![]() Laser is not a substitute for surgical management. In the context of burns, the traditional approaches of surgical revision with grafts, Z-pasties, tissue expanders, & contracture release all applies. Lasers are useful as adjunctive treatment for surgical, traumatic, & burn scarring. Despite all our efforts the idiots at the top won’t listen. I have provided them with evidence, I have also got other senior dermatologists to do the same. I have lobbied, written, & faced committee panels. Despite this, Medicare does not recognise fractional CO2 laser as an appropriate treatment for scarring. All burn units throughout the world recognise this as a treatment that gives unparalleled improvements, both psychologically & physically. The evidence that fractional lasers, in particular CO2 lasers have on burn scarring is irrefutable. Talk about retardation of our medical system. A patient with full thickness burns that finds it difficult to swallow has zero subsidy. They are entitled to a lifetime of subsidised (often fully paid treatments by Medicare). A psoriasis patient can accumulate up to $30,000 worth of subsidised Medicare & PBS bills within 5 years. Medicare subsides over $6000 worth of phototherapy a year, for many, many years. For example, if you have a patch of dry skin that resembles psoriasis on your elbows or knees, treatments are available. The idiots who decide on Medicare item number should really understand (experience) the physical & psychological effects of burn scars. I also deliver other drugs such as PG analogues, tacrolimus & others to stimulate pigment production.ĭon’t get me started on this. The drug of choice is triamcinolone as this can improve scar pliability. In this context I may use a combination of deep CO2, with low density, & superficial thulium 1927 lasers. Lasers also help with dermal drug delivery. In some cases, I use a Lutronic laser as it has an even shorter pulse duration (fire a Lumenis side by side with the same depth of penetration to compare & you will understand the PD). For more superficial scars, my density level is 3-6. Hence for 4mm depth penetration, my density level is 1-2. The concept of treating burn scars is easy to understand– if I push up the power, I reduce the density of CO 2 laser. This does not sound that deep, but in reality, it is 30 to 40 times the thickness of epidermis. In the context of deep scars, I can go down to 4,000 microns or 4 mm. This laser is ancient, however with a recent software update it can produce a lot of power. I use the gold stand of CO2 lasers for burns – the Lumenis Ultrapulse SCAAR FX.
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