Back on the court

By Michelle Ryan
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This story was originally featured in the Spring 2025 edition of the USA Health magazine.

Kayson Metcalf just wanted to be able to move his hand and knee so he could play basketball again. Burns on his hand, arm and the back of his leg from a gasoline fire when he was 8 restricted his range of motion to the point he no longer could.

But thanks to an innovative burn scar revision laser treatment performed in the outpatient setting – first offered on the Gulf Coast by USA Health – Kayson’s range of motion was restored, as well as his ability to play his favorite sport.

“Basketball is his favorite thing in the world,” said his mom, Rachel Rieben, who fostered him since he was two days old and adopted him with her then-husband Steven Metcalf when Kayson was 1 year old.

Scar revision treatments, which were once only treatable by surgery, and were costly, painful and often stressful for patients, are now more tolerable and accessible to burn survivors, like Kayson, in the Southeast region, thanks to the collaborative efforts of two USA Health physicians.

Andrew Bright, D.O., medical director of USA Health’s burn unit and an assistant professor of surgery at the Frederick P. Whiddon College of Medicine, and Kimberly Donnellan, M.D., a facial plastic and reconstructive surgeon, found that laser treatments in the outpatient setting can dramatically address burn patients’ range of motion, chronic pain or itching — some of their most common complaints — caused by their healed wounds. Kayson’s is just one of their many success stories.

What started as a slower-paced day on Dec. 20, 2021, the first day of their holiday break, Rieben and her 10 children — seven boys and three girls she’s adopted — ended with a life-changing trip to University Hospital, the region’s only Level I trauma center.

“We slept in and had this great sleepy morning,” she said. Plans included a jog at a nearby park, making lunch, and possibly seeing a movie to celebrate four of her kids’ adoption anniversary.

While Rieben was picking up one of her sons from his friend’s house, some of the children started clearing out trash and burning boxes on their large plot of land.

She was close to the house when her oldest son, DJ, called her. She answered but couldn’t hear clearly. “I’m almost home,” she told him. “Hold on, I’m almost there.”

When Rieben arrived, DJ – who now works with Orange Beach 911 dispatch – ran to her with Kayson in his arms, saying they needed to get to the hospital immediately.

She frantically called 911, but instead of waiting, she made the quick drive to the hospital in Bay Minette, less than two miles away. From there, Kayson was airlifted to University Hospital, where he was treated at the Arnold Luterman Regional Burn Center, the only one of its kind along the Gulf Coast.

While struggling to get the fire started, one of the children had poured gasoline on the pile of boxes. “The best that we can tell,” Rieben said, “is that the gasoline splashed on Kayson, who was just the bystander, and the fire lit at the same time.”

Kayson sustained burns to his face, right hand and left leg — 14% of his total body surface area. He was released from the hospital just before Christmas, so the family celebrated together. But what followed was a grueling round of surgeries, wound debridement and skin grafts.

“The only time Kayson really gets upset is when something’s out of order or out of line,” Rieben said. “Being in the hospital and him being too little to understand, all of that just flared up, and it was really hard for him and for me.”

As his physical scars began to heal, doctors were concerned that they were forming puffy, round protrusions called keloids, which can be itchy, tender or painful. They tried custom-made compression sleeves, a treatment that is intended to help flatten the scars.

“There’s little things he can’t do,” his mom said, “and a lot of that came up during all of this because it was painful and uncomfortable, and everything was out of schedule and routine.”

Scars like Kayson’s can restrict movement when they form over a joint, and left him unable to run.

A referral to Donnellan in July 2022 would give Kayson new hope — but not without new challenges. The lasers caused a burnt flesh smell, which brought back some traumatic memories.

“At first it was really scary, not just for Kayson, but for me too,” Rieben said. “By the time we were done, he was used to it and also thankful because it was very obvious the difference that those treatments made.”

Kayson required 10 treatments over the course of a year. “Our goals were to decrease scarring, increase range of motion in the right hand, and eliminate itching,” Donnellan said. “Thankfully, we were able to achieve all of these goals.”

Typically, standard methods still require patients to undergo general anesthesia due to the pain associated with the procedure in the hospital, an already stressful environment for a burn survivor. Faced with this as an option, some patients simply learn to live with their physical limitations instead.

The DEKA Cartessa Smartxide Tetra CO2 refractory laser system used in Kayson’s treatment works by perforating dense scars and creating tiny channels in the tissue that improve tissue motion and stimulate regeneration. In the outpatient setting, pharmacy-compounded topical anesthetics are used instead of general anesthesia.

Using lasers helps reduce the trauma of treatment, yet they retain their effectiveness. Especially effective on scars from wounds that have abnormally healed, they work by breaking down scar tissue to reveal softer, smoother skin, which helps increase range of motion, restore the skin’s function, reduce pain, and improve cosmetic appearance.

“Patients regain confidence as the cosmetic benefits are dramatic, and they can return to their pre-accident routines by performing simple tasks, like writing, gripping objects, or in Kayson’s case, playing basketball,” Donnellan said. “I am so thankful to be able to be a part of their rehabilitation and to be associated with our regional burn center. These patients become part of our family, and we are fortunate to be able to make their lives better.”

Rieben appreciated that Donnellan and the care team took time to explain the process, showing Kayson pictures and doing everything they could to make him comfortable.

“Dr. Donnellan and her team were absolutely amazing to work with and helped Kayson so very much,” Rieben said. “We are eternally grateful for her and her staff because they really gave Kayson his life back. He wanted to be able to move his hand and knee to play basketball, and he does now!”

Today, the 11-year-old sixth grader at Bay Minette Elementary has been playing in the city basketball league for the past two seasons. “He’s just a regular little boy,” his mom said. He goes fishing with his brothers, jumps on the trampoline, and plays video games.

Despite the return to normalcy, Rieben still remembers how much can change from one day to the next.

“The day before, Kayson had ridden to Atmore with me and a friend, and we went to a Christmas store and coffee shop,” she said. “The next day, that happened, and I almost lost him. Life changes so quickly.”