By Stephen Spotswood

SAN DIEGO NAVAL MEDICAL CENTER, CA — Thanks to the work of physicians here and at a select number of facilities around the country, the paradigm of how scars are treated might be shifting.

Whereas, in the past, the use of fractional lasers on scar tissue has been relegated mostly to cosmetic repairs, new techniques are allowing for more functional improvements. After these treatments, wounded warriors are able to more freely maneuver digits and limbs, which they previously had been unable to do because of the tightness of scar tissue.

A decade ago, when dermatologists Cmdr. Peter Shumaker, MD and Cmdr. Nathan Uebelhoer, MD, were new to  the Naval Medical Center (NMCSD), lasers already were being utilized to mitigate scarring on injured servicemembers.

“Even in 2001, a lot of the current technology was around. It was being used to improve the redness and brown aspects of scars,” Uebelhoer said. “Treating the actual texture of the scar tissue was not easy. Often we would treat the texture, but the color would change poorly — the color would actually get worse, and the skin would get whiter. Treating the texture wasn’t a great option.”

Over the next decade, however, the technology improved swiftly. In 2004, the dermatologists started noticing that some of the newer laser technology could affect the texture without making the scar tissue look cosmetically worse. That same year, Rox Anderson, MD, a professor of dermatology at Harvard Medical School, developed fractional laser technology.

The technology he developed took the lasers being used by dermatologists and shrank the size of the beam from something measured in milligrams to something measured in microns. The needle-like laser was originally developed specifically for wrinkles. But over the next few years, dermatologists working on scar and burn victims found that fractionated lasers improved scars in terms of texture better than anything previously available.

Cmdr. Peter Shumaker, left, and Lt. Cmdr. Nathan Uebelhoer, top right, perform a fractional carbon dioxide laser surgery on Lance Cpl. Juan Dominquez, assigned to Wounded Warrior Battalion-West, NMCSD detachment. Navy photo by Mass Communication Specialist Seaman Joseph A. Boomhower.

“Fractional technology is really one of the big breakthroughs,” Shumaker said. “I would describe it as a lawn aerator. It creates a controlled injury, like little plugs of turf, separated by untreated areas. These untreated areas are reservoirs of normal skin. By treating these microcolumns of skin, we can achieve depths that were unavailable to previous lasers.”

The reservoir of untreated skin also seems to improve healing time and the margin of safety of the procedure. “The treatment appears to be very well tolerated in terms of complication rates,” Shumaker said.