Ablative Fractional Resurfacing in Acute Care Management of Facial Burns: A New Approach to Minimize the Need for Acute Surgical Reconstruction

J Burn Care Res. 2019 Apr 26;40(3):368-372. doi: 10.1093/jbcr/irz030.

Nicola A Clayton, Peter A Haertsch, Peter K Maitz, Andrea C Issler-Fisher
Burns Unit, Concord Repatriation General Hospital, Sydney, Australia.

Abstract

Current evidence suggests awaiting for scars to fully mature before engaging surgical reconstruction unless acute indications to prevent secondary damage, such as microstomia and eyelid ectropion are apparent. To evaluate the efficacy of ablative fractional CO2 laser intervention early in the acute treatment of panfacial burn injury. A 39-year-old Asian male with 60% TBSA flame burns including panfacial involvement was developing microstomia and upper and lower eyelid ectropion early proceeding epithelialization. At 6-weeks postinjury, ablative fractional CO2 laser treatment was commenced while still in the intensive care unit, and subsequently delivered at regular intervals. Nonsurgical scar contracture management was provided concurrently as per site specific standard protocols. Measurements and photographic data relative to deficits in eye and mouth competence were obtained at rest, as well as maximal opening at baseline and routinely until scar stabilization was reached. The outcomes were subsequently compared with facial burn patient historical data within our facility. No significant difference was identified in the functional ROM for mouth and eye regions; treatment duration was, however, shorter and aesthetic outcomes were considered superior to their surgical reconstruction counterparts in the historical cohort. This case report reveals that early ablative fractional CO2 resurfacing treatment, coalesced with nonsurgical scar management is an efficacious interventional approach to abate contractures to the face, accelerates and enhances scar maturation processes and may alleviate the need for surgical scar reconstructions. Moreover, optimal aesthetic outcomes may be achieved compared with traditional reconstructive methods.