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Meetam T, Angspatt A, Aramwit P. Evidence of Potential Natural Products for the Management of Hypertrophic Scars. J Evid Based Integr Med 2024; 29:2515690X241271948. [PMID: 39196306 PMCID: PMC11359448 DOI: 10.1177/2515690x241271948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 05/29/2024] [Accepted: 06/26/2024] [Indexed: 08/29/2024] Open
Abstract
Hypertrophic scarring is an aberrant wound-healing response to reestablish dermal integrity after an injury and can cause significant abnormalities in physical, aesthetic, functional, and psychological symptoms, impacting the patient's quality of life. There is currently no gold standard for preventing and treating hypertrophic scars. Therefore, many researchers have attempted to search for antihypertrophic scar agents with greater efficacy and fewer side effects. Natural therapeutics are becoming attractive as potential alternative anti-scarring agents because of their high efficacy, safety, biocompatibility, low cost, and easy accessibility. This review demonstrates various kinds of natural product-based therapeutics, including onion, vitamin E, Gotu kola, green tea, resveratrol, emodin, curcumin, and others, in terms of their mechanisms of action, evidence of efficacy and safety, advantages, and disadvantages when used as anti-scarring agents. We reviewed the literature based on data from in vitro, in vivo, and clinical trials. A total of 23 clinical trials were identified in this review; most clinical trials were ranked as having uncertain results (level of evidence 2b; n = 16). Although these natural products showed beneficial effects in both in vitro and in vivo studies of potential anti-scarring agents, there was limited clinical evidence to support their efficacy due to the limited quality of the studies, with individual flaws including small sample sizes, poor randomization, and blinding, and short follow-up durations. More robust and well-designed clinical trials with large-scale and prolonged follow-up durations are required to clarify the benefits and risks of these agents.
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Affiliation(s)
- Thunyaluk Meetam
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences and Center of Excellence in Bioactive Resources for Innovative Clinical Applications, Chulalongkorn University, Bangkok, Thailand
- Sirindhorn College of Public Health Trang, Faculty of Public Health and Allied Health Sciences, Praboromarajchanok Institute, Trang, Thailand
| | - Apichai Angspatt
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Pornanong Aramwit
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences and Center of Excellence in Bioactive Resources for Innovative Clinical Applications, Chulalongkorn University, Bangkok, Thailand
- The Academy of Science, The Royal Society of Thailand, Dusit, Bangkok,
Thailand
- Faculty of Pharmacy, Silpakorn University, Nakhon Pathom, Thailand
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Jung SH, Jang BH, Kwon S, Park SJ, Park TE, Kang JH. Nematic Fibrin Fibers Enabling Vascularized Thrombus Implants Facilitate Scarless Cutaneous Wound Healing. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2023:e2211149. [PMID: 37052392 DOI: 10.1002/adma.202211149] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/15/2023] [Indexed: 06/19/2023]
Abstract
Autologous implantable scaffolds that induce vasculogenesis have shown great potential in tissue regeneration; however, previous attempts mainly relied on cell-laden hydrogel patches using fat tissues or platelet-rich plasma, which are insufficient for generating a uniform vasculature in a scalable manner. Here, implantable vascularized engineered thrombi (IVETs) are presented using autologous whole blood, which potentiate effective skin wound healing by constructing robust microcapillary vessel networks at the wound site. Microfluidic shear stresses enable the alignment of bundled fibrin fibers along the direction of the blood flow streamlines and the activation of platelets, both of which offer moderate stiffness of the microenvironment optimal for facilitating endothelial cell maturation and vascularization. Rodent dorsal skin wounds patched with IVET present superior wound closure rates (96.08 ± 1.58%), epidermis thickness, collagen deposition, hair follicle numbers, and neutrophil infiltration, which are permitted by enhanced microvascular circulation. Moreover, IVET treatment accelerates wound healing by recruiting M2 phenotype macrophages.
