The role of CO2 laser in paediatric hand burns

Miss Nathania Tanoto1, Dr Lisa Martin1,2, Dr Helen  Douglas3, Professor Fiona Wood1,2,3

1University Of Western Australia, Crawley, Australia, 2Fiona Wood Foundation, Murdoch, Australia, 3Burn Service of Western Australia, Fiona Stanley Hospital, Murdoch, Australia


Paediatric hand burns are a common injury and largely sustained by contact.¹ Treatment of problematic scarring following burn injury in paediatric patients remains a significant challenge for clinicians.² Traditionally, these scars require surgical release of contractures and reconstructive surgery.⁴ However, ablative fractional CO₂ laser therapy (AFCO₂L) is emerging as a promising technological advance in managing hypertrophic scars.³ The aim of this audit was to assess whether the use of AFCO₂L has decreased the need for traditional reconstructive surgeries in paediatric patients with hand burn scars.

A retrospective audit was conducted of surgical data in paediatric hand burn patients at the specialist paediatric burns unit in Perth, Western Australia from 2000 to 2021.

There were a total of 184 surgeries for 88 individuals with a mean rate of 2.1 surgeries per person. No significant difference in surgery rates from pre to post-laser introduction was found (p=0.872). There appears to be an upward trend from 2000 to 2009. Followed by a rate flattening from 2010, which is unassociated with the timing of laser introduction in 2013.

The study did not support our hypothesis that laser therapy reduces reconstructive surgical need. Possible reasons for this may include; laser therapy may expand surgical options for aesthetic and functional outcomes, allowing us to ‘raise the bar’ on acceptable scar outcomes. Further research to assess rationales for choice of scar management, including laser therapy and reconstructive surgery, in relation to scar outcomes and patient satisfaction is required.

El-Hoshy, K., Abdel-Halim, M. R. E., Dorgham, D., El-Din Sayed, S. S. and El-Kalioby, M. (2017)
‘Efficacy of Fractional Carbon Dioxide Laser in the Treatment of Mature Burn Scars: A
Clinical, Histopathological, and Histochemical Study’, J Clin Aesthet Dermatol, 10(12), 36-43.

Krakowski, A. C., Goldenberg, A., Eichenfield, L. F., Murray, J. P. and Shumaker, P. R. (2014) ‘Ablative fractional laser resurfacing helps treat restrictive pediatric scar contractures’, Pediatrics,
134(6), e1700-5.

Kroonen, L., Shumaker, P. R., Kwan, J. M., Uebelhoer, N. and Hofmeister, E. (2013) ‘Treatment of split-thickness skin graft-related forearm scar contractures with a carbon dioxide laser protocol: 3 case reports’, J Hand Surg Am, 38(11), 2164-8.

M Argirova, O. H. A. B. F. D.-. (2005) ‘Treatment of palm burns in children’, Annals of Burns and Fire
Disasters 18(4), 190-193.

Palmieri TL, N.-M. K., Kagan RJ, Stubbs TK, Meyer WJ 3rd, Herndon DN, Hinson MI, Lee AF, Li NC, Kazis LE, Tompkins RG (2012) ‘Impact of hand burns on health-related quality of life in children younger than 5 years’, J Trauma Acute Care Surg, 73(3), 197-204.

Patel, S. P., Nguyen, H. V., Mannschreck, D., Redett, R. J., Puttgen, K. B. and Stewart, F. D. (2019)
‘Fractional CO2 Laser Treatment Outcomes for Pediatric Hypertrophic Burn Scars’, J Burn
Care Res, 40(4), 386-391.

Sabapathy, S. R., Bajantri, B. and Bharathi, R. R. (2010) ‘Management of post burn hand deformities’,
Indian J Plast Surg, 43(Suppl), S72-9.

Sorkin, M., Cholok, D. and Levi, B. (2017) ‘Scar Management of the Burned Hand’, Hand Clin, 33(2),

Tracy LM, R. S., & Gabbe BJ (2020) Burns Registry of Australia and New Zealand (BRANZ) 2018/19
Annual Report, Department of Epidemiology and Preventive Medicine, Monash University. Melbourne, Australia.

Wallace, H. J., Fear, M. W., Crowe, M. M., Martin, L. J. and Wood, F. M. (2017) ‘Identification of factors predicting scar outcome after burn in adults: A prospective case-control study’, Burns, 43(6), 1271-1283.

‘WHO Guidelines Approved by the Guidelines Review Committee’ in (2008) Peden, M., Oyegbite, K., Ozanne-Smith, J., Hyder, A. A., Branche, C., Rahman, A., Rivara, F. and Bartolomeos, K., eds., World Report on Child Injury Prevention, Geneva: World Health Organization. Copyright © World Health Organization 2008.


Nathania Tanoto is a final year medical student at the University of Western Australia, and has a special interest in Burns, Plastics & Reconstructive surgery.

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