title: Non-ablative fractional resurfacing in the treatment of scar contracture.
abstract: OBJECTIVE
  A 28-year-old female presented with extensive scarring after a traumatic injury to her right lower extremity. She had been hit by a vehicle one year prior to presentation and had several open fractures with extensive overlying cutaneous damage, which required multiple surgeries and skin grafts. She had limited range of motion of the affected limb secondary to scar contracture.
  
  
  METHODS
  The patient received 6 treatments with a non-ablative fractional resurfacing (NAFR) device with two wavelengths (Fraxel DUAL, Solta Medical, Hayward, CA) spaced 4-8 weeks apart. The patient received two treatments with the 1927 nm NAFR thulium laser (10 mJ, 30% density, 8 passes) and two treatments with the 1550 nm NAFR laser (40 mJ, 17-26% density, 8 passes). Before and after treatment photographs were taken, as well as range of motion measurements with respect to her right ankle.
  
  
  RESULTS
  The patient had 50-75% improvement in the texture and discoloration. There was both subjective and objective improvement in the range of motion of her right lower extremity. The patient experienced mild erythema and edema, both of which resolved after 7-10 days.
  
  
  CONCLUSIONS
  Recent studies have shown great functional improvement in scar contractures with ablative fractional laser treatments; however, these treatments are accompanied by significant downtime along with risk of further scarring and infection. NAFR is an accessible treatment with a low side effect profile and to our knowledge has not been reported as efficacious in the treatment of scar contracture. This case report is novel in its demonstration of the utility of a dual wavelength NAFR in the treatment of scar contracture and functional impairment.
authors.affiliation: Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, 833 Chestnut St., Ste. 740, Philadelphia, Pennsylvania, 19107.
authors.forename: Robert
authors.initials: R
authors.lastname: Finney
authors.affiliation: Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, 833 Chestnut St., Ste. 740, Philadelphia, Pennsylvania, 19107.
authors.forename: Richard
authors.initials: R
authors.lastname: Torbeck
authors.affiliation: Department of Dermatology and Cutaneous Biology, Thomas Jefferson University, 833 Chestnut St., Ste. 740, Philadelphia, Pennsylvania, 19107.
authors.forename: Nazanin
authors.initials: N
authors.lastname: Saedi
mesh_terms: D000328:Adult; D000843:Ankle Joint / Q000502:physiology*; D002921:Cicatrix / Q000150:complications*; D003286:Contracture / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D016059:Range of Motion, Articular
keywords: 1550; 1927; NAFR; functional impairment; non-ablative fractional laser; non-ablative fractional resurafacing; scar; scar contracture; scar treatment; traumatic scarring