Carbon dioxide laser ablation with immediate autografting in a full- thickness porcine burn model

Robert D. Glatter, Julie S. Goldberg, Kevin T. Schomacker, Carolyn Compton, Thomas J. Flotte, Dominic P. Bua, Kenneth W. Greaves, Norman S. Nishioka, Robert L. Sheridan

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective: To compare the long-term clinical and histologic outcome of immediate autografting of full-thickness burn wounds ablated with a high- power continuous-wave CO2 laser to sharply debrided wounds in a porcine model. Summary Background Data: Continuous-wave CO2 lasers have performed poorly as tools for burn excision because the large amount of thermal damage to viable subeschar tissues precluded successful autografting. However, a new technique, in which a high-power laser is rapidly scanned over the eschar, results in eschar vaporization without significant damage to underlying viable tissues, allowing successful immediate autografting. Methods: Full- thickness paravertebral burn wounds measuring 36 cm2 were created on 11 farm swine. Wounds were ablated to adipose tissue 48 hours later using either a surgical blade or a 150-Watt continuous-wave CO2 laser deflected by an x-y galvanometric scanner that translated the beam over the tissue surface, removing 200 μm of tissue per scan. Both sites were immediately autografted and serially evaluated clinically and histologically for 180 days. Results: The laser-treated sites were nearly bloodless. The mean residual thermal damage was 0.18 ± 0.05 mm. The mean graft take was 96 ± 11% in manual sites and 93 ± 8% in laser sites. On postoperative day 7, the thickness of granulation tissue at the graft-wound bed interface was greater in laser- debrided sites. By postoperative day 180, the manual and laser sites were histologically identical. Vancouver scar assessment revealed no differences in scarring at postoperative day 180. Conclusions: Long-term scarring, based on Vancouver scar assessments and histologic evaluation, was equivalent at 6 months in laser-ablated and sharply excised sites. Should this technology become practical, the potential clinical implications include a reduction in surgical blood loss without sacrifice of immediate engraftment rates or long- term outcome.

Original languageEnglish (US)
Pages (from-to)257-265
Number of pages9
JournalAnnals of Surgery
Volume228
Issue number2
DOIs
StatePublished - Aug 1998
Externally publishedYes

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Gas Lasers
Autologous Transplantation
Laser Therapy
Lasers
Swine
Cicatrix
Wounds and Injuries
Hot Temperature
Surgical Blood Loss
Transplants
Volatilization
Granulation Tissue
Adipose Tissue
Technology

ASJC Scopus subject areas

  • Surgery

Cite this

Glatter, R. D., Goldberg, J. S., Schomacker, K. T., Compton, C., Flotte, T. J., Bua, D. P., ... Sheridan, R. L. (1998). Carbon dioxide laser ablation with immediate autografting in a full- thickness porcine burn model. Annals of Surgery, 228(2), 257-265. https://doi.org/10.1097/00000658-199808000-00016

Carbon dioxide laser ablation with immediate autografting in a full- thickness porcine burn model. / Glatter, Robert D.; Goldberg, Julie S.; Schomacker, Kevin T.; Compton, Carolyn; Flotte, Thomas J.; Bua, Dominic P.; Greaves, Kenneth W.; Nishioka, Norman S.; Sheridan, Robert L.

In: Annals of Surgery, Vol. 228, No. 2, 08.1998, p. 257-265.

Research output: Contribution to journalArticle

Glatter, RD, Goldberg, JS, Schomacker, KT, Compton, C, Flotte, TJ, Bua, DP, Greaves, KW, Nishioka, NS & Sheridan, RL 1998, 'Carbon dioxide laser ablation with immediate autografting in a full- thickness porcine burn model', Annals of Surgery, vol. 228, no. 2, pp. 257-265. https://doi.org/10.1097/00000658-199808000-00016
Glatter, Robert D. ; Goldberg, Julie S. ; Schomacker, Kevin T. ; Compton, Carolyn ; Flotte, Thomas J. ; Bua, Dominic P. ; Greaves, Kenneth W. ; Nishioka, Norman S. ; Sheridan, Robert L. / Carbon dioxide laser ablation with immediate autografting in a full- thickness porcine burn model. In: Annals of Surgery. 1998 ; Vol. 228, No. 2. pp. 257-265.
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abstract = "Objective: To compare the long-term clinical and histologic outcome of immediate autografting of full-thickness burn wounds ablated with a high- power continuous-wave CO2 laser to sharply debrided wounds in a porcine model. Summary Background Data: Continuous-wave CO2 lasers have performed poorly as tools for burn excision because the large amount of thermal damage to viable subeschar tissues precluded successful autografting. However, a new technique, in which a high-power laser is rapidly scanned over the eschar, results in eschar vaporization without significant damage to underlying viable tissues, allowing successful immediate autografting. Methods: Full- thickness paravertebral burn wounds measuring 36 cm2 were created on 11 farm swine. Wounds were ablated to adipose tissue 48 hours later using either a surgical blade or a 150-Watt continuous-wave CO2 laser deflected by an x-y galvanometric scanner that translated the beam over the tissue surface, removing 200 μm of tissue per scan. Both sites were immediately autografted and serially evaluated clinically and histologically for 180 days. Results: The laser-treated sites were nearly bloodless. The mean residual thermal damage was 0.18 ± 0.05 mm. The mean graft take was 96 ± 11{\%} in manual sites and 93 ± 8{\%} in laser sites. On postoperative day 7, the thickness of granulation tissue at the graft-wound bed interface was greater in laser- debrided sites. By postoperative day 180, the manual and laser sites were histologically identical. Vancouver scar assessment revealed no differences in scarring at postoperative day 180. Conclusions: Long-term scarring, based on Vancouver scar assessments and histologic evaluation, was equivalent at 6 months in laser-ablated and sharply excised sites. Should this technology become practical, the potential clinical implications include a reduction in surgical blood loss without sacrifice of immediate engraftment rates or long- term outcome.",
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