title: Treatment of split-thickness skin graft-related forearm scar contractures with a carbon dioxide laser protocol: 3 case reports.
abstract: Split-thickness skin grafts in the forearm can lead to motion restriction and disability through the dense scarring of the skin and formation of graft-tendon adhesions. Three patients were referred for laser treatment of motion-limiting scar-associated split-thickness skin grafts to the forearm. All patients had reached a plateau in range of motion despite aggressive hand therapy and underwent serial laser scar treatments at 6- to 8-week intervals. Treatments were performed in a clinic setting and were initiated 2 to 5 months after reconstructive surgery. Rapid subjective functional and objective improvements in range of motion were noted after laser therapy. Results were cumulative and durable at final follow-up ranging from 10 to 15 months after the initial treatment. No complications were noted. Fractionated carbon dioxide laser therapy is a promising adjunct to hand therapy when the main restraint to motion is superficial skin scarring and skin-tendon adhesions.
authors.affiliation: Departments of Orthopedics and Dermatology, Naval Medical Center San Diego, San Diego, California. Electronic address: leo.kroonen@med.navy.mil.
authors.forename: Leo
authors.initials: L
authors.lastname: Kroonen
authors.forename: Peter R
authors.initials: PR
authors.lastname: Shumaker
authors.forename: Julia M
authors.initials: JM
authors.lastname: Kwan
authors.forename: Nathan
authors.initials: N
authors.lastname: Uebelhoer
authors.forename: Eric
authors.initials: E
authors.lastname: Hofmeister
mesh_terms: D000328:Adult; D000368:Aged; D001753:Blast Injuries / Q000601:surgery; D002921:Cicatrix / Q000150:complications; D003286:Contracture / Q000209:etiology / Q000601:surgery*; D005543:Forearm Injuries / Q000601:surgery; D050723:Fractures, Bone / Q000601:surgery; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D054020:Lasers, Gas / Q000627:therapeutic use*; D008297:Male; D016059:Range of Motion, Articular; D012509:Sarcoma / Q000601:surgery*; D016038:Skin Transplantation / Q000009:adverse effects*; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery; D055815:Young Adult
keywords: Laser; contracture; scar; skin-graft