To analyze the effect of CO2 fractional laser combined with scar plastic surgery in patients with burn hypertrophic scar. Methods A total of 60 patients with burn hypertrophic scar admitted to our hospital from February 2021 to January 2023 were selected as the research objects and divided into control group and observation group by random number table method, with 30 patients in each group. The control group was treated with conventional scar repair, and the observation group was treated with CO2 fractional laser combined with scar plastic surgery. The scar condition, pain degree and skin itching degree were compared between the two groups. Results The VSS scores of the observation group were lower than those of the control group at 1, 2 and 3 months after operation (P <0.05). The VAS score of the observation group was lower than that of the control group at 1, 2 and 3 months after operation (P <0.05). The scores of skin pruritus in the observation group were lower than those in the control group at 1, 2 and 3 months after operation (P <0.05). Conclusion CO2 fractional laser combined with scar plastic surgery has a good effect in the treatment of burn hypertrophic scar, which can effectively reduce the degree of pain and itching, and the effect of scar repair is better, which is worthy of clinical application.