Evaluation of clinical results, histological architecture, and collagen expression following treatment of mature burn scars with a fractional carbon dioxide laser.
OBJECTIVE
To assess mature burn scars treated with a fractional carbon dioxide laser for changes in histological architecture, type I to III collagen ratios, density of elastic tissue, and subjective measures of clinical improvements.


METHODS
Uncontrolled, prospective study of patients with mature burn scars, from a clinical and histological perspective. Biopsy specimens were obtained before and 2 months after 3 treatment sessions. The tissue was prepared with Verhoff von Giesen (VVG) stain to discern elastic tissue and Herovici stain to differentiate types I and III collagen.


METHODS
Subjects were recruited from the Grossman Burn Centers.


METHODS
Of 18 patients with mature burn scars, 10 completed the entire treatment protocol.


METHODS
Participants received 3 treatments with a fractional carbon dioxide laser.


METHODS
Vancouver Scar Scale and Patient and Observer Scar Assessment Scale survey scores. In histological analysis, imaging software was used to measure changes in collagen subtype and elastic tissue. A rating scale was developed to assess normal vs scar architecture.


RESULTS
The first hypothesis that significant histological improvement would occur and the second hypothesis of a statistically significant increase in type III collagen expression or a decrease in type I collagen expression were confirmed. There were no significant changes in elastic tissue. Statistically significant improvements were seen in all survey data.


CONCLUSIONS
Treatment with a fractional carbon dioxide laser improved the appearance of mature burn scars and resulted in a significant improvement in collagen architecture following treatment. Furthermore, in treated skin specimens, a collagen subtype (types I and III collagen) profile resembling that of nonwounded skin was found.
Department of Dermatology, Henry Ford Hospital, Detroit, Michigan 48202, USA. dozog1@hfhs.org
David M
DM
Ozog
Austin
A
Liu
Marsha L
ML
Chaffins
Adrian H
AH
Ormsby
Edgar F
EF
Fincher
Lisa K
LK
Chipps
Qing-Sheng
QS
Mi
Peter H
PH
Grossman
John C
JC
Pui
Ronald L
RL
Moy
D000328:Adult; D002056:Burns / Q000150:complications*; D002921:Cicatrix / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D024042:Collagen Type I / Q000378:metabolism*; D024061:Collagen Type III / Q000378:metabolism*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013194:Staining and Labeling; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D024042:Collagen Type I; D024061:Collagen Type III