Efficacy of Laser Debridement With Autologous Split-Thickness Skin Grafting in Promoting Improved Wound Healing of Deep Cutaneous Sulfur Mustard Burns

摘要

The consequences of receiving a cutaneous sulfur mustard (SM) burn are a prolonged wound healing phase and secondary infection. This study was undertaken to find a treatment that promotes speedier healing with fewer complications and minimal disfigurement. Deep SM burns were generated on the ventrum of weanling pigs and treated at 48 h. Four treatments were compared including: (1) full thickness CO2 laser debridement followed by skin grafting, (2) full thickness sharp surgical tangential excision followed by skin grafting, the 'Gold Standard' used in deep thermal burns management, (3) partial thickness laser ablation with no grafting, and (4) partial thickness sharp excision with no grafting. Ulceration, wound morphometry, wound contraction, skin color, epidermal barrier function, cutaneous blood flow, skin hardness and elasticity, and histopathology were evaluated during a 36-day healing period. Laser debridement followed by skin grafting was as efficacious in improving the wound healing of deep SM burns as the 'Gold Standard.' Laser debridement offered additional benefits that included hemostatic control during surgery and minimal debridement of normal perilesional skin, resulting in significantly less blood loss and an improved cosmetic result. Mid-dermal debridement by sharp excision or laser ablation without grafting produced less desirable results but was better than no treatment.