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Affiliation(s)
- Su Hyun Jung
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology (UNIST), UNIST gil 50, Ulsan, 44919, Republic of Korea
| | - Bong Hwan Jang
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology (UNIST), UNIST gil 50, Ulsan, 44919, Republic of Korea
| | - Seyong Kwon
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology (UNIST), UNIST gil 50, Ulsan, 44919, Republic of Korea
| | - Sung Jin Park
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology (UNIST), UNIST gil 50, Ulsan, 44919, Republic of Korea
| | - Tae-Eun Park
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology (UNIST), UNIST gil 50, Ulsan, 44919, Republic of Korea
| | - Joo H Kang
- Department of Biomedical Engineering, Ulsan National Institute of Science and Technology (UNIST), UNIST gil 50, Ulsan, 44919, Republic of Korea
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Megas IF, Tolzmann DS, Bastiaanse J, Fuchs PC, Kim BS, Kröz M, Schad F, Matthes H, Grieb G. Integrative Medicine and Plastic Surgery: A Synergy-Not an Antonym. ACTA ACUST UNITED AC 2021; 57:medicina57040326. [PMID: 33915729 PMCID: PMC8066838 DOI: 10.3390/medicina57040326] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/09/2021] [Accepted: 03/25/2021] [Indexed: 01/25/2023]
Abstract
Background: Integrative medicine focuses on the human being as a whole—on the body, mind, and spirit—to achieve optimal health and healing. As a synthesis of conventional and complementary treatment options, integrative medicine combines the pathological with the salutogenetic approach of therapy. The aim is to create a holistic system of medicine for the individual. So far, little is known about its role in plastic surgery. Hypothesis: We hypothesize that integrative medicine based on a conventional therapy with additional anthroposophic therapies is very potent and beneficial for plastic surgery patients. Evaluation and consequence of the hypothesis: Additional anthroposophic pharmacological and non-pharmacological treatments are promising for all areas of plastic surgery. We are convinced that our specific approach will induce further clinical trials to underline its therapeutic potential.
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Affiliation(s)
- Ioannis-Fivos Megas
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (I.-F.M.); (D.S.T.); (J.B.)
| | - Dascha Sophie Tolzmann
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (I.-F.M.); (D.S.T.); (J.B.)
| | - Jacqueline Bastiaanse
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (I.-F.M.); (D.S.T.); (J.B.)
| | - Paul Christian Fuchs
- Department of Plastic Surgery and Hand Surgery, Burn Center, University of Witten/Herdecke, Kliniken der Stadt Köln, Ostmerheimer Str. 200, 51109 Köln, Germany;
| | - Bong-Sung Kim
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland;
| | - Matthias Kröz
- Institute of Integrative Medicine, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58448 Witten, Germany;
- Research Department Klinik Arlesheim, Pfeffingerweg 1, 4144 Arlesheim, Switzerland
- Research Institute Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (F.S.); (H.M.)
| | - Friedemann Schad
- Research Institute Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (F.S.); (H.M.)
| | - Harald Matthes
- Research Institute Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (F.S.); (H.M.)
- Institute of Social Medicine, Epidemiology and Health Economics CCM, Charité University Medicine, Charitéplatz 1, 10117 Berlin, Germany
| | - Gerrit Grieb
- Department of Plastic Surgery and Hand Surgery, Gemeinschaftskrankenhaus Havelhoehe, Kladower Damm 221, 14089 Berlin, Germany; (I.-F.M.); (D.S.T.); (J.B.)
- Department of Plastic Surgery and Hand Surgery, Burn Center, Medical Faculty, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany
- Correspondence:
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Surakunprapha P, Winaikosol K, Chowchuen B, Jenwitheesuk K, Jenwitheesuk K. Adding herbal extracts to silicone gel on post-sternotomy scar: a prospective randomised double-blind study. J Wound Care 2021; 29:S36-S42. [PMID: 32279615 DOI: 10.12968/jowc.2020.29.sup4.s36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Silicone gel has been shown effective in improving healing post-sternotomy scars. It remains to be determined whether adding herbal extracts to the gel would augment the healing effect. METHOD After median sternotomy, patients were randomised into two groups. Group 1: topical silicone gel plus herbal extract gel (Allium cepa, Centella Asiatica, Aloe vera and Paper Mulberry) and Group 2: silicone gel. Patients were treated for six months. The postoperative scars were assessed at three and six months by plastic surgeons using the Vancouver Scar Scale (VSS) and the patient assessment scar scale. RESULTS Each group comprised 23 patients (n=46 in total). The VSS was significantly lower in Group 1 than in Group 2 (p=0.018 and p=0.051, respectively). In Group 1, the four differences from baseline were vascularity scores at three and six months (-0.391, p=0.025; -0.435, p=0.013, respectively), and pigmentation scores at three and six months (-0.391, p=0.019; -0.609, p=0.000, respectively). In Group 2, differences from baseline were the pigmentation and vascularity score at six months (-0.6609, p=0.000; -0.348, p=0.046, respectively). CONCLUSION Our results suggest, post-sternotomy scars trend to have better vascularity and pigmentation when treated with silicone gel plus herbal extracts.
