Laser Scar Rehabilitation Transforms Wounded Warriors | VA Tampa Health Care
“That was the last thing I remembered, before waking up lying on the floor.”
On November 20, 2011, Burgess was in Afghanistan, attached to a mission heading to a village where at least 50 known improvised explosive devices (IEDs) had been found and disposed of. That morning, the team had already found four IEDs, each marked with something red, like a rock or a piece of cloth. As the team waited in an alley for another IED to be blown into place, they were unaware that just inches from where they were waiting was a legacy IED, marked in blue. Burgess’ right foot made contact.
During the explosion, Burgess suffered a traumatic amputation. “They said the only thing they could find was pieces of my quarter and half dollar boot. I’m not going to lie, I’m still crazy to this day! Those boots were the paradise.” Burgess was evacuated from the country with his sense of humor intact. He credits the Corpsman on patrol with him for saving his life. “I was his first traumatic blow, a phenomenal child, I did a great job. I ended up with about four tourniquets on me. Most battlefield care, I can’t remember. J I was given a lot of morphine. Once I got on the bird, I asked the ship’s doctor to put me to sleep and passed out.”
Eventually, he was airlifted to the United States to begin his rehabilitation process at Joint Base San Antonio-Fort Sam Houston. It was there that he first met Dr. Chad Hivnor and Dr. Thomas Beachkofsky, military doctors at the time who now work for VA.
“We were seeing a lot of patients coming back from the war as amputees with scars and traumatic burns,” says Dr. Thomas Beachkofsky, dermatologist and head of dermatologic laser surgery at James A. Haley Veterans’ Hospital (JAHVH, Tampa VA). “Caring for residual limb skin after limb loss is absolutely essential. It is the interface between the patient and the prosthesis and an area of significant pressure, friction, perspiration, skin irritation and often scarring. disease that causes pain, infection, and the inability to wear prostheses. This negative impact on quality of life is where trauma dermatologists can provide important support to help them regain their functional goals.
Even with a scar massage, Burgess’ skin graft scars on his left leg healed slowly and tightly. “You couldn’t bend it,” he said. Dr. Chad Hivnor, now chief of the San Antonio VA dermatology department, had a solution he thought might work. By using Microablative Fractional Resurfacing – microscopic laser beams – and initiating a small rewind process, patients see and feel improved skin collagen, elasticity, blood flow, and reduced pain and itching. Dr. Beachkofsky, a resident with Dr. Hivnor at the time and continuing the work in Tampa VA, explains, “While not entirely accurate, I liken this procedure to mechanical lawn aeration in terms of ability to stimulate growth and improve quality.We use light to generate heat and make microscopic holes in scar tissue to stimulate a wound healing process resulting in healthier skin and happier patients.”
It’s a treatment that worked for Daniel Burgess. “You could see the improvement. Other people who hadn’t, their scars looked like thick, nasty, sloppy scars. Mine started to look nice and there was progress.”
Now part of the interdisciplinary Combat Trauma Veteran Awareness and Rehabilitation Project (VICTORY Project). Hivnor and Beachkofsky along with Dr. Peter Shumaker, Chief of Mohs Surgery at San Diego VA, are bringing this specialized approach nationwide, with the planned development of Centers of Excellence within San Antonio Veterans Hospitals, Tampa and San Diego. Having collaborated and cultivated this field of trauma dermatology and scar care for years, they are now unified as VA employees and bring their expertise to veteran patients every day. Burgess is one of the few patients treated by all three at once, united to simultaneously perform the largest laser procedure they have ever performed outside of an operating room.
“I’ve already changed the way I think about different patients,” says Dr. Elana Hartman, advanced fellow at the Office of Academic Affiliations in Amputation Rehabilitation, JAHVH. “Even the patients who are not trauma-related, who come in because they’ve had delayed healing and now have a scar that’s adhesive and doesn’t move, when we try to put a prosthesis on them, they “Can’t adapt well and they end up with another open wound. We now have something to offer them. We have more options. The condition of the skin and scarring is causing a domino effect in recovery. Without a strong, pliable scar, this can result in a patient being fitted with a less than optimal prosthetic design. Laser scar rehabilitation can bring improvement, quickly. Hartman has seen results. “Even after one treatment, the range of motion in a patient’s knee has gone from fairly severe contracture to fairly minimal degrees.” This translates to the ability to wear a prosthesis longer, to be more active, to use less of a wrongdoer rolling it out and achieving lifestyle goals.
“This can only exist in a VA where this training system, the support system, the laser devices and the funding can support this work. No other institution is doing this kind of work,” says Dr. Eugene Sanik, Deputy Chief of dermatology. in Tampa VA. With the unique care team approach, patients have access to specialist teams including prosthetics, dermatology, plastic surgery, physiotherapy and more. “That doesn’t exist in the civilian world – the intimate interdisciplinary collaboration that occurs between medical and surgical specialties that might never interact on a day-to-day basis is the foundation of our success with these wounded warrior patients,” says Dr. Brooke Baldwin, chief of dermatology at Tampa VA. Dr. Joe Lezama, Chief of Staff for Medicine and Specialty Care, agrees: “This is where all of Haley’s heroes come together, almost like a big blockbuster motion picture to provide exceptional and innovative care. to a veteran. It’s really, really exciting.”
For patients with scarring considering treatment, a dermatology consultation is a good first step. Scars don’t have to be new to benefit. According to Dr. Jeffrey Heckman, Medical Director of the Regional Amputation Center, “People who were injured in the late 1960s, Vietnam era, are living with these scars and contractures, and all these skin issues. , these chronic wounds, for a long time and now we’re saying now — we think we can do something! So let’s come back and talk about that and think about what your goals are and where we think we can take you.
Although the treatment may be groundbreaking, Daniel Burgess knows, “it radically works” and urges patients to seek it out. “It’s your life, and your life matters. Something non-invasive that you would never expect can change your life. That’s what happened to me.” Being on the cutting edge is a great place. “We can’t fully control wound healing to prevent scarring, we’re just not there yet,” says Dr. Beachkofsky, “However, we are very successful in scar rehabilitation through the use of lasers. medical and other complementary treatments. I am proud that we can offer a multidisciplinary approach to our patients. Project VICTORY aims to provide personalized care to each veteran and is dedicated to reducing symptoms and restoring function .
Today, Daniel Burgess travels, runs with his children at school events, and is happy to have tried his luck in therapy. “Go with an open mind. James Haley’s knowledge for some of these injuries, you’re going to find someone who can help you.”