Efficacy of laser debridement with autologous split-thickness skin grafting in promoting improved healing of deep cutaneous sulfur mustard burns

Abstract

Sulfur mustard [bis(2-chloroethyl)sulfide; SM] is a blistering chemical warfare agent that remains a threat to war fighters and civilians worldwide. The consequences of receiving a cutaneous SM burn are a prolonged healing phase and secondary infection. Blister aspiration, debridement, irrigation, topical antibiotics and sterile dressings have been the main treatments. The reason for undertaking this study was to find a new treatment that promotes speedier healing with fewer complications and less disfigurement. The principal objective of the study was to compare four treatments and establish which achieved the shortest healing time and least amount of wound contraction. These treatments included (1) full thickness debridement with a computer controlled, raster scanned continuous wave CO2 laser followed by autologous split thickness skin grafting, (2) full thickness sharp surgical tangential excision followed by skin grafting, the "Gold Standard" used in human deep dermal/full-thickness thermal burns management, (3) partial thickness laser ablation with no grafting, and (4) partial thickness sharp excision with no grafting. Fifteen female Yorkshire Cross weanling pigs were used. Liquid SM was applied to the ventral surface for 2 h to generate six large 4-cm diameter deep dermal/full-thickness burns. The treatments were conducted 48 h post-exposure. A variety of non-invasive bioengineering methods were used to evaluate ulceration, wound size, shape and contraction, skin color, epidermal barrier function, cutaneous blood flow, and skin hardness and elasticity during a 36-day healing period. Vancouver scar assessments and histopathological evaluations were conducted at the end of the healing period. Laser debridement followed by skin grafting was as equally efficacious in improving the wound healing of deep dermal/full thickness cutaneous SM burns as the "Gold Standard". Engraftment rates and Vancouver scar assessments were similar between both methods of debridement. 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 surgical treatment of the wounds at all. Noninvasive bioengineering methods were useful in monitoring the progress of wound healing.