Recovery in patients undergoing ablative fractional carbon dioxide laser for adult hypertrophic burn scars: A longitudinal cohort study

• Published in: Burns Vol. 51; no. 1; p. 107300
• Main Authors: Betar, Noah, Donovan, Michelle, Tyack, Zephanie, Warren, Jacelle, McPhail, Steven M., Vujcich, Elizabeth, Brown, Jason
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01-02-2025
• Subjects: BBSIP; Burn; Health-related quality of life; Hypertrophic scar; Laser; Patient reported outcome measure; Burn; Health-related quality of life; Hypertrophic scar; BBSIP; Patient reported outcome measure; Laser
• ISSN: 0305-4179; 1879-1409; 1879-1409
• DOI: 10.1016/j.burns.2024.107300

Ablative fractional carbon dioxide laser (AFCO2L) is widely used as a treatment for hypertrophic burn scars. This study aimed to evaluate clinician and patient-reported outcomes after AFCO2L treatment, safety, and identify factors influencing outcomes.
This longitudinal study recruited adult patients with hypertrophic burn scars treated with AFCO2L at a single Australian burn unit. Patients received up to four AFCO2L treatments over approximately 12 months. Outcomes were ultrasound scar thickness, the Patient and Observer Scar Assessment Scale (POSAS), and the Brisbane Burn Scar Impact Scale (BBSIP), measured at baseline and 3, 6, and 12 months after the first AFCO2L treatment. Analysis used mixed effects linear models.
47 patients were included with median age 32 years (IQR: 24, 53) and median burn TBSA of 35 % (IQR: 7.5 %, 48 %). Statistically significant improvements between baseline and 12-month follow-up occurred in scar thickness, and all POSAS and BBSIP subscores. Most improvements remained when accounting for TBSA, Fitzpatrick skin type, scar maturity, and body area treated. Patients reported transient symptoms after 61 of 89 (69 %) AFCO2L treatments, but infection or delayed wound healing occurred after only 4 of 89 (4 %) treatments.
This study supports safety and improved clinician and patient-reported outcomes in patients undergoing AFCO2L for hypertrophic burn scars.
•Treatment of hypertrophic burn scars with AFCO2L was associated with improved clinician and patient reported outcomes.•Most improvements persisted when adjusting for confounders including scar maturity.•AFCO2L treatment was safe and well-tolerated.