Functional Improvement After Ablative Fractional Laser Treatment of a Scar Contracture

Kwan, Julia M.; Wyatt, Marilynn; Uebelhoer, Nathan S.; Pyo, Jay; Shumaker, Peter R.

doi:10.1016/j.pmrj.2011.07.007

Cited by 26 publications

(13 citation statements)

References 4 publications

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“…Intralesional corticosteroids have been a mainstay in the treatment of hypertrophic scars for decades, leading to improvements through a variety of mechanisms including diminished collagen synthesis and increased collagen degradation 20. The advent of fractional laser technology within the last decade has significantly increased potential treatment options for patients with disfiguring and disabling scars 15–18. The results of our series indicate that combination same‐session therapy with laser and laser‐assisted delivery of triamcinolone acetonide offers efficient, safe, and effective treatment of challenging hypertrophic cutaneous scars.…”

Section: Discussionmentioning

confidence: 81%

“…Fractional lasers were developed within the last decade and have mainly been applied to cosmetic indications such as the mitigation of rhytides 13, 14. However, there is increasing evidence that fractional lasers are an emerging therapeutic option for the aesthetic restoration and functional enhancement of traumatic scars at virtually any location on the body 14–18. Fractional lasers create zones of ablation at variable depths determined by the treatment settings.…”

Section: Introductionmentioning

confidence: 99%

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Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery

2013

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Background and Objectives: Hypertrophic scars and contractures are common following various types of trauma and procedures despite skilled surgical and wound care. Following ample time for healing and scar maturation, many millions of patients are burdened with persistent symptoms and functional impairments. Cutaneous scars can be complex and thus the approach to therapy is often multimodal. Intralesional corticosteroids have long been a staple in the treatment of hypertrophic and restrictive scars. Recent advances in laser technology and applications now provide additional options for improvements in function, symptoms, and cosmesis. Fractional ablative lasers create zones of ablation at variable depths of the skin with the subsequent induction of a wound healing and collagen remodeling response. Recent reports suggest these ablative zones may also be used in the immediate post-operative period to enhance delivery of drugs and other substances. We present a case series evaluating the efficacy of a novel combination therapy that incorporates the use of an ablative fractional laser with topically applied triamcinolone acetonide suspension in the immediate post-operative period. Methods: This is a prospective case series including 15 consecutive subjects with hypertrophic scars resulting from burns, surgery or traumatic injuries. Subjects were treated according to typical institutional protocol with three to five treatment sessions at 2-to 3-month intervals consisting of fractional ablative laser treatment and immediate post-operative topical application of triamcinolone acetonide suspension at a concentration of 10 or 20 mg/ml. Three blinded observers evaluated photographs taken at baseline and six months after the final treatment session. Scores were assigned using a modified Manchester quartile score to evaluate enhancements in dyschromia, hypertrophy, texture, and overall improvement. Limitations: Small sample size and lack of a control arm. Results: Combination same session laser therapy and immediate post-operative corticosteroid delivery resulted in average overall improvement of 2.73/3.0. Dyschromia showed the least amount of improvement while texture showed the most improvement. Conclusion: Combination same-session therapy with ablative fractional laser-assisted delivery of triamcinolone acetonide potentially offers an efficient, safe and effective combination therapy for challenging hypertrophic and restrictive cutaneous scars.

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Section: Discussionmentioning

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery

2013

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“…Recent reports suggest that AFR can result in consistent enhancements in appearance, function, and symptoms, such as pain and itch, in severe traumatic scars. [5][6][7][8][9] Herein we demonstrate objective functional improvements in 2 pediatric patients with debilitating scar contractures treated with AFR. Their ROM gains occurred after both had plateaued with traditional interventions (ie, therapy and surgery) and coincided temporally with laser surgery (Figs 1 and 2).…”

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confidence: 71%

Ablative Fractional Laser Resurfacing Helps Treat Restrictive Pediatric Scar Contractures

et al. 2014

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Conventional management of debilitating pediatric scar contractures, including hand therapy and surgery, may often be beset by delayed treatment, suboptimal results, and additional surgical morbidity. Ablative fractional laser resurfacing is an emerging adjunctive procedural option for scar contractures because of its promising efficacy and safety profile. However, its use to improve function has not been studied in the pediatric population. Herein we report 2 pediatric patients with recalcitrant scar contractures, causing persistent functional deficits, treated with an ablative fractional laser protocol. Both patients experienced rapid and cumulative subjective and objective improvements in range of motion and function as measured by an independent occupational therapist without reported complications. We highlight ablative fractional laser resurfacing as a novel and promising tool in the management of function-limiting scar contractures in children and propose that the technique be incorporated into existing scar treatment paradigms, guided by future research.

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“…1Y5 Incidental improvements in associated scar contractures have been noted in a few cases, but very little has been reported specifically addressing functional improvements associated with AFR. 6,7 After a decade of conflict, the population of wounded warriors with disfiguring and disabling scars has increased tremendously. In an effort to more effectively address the specific aesthetic and functional requirements of these patients, the Department of Dermatology at the Naval Medical Center in San Diego established a scar clinic under the auspices of the medical center's comprehensive aesthetic recovery effort.…”

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confidence: 99%

Functional improvements in traumatic scars and scar contractures using an ablative fractional laser protocol

Shumaker

Kwan

Landers

et al. 2012

Journal of Trauma and Acute Care Surgery

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BACKGROUND:Reports describing the use of ablative fractional resurfacing (AFR) for cosmetic improvements in skin dyschromia, rhytides, and textural irregularities are becoming increasingly common in the literature. However, the is little mention of its functional impact on patients with traumatic scars and scar contractures. We present our experience treating scars with AFR, highlighting four illustrative cases and providing a review on possible mechanisms. METHODS:Up to three ablative fractional carbon dioxide laser treatments were performed at 1-month to 2-month intervals on four patients with functional deficits related to refractory scar contractures. Treatments were individualized and began as early as 2 months after injury or final reconstructive surgery. Cases were performed in the outpatient clinic using topical anesthetic supplemented by forced air cooling. Postprocedure care included diluted-vinegar compresses two to three times daily and application of ointment over the treatment area for approximately 3 days after the procedure. Postprocedure pain was minimal, and all patients were allowed to resume physical therapy as early as the day of treatment. RESULTS:AFR was well tolerated without serious complications. Durable and cumulative improvements in range of motion or overall skin functionality were noted in all patients. AFR can be surgery sparing and facilitated earlier return to full or modified activities based on associated injuries. CONCLUSION:AFR is a novel, well tolerated, and effective complement to traditional rehabilitative management for patients with traumatic scars and scar contractures. Potential paradigm shifts include earlier initiation of treatment and a focus on functional improvements. (J Trauma Acute Care Surg. 2012;73: S116YS121.

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Functional Improvement After Ablative Fractional Laser Treatment of a Scar Contracture

Cited by 26 publications

References 4 publications

Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery

Treatment of hypertrophic scars using laser and laser assisted corticosteroid delivery

Ablative Fractional Laser Resurfacing Helps Treat Restrictive Pediatric Scar Contractures

Functional improvements in traumatic scars and scar contractures using an ablative fractional laser protocol

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