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Guo JS, Ng KLB, Lee SS, Lai YW, Wu YC. Custom-Made Implant Fabrication for Chin Augmentation Using Piled-Up Expanded Polytetrafluoroethylene Sheets: An Innovative Surgical Technique and Literature Review. Aesthetic Plast Surg 2024; 48:2018-2024. [PMID: 38499874 DOI: 10.1007/s00266-024-03918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/08/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Alloplastic chin augmentation is the most common esthetic surgical treatment to reshape the chin. However, factory-made chin implants are typically standardized rather than custom-made and have potential to cause complications. Although the fabrication of custom-made implants by using computer-assisted planning and 3D-printing technology has become widespread, the process has several disadvantages, including long preoperative prosthesis preparation times, high costs, and unsuitability for patients with asymmetric chins or those who undergo combined mandibuloplasty before implant placement. The present study developed an innovative chin augmentation technique involving stacked expanded polytetrafluoroethylene (e-PTFE) sheets that is suitable for most patients and has minimal side effects. MATERIALS AND METHODS A retrospective review of a single surgeon's experience was performed over a 2 year period for patients who underwent a procedure involving piled-up e-PTFE sheets for alloplastic chin augmentation. This study analyzed the outcomes, complications (temporary nerve numbness, wound infection, hematoma formation, and implant displacement), and patient satisfaction during follow-up. RESULTS Between January 2018 and December 2020, 38 patients underwent the procedure involving piled-up e-PTFE sheets for alloplastic chin augmentation. Six patients (15.8%) experienced nerve-related temporary numbness, and one (2.6%) experienced wound infection. None had developed major complications such as implant displacement or wound infection at follow-up. Moreover, the patients demonstrated a high level of satisfaction with the surgical results. CONCLUSION Piled-up e-PTFE sheets can be used to produce custom-fit porous polyethylene chin implants that result in minimal complications and a very high satisfaction rate. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Jing-Song Guo
- The Bishop Clinic, 6F, No.6, Heping E Road, Da'an District, Taipei, Taiwan
| | - Kwan Lok Benjamin Ng
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807, Taiwan
| | - Su-Shin Lee
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Regenerative medicine and cell therapy research centre, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ya-Wei Lai
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807, Taiwan
- The Bishop Clinic, 6F, No.6, Heping E Road, Da'an District, Taipei, Taiwan
| | - Yi-Chia Wu
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No.100, Tzyou 1st Road, Kaohsiung, 807, Taiwan.
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan.
- Regenerative medicine and cell therapy research centre, Kaohsiung Medical University, Kaohsiung, Taiwan.
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Meikle B, Simons M, Mahoney T, Reddan T, Dai B, Kimble RM, Tyack Z. Ultrasound measurement of traumatic scar and skin thickness: a scoping review of evidence across the translational pipeline of research-to-practice. BMJ Open 2024; 14:e078361. [PMID: 38594186 PMCID: PMC11015304 DOI: 10.1136/bmjopen-2023-078361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES To identify the ultrasound methods used in the literature to measure traumatic scar thickness, and map gaps in the translation of these methods using evidence across the research-to-practice pipeline. DESIGN Scoping review. DATA SOURCES Electronic database searches of Ovid MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature and Web of Science. Grey literature searches were conducted in Google. Searches were conducted from inception (date last searched 27 May 2022). DATA EXTRACTION Records using brightness mode (B-mode) ultrasound to measure scar and skin thickness across the research-to-practice pipeline of evidence were included. Data were extracted from included records pertaining to: methods used; reliability and measurement error; clinical, health service, implementation and feasibility outcomes; factors influencing measurement methods; strengths and limitations; and use of measurement guidelines and/or frameworks. RESULTS Of the 9309 records identified, 118 were analysed (n=82 articles, n=36 abstracts) encompassing 5213 participants. Reporting of methods used was poor. B-mode, including high-frequency (ie, >20 MHz) ultrasound was the most common type of ultrasound used (n=72 records; 61% of records), and measurement of the combined epidermal and dermal thickness (n=28; 24%) was more commonly measured than the epidermis or dermis alone (n=7, 6%). Reliability of ultrasound measurement was poorly reported (n=14; 12%). The scar characteristics most commonly reported to be measured were epidermal oedema, dermal fibrosis and hair follicle density. Most records analysed (n=115; 97%) pertained to the early stages of the research-to-practice pipeline, as part of research initiatives. CONCLUSIONS The lack of evaluation of measurement initiatives in routine clinical practice was identified as an evidence gap. Diverse methods used in the literature identified the need for greater standardisation of ultrasound thickness measurements. Findings have been used to develop nine methodological considerations for practitioners to guide methods and reporting.
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Affiliation(s)
- Brandon Meikle
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
| | - Megan Simons
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Occupational Therapy, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Tamsin Mahoney
- Surgical, Treatment and Rehabilitation Services (STARS), Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Tristan Reddan
- Medical Imaging and Nuclear Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bryan Dai
- The University of Queensland, Saint Lucia, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Zephanie Tyack
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Australian Centre for Health Service Innovation (AusHI), Centre for Healthcare Transformation, and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Huang PP, Zhang R, Zhang XF, Xu ZT, Zeng DC, Sun FB, Zhang WJ. Effects of ultrashort wave diathermy on skin wounds in rabbit ears. Connect Tissue Res 2023; 64:569-578. [PMID: 37550846 DOI: 10.1080/03008207.2023.2242655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 07/11/2023] [Accepted: 07/13/2023] [Indexed: 08/09/2023]
Abstract
PURPOSE Ultrashort wave diathermy (USWD) is commonly used in diseases associated with osteoarticular and soft tissue injuries. However, while accelerating wound healing and preventing joint stiffness, there have been few reports on whether it leads to excessive hypertrophic scarring. The aim was to investigate the effects of different doses of USWD on hypertrophic scars. MATERIALS AND METHODS A rabbit model of hypertrophic scars was used to determine which dose of USWD reduced scar hyperplasia. The scar thickness was calculated using Sirius red staining. All protein expression levels were determined by western blotting, including fibrosis, collagen deposition, and neoangiogenesis related proteins. Subsequently, flow cytometry and ELISAs were used to determine the proportions of macrophage and inflammatory levels. RESULTS The wounds with USWD in histopathology showed the dermis was more markedly thickened in the 120 mA group, whereas the wounds with the 60 mA were less raised, comparing with the 0 mA; all detected protein levels were increased significantly, the 120 mA group comparing with the others, including heat shock, fibrosis, and neoangiogenesis, whereas the collagen deposition relative protein levels were decreased, the 60 mA group comparing with Sham group; Finally, in the proportion of macrophages and inflammatory levels the 120 mA group were the highest, and the group Sham was lower than group 60 mA. CONCLUSIONS In hypertrophic scars, the 60 mA USWD could relieve scar formation and inflammatory reactions; however, higher doses could result in opposite consequences.
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Affiliation(s)
- Peng-Peng Huang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Rui Zhang
- Department of Rehabilitation Medicine, The Second Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xiao-Feng Zhang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zhi-Tao Xu
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Du-Chun Zeng
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Feng-Bao Sun
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Wen-Jie Zhang
- Center for Rehabilitation Medicine, Rehabilitation & Sports Medicine Research Institute of Zhejiang Province, Department of Rehabilitation Medicine, Zhejiang Provincial People's Hospital(Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
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Leung AKP, Ouyang H, Pang MYC. Effects of mechanical stimulation on mastectomy scars within 2 months of surgery: A single-center, single-blinded, randomized controlled trial. Ann Phys Rehabil Med 2023; 66:101724. [PMID: 36645966 DOI: 10.1016/j.rehab.2022.101724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/17/2022] [Accepted: 10/24/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND One common complication after mastectomy is thickened scars at the surgical site that impair shoulder function. This study aimed to investigate the effects of mechanical stimulation on scar appearance, arm function, and quality of life of breast cancer survivors after mastectomy. METHODS This was a single-center, single-blinded (assessor), randomized controlled trial with a 3-month follow-up. Women who had undergone mastectomy in the preceding 6 weeks for breast cancer were randomly allocated to an experimental group and a control group by permuted block randomization (block size=6). The experimental group received conventional treatment (mobilization and strengthening exercises) and mechanical stimulation applied to the mastectomy scar twice a week for 6 weeks (12 sessions). The control group received 12 sessions of conventional treatment only. Primary outcome measures included the Vancouver Scar scale (VSS) to assess scar quality. The secondary outcomes were spectrophotometry, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire; shoulder range of motion; the Numeric Pain Rating scale; hand grip strength; and Functional Assessment of Chronic Illness Therapy-Breast Cancer (FACT-B). RESULTS One hundred and eight participants were equally randomized to 2 groups. All follow-up assessments were completed in September 2018. Intention-to-treat analysis revealed a significant group × time interaction on the VSS (η² = 0.161, p < 0.001), DASH (η² = 0.060, p = 0.003), and FACT-B functional well-being scores (η² = 0.033, p = 0.034), indicating that the experimental group (n=54) showed greater improvement in these outcomes than the control group (n=54). Post-hoc analysis showed that the improvements in the VSS and DASH scores remained apparent at the 3-month follow-up. Other outcomes did not yield significant group × time interaction. No adverse effects were reported. CONCLUSION The addition of mechanical stimulation to a conventional intervention program improved scar appearance, arm function, and functional well-being compared with conventional intervention alone.
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Affiliation(s)
- Andrea K P Leung
- Physiotherapy Department, Queen Elizabeth Hospital, Kowloon, Hong Kong, China
| | - Huixi Ouyang
- Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, Hong Kong, China
| | - Marco Y C Pang
- Department of Rehabilitation Sciences, the Hong Kong Polytechnic University, Hong Kong, China.
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Chen H, Xu K, Sun C, Gui S, Wu J, Wang S. Inhibition of ANGPT2 activates autophagy during hypertrophic scar formation via PI3K/AKT/mTOR pathway. An Bras Dermatol 2023; 98:26-35. [PMID: 36272879 PMCID: PMC9837657 DOI: 10.1016/j.abd.2021.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/17/2021] [Accepted: 12/28/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Hypertrophic scar (HS), a fibroproliferative disorder caused by aberrant wound healing following skin injuries such as burns, lacerations and surgery, is characterized by invasive proliferation of fibroblasts and excessive extracellular matrix (ECM) accumulation. The dysregulation of autophagy is the pathological basis of HS formation. Previously, angiopoietin-2 (ANGPT2) was found to be overexpressed in HS fibroblasts (HSFs) compared with normal skin fibroblasts. However, whether ANGPT2 participates in the process of HS formation and the potential molecular mechanisms are not clear. OBJECTIVE This study is intended to figure out the role of ANGPT2 and ANGPT2-mediated autophagy during the development of HS. METHODS RT-qPCR was used to detect ANGPT2 expression in HS tissues and HSFs. HSFs were transfected with sh-ANGPT2 to knock down ANGPT2 expression and then treated with MHT1485, the mTOR agonist. The effects of sh-ANGPT2 or MHT1485 on the proliferation, migration, autophagy and ECM accumulation of HSFs were evaluated by CCK-8 assay, Transwell assay and western blotting. The expression of PI3K/Akt/mTOR pathway-related molecules (p-PI3K, p-Akt and p-mTOR) was assessed by western blotting. RESULTS ANGPT2 expression was markedly upregulated in HS tissues and HSFs. ANGPT2 knockdown decreased the expression of p-PI3K, p-Akt and p-mTOR. ANGPT2 knockdown activated autophagy and inhibited the proliferation, migration, and ECM accumulation of HSFs. Additionally, the treatment of MHT1485, the mTOR agonist, on ANGPT2-downregulated HSFs, partially reversed the influence of ANGPT2 knockdown on HSFs. STUDY LIMITATIONS The study lacks the establishment of more stable in vivo animal models of HS for investigating the effects of ANGPT2 on HS formation in experimental animals. CONCLUSIONS ANGPT2 downregulation represses growth, migration, and ECM accumulation of HSFs via autophagy activation by suppressing the PI3K/Akt/mTOR pathway. Our study provides a novel potential therapeutic target for HS.
