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Bueno A, Nevado-Sanchez E, Pardo-Hernández R, de la Fuente-Anuncibay R, González-Bernal JJ. Treatment and Improvement of Healing after Surgical Intervention. Healthcare (Basel) 2023; 11:2213. [PMID: 37570454 PMCID: PMC10418496 DOI: 10.3390/healthcare11152213] [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: 06/10/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
The development of abnormal scars has a great impact on people's well-being, and improving scarring outcomes after surgery is a field that currently lacks consensus. This review aims to identify newly researched approaches to improving the quality of surgical scars. A systematic search of PubMed, Scopus, Web of Science, and ScienceDirect was conducted between 13 May 2023 and 17 May 2023, in accordance with the recommendations of the PRISMA Statement. Study selection and analysis of methodological quality were performed in parts, independently and blindly, based on eligibility criteria. The 21 prospective, comparative, and randomized studies reviewed included 1057 subjects and studied approaches such as topical applications of creams with herbal extracts and silicone gels, growth factors, negative pressure dressings, oligonucleotides, intralesional injection of compounds such as botulinum toxin, skin closure techniques such as suturing and tissue adhesive, and laser treatments. There are recent research techniques that generate good results and are really promising to improve the results of surgical scars; however, the available evidence is extremely limited in some cases, and it is necessary to deepen its analysis to obtain reliable action protocols in each type of surgery.
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Affiliation(s)
- Andrea Bueno
- Health Center of Las Huelgas, 09001 Burgos, Spain;
| | - Endika Nevado-Sanchez
- Reconstructive and Aesthetic Plastic Surgery Service, University Hospital of Burgos, 09006 Burgos, Spain
- Propios Nevado Clinic, 09004 Burgos, Spain
| | - Rocío Pardo-Hernández
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (R.d.l.F.-A.); (J.J.G.-B.)
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Li SH, Wu YD, Wu YY, Liao X, Cheung PN, Wan T, Xiao LL, Song JX, Huang HL, Liu HW. Autologous fat transplantation for the treatment of abdominal wall scar adhesions after cesarean section. J Plast Surg Hand Surg 2021; 55:210-215. [PMID: 33530846 DOI: 10.1080/2000656x.2020.1856675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cesarean section results in scarring, which usually leads to adhesion between the subcutaneous fat and the abdominal wall muscle. The present study aimed to evaluate the therapeutic effect of autologous fat grafting on scar adhesion to the abdominal wall after cesarean section. Thirty-six patients with scar adhesion to the abdominal wall after cesarean section were recruited and treated between October 2013 and December 2015. The adhesion between the subcutaneous fat and the abdominal wall muscle was carefully separated through a small incision in the original scar to form multiple subcutaneous tunnels. Aspirated fat was injected into the scar lesion and subcutaneous tunnels, and the wound was then sutured. The clinical outcome was evaluated by comparing the pretreatment and 1-year posttreatment photographs and Patient and Observer Scar Assessment Scale (POSAS) scores. All patients had a marked improvement in the appearance, texture, and depression of the scar during 12 months of follow-up. The 1-year posttreatment POSAS scores for the color, pain, pruritus, hardness, fullness, mobility, and appearance of the scar were significantly decreased compared with the pretreatment scores. Hematoxylin-eosin staining revealed adipocyte-like cells in treated scar tissue specimens obtained 1 year after treatment. None of the patients reported severe adverse reactions. Autologous fat grafting combined with adhesion release may be a good treatment option for abdominal wall scarring after cesarean section. This method is minimally invasive and effective in achieving good functional and esthetic outcomes.
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Affiliation(s)
- Sheng-Hong Li
- Department of Plastic Surgery, The First Affiliated Hospital, Jinan University, Key Laboratory of Regenerative Medicine, Ministry of Education, Institute for New Technologies of Plastic Surgery of Jinan University, Guangzhou, China
| | - Yin-Di Wu
- Department of Plastic Surgery, The First Affiliated Hospital, Jinan University, Key Laboratory of Regenerative Medicine, Ministry of Education, Institute for New Technologies of Plastic Surgery of Jinan University, Guangzhou, China
| | - Yan-Yun Wu
- Department of Plastic Surgery, The First Affiliated Hospital, Jinan University, Key Laboratory of Regenerative Medicine, Ministry of Education, Institute for New Technologies of Plastic Surgery of Jinan University, Guangzhou, China
| | - Xuan Liao
- Department of Plastic Surgery, The First Affiliated Hospital, Jinan University, Key Laboratory of Regenerative Medicine, Ministry of Education, Institute for New Technologies of Plastic Surgery of Jinan University, Guangzhou, China
| | - Pik-Nga Cheung
- Department of Plastic Surgery, The First Affiliated Hospital, Jinan University, Key Laboratory of Regenerative Medicine, Ministry of Education, Institute for New Technologies of Plastic Surgery of Jinan University, Guangzhou, China
| | - Ting Wan
- Department of Obstetrics and Gynecology, Guangzhou Women and Children's Medical Center, Guangzhou, China
| | - Li-Ling Xiao
- Department of Plastic Surgery, The First Affiliated Hospital, Jinan University, Key Laboratory of Regenerative Medicine, Ministry of Education, Institute for New Technologies of Plastic Surgery of Jinan University, Guangzhou, China
| | - Jian-Xing Song
- Department of Plastic Surgery, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Hai-Ling Huang
- Department of Plastic Surgery, The First Affiliated Hospital, Jinan University, Key Laboratory of Regenerative Medicine, Ministry of Education, Institute for New Technologies of Plastic Surgery of Jinan University, Guangzhou, China
| | - Hong-Wei Liu
- Department of Plastic Surgery, The First Affiliated Hospital, Jinan University, Key Laboratory of Regenerative Medicine, Ministry of Education, Institute for New Technologies of Plastic Surgery of Jinan University, Guangzhou, China
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Nonsurgical Management of Hypertrophic Scars: Evidence-Based Therapies, Standard Practices, and Emerging Methods. Aesthetic Plast Surg 2020; 44:1320-1344. [PMID: 32766921 DOI: 10.1007/s00266-020-01820-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 01/05/2007] [Indexed: 12/12/2022]
Abstract
Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis. Hypertrophic scars are among the most common and frustrating problems after injury. As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. However, hypertrophic scars remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with available treatment methods. This review explores the various treatment methods for hypertrophic scarring described in the literature including evidence-based therapies, standard practices, and emerging methods, attempting to distinguish those with clearly proven efficiency from anecdotal reports about therapies of doubtful benefits while trying to differentiate between prophylactic measures and actual treatment methods. Unfortunately, the distinction between hypertrophic scar treatments and keloid treatments is not obvious in most reports, making it difficult to assess the efficacy of hypertrophic scar treatment.
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Sharobaro VI, Romanets OP, Grechishnikov MI, Baeva AA. [Optimization of treatment and prevention of scars]. Khirurgiia (Mosk) 2016:85-90. [PMID: 26762086 DOI: 10.17116/hirurgia2015985-90] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- V I Sharobaro
- A.V. Vishnevskiy Institute for Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - O P Romanets
- A.V. Vishnevskiy Institute for Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - M I Grechishnikov
- A.V. Vishnevskiy Institute for Surgery, Health Ministry of the Russian Federation, Moscow, Russia
| | - A A Baeva
- A.V. Vishnevskiy Institute for Surgery, Health Ministry of the Russian Federation, Moscow, Russia
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Topical Silicone Gel versus Placebo in Promoting the Maturation of Burn Scars: A Randomized Controlled Trial. Plast Reconstr Surg 2010; 126:524-531. [DOI: 10.1097/prs.0b013e3181e09559] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stoffels I, Wolter TP, Sailer AM, Pallua N. [The impact of silicone spray on scar formation. A single-center placebo-controlled double-blind trial]. Hautarzt 2010; 61:332-8. [PMID: 19967328 DOI: 10.1007/s00105-009-1886-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
For more than two decades silicone has successfully been employed in the treatment and prevention of hypertrophic scars and keloids as a painless noninvasive modality with few side effects. In the present trial, after 3 months of treatment the Patient Scar Assessment Scale demonstrated that patient satisfaction with the silicone application was significantly higher compared to placebo. When treatment was stopped after 3 months, the topical silicone spray did not exhibit any lasting long-term impact on the objective results of scar formation. Due to the significant differences in patient satisfaction once treatment has ended and since the administration is safe and simple, any final decision on treatment indication should be tailored to the patient and include the psychological well-being of the patient as well as the temporary improvement in scar formation during treatment.
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Affiliation(s)
- I Stoffels
- Klinik für Plastische Chirurgie, Hand- und Verbrennungschirurgie, Universitätsklinikum RWTH Aachen, Pauwelsstr. 30, 52074 Aachen.
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Unglaub F, Wolf E, Goldbach C, Hahn P, Kroeber MW. Subjective and functional outcome after revision surgery in carpal tunnel syndrome. Arch Orthop Trauma Surg 2008; 128:931-6. [PMID: 17874323 DOI: 10.1007/s00402-007-0451-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2007] [Indexed: 12/31/2022]
Abstract
INTRODUCTION In spite of carpal tunnel release's prevalent good postoperative results, the number of revision surgeries needed should not be underestimated. In this study, subjective and functional results after carpal tunnel revision surgery were determined. MATERIALS AND METHODS Thirty-eight patients were examined approximately 2 years after their revision surgery of the carpal tunnel release. The subjective outcome of the patients was assessed using two different questionnaires (Amadio and DASH). A clinical examination was undertaken on selected patients who had persistent complaints. The clinical assessment analyzed grip strength, thumb opposition, pulp-to-pulp-pinch, key-pinch, hook-grip, Moberg-Pickup-test, two-point-discrimination, Phalen-test, and the Hoffmann-Tinel-sign. RESULTS The subjective assessment showed that after the revision surgery, patients experienced load induced pain that occurred during daytime. However, the revision was able to improve the impaired sensibility. The functional outcome showed a persistent lack of strength when performing daily activities. The clinical assessment of the patients with relevant complaints confirmed the subjective outcome. CONCLUSION The revision surgery can improve the impaired sensibility, particularly, paresthesia nocturna. The persistent weakness of the hand can only partly be improved. In spite of remaining complaints, revision surgery can yield satisfactory results for the patients.
