Laser technology provides innovative approaches to burns.
After our patients go through a major trauma or burn injury, it is our responsibility to restore them to a life that has the highest quality possible. That means we need to advocate for that patient – not only restoring their functional abilities, but also their total quality of life, including their appearance.
Leufry is grateful to plastic surgeon Matthias Donelan, M.D., for improving the appearance and mobility of his burn scars.
When Leufry first came to Shriners Children's Boston (left) his burn scars inhibited his neck mobility. After laser treatments (right), Leufry had improved mobility and better appearance of his burn scars.
Leufry and his mother Yohanna believe that Shriners Children's Boston is special because everyone welcomes them like family when they come for care.
Patients like Leufry, a teenager from the Dominican Republic, are experiencing incredible outcomes with fewer trips to the operating room thanks to advances in laser medicine, many of which plastic surgeons at Shriners Children’s Boston pioneered.
Leufry was just 6 years old when he sustained burns over 30% of his body after a live high-tension wire fell on him as he stepped onto his balcony. His grandmother found Leufry unconscious. He was rushed to a children’s hospital in Santo Domingo where he spent two months undergoing multiple procedures to cover his wounds. Fortunately, he was seen by the Shriners Children’s Boston outreach team at a clinic in the Dominican Republic and has been treated in Boston since then. Over the past 10 years, Leufry has had 15 surgeries to manage his burn scars.
Common practice in burn care has been to cover a burn wound with skin grafts taken from another part of the body. Skin grafting is highly effective in closing acute burn wounds quickly, but the recovery can be painful, and the area from which the graft is taken, known as the donor site, is left scarred. Additionally, both the grafted area and the donor site can develop thick hypertrophic (raised) scars that impair mobility and function, and result in less than optimal cosmetic results.
Today, clinical practice has advanced and doctors may recommend allowing some less severe burns to heal on their own, without grafting, eliminating additional donor site scarring. Shriners Children’s Boston has been at the forefront of progress in the use of lasers for burn scar treatment for over 25 years. Lasers have been used for burn scar treatment since the 1990s. Different lasers have specific effects so individualized application is important.
Matthias Donelan, M.D., plastic surgeon at Shriners Children’s Boston, describes the future of burn care as less surgery and more laser treatment. He published an article in 2008 describing the use of the pulsed-dye laser as an alternative to excising facial scars. The pulsed-dye laser, combined with tension relieving small plastic surgical procedures, enables scars to remodel themselves and return to close to normal in appearance and function. Patients benefit because extensive scar excisions are no longer necessary. In many cases, donor sites are no longer necessary to close open areas because scar removal is not needed. This eliminates additional trauma and scarring at donor sites. Outcomes are better and patients love this approach.
Dr. Donelan started using the pulsed-dye laser on patients over 20 years ago and continues to be impressed by the results. “Laser medicine decreases hospitalization and does not cause deformity in other parts of the patient’s body,” said Dr. Donelan. “These advances are not only keeping children out of the operating room, but they are ultimately contributing to better outcomes and a better long-term quality of life for our patients.”
Another innovative laser, the fractional ablative CO2 laser, was developed right across the street from Shriners Children’s Boston a few years later by Rox Anderson, M.D., and Dieter Manstein, M.D., Ph.D., at Wellman Laboratories. This different type of laser proved to be an even more powerful tool for burn scars than the pulsed-dye laser. It loosened and diminished hypertrophy in many scars without the need for local plastic surgery procedures.
“We now use both lasers routinely in our practice at Shriners Children’s Boston,” added Dr. Donelan. “We rarely excise hypertrophic burn scars today because we can make them better by rehabilitation than by removal.”
For Leufry, this has meant fewer surgeries, improved mobility and the better appearance of his burn scars. Now 18, Leufry is able to do the things he loves thanks to the life-changing care he has received at Shriners Children’s Boston. Back home in the DR, he is focused on school – with a real love of the social and natural sciences – and is quick to play any sport he can. With a bright smile and welcoming spirit, it is no surprise that Leufry also enjoys meeting new people and loves to gather with friends.
In 2021, Leufry and his mother Yohanna came to stay at Shriners Children’s Boston for three months for follow-up care. Dr. Donelan used z-plasty and laser medicine to help release the tension of the scars on Leufry’s neck, allowing him to move his head more freely. “Dr. Donelan is such a good doctor. I have so much gratitude to him and everyone at the hospital. I have known many staff members for a very long time, like Susie the photographer and many nurses who are so warm and caring. Shriners is like my second home,” said Leufry.
Yohanna echoed that sentiment and expressed that Shriners Children’s is unique because it is not just the doctors and nurses who care about the patients. From Spanish interpreter Miriam to their long-time care manager Sandy to Ernesto in patient access, Sandra and Gloria in the cafeteria, and Celina in housekeeping, the whole team comes together to care for patients. “The staff show patients that everyone is important. Shriners is special because they welcome us like family when we come for care,” Yohanna said.
Using laser technology has transformed the way we treat burn scars today. It is a superb example of how scientific advances can be incorporated into daily surgical practice for patient benefit. Patients like Leufry go on to lead fulfilling lives that are not limited by their burn scars. They grow up to be confident young adults who can reach their full potential. For over 50 years, Shriners Children’s Boston has been at the forefront of treatment and technology that not only saves patients’ lives, but helps return them to being active, happy children as well.
