title: Prospective, before-after cohort study to assess the efficacy of laser therapy on hypertrophic burn scars.
abstract: BACKGROUND
  Hypertrophic burn scars produce significant morbidity, including itching, pain, stiffness, and contracture. Best practices for management continue to evolve. Lasers have recently been added to treatment algorithms, but indications and efficacy have not been fully defined. We studied the impact of laser therapies on hypertrophic burn scars.
  
  
  METHODS
  We conducted a prospective, before-after study in burn patients with hypertrophic scars. Procedures were performed more than 6 months after burn injury and were repeated monthly. The pulsed-dye laser was used for pruritus and erythema, whereas the fractional CO2 laser was used for stiffness and abnormal texture. All procedures were performed in the OR, with anesthesia. Outcomes are as follows: (1) Vancouver Scar Scale (objective changes in pigmentation, erythema, pliability, height; range, 0-15) and (2) UNC Scar Scale (subjective changes in pain, itching, tingling, stiffness; range, 0-12). Before-after scores were compared by Student t test, with significance assigned to P values of <0.05.
  
  
  RESULTS
  During 2011, we treated 147 patients (mean age, 26.9 years; mean TBSA, 16.1%) over 415 sessions (2.8 sessions/patient), including pulsed dye laser (n = 327) and CO2 (n = 139), mean surface area of 83 cm. Etiology included flame (75), scald (37), and other (35). Treatments occurred 16 months (median) and 48 months (mean) after burn injury. Vancouver Scar Scale decreased from 10.4 (SD, 2.4) to 5.2 (1.9) (P < 0.0001). UNC Scar Scale decreased from 5.4 (2.5) to 2.1 (1.7) (P < 0.0001). Mean length of follow-up was 4.7 months.
  
  
  CONCLUSIONS
  Laser therapies significantly improve both the signs and symptoms of hypertrophic burn scars, as measured by objective and subjective instruments.
authors.affiliation: Division of Plastic Surgery, University of North Carolina Health Care System, Chapel Hill, NC 27516-7195, USA. cshult@med.unc.edu
authors.forename: Charles Scott
authors.initials: CS
authors.lastname: Hultman
authors.forename: Renee E
authors.initials: RE
authors.lastname: Edkins
authors.forename: Cindy
authors.initials: C
authors.lastname: Wu
authors.forename: Catherine T
authors.initials: CT
authors.lastname: Calvert
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
mesh_terms: D000293:Adolescent; D000328:Adult; D002056:Burns / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D017439:Cicatrix, Hypertrophic / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D054025:Lasers, Dye / Q000627:therapeutic use*; D054020:Lasers, Gas / Q000627:therapeutic use*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult