Carbon dioxide laser treatment in burn-related scarring: A prospective randomised controlled trial

Aim: To investigate the effect of ablative fractional CO2 laser (AFCO(2)L) on burns scar appearance and dermal architecture at 6 weeks and up to 3-years post-treatment. Methods: Twenty adult patients with a burn-related scar were recruited. Inclusion criteria were a minimum scar area of 10 x 10 cm and Vancouver scar scale (VSS) score of >5 and >= 6 months since the time of injury. The region of scar was randomised to treatment/control zones. Treatment zones received 3 standardised laser treatments at 4- to 6-week intervals. All areas of scar received standard scar care. Outcome measures were recorded at baseline, 6-weeks post final treatment and up to 3 years post-treatment. Measures included blinded assessor VSS, Patient Scar Assessment Scale and histological tissue analysis. Results: Nineteen and nine patients completed the short- and long-term studies, respectively. Clinical results revealed improvement in all scar areas over time. There was a statistically significant improvement in pain and itch in the treatment zone compared to the control zone at 6 weeks. Histological data revealed a significant increase in medium-sized collagen fibres at 6 weeks relative to the control site. Sub-group analysis according to scar age revealed greater histological improvement following laser treatment in immature scars relative to more mature scar. Conclusions: Results demonstrate that 3 treatments of AFCO(2)L significantly improve scar pain, itch and dermal architecture at 6 weeks post-treatment. Histological results suggest greater potential in treating immature scar. Further investigation into the timing of laser treatment could help assist treatment protocols. (C) 2019 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.