INTRODUCTION
The efficacy of lasers for scar treatment is well documented and multiple lasers are known to improve scars. Ablative fractional resurfacing (AFR) can be especially beneficial to improve scar appearance, texture, pain and associated contractures.1 AFR is performed with carbon dioxide (CO2) and erbium yttrium aluminum garnet (Er:YAG) lasers with water as the target chromophore.
Fractional photothermolysis works by creating columns or microthermal treatment zones (MTZs) of controlled thermal injury with a grid-like pattern at an operator-determined depth and density.2 The clinician can target the approximate depth of the scar and make depth and density adjustments based on body location as well as scar characteristics. The healthy skin between the MTZs facilitates a rapid wound healing response contributing collagen reconstruction and scar remodeling.3 The ablated pinholes from
AFR also relax skin contractures, promoting improvement, some immediate, in areas of tension.4,5 The open MTZs also can act as channels for topical drug delivery, which can be used to enhance treatment and achieve less painful more uniform distribution of drugs.6
AFR has been established as the first line method for the treatment for traumatic scars in many centers.7,8 Multiple studies have consistently documented significant subjective and objective improvements in scar appearance, color, height, texture, pliability, restriction, pain and itch, as well as an overall improvement in quality of life.8 Most experts agree that AFR is the most effective overall laser platform for traumatic scars.8
Non-healing ulcers can develop in areas of scarring. Previous reports have demonstrated success treating select chronic ulcers in the presence of scar contractures with AFR, citing decreased tension from improved scar pliability and texture, along with potential wound debridement, biofilm disruption, and molecular changes in the skin.1,9-13 We present a case of traumatic scarring with non-healing ulceration treated with AFR to facilitate wound healing and then review the literature on this indication for AFR.
Fractional photothermolysis works by creating columns or microthermal treatment zones (MTZs) of controlled thermal injury with a grid-like pattern at an operator-determined depth and density.2 The clinician can target the approximate depth of the scar and make depth and density adjustments based on body location as well as scar characteristics. The healthy skin between the MTZs facilitates a rapid wound healing response contributing collagen reconstruction and scar remodeling.3 The ablated pinholes from
AFR also relax skin contractures, promoting improvement, some immediate, in areas of tension.4,5 The open MTZs also can act as channels for topical drug delivery, which can be used to enhance treatment and achieve less painful more uniform distribution of drugs.6
AFR has been established as the first line method for the treatment for traumatic scars in many centers.7,8 Multiple studies have consistently documented significant subjective and objective improvements in scar appearance, color, height, texture, pliability, restriction, pain and itch, as well as an overall improvement in quality of life.8 Most experts agree that AFR is the most effective overall laser platform for traumatic scars.8
Non-healing ulcers can develop in areas of scarring. Previous reports have demonstrated success treating select chronic ulcers in the presence of scar contractures with AFR, citing decreased tension from improved scar pliability and texture, along with potential wound debridement, biofilm disruption, and molecular changes in the skin.1,9-13 We present a case of traumatic scarring with non-healing ulceration treated with AFR to facilitate wound healing and then review the literature on this indication for AFR.
CASE REPORT
A 69-year-old obese and hypertensive female presented with a two-year history of multiple chronic, non-healing ulcers on the central abdomen with surrounding scarring refractory to standard wound care. Four years prior, a dermatitis of unspecified etiology developed, and ulceration occurred. The cause of the ulceration was unclear but pruritus and aggressive scratching were thought to have contributed per chart review. Months later, she underwent an Oasis® grafting procedure. The graft became pruritic and the wounds returned, grew in size, and became increasingly painful. Biopsies were performed to rule out malignancy, fungal infection, and vasculitis. The wounds were repeatedly infected and did not respond to wound care, debridement, or hydrotherapy.
After multiple cycles of wound-improvement and recurrence, the wound-care specialist referred the patient for AFR in an effort to assist with wound healing. On physical exam, multiple open erosions on the central abdomen ranging from 1 to 3 cm in size were present with surrounding contracted scar tissue measuring about 8 cm x 5 cm. After evaluation, we proceeded with AFR using a 2940 nm Er:YAG laser (Sciton, Profractional, Palo Alto, CA). Prior to each laser application, the treatment area was topically anesthetized for 1 hour, cleaned
After multiple cycles of wound-improvement and recurrence, the wound-care specialist referred the patient for AFR in an effort to assist with wound healing. On physical exam, multiple open erosions on the central abdomen ranging from 1 to 3 cm in size were present with surrounding contracted scar tissue measuring about 8 cm x 5 cm. After evaluation, we proceeded with AFR using a 2940 nm Er:YAG laser (Sciton, Profractional, Palo Alto, CA). Prior to each laser application, the treatment area was topically anesthetized for 1 hour, cleaned
