Randomized, Controlled Early Intervention of Dynamic Mode Fractional Ablative CO₂ Laser on Acute Burn Injuries for Prevention of Pathological Scarring

Abstract

Background and Objectives: This study challenges the currently accepted treatment parameters of waiting 1 year following burn injury to treat the resultant scarring. It assesses the impact of treating burn and trauma wounds at less than 3 months of injury on scar formation, providing a new temporal paradigm to patients in the prevention and minimization of scar formation. Study Design/Materials and Methods: This randomized clinical trial included 19 patients with moderate-tosevere acute burn injuries less than 3 months from injury. The treatment areas underwent three fractional ablative CO 2 laser treatments at 8-week intervals. The primary outcomes were improvement in the Manchester Scar Scale (MSS) and photography. Secondary outcomes were optical coherence tomography (OCT), treatment time, immediate post-treatment response, and histology. Results: Upon blinded evaluation, 100% of treatment areas were correctly identified when compared with control. MSS scores before and after treatment were totaled with an averaged sum of 13.33 per scar at baseline to 8.39 after treatment, a 63% average improvement versus control (P < 0.001). Histology and OCT demonstrated a re-organization of the underlying skin structure. The average treatment time was 18 minutes. Immediate posttreatment responses were limited to mild-to-moderate erythema. Conclusions: Early intervention with ablative fractional laser on acute traumatic wounds resulted in significant decrease of scar formation compared with untreated areas on the same wounds, providing an impactful new time course to treat severe burn and trauma injuries. Lasers Surg. Med.

Hypertrophic Scar Improvement by Early Intervention With Ablative Fractional Carbon Dioxide Laser Treatment

“…The traditional recommendation has been to start laser treatment 3–6 months after scar formation. However, a recent study showed that early intervention with ablative fractional laser treatment in acute traumatic wounds less than 3 months after injury resulted in a significant decrease in scar formation [13]. In our study, we further demonstrated that ablative fractional laser treatment within 1 month after injury was also effective for improving the VSS score and the hardness and redness of scars.…”

Evaluation of Fractional CO2 Versus Long Pulsed Nd:YAG Lasers in Treatment of Hypertrophic Scars and Keloids: A Randomized Clinical Trial

“…Similar findings were reported by El‐Zawahry et al [13], who suggested that compared with keloids, hypertrophic scars showed greater improvement following treatment with fractional CO 2 laser. Moreover, Waibel et al [17] suggest earlier intervention of acute burn injuries with ablative fractional laser in the first 3 months post‐injury.…”

Clinical and Histological Assessment of Combined Fractional CO2 Laser and Growth Factors Versus Fractional CO2 Laser Alone in the Treatment of Facial Mature Burn Scars: A Pilot Split‐Face Study

“…Moreover, recent studies encourage early use of ablative fractional lasers only 6 weeks after the burn injury [25,26]. Douglas et al [6] found more significant collagen improvement in the deep dermis in immature scars treated with fractional laser when compared with mature ones.…”