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Affiliation(s)
- Hongxin Chen
- School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, China,Department of Burn and Plastic Surgery, General Hospital of Central Theater Command of People’s Liberation Army, Wuhan, Hubei, China,Hubei Key Laboratory of Central Nervous System Tumor and Intervention, Wuhan, Hubei, China
| | - Kai Xu
- Department of Burn and Plastic Surgery, General Hospital of Central Theater Command of People’s Liberation Army, Wuhan, Hubei, China,Hubei Key Laboratory of Central Nervous System Tumor and Intervention, Wuhan, Hubei, China
| | - Chao Sun
- The Sixth Resignation Cadre Sanatorium of Shandong Province Military Region, Qingdao, China
| | - Si Gui
- Department of Burn and Plastic Surgery, General Hospital of Central Theater Command of People’s Liberation Army, Wuhan, Hubei, China,Hubei Key Laboratory of Central Nervous System Tumor and Intervention, Wuhan, Hubei, China
| | - Juanjuan Wu
- Department of Burn and Plastic Surgery, General Hospital of Central Theater Command of People’s Liberation Army, Wuhan, Hubei, China,Hubei Key Laboratory of Central Nervous System Tumor and Intervention, Wuhan, Hubei, China
| | - Song Wang
- School of Medicine, Wuhan University of Science and Technology, Wuhan, Hubei, China,Department of Burn and Plastic Surgery, General Hospital of Central Theater Command of People’s Liberation Army, Wuhan, Hubei, China,Hubei Key Laboratory of Central Nervous System Tumor and Intervention, Wuhan, Hubei, China,Corresponding author.
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Ilori OS, Olaitan PB, Ilori OR, Aderounmu AO. Patients’ satisfaction with the effects of microporous tape on surgical scars: a randomized controlled study. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2022. [DOI: 10.14730/aaps.2022.00500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Following surgery or other types of trauma, scar formation occurs with wound healing because of the replacement of normal skin with fibrous tissue. The conversion of a normal scar to an abnormal scar usually occurs 6 to 8 weeks after surgery. Abnormal scars can be a source of patient dissatisfaction, especially following cosmetic surgical procedures. Therefore, supporting scars with tape after surgery is critical for reducing scar tension. The aim of this study was to determine the extent of patients’ satisfaction with their scar outcomes following microporous taping and to identify the determinants of scar satisfaction.Methods A prospective randomized controlled study was conducted to compare the scar satisfaction of postsurgical patients who underwent scar taping with microporous tape to those who did not. The scars were assessed at 6 weeks, 3 months, and 6 months after surgery using the Patient Scar Assessment Scale (PSAS). The test group had microporous tape applied to their scars and the tape was worn 24 hours a day for a period of 6 months. The data were analyzed using SPSS version 22.0. Categorical variables and mean PSAS scores were compared using the chi-square test and repeated-measures analysis of variance, respectively.Results At 6 weeks, 3 months, and 6 months the taped group had significantly lower PSAS scores and higher satisfaction scores than the control group. Scar thickness and pruritus were statistically significant determinants of patient satisfaction.Conclusions Microporous tape is an effective modality for improving scar satisfaction in postsurgical patients.
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Cai Y, Xiao M, Li X, Zhou S, Sun Y, Yu W, Zhao T. BMS‐202, a PD‐1/PD‐L1 inhibitor, decelerates the pro‑fibrotic effects of fibroblasts derived from scar tissues via ERK and TGFβ1/Smad signaling pathways. Immun Inflamm Dis 2022; 10:e693. [PMID: 36169254 PMCID: PMC9449589 DOI: 10.1002/iid3.693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Hypertrophic scar (HS), a fibroproliferative disorder of the skin with some tumor‐like properties, is closely related to dysregulated inflammation. PD‐1/PD‐L1 inhibitor is a promising medication for cancer therapy as its potent functions on adaptive immune response; whether it could be a candidate for HS therapy has aroused our interest. This study aimed to explore the effect and the mechanism of BMS‐202, a PD‐1/PD‐L1 inhibitor, in HS. Methods Ten HS and adjacent normal skin tissues collected from HS patients were used to detect α‐SMA, collagen I, and PD‐L1 expression by Quantitative reverse transcription‐polymerase chain reaction and western blot (WB) analysis. Fibroblasts derived from HS tissues (HFBs) were exposed to diverse concentrations of BMS‐202, of which proliferation, migration, apoptosis, and collagen synthesis were evaluated by Cell Counting Kit‐8, wound healing, terminal deoxynucleotidyl transferase (TdT) dUTP Nick‐End labeling, and [3H]‑proline incorporation assays, respectively. The effect of BMS‐202 on α‐SMA and collagen I expression, and transforming growth factor beta 1 (TGFβ1)/Smad signaling in HFBs was also determined by WB and enzyme‐linked immunosorbent assay. Results The expression level of PD‐L1 was significantly elevated in both HS tissues and HFBs, which was positively correlated with α‐SMA and collagen I expressions. BMS‐202 exerted a significant suppression effect on the cell proliferation, migration, collagen synthesis, and α‐SMA and collagen I expression of HFBs in a concentration‐dependent way; but did not affect apoptosis. Finally, BMS‐202 could reduce the phosphorylation of ERK1/2, Smad2, and Smad3, and the TGFβ1 expression once its concentration reached 2.5 nM. Conclusion BMS‐202 effectively suppressed proliferation, migration, and extracellular matrix deposition of HFBs, potentially through the regulation of the ERK and TGFβ1/Smad signaling pathways.
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Affiliation(s)
- Yuanyuan Cai
- Department of Plastic and Cosmetic Surgery The Second Affiliated Hospital of Soochow University Soochow Jiangsu China
- Department of Plastic and Cosmetic Surgery Changzhou No.2 People's Hospital Changzhou Jiangsu China
| | - Min Xiao
- Department of Oncology Changzhou Cancer Hospital Affiliated to Soochow University Changzhou Jiangsu China
| | - Xinqing Li
- Department of Plastic and Cosmetic Surgery Changzhou No.2 People's Hospital Changzhou Jiangsu China
| | - Shanyu Zhou
- Department of Plastic and Cosmetic Surgery Changzhou No.2 People's Hospital Changzhou Jiangsu China
| | - Yangyang Sun
- Department of Pathology Changzhou No.2 People's Hospital Changzhou Jiangsu China
| | - Wenyuan Yu
- Department of Plastic and Cosmetic Surgery The Second Affiliated Hospital of Soochow University Soochow Jiangsu China
| | - Tianlan Zhao
- Department of Plastic and Cosmetic Surgery The Second Affiliated Hospital of Soochow University Soochow Jiangsu China
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Leszczynski R, da Silva CA, Pinto ACPN, Kuczynski U, da Silva EM. Laser therapy for treating hypertrophic and keloid scars. Cochrane Database Syst Rev 2022; 9:CD011642. [PMID: 36161591 PMCID: PMC9511989 DOI: 10.1002/14651858.cd011642.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hypertrophic and keloid scars are common skin conditions resulting from abnormal wound healing. They can cause itching, pain and have a negative physical and psychological impact on patients' lives. Different approaches are used aiming to improve these scars, including intralesional corticosteroids, surgery and more recently, laser therapy. Since laser therapy is expensive and may have adverse effects, it is critical to evaluate the potential benefits and harms of this therapy for treating hypertrophic and keloid scars. OBJECTIVES To assess the effects of laser therapy for treating hypertrophic and keloid scars. SEARCH METHODS In March 2021 we searched the Cochrane Wounds Specialised Register, CENTRAL, MEDLINE, Embase, CINAHL EBSCO Plus and LILACS. To identify additional studies, we also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses, and health technology reports. There were no restrictions with respect to language, date of publication, or study setting. SELECTION CRITERIA We included randomised controlled trials (RCTs) for treating hypertrophic or keloid scars (or both), comparing laser therapy with placebo, no intervention or another intervention. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, extracted the data, assessed the risk of bias of included studies and carried out GRADE assessments to assess the certainty of evidence. A third review author arbitrated if there were disagreements. MAIN RESULTS We included 15 RCTs, involving 604 participants (children and adults) with study sample sizes ranging from 10 to 120 participants (mean 40.27). Where studies randomised different parts of the same scar, each scar segment was the unit of analysis (906 scar segments). The length of participant follow-up varied from 12 weeks to 12 months. All included trials had a high risk of bias for at least one domain: all studies were deemed at high risk of bias due to lack of blinding of participants and personnel. The variability of intervention types, controls, follow-up periods and limitations with report data meant we pooled data for one comparison (and only two outcomes within this). Several review secondary outcomes - cosmesis, tolerance, preference for different modes of treatment, adherence, and change in quality of life - were not reported in any of the included studies. Laser versus no treatment: We found low-certainty evidence suggesting there may be more hypertrophic and keloid scar improvement (that is scars are less severe) in 585-nm pulsed-dye laser (PDL) -treated scars compared with no treatment (risk ratio (RR) 1.96; 95% confidence interval (CI): 1.11 to 3.45; two studies, 60 scar segments). It is unclear whether non-ablative fractional laser (NAFL) impacts on hypertrophic scar severity when compared with no treatment (very low-certainty evidence). It is unclear whether fractional carbon dioxide (CO2) laser impacts on hypertrophic and keloid scar severity compared with no treatment (very low-certainty evidence). Eight studies reported treatment-related adverse effects but did not provide enough data for further analyses. Laser versus other treatments: We are uncertain whether treatment with 585-nm PDL impacts on hypertrophic and keloid scar severity compared with intralesional corticosteroid triamcinolone acetonide (TAC), intralesional Fluorouracil (5-FU) or combined use of TAC plus 5-FU (very low-certainty evidence). It is also uncertain whether erbium laser impacts on hypertrophic scar severity when compared with TAC (very low-certainty evidence). Other comparisons included 585-nm PDL versus silicone gel sheeting, fractional CO2 laser versus TAC and fractional CO2 laser versus verapamil. However, the authors did not report enough data regarding the severity of scars to compare the interventions. As only very low-certainty evidence is available on treatment-related adverse effects, including pain, charring (skin burning so that the surface becomes blackened), telangiectasia (a condition in which tiny blood vessels cause thread-like red lines on the skin), skin atrophy (skin thinning), purpuric discolorations, hypopigmentation (skin colour becomes lighter), and erosion (loss of part of the top layer of skin, leaving a denuded surface) secondary to blistering, we are not able to draw conclusions as to how these treatments compare. Laser plus other treatment versus other treatment: It is unclear whether 585-nm PDL plus TAC plus 5-FU leads to a higher percentage of good to excellent improvement in hypertrophic and keloid scar severity compared with TAC plus 5-FU, as the certainty of evidence has been assessed as very low. Due to very low-certainty evidence, it is also uncertain whether CO2 laser plus TAC impacts on keloid scar severity compared with cryosurgery plus TAC. The evidence is also very uncertain about the effect of neodymium-doped yttrium aluminium garnet (Nd:YAG) laser plus intralesional corticosteroid diprospan plus 5-FU on scar severity compared with diprospan plus 5-FU and about the effect of helium-neon (He-Ne) laser plus decamethyltetrasiloxane, polydimethylsiloxane and cyclopentasiloxane cream on scar severity compared with decamethyltetrasiloxane, polydimethylsiloxane and cyclopentasiloxane cream. Only very low-certainty evidence is available on treatment-related adverse effects, including pain, atrophy, erythema, telangiectasia, hypopigmentation, regrowth, hyperpigmentation (skin colour becomes darker), and depigmentation (loss of colour from the skin). Therefore, we are not able to draw conclusions as to how these treatments compare. AUTHORS' CONCLUSIONS: There is insufficient evidence to support or refute the effectiveness of laser therapy for treating hypertrophic and keloid scars. The available information is also insufficient to perform a more accurate analysis on treatment-related adverse effects related to laser therapy. Due to the heterogeneity of the studies, conflicting results, study design issues and small sample sizes, further high-quality trials, with validated scales and core outcome sets should be developed. These trials should take into consideration the consumers' opinion and values, the need for long-term follow-up and the necessity of reporting the rate of recurrence of scars to determine whether lasers may achieve superior results when compared with other therapies for treating hypertrophic and keloid scars.