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Affiliation(s)
- Palakorn Surakunprapha
- Plastic and Reconstructive Surgery Unit, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Kengkart Winaikosol
- Plastic and Reconstructive Surgery Unit, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Bowornsilp Chowchuen
- Plastic and Reconstructive Surgery Unit, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Kriangsak Jenwitheesuk
- Plastic and Reconstructive Surgery Unit, Faculty of Medicine, Khon Kaen University, 40002, Thailand
| | - Kamonwan Jenwitheesuk
- Plastic and Reconstructive Surgery Unit, Faculty of Medicine, Khon Kaen University, 40002, Thailand
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Abstract
BACKGROUND Surveys have reported that as high as 80% of plastic surgery patients utilize integrative medicine approaches including natural products (NPs) and mind-body practices (MBPs). Little is known regarding the evidence of benefit of these integrative therapies specifically in a plastic surgery patient population. METHODS We conducted a systematic review of studies in MEDLINE, PubMed, and EMBASE (inception through December 2016) evaluating integrative medicine among plastic surgery patients. Search terms included 76 separate NP and MBP interventions as listed in the 2013 American Board of Integrative Health Medicine Curriculum. Two independent reviewers extracted data from each study, including study type, population, intervention, outcomes, conclusions (beneficial, harmful, or neutral), year of publication, and journal type. Level of evidence was assessed according to the American Society of Plastic Surgeons Rating Levels of Evidence and Grading Recommendations. RESULTS Of 29 studies analyzed, 13 studies (45%) evaluated NPs and 16 (55%) studied MBPs. Level II reproducible evidence supports use of arnica to decrease postoperative edema after rhinoplasty, onion extract to improve scar pigmentation, hypnosis to alleviate perioperative anxiety, and acupuncture to improve perioperative nausea. Level V evidence reports on the risk of bleeding in gingko and kelp use and the risk of infection in acupuncture use. After year 2000, 92% of NP studies versus 44% of MBP studies were published (P = 0.008). CONCLUSIONS High-level evidence studies demonstrate promising results for the use of both NPs and MBPs in the care of plastic surgery patients. Further study in this field is warranted.
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Wang F, Li X, Wang X, Jiang X. Efficacy of topical silicone gel in scar management: A systematic review and meta-analysis of randomised controlled trials. Int Wound J 2020; 17:765-773. [PMID: 32119763 DOI: 10.1111/iwj.13337] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 02/05/2023] Open
Abstract
To assess the efficacy of topical silicone gel in the management of scars, we conducted this meta-analysis. The systematic search was performed on PubMed, Web of Science and Embase, and six randomised controlled trials with a total of 375 patients were involved. The outcome data of Vancouver Scar Scale were extracted from the studies and their effect sizes were calculated using Review Manager 5.3. As a result, topical silicone gel significantly reduced pigmentation, height, and pliability scores postoperatively compared with placebos or no treatment (Pigmentation: standard mean difference [SMD] = -0.55 [-0.83 to -0.26], P = .0002; Height: SMD = -0.73 [-1.02 to -0.44], P < .00001; Pliability: SMD = -0.49 [-0.95 to -0.03], P = .04). Topical silicone gel and silicone gel sheet were comparably effective (P > .05). The performance of topical silicone gel and other non-silicone topical treatment was also similar (P > .05). In summary, topical silicone gel was effective in post-operative scar prevention.
