Predictors of Response to Fractional CO₂ Laser Therapy in Hypertrophic Burn Scars: A Retrospective Cohort Study

Abstract Hypertrophic burn scars are associated with significant functional impairment and psychosocial morbidity. While fractional CO₂ laser therapy has demonstrated efficacy in improving scar quality and symptoms, limited data exist on how baseline scar characteristics and patient factors influence treatment response. This study evaluated whether baseline scar severity, total body surface area (TBSA), and duration of initial hospital stay predict responsiveness to fractional CO₂ laser therapy, and whether laser treatment is associated with a reduced need for scar contracture release procedures. A retrospective cohort study was conducted including burn patients who underwent fractional CO₂ laser therapy. Scar severity was assessed using the Vancouver Scar Scale (VSS) before and after treatment. Additional variables included TBSA, length of initial hospitalization, and incidence of subsequent scar contracture release procedures. A control cohort of burn patients who did not receive laser therapy was included for comparison. Statistical analyses were performed to identify predictors of scar improvement and associations with procedural outcomes. Baseline VSS score was the strongest predictor of treatment response, with higher initial severity associated with greater improvement following laser therapy. TBSA and hospital length of stay were not significantly associated with treatment response. Laser therapy was associated with fewer scar contracture release procedures; however, this did not reach statistical significance, likely due to limited sample size. These findings suggest initial scar severity is a key determinant of laser responsiveness and support further study in larger cohorts.