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Flori L, Lazzarini G, Spezzini J, Pirone A, Calderone V, Testai L, Miragliotta V. The isoproterenol-induced myocardial fibrosis: A biochemical and histological investigation. Biomed Pharmacother 2024; 174:116534. [PMID: 38565062 DOI: 10.1016/j.biopha.2024.116534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/04/2024] Open
Abstract
The isoproterenol (ISO)-induced myocardial fibrosis is considered a reliable and repeatable experimental model characterized by a relatively low mortality rate. Although is well-known that ISO stimulates the β1 adrenergic receptors at the myocardial level, a high degree of heterogeneity emerges around the doses and duration of the treatment generating unclear results. Therefore, we propose to gain insights into the progression of ISO-induced myocardial fibrosis, in order to critically analyze and optimize the experimental model. Male Wistar rats (12-14-week-old) were submitted to subcutaneous injection of ISO, in particular, two doses were selected: the commonly used dose of 5 mg/kg and a lower dose of 1 mg/kg, administered for 3 and 6 days. Biochemical and histological examinations were conducted either immediately after the last administration or after a recovering period of 7 or 14 days from the initial administration. Noteworthy, from our investigation emerged that even the lower dose of ISO was able to induce the maximal biochemical and histological alterations, suggesting that lower doses should be considered to control the progression of the damage more precisely and to identify a prodromic phase in which intervention with pharmacological or nutraceutical tools can be effectively attempted.
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Affiliation(s)
- Lorenzo Flori
- Department of Pharmacy, University of Pisa, via Bonanno 6-56120, Pisa, Italy
| | - Giulia Lazzarini
- Department of Veterinary Sciences, University of Pisa, via Delle Piagge 2-56124, Pisa, Italy
| | - Jacopo Spezzini
- Department of Pharmacy, University of Pisa, via Bonanno 6-56120, Pisa, Italy
| | - Andrea Pirone
- Department of Veterinary Sciences, University of Pisa, via Delle Piagge 2-56124, Pisa, Italy
| | - Vincenzo Calderone
- Department of Pharmacy, University of Pisa, via Bonanno 6-56120, Pisa, Italy; CISUP, Centro per l'Integrazione della Strumentazione dell'Università di Pisa, Lungarno Pacinotti 43, Pisa 56126, Italy
| | - Lara Testai
- Department of Pharmacy, University of Pisa, via Bonanno 6-56120, Pisa, Italy; CISUP, Centro per l'Integrazione della Strumentazione dell'Università di Pisa, Lungarno Pacinotti 43, Pisa 56126, Italy.
| | - Vincenzo Miragliotta
- Department of Veterinary Sciences, University of Pisa, via Delle Piagge 2-56124, Pisa, Italy; CISUP, Centro per l'Integrazione della Strumentazione dell'Università di Pisa, Lungarno Pacinotti 43, Pisa 56126, Italy
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Šuca H, Čoma M, Tomšů J, Sabová J, Zajíček R, Brož A, Doubková M, Novotný T, Bačáková L, Jenčová V, Kuželová Košťáková E, Lukačín Š, Rejman D, Gál P. Current Approaches to Wound Repair in Burns: How far Have we Come From Cover to Close? A Narrative Review. J Surg Res 2024; 296:383-403. [PMID: 38309220 DOI: 10.1016/j.jss.2023.12.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 02/05/2024]
Abstract
Burn injuries are a significant global health concern, with more than 11 million people requiring medical intervention each year and approximately 180,000 deaths annually. Despite progress in health and social care, burn injuries continue to result in socioeconomic burdens for victims and their families. The management of severe burn injuries involves preventing and treating burn shock and promoting skin repair through a two-step procedure of covering and closing the wound. Currently, split-thickness/full-thickness skin autografts are the gold standard for permanent skin substitution. However, deep burns treated with split-thickness skin autografts may contract, leading to functional and appearance issues. Conversely, defects treated with full-thickness skin autografts often result in more satisfactory function and appearance. The development of tissue-engineered dermal templates has further expanded the scope of wound repair, providing scar reductive and regenerative properties that have extended their use to reconstructive surgical interventions. Although their interactions with the wound microenvironment are not fully understood, these templates have shown potential in local infection control. This narrative review discusses the current state of wound repair in burn injuries, focusing on the progress made from wound cover to wound closure and local infection control. Advancements in technology and therapies hold promise for improving the outcomes for burn injury patients. Understanding the underlying mechanisms of wound repair and tissue regeneration may provide new insights for developing more effective treatments in the future.
