Laser ablation of burns: Initial clinical trial

Abstract

Background: Scanning, high-powered carbon dioxide laser ablation of eschar may facilitate blood conservation in patients with burns. Methods: Twenty-one children with full-thickness burns that required serial excisions were enrolled in a Human Studies Committee approved protocol in which a full-thickness wound was ablated with a rapidly scanned continuous wave carbon dioxide laser system. A control wound was sharply excised, and both wounds were immediately autografted. End points were engraftment at 7 days and serial Vancouver scar scores. Results: The children had an average age of 8.3 ± 1.2 years, weight of 36.3 ± 4.9 kg, and burn size of 40% ± 5.1%. The study wounds were ablated with an average energy of 99.2 ± 5.7 W; there was no bleeding from 19 successfully ablated wounds. Initial engraftment averaged 94.7% ± 3.5% in the control sites and 94.7% ± 3.3% in the study sites ( P = 1.0). There was no significant difference in Vancouver scar scores at an average follow-up of 32.0 ± 5.2 weeks. Conclusions: This pilot study follows a successful trial of this concept in a porcine model and demonstrates the technical feasibility of laser vaporization of burn eschar in humans with immediate autografting. Further refinement of the technique is required before it can be generally recommended. (Surgery 1999;125:92-5.)