Lasers and ancillary treatments for scar management: personal experience over two decades and contextual review of the literature. Part I: Burn scars

Abstract

[Formula: see text][Formula: see text][Formula: see text]The formation of a wide range of excessive scars following various skin injuries is a natural consequence of healing. Scars resulting from surgery or trauma affect approximately 100 million people per annum in the developed world and can have profound physical, aesthetic, psychological and social consequences. Thus, scar treatment is a priority for the plastic surgeon.We aim to explore new approaches to the management of such scarring. The senior authors current use of laser technology, chemotherapeutic agents, pharmacotherapy and cryosurgery will be reviewed. This is placed in the context of the current literature and evidence base and is illustrated with case studies, starting with burns scars in part I, and focusing on keloid and hypertrophic scars in part II, acne scars in part III and finally pigmented scars in part IV. In Part I we focus on burns scar treatment with fractional ablative 10,600 nm wavelength carbon dioxide (CO2) laser therapy.Lay SummaryScars can result as part of the normal healing process after a burn or other trauma such as surgery or injury. However, there is a range of scarring from ‘good’ to ‘bad’ depending on various features of the scars. Some can be can be lumpy and raised (hypertrophic and keloid scars), have changes in pigmentation (increased or decreased colouration) or have specific features related to the cause (for instance acne scars, burns scars). We review the senior author’s experience over twenty years in treating scars with a range of treatments in conjunction with lasers. This first article from a 4-part series looks at burns scars. Subsequent articles focus on thickened scars known as hypertrophic and keloid scars; acne scars; and the treatment of pigmented scars (parts2-4). Central to the treatment strategy in this article on burns scarsis the carbon dioxide laser which is an ablative laser (removes tissue and penetrates tissue) requiring some down time for healing sometimes with dressings.