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Affiliation(s)
| | | | - Ana Carolina Pereira Nunes Pinto
- Cochrane Brazil, Health Technology Assessment Center, São Paulo, Brazil
- Post-graduation program in Evidence-Based Health, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil
- Biological and Health Sciences Department, Federal University of Amapa, Macapá, Brazil
| | | | - Edina Mk da Silva
- Emergency Medicine and Evidence Based Medicine, Universidade Federal de São Paulo, São Paulo, Brazil
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Ilieș R, Halmagyi SR, Cătană A, Aioanei C, Lukacs I, Tokes RE, Rotar I, Pop I. Role of hTERT rs2736100 in pathological scarring. Exp Ther Med 2022; 23:260. [DOI: 10.3892/etm.2022.11186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/25/2021] [Indexed: 11/05/2022] Open
Affiliation(s)
- Roxana Ilieș
- Department of Medical Genetics, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
| | - Salomea-Ruth Halmagyi
- Department of Medical Genetics, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
| | - Andreea Cătană
- Department of Medical Genetics, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
| | - Casian Aioanei
- Department of Medical Genetics, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
| | - Istvan Lukacs
- 1st Department of Obstetrics and Gynecology, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
| | - Reka-Eniko Tokes
- 1st Department of Obstetrics and Gynecology, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
| | - Ioana Rotar
- 1st Department of Obstetrics and Gynecology, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
| | - Ioan Pop
- Department of Medical Genetics, ‘Iuliu Hațieganu’ University of Medicine and Pharmacy, 400012 Cluj‑Napoca, Romania
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10
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Huang SH, Wu KW, Lo JJ, Wu SH. Synergic Effect of Botulinum Toxin Type A and Triamcinolone Alleviates Scar Pruritus by Modulating Epidermal Hyperinnervation: A Preliminary Report. Aesthet Surg J 2021; 41:NP1721-NP1731. [PMID: 33662123 DOI: 10.1093/asj/sjab105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Patients often experience scar-related pruritus, which adversely affects quality of life. Triamcinolone acetonide (TAC) is widely used to treat pathologic scars, and botulinum toxin type A (BTX-A) reportedly improves scarring and associated discomfort. OBJECTIVES The aim of this study was to investigate the clinical efficacy of combining TAC and BTX-A to reduce scar itch; potential mechanisms were investigated via an animal model. METHODS For the clinical study, each scar on a patient was divided into 2 equal parts, with one part receiving TAC/BTX-A and the other TAC alone. Therapeutic interventions were administered over 3 sessions at 4-week intervals. Itch intensity was measured on a visual analog scale before each therapeutic intervention (V1, V2, V3) and 4 weeks after the last intervention (V4). For the animal model, rats were allocated into 5 groups: control, untreated burn, TAC, BTX-A, and TAC/BTX-A. We evaluated alloknesis in the right hind paw and analyzed possible molecular mechanisms. RESULTS In humans, TAC/BTX-A significantly reduced scar itch compared with TAC alone at V4 (P = 0.04). In rats, post-burn itch was mitigated at 4 weeks after treatment with TAC, BTX-A, and TAC/BTX-A (P = 0.03, P = 0.0054, and P = 0.0053, respectively). TAC/BTX-A significantly decreased the density of intraepidermal nerve fibers post-burn relative to the untreated burn (P = 0.0008). TAC/BTX-A downregulated the expressions of nerve growth factor and protein transient receptor potential vanilloid subtype 1. CONCLUSIONS TAC/BTX-A therapy exhibited enhanced and sustained clinical efficacy in relieving scar itch, possibly via modulating epidermal innervation and expression of transient receptor potential vanilloid subtype 1 . LEVEL OF EVIDENCE: 2
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Affiliation(s)
- Shu-Hung Huang
- Division of Plastic Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuo-Wei Wu
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jing-Jou Lo
- Department of General Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Hua Wu
- Department of Anesthesiology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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11
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Nabai L, Pourghadiri A, Ghahary A. Hypertrophic Scarring: Current Knowledge of Predisposing Factors, Cellular and Molecular Mechanisms. J Burn Care Res 2021; 41:48-56. [PMID: 31999336 DOI: 10.1093/jbcr/irz158] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hypertrophic scarring (HSc) is an age-old problem that still affects millions of people physically, psychologically, and economically. Despite advances in surgical techniques and wound care, prevention and treatment of HSc remains a challenge. Elucidation of factors involved in the development of this common fibroproliferative disorder is crucial for further progress in preventive and/or therapeutic measures. Our knowledge about pathophysiology of HSc at the cellular and molecular level has grown considerably in recent decades. In this article, current knowledge of predisposing factors and the cellular and molecular mechanisms of HSc has been reviewed.
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Affiliation(s)
- Layla Nabai
- BC Professional Firefighters' Burn & Wound Healing Research Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amir Pourghadiri
- BC Professional Firefighters' Burn & Wound Healing Research Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aziz Ghahary
- BC Professional Firefighters' Burn & Wound Healing Research Laboratory, Department of Surgery, Division of Plastic Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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12
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Hsu YL, Hsieh CE, Lin PY, Lin SL, Lin KH, Weng LC, Chen YL. Postoperative incision scars and cosmetic satisfaction of living liver donors. Medicine (Baltimore) 2021; 100:e26187. [PMID: 34115002 PMCID: PMC8202607 DOI: 10.1097/md.0000000000026187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/15/2021] [Indexed: 11/25/2022] Open
Abstract
Cosmetic appearance is a major concern for living donors. However, little is known about the impact of a surgical scar on body image changes in living liver donors. The aim of this study was to identify potential factors that cause displeasing upper midline incision scar, and to evaluate the overall satisfaction regarding body image and scarring after living donor hepatectomy.Donors who underwent right lobe hepatectomy were recruited. Exclusion criteria included reoperation, refusal to participate, and lost follow-up. All donors were invited to complete the Vancouver Scar Scale (VSS) and the body image questionnaire. According to the VSS results of upper midline incision scar, donors were divided into 2 groups: good scarring group (VSS ≤4) and bad scarring group (VSS >4). we compared the clinical outcomes, including the demographics, preoperation, intraoperation, and postoperation variables. The study also analyzed the results of the body image questionnaire.The proportion of male donors was 48.9%. The bad scarring group consisted of 63% of the donors. On multivariate analysis, being a male donor was found to be an independent predictor of a cosmetically displeasing upper midline incision scar with statistical significance. The results of body image questionnaires, there were significant differences in cosmetic score and confidence score among the 2 groups.The upper midline incision and male donors have higher rates of scarring in comparison with the transverse incision and female donors. Donors who reported having a higher satisfaction with their scar appearance usually had more self-confidence. However, the body image won't be affected. Medical staff should encourage donors to take active participation in wound care and continuously observe the impact of surgical scars on psychological changes in living liver donors.
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Affiliation(s)
- Ya-Lan Hsu
- Nurse Practitioner of liver transplantation, Department of Nursing, Changhua Christian Hospital, Changhua
| | - Chia-En Hsieh
- Nurse Practitioner of liver transplantation, Department of Nursing, Changhua Christian Hospital, Changhua
| | - Ping-Yi Lin
- Department of Nursing, Hung Kung University, Taichung
| | | | - Kuo-Hua Lin
- Department of General Surgery, Changhua Christian Hospital, Changhua
| | - Li-Chueh Weng
- Associate Professor, Department of Nursing, Graduate Institute of Clinical Medical Science, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Li Chen
- Department of General Surgery, Changhua Christian Hospital, Changhua
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13
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Xue Y, Qi C, Dong Y, Zhang L, Liu X, Liu Y, Wang S. Poly (γ-glutamic acid)/chitooligo-saccharide/papain hydrogel prevents hypertrophic scar during skin wound healing. J Biomed Mater Res B Appl Biomater 2021; 109:1724-1734. [PMID: 33739603 DOI: 10.1002/jbm.b.34830] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 02/02/2021] [Accepted: 02/14/2021] [Indexed: 12/18/2022]
Abstract
Hypertrophic scar, a common skin disorder typically caused by deep burns or scald were usually treated via surgical resection, laser irradiation, and drugs. However, all the approaches were always companied with complications and devastatingly subjected to relapse, which indicated the urgently need of an effective treatment method. In this project, a new hydrogel composed of Poly (γ-glutamic acid) (γ-PGA), Chitooligo-saccharide, and Papain was developed via crosslinker (EDC&NHS), and characterized with good porously three-dimensional network structure, good water absorption, and mechanical properties. Besides, G/C/P hydrogel facilitated cell adhesion and inhibited excessive proliferation of fibroblasts, which indicated the potential of in vivo application. After applied onto skin wound healing in vivo on a rabbit ear skin wound model, G/C/P hydrogel inhibited excessive collagen deposition and the generation of hyperplastic scars effectively during wound healing. The hydrogel described here provide a new platform for regeneration field and hold great promise for solving serious skin disorder.
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Affiliation(s)
- Yueming Xue
- Key Laboratory of Bioactive Materials for Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
| | - Chunxiao Qi
- Key Laboratory of Bioactive Materials for Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
| | - Yunsheng Dong
- Key Laboratory of Bioactive Materials for Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
| | - Lin Zhang
- Key Laboratory of Bioactive Materials for Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
| | - Xiangsheng Liu
- Key Laboratory of Bioactive Materials for Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
| | - Yufei Liu
- Key Laboratory of Bioactive Materials for Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
| | - Shufang Wang
- Key Laboratory of Bioactive Materials for Ministry of Education, College of Life Sciences, Nankai University, Tianjin, China
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14
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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: 0.7] [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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15
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Chow L, Yick KL, Sun Y, Leung MSH, Kwan MY, Ng SP, Yu A, Yip J, Chan YF. A Novel Bespoke Hypertrophic Scar Treatment: Actualizing Hybrid Pressure and Silicone Therapies with 3D Printing and Scanning. Int J Bioprint 2021; 7:327. [PMID: 33585716 PMCID: PMC7875059 DOI: 10.18063/ijb.v7i1.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 12/30/2020] [Indexed: 12/02/2022] Open
Abstract
The treatment of hypertrophic scars (HSs) is considered to be the most challenging task in wound rehabilitation. Conventional silicone sheet therapy has a positive effect on the healing process of HSs. However, the dimensions of the silicone sheet are typically larger than those of the HS itself which may negatively impact the healthy skin that surrounds the HS. Furthermore, the debonding and displacement of the silicone sheet from the skin are critical problems that affect treatment compliance. Herein, we propose a bespoke HS treatment design that integrates pressure sleeve with a silicone sheet and use of silicone gel using a workflow of three-dimensional (3D) printing, 3D scanning and computer-aided design, and manufacturing software. A finite element analysis (FEA) is used to optimize the control of the pressure distribution and investigate the effects of the silicone elastomer. The result shows that the silicone elastomer increases the amount of exerted pressure on the HS and minimizes unnecessary pressure to other parts of the wrist. Based on this treatment design, a silicone elastomer that perfectly conforms to an HS is printed and attached onto a customized pressure sleeve. Most importantly, unlimited scar treating gel can be applied as the means to optimize treatment of HSs while the silicone sheet is firmly affixed and secured by the pressure sleeve.
