Laser Resurfacing Of Hypertrophic Burn Scars: Utility Of An Algorithm To Aid Decision-making In A Large, Partially Blinded, Independently Rated, Before-after Cohort Study
C. S. Hultman, MD, MBA, FACS1, Renee E. Edkins, NP, DNP2.
1Johns Hopkins University, Baltimore, MD, USA, 2University of North Carolina, Chapel Hill, NC, USA.
PURPOSE: Laser resurfacing has recently emerged as an accepted modality for the treatment of hypertrophic burn scars, but the timing and type of laser treatments remain controversial. We developed and tested an algorithm, based on subjective symptoms and objective signs, to aid decision-making and determine the optimal platform for laser therapies.
METHODS: A before-after cohort study was performed in 206 consecutive patients who underwent laser treatment of hypertrophic burn scars, with either pulsed dye laser (PDL) or fractional CO2 laser (fCO2). The laser platform chosen was based on an algorithm that incorporated pruritis, vascularity, stiffness, and pliability. An independent, blinded rater assessed a constant anchor spot, using Vancouver Scar Score and UNC5P. Data entered prospectively into a scar registry were analyzed post hoc. Outcome measures were compared by chi-square and Studentís T test; p values < 0.05 were assigned significance.
RESULTS: 206 patients underwent 452 laser sessions, with 122 patients receiving PDL and 255 patients receiving fCO2. The algorithm guided therapy in 77.1% of PDL cases but only 51.8% of fCO2 cases. Median time from injury to first laser was 1.4 years. Laser therapy improved VSS from 8.50 to 7.05 (p<0.001) and UNC5P from 4.00 to 2.81 (p<0.01), with the greatest effect from fCO2 lasers (data not shown).
CONCLUSIONS: In this partially blinded, before-after cohort study, laser resurfacing significantly improved the signs and symptoms of hypertrophic burn scars. An algorithm based on patient and provider inputs can aid decision-making regarding the type and timing of laser therapies.
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