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Affiliation(s)
- Hubert Šuca
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Matúš Čoma
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic; Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic
| | - Júlia Tomšů
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Jana Sabová
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - Robert Zajíček
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Antonín Brož
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Martina Doubková
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Tomáš Novotný
- Department of Orthopaedics, University J.E. Purkině and Masaryk Hospital, Ústí nad Labem, Czech Republic; Department of Histology and Embryology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Lucie Bačáková
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Věra Jenčová
- Department of Chemistry, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic
| | - Eva Kuželová Košťáková
- Department of Chemistry, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic
| | - Štefan Lukačín
- Department of Heart Surgery, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic
| | - Dominik Rejman
- Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Peter Gál
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic; Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic; Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic; Department of Pharmacognosy and Botany, Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic; Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovak Republic.
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Poelchow F, Codde J, Kendell R, Edgar DW, Wood FM. A randomised investigation of film-forming silicone gel in superficial partial thickness face and neck burn patients: Indication of improved early scar pigmentation outcomes. Burns 2024:S0305-4179(24)00105-0. [PMID: 38614897 DOI: 10.1016/j.burns.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Burns to the face and neck are a source of considerable distress and a challenge to manage with dressings. Further, these often superficial injuries pose a risk of scarring and altered pigmentation. Silicone gels have emerged as a potential solution to the challenges of conservative management for face and neck burn injuries. The aims of this study were to explore the effect of topical silicone compared to routine treatment of conservatively managed burns to the face and neck. METHODS This single-blind, randomised, controlled trial compared topical silicone film-forming dressing to standard of care for superficial partial thickness burns to the face and neck. Time to healing was the primary outcome and secondary outcomes included: 1) scar assessments (modified Vancouver Scar Scale, Dermalab Combo and Patient and Observer Scar Assessment Scale) at six weeks and three months; and 2) pain intensity scale at wound review appointments. RESULTS Of the 55 participants in the face/neck study, 34 were male and 21 were female. Median age was 36 years (range from 25 to 47 years). The median time to healing for the silicone group was 9 days (CI 7.6 -10.4) and the control group was 7 days (CI 5.3- 8.7), p = 0.056. Analysis demonstrated significantly reduced pigmentation at six weeks in mVSS scores for the silicone group (Md = 0, IQR = 0) compared to the control group (Md = 0, IQR = 0 - 3), p = 0.043. We found no evidence of differences in reported pain between the groups (Silicone - Md = 1.15, IQR 0.3 - 4.5 vs control group - Md = 1.5, IQR 0.6 - 3.8, z = -0.63, p = 0.53). No other differences were observed, and no adverse events were associated with the topical silicone in the study whereas an infection and a reaction were experienced in the control group. CONCLUSION Film-forming silicone gel had comparable effects to standard of care emollient on wound healing of superficial partial thickness burns of the face and neck. Silicone treated wounds were associated with a significant improvement in scar pigmentation outcome at six weeks post-burn.
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Affiliation(s)
- Fiona Poelchow
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Jim Codde
- The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Rosemary Kendell
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia; Armadale Kalamunda Group Health Service, Safety and Quality Unit, East Metropolitan Health Service, Mt Nasura, Western Australia, Australia; Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia; Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia.
