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Prospective, Before-After Cohort Study to Assess the Efficacy of Laser Therapy on Hypertrophic Burn Scars

Hultman, Charles Scott MD, MBA, FACS*†; Edkins, Renee E. RN, NP*†; Wu, Cindy MD*; Calvert, Catherine T. PhD; Cairns, Bruce A. MD, FACS

doi: 10.1097/SAP.0b013e31827eac5e
Clinical Papers

Introduction Hypertrophic burn scars produce significant morbidity, including itching, pain, stiffness, and contracture. Best practices for management continue to evolve. Lasers have recently been added to treatment algorithms, but indications and efficacy have not been fully defined. We studied the impact of laser therapies on hypertrophic burn scars.

Methods We conducted a prospective, before-after study in burn patients with hypertrophic scars. Procedures were performed more than 6 months after burn injury and were repeated monthly. The pulsed-dye laser was used for pruritus and erythema, whereas the fractional CO2 laser was used for stiffness and abnormal texture. All procedures were performed in the OR, with anesthesia. Outcomes are as follows: (1) Vancouver Scar Scale (objective changes in pigmentation, erythema, pliability, height; range, 0–15) and (2) UNC Scar Scale (subjective changes in pain, itching, tingling, stiffness; range, 0–12). Before-after scores were compared by Student t test, with significance assigned to P values of <0.05.

Results During 2011, we treated 147 patients (mean age, 26.9 years; mean TBSA, 16.1%) over 415 sessions (2.8 sessions/patient), including pulsed dye laser (n = 327) and CO2 (n = 139), mean surface area of 83 cm2. Etiology included flame (75), scald (37), and other (35). Treatments occurred 16 months (median) and 48 months (mean) after burn injury. Vancouver Scar Scale decreased from 10.4 (SD, 2.4) to 5.2 (1.9) (P < 0.0001). UNC Scar Scale decreased from 5.4 (2.5) to 2.1 (1.7) (P < 0.0001). Mean length of follow-up was 4.7 months.

Conclusions Laser therapies significantly improve both the signs and symptoms of hypertrophic burn scars, as measured by objective and subjective instruments.

From the *Division of Plastic 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