Department of Dermatology, Naval Medical Center, San Diego, California 92134, USA.
J Trauma Acute Care Surg. 2012 Aug;73(2 Suppl 1):S116-21. doi: 10.1097/TA.0b013e318260634b.
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.
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.
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.
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.
在文献中，越来越多的报告描述了消融性微剥脱（AFR）在改善皮肤色素沉着、皱纹和纹理不规则方面的美容效果。然而，很少有提及它对创伤性瘢痕和瘢痕挛缩患者的功能影响。我们介绍了使用 AFR 治疗瘢痕的经验，重点介绍了四个典型病例，并对可能的机制进行了综述。
对 4 名因难治性瘢痕挛缩而导致功能障碍的患者，在 1 至 2 个月的时间间隔内，最多进行 3 次消融性微剥脱二氧化碳激光治疗。治疗方案个体化，从受伤或最后一次重建手术后 2 个月开始。在门诊使用局部麻醉剂，辅以强制风冷进行手术。术后护理包括每天 2 至 3 次稀释的醋敷布和在治疗区域涂抹软膏约 3 天。术后疼痛轻微，所有患者均允许在治疗当天恢复物理治疗。
AFR 耐受性良好，无严重并发症。所有患者的关节活动度或整体皮肤功能均有持久和累积的改善。AFR 可以避免手术，并根据相关损伤更早地恢复完全或改良活动。
AFR 是一种新颖的、耐受性良好的、有效的治疗创伤性瘢痕和瘢痕挛缩的方法，可作为传统康复管理的补充。潜在的范式转变包括更早开始治疗和关注功能改善。
