To observe the clinical effect of ablative fractional CO₂ laser in the treatment of hypertrophic scar in children after burn.

The clinical data of patients with post-burn hypertrophic scar in children who met the inclusion and exclusion criteria in the Cosmetic Clinic and Burn Clinic of the Third People’s Hospital of Bengbu City Affiliated to Bengbu Medical College from January 2019 to March 2021 were collected, and a retrospective study was conducted. All patients were divided into laser group and control group, and laser group was further divided into 1-2 times subgroups and 3-4 times subgroups. The laser group received ablative fractional CO₂ laser treatment 1-4 times on the basis of conventional anti-scar treatment (pressure therapy and topical silicone drugs), and the treatment interval was 1-3 months; the control group only received conventional anti-scar treatment. The color, blood vessel distribution, thickness and softness of scar were scored by Vancouver Scar Scale (VSS), before treatment and 2 months after treatment In the laser group, and at 3 and 6 months in the control group, respectively. The degree of pruritus of the scar was scored with Visual Analogue Scale (VAS). The patient’s satisfaction evaluation is graded as four levels: very satisfied, relatively satisfied, generally satisfied, and dissatisfied. All data were analyzed by SPSS 19.0 software with paired t-test, Wilcoxon rank-sum test or chi-square test according to the type and nature of the data.

A total of 103 patients with hypertrophic scars were included, with a total of 134 scars, including 58 males and 45 females; the age was (3.9±3.0) years, range 0-11 years old; the scar area accounted for 4.2%±3.1% of the body surface area; the course of scar was (3.6±2.2) months. There were 72 patients (94 scars) in the laser group, including 29 patients (37 scars) in the 1-2 times subgroup and 43 (57 scars) in the 3-4 times subgroup; 31 patients in the control group(40 scars). (1) Vascular distribution, softness and overall score assessed by VSS in 1-2 times subgroup after treatments were significantly lower than those before treatment (P<0.05). The thickness, blood vessel distribution, softness and overall score assessed by VSS in 3-4 times subgroup after treatments were significantly lower than those before treatment (P<0.05). The improvement degree of scar after treatment in each group was different. Compared with the control group, the improvement degree in the 1-2 times subgroup and the 3-4 times subgroup was more obvious (P<0.05). The improvement degree in the 3-4 times subgroup was better than that in the 1-2 times subgroups (P<0.05). (2) Compared with before treatment, the VSS scores of scars after laser treatment in different parts were significantly different except for the thickness scores of face and neck, trunk, and upper limbs group (P<0.05). (3) The degree of pruritus was assessed by VAS method. The pruritus score of the 1-2 times subgroups and 3-4 times subgroups before treatment was (4.86±1.35) points, (4.97±0.93) points, and the pruritus score 2 months after treatment was (1.93±0.99) points, (1.90±0.83) points, the pruritus score improved significantly after treatment, and the difference was statistically significant (P<0.01). The pruritus scores of the control group at 3 months and 6 months were (4.83±0.82) points and (4.22±0.66) points, and the scores at 6 months were slightly improved compared with those at 3 months, and the difference was statistically significant (P<0.01). (4) In the laser group, 5 patients (6.9%) had pigmentation after the first treatment, and then gradually subsided; 7 patients (9.7%) had blisters after the second treatment, which healed after dressing change. In the control group, 3 cases (9.7%) had erosions, and the erosions improved after adjusting the pressure appropriately. (5) The overall satisfaction of patients in the laser group was higher than that in the control group [100% (72/72) vs. 80.6% (25/31), P<0.05].

Fractional CO₂ laser has a good effect on the treatment of hypertrophic scars in early childhood burns. It can effectively inhibit scar hyperplasia and improve the degree of itching in patients. The satisfaction of both doctors and patients is high.

Cicatrix; Lasers, gas; Child; Fractional carbon dioxide laser; Burns