Carbon dioxide laser ablation with immediate autografting in a full-thickness porcine burn model.
OBJECTIVE
To compare the long-term clinical and histologic outcome of immediate autografting of full-thickness burn wounds ablated with a high-power continuous-wave CO2 laser to sharply débrided wounds in a porcine model.


BACKGROUND
Continuous-wave CO2 lasers have performed poorly as tools for burn excision because the large amount of thermal damage to viable subeschar tissues precluded successful autografting. However, a new technique, in which a high-power laser is rapidly scanned over the eschar, results in eschar vaporization without significant damage to underlying viable tissues, allowing successful immediate autografting.


METHODS
Full-thickness paravertebral burn wounds measuring 36 cm2 were created on 11 farm swine. Wounds were ablated to adipose tissue 48 hours later using either a surgical blade or a 150-Watt continuous-wave CO2 laser deflected by an x-y galvanometric scanner that translated the beam over the tissue surface, removing 200 microm of tissue per scan. Both sites were immediately autografted and serially evaluated clinically and histologically for 180 days.


RESULTS
The laser-treated sites were nearly bloodless. The mean residual thermal damage was 0.18+/-0.05 mm. The mean graft take was 96+/-11% in manual sites and 93+/-8% in laser sites. On postoperative day 7, the thickness of granulation tissue at the graft-wound bed interface was greater in laser-debrided sites. By postoperative day 180, the manual and laser sites were histologically identical. Vancouver scar assessment revealed no differences in scarring at postoperative day 180.


CONCLUSIONS
Long-term scarring, based on Vancouver scar assessments and histologic evaluation, was equivalent at 6 months in laser-ablated and sharply excised sites. Should this technology become practical, the potential clinical implications include a reduction in surgical blood loss without sacrifice of immediate engraftment rates or long-term outcome.
Wellman Laboratories of Photomedicine, Massachusetts General Hospital, and the Department of Dermatology, Harvard Medical School, Boston 02114, USA.
R D
RD
Glatter
J S
JS
Goldberg
K T
KT
Schomacker
C C
CC
Compton
T J
TJ
Flotte
D P
DP
Bua
K W
KW
Greaves
N S
NS
Nishioka
R L
RL
Sheridan
D000818:Animals; D002056:Burns / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery*; D002245:Carbon Dioxide; D003646:Debridement / Q000379:methods*; D004195:Disease Models, Animal; D005260:Female; D053685:Laser Therapy; D016038:Skin Transplantation / Q000379:methods*; D013552:Swine; D014182:Transplantation, Autologous; D014945:Wound Healing
D002245:Carbon Dioxide