Patient Story 04
Procedure performed by Dr. Matteo Tretti Clementoni (Milan, Italy)
A 49 year old female sustained 2nd and 3rd degree burns while attempting to sprinkle alcohol on wooden logs in her fireplace . The alcohol bottle exploded due to a backfire and caused burns over her hands, anterior part of the left forearm, left side of the face and neck, upper chest and thighs. Patient was hospitalised and underwent multiple surgeries at a burn and trauma centre in North Italy for 2 months.
Patient presented to us with a hypertrophic scar on the dorsum of the right hand and wrist. She complained of difficulty in flexing and extending the index, middle and ring finger along with restricted abduction of the thumb. She had itching and pain for which she took pain killers on a regular basis.
Our patient was treated with 4 sessions of Pulsed Dye Laser (PDL) and Ultrapulse C02 fractional laser performed in the same session at an interval of 45-60 days. During each session she first received PDL (595 nm wavelength, 10 mm spot size, 1.5 ms pulse duration , 6.5 J/cm2) followed by ultrapulse fractional CO2 procedure (100 mJ, 1% density,300 Hz frequency) on the affected area . Post laser, a cocktail of 5-fluorouracil , Triamcinolone 40mg/ml and Botulinum toxin (5FU and TAC ratio 8:2 + 20 units of BoNTA) was applied and vigorously massaged on the scar . Patient was advised to apply silicone gel (Stratamed – StratPharma ) during the first few days post procedure and silicon gel (Strataderm – StratPharma) in the subsequent weeks.
Patient reported reduction in pruritis and pain by 70 % only after the 1 session. 1 month following the 2nd session, patient returned to work and performed her daily chores without painkillers. During subsequent sessions, there was an improvement in her flexion, extension and abduction movements . Visually, the scar reacquired skin colour and became softer, thinner and more elastic.