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Blome-Eberwein SA, Schwartz A, Ferdock M, Starner S, Gogal C. Minimally invasive burn reconstruction with subcutaneous scar contracture release. Burns 2024:S0305-4179(24)00094-9. [PMID: 38609745 DOI: 10.1016/j.burns.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Scar contracture bands after burns are frequent problems that cause discomfort and physical limitation. This study investigates the efficacy of a minimally invasive contracture band release technique (MICBR) inspired by closed platysmotomy. METHODS Patients with burn scars treated with MICBR in our center were included retrospectively. Our routine scar and contracture treatments (non-invasive and invasive) were utilized prior to undergoing MICBR. Range of motion (ROM) and Vancouver Scar Scale was measured before and after the procedure when feasible. RESULTS Forty-five patients were included, with 97 total contracture sites treated all over the body. An average of 1.6 sites were treated per patient, with a maximum of six. Patients age was 6-68 years; total burn surface area ranged from 0.5% to 85%. 24% were performed under local anesthesia. 84% were in originally skin grafted areas. We found significant improvements in ROM and VSS. 84% of patients surveyed were "satisfied" or "very satisfied". 95% reported improved mobility. No significant adverse events occurred. CONCLUSION This MICBR technique is a versatile, safe, and well-tolerated adjunct procedure that can help patients regain mobility after a burn injury.
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Affiliation(s)
- Sigrid A Blome-Eberwein
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA.
| | - Adam Schwartz
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | | | - Sophia Starner
- Department of Surgery, Division of Burn Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Christina Gogal
- Network Office of Research and Innovation, Lehigh Valley Health Network, Allentown, PA, USA
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Knoz M, Holoubek J, Lipový B, Faldyna M, Chaloupková R, Pavliňáková V, Muchová J, Kacvinská K, Brtníková J, Jarkovský J, Vojtová L. Evaluation of viscoelastic parameters and photo-based assessment of newly developed dermal substitutes modified with thermostabilized fibroblast growth factor 2. Burns 2024:S0305-4179(24)00092-5. [PMID: 38641499 DOI: 10.1016/j.burns.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND The purpose of dermal substitutes is to mimic the basic properties of the extracellular matrix of human skin. The application of dermal substitutes to the defect reduces the formation of hypertrophic scars and improves the scar quality. This study aims to develop an original dermal substitute enriched with stable fibroblast growth factor 2 (FGF2-STAB®) and test it in an animal model. METHODS Dermal substitutes based on collagen/chitosan scaffolds or collagen/chitosan scaffolds with nanofibrous layer were prepared and enriched with FGF2-STAB® at concentrations of 0, 0.1, 1.0, and 10.0 µg ‧ cm-2. The performance of these dermal substitutes was tested in vivo on artificially formed skin defects in female swine. The outcomes were evaluated using cutometry at 3 and 6 months. In addition, visual appearance was assessed based on photos of the scars at 1-month, 3-month and 6-month follow-ups using Yeong scale and Visual Analog Scale. RESULTS The dermal substitute was fully integrated into all defects and all wounds healed successfully. FGF2-STAB®-enriched matrices yielded better results in cutometry compared to scaffolds without FGF2. Visual evaluation at 1, 3, and 6 months follow-ups detected no significant differences among groups. The FGF2-STAB® effectiveness in improving the elasticity of scar tissues was confirmed in the swine model. This effect was independently observed in the scaffolds with nanofibres as well as in the scaffolds without nanofibres. CONCLUSION The formation of scars with the best elasticity was exhibited by addition 1.0 µg ‧ cm-2of FGF2-STAB® into the scaffolds, although it had no significant effect on visual appearance at longer follow-ups. This study creates the basis for further translational studies of the developed product and its progression into the clinical phase of the research.
