, sd 2.54 | 2.89, sd 1.91 | 2.05, sd 1.67 | 1.74, sd 1.72 | <0.001 |
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