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