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Affiliation(s)
- Lung Chow
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| | - Kit-lun Yick
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| | - Yue Sun
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
- School of Fashion Design and Engineering, Zhejiang Sci-Tech University, Hangzhou
| | - Matthew S. H. Leung
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| | - Mei-ying Kwan
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| | - Sun-pui Ng
- Division of Science, Engineering and Health Studies, College of Professional and Continuing Education, The Hong Kong Polytechnic University, Hong Kong
| | - Annie Yu
- Department of Advanced Fibro Science, Kyoto Institute of Technology, Japan
| | - Joanne Yip
- Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Hong Kong
| | - Ying-fan Chan
- Department of Occupational Therapy, Prince of Wales Hospital, Hong Kong
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16
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Selvi I, Arik AI, Basay MS, Basar H. The effect of proliferative hypertrophic scars on determining treatment options for preventing recurrence of vesicourethral anastomotic stenosis after radical prostatectomy: a single-center cross-sectional study. SAO PAULO MED J 2021; 139:241-250. [PMID: 33909829 PMCID: PMC9625006 DOI: 10.1590/1516-3180.2020.0349.r1.28012021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 01/28/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. OBJECTIVES To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. DESIGN AND SETTING Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. METHODS Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. RESULTS Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. CONCLUSIONS VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.
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Affiliation(s)
- Ismail Selvi
- MD. Physician, Department of Urology, Department of Urology, Karabük University Training and Research Hospital, Karabük, Turkey
| | - Ali Ihsan Arik
- MD. Physician, Department of Urology, Health Science University Dr. Abdurrahman Yurtaslan, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Mehmet Sinan Basay
- MD. Physician, Department of Urology, Health Science University Dr. Abdurrahman Yurtaslan, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
| | - Halil Basar
- MD. Professor, Department of Urology, Health Science University Dr. Abdurrahman Yurtaslan, Ankara Oncology Training and Research Hospital, Ankara, Turkey.
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17
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Zhang EW, Li-Tsang CW, Li TM, Huang L, Cheung KK. Smart Scar Care Pad: An Innovated Silicone-Based Insert That Improved Severe Hypertrophic Scar by Integrating Optimal Pressure and Occlusion Effects. Adv Wound Care (New Rochelle) 2020. [DOI: 10.1089/wound.2019.1016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Eve Walei Zhang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Cecilia W.P. Li-Tsang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Tim M.H. Li
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Lin Huang
- Department of Surgery, Prince of Wales Hospital, Shatin, Hong Kong
- Skin Bank, Burns Centre, Prince of Wales Hospital, Shatin, Hong Kong
| | - Kwok-Kuen Cheung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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18
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DeJong H, Abbott S, Zelesco M, Spilsbury K, Ziman M, Kennedy BF, Martin L, Wood FM. Objective quantification of burn scar stiffness using shear-wave elastography: Initial evidence of validity. Burns 2020; 46:1787-1798. [PMID: 32534890 DOI: 10.1016/j.burns.2020.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 04/21/2020] [Accepted: 05/12/2020] [Indexed: 12/18/2022]
Abstract
Shear-wave elastography (SWE) is an ultrasound based technology that can provide reliable measurements (velocity) of scar stiffness. The aim of this research was to evaluate the concurrent validity of using both the measured velocity and the calculated difference in velocity between scars and matched controls, in addition to evaluating potential patient factors that may influence the interpretation of the measurements. METHODS A cross-sectional study of 32 participants, with 48 burn scars and 48 matched contralateral control sites were evaluated with SWE, the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS) tactile sub-scores. RESULTS Spearman's rho demonstrated high correlations (r > 0.7) between the measured scar velocity and both the POSAS and VSS pliability sub-scores, whereas moderate correlations (r > 0.6) were found with the calculated difference in velocity. Regression analysis indicated that the association of increased velocity in scars, varied by length of time after burn injury and gender. Body location and Fitzpatrick skin type also demonstrated significant associations with velocity, whereas age did not. CONCLUSION SWE shows potential as a novel tool to quantify burn scar stiffness, however patient factors need to be considered when interpreting results. Further research is recommended on a larger variety of scars to support the findings.
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Affiliation(s)
- Helen DeJong
- Perth Scar and Pain Clinic, 2/5 Norfolk Street, Fremantle, Western Australia 6160, Australia; School of Medical and Health Science, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia; BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre Nedlands and Centre for Medical Research, The University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia 6009, Australia; Fiona Wood Foundation, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, Western Australian 6150, Australia.
| | - Steven Abbott
- Department of Medical Imaging, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, Western Australian, 6150, Australia
| | - Marilyn Zelesco
- Department of Medical Imaging, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, Western Australian, 6150, Australia
| | - Katrina Spilsbury
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Melanie Ziman
- School of Medical and Health Science, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia; School of Biomedical Science, The University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia 6009, Australia
| | - Brendan F Kennedy
- BRITElab, Harry Perkins Institute of Medical Research, QEII Medical Centre Nedlands and Centre for Medical Research, The University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia 6009, Australia; Department of Electrical, Electronic and Computer Engineering, School of Engineering, The University of Western Australia, 35 Stirling Hwy, Crawley, 6009, Western Australia, Australia; Australian Research Council Centre for Personalised Therapeutics Technologies, Australia
| | - Lisa Martin
- Fiona Wood Foundation, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, Western Australian 6150, Australia
| | - Fiona M Wood
- Fiona Wood Foundation, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, Western Australian 6150, Australia; Burn Injury Research Unit, The University of Western Australia, 35 Stirling Hwy, Crawley, Western Australia 6009, Australia; Burn Service of Western Australia, Fiona Stanley Hospital, 11 Robin Warren Dr, Murdoch, Western Australian 6150, Australia
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Surakunprapha P, Winaikosol K, Chowchuen B, Punyavong P, Jenwitheesuk K, Jenwitheesuk K. A Prospective Randomized Double-blind study of silicone gel plus Herbal Extracts Versus Placebo in Pre-sternal hypertrophic scar prevention and amelioration. Heliyon 2020; 6:e03883. [PMID: 32405550 PMCID: PMC7210591 DOI: 10.1016/j.heliyon.2020.e03883] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/17/2019] [Accepted: 04/27/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Post-surgical hypertrophic scar is more frequently reported in Asians. Many modalities can treat scars but there have not been any publications to define the efficacy of silicone gel plus herbal extracts for scar prevention or amelioration. Design 48 patients, who underwent median sternotomy were randomized and double-blinded to 2 groups to use topical silicone gel plus herbal extract gel or placebo for 6 months. Patients were treated either with topical silicone gel plus herbal extract gel or control using only placebo for 6 months. The scars were observed by experienced plastic surgeons using the Vancouver scar scale. Setting A single tertiary care center at Khon Kaen University. Paticipants 48 patients who underwent median sternotomy were enrolled in this study. All patients were aged over 18 years. All the wounds were sutured with polyglycolic 4/0 subcuticular suture material and did not receive other scar management before participating in this study. Intervention The silicone gel plus herbal extract gel (Bangkok Botanica, Bangkok, Thailand) in semi-liquid form was formulated from 15% Herbal extract (Allium Cepa extract, Centella Asiatica extract, Aloe Vera extract and Paper Mulberry extract), 50% polydemethysiloxane, 30% cyclopentasiloxane and 5% silica. The placebo gel was a composite of water, acrylate, C10-30 alkyl acrylate cross-polymer, polysorbate 20 and fragrance that was similar in color and consistency as that of the active gel and packed in the similar sealed packages. Main outcome measures The scar was assessed using the Vancouver scar scale to determine pigmentation, vascularity, pliability and height. Results the study showed the silicone gel plus herbal extract gel could improve scar amelioration in height (p = 0.005) and pliability (p < 0.001) when compared to the placebo. The vascularity and pigmentation showed improvement using silicone gel plus herbal extracts but the improvement was not statistically significant. Conclusion The silicone gel plus herbal extracts gel was effective for scar improvement in median sternotomy wounds.
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Affiliation(s)
- Palakorn Surakunprapha
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kengkart Winaikosol
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Bowornsilp Chowchuen
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Puttama Punyavong
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kriangsak Jenwitheesuk
- General Surgery Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kamonwan Jenwitheesuk
- Plastic & Reconstructive Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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20
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Rennekampff HO, Tenenhaus M. Theoretical basis for optimal surgical incision planning to reduce hypertrophic scar formation. Med Hypotheses 2020; 140:109672. [PMID: 32197119 DOI: 10.1016/j.mehy.2020.109672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 02/29/2020] [Accepted: 03/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND After approximately 24 weeks of gestation, human cutaneous wounds and incisions heal by scar formation. Continued or unregulated stimulation of tissue fibroblasts is thought to lead to an activated state with ongoing collagen deposition resulting in a visible hypertrophic scar. There is evidence that mechanical forces as sensed by fibroblasts lead to downstream events such as excessive extracellular matrix deposition. Mechanical forces acting on the wound fibroblast are exerted by underlying muscles as well as intrinsic forces found in the dermal component of the surrounding skin. Under static conditions, collagen is oriented parallel to the direction of strain. In an effort to minimize resultant scar formation various and often contradictory lines of non-extension, lines of least tension, have been described for planning optimal surgical incisions. HYPOTHESIS We hypothesize that it is possible to avoid longitudinal stretch on incisions and thereby minimize resultant pathologic scars if defined anatomical considerations are respected. We hypothesize that placement of skin incisions parallel to lines of minimal longitudinal stretch, non-invasively measured by orientation of collagen orientation would in turn result in minimal scar formation. EVIDENCE Historical recommendations often derived from human post mortem studies and animal experiments have shed some light on cutaneously observed lines of non-extension. Theoretical considerations of non-extension lines have suggested possible directions of surgical incisions. Post surgical analysis of dermatological interventions have similarly added to our understanding of possible non-extension lines. Measuring anisotropy in the skin can determine collagen orientation in the skin and may therefore allow one to objectively place incisions parallel to non-extension lines. To date no randomized clinical study in humans has addressed whether such an approach would lead to less scarring. A study involving volunteers examining many body areas seems ethically challenged. CONCLUSION The hypothesis, although not proven, is supported by available evidence. If our hypothesis that measurable cutaneous collagen orientation guided incisions improved scar formation then surgical incision planning would deservedly require more clinical attention. Preoperative measurement or at least pre-closure assessment of anisotropy prior to surgical incision placement or closure would notably reduce the incidence of hypertrophic scars.
