Laser treatment of hypertrophic scars: the operative and peri-operative practices of burns clinicians

Abstract Purpose. Laser treatment is rapidly becoming a staple of hypertrophic scar management, but literature reviews have identified significant heterogeneity in laser protocols. Mapping laser operative practices can help to share clinical expertise and identify new research directions. A questionnaire to characterize laser treatment techniques for hypertrophic scars was conducted. Methods. The questionnaire was developed with a multidisciplinary team of burns clinicians and researchers and translated into Spanish, Chinese and German. It was distributed internationally to burns clinicians between December 2021 and June 2023. Results. Forty-three clinicians participated in the questionnaire. Respondents used laser to treat both immature (n = 36, 84%) and mature (n = 42, 98%) scars, with varying approaches to how soon therapy should commence post-injury, and how frequently it should be repeated. Almost all respondents used CO 2 fractional ablative laser (n = 41, 95%) for scar treatment, one-third used pulsed dye laser (n = 14, 33%), and approximately one-half reported using more than one laser during a single procedure (n = 21, 49%). Respondents used scar thickness to assist with setting laser parameters (n = 29, 67%), chiefly determining this by estimation (n = 25, 58%). 60% of respondents performed scar reconstruction (n = 26), and 91% (n = 39) used adjunct therapies, such as corticosteroids, concurrently with laser treatment. Choices of anesthetic, analgesia and dressings varied widely. Conclusion. While there are similarities in the broad aspects of how burns clinicians use laser to treat hypertrophic scars, there are several differences in practice. These variations highlight potential research directions to optimize patient outcomes from this treatment modality.