Treatment of Chronic Hypertrophic Burn Scars With a Fractional CO₂ Laser Is Well Tolerated in an Outpatient Clinic Setting

Abstract

Introduction 

The necessity of treating hypertrophic burn scars has expanded significantly with increased burn survivorship. Ablative lasers, such as carbon dioxide (CO₂) lasers, have been the most common nonoperative option for improving functional outcomes in severe recalcitrant hypertrophic burn scars. However, the overwhelming majority of ablative lasers used for this indication require a combination of systemic analgesia, sedation, and/or general anesthesia due to the painful nature of the procedure. More recently, the technology of ablative lasers has advanced and is more tolerable than their first-generation counterparts. Herein, we hypothesized that refractory hypertrophic burn scars can be treated by a CO₂ laser in an outpatient clinic.

Methods 

We enrolled 17 consecutive patients with chronic hypertrophic burn scars that were treated with a CO₂ laser. All patients were treated in the outpatient clinic with a combination of a topical solution (23% lidocaine and 7% tetracaine) applied to the scar 30 minutes before the procedure, Cryo 6 air chiller by Zimmer, and some patients received a mixture of N₂O/O₂. Laser treatments were repeated every 4 to 8 weeks until the patient's goals were met. Each patient completed a standardized questionnaire to assess tolerability and patient satisfaction of functional results.

Results 

All patients tolerated the laser well in the outpatient clinic setting, with 0% indicating “not tolerable,” 70.6% “tolerable,” and 29.4% “very tolerable.” Each patient received more than 1 laser treatment for the following complaints: decreased range of motion (n = 16, 94.1%), pain (n = 11, 64.7%), or pruritis (n = 12, 70.6%). Patients were also satisfied with the results of the laser treatments (“no improvement or worsened” = 0%, “improved” = 47.1%, and “significant improvement” = 52.9%). The age of patient, type of burn, location of burn, presence of skin graft, or age of scar did not significantly affect the tolerability of treatment or satisfaction of outcome.

Conclusions 

The treatment of chronic hypertrophic burn scars with a CO₂ laser is well tolerated in an outpatient clinic setting in select patients. Patients reported a high level of satisfaction with notable improvement in functional and cosmetic outcomes.