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Affiliation(s)
- H O Rennekampff
- Dept of Plastic Surgery, Hand and Burn Surgery, RheinMaas Klinikum, Aachen/Wuerselen, Germany.
| | - M Tenenhaus
- Dept of Plastic Surgery, Hand and Burn Surgery, RheinMaas Klinikum, Aachen/Wuerselen, Germany
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Aydemir H, Saglam HS, Budak S, Kose O, Gokce A. Can proliferative hypertrophic scars of the median sternotomy incision predict the occurrence and characteristics of urethral stricture? Saudi Med J 2020; 40:701-706. [PMID: 31287131 PMCID: PMC6757202 DOI: 10.15537/smj.2019.7.24285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Objectives: To investigate the correlation between the characteristics of urethral stricture and incision scars in patients with urethral stricture and median sternotomy incision. Methods: We identified 368 patients who had undergone internal urethrotomy between January 2014 and December 2017. A total of 49 male patients with a median sternotomy scar and diagnosed with urethral stricture were retrospectively evaluated. The median sternotomy incision scars were assessed using the Vancouver Scar Scale (VSS) and the patients were divided into 2 groups. Group I consisted of patients with a VSS score of <4 points, and those with ≥4 points constituted group II. The groups were compared in terms of age, smoking habit, body mass index, diabetes mellitus, hypertension, urethral stricture etiology, length and localization, and stricture relapse after intervention. Results: The mean total VSS score was 2.0 points in group I and 7.46 points in group II. There was a significant correlation between the VSS total score and the urethral stricture length among the whole study population (correlation coefficient value=0.481; p<0.001). The urethral stricture was longer as the VSS score increased. Conclusion: A poorly healed median sternotomy incision scar can predict a poor wound healing in the urethra tissue. Further large scale, multi-center and prospective studies are needed to clarify this relationship.
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Affiliation(s)
- Huseyin Aydemir
- Department of Urology, Sakarya University, Education and Research Hospital, Sakarya, Turkey. E-mail.
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Chen J, Zhou R, Liang Y, Fu X, Wang D, Wang C. Blockade of lncRNA-ASLNCS5088-enriched exosome generation in M2 macrophages by GW4869 dampens the effect of M2 macrophages on orchestrating fibroblast activation. FASEB J 2019; 33:12200-12212. [PMID: 31373848 DOI: 10.1096/fj.201901610] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In hypertrophic scar (HS) formation, the type 2 immune response induces the alternatively activated macrophages (M2), which manipulate fibroblasts to differentiate into myofibroblasts with active biologic functions and proliferation. Myofibroblasts express α-smooth muscle actin (α-SMA) and synthesize and produce additional collagen type I and collagen type III, inducing HS formation. However, studies on the mechanism of M2 macrophage modulation are only based on the recognition of profibrotic factors such as TGF-β1 secreted by macrophages. The influence of exosomes from M2 macrophages on scar formation is still unknown. Both M2 macrophages and myofibroblasts highly express glutaminases (GLSs). GLS is a critical enzyme in glutaminolysis and is important for M2 macrophage and fibroblast polarization. In this study, we found that in a TGF-β1-stimulated coculture system, a long noncoding RNA (lncRNA) named lncRNA-ASLNCS5088 was enriched in M2 macrophage-derived exosomes. This lncRNA could be transferred with high efficiency to fibroblasts and acted as an endogenous sponge to adsorb microRNA-200c-3p, resulting in increased GLS and α-SMA expression. Pretreatment with GW4869, which impairs M2 macrophage exosome synthesis, ameliorated these pathologic changes in fibroblasts in vitro. Local injection in the late scar formation period with GW4869 reduced α-SMA+ fibroblasts and alleviated the fibrosis of tissue after wound healing in vivo.-Chen, J., Zhou, R., Liang, Y., Fu, X., Wang, D., Wang, C. Blockade of lncRNA-ASLNCS5088-enriched exosome generation in M2 macrophages by GW4869 dampens the effect of M2 macrophages on orchestrating fibroblast activation.
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Affiliation(s)
- Jialin Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Renpeng Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yimin Liang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiujun Fu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danru Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Rashaan ZM, Kwa KAA, van der Wal MBA, Tuinebreijer WE, van Zuijlen PPM, Breederveld RS. Patterns and predictors of burn scar outcome in the first 12 months after burn: The patient's perspective. Burns 2019; 45:1283-1290. [PMID: 31176509 DOI: 10.1016/j.burns.2019.03.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/22/2019] [Accepted: 03/26/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE This study aimed to provide insight into the patterns and factors that predict burn scar outcomes at 3, 6 and 12 months after burn. METHODS The Patient and Observer Scar Assessment Scale (POSAS) was used to assess the scar formation of each patient. Structural equation modelling was used. The predictor variables used in this study were sex, three age categories, TBSA, depth of the wound and cause of the burn. RESULTS The POSAS patient total and individual item scores demonstrated a statistically significant decrease in the first 12 months after burn, except for the relief item. Male patients had a lower total and items scores (better scar quality) for pain and pruritus compared with female patients. Full thickness burns had a higher scores for pruritus, pliability, thickness and relief compared to the partial-thickness burns. Ages younger than 5 years, higher TBSA values and flame burns were predictors of various POSAS items at 3 and 6 months after burn. CONCLUSION The POSAS patient total and individual item scores demonstrated a statistically significant improvement in the scar quality in the first 12 months after burn, except for the relief. Sex, age, depth of the wound, the percentage of TBSA and flame burns were predictors of various POSAS patient items at 3, 6 and 12 months after burn.
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Affiliation(s)
- Z M Rashaan
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - K A A Kwa
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - M B A van der Wal
- Association of Dutch Burn Centres, Zeestraat 27-29, 1941 AJ, Beverwijk, The Netherlands.
| | - W E Tuinebreijer
- Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
| | - P P M van Zuijlen
- Burn Centre and Department of Plastic and Reconstructive Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands; Department of Plastic and Reconstructive Surgery and MOVE Research Institute, VU University of Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - R S Breederveld
- Department of Surgery, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, Leiden, The Netherlands; Burn Centre and Department of Surgery, Red Cross Hospital, Vondellaan 13, 1942 LE, Beverwijk, The Netherlands.
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Kruglikov IL, Scherer PE. Caveolin-1 as a target in prevention and treatment of hypertrophic scarring. NPJ Regen Med 2019; 4:9. [PMID: 31044089 PMCID: PMC6486604 DOI: 10.1038/s41536-019-0071-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/02/2019] [Indexed: 12/11/2022] Open
Abstract
Reduced expression of caveolin-1 (Cav-1) is an important pathogenic factor in hypertrophic scarring (HTS). Such a reduction can be found in connection with the main known risk factors for HTS, including dark skin, female gender, young age, burn site and severity of the injury. The degree of overexpression of Cav-1 associated with different therapeutic options for HTS correlates with clinical improvements in HTS. This makes endo- or exogenous induction of Cav-1 not only an important therapeutic target for HTS, but also highlights its use as a preventive target to reduce or avoid HTS formation.
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Affiliation(s)
| | - Philipp E. Scherer
- Touchstone Diabetes Center, University of Texas Southwestern Medical Center, Dallas, TX 75390-8549 USA
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van de Kar AL, Koolbergen DR, van Avendonk JPH, van der Horst CMAM. Comparison of wound closure techniques in median sternotomy scars in children: subcuticular suture versus Steri-Strip™ S. J Plast Surg Hand Surg 2019; 53:161-166. [PMID: 30688134 DOI: 10.1080/2000656x.2019.1566737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The aim of this retrospective study was to compare subcuticular sutures and Steri-Strip™ S in closing median sternotomy incisions in children with regard to wound healing and scar formation. METHODS Fifty-three children and adolescents were enrolled in this study who all underwent a median sternotomy at age 0-18 years and had their presternal cutaneous wounds closed with either a running subcuticular suture (Group 1) or Steri-Strip™ S (Group 2). Their scars were assessed using the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcome measures were the scar measurements and the incidence of wound problems post-surgery. RESULTS A significant difference was found between both groups in median POSAS observer scale scores for the items thickness (p = .027), pliability (p = .045), surface area (p = .045) and the total score (p = .048). All in favor of the subcuticular suture group. There were no significant differences concerning the POSAS patient scale scores. Middle parts of scars of patients in Group 2 were significantly broader (p = .001) than scars of patients in Group 1. No significant differences concerning wound problems were found. CONCLUSIONS There are, according to our results, no significant differences in wound healing of median sternotomy incisions in children closed with either a subcuticular suture or Steri-Strip™ S. Significant differences do exist regarding scar formation and final cosmetic results of the scars, in favor of subcuticular closure.
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Affiliation(s)
- Annekatrien L van de Kar
- a Department of Plastic, Reconstructive and Hand Surgery , Amsterdam University Medical Centers, location AMC , Amsterdam , The Netherlands.,b Department of Plastic, Reconstructive and Hand Surgery , Onze Lieve Vrouwe Gasthuis Oost , Amsterdam , The Netherlands
| | - David R Koolbergen
- c Department of Cardiothoracic Surgery , Amsterdam University Medical Centers, location AMC , Amsterdam , The Netherlands.,d Department of Cardiothoracic Surgery , Leiden University Medical Center , Leiden , The Netherlands
| | - Janne P H van Avendonk
- a Department of Plastic, Reconstructive and Hand Surgery , Amsterdam University Medical Centers, location AMC , Amsterdam , The Netherlands
| | - Chantal M A M van der Horst
- a Department of Plastic, Reconstructive and Hand Surgery , Amsterdam University Medical Centers, location AMC , Amsterdam , The Netherlands
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Wallace HJ, Cadby G, Melton PE, Wood FM, Falder S, Crowe MM, Martin LJ, Marlow K, Ward SV, Fear MW. Genetic influence on scar height and pliability after burn injury in individuals of European ancestry: A prospective cohort study. Burns 2018; 45:567-578. [PMID: 30595539 DOI: 10.1016/j.burns.2018.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/15/2018] [Accepted: 10/04/2018] [Indexed: 12/26/2022]
Abstract
After similar extent of injury there is considerable variability in scarring between individuals, in part due to genetic factors. This study aimed to identify genetic variants associated with scar height and pliability after burn injury. An exome-wide array association study and gene pathway analysis were performed on a prospective cohort of 665 patients treated for burn injury. Outcomes were scar height (SH) and scar pliability (SP) sub-scores of the modified Vancouver Scar Scale (mVSS). DNA was genotyped using the Infinium® HumanCoreExome-24 BeadChip. Associations between genetic variants (single nucleotide polymorphisms) and SH and SP were estimated using an additive genetic model adjusting for age, sex, number of surgical procedures and % total body surface area of burn in subjects of European ancestry. No individual genetic variants achieved the cut-off threshold of significance. Gene regions were analysed for spatially correlated single nucleotide polymorphisms and significant regions identified using comb-p software. This gene list was subject to gene pathway analysis to find which biological process terms were over-represented. Using this approach biological processes related to the nervous system and cell adhesion were the predominant gene pathways associated with both SH and SP. This study suggests genes associated with innervation may be important in scar fibrosis. Further studies using similar and larger datasets will be essential to validate these findings.
