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Incidence and Management of Adverse Events After the Use of Laser Therapies for the Treatment of Hypertrophic Burn Scars

Clayton, John L. MD, PhD*; Edkins, Renee RN, MS*†; Cairns, Bruce A. MD, FACS; Hultman, Charles Scott MD, MBA, FACS*†

doi: 10.1097/SAP.0b013e31827eac79
Clinical Papers

Introduction Hypertrophic burn scars may generate significant morbidity, due to intense pruritus, persistent dysesthesias, and contracture. Although treatment with pulsed dye laser and fractional CO2 laser may improve symptoms, incidence of secondary wound complications is not well known. We examined the adverse event profile of laser therapies for the treatment of hypertrophic burn scars.

Methods We performed a descriptive, retrospective, 6-month study of all patients who underwent laser therapies, at an accredited regional burn center, to improve the vascularity, texture, thickness, and stiffness of symptomatic burn scars. Data regarding skin type, mechanism, area treated, and laser parameters were collected. Main outcome measures included pigmentation changes, blistering, rash, infection. χ2 analysis and Student t test were used to evaluate associations between variables.

Results A total of 95 patients underwent 163 treatment sessions (mean, 2.7 sessions/patient) with pulsed dye laser (71%), CO2 laser (22%), and other lasers (7%). Forty-one adverse events were recorded: hyperpigmentation (2%), hypopigmentation (12%), mild blistering (27%), pain (37%), rash (7%), fever (10%), and infection (2%). Patients with scald burns were more likely to develop blistering, rash, and fever after treatment (all P < 0.05). Higher Fitzpatrick skin type was associated with hypopigmentation and blistering, whereas CO2 laser was associated with increased postoperative pain (all P < 0.05)

Conclusions Despite the frequent occurrence of pain and mild blistering after laser treatment of hypertrophic burn scars, major adverse effects were exceedingly rare, with improvement noted in all patients. Patients with higher Fitzpatrick skin types must be handled with care, to avoid complications of blistering and hypopigmentation.

From the *Division of Plastic and Reconstructive Surgery and †NC Jaycee Burn Center University of North Carolina Health Care System, Chapel Hill, NC.

Received November 7, 2012, and accepted for publication, after revision, November 18, 2012.

Presented at the 55th Annual Scientific Meeting of the Southeastern Society of Plastic and Reconstructive Surgeons, June 2–6, 2012, Amelia Island, FL.

Conflicts of interest and sources of funding: Supported in part by the Ethel and James Valone Plastic Surgery Research Endowment, University of North Carolina.

Reprints: Charles Scott Hultman, MD, MBA, FACS, Division of Plastic Surgery, Suite 7038, Burnett Womack, CB#7195, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-7195. E-mail:

© 2013 by Lippincott Williams & Wilkins