Brief Answer:
I suggest conservative treatment with topical tretinoin 0.05%

Detailed Answer:
Hello. Welcome back and thank you again for writing to us

I have answered your previous query related to the same problem.

I agree with your doctor and this was my concern too, if you can refer back to my first reply to your earlier query where I did 'nt even mention about fractional CO 2 Laser because this was not my first choice too, for a thin skin graft!! Subsequently in my following replies, I had mentioned that since superficial thickness skin grafts (STSG) are thin grafts and therefore devoid of skin appengades, therefore healing would be slow post-laser and there would be more chances of complications like pigmentation and scaring. Post fractional CO 2 laser procedure, skin would normally regenerate from intact skin appendages like hair, sebaceous and sweat glands and eventually cover the entire Lasered area but if skin appendages are devoid already or are scant as in a thin graft, then of course healing would be slow and there would be more chances of scaring and pigmentation.

Anyways, I still believe that undergoing fractional CO 2 Procedure for this scar is an individual choice by dermatologists but you need to be aware of more chances of complications post laser and hence take a wise decision beforehand.

If this would have been a full thickness skin graft (FTSG) which are thick and have preserved skin appendages, there would have been no problem lasering it because new skin is expected to regenerate from intact/ preserved skin appengades.

In my view too, the best option would be to manage it conservatively with topical tretinoin 0.05% cream and expect modest improvement with it.

Regards
Take care

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Brief Answer:
trteinoin may cause transient irritation or redness but otherwise its safe

Detailed Answer:
Hi XXXXXXX

1. Grafting with a full thickness skin graft (FTSG) is usually done for smaller defects on face, for better cosmesis. This being a relatively larger area on foot I am not very sure whether a FTSG would be advisable for this scar because a big area such as this would require a big chunk of skin i.e a bigger chunk from donor site and donor defect too would need to be closed by close approximation of margins which would create another linear scar/ stitch line at donor site. I suggest that you visit and talk to a burns/ plastic surgeon for his expert advice on this. He/ she would be the best person to advice whether to go for regrafting with a FTSG/ skin flap or not. If this regrafting procedure with FTSG is possible, of course it would give her a much better cosmesis than a STSG.

Dependent edema due to lymph accumulation as a result of damage/scaring to lymphatic channels during grafting is always a risk with skin grafting, even with re-grafting procedure with FTSG and may take a long time i.e weeks or months, to reduce. This complication is more common on legs due to gravitational effect.

2. Tretinoin 0.05% may cause some redness and irritation at site of application. Contractubex (which is allium cepae extract, allantoin, heparin sodium), is absolutely safe.

Regards

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