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Affiliation(s)
- Hilary J Wallace
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; School of Medicine, The University of Notre Dame Australia, Fremantle, Australia.
| | - Gemma Cadby
- Centre for Genetic Origins of Health and Disease, Faculty of Health and Medical Sciences, The University of Western Australia and Faculty of Health Science, Curtin University, Perth, Australia
| | - Phillip E Melton
- Centre for Genetic Origins of Health and Disease, Faculty of Health and Medical Sciences, The University of Western Australia and Faculty of Health Science, Curtin University, Perth, Australia; School of Pharmacy and Biomedical Sciences, Faculty of Health Science, Curtin University, Perth, Australia
| | - Fiona M Wood
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia; Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, Australia
| | - Sian Falder
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Margaret M Crowe
- Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, Australia
| | - Lisa J Martin
- Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, Australia
| | - Karen Marlow
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Sarah V Ward
- Centre for Genetic Origins of Health and Disease, Faculty of Health and Medical Sciences, The University of Western Australia and Faculty of Health Science, Curtin University, Perth, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Australia
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Li P, Li-Tsang CWP, Deng X, Wang X, Wang H, Zhang Y, Tan Z, He C. The recovery of post-burn hypertrophic scar in a monitored pressure therapy intervention programme and the timing of intervention. Burns 2018; 44:1451-1467. [DOI: 10.1016/j.burns.2018.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 12/09/2017] [Accepted: 01/08/2018] [Indexed: 12/14/2022]
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The Cellular Response of Keloids and Hypertrophic Scars to Botulinum Toxin A: A Comprehensive Literature Review. Dermatol Surg 2018; 44:149-157. [PMID: 29401161 DOI: 10.1097/dss.0000000000001360] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Keloids and hypertrophic scars are conditions of pathologic scarring characterized by fibroblast hyperproliferation and excess collagen deposition. These conditions significantly impact patients by causing psychosocial, functional, and aesthetic distress. Current treatment modalities have limitations. Clinical evidence indicates that botulinum toxin A (BoNT-A) may prevent and treat keloids and hypertrophic scars. OBJECTIVE To examine investigated cellular pathways involved in BoNT-A therapeutic modulation of keloids and hypertrophic scars. METHODS The authors searched PubMed, Embase, and Web of Science for basic science articles related to botulinum toxin therapy, scarring, fibroblasts, keloids, and hypertrophic scars. RESULTS Eleven basic science articles involving keloids and hypertrophic scars were reviewed. DISCUSSION BoNT-A may reduce skin fibrosis by decreasing fibroblast proliferation, modulating the activity of transforming growth factor-β, and reducing transcription and expression of profibrotic cytokines in keloid-derived and hypertrophic scar-derived dermal fibroblasts. BoNT-A may modulate collagen deposition, but there is a paucity of evidence regarding specific mechanisms of action. CONCLUSION Overall, BoNT-A has the potential to prevent or treat pathologic scars in patients with a known personal or family history of keloids and hypertrophic scars, which may improve patient psychosocial distress and reduce clinic visits and health care costs. Variability in keloid and hypertrophic scar response to BoNT-A may be due to interexperiment differences in dosing, tissue donors, and assay sensitivity.
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Qu R, Guo Y, Hu X, Luo L, Liu D. Endoscopic Thyroid Surgeries via Areola Approach: Experience and Outcomes of 500 Cases in a Single Institute. Indian J Surg 2018. [DOI: 10.1007/s12262-018-1758-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Wei Y, Wang Y, Zhang M, Yan G, Wu S, Liu W, Ji G, Li-Tsang CW. The application of 3D-printed transparent facemask for facial scar management and its biomechanical rationale. Burns 2018; 44:453-461. [DOI: 10.1016/j.burns.2017.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/17/2017] [Accepted: 08/09/2017] [Indexed: 11/30/2022]
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31
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Prospective case-control trial evaluating silicone gel for the treatment of direct brow lift scars. Can J Ophthalmol 2018; 53:29-33. [DOI: 10.1016/j.jcjo.2017.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 07/04/2017] [Accepted: 07/19/2017] [Indexed: 11/17/2022]
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Wang L, Yang J, Ran B, Yang X, Zheng W, Long Y, Jiang X. Small Molecular TGF-β1-Inhibitor-Loaded Electrospun Fibrous Scaffolds for Preventing Hypertrophic Scars. ACS APPLIED MATERIALS & INTERFACES 2017; 9:32545-32553. [PMID: 28875694 DOI: 10.1021/acsami.7b09796] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Hypertrophic scarring (HS) is a disorder that occurs during wound healing and seriously depresses the quality of human life. Scar-inhibiting scaffolds, though bringing promise to HS prevention, face problems such as the incompatibility of the scaffold materials and the instability of bioactive molecules. Herein, we present a TGF-β1-inhibitor-doped poly(ε-caprolactone) (PCL)/gelatin (PG) coelectrospun nanofibrous scaffold (PGT) for HS prevention during wound healing. The appropriate ratio of PCL to gelatin can avoid individual defects of the two materials and achieve an optimized mechanical property and biocompatibility. The TGF-β1 inhibitor (SB-525334) is a small molecule and is highly stable during electrospinning and drug release processes. The PGT effectively inhibits fibroblast (the major cell type contributing to scar formation) proliferation in vitro and successfully prevents HS formation during the healing of full-thickness model wounds on rabbit ear. Our strategy offers an excellent solution for potential large-scale production of scaffolds for clinical HS prevention.
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Affiliation(s)
- Le Wang
- Collaborative Innovation Center for Nanomaterials & Devices, College of Physics, Qingdao University , Qingdao 266071, China
- CAS Center of Excellence for Nanoscience, Beijing Engineering Research Center for BioNanotechnology, CAS Key Lab for Biological Effects of Nanomaterials and Nanosafety, National Center for NanoScience and Technology , Beijing, 100190, China
| | - Junchuan Yang
- CAS Center of Excellence for Nanoscience, Beijing Engineering Research Center for BioNanotechnology, CAS Key Lab for Biological Effects of Nanomaterials and Nanosafety, National Center for NanoScience and Technology , Beijing, 100190, China
| | - Bei Ran
- CAS Center of Excellence for Nanoscience, Beijing Engineering Research Center for BioNanotechnology, CAS Key Lab for Biological Effects of Nanomaterials and Nanosafety, National Center for NanoScience and Technology , Beijing, 100190, China
| | - Xinglong Yang
- CAS Center of Excellence for Nanoscience, Beijing Engineering Research Center for BioNanotechnology, CAS Key Lab for Biological Effects of Nanomaterials and Nanosafety, National Center for NanoScience and Technology , Beijing, 100190, China
- University of Chinese Academy of Sciences , Beijing, 100049, China
| | - Wenfu Zheng
- CAS Center of Excellence for Nanoscience, Beijing Engineering Research Center for BioNanotechnology, CAS Key Lab for Biological Effects of Nanomaterials and Nanosafety, National Center for NanoScience and Technology , Beijing, 100190, China
| | - Yunze Long
- Collaborative Innovation Center for Nanomaterials & Devices, College of Physics, Qingdao University , Qingdao 266071, China
| | - Xingyu Jiang
- CAS Center of Excellence for Nanoscience, Beijing Engineering Research Center for BioNanotechnology, CAS Key Lab for Biological Effects of Nanomaterials and Nanosafety, National Center for NanoScience and Technology , Beijing, 100190, China
- University of Chinese Academy of Sciences , Beijing, 100049, China
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Wei Y, Li-Tsang CW, Liu J, Xie L, Yue S. 3D-printed transparent facemasks in the treatment of facial hypertrophic scars of young children with burns. Burns 2017; 43:e19-e26. [DOI: 10.1016/j.burns.2016.08.034] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 08/24/2016] [Accepted: 08/31/2016] [Indexed: 11/27/2022]
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Zhao J, Shu B, Chen L, Tang J, Zhang L, Xie J, Liu X, Xu Y, Qi S. Prostaglandin E2 inhibits collagen synthesis in dermal fibroblasts and prevents hypertrophic scar formation in vivo. Exp Dermatol 2016; 25:604-10. [PMID: 26997546 DOI: 10.1111/exd.13014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 01/07/2023]
Abstract
Hypertrophic scarring is a common dermal fibroproliferative disorder characterized by excessive collagen deposition. Prostaglandin E2 (PGE2 ), an important inflammatory product synthesized via the arachidonic acid cascade, has been shown to act as a fibroblast modulator and to possess antifibroblastic activity. However, the mechanism underlying the antifibrotic effect of PGE2 remains unclear. In this study, we explored the effects of PGE2 on TGF-β1-treated dermal fibroblasts in terms of collagen production and to determine the regulatory pathways involved, as well as understand the antiscarring function of PGE2 in vivo. We found that PGE2 inhibited TGF-β1-induced collagen synthesis by regulating the balance of matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinase (TIMP). It did so by upregulating cAMP through the E prostanoid (EP)2 receptor. We determined that inhibition of the TGF-β1/Smad pathway by PGE2 is associated with its ability to inhibit collagen synthesis. An in vivo study further confirmed that PGE2 inhibits hypertrophic scar formation by decreasing collagen production. Our results demonstrate that the novel anti-scarring function of PGE2 is achieved by balancing MMPs/TIMP expression and decreasing collagen production.
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Affiliation(s)
- Jingling Zhao
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bin Shu
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lei Chen
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinming Tang
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lijun Zhang
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Julin Xie
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xusheng Liu
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yingbin Xu
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaohai Qi
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Lee KC, Dretzke J, Grover L, Logan A, Moiemen N. A systematic review of objective burn scar measurements. BURNS & TRAUMA 2016; 4:14. [PMID: 27574684 PMCID: PMC4964074 DOI: 10.1186/s41038-016-0036-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/29/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Problematic scarring remains a challenging aspect to address in the treatment of burns and can significantly affect the quality of life of the burn survivor. At present, there are few treatments available in the clinic to control adverse scarring, but experimental pharmacological anti-scarring strategies are now beginning to emerge. Their comparative success must be based on objective measurements of scarring, yet currently the clinical assessment of scars is not carried out systematically and is mostly based on subjective review of patients. However, several techniques and devices are being introduced that allow objective analysis of the burn scar. The aim of this article is to evaluate various objective measurement tools currently available and recommend a useful panel that is suitable for use in clinical trials of anti-scarring therapies. METHODS A systematic literature search was done using the Web of Science, PubMed and Cochrane databases. The identified devices were then classified and grouped according to the parameters they measured. The tools were then compared and assessed in terms of inter- and intra-rater reproducibility, ease of use and cost. RESULTS After duplicates were removed, 5062 articles were obtained in the search. After further screening, 157 articles which utilised objective burn scar measurement systems or tools were obtained. The scar measurement devices can be broadly classified into those measuring colour, metric variables, texture, biomechanical properties and pathophysiological disturbances. CONCLUSIONS Objective scar measurement tools allow the accurate and reproducible evaluation of scars, which is important for both clinical and scientific use. However, studies to evaluate their relative performance and merits of these tools are scarce, and there remain factors, such as itch and pain, which cannot be measured objectively. On reviewing the available evidence, a panel of devices for objective scar measurement is recommended consisting of the 3D cameras (Eykona/Lifeviz/Vectra H1) for surface area and volume, DSM II colorimeter for colour, Dermascan high-frequency ultrasound for scar thickness and Cutometer for skin elasticity and pliability.
