53 Pulsed Dye Laser Photothermolysis <i>versus</i> Fractional CO2 Laser Ablation for the Treatment of Hypertrophic Burn Scars: Results from a Large, Rater-Blinded, before-after Cohort Study
Bibliographic record
Abstract
Although laser resurfacing has become an accepted treatment in the management of hypertrophic burn scars, no studies have directly compared different platforms, such as pulsed dye laser (PDL) or fractional CO2 laser (fCO2). We present the first rater-blinded study that compares these two modalities, using objective and subjective outcome measures, to determine the efficacy of laser therapy in burn patients with symptomatic, hypertrophic scars. A rater-blinded, before-after cohort study was performed in 206 consecutive patients who underwent laser treatment of hypertrophic burn scars. A specific laser platform was chosen based on a pre-determined algorithm incorporating pruritis and vascularity, as well as stiffness and pliability, to guide the use of PDL or fCO2. A constant anchor spot was established prior to therapy and assessed using the Vancouver Scar Score and UNC5P. Data were collected by an independent, blinded rater, entered prospectively into a scar registry, and analyzed post hoc. PDL and fCO2 groups were compared by chi-square and Student’s T tests, with p values < 0.05 determined to be statistically significant. 206 patients underwent 452 laser sessions, with 122 patients receiving PDL and 255 patients receiving fCO2. Median time from injury to first laser was 1.4 years. Median size of the burn was 8% of the total body surface area. PDL improved VSS from 9.03 to 7.48 (p<0.05) but nominally decreased UNC5P from 4.34 to 3.72 (NS). fCO2 improved both VSS from 8.33 to 6.93 (p<0.00001) and UNC5P from 3.89 to 2.65 (p< 0.01). In this rater-blinded, before-after cohort study, PDL significantly improved objective measures of hypertrophic burn scars, but fCO2 lasers significantly improved both objective and subjective measures. These data strongly support previous clinical observations that fractional CO2 resurfacing may be more efficacious than pulsed dye laser, in the treatment of hypertrophic burn scars. This study assists providers in determining what type of laser to use to treat hypertrophic burn scars.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".