Burn Scar Revision With Tissue Expansion, Long-Pulsed 1064-nm Neodymium-Doped Yttrium Aluminum Garnet (Nd:YAG) Laser, and Microneedling: A Case Report

Therapeutic heat devices can cause iatrogenic burns that lead to infection, grafting, and disfiguring scars. A 56-year-old woman sustained full-thickness burns of the left flank/posterior trunk after postoperative application of microwaved saline hot packs. The wounds became infected and necrotic, requiring antibiotics, debridement, and split-thickness skin grafting. Two years later, she presented with a hypertrophic, hyperpigmented ~20×10 cm graft scar and contour deformity. We implemented a staged plan: placement of two tissue expanders with serial fills over ~8 weeks; expander removal with complete scar excision and tension-free closure using the expanded native skin; adjunct scar therapies including multiple sessions of long-pulsed 1064-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser and microneedling; and a focused office scar-revision excision (6×3 cm) for residual margin hypertrophy. Objective assessment was done with the Modified Vancouver Scar Scale (MVSS), total score improved from ~10 (pigment 3, vascularity 2, pliability 3, height 2) to ~3 at 23 months (pigment 1, vascularity 1, pliability 1, height 0). No expander-related complications occurred. This case shows that for extensive trunk graft scars, staged tissue expansion provides like-for-like, sensate skin to restore contour, while 1064-nm laser and microneedling further improve scar vascularity, thickness, pliability, and color with low morbidity.