Ablative Fractional Resurfacing for Burn Scars & the Impact on Adult Reconstructive Burn Surgery: Exploring the Effects of a Novel Treatment Paradigm

Abstract

Burn scars are a major challenge in modern burn surgery. Severe scars often remain and can significantly diminish quality of life by causing disfigurement, pain, itchiness, contractures limiting the range of motion and functions of the body and joints. Ablative fractional CO2 laser (AFL-CO2) resurfacing has become a promising treatment modality for severe burn scars. The aim of this thesis was to analyse the efficacy and safety of AFL-CO2, whilst simultaneously aspiring to find explanations as to why this treatment modality has led to an overall different understanding of burn scar remodelling and why a simple approach can treat the underlying problem much more efficiently than conventional reconstructive burn surgery. A review of burn scars, traditional burn scar therapies, and an overview of light-based therapies for burn scars is provided. Subsequently, the creation of an extensive prospective database of every burn patient who was treated at Concord with AFL-CO2 laser as well as the methodologies of the following studies is described. The first study includes an analysis of the effectiveness and safety of AFL-CO2 laser for burn scars. The second project explores the effects of various laser penetration depths to establish guidance on new treatment settings. The third project includes an analysis of the effect of AFL-CO2 on conventional reconstructive procedures, hospital admission patterns, and length of stay. The fourth study illustrates the prophylactic potential of AFL-CO2 in the acute management of burn injuries. During the study period, the thorough, repetitive, and systematic clinical assessment of each burn scar over several years allowed for an improved understanding of burn scar development. This has in turn led to optimal treatment algorithms to be defined which are presented in this thesis as a conclusion of the previously listed projects. Overall, it has become clear that AFL-CO2 has allowed us to redefine the reconstructive approach to burn scars.