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Affiliation(s)
- Kwang Chear Lee
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, B15 2TH UK
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Janine Dretzke
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Liam Grover
- School of Chemical Engineering, University of Birmingham, Birmingham, B15 2TT UK
| | - Ann Logan
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Naiem Moiemen
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, B15 2TH UK
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Xie Q, Wang P, Yan H, Wang Y. Feasibility and Effectiveness of Intraoperative Nerve Monitoring in Total Endoscopic Thyroidectomy for Thyroid Cancer. J Laparoendosc Adv Surg Tech A 2016; 26:109-15. [PMID: 26690784 DOI: 10.1089/lap.2015.0401] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Qiuping Xie
- Department of Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Ping Wang
- Department of Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Haichao Yan
- Department of Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Yong Wang
- Department of Surgery, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
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Bilateral areolar approach endoscopic thyroidectomy for low-risk papillary thyroid carcinoma: a review of 137 cases [corrected]. Surg Laparosc Endosc Percutan Tech 2015; 25:19-22. [PMID: 25635670 DOI: 10.1097/sle.0b013e3182a50f1f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to analyze the clinicopathologic characteristics and postoperative outcomes and to evaluate the feasibility of the bilateral areolar approach (BAA) endoscopic thyroidectomy for low-risk papillary thyroid carcinoma (PTC). MATERIALS AND METHODS From January 2012 to February 2013, 137 low-risk PTC patients underwent BAA endoscopic thyroidectomy. Their clinicopathologic characteristics and postoperative outcomes (postoperative cosmetic satisfaction, type of thyroidectomy, number of lymph nodes, postoperative complications, and recurrence of disease) were analyzed. RESULTS The 137 patients comprised 135 female and 2 male individuals. The average age of patients was 32.02±8.32 years. The mean tumor size was 0.82±0.41 cm. The ratio of minimal extrathyroidal extension patients was 1:19.6. According to the American Joint Committee on Cancer tumor stage, 132 cases were stage I and 5 cases were stage III. The mean follow-up period was 7.80±3.86 months (range, 3 to 15 mo, and median, 7 mo). At 3 months, postoperatively, patients were very satisfied with the cosmetic result as evaluated by a 10-point visual analogue scale (9.14±1.17). After surgery, the mean number of lymph nodes was 5.70±2.92, whereas the mean number of lymph node metastases was 1.06±1.96. Regarding the major postoperative complications, the rates of transient recurrent laryngeal nerve palsy and transient hypoparathyroidism were 4.4% and 27.7%, respectively. None of the patients experienced a thyroid cancer-related death or recurrence. CONCLUSIONS BAA is feasible and safe for the treatment of low-risk PTC patients, with favorable cosmesis. Thus, it is an alternative therapeutic treatment for selected patients with low-risk PTC. However, oncologic safety of BAA thyroidectomy for PTC patients needs to be verified by a large comparative series and long-term follow-up.
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Aesthetic assessment in periciliary "v-incision" versus conventional external dacryocystorhinostomy in Asians. Graefes Arch Clin Exp Ophthalmol 2015; 253:1783-90. [PMID: 26156681 DOI: 10.1007/s00417-015-3098-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 06/21/2015] [Accepted: 06/22/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To determine the functional and aesthetic outcomes of periciliary "v-incision" external dacryocystorhinostomy (DCR) and to compare with conventional approach. METHOD Charts review of consecutive cases of "v-incision" (VDCR) or conventional DCR performed in a single institute, between January 2007 and March 2014. All procedures were performed or supervised by a single surgeon. Two periciliary incisions were made near the skin-mucosal junction at the upper and lower eyelid margins medial to the punctum joining at the medial canthal angle to form a "v" shape. Subcutaneous dissection was carried out inferomedially to reach the anterior lacrimal crest. DCR was then performed in the usual manner. Functional success was defined as no persistent or recurrent epiphora and patency on irrigation of the lacrimal drainage system at least 6 months post-surgery. A cross-sectional aesthetic survey was conducted by asking the patients to rate their scar appearance satisfaction on a visual analogue scale (VAS). External photographs were graded by two independent, masked physicians using VAS as well as the Stony Brook scar evaluation scale (SBSES). RESULTS Sixty-one patients with median age of 64 years met the inclusion criteria, with median follow-up duration of 28 months. Thirty-eight eyes underwent VDCR, and 23 had conventional DCR. The functional success rate for VDCR was 83.3, 95 % confidence intervals (95%CI) [lower 0.68, upper 0.92] and for conventional DCR was 73.9 %, 95%CI [lower 0.54, upper 0.87]; without statistically significant difference (p = 0.38). VDCR patients rated higher aesthetic outcome on VAS (mean scores 95.5 ± 16.8 vs 82.9 ± 25.1, p = 0.03). On the SBSES, both observers gave higher aesthetic scores to the VDCR group (observer #1 4.6 ± 1.1 and #2 4.7 ± 1.2, p < 0.01) than conventional DCR (observer #1 3.1 ± 2.8 and #2 2.8 ± 2.1, p < 0.01). More patients reported that they could wear spectacles within 1 week post-VDCR (44.7 vs 4.3 %, p < 0.01). CONCLUSION "V-incision" external DCR has a similar functional success rate to that of the conventional approach and has superior aesthetic outcomes as reported by surgeons and patients. However, a higher proportion of trainees under supervision performed conventional DCR, and it is uncertain whether the outcomes were also influenced by the level of surgeon's expertise.
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Leszczynski R, da Silva CAP, Kuczynski U, da Silva EMK. Laser therapy for treating hypertrophic and keloid scars. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Rafael Leszczynski
- Inderma; Department of Dermatology; Avenida Sao Paulo, 1061 - Sala 1418 Maringa Parana Brazil 87013-040
| | - Carolina AP da Silva
- Universidade Federal de São Paulo; Department of Dermatology; Rua Borges Lagoa 564 conj 64 São Paulo São Paulo Brazil 04038-000
| | - Uliana Kuczynski
- Street/Address:Pedro Rolim de Moura, 25, aptº 202, Alto da Glória Curitiba Paraná Brazil 80030-250
| | - Edina MK da Silva
- Universidade Federal de São Paulo; Emergency Medicine and Evidence Based Medicine; Rua Borges Lagoa 564 cj 64 Vl. Clementino São Paulo São Paulo Brazil 04038-000
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Modified Condylar Distraction Osteogenesis via Single Preauricular Incision for Treatment of Temporomandibular Joint Ankylosis. J Craniofac Surg 2015; 26:509-11. [DOI: 10.1097/scs.0000000000001291] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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A histological study on the effect of pressure therapy on the activities of myofibroblasts and keratinocytes in hypertrophic scar tissues after burn. Burns 2015; 41:1008-16. [PMID: 25681960 DOI: 10.1016/j.burns.2014.11.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 11/12/2014] [Accepted: 11/25/2014] [Indexed: 12/11/2022]
Abstract
Although pressure therapy (PT) has been widely used as the first-line treatment for hypertrophic scars (HS), the histopathological changes involved have seldom been studied. This study aimed to examine the longitudinal effect of PT on the histopathological changes in HS. Ten scar samples were selected from six patients with HS after burn and they were given a standardized PT intervention for 3 months while 16 scar samples were obtained on those without PT. The scar biopsies were collected pre-treatment, 1 and 3 months post-intervention for both clinical and histopathological examinations. Clinical assessments demonstrated significant improvement in the thickness and redness of the scars after PT. Histological examination revealed that cell density in the dermal layer was markedly reduced in the 3-months post-pressurized scar tissues, while the arrangement of the collagen fiber was changed from nodular to wave-like pattern. The α-smooth muscle actin immunoreactivity was significantly decreased after 1-month pressure treatment. There was a significant reduction of myofibroblasts population and a concomitant increase in the apoptotic index in the dermal layer in the 3-months' post-pressurized scars. A significant negative correlation was found between the myofibroblasts population and the apoptotic index. The keratinocyte proliferation was found inhibited after PT. Results demonstrated that PT appeared to promote HS maturation by inhibiting the keratinocyte proliferation and suppressing myofibroblasts population, the latter possibly via apoptosis.
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Nedelec B, Correa JA, de Oliveira A, LaSalle L, Perrault I. Longitudinal burn scar quantification. Burns 2014; 40:1504-12. [PMID: 24703337 DOI: 10.1016/j.burns.2014.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 02/28/2014] [Accepted: 03/06/2014] [Indexed: 12/24/2022]
Abstract
Quantitative studies of the clinical recovery of burn scars are currently lacking. Previous reports validate the objective, precise, diagnostic capabilities of high-frequency ultrasound to measure thickness, the Cutometer(®) to measure pliability and the Mexameter(®) to measure erythema and pigmentation of scars. Thus, we prospectively quantified clinical characteristics of patient-matched, after burn hypertrophic scar (HSc), donor site scar (D) and normal skin (N) using these instruments. One investigator measured 3 sites (HSc, D, N) in 46 burn survivors at 3, 6, and 12 months after-burn. A mixed model regression analysis, adjusting p-values for multiplicity of testing, was used to compare means among sites and time points. Participants were 41.2±13.5 years old, 87% males, predominantly Caucasian, with an average of 19.5% body surface area burned. HSc thickness decreased significantly between 3 and 6, 6 and 12, and 3 and 12 months (all p<0.0001), but remained thicker than D and N skin (all p<0.0001). Pliability differed significantly between HSc, D and N sites at all time points (all p<0.0001), with HSc and D increasing between 3 and 12 months (p<0.05) but not reaching normal. HSc and D sites were significantly more erythematous than normal skin (p<0.05) at 3 and 6 months but D sites approached normal by 12 months. The only time points at which pigmentation significantly differed were the HSc and D sites at 6 months. Thickness, pliability, erythema and pigmentation of N skin remained similar over the 12 months. We found that post-burn HSc thickness, pliability and erythema differed significantly from D and N skin at 3, 6, and 12 months and does not return to normal by 12 months after-injury; however, significant improvements towards normal can be expected. Donor sites are redder than normal skin at 3 and 6 months but can be expected to return to normal by 12 months. Although the color of HSc and D sites change markedly with time these color changes are primarily due to changes in redness of the site, not melanin in this primarily Caucasian population.
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Affiliation(s)
- Bernadette Nedelec
- School of Physical and Occupational Therapy, McGill University, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Canada; Hôpital de réadaptation Villa Medica, Canada.
| | - José A Correa
- Department of Mathematics and Statistics, McGill University, Montreal, Quebec, Canada
| | - Ana de Oliveira
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Canada; Hôpital de réadaptation Villa Medica, Canada
| | - Leo LaSalle
- Hôpital de réadaptation Villa Medica, Canada
| | - Isabelle Perrault
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Canada
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Cho YS, Jeon JH, Hong A, Yang HT, Yim H, Cho YS, Kim DH, Hur J, Kim JH, Chun W, Lee BC, Seo CH. The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: a randomized controlled trial. Burns 2014; 40:1513-20. [PMID: 24630820 DOI: 10.1016/j.burns.2014.02.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 02/01/2014] [Accepted: 02/09/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn. METHOD One hundred and forty-six burn patients with hypertrophic scar(s) were randomly divided into an experimental group and a control group. All patients received standard rehabilitation therapy for hypertrophic scars and 76 patients (massage group) additionally received burn scar rehabilitation massage therapy. Both before and after the treatment, we determined the scores of visual analog scale (VAS) and itching scale and assessed the scar characteristics of thickness, melanin, erythema, transepidermal water loss (TEWL), sebum, and elasticity by using ultrasonography, Mexameter(®), Tewameter(®), Sebumeter(®), and Cutometer(®), respectively. RESULTS The scores of both VAS and itching scale decreased significantly in both groups, indicating a significant intragroup difference. With regard to the scar characteristics, the massage group showed a significant decrease after treatment in scar thickness, melanin, erythema, TEWL and a significant intergroup difference. In terms of scar elasticity, a significant intergroup difference was noted in immediate distension and gross skin elasticity, while the massage group significant improvement in skin distensibility, immediate distension, immediate retraction, and delayed distension. CONCLUSION Our results suggest that burn rehabilitation massage therapy is effective in improving pain, pruritus, and scar characteristics in hypertrophic scars after burn.
