Introduction: Treatment of symptomatic burn scar hypertrophy and contracture is a challenge in burns of all sizes. CO2 laser is a recognized method for treating symptomatic hypertrophic, hyperemic, painful, pruritic burn scars and contractures. Evidence shows that many patients have improvement in symptoms with laser therapy treatment. In 2019, we switched to a patented silicone temporary skin substitute dressing, indicated for post-operative laser resurfacing and dermabrasion wounds. The benefits of this silicone dressing on these types of wounds are a) transparencyfor easy visualization of the wound,; b)the ability to gently cling to the wound surface and surrounding skin, without incorporation into the wound and c) painless, atraumatic removal when desired. The purpose of this study was to evaluate the features and benefits of this dressing and determine whether a decrease in required number of laser treatments to achieve the goal effect was possible.

Methods: This study received IRB exemption. Study design was a retrospective, matched cohort outcomes study. Subject groups were matched by age and size of original burn (Range 1-70%) and included all subjects treated with CO2 who completed at least three treatments in 2018 and 2019. Excluded were any subject treated in both years, any subject still being treated at the time of data collection, and any subject who did not complete 3 full treatments.

Results: In 2018, a total of 27 subjects with an average age of 27 years old were treated (range 2-62). Fifty-six percent (15) of these subjects were male and forty-four percent (12) were female. These subjects averaged 8.38 treatments for symptomatic management. In 2019, a total of 18 patients with an average age of 28 years old were treated (range 2-63). Forty-four percent (8) of these subjects were male and fifty-six percent (10) were female. These subjects averaged 5.84 treatments for symptomatic management – a reduction of more than 2.5 fewer treatments when using the silicone temporary skin substitute dressing as part of the CO2 protocol at our institution. Statistical significance was achieved using a two-tailed t test measurement (p=0.0124). Limitations of this study include the retrospective design, making it difficult to evaluate and compare direct symptoms in each and every case

Conclusion: The use of this silicone temporary skin substitute dressing proved significant beneficial outcomes in decreasing the number of treatments required to obtain symptom control in patients pre and post initiation of the dressing. In our anecdotal experience, this dressing simplified post-operative management and limited pain as compared to our other CO2 post-operative dressing management. Using this silicone dressing supports the scar management continuum of care for these challenging burn scars. Ideally, a randomized, controlled trial would be indicated to further evaluate the treatment paradigm and patient outcomes of this dressing with CO2 lasers as part of our protocol.

References and Resources

1. Kevin M Klifto, Mohammed Asif, C Scott Hultman (2020). Laser management of hypertrophic burn scars: a comprehensive review. Burns & Trauma, 8.
2. Fu, X., Wang, S., & Yan, M., Yoa, M. (2019). Advances in the treatment of traumatic scars with laser, intense pulsed light, radiofrequency, and ultrasound. Burns Trauma 7(1).
3. Yelvington, A., Tang, M., Brown, X. (2014). Ablative fractional photothermolysis for the treatment of hypertrophic burn scars in adult and pediatric patients: A single surgeon’s experience. J Burn Care Res, 35, 455-463.
4. Qu, L. et al., (2012). Clinical and molecular effects on mature burn scars after treatment with a fractional CO2 laser. Lasers Surg Med, 44, 517-524.