Written by: Staff Sgt. Robert Barnett
A major improvement is coming in the field of dermatology and plastic surgery, specifically in the recovery and care for wounded warrior burn victims.
"As I've studied cosmetic improvement in burn victims, I've noticed more improvements in the range of motion than in the cosmetics because the scars are softer," said Lt. Col. (Dr.) Chad Hivnor, the associate director of the dermatology program at Wilford Hall Medical Center.
Dr. Hivnor treats battle scars on troops injured in operations Iraqi and Enduring Freedom using a fractional laser.
"That led me to my hypothesis that if contractures were from the skin as opposed to the muscles or joints, remodeling the skin would increase the range of motion for the patients," he said.
Dr. Hivor said, a research grant of more than a million dollars will cover a three-year study that will be in conjunction with another study site in Baltimore.
Dr. Robert Spence, a burn reconstructive surgeon, founded the National Burn Reconstruction Center at Good Samaritan Hospital in Baltimore, Maryland. A graduate from Johns Hopkins School of Medicine and practitioner in plastic and burn surgery as well as co-director and director of burn surgery there for 23 years, Dr. Spence's main interest has always been burn reconstruction. He started work with burn injuries there in 1983, and from 2000 to 2005 held the position of director of the Johns Hopkins Burn Center.
Leaders at Brooke Army Medical Center, Ft. Sam Houston, Texas, asked Dr. Spence to establish a burn reconstruction program at their U.S. Army Institute for Surgical Research Burn Center. He left Johns Hopkins to found the National Burn Reconstruction Center in Baltimore. This enabled him to make regular trips to work at BAMC as well, where he has shared patients with Dr. Hivnor.
"I sent patients to Dr. Hivnor for laser surgery and I became more interested in his use of laser surgery on burn survivors," Dr. Spence said. "It became very advantageous for us to have a close working relationship because it helped the warriors we were treating. It also turned out that the use of the laser for burn survivors is so new that it needed to be investigated."
Dr. Spence continues to partner with Dr. Hivnor in this research. Some of the funding will go to Dr. Spence so he will have access to the same equipment Wilford Hall is using, Dr. Hivnor said.
"I have the advantage of 25 years of experience treating patients with burn scars. I also have the experience and access to a large number of burn survivors with older burn scars." Dr. Spence said. "We, together, felt that by the addition of the patient base at my center, we could get a better idea of how the carbon dioxide fractional laser improves mature scars ... patients with scars that are many years old."
Dr. Hivnor said he feels the research will be more validly accepted coming from two separate facilities and different subspecialties.
Among the equipment Dr. Hivnor has purchased is a 3-D imaging camera. The camera enables a computer program to visualize the scars and the textural improvement that has been noted clinically. They can rotate the image in any 3-dimensional direction, providing a detailed look at the scars. Other devices will be used to actually measure for compliance or softness of the scars and to objectify things as much as possible by providing tangible numbers.
One improvement he has seen has been in patient goniometry, or the range of motion at the joint.
"Even if it doesn't improve the motion, it can make it easier to do the same things the patient was already doing since the skin will be smoother; it won't be so tight upon movement," Dr. Hivnor said. "It will improve their quality of life."
Dr. Hivnor continues to be impressed with the results his treatments have given wounded warriors.
"The most amazing thing I've seen is a patient with scar tissue that webbed their fingers together," he said. "I stretched it out as far as it would go and then used the laser on it and I could literally see the fingers separating as I went."
Dr. Hivnor and Dr. Spence said they intend to use the project to answer some important questions.
"I am particularly interested if it can affect contractures," Dr. Spence said. "Scars around the mouth that cause people to not open their mouths well, and tight scars at the elbow, preventing people from moving their arms, are the main areas in particular."
The three-year research study will hopefully shed light on a lot of issues.
"The big question we want the research to answer is can we sustain the improvement that we've shown here in the long term," Dr. Hivnor said.
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