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Affiliation(s)
- Yoon Soo Cho
- Department of Rehabilitation Medicine, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
| | - Jong Hyun Jeon
- Department of Rehabilitation Medicine, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea
| | - Aram Hong
- Hallym University Burn Institute, Seoul, Republic of Korea
| | - Hyeong Tae Yang
- Department of Burn Surgery, Hallym Burn Center, Seoul, Republic of Korea
| | - Haejun Yim
- Department of Burn Surgery, Hallym Burn Center, Seoul, Republic of Korea
| | - Yong Suk Cho
- Department of Burn Surgery, Hallym Burn Center, Seoul, Republic of Korea
| | - Do-Hern Kim
- Department of Burn Surgery, Hallym Burn Center, Seoul, Republic of Korea
| | - Jun Hur
- Department of Burn Surgery, Hallym Burn Center, Seoul, Republic of Korea
| | - Jong Hyun Kim
- Department of Burn Surgery, Hallym Burn Center, Seoul, Republic of Korea
| | - Wook Chun
- Hallym University Burn Institute, Seoul, Republic of Korea; Department of Burn Surgery, Hallym Burn Center, Seoul, Republic of Korea
| | - Boung Chul Lee
- Department of Psychiatry, Hallym Burn Center, Seoul, Republic of Korea
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Burn Center, Hangang Sacred Heart Hospital, Hallym University Medical Center, Seoul, Republic of Korea; Hallym University Burn Institute, Seoul, Republic of Korea.
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In vivo inhibition of hypertrophic scars by implantable ginsenoside-Rg3-loaded electrospun fibrous membranes. Acta Biomater 2013; 9:9461-73. [PMID: 23938200 DOI: 10.1016/j.actbio.2013.07.040] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 07/25/2013] [Accepted: 07/31/2013] [Indexed: 12/15/2022]
Abstract
Clinically, hypertrophic scarring (HS) is a major concern for patients and has been a challenge for surgeons, as there is a lack of treatments that can intervene early in the formation of HS. This study reports on a Chinese drug, 20(R)-ginsenoside Rg3 (GS-Rg3), which can inhibit in vivo the early formation of HS and later HS hyperplasia by inducing the apoptosis of fibroblasts, inhibiting inflammation and down-regulating VEGF expression. Implantable biodegradable GS-Rg3-loaded poly(l-lactide) (PLA) fibrous membranes were successfully fabricated using co-electrospinning technology to control drug release and improve drug utilization. The in vivo releasing time of GS-Rg3 lasts for 3 months, and the drug concentration released in rabbits can be controlled by varying the drug content of the electrospun fibers. Histological observations of HE staining indicate that GS-Rg3/PLA significantly inhibits the HS formation, with obvious improvements in terms of dermis layer thickness, epidermis layer thickness and fibroblast proliferation. The results of immunohistochemistry staining and Masson's trichrome staining demonstrate that GS-Rg3/PLA electrospun fibrous membranes significantly inhibit HS formation, with decreased expression of collagen fibers and microvessels. VEGF protein levels are much lower in the group treated with GS-Rg3/PLA eletrospun membranes compared with other groups. These results demonstrate that GS-Rg3 is a novel drug, capable of inhibiting the early formation of HS and later HS hyperplasia. GS-Rg3/PLA electrospun membrane is a very promising new treatment for early and long-term treatment of HS.
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Ling XF, Peng X, Samman N. Donor-site morbidity of free fibula and DCIA flaps. J Oral Maxillofac Surg 2013; 71:1604-12. [PMID: 23810616 DOI: 10.1016/j.joms.2013.03.006] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 02/18/2013] [Accepted: 03/05/2013] [Indexed: 11/18/2022]
Abstract
PURPOSE This study evaluated and compared the long-term donor-site morbidity of the free fibula flap with the deep circumflex iliac artery (DCIA) flap in maxillofacial reconstruction. MATERIALS AND METHODS Thirty-four patients (19 in the fibula group and 15 in the DCIA group) were evaluated for long-term morbidity. All clinical data were analyzed, including primary disease, type of defect, type of flap, length of bone harvested, total blood loss, operating time, length of hospitalization, and postoperative unaided gait. Subjective evaluation included cosmesis, function, and pain. Objective evaluation included physical examination, neurosensory assessment, Stony Brook Scar Evaluation, gait assessment, and goniometric measurement of range of movement. RESULTS In the subjective evaluation, no significant differences in cosmetic outcome, functional loss, wound healing, or pain between the 2 groups were noted (P > .05). However, neurosensory deficit was worse in the DCIA group (P ≤ .05). In the objective evaluation, 4 patients (27%) in the DCIA group had neurosensory deficit in the lateral thigh region. The DCIA group had a better Stony Brook Scar score (median, 5) than the fibula group (median, 4; P ≤ .05). However, there was no difference in walking ability between the 2 groups (P > .05). Goniometric measurement showed a significant difference between the operated and unoperated sites in the 2 groups; however, it was not severe enough in either group to affect patients' function. In the fibula group, 7 patients (38.9%) had claw toe deformity and 2 patients (12.1%) had weakness of the great toe, and the mean American Orthopedic Foot and Ankle Society score was 96.89. In the DCIA group, 1 patient (8.3%) had a hernia and the mean Harris Hip score was 98.33. CONCLUSION Given that these 2 options present donor-site concerns, the authors consider the fibula free flap the first choice for maxillofacial reconstruction in most cases and the DCIA free flap a reliable complementary flap in selected patients.
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Affiliation(s)
- Xiao Feng Ling
- Oral Surgery, Hospital Kulim, Ministry of Health, Kedah, Malaysia
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Karimi H, Mobayen M, Alijanpour A. Management of Hypertrophic Burn Scar: A Comparison between the Efficacy of Exercise-Physiotherapy and Pressure Garment-Silicone on Hypertrophic Scar. Asian J Sports Med 2013; 4:70-5. [PMID: 23785579 PMCID: PMC3685163 DOI: 10.5812/asjsm.34536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 08/05/2012] [Indexed: 11/17/2022] Open
Abstract
Purpose Our study aims to investigate the effectiveness of other treatment methods for burn related scarring and to determine the possibility of their routine administration in similar clinical settings. Methods Through a prospective study, 66 patients were enrolled to receive either the conventional pressure garment therapy (PGT) and Silicone (control group) or exercise and physiotherapy (case group). Patients were visited regularly to be examined for the status of their scars’ regression, limbs’ dysfunction, and joint motion. Then, these two groups were compared to determine the efficacy of exercise and physiotherapy as an alternative to the conventional treatment with PGT. Results After about 20 months follow-up, decreased articular range of motion (ROM) was: 16 (51.5%) cases compared to 5 (15%) of controls had mild, 11 (35.5%) of the cases compared to 13 (39.5%) of the controls had moderate; and 4 (13%) of the cases compared to 15 (45.5%) of the controls had severe decreased ROM which revealed statistically significant difference (P<0.01). At the same time, Vancouver Scar Scale score was: 15 (48%) of the cases and 6 (18%) of the controls had mild Scar Scale, 12 (39%) of the cases and 14 (42.5%) of the controls had moderate score and 4 (3%) of the cases and 13 (39.5%) of the controls had severe score which revealed a statistically significant difference (P<0.05). Conclusion Our study showed that physical therapy andexercise are more effective than PGT, in management of burn hypertrophic scar, hence could be an alternative in cases that conventional therapy cannot be used for any reason.
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Affiliation(s)
- Hamid Karimi
- Department of Plastic and Reconstructive Surgery, Motahari Burn Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammadreza Mobayen
- Burn Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Address: Burn Research Center of Tehran, Motahri Burn Hospital, Shahid Yasami Street, Vali e asr street, Tehran, Iran.
| | - Aboulhasan Alijanpour
- Department of Plastic and Reconstructive Surgery, Motahari Burn Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Li J, Li-Tsang C, Huang Y, Chen Y, Zheng Y. Detection of changes of scar thickness under mechanical loading using ultrasonic measurement. Burns 2013; 39:89-97. [DOI: 10.1016/j.burns.2012.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Revised: 05/11/2012] [Accepted: 05/21/2012] [Indexed: 11/28/2022]
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Lee TJ, Jeong WS, Eom JS, Kim EK. Adjuvant chemotherapy reduces the incidence of abdominal hypertrophic scarring following immediate TRAM breast reconstruction. Breast Cancer Res Treat 2013; 137:767-71. [PMID: 23283525 DOI: 10.1007/s10549-012-2394-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 12/17/2012] [Indexed: 11/25/2022]
Abstract
Among the many factors that affect the degree of completion and satisfaction of breast reconstruction, the scarring is one issue that a surgeon cannot completely control. We hypothesized that the administration of cytotoxic drugs following the immediate breast reconstruction using transverse rectus abdominis musculocutaneous (TRAM) flap might affect the process of scarring, thus resulting in reduced incidence of hypertrophic scarring at the donor site. Data have been collected from 1,000 consecutive patients between July 2001 and December 2009. The relationship between the adjuvant chemotherapy and the incidence of hypertrophic scarring was studied, and the influence of other presumed risk factors was analyzed. The incidence of hypertrophic scarring was 18.6 % (75 of 404) in the non-CTX group and 3.8 % (20 of 530) in the CTX group. Univariate analysis using logistic regression modeling confirmed the statistical significance of the reducing effect of chemotherapy on the incidence of hypertrophic scarring (p < 0.001; OR: 0.172). The incidence of donor-site hypertrophic scarring following immediate TRAM breast reconstruction was found in nearly 20 % of the patients without chemotherapy, showing a significant difference from the patients with chemotherapy. We believe that Asian patients who undergo immediate TRAM breast reconstruction without chemotherapy are a high-risk group that is prone to hypertrophic scarring, requiring active preventive measures.
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Affiliation(s)
- Taik Jong Lee
- Department of Plastic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Pungnap-2 dong, Songpa gu, Seoul, Korea
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Jenwitheesuk K, Surakunprapha P, Jenwitheesuk K, Kuptarnond C, Prathanee S, Intanoo W. Role of silicone derivative plus onion extract gel in presternal hypertrophic scar protection: a prospective randomized, double blinded, controlled trial. Int Wound J 2012; 9:397-402. [PMID: 22168750 PMCID: PMC7950361 DOI: 10.1111/j.1742-481x.2011.00898.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Use of silicone derivative and onion extract had been reported in the prevention of hypertrophic scarring. Our experience showed the preventive use of silicone derivative plus onion extract gel on hypertrophic scars after median sternotomy. In a randomized, double blinded, placebo-controlled study, 60 patients after median sternotomy incisions were separated into two groups. All patients were treated either with silicone derivative plus onion extract gel (Cybele(®) scagel) or placebo gel twice daily for a total treatment period of 12 weeks. During each visit, pain and itching scores were graded by the patients and scar characteristics were observed by surgeons using the Vancouver scar scale. Pain and itch score values from patients' who applied silicone derivative plus onion extract gel was less than another group (P < 0·05). Pigmentation was significantly different between two groups (P < 0·05) and the reduction of scores on vascularity, pliability, height in treated group was not superior to the untreated group. No adverse events were reported by any of the patients. A silicone derivative plus onion extract gel is safe and effective for the preventing the hypertrophic scarring after median sternotomy.
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Affiliation(s)
- Kamonwan Jenwitheesuk
- Division of plastic surgery, Department of Surgery, Faculty of Medicine, Khon Kaen University, Muang, Khon Kaen, Thailand.
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