Difference between revisions of "Laser treatment for burn scar"

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{{Infobox surgical procedure
| anesthesia_type = MAC orGeneral
| airway = LMA or Natural Airway
| lines_access = PIV x1
| monitors = Standard
| considerations_preoperative =
| considerations_intraoperative = Intraoperative laser
| considerations_postoperative = Pain control
}}
 
== Overview ==
CO2 lasers resurfacing is a surgical procedure used to improve the appearance of hypertrophic scars from burns or other trauma. The CO2 lasers help to remodel and redistribute dermal collagen fibers, flattening and softening them to reduce scar thickness and improve functionality. It is often combined with local 5-Flurouracil injections and steroid injections for further collogen breakdown and fibroblast inhibition.<ref>{{Cite journal|last=Klifto|first=Kevin M.|last2=Asif|first2=Mohammed|last3=Hultman|first3=C. Scott|date=2020|title=Laser management of hypertrophic burn scars: a comprehensive review|url=https://pmc.ncbi.nlm.nih.gov/articles/PMC7175764/|journal=Burns & Trauma|volume=8|pages=tkz002|doi=10.1093/burnst/tkz002|issn=2321-3868|pmc=7175764|pmid=32346540}}</ref><ref>{{Cite book|last=Jaffe|first=Richard|title=Anesthesiologist's Manual of Surgical Procedures|publisher=Wolters Kluwer|year=2014|isbn=978-1-4511-7660-5|location=Philadelphia, PA|pages=1104-1106}}</ref>
 
Laser treatments for scars usually take 3-8 sessions spaced 4-8 weeks apart for optimal scar and mobility improvements.
 
== Preoperative management ==
 
=== Patient evaluation<!-- Describe the unique and important aspects of preoperative evaluation. Add or remove rows from the systems table as needed. --> ===
{| class="wikitable"
|+
!System
!Considerations
|-
|Airway
|Airway evaluation, consideration for natural airway vs. LMA vs. ETT
|-
|Neurologic
|Outpatient pain medication
|-
|Cardiovascular
|CAD, CHF
|-
|Pulmonary
|Smoking hx
|-
|Gastrointestinal
|GERD
|-
|Other
|Skin infections
|}
 
=== Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. --> ===
Labs and studies should be aimed at patient comorbidities
 
=== Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. --> ===
Ensure proper laser-approved eye-protection for both patient and physician
 
=== Patient preparation and premedication<!-- Describe any unique considerations for patient preparation and premedication. If none, this section may be removed. --> ===
Premedication with Tylenol for pain is recommended for patients with good hepatic function
 
As this is an outpatient procedure, premedication with benzodiazepines are discouraged to ensure appropriately timed PACU course. However, lorazepam PO can be taken prior to the procedure for severely anxious patients.
 
== Intraoperative management ==
 
=== Monitoring and access<!-- List and/or describe monitors and access typically needed for this case. Please describe rationale for any special monitors or access. --> ===
Standard Monitoring
 
PIV x1
 
=== Induction and airway management<!-- Describe the important considerations and general approach to the induction of anesthesia and how the airway is typically managed for this case. --> ===
Procedure can be done under MAC or general anesthesia. General anesthesia can be done with a natural airway, LMA, or ETT with consideration to airway patency.
 
Maintain spontaneous ventilation if using natural airway or LMA
 
=== Positioning<!-- Describe any unique positioning considerations, including potential intraoperative position changes. If none, this section may be removed. --> ===
Supine
 
=== Maintenance and surgical considerations<!-- Describe the important considerations and general approach to the maintenance of anesthesia, including potential complications. Be sure to include any steps to the surgical procedure that have anesthetic implications. --> ===
 
* Propofol infusion
* IV opioids
 
=== Emergence<!-- List and/or describe any important considerations related to the emergence from anesthesia for this case. --> ===
Natural airway: cessation of maintenance anesthetic
 
LMA: able to remove LMA in deep plane of anesthesia if patient is breathing spontaneously and ventilating/oxygenating appropriately
 
== Postoperative management ==
 
=== Disposition<!-- List and/or describe the postoperative disposition and any special considerations for transport of patients for this case. --> ===
PACU to home
 
=== Pain management<!-- Describe the expected level of postoperative pain and approaches to pain management for this case. --> ===
 