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Affiliation(s)
- Fan Wang
- Department of Dermatology and Venerology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoxue Li
- Department of Dermatology and Venerology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiuyun Wang
- Department of Abdominal Cancer, West China Hospital of Sichuan University, Chengdu, China
| | - Xian Jiang
- Department of Dermatology and Venerology, West China Hospital of Sichuan University, Chengdu, China
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Kim J, Kim R, Jeong W, Choi J, Park SW. Longitudinal progress of transepidermal water loss, color, and sensory elements in split-thickness skin graft donor sites in East Asians. Int J Dermatol 2019; 58:616-621. [PMID: 30746680 DOI: 10.1111/ijd.14389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/27/2018] [Accepted: 01/09/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is little research available that describes the natural progression of split-thickness skin graft (STSG) donor site wounds after re-epithelialization. The purpose of this study was to evaluate the longitudinal clinical progress of transepidermal water loss (TEWL), color, and sensory elements in STSG donor sites in East Asians. METHODS Eighteen patients participated in this study. The TEWL, color, pressure threshold, and static two-point discrimination were evaluated from the center and upper lateral corner of the wounds and adjacent normal skin preoperatively and at 1, 2, 7, and 12 months postoperatively. RESULTS The age was negatively correlated with preoperative values of TEWL (r = -0.49, P = 0.039). The elevated TEWL level from the STSG donor sites did not return to normal until 12 months after surgery. In the measurement of skin color, the elevated L* value normalized after 12 months following surgery, while the elevated a* and b* values persisted. In the sensory testing, there were no significant changes during the observation period except at 2 months postoperatively, representing a significant increase of pressure threshold in the periphery. CONCLUSIONS In East Asians, elevated skin lightness level in STSG donor sites returned to normal at 12 months postoperatively, while the elevated TEWL and skin redness levels were improved but were not normalized at 12 months after surgery.
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Affiliation(s)
- Junhyung Kim
- Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Ryeolwoo Kim
- Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Woonhyeok Jeong
- Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Jaehoon Choi
- Department of Plastic and Reconstructive Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Sang Woo Park
- Department of Plastic and Reconstructive Surgery, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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A Prospective Randomized, Controlled, Double-Blind Trial of the Efficacy Using Centella Cream for Scar Improvement. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:9525624. [PMID: 30310413 PMCID: PMC6166374 DOI: 10.1155/2018/9525624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/03/2018] [Accepted: 08/16/2018] [Indexed: 12/20/2022]
Abstract
Objective This study was performed to evaluate the efficacy of Centella asiatica extract in cream, a preparation for the prevention of scar development of the split-thickness skin graft (STSG) donor site. Methods A prospective randomized, double-blind control study was performed to evaluate the efficacy of Centella cream in 30 patients who underwent a STSG operation. Both Centella cream and placebo were applied equally to the donor site at least 2 weeks after epithelialization was completed. A scar assessment using the Vancouver Scar Scale (VSS) was taken at 4, 8, and 12 weeks. Results Of the original 30 patients, 23 patients completed evaluation. There were significant differences in pigmentation parameter of VSS and comparative total VSS scores between 4 and 12 weeks in Centella cream group. Conclusion The effect of Centella cream on scar development of a STSG operation may be attainable in terms of better pigmentation. By means of objective measurements and longer follow-up times, Centella cream may prove to be an alternative product for hypertrophic scar amelioration.
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Bodeker G, Ryan TJ, Volk A, Harris J, Burford G. Integrative Skin Care: Dermatology and Traditional and Complementary Medicine. J Altern Complement Med 2017; 23:479-486. [PMID: 28410445 DOI: 10.1089/acm.2016.0405] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Skin problems and diseases are extremely common globally and, due to their visibility, often result in severe distress and stigma for sufferers. Traditional (i.e., indigenous or local) and complementary health systems are widely used and incorporate many treatment modalities suitable for skin care, and a body of evidence for their efficacy and safety has built up over many decades. These approaches are often used as part of a broader "integrative medicine" (IM) approach that may also include, for example, nutrition and mind-body approaches. This article presents an overview of current knowledge about traditional and complementary medicine (T&CM) and IM principles and practices for skin health; reviews published epidemiologic studies, clinical trials, and wider literature; and discusses the challenges of conducting research into T&CM and IM. It also highlights the need for an innovative research agenda-one which is congruent with the principles of IM, as well as taking policy and public health dimensions into consideration.
