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Expedient primary excision of deep dermal and full-thickness burn wounds with subsequent skin grafting is the standard of care in most burn institutions, but differentiating full-thickness from partial-thickness burns is often difficult. Because accurate early assessment of burn depth may improve care, a variety of technical methods have attempted to measure burn depth but these methods have had limited success. We describe a new technique to determine burn depth that uses infrared (840- to 850-nm) fluorescence emission from intravenously administered indocyanine green following excitation with infrared (780 nm) and UV light (369 nm). Full-thickness and partial-thickness burns in hairless rat skin were distinguished based on the infrared-induced and UV-induced fluorescence intensity ratios relative to normal, unburned skin immediately after the burn and on post-burn days 1 through 3 and 7. Dual-wavelength excitation of indocyanine green infrared fluorescence can delineate full-thickness from partial-thickness burns at an early date, allowing prognosis, surgical planning, and early primary excision and grafting.

ObjectiveTo compare the long-term clinical and histologic outcome of immediate autografting of full-thickness burn wounds ablated with a high-power continuous-wave C02 laser to sharply d6-brided wounds in a porcine model. Summary Background DataContinuous-wave CO2 lasers have performed poorly as tools for burn excision because the large amount of thermal damage to viable subeschar tissues precluded successful autografting. However, a new technique, in which a high-power laser is rapidly scanned over the eschar, results in eschar vaporization without significant damage to underlying viable tissues, allowing successful immediate autografting. MethodsFull-thickness paravertebral burn wounds measuring 36 cm2 were created on 11 farm swine. Wounds were ablated to adipose tissue 48 hours later using either a surgical blade or a 1 50-Watt continuous-wave CO2 laser deflected by an x-y galvanometric scanner that translated the beam over the tissue surface, removing 200 ,um of tissue per scan. Both sites were immediately autografted and serially evaluated clinically and histologically for 180 days. ResultsThe laser-treated sftes were nearly bloodless. The mean residual thermal damage was 0.18 ± 0.05 mm. The mean graft take was 96 ± 1 1% in manual sftes and 93 ± 8% in laser sites. On postoperative day 7, the thickness of granulation tissue at the graftwound bed interface was greater in laser-d6brded sites. By postoperative day 180, the manual and laser sites were histologicalty identical. Vancouver scar assessment revealed no differences in scarning at postoperative day 180. ConclusionsLong-term scarring, based on Vancouver scar assessments and histologic evaluation, was equivalent at 6 months in laserablated and sharply excised sites. Should this technology become practical, the potential clinical implications include a reduction in surgical blood loss without sacrifice of immediate engraftment rates or long-term outcome.Although early excision and grafting of deep dermal and full-thickness burns has improved patient survival rates,'