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Affiliation(s)
- Martin Knoz
- Department of Burns and Plastic Surgery, Institution Shared with the University Hospital Brno, Faculty of Medicine, Jihlavská 20, 625 00 Brno, Czech Republic; Clinic of plastic and esthetic surgery, St Anne's University Hospital, Pekarska 664/53, 602 00 Brno, Czech Republic
| | - Jakub Holoubek
- Department of Burns and Plastic Surgery, Institution Shared with the University Hospital Brno, Faculty of Medicine, Jihlavská 20, 625 00 Brno, Czech Republic.
| | - Břetislav Lipový
- Department of Burns and Plastic Surgery, Institution Shared with the University Hospital Brno, Faculty of Medicine, Jihlavská 20, 625 00 Brno, Czech Republic; CEITEC-Central European Institute of Technology, Brno University of Technology, Purkynova 123, 612 00 Brno, Czech Republic
| | - Martin Faldyna
- Veterinary Research Institute, Hudcova 296/70, 621 00 Brno, Czech Republic
| | | | - Veronika Pavliňáková
- CEITEC-Central European Institute of Technology, Brno University of Technology, Purkynova 123, 612 00 Brno, Czech Republic
| | - Johana Muchová
- CEITEC-Central European Institute of Technology, Brno University of Technology, Purkynova 123, 612 00 Brno, Czech Republic
| | - Katarína Kacvinská
- CEITEC-Central European Institute of Technology, Brno University of Technology, Purkynova 123, 612 00 Brno, Czech Republic
| | - Jana Brtníková
- CEITEC-Central European Institute of Technology, Brno University of Technology, Purkynova 123, 612 00 Brno, Czech Republic
| | - Jiří Jarkovský
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 735/5, 625 00 Brno, Czech Republic
| | - Lucy Vojtová
- CEITEC-Central European Institute of Technology, Brno University of Technology, Purkynova 123, 612 00 Brno, Czech Republic
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Lin-Hui L, Yuan-Yuan Z, Ming-Yu L, Xu-Dong H, Yin-Jia D, Yue Z, Yang-Hong-Hong F, Ai-Fen C, Xu-Dong Z, Zheng-Li C, Jian J. Recombinant Human Collagen Type III Improves Hypertrophic Scarring by Regulating the Ratio of Type I/III Collagen. J Burn Care Res 2024:irae040. [PMID: 38477626 DOI: 10.1093/jbcr/irae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Indexed: 03/14/2024]
Abstract
Hypertrophic scar development is a complication associated with wound healing, impacting local appearance and function. The type I/III collagen ratio affects the extent of hypertrophic scarring; a reduced ratio can ameliorate this. In this study, recombinant human collagen type III was developed. Liquid chromatography-tandem mass spectrometry was used to determine its amino acid sequence and confirm its high level of homology with natural human type III collagen. Recombinant human collagen type III displayed no cytotoxicity and did not confer skin irritation and sensitization. Immunofluorescence and western blot analyses of histidine following incubation with fibroblasts suggested cell entry of recombinant human collagen type III. Furthermore, recombinant human collagen type III promoted the synthesis of the natural type III collagen in fibroblasts, resulting in a more obvious increase of type III collagen content in fibroblasts than that of type I collagen, and then decreased the ratio of type I/III collagen. The results of 5-ethynyl-2'-deoxyuridine staining assay suggested enhanced fibroblast proliferation. Following local injection of recombinant human collagen type III, rabbit ear scarring was significantly reduced after 60 days. Vancouver Scar Scale evaluation showed that all index scores were significantly reduced. Western blotting and Picro-Sirius red staining showed that the natural type III collagen increase in scar tissue was greater than that of type I collagen, decreasing the type I/III ratio. In summary, recombinant human collagen type III can be taken up by fibroblasts and promote natural collagen synthesis-especially that of type III-thereby reducing the type I/III ratio and improving hypertrophic scarring.
