title: Laser resurfacing and remodeling of hypertrophic burn scars: the results of a large, prospective, before-after cohort study, with long-term follow-up.
abstract: OBJECTIVE
  Hypertrophic burn scars produce significant morbidity, including itching, pain, stiffness, and contracture, but best management practices remain unclear. We present the largest study to date that examines long-term impact of laser therapies, a potentially transformative technology, on scar remodeling.
  
  
  METHODS
  We conducted a prospective, before-after cohort study in burn patients with hypertrophic scars. Pulsed-dye laser was used for pruritus and erythema; fractional CO2 laser was used for stiffness and abnormal texture. Outcomes included (1) Vancouver Scar Scale (VSS), which documents pigmentation, erythema, pliability, and height, and (2) University of North Carolina "4P" Scar Scale (UNC4P), which rates pain, pruritus, paresthesias, and pliability.
  
  
  RESULTS
  A total of 147 burn patients (mean age, 26.9 years; total body surface area, 16.1%) received 415 laser sessions (2.8 sessions/patient), 16 months (median) after injury, including pulsed dye laser (n = 327) and CO2 (n = 139). Laser treatments produced rapid, significant, and lasting improvements in hypertrophic scar. Provider-rated VSS dropped from 10.43 [standard deviation (SD) 2.37] to 5.16 (SD 1.92), by the end of treatments, and subsequently decreased to 3.29 (SD 1.24), at a follow-up of 25 months. Patient-reported UNC4P fell from 5.40 (SD 2.54) to 2.05 (SD 1.67), after the first year, and further decreased to 1.74 (SD 1.72), by the end of the study period.
  
  
  CONCLUSIONS
  For the first time, ever, in a large prospective study, laser therapies have been shown to dramatically improve both the signs and symptoms of hypertrophic burn scars, as measured by objective and subjective instruments. Laser treatment of burn scars represents a disruptive innovation that can yield results not previously possible and may displace traditional methods of operative intervention.
authors.affiliation: *Division of Plastic Surgery †The NC Jaycee Burn Center, University of North Carolina Health Care System, Chapel Hill.
authors.forename: C Scott
authors.initials: CS
authors.lastname: Hultman
authors.forename: Jonathan S
authors.initials: JS
authors.lastname: Friedstat
authors.forename: Renee E
authors.initials: RE
authors.lastname: Edkins
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Cairns
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Meyer
mesh_terms: D000293:Adolescent; D000328:Adult; D002056:Burns / Q000601:surgery*; D002675:Child, Preschool; D017439:Cicatrix, Hypertrophic; D005151:Facial Injuries / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006230:Hand Injuries / Q000601:surgery; D006801:Humans; D053685:Laser Therapy; D054025:Lasers, Dye / Q000627:therapeutic use*; D008297:Male; D017060:Patient Satisfaction; D011446:Prospective Studies; D055815:Young Adult