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Use of a Fractionated Carbon Dioxide Laser Treatment Protocol for the Treatment of Scars and Adhesions in the Upper Extremity
Julia Kwan, MD2; Leo T. Kroonen, MD1; Eric P. Hofmeister, MD1; Brian Fitzgerald, MD1; Nathan Uebelhoer, DO2; Peter Shumaker, MD2
1Department of Orthopedic Surgery, Naval Medical Center San Diego, San Diego, CA; 2Department of Dermatology, Naval Medical Center San Diego, San Diego, CA

Introduction: The formation of scar tissue after trauma or surgery of the hand is a frequent cause of functional limitation.  Such scarring can cause dysfunction through the binding of underlying muscle/tendon units or through the stiffness of the scar tissue itself.  We report a diverse case series of patients in which use of a fractionated ablative laser for treatment of dense scarring resulted in subjective and objective functional improvements.

Methods: The Hand & Microvascular service at our institution has begun collaboration with the Dermatology department to identify post-surgical and post-traumatic patients in whom scar tissue is likely to cause limitations in finger and wrist mobility.  Patients are referred for evaluation and treated with a fractionated carbon dioxide laser over the scar.  Treatment consists of up to three or more consecutive laser treatments separated by one month.  The patientsí functional status was captured pre and post treatment with still photography and video in certain cases.  Results are reported in terms of patient satisfaction and functional improvement in digital and or wrist motion as appropriate.

Results: We report on 6 different cases in which functional improvement was noted in a direct temporal relationship to the cutaneous application of a fractional ablative laser.  Injuries treated included a blast injury, a burn, a crushing injury, a sharp laceration across a digital crease, skin grafting after a fasciotomy and a multiply operated upon patient with atypical infection.  All patients reported subjective improvement in sensations of tightness.  Our first case avoided a tenolysis surgery as a results of his improvement.

Conclusions: Treatment of scarring in the hand with a fractionated carbon dioxide laser can improve both subjective and objective function in patients with a diverse array of hand conditions.  These functional changes can lead to dramatic improvements in patients' overall quality of life.  Therefore, further investigation is warranted to better define the role for this new technology in improving functional outcomes.

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