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Affiliation(s)
- Li Lin-Hui
- Department of Burns, The First Affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Zha Yuan-Yuan
- Department of Burns, The First Affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Liu Ming-Yu
- 967th Hospital of the Joint Logistics Support Force of PLA, 80 Shengli Road, Xigang District, Dalian,116000, China
| | - Hong Xu-Dong
- Department of Burns and Plastic, 903rd Hospital of PLA,14 Lingyin Road, Xihu District, Hangzhou, 313000, China
| | - Ding Yin-Jia
- Department of Burns and Plastic, 903rd Hospital of PLA,14 Lingyin Road, Xihu District, Hangzhou, 313000, China
| | - Zhou Yue
- Department of Burns and Plastic, 903rd Hospital of PLA,14 Lingyin Road, Xihu District, Hangzhou, 313000, China
| | - Fei Yang-Hong-Hong
- Department of Burns and Plastic, 903rd Hospital of PLA,14 Lingyin Road, Xihu District, Hangzhou, 313000, China
| | - Chen Ai-Fen
- Department of Burns and Plastic, 903rd Hospital of PLA,14 Lingyin Road, Xihu District, Hangzhou, 313000, China
| | - Zhang Xu-Dong
- Department of Burns and Plastic, 903rd Hospital of PLA,14 Lingyin Road, Xihu District, Hangzhou, 313000, China
| | - Chen Zheng-Li
- Department of Burns, The First Affiliated Hospital of Naval Medical University, 168 Changhai Road, Yangpu District, Shanghai, 200433, China
| | - Jin Jian
- State Key Laboratory of Molecular Engineering of Polymers, Department of Macromolecular Science, Fudan University, Shanghai, 200438, China
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Zhou P, Jiang Y, Liu AY, Chen XL, Wang F. Patients with hypertrophic scars following severe burn injury express different long noncoding RNAs. Burns 2024:S0305-4179(24)00059-7. [PMID: 38503573 DOI: 10.1016/j.burns.2024.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 01/19/2024] [Accepted: 02/26/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE Research indicates that long noncoding RNAs (lncRNAs) contribute significantly to fibrotic diseases. Although lncRNAs may play a role in hypertrophic scars after burns, its mechanisms remain poorly understood. METHODS Using chip technology, we compared the lncRNA expression profiles of burn patients and healthy controls (HCs). Microarray results were examined by quantitative reverse-transcription polymerase chain reaction (RT-PCR) to verify their reliability. The biological functions of differentially expressed mRNAs and the relationships between genes and signaling pathways were investigated by Gene Ontology (GO) and pathway analyses, respectively. RESULTS In contrast with HCs, it was found that 2738 lncRNAs (1628 upregulated) and 2166 mRNAs (1395 upregulated) were differentially expressed in hypertrophic scars after burn. Results from RT-PCR were consistent with those from microarray. GO and pathway analyses revealed that the differentially expressed mRNAs are mainly associated with processes related to cytokine secretion in the immune system, notch signaling, and MAPK signaling. CONCLUSION The lncRNA expression profiles of hypertrophic scars after burn changed significantly compared with HCs. It was believed that the transcripts could be used as potential targets for inhibiting abnormal scar formation in burn patients.
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Affiliation(s)
- Ping Zhou
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Yan Jiang
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Ao-Ya Liu
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Xu-Lin Chen
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China
| | - Fei Wang
- Department of Burns, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, PR China.
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Chen Y, Zhao H, Wijaya WA, Qing Y, Wu J. Supraciliary Incision as a Modified Approach for Asian Blepharoptosis Patients. Aesthetic Plast Surg 2024; 48:1094-1103. [PMID: 37605027 DOI: 10.1007/s00266-023-03545-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/23/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Blepharoptosis may result in an unattractive appearance and vision problems. According to the severity of ptosis, patients may undergo correction surgery using upper eyelid retractors. The conventional incision for surgical procedures was the double-eyelid incision, potentially resulting in an obvious and unnatural scar or long-lasting edema and prolonged recovery time. OBJECTIVES The aim of this study was to introduce a supraciliary incision as an alternative to the double-eyelid incision for blepharoptosis correction that creates a scarless, natural appearance with a quick recovery time. METHODS From June 2019 to June 2021, 32 patients (36 eyelids) underwent blepharoptosis correction through a supraciliary incision. MRD1, the height of the eyelid fissure, and the patient's satisfaction with the shape and scar as well as postoperative complications (eyelid insufficiency, conjunctival prolapse, inadequate correction of ptosis, and excessive correction of ptosis). RESULTS All 32 patients (36 eyelids) were followed up for 6 to 18 months, with an average follow-up of 11.6 months. The postoperative satisfaction rate was 96.43%. There was no overcorrection, but one patient (1 eyelid, 2.8%) was under correction that required secondary correction. One patient (1 eyelid, 2.8%) experienced conjunctival prolapse. Sixteen patients showed lagophthalmos early after surgery, in which one patient experienced early-stage keratitis and completely recovered within two months. CONCLUSION Blepharoptosis correction via supraciliary incision allows for broader indications and fewer surgical scars without disrupting eyelid integrity, resulting in quick recovery after surgery. 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)
- Yuankun Chen
- Yestar Medical Cosmetology Hospital, No. 95 Dongmen Street, Qingyang District, Chengdu, 610041, Sichuan, China
| | - Hanxing Zhao
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Wilson A Wijaya
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yong Qing
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Junliang Wu
- Department of Burn and Plastic Surgery, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Wuhou District, Chengdu, 610041, Sichuan, China.
