Reconstruction of Skin Graft Scars Using the Pinholxell Method: A Dual-Mode CO<sub>2 </sub>Laser Approach with Structured Dermal Remodeling

Despite advances in surgical and laser techniques, skin graft scars remain challenging to treat, and conventional interventions frequently yield limited outcomes. The Pinholxell method represents a reconstruction-based laser approach that combines a pinhole procedure—utilizing a CO₂ laser to create deep columns measuring approximately 1 mm in diameter—with an immediate fractional CO₂ laser overlay.This dual-mode system enables simultaneous deep dermal remodeling and superficial epidermal regeneration. The macro-pinhole columns act as controlled zones of injury that initiate a localized cytokine cascade, while the intervening intact tissue serves as a “safety zone,” supporting structured dermal regeneration and epithelial recovery.This study presents five cases of patients with skin graft scars treated using the Pinholxell method. The treatment protocols included repeated sessions of Pinholxell therapy administered at 2-month intervals, supplemented with additional fractional CO₂ laser procedures as clinically indicated. The number of treatment sessions was determined based on the severity and characteristics of the scar, including the degree of hypertrophy and the presence of keloidal features.On average, patients underwent 5 to 10 sessions of Pinholxell therapy, along with 7 to 10 sessions of adjunctive fractional CO₂ laser treatments, tailored to enhance epidermal resurfacing and promote comprehensive dermal remodeling, particularly in cases with extensive fibrosis, elevated vascularity, or nodular keloidal architecture. The treatment period ranged from 18 months to 4 years and 4 months.All patients exhibited marked clinical improvement in pigmentation, thickness, surface texture, and pliability of the scar, along with alleviation of symptoms such as pruritus, pain, and functional limitations caused by contracture. No complications were observed, and patient satisfaction was high.These findings suggest that the Pinholxell method is not merely a resurfacing technique but a structured reconstruction strategy for skin graft scars, offering both structural and symptomatic improvement through targeted tissue remodeling and regeneration.