* Acetaminophen
* Ibuprofen
* Oral opioids
 
=== Potential complications<!-- List and/or describe any potential postoperative complications for this case. --> ===
Laser fire (more likely with facial procedures)
 
== Procedure variants<!-- This section should only be used for cases with multiple approaches (e.g. Laparoscopic vs. open appendectomy). Otherwise, remove this section. Use this table to very briefly compare and contrast various aspects between approaches. Add or remove rows as needed to maximize relevance. Consider using symbols rather than words when possible (e.g. +, –, additional symbols such as ↑ and ↓ are available using the "Ω" tool in the editor). --> ==
 
{| class="wikitable wikitable-horizontal-scroll"
|+
!
!Variant 1
|-
|Unique considerations
|Eye protection for laser use
|-
|Indications
|Hypertrophic scar reduction
|-
|Position
|Supine
|-
|Surgical time
|30-60 minutes
|-
|EBL
|Minimal
|-
|Postoperative disposition
|Outpatient
|-
|Pain management
|Tylenol, ibuprofen
|-
|Potential complications
|Laser fire
|}
 
== References ==
 
[[Category:Surgical procedures]]

Latest revision as of 18:04, 16 March 2026

Laser treatment for burn scar
Anesthesia type

MAC orGeneral

Airway

LMA or Natural Airway

Lines and access

PIV x1

Monitors

Standard

Primary anesthetic considerations
Preoperative
Intraoperative

Intraoperative laser

Postoperative

Pain control

Article quality
Editor rating
Unrated
User likes
0

Overview

CO2 lasers resurfacing is a surgical procedure used to improve the appearance of hypertrophic scars from burns or other trauma. The CO2 lasers help to remodel and redistribute dermal collagen fibers, flattening and softening them to reduce scar thickness and improve functionality. It is often combined with local 5-Flurouracil injections and steroid injections for further collogen breakdown and fibroblast inhibition.[1][2]

Laser treatments for scars usually take 3-8 sessions spaced 4-8 weeks apart for optimal scar and mobility improvements.

Preoperative management

Patient evaluation

System Considerations
Airway Airway evaluation, consideration for natural airway vs. LMA vs. ETT
Neurologic Outpatient pain medication
Cardiovascular CAD, CHF
Pulmonary Smoking hx
Gastrointestinal GERD
Other Skin infections

Labs and studies

Labs and studies should be aimed at patient comorbidities

Operating room setup

Ensure proper laser-approved eye-protection for both patient and physician

Patient preparation and premedication

Premedication with Tylenol for pain is recommended for patients with good hepatic function

As this is an outpatient procedure, premedication with benzodiazepines are discouraged to ensure appropriately timed PACU course. However, lorazepam PO can be taken prior to the procedure for severely anxious patients.

Intraoperative management

Monitoring and access

Standard Monitoring

PIV x1

Induction and airway management

Procedure can be done under MAC or general anesthesia. General anesthesia can be done with a natural airway, LMA, or ETT with consideration to airway patency.

Maintain spontaneous ventilation if using natural airway or LMA

Positioning

Supine

Maintenance and surgical considerations

  • Propofol infusion
  • IV opioids

Emergence

Natural airway: cessation of maintenance anesthetic

LMA: able to remove LMA in deep plane of anesthesia if patient is breathing spontaneously and ventilating/oxygenating appropriately

Postoperative management

Disposition

PACU to home

Pain management

  • Acetaminophen
  • Ibuprofen
  • Oral opioids

Potential complications

Laser fire (more likely with facial procedures)

Procedure variants

Variant 1
Unique considerations Eye protection for laser use
Indications Hypertrophic scar reduction
Position Supine
Surgical time 30-60 minutes
EBL Minimal
Postoperative disposition Outpatient
Pain management Tylenol, ibuprofen
Potential complications Laser fire

References

  1. ↑ Klifto, Kevin M.; Asif, Mohammed; Hultman, C. Scott (2020). "Laser management of hypertrophic burn scars: a comprehensive review". Burns & Trauma. 8: tkz002. doi:10.1093/burnst/tkz002. ISSN 2321-3868. PMC 7175764. PMID 32346540.
  2. ↑ Jaffe, Richard (2014). Anesthesiologist's Manual of Surgical Procedures. Philadelphia, PA: Wolters Kluwer. pp. 1104–1106. ISBN 978-1-4511-7660-5.

Top contributors: Chelsea Rogers and Tony Wang

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