Clinical outcomes of Pinholxell Therapy for skin graft scars: A retrospective cohort study of 117 patients.

Abstract

Skin graft scars frequently remain hypertrophic, stiff, tethered, and dyschromic despite standard care. These scars are characterized by chronic inflammation, biomechanical rigidity, and surface irregularity, and often respond poorly to conventional fractional resurfacing or intralesional triamcinolone monotherapy due to limited penetration in thick, mature grafted tissue. Pinholxell Therapy is a standardized dual-step CO₂ laser protocol that combines deep macro-pinhole column creation (∼1 mm) with an immediate fractional CO₂ overlay, aiming to achieve simultaneous deep dermal release and surface normalization within a single session. We retrospectively analyzed 117 consecutive patients with mature graft-site scars treated with repeated sessions of the standardized dual-step Pinholxell CO₂ laser protocol at approximately 2-month intervals. Most patients underwent multiple treatments over an extended remodeling period. Scar outcomes were evaluated before and after treatment using the Vancouver Scar Scale (VSS) and the Observer Scar Assessment Scale (OSAS). Marked improvements were noted across all scar domains. The total VSS score decreased from 7.76 ± 2.22 to 1.47 ± 1.09 (p < 0.001; 81.1% reduction), with the greatest improvements in pigmentation and vascularity. The OSAS six-item total score improved from 31.78 ± 7.09 to 11.44 ± 2.59 (p < 0.001), and the overall opinion score improved from 7.15 ± 1.41 to 2.38 ± 0.48 (p < 0.001). The dual-step macro-pinhole column plus fractional CO₂ protocol produced substantial and consistent improvement in mature graft-site scars, supporting Pinholxell Therapy as a reproducible, office-based option for functional and aesthetic scar rehabilitation.