Ablative fractional resurfacing in acute care management of facial burns: a new approach to minimising the need for acute surgical reconstruction

Dr Nicola Clayton1,2, Prof Peter Haertsch1, Prof Peter Maitz1, Dr Andrea Issler-Fisher1

1Burns Unit, Concord Repatriation General Hospital, 2Speech Pathology Department, Concord Repatriation General Hospital

Background & Aim: Apart from acute indications for reconstructive procedures to prevent secondary damage, including eyelid ectropion, microstomia and acute contractures, current evidence suggests to await full scar maturation prior to surgical intervention. Particularly in facial burns, surgical reconstructions often need to be performed several times and outcomes are not always ideal. The aim was to evaluate the efficacy of early intervention with the ablative fractional CO2 laser in the acute management of panfacial burn injuries.

Methods & Results: A 39 year old Asian male with a 60% TBSA flame burn injury with panfacial involvement was developing upper and lower eyelid ectropions as well as microstomia early following epithelialization. Treatment with the ablative fractional CO2 laser was initiated 6 weeks post injury whilst still in the Intensive Care Unit, and provided at regular subsequent intervals. Concurrent non-surgical scar contracture management was provided as per site specific standard protocols. Photographic data and measurements specific to deficits in eye and mouth closure were taken at rest, in addition to maximal opening at baseline and routinely until scar stabilisation was achieved. The results were then compared to historical data of patients with facial burns within our facility.

Conclusion: This case report demonstrates that early intervention of ablative fractional CO2 resurfacing, combined with non-surgical scar management is a valuable treatment approach to minimize facial contractures, enhances and accelerates scar maturation and may prevent the need for surgical scar reconstructions. Further, it may provide more optimal functional and aesthetic results compared to traditional reconstructive methods.

Dr Nicola Clayton is a highly experienced clinical specialist Speech Pathologist who has been affiliated with the Burns Unit at Concord Repatriation General Hospital for over 12 years. She is passionate about burns research and completed her PhD in this area in 2016.

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