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Introduction
CHAPTER 63 Lasers for Burns and
Trauma
Nathanial R. Miletta Thomas M. Beachkofsky Matthias B. Donelan Stephanie E. Kaiser Chad M. Hivnor
SUMMARY
The prevalence of hypertrophic scarring, much of it trauma-related, in the
developed and developing world is currently at an all-time high.
Given the ubiquity of hypertrophic scarring and its potential impact on health-
related quality of life, it is paramount that patients have access to safe and effective treatment.
Beginner Pearls
The current literature suggests that 32% to 72% of burn patients will go on to develop
hypertrophic scarring.
The physical impact of hypertrophic scarring varies widely and should not be assessed
through visual inspection alone.
The pulsed dye laser (PDL) has proven to be a cornerstone in the treatment of
erythematous hypertrophic scars.
Expert Pearls
Ablative fractional laser (AFL) is primarily used for hypertrophic scars.
When using IPL, the 515- to 590-nm filters are commonly used with a pulse width of
approximately 10 ms.
Often, the simplest approach is best, including Z- or W-plasty in conjunction with
AFL, PDL, and other adjunctive therapies.
Donโt Forget!
In general, NAFLs do not have a significant role in the management of hypertrophic
scars at this time.
The use of combination intralesional corticosteroid/5-FU therapy has been associated
with improved scar regression, reduced recurrence, and fewer side effects.
Z-plasty performed within scars is virtually undetectable, and the resulting decrease in
tension helps scar maturation.
Pitfalls and Cautions
To avoid unwanted atrophy, the concentration of triamcinolone is subsequently reduced
as scars flatten.
A protocol that promotes the safety and well-being of the laser surgeon and the patient
should be established in every practice.
Patient Education Points
Given the complexity of hypertrophic scar management and the general lack of
awareness of the available treatment options and associated outcomes by the patient, it is essential to incorporate this discussion during the clinical evaluation.
The understanding of the patientโs needs and expectations by the physician produces
greater satisfaction of care, which has been correlated with greater adherence to therapy, less doctor shopping, and a lower propensity to sue for malpractice.
CHAPTER 63 Lasers for Burns and