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Affiliation(s)
- Gerard Bodeker
- 1 Green Templeton College, University of Oxford , Oxford, United Kingdom
- 2 Global Initiative for Traditional Systems of Health , Oxford, United Kingdom
- 3 Department of Epidemiology, Columbia University , New York, N.Y
| | - Terence J Ryan
- 1 Green Templeton College, University of Oxford , Oxford, United Kingdom
- 2 Global Initiative for Traditional Systems of Health , Oxford, United Kingdom
- 4 Faculty of Health and Life Sciences, Oxford Brookes University , Oxford, United Kingdom
- 5 Centre for Biocultural Diversity, University of Kent, Canterbury, United Kingdom
| | - Adva Volk
- 2 Global Initiative for Traditional Systems of Health , Oxford, United Kingdom
| | - Jahnavi Harris
- 2 Global Initiative for Traditional Systems of Health , Oxford, United Kingdom
| | - Gemma Burford
- 2 Global Initiative for Traditional Systems of Health , Oxford, United Kingdom
- 5 Centre for Biocultural Diversity, University of Kent, Canterbury, United Kingdom
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Challenging the Conventional Therapy: Emerging Skin Graft Techniques for Wound Healing. Plast Reconstr Surg 2016; 136:524e-530e. [PMID: 26397272 DOI: 10.1097/prs.0000000000001634] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Split-thickness skin grafting is the current gold standard for treatment of major traumatic skin loss. However, split-thickness skin grafting is limited by donor-skin availability, especially in large burns. In addition, the donor-site wound is associated with pain and scarring. Multiple techniques have been developed in the past to overcome these limitations but have been unable to achieve clinical relevance. In this study, the authors examine the novel emerging skin grafting techniques, aiming to improve the utility of split-thickness skin grafting. METHODS An extensive literature review was conducted on PubMed, MEDLINE, and Google Scholar to look for new skin grafting techniques. Special focus was given to techniques with potential for large expansion ratio and decreased donor-site pain. RESULTS The new modalities of modified skin grafting technique, discussed in this article, include (1) Xpansion Micrografting System, (2) fractional skin harvesting, (3) epidermal suction blister grafting, and (4) ReCell technology. These techniques are able to achieve significantly increased expansion ratios compared with conventional split-thickness skin grafting and also have decreased donor-site morbidity. CONCLUSIONS These techniques can be used separately or in conjunction with split-thickness skin grafting to overcome the associated pitfalls. Further studies and clinical trials are needed to define the utility of these procedures and where they fit into routine clinical practice.
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Sidgwick GP, McGeorge D, Bayat A. A comprehensive evidence-based review on the role of topicals and dressings in the management of skin scarring. Arch Dermatol Res 2015; 307:461-77. [PMID: 26044054 PMCID: PMC4506744 DOI: 10.1007/s00403-015-1572-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 04/11/2015] [Accepted: 04/29/2015] [Indexed: 12/22/2022]
Abstract
Wound healing after dermal injury is an imperfect process, inevitably leading to scar formation as the skin re-establishes its integrity. The resulting scars have different characteristics to normal skin, ranging from fine-line asymptomatic scars to problematic scarring including hypertrophic and keloid scars. Scars appear as a different colour to the surrounding skin and can be flat, stretched, depressed or raised, manifesting a range of symptoms including inflammation, erythema, dryness and pruritus, which can result in significant psychosocial impact on patients and their quality of life. In this paper, a comprehensive literature review coupled with an analysis of levels of evidence (LOE) for each published treatment type was conducted. Topical treatments identified include imiquimod, mitomycin C and plant extracts such as onion extract, green tea, Aloe vera, vitamin E and D, applied to healing wounds, mature scar tissue or fibrotic scars following revision surgery, or in combination with other more established treatments such as steroid injections and silicone. In total, 39 articles were included, involving 1703 patients. There was limited clinical evidence to support their efficacy; the majority of articles (n = 23) were ranked as category 4 LOE, being of limited quality with individual flaws, including low patient numbers, poor randomisation, blinding, and short follow-up periods. As trials were performed in different settings, they were difficult to compare. In conclusion, there is an unmet clinical need for effective solutions to skin scarring, more robust long-term randomised trials and a consensus on a standardised treatment regime to address all aspects of scarring.
