Functional Improvements in Traumatic Scars and Scar Contractures Using an Ablative Frac¬tional Laser Protocol
AUTHORS: Peter R. Shumaker, MD, Julia M. Kwan, MD, John T. Landers, MD, Nathan S. Uebelhoer, DO
RESEARCH SITES: Department of Dermatology, Naval Medical Center, San Diego, California
PUBLICATION: J Trauma Acute Care Surg. 2012, 73: S116YS121.
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.