37 Analysis of the Utility of CO2 and Pulse-Dye Lasers in the Treatment of Hypertrophic Burn Scars

Abstract

Abstract Introduction Despite advances in burn care, hypertrophic burn scars (HTBS) remain a significant source of morbidity. Treatment often involves use of CO2 lasers to reduce thickness and pulse-dye lasers (PDL) to reduce erythema. Despite frequent utilization, little quantitative data exists. This study seeks to objectively determine the effects of these laser treatments on burn scars. Methods Patients found to have HTBS undergoing laser treatments were approached for enrollment. Following enrollment, an area of HTBS outside of the treatment area was divided into 4 equal 3x3cm squares which were randomized to receive either CO2, PDL, CO2+PDL, or no treatment. Patients underwent a total of 3 treatments, 4–6 weeks apart, and were seen for follow-up over 3–6 months. Scar assessments occurred at each visit prior to treatment and consisted of digital photographs, ultrasound assessment for scar thickness, colorimetry, and the Patient and Observer Scar Assessment Score (POSAS). Results Twenty-five patients were enrolled at our institution. To date, 12 (48%) have completed all 3 treatments and the remainder are still in their follow-up period. Median initial scar thickness (ST) was 0.3cm. Mean time since injury was 9 months. Overall, there was a significant decrease in ST over time (p=0.0246) but not between treatment groups. There were no significant changes seen in melanin, erythema, or POSAS scores (p=0.9030, 0.6470, and 0.1495, respectively). When separated by ST before initiation of treatment, thin scars (< 3cm) appeared to be overall less erythematous in groups treated with PDL and CO2+PDL and untreated groups (p=0.0358, 0.0027. 0.0118, respectively) as compared to thick scars (≥3cm). Thin scars treated with PDL and CO2+PDL were also less pigmented than thick scars (p=0.0127, 0.0213, respectively). Erythema significantly decreased between the last treatment and the final visit for PDL and CO2+PDL groups (p< 0.0001). Older scars (≥9 months prior to treatment) tended to have a greater reduction in thickness as compared to newer scars but the difference was not significant to date. Conclusions Laser therapy is often employed in the treatment of HTBS. However, few studies have determined their objective benefits. Based on a preliminary analysis of our data, we have shown an overall decrease in scar thickness, less pigmentation, and less erythema in thin scars treated with PDL or CO2+PDL. Further analysis will be performed after additional follow-up information is collected.