Ablative fractional carbon dioxide laser improves quality of life in patients with extensive burn scars: A nested case-control study

Background and Objectives Ablative fractional carbon dioxide laser (CO2-AFL) for small-area burn scar management shows encouraging outcomes. Few studies, however, focused on comprehensive outcomes following CO2-AFL treatment for extensive burn scars. This study evaluated whether CO2-AFL surgery improved the quality of life (QoL) for burn survivors with extensive hypertrophic scars. Methods A retrospective nested case-control study was initiated to analyze the efficacy of CO2-AFL treatment for patients with large-area burn scars. Patients with extensive burn scars (>= 30% total body surface area [TBSA]) were registered in our hospital from March 2016 to October 2018. Patients undergoing CO2-AFL surgery were divided into CO2-AFL group, and patients undergoing conventional surgery were matched in a 1:1 ratio as the conventional surgery group according to the burned area. The questionnaires were collected and followed up. The 36-Item Short Form Health Survey (SF-36) and Burns Specific Health Scale-Brief (BSHS-B) were the primary parameters. Secondary parameters included the Pittsburgh Sleep Quality Index (PSQI), University of North Carolina "4P" Scars Scale (UNC4P), Patient Scars Assessment Scale for Patient (POSAS-P), and Douleur Neuropathique 4 questions (DN4). Results 23 patients (55.96 +/- 21.59% TBSA) were included in CO2-AFL group and 23 patients (57.87 +/- 18.21% TBSA) in conventional surgery group. Both the BSHS-B total score (CO2-AFL vs. conventional surgery: 115.35 +/- 29.24 vs. 85.43 +/- 33.19, p = 0.002) and the SF-36 total score (CO2-AFL vs. conventional surgery: 427.79 +/- 118.27 vs. 265.65 +/- 81.66, p < 0.001) for the CO2-AFL group were higher than those for the conventional surgery group. Parameters for the CO2-AFL group were lower than those for the conventional surgery group in all of the following comparisons: PSQI total score (CO2-AFL vs. conventional surgery: 7.70 +/- 3.74 vs. 12.26 +/- 4.61, p = 0.001), POSAS-P total score (CO2-AFL vs. conventional surgery: 26.48 +/- 6.60 vs. 33.04 +/- 4.56, p < 0.001), UNC4P total score (CO2-AFL vs. conventional surgery: 5.57 +/- 1.97 vs. 7.26 +/- 1.81, p = 0.004), and DN4 score (CO2-AFL vs. conventional surgery: 3 [2-5] vs. 5 [4-8], p = 0.004). Conclusions Compared to conventional surgery, whole scar CO2-AFL surgery dramatically improved physical and mental health as well as QoL for people with extensive burn scars. Additionally, CO2-AFL enhanced the evaluation of scars including their appearance, pain, itching, and a host of other symptoms.