314 Inflammatory and Infectious Complications of Laser Therapy in Treatment of Hypertrophic Burn Scars: Correlations in Literature Review and Case Reports

Abstract Introduction Hypertrophic burn scars contribute to morbidity through secondary symptoms of pain, pruritus, and scar contracture. Traditional treatment methods are now augmented by the use of monochromatic light therapies, which are generally accepted as safe and effective. However, there is little literature available regarding the complications of laser treatments of hypertrophic burn scars and even less regarding inflammatory and infectious complications. Methods A literature search using PubMed was performed to identify literature pertaining to infectious and inflammatory complications of cutaneous laser treatments. Additionally, we reviewed cases of inflammatory and infectious complications occurring at our institute after laser treatment of hypertrophic burn scars. Results We only identified 1 publication related to complications of laser therapy in the treatment of burn scars. In 163 laser sessions, the reported incidence of adverse events was 25.1%, of which only 14.6% were related to infectious processes. Nine cases of inflammatory and infectious complications were observed at our institute between Dec, 2015 and Jul, 2016. Cases included 3 each of cellulitis, Systemic Inflammatory Response Syndrome (SIRS), and complicated SIRS. Conclusions We found the most common inflammatory complication was SIRS with MSSA positive wound cultures. Three cases required hospitalization, antibiotics, fluids and vasopressors, despite negative blood cultures. In light of the high prevalence of MSSA in the natural skin flora and negative blood cultures, the inability to establish a true source of infection lead to declaring these cases “complicated SIRS” and not sepsis. Correlative factors that may have led to complications reported in our cases were: preop evidence of infection, no preop antibiotics administered, no postop antibiotic dressings, combined procedures, and large treatment areas. The true mechanism of inflammatory and infectious complication is yet to be determined, but we postulate that these factors place a greater challenge on an already burdened immune system. Determining whether this is a true causal mechanism, leading to an aggravated inflammatory response, requires further investigation. Applicability of Research to Practice We urge institutions preforming such procedures to advise patients on preop wound preparation. We recommend that each individual with a preexisting history of infection and/or preop culture evidence of infection receive