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Affiliation(s)
- Frank Unglaub
- Handsurgery, Vulpiusklinik, Vulpiusstrasse 29, Bad Rappenau, Germany.
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Berman B, Perez OA, Konda S, Kohut BE, Viera MH, Delgado S, Zell D, Li Q. A review of the biologic effects, clinical efficacy, and safety of silicone elastomer sheeting for hypertrophic and keloid scar treatment and management. Dermatol Surg 2007; 33:1291-302; discussion 1302-3. [PMID: 17958580 DOI: 10.1111/j.1524-4725.2007.33280.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Silicone elastomer sheeting is a medical device used to prevent the development of and improve the appearance and feel of hypertrophic and keloid scars. The precise mechanism of action of silicone elastomer sheeting has not been defined, but clinical trials report that this device is safe and effective for the treatment and prevention of hypertrophic and keloid scars if worn over the scar for 12 to 24 hours per day for at least 2 to 3 months. Some of the silicone elastomer sheeting products currently on the market are durable and adhere well to the skin. These products are an attractive treatment option because of their ease of use and low risk of adverse effects compared to other treatments, such as surgical excision, intralesional corticosteroid injections, pressure therapy, radiation, laser treatment, and cryotherapy. Additional controlled clinical trials with large patient populations may provide further evidence for the efficacy of silicone elastomer sheeting in the treatment and prevention of hypertrophic and keloid scars. The purpose of this article is to review the literature on silicone elastomer sheeting products and to discuss their clinical application in the treatment and prevention of hypertrophic and keloid scars.
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Affiliation(s)
- Brian Berman
- Department of Dermatology and Cutaneous Surgery, University of Miami, Miller School of Medicine, Miami, Florida, USA
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BERMAN BRIAN, PEREZ OLIVERA, KONDA SAILESH, KOHUT BRUCEE, VIERA MARTHAH, DELGADO SUZETTE, ZELL DEBORAH, LI QING. A Review of the Biologic Effects, Clinical Efficacy, and Safety of Silicone Elastomer Sheeting for Hypertrophic and Keloid Scar Treatment and Management. Dermatol Surg 2007. [DOI: 10.1097/00042728-200711000-00001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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10
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Atiyeh BS. Nonsurgical management of hypertrophic scars: evidence-based therapies, standard practices, and emerging methods. Aesthetic Plast Surg 2007; 31:468-92; discussion 493-4. [PMID: 17576505 DOI: 10.1007/s00266-006-0253-y] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2006] [Accepted: 01/05/2007] [Indexed: 01/10/2023]
Abstract
Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis. Hypertrophic scars are among the most common and frustrating problems after injury. As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. However, hypertrophic scars remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with available treatment methods. This review explores the various treatment methods for hypertrophic scarring described in the literature including evidence-based therapies, standard practices, and emerging methods, attempting to distinguish those with clearly proven efficiency from anecdotal reports about therapies of doubtful benefits while trying to differentiate between prophylactic measures and actual treatment methods. Unfortunately, the distinction between hypertrophic scar treatments and keloid treatments is not obvious in most reports, making it difficult to assess the efficacy of hypertrophic scar treatment.
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Affiliation(s)
- Bishara S Atiyeh
- Division Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon.
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Abstract
Aberrant wound healing results in unsightly scarring, hypertrophic scarring, and keloid formation, causing functional and cosmetic deformities, discomfort, psychological stress, and patient dissatisfaction. Scar prevention and management continue to be important issues for the facial plastic surgeon. This article presents an overview on the pathogenesis of a scar and of the different types of scars. Differences between keloids, hypertrophic scars and normal scars include distinct scar appearance, histologic morphology and cellular function in response to growth factors. Recent advances in our understanding of the wound healing process reveal possible causes for hypertrophic scars and keloids. This information might assist in the development of efficacious prevention and treatment for hypertrophic scar and keloid formation. This article also describes the strategies available for scar prevention. Recommendations focus on the management of hypertrophic scars and keloids.
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Affiliation(s)
- A Baisch
- Universitäts-Hals-Nasen-Ohren-Klinik Mannheim
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