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

Abstract

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.

A new CO2 laser technique for the treatment of pediatric hypertrophic burn scars

“…[12,20,24,55,59,62,63,67] The effect of treatment is to change 1 or more of the parameters characterized by scarring, such as abnormal pigmentation, scars, eminence above the level of intact skin, cohesion, and vascularization. These parameters assessed in VSS determine the outcome of the surgery.…”

Ablative Fractional Laser Resurfacing Helps Treat Restrictive Pediatric Scar Contractures

“…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).…”

Residual Scarring From Hidradenitis Suppurativa: Fractionated CO2 Laser as a Novel and Noninvasive Approach

“…10,11 Although there are no treatment modalities aimed specifically at residual HS scarring, a number of different laser types such as pulsed dye lasers, full-field ablative lasers, and ablative and nonablative fractional lasers have shown benefit in the treatment of other types of scarring such as from acne, surgery, and trauma. [12][13][14][15][16][17][18] Manstein et al 19 first described the concept of fractional photothermolysis in 2004. This method involves the lasermediated generation of relatively deep and narrow pixelated columns of thermal injury over a fraction of the treatment area.…”