title: Efficacy of laser debridement with autologous split-thickness skin grafting in promoting improved healing of deep cutaneous sulfur mustard burns.
abstract: The consequences of receiving a cutaneous sulfur mustard (SM) burn are prolonged wound healing and secondary infection. This study was undertaken to find a treatment that promotes quick healing with few complications and minimal disfigurement. Multiple deep SM burns (4 cm diameter) were generated on the ventrum of weanling pigs and treated at 48 h. Four treatments were compared: (1) full-thickness CO(2) laser debridement followed by skin grafting; (2) full-thickness sharp surgical tangential excision followed by skin grafting, the "Gold Standard" used in deep thermal burns management; (3) partial-thickness laser ablation with no grafting; and (4) partial-thickness sharp excision with no grafting. A computer controlled, raster scanned, high-powered continuous wave (cw) CO(2) laser was utilized. Ulceration, wound geometry, and wound contraction were evaluated during a 36-day healing period. Histopathological evaluations were conducted at the end of the healing period. Engraftment rates were similar between both methods of debridement. Laser debridement followed by skin grafting was as efficacious in improving the wound healing of deep SM burns as the "Gold Standard." Full-thickness laser debridement of these small total body surface area (TBSA) burns was time efficient and provided adequate beds for split-thickness skin grafting. Laser debridement offered additional benefits that included hemostatic control during surgery and minimal debridement of normal perilesional skin. Mid-dermal debridement by sharp excision or laser ablation without grafting produced less desirable results but was better than no treatment.
authors.affiliation: Comparative Pathology Branch, Comparative Medicine Division, US Army Medical Research Institute of Chemical Defense, Aberdeen Proving Ground, Maryland, MD 21010, USA. john.graham@amedd.army.mil
authors.forename: John S
authors.initials: JS
authors.lastname: Graham
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Schomacker
authors.forename: Robert D
authors.initials: RD
authors.lastname: Glatter
authors.forename: Crystal M
authors.initials: CM
authors.lastname: Briscoe
authors.forename: Ernest H
authors.initials: EH
authors.lastname: Braue
authors.forename: Katherine S
authors.initials: KS
authors.lastname: Squibb
mesh_terms: D000818:Animals; D002057:Burns, Chemical / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D003646:Debridement; D003879:Dermatologic Agents / Q000009:adverse effects*; D062109:Dermatologic Surgical Procedures; D005260:Female; D007091:Image Processing, Computer-Assisted; D053685:Laser Therapy; D023421:Models, Animal; D009151:Mustard Gas / Q000009:adverse effects*; D012867:Skin / Q000293:injuries* / Q000473:pathology; D016038:Skin Transplantation; D034421:Sus scrofa; D014886:Weaning; D014945:Wound Healing
chemical_list: D003879:Dermatologic Agents; D009151:Mustard Gas