If you’ve had a skin graft after a burn, some background on how scars and skin grafts work can be helpful when aiming to make the scar more comfortable and less prominent.
One of our best strategies for improving scar appearance and comfort is laser treatment. We can remodel collagen and elastin fibres to create more flexibility in scarring, particularly after a skin graft.
Understanding skin, skin injury and skin repair
A scar will form when we damage the skin past the epidermis (top layer). The scar will be different in colour to the surrounding skin, to a greater or lesser degree depending on several elements of the original wound, for example, depth, site and coverage.
When the damage to the skin reaches the dermis (second layer), we hit some important structures – glands, hair follicles, collagen, blood vessels and nerves. We use skin grafts to heal this type of wound by surgically removing a thin skin shaving from another unaffected area and applying it to the injury site to close the wound.
We use a split-thickness skin graft for burns that won’t heal independently and involve just the dermis and epidermis from the healthy graft donor site. A full-thickness graft uses the entire skin thickness and requires closing with stitches.
The scars that form after a skin graft or slow-healing wound come in all shapes and sizes, from flat and hardly noticeable to red, raised, itchy and tight. Scars tend to lack hair and nerve-endings, but they can include the odd ingrown hair and nerves.
As split-thickness grafts heal, they appear with a criss-cross pattern due to cuts being made in the grafts to allow the skin to stretch over a greater surface area when applied.
Burn scar formation takes about five years to fully complete, with the process running from immediately after surgery, where scars are usually red, flat and quite supple. The coming three months see changes, as scar tissue may become thicker, raised, irritated, itchy, painful and tight. These changes may resolve in the coming 6-18 months, but sometimes discomforts stick around.
Each of these symptoms is addressed separately here in terms of how we handle them, as they are all part of a different part of the healing and scarring process.
Treating burn skin graft scars – burn scar removal
A burn scar will never return to normal skin; the area is forever changed. Historically, doctors have used several main methods to eliminate scar tissue, for example, cutting the scar out, stretching/expanding healthy skin, and other surgeries, with often quite good results – except in burn scars.
Burn scars are often in tricky anatomical locations, there may not be enough healthy skin for transplantation, or the skin graft doesn’t match the receiving area. For example, with the latter, hand and leg skin have different textures, thicknesses, etc. It isn’t simply a case of switching one skin for another. Burn scar treatment is unique in scar management.
The donor skin chosen is of great importance when considering a skin graft’s aesthetic and functional outcomes. A skin graft will always heal by scarring, even in the best-case scenario of being able to cut healthy skin out and do a straight replacement. So there will always be some skin graft scar, but we can work on how it looks and feels.
Laser surgery for skin graft scar treatment
Standard best practice for burn scar treatment and prevention of further scarring is a moisturiser, scar massage, stretching, splinting at night and compression. But, we also have some high-tech advancements in the form of laser scar treatment.
Studies have found that laser surgery can improve mature scars (years old) and remodel scar tissue in fresher scars (3-18 months). Skin graft scar treatments using laser can also alleviate itching and redness in scars, while CO2 lasers can reduce thickness and improve the surface, tightness and scar structure.
We can even treat ingrown hairs and hair in unwanted places due to the graft, and while a little more complicated, even attempt to correct colour differences. These are all significant developments in scar rehabilitation.
How lasers work to improve scars – burn scar removal
Lasers, counterintuitively, burn tissue to exert a positive effect, though the treatment is very selective and targeted. Thermal energy (heat) applied via a laser stimulates the body’s natural repair process and improves scar tissue, particularly fractional lasers.
Fractional lasers leave minuscule gaps between the laser beam’s tiny holes, which means not all cells in the treatment area are being affected simultaneously. We can also apply treatments deeply to the scar via these tiny holes.
Some lasers act via skin resurfacing, working to even out bumps and lumps that create shadows on a scar. Shadows make a mottled, darker surface, so more even scar tissue doesn’t draw the eye so much. There is no such thing as complete laser scar removal, but we can certainly make positive changes to the scar, making it less visible, red, raised or tight.
We often use the unique Portrait plasma laser in scar rehabilitation, but we could use other lasers to achieve different end goals depending on the scarring.
Benefits of laser treatment of scars
- Scars mature faster and are less raised (hypertrophic) when treated with the CO2 laser in the remodelling phase.
- Scars over three months old can undergo treatment.
- All age groups are eligible if they can tolerate anaesthesia and keep still during treatment.
- Non-ablative lasers can reduce itching and thickening in 3-12 weeks old scars.
- Intense pulsed light (IPL) treatments can reduce redness and itch
- Fractional CO2 treatments at 3-6 months post-wound-healing can help reduce thickening
- After the scar has matured (12-18 months), treatment is by symptom, including thickness, tightness, surface irregularities, pigmentation, ingrown hair and hair growth, itching or redness
- Even very old scars respond favourably to CO2 laser treatments
- No set number of treatments – everyone is different
How to prevent scarring from a burn
Each scar is unique, so it’s best to talk to your cosmetic dermatologist and undergo an assessment for effective burn scar treatment. There are important factors at play, such as the location of the burn scar and if the scar has a graft or not – not all burns receive skin grafts.
We can work with your scars. Contact our friendly staff to make an appointment with one of our dermatologists to discuss how we could help with scar appearance.
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