Health.mil staff (Karen Carstens)July 29, 2014
Military dermatologists have pioneered the use of laser treatments developed for cosmetic purposes to heal scar tissue from injuries sustained by service members in the line of duty.
“It was a serendipitous finding – it just made sense to try it,” said Air Force Lt. Col. (Dr.) Chad Hivnor, 42, who recently separated from the 59th Medical Wing, headquartered at Joint Base San Antonio-Lackland in Texas, but remains in the Air Force Reserve.
Healing damaged skin through a ‘controlled burn’
What he realized is that ablative fractional lasers commonly used to smooth out wrinkles or erase acne scarring can also improve battlefield scars, even if this means placing a burn on top of a burn, which may seem counterintuitive at first. The lasers deliver tiny columns of heat quickly to the damaged skin, which produces a wound that heals with the help of the surrounding healthy skin tissue.
Hivnor likened the procedure to aerating a lawn. “You get your lawn aerated to help it ‘breathe’ – that’s the same principle we’re applying here, we are putting holes in the skin,” he said. “It’s like a controlled burn: When the space shuttle re-enters the atmosphere, if it comes in too steep, it can burn up, if it comes in too shallow, it can bounce off the atmosphere. It’s very similar to this. The goal is to find that perfect amount of damge to allow the right amount of skin to heal, to have a little controlled damage to allow it to rehabilitate the scar.”
And it takes time. “It’s like the tortoise versus the hare,” he added. “We have to do this very slowly and methodically, with multiple treatments over multiple months, if not years, to rehab the area.”
Research that restores range of motion
Last year, Hivnor received the Air Force Associations’ prestigious Paul W. Myers Award for his work using lasers to improve skin texture and flexibility in wounded warriors. He was awarded a $1.1 million grant to conduct a study in a joint research project with Massachusetts General Hospital and Shriner’s Hospital of Boston into these treatments, which he began in 2010.
They enhance range of motion, for example by allowing someone with scar tissue on their hands to type on a computer, do push-ups or fire a weapon again. One patient, for instance, was a sniper who could no longer pull a trigger on a rifle or gun with either hand. “Now he’s back out there doing all his Black Ops sniper stuff,” said Hivnor. “So you’re getting people back out into the fight.”
Amputees benefit from new treatments
The treatments also extend to amputees, where Hivnor has found he was able to use lasers to increase the ability to sweat and decrease hair growth leading to frictional folliculitis, a skin condition caused by inflammation of hair follicles due to the wearing of prosthetics.
“We’re allowing normal function to slowly come back,” he said. “Sweat can regenerate if you still have normal sweat glands beneath the scar.”
Hivnor also discovered that botulinum toxin A injections decrease perspiration where the prosthetic limb attaches, helping stop it from slipping off while a person is exercising or in hot climates.
When summertime temperatures reach nearly 100 degrees in a city like San Antonio, he said, active patients could literally run into trouble if perspiration impairs the seal of a prosthetic limb, causing it to become detached, sometimes mid-stride.
“What will happen is that the amputee will fall flat on his face,” he said, “so just a little thing like that – using Botox for a prosthetic limb – can be life-changing.”
Procedures also apply to civilian population
Fractional laser surgery has been developed in recent years by Hivnor and Cmdr. Peter Shumaker, chief of dermatology at Naval Medical Center San Diego, among others, to treat wounded warriors.
The findings, including Hivnor’s recommendations on botulinum toxin A injections, were recently presented to the American Academy of Dermatology with a view to also promoting these treatments in the civilian population for injuries and scars sustained, for instance, in motorcycle accidents, from dog bites or in fires.
Different lasers, fillers can achieve a variety of results
Hivnor has treated patients with various types of lasers, including pulsed dye lasers and fractional lasers. “No single laser is going to do everything. It takes a combination of lasers,” said Hivnor.
His research, however, focuses primarily on carbon dioxide fractional lasers, which he has found particularly effective. At the same time, he approaches each patient as an individual who may require a variety of dermatological treatments to achieve optimal results, including lasers, fillers and Botox.
“There’s a lot more that’s left to be figured out,” said Hivnor, who plans to continue to treat service members on a weekly basis at the Wilford Hall Ambulatory Surgical Center on JBSA-Lackland where he was previously the 59th Medical Wing’s program director of the dermatological residency. Hivnor also maintains a private practice in San Antonio. “We’re really at the tip of the iceberg when it comes to the ramifications.”
Tags: Conditions and Treatments, Innovation, Research, Extremities Loss
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