Case Report
A 64-year-old Caucasian man with past medical history of T0N3M0 squamous cell carcinoma of right neck status
post primary chemoradiotherapy and salvage radical
neck dissection/pectoralis major myocutaneous flap (RND/PMC) presented to dermatology clinic for skin graft revision due to unnatural cosmetic appearance and functional limitation associated with surgery and skin graft placement ten years ago. The patient described the skin graft appearance as “a band aid stuck to my neck,†and decreased range of motion due to the graft. He stated his personal and social life was significantly impacted.
His medications and family history were not contributory.
Physical examination revealed a well-healed large skin graft on the right neck that did not match in color, tone, or texture to the surrounding skin (Figure 1). The skin graft also limited patient’s
range of motion. Patient underwent two treatments with DEKA SmartXide DOT HP fractional CO2 laser (DEKA Medical, San Francisco, CA) approximately three months apart (Table 1). Plume was evacuated with a Buffalo filter vacuum. After each laser treatment, the patient applied triamcinolone 0.1% ointment
to the treated area once daily for one week, then white petrolatum daily to enhance wound healing post laser graft revision.
Our patient followed-up three months post initial treatment and reported significant improvement and was happy with the noticeable improvement. A second treatment with fractionated CO2 laser was performed at this time. The patient returned to dermatology clinic one-month post second treatment and stated
he was doing well and “thrilled†with the results. Physical examination
revealed pink to flesh-toned pigmentation within the skin graft and the texture was smooth and improved compared to pre-treatment (Figure 2). The laser-revised graft scar blended in well with surrounding skin and had a more natural-looking appearance. The patient also commented on increased range of motion of the neck post fractionated CO2 laser treatment. The patient tolerated the treatment well and was very pleased with the aesthetic and functional outcome. Six months post-last treatment, the patient’s aesthetic and functional results are sustained and the patient is happy.
DISCUSSION
Skin grafts can significantly impact daily life, restrict movement, and create issues in self-esteem.1 Patients may experience a lower quality-of-life, anxiety, social avoidance, and depression that is often not adequately addressed by healthcare providers.
2 There are many published studies on scar revisions that focus on hypertrophic scars, keloids, acne scars, burn scars, lacerations, and surgical scars, but there are few published studies on skin graft revisions. Here, we review the medical literature on laser skin graft revision techniques and demonstrate
a method using fractionated CO2 laser that provided an excellent aesthetic and functional outcome for our patient with a previously cosmetically inadequate and functionally limiting skin graft.
Search Strategy
We performed a review of the published literature on October
7, 2014. We searched the medical bibliographic databases
