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

Dr Helen Douglas1, Dr Karl Anton-Harms3, Dr Alexandra Murray1, Miss Tadyn Krop2, Miss Lauren Kunath1, Dr Jessica Lynch2, Dr Sarah McGarry1, Professor Mark Fear2, Professor Suzanne Rea1, Professor Fiona Wood1

1State Burns Service WA, Perth, Australia, 2University of Western Australia, Perth, Australia, 3Monash University, Melbourne, Australia


Burn scars can be painful, restrictive and disfiguring. Reconstructive surgery for such scars can pose high risks and significant patient down-time.

Carbon dioxide ablative fractional laser (CO2AFL) represents an emerging technique for the treatment of burns-related scarring, though currently the literature lacks robust randomised controlled data to support its use.


Twenty adult patients with a burns-related scar of at least 10x10cm and a Vancouver Scar Scale (VSS) score of >5 were recruited. Scars were at least 6 months old and randomly divided into treatment/control halves.

Treatment zones received 3 standardised laser treatments at 4-6 week intervals. All areas of scar received standard scar care. Outcome measures taken at baseline and 6 weeks post-treatment included:

1. Blinded assessor VSS

2. Patient Scar Assessment Scale

3. Histological tissue analysis


Clinical results revealed improvement in all scar areas over time, though differences between control and treatment segments failed to reach statistical significance.

Histological data revealed significant (p=0.01) improvement in dermal architecture in treatment segments compared to controls. Micro-thermal zones (MTZ’s) of varying depth were seen in biopsies taken 48-72h post-treatment, consistent with micro-fenestration scar release. Immature scars (< 2 years old) may respond more favourably to laser than mature scars.


Results demonstrate that 3 treatments of CO2AFL significantly improve burn scar dermal architecture, adding to the known literature regarding CO2AFL treatment of burns-related scarring and supporting current evidence of its use to modulate scars.

2-year clinical and histological follow-up is currently being performed to assess long-term effects of CO2AFL.

Helen Douglas is the current burns fellow at the state burns unit in WA.

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