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Alessandri Bonetti M, Arellano JA, Scarabosio A, Liu HY, Giorgino R, Ejaz A, Rubin JP, Egro FM. The Effect of Fat Grafting on Scars Hyperpigmentation: A Systematic Review and Meta-Analysis. Aesthetic Plast Surg 2024; 48:989-998. [PMID: 38286897 DOI: 10.1007/s00266-023-03828-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/18/2023] [Indexed: 01/31/2024]
Abstract
BACKGROUND Hyperpigmented scars, particularly in exposed body areas, can be difficult to conceal and may evoke psychological distress. While the precise causes of scar dyschromia are not fully understood, alterations in melanogenic activity appear to hold more significance than changes in melanocyte quantity. Current treatments encompass laser interventions. However, it is essential to consider their costs and potential complications in relation to their limited proven effectiveness. Fat grafting has gained interest as a scar modulation technique due to its regenerative properties, and its efficacy in reducing scar hyperpigmentation is currently under investigation. METHODS A systematic review and meta-analysis was reported according to PRISMA guidelines. PubMed, Embase, and Cochrane Library databases were accessed. PROSPERO registration number is CRD42023457778. The primary outcome was a change in scar pigmentation after fat grafting. Pigmentation changes after fat grafting were calculated using the standardized mean difference (SMD) between baseline and postoperative scores according to POSAS and VSS scales. Bias assessment was conducted according to the National Institute for Health and Clinical Excellence quality assessment tool. RESULTS A total of 8 articles meeting inclusion and exclusion criteria were identified, involving 323 patients with hyperpigmented scars treated with fat grafting. A significant difference in scar pigmentation was noted after treatment with fat grafting according to observers' ratings, with a SMD of - 1.09 [95% CI: - 1.32; - 0.85], p<0.01. The SMD for patient-reported scar pigmentation after treatment with fat grafting was - 0.99 [96% CI: - 1.31; - 0.66], p<0.01. Four studies provided objective measurements of melanin changes after fat grafting and revealed inconsistent findings compared to subjective observations. CONCLUSIONS Fat grafting shows promise in ameliorating hyperpigmented scars based on subjective assessments, but further corroborating evidence from objective measures is required. 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)
- Mario Alessandri Bonetti
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Jose Antonio Arellano
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Anna Scarabosio
- Department of Plastic Surgery, Ospedale Santa Maria della Misericordia, 33100, Udine, Italy
| | - Hilary Y Liu
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Riccardo Giorgino
- Residency Program in Orthopedics and Traumatology, University of Milan, 20141, Milan, Italy
| | - Asim Ejaz
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - J Peter Rubin
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, 1350 Locust Street, Pittsburgh, PA, 15219, USA.
