Definition and Overview
Burns are injuries to the skin and underlying tissues caused by extreme temperatures (heat or cold), chemicals, radiation, electricity, or friction. Most burn injuries are preventable.
There are four kinds of burn injuries, ranging from first-degree to fourth-degree burns. Superficial burns, known as first-degree burns, are generally treated at home or managed with over-the-counter pain medications. Second to fourth-degree burns, on the other hand, typically require immediate medical attention, and in more severe cases, specialised surgery.
Who Should Undergo and Expected Results
Burn scars are not only unsightly—they can also affect an individual’s range of motion, especially when contracture sets in. This is the tightening of the skin and underlying tissues that often occur with burn scars, especially in body parts where movement is important, such as the fingers, toes, legs, arms, neck, and shoulders.
The amount of scarring depends on the depth of the burn injury. First-degree burns typically heal faster, as the human body is capable of re-growing the epidermis. Such superficial burns usually involve little to no scarring, but the individual might observe some discolouration in the skin as it grows a new layer. However, deeper burn injuries destroy the cells in the skin that foster healing and re-growth of a new skin layer. It is these deeper wounds that result in contractures, which limit the movement of joints. More severe contractures can even affect the normal position of key structures such as the eyelids and the mouth.
Over time, usually years after the burn injury, the scars will gradually improve—they become less red in colour, less raised, thinner, and softer. However, some patients do not have the luxury of time waiting for the scars to improve decades after the injury.
Burn scar removal is an umbrella term that refers to several forms of treatment or management of scars caused by more severe burn injuries. Many patients opt to use non-invasive methods such as topical ointments and creams that promote the growth of new skin layers, which can improve the appearance of their burn scars (particularly in areas where the contracture does not significantly affect the motion and function of affected body parts).
For patients who need more immediate and dramatic results, laser burn scar removal is the best option. This type of treatment creates a specific therapeutic response in the affected area by transforming light energy into heat. Laser therapy vaporises the old scar and creates a wound in the area. The new wound then stimulates the body’s healing processes, resulting in a new, scar-free skin layer.
Healthy patients who have suffered through severe burn scarring, especially those that have resulted in contractures, are considered ideal patients for laser burn scar removal. To be considered for the procedure, they must not have any medical condition that may interfere with the body’s natural healing process, such as diabetes. Research shows that this type of treatment is effective in patients with 16% or less burn scarring in the body.
Expected results are less obvious burn scars, which can gradually fade over time.
Older scars are more challenging to treat through laser procedures. Doctors recommend getting such treatments as soon as the burn injuries have healed.
How is the procedure performed?
As burn scar removal is not an emergency procedure, the patient and the doctor can discuss the treatment method longer. The doctor can also make an accurate analysis of the patient’s situation and develop a plan to make the most of the laser treatment.
Laser treatment is generally painless, but for larger affected areas, the patient can opt for local anaesthesia or conscious sedation.
To start the procedure, the treatment area is cleaned thoroughly to remove surface oils and allow the doctor to see the scars better. A handpiece connected to a laser machine is then held over the scarred areas, where it emits high-temperature light directly on the scars. The laser will heat up the scar to vaporise it. In some cases, there is a smoke evacuator used during the procedure to suck up the patient’s skin during the treatment.
The laser creates a tiny third-degree burn on the skin in order to remove the raised or tightened scars allowing the body to grow new layers of healthy skin that are visibly scar-free.
Another laser will be used on the patient’s skin to deliver topical treatments, such as steroids, directly where the patient’s body needs it to facilitate natural healing. This second laser penetrates more deeply into the skin. These topical treatments can help flatten the scar and create a smooth layer of skin where the scars used to be.
Possible Risks and Complications
Laser burn scar removal is generally safe and does not result in serious complications when performed by a qualified and experienced professional.
However, when an anaesthetic is used, there is a risk that the patient will develop negative reaction to it.
Kraft R, Herndon DN, Al-Mousawi AM, Williams FN, Finnerty CC, Jeschke MG. Burn size and survival probability in paediatric patients in modern burn care: a prospective observational cohort study. Lancet. 2012 Mar 17. 379(9820):1013-21.
Jeschke MG, Finnerty CC, Kulp GA, Przkora R, Micak RP, Herndon DN. Combination of recombinant human growth hormone and propanol decreases hypermetabolism and inflammation in severely burned children.Pediatr Crit Care Med. Mar 2008. 9:209-216