The Dermatologist's Role in Rehabilitation: A Novel Multidisciplinary Treatment Approach Combining Ablative Fractional Laser Resurfacing and Physical Therapy in Managing a Patient with Scar Contracture of the Neck

Abstract

Objective: To employ a multidisciplinary approach combining ablative fractional laser resurfacing concurrently with physical therapy to improve functional and cosmetic deficits associated with traumatic scarring status-post parotid cancer treatment. Methods: A 65-year-old female presented to dermatology with scar contracture of the right neck secondary to multiple surgeries and 36 rounds of adjuvant radiation therapy for stage III adenoid cystic carcinoma of the parotid gland. Severe scar-related complications included impaired physical strength, limited range of motion of the neck, and activity intolerance. The patient also reported difficulty with swallowing and limited ability to open her mouth, resulting in a 30-pound weight loss. Ablative fractional laser resurfacing treatments and laser-assisted delivery of triamcinolone in combination and in parallel with physical therapy sessions were initiated. Results: By month five of combination treatment, the patient had objectively decreased scar fibrosis and swelling, decreased facial swelling composite scores, increased range of motion of the neck, and increased right shoulder strength. Subjectively, the patient expressed increased satisfaction in scar appearance, decreased pain, and increased tolerance to activities such as lifting and reaching. Conclusion: Ablative fractional laser resurfacing is a promising adjunct to established interventions for improving functional and cosmetic deficits and quality of life in patients with scar contractures due to its safety profile and efficacy.