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Affiliation(s)
- G. P. Sidgwick
- />Plastic and Reconstructive Surgery Research, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN UK
| | - D. McGeorge
- />Grosvenor Nuffield Hospital, Wrexham Road, Chester, CH4 7QP England, UK
| | - A. Bayat
- />Plastic and Reconstructive Surgery Research, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN UK
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Miller JD, Rankin TM, Hua NT, Ontiveros T, Giovinco NA, Mills JL, Armstrong DG. Reduction of pain via platelet-rich plasma in split-thickness skin graft donor sites: a series of matched pairs. Diabet Foot Ankle 2015; 6:24972. [PMID: 25623477 PMCID: PMC4306752 DOI: 10.3402/dfa.v6.24972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 11/01/2014] [Accepted: 11/09/2014] [Indexed: 11/27/2022]
Abstract
In the past decade, autologous platelet-rich plasma (PRP) therapy has seen increasingly widespread integration into medical specialties. PRP application is known to accelerate wound epithelialization rates, and may also reduce postoperative wound site pain. Recently, we observed an increase in patient satisfaction following PRP gel (Angel, Cytomedix, Rockville, MD) application to split-thickness skin graft (STSG) donor sites. We assessed all patients known to our university-based hospital service who underwent multiple STSGs up to the year 2014, with at least one treated with topical PRP. Based on these criteria, five patients aged 48.4±17.6 (80% male) were identified who could serve as their own control, with mean time of 4.4±5.1 years between operations. In both therapies, initial dressing changes occurred on postoperative day (POD) 7, with donor site pain measured by Likert visual pain scale. Paired t-tests compared the size and thickness of harvested skin graft and patient pain level, and STSG thickness and surface area were comparable between control and PRP interventions (p>0.05 for all). Donor site pain was reduced from an average of 7.2 (±2.6) to 3 (±3.7), an average reduction in pain of 4.2 (standard error 1.1, p=0.0098) following PRP use. Based on these results, the authors suggest PRP as a beneficial adjunct for reducing donor site pain following STSG harvest.
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Affiliation(s)
- John D Miller
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Timothy M Rankin
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Natalie T Hua
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Tina Ontiveros
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Nicholas A Giovinco
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - Joseph L Mills
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
| | - David G Armstrong
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA;
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Abstract
There are many options for nonmicrosurgical soft tissue coverage of hand wounds, ranging from split thickness skin grafting to pedicled soft tissue transfer, depending on the size, location, blood supply, and depth of the wound. Although many of these techniques have been available for decades, recent advancements in wound management include synthetic dermal substitution, new dressing materials, and variations on previously described or novel pedicled flaps.The goals of coverage include maximizing healing, function, aesthetic appearance, and patient satisfaction, while minimizing donor site morbidity. Optimal management often relies on an individual surgeon's assessment and judgment, as hand wounds can vary greatly and pose unique challenges, and multiple coverage options often exist for each wound. Here, we aim to present useful and up-to-date information on nonmicrosurgical soft tissue coverage for hand reconstruction focusing on recent findings of interest to provide an update on areas with evolving evidence.
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Affiliation(s)
- Jun Matsui
- Washington University in St. Louis, 660 S. Euclid Ave. Campus, Box 8233, St. Louis, MO 63110 USA
| | - Samantha Piper
- Washington University in St. Louis, 660 S. Euclid Ave. Campus, Box 8233, St. Louis, MO 63110 USA
| | - Martin I. Boyer
- Washington University in St. Louis, 660 S. Euclid Ave. Campus, Box 8233, St. Louis, MO 63110 USA
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