Ablative fractional resurfacing for burn scar management: Does the depth of laser penetration matter?

Dr Andrea C Issler-Fisher1,4, Dr Oliver M Fisher2,3, Dr Shivani Aggarwala1,4, A/Prof Peter Haertsch1,4, Dr Zhe Li1,4,5, Prof Peter KM Maitz1,4,5

1Burns Unit, Concord Repatriation General Hospital, Concord, Australia, 2Department of Surgery, St George Hospital , Kogarah , Australia, 3Department of Surgery, University of Notre Dame, School of Medicine, Sydney , Australia, 4University of Sydney, Camperdown, Australia, 5ANZAC Research Institute, Concord Repatriation General Hospital, Concord, Australia


Purpose. To investigate whether the maximum depth of ablative factional CO2 laser (AFL) penetration in pathological burn scars influences patient outcomes after one treatment.
Methods. All patients presenting to the Concord Repatriation General Hospital (CRGH) Scar Clinic received ultrasound measurement at the thickest point of their burn scars. Subsequently, the effect of various AFL settings (energy which correlates to penetration depths) on different outcome parameters was analysed. Patients were divided into 5 groups depending on maximal scar penetration depth.
Results. 78 patients (158 scars) had complete data allowing for analysis. Median scar thickness was 3400 micrometers and median laser scar penetration depth was 900 micrometers. Scar penetration categories were as follows: 0-25% (n=40), 25-50% (n=67), 50-75% (n=31), 75-100% (n=8), >100% (n=3). Median reduction in maximum scar thickness was 800 micrometers following one treatment (p<0.001). However, this effect depended on scar penetration depth, whereby scars that were penetrated 75% showed no significant improvement in scar thickness and those penetrated >100% showed a tendency to become worse. Despite this, the Vancouver Scar Scale improved significantly over all groups up to 100%, although no significant improvement was seen if the scar was penetrated >100%. Similar results were seen with the Patient and Observer Scar Assessment Scale. Likewise, neuropathic pain scores only showed significant improvement in scars penetrated up to 75%. Intriguingly however, pruritus scores showed significant improvement over all penetration categories.
Conclusion. AFL scar penetration depth significantly influences subjective and objective pathologic burn scar modulation. This presentation will further elucidate factors contributing to the identified changes.


Following training in general surgery, burns & plastic surgery in Switzerland, Dr Issler-Fisher joined the Sydney University Burns Unit of Concord Repatriation General Hospital (CRGH) in Sydney in 2013, where she established and now runs the Burns Scar Clinic in 2015.


ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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