Minimally Invasive Multimodal Treatment of a Traumatic Hypertrophic Scar Using Energy-Based and Regenerative Therapies: A Case Report

Background : Hypertrophic scars are fibroproliferative lesions caused by abnormal wound healing and involve complex vascular and fibrotic processes. Current treatments often yield variable outcomes, supporting interest in multimodal approaches that target different components of scar pathology. Case Presentation: A 30-year-old male presented with a traumatic hypertrophic scar on the dorsum of the right hand following a degloving/avulsion injury involving deep dermal and subcutaneous tissue. After immediate surgical debridement, the patient received two months of biweekly polydeoxyribonucleotide (PDRN) injections and regenerative laser therapy without noticeable improvement. After an 8-month treatment free interval, the patient underwent six biweekly sessions combining vascular laser, fractional ablative laser, radiofrequency microneedling, and topical exosome-based therapy, alternating with vascular laser monotherapy. Outcomes were assessed using the Vancouver Scar Scale (VSS) and Global Aesthetic Improvement Scale (GAIS). Results: Vascularity, pliability, scar height, and overall appearance improved progressively. The VSS score decreased from 10 at baseline to 4 after six sessions, with a transition from a purple, firm, raised scar to a pink, supple, and flat lesion. GAIS improved from 3 after the second session to 1 after the fifth and sixth sessions. Residual hyperpigmentation persisted. No treatment-related adverse events were observed. Conclusion: This case highlights the potential of a minimally invasive, multimodal approach to improve vascularity and remodeling in traumatic hypertrophic scars. Further studies are required to validate these findings.