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10
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Francia P, Falasconi G, Penela D, Viveros D, Alderete J, Saglietto A, Bellido AF, Martí-Almor J, Franco-Ocaña P, Soto-Iglesias D, Zaraket F, Turturiello D, Berruezo A. Scar architecture affects the electrophysiological characteristics of induced ventricular arrhythmias in hypertrophic cardiomyopathy. Europace 2024; 26:euae050. [PMID: 38375690 PMCID: PMC10914403 DOI: 10.1093/europace/euae050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 02/09/2024] [Indexed: 02/21/2024] Open
Abstract
AIMS Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) detects myocardial scarring, a risk factor for ventricular arrhythmias (VAs) in hypertrophic cardiomyopathy (HCM). The LGE-CMR distinguishes core, borderzone (BZ) fibrosis, and BZ channels, crucial components of re-entry circuits. We studied how scar architecture affects inducibility and electrophysiological traits of VA in HCM. METHODS AND RESULTS We correlated scar composition with programmed ventricular stimulation-inducible VA features using LGE intensity maps. Thirty consecutive patients were enrolled. Thirteen (43%) were non-inducible, 6 (20%) had inducible non-sustained, and 11 (37%) had inducible sustained mono (MMVT)- or polymorphic VT/VF (PVT/VF). Of 17 induced VA, 13 (76%) were MMVT that either ended spontaneously, persisted as sustained monomorphic, or degenerated into PVT/VF. Twenty-seven patients (90%) had LGE. Of these, 17 (57%) had non-sustained or sustained inducible VA. Scar mass significantly increased (P = 0.002) from non-inducible to inducible non-sustained and sustained VA patients in both the BZ and core components. Borderzone channels were found in 23%, 67%, and 91% of non-inducible, inducible non-sustained, and inducible sustained VA patients (P = 0.003). All 13 patients induced with MMVT or monomorphic-initiated PVT/VF had LGE. The origin of 10/13 of these VTs matched scar location, with 8/10 of these LGE regions showing BZ channels. During follow-up (20 months, interquartile range: 7-37), one patient with BZ channels and inducible PVT had an ICD shock for VF. CONCLUSION Scar architecture determines inducibility and electrophysiological traits of VA in HCM. Larger studies should explore the role of complex LGE patterns in refining risk assessment in HCM patients.
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Affiliation(s)
- Pietro Francia
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- Cardiology Unit, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, University Sapienza, Rome, Italy
| | - Giulio Falasconi
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- IRCCS Humanitas Research Hospital, Cardiovascular Department, Milan, Italy
| | - Diego Penela
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- IRCCS Humanitas Research Hospital, Cardiovascular Department, Milan, Italy
| | - Daniel Viveros
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - José Alderete
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Andrea Saglietto
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
- Division of Cardiology, Cardiovascular and Thoracic Department, ‘Citta della Salute e della Scienza Hospital, Turin, Italy
| | - Aldo Francisco Bellido
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Julio Martí-Almor
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Paula Franco-Ocaña
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - David Soto-Iglesias
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Fatima Zaraket
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Dario Turturiello
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
| | - Antonio Berruezo
- Arrhythmia Department, Teknon Heart Institute, Teknon Medical Center, C/Vilana 12, 08022 Barcelona, Spain
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11
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Kivi MK, Jafarzadeh A, Hosseini-Baharanchi FS, Salehi S, Goodarzi A. The efficacy, satisfaction, and safety of carbon dioxide (CO2) fractional laser in combination with pulsed dye laser (PDL) versus each one alone in the treatment of hypertrophic burn scars: a single-blinded randomized controlled trial. Lasers Med Sci 2024; 39:69. [PMID: 38376542 DOI: 10.1007/s10103-024-03976-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 01/02/2024] [Indexed: 02/21/2024]
Abstract
The tendency to use less-invasive laser-based methods with far more obvious effectiveness has been taken into consideration today for improvement of burning scars. The present study thus aimed to assess the efficacy of two laser-based techniques including pulsed dye laser (PDL) and ablative fractional CO2 laser (AFCL) and its combination on improving different aspects of burning scars regardless of the types of scar as hypertrophic or keloid scars. This randomized single-blinded clinical trial was performed on patients suffering hypertrophic or keloid burning scars. The patients were randomly assigned into three groups scheduling for treatment with PDL alone, AFCL alone, or its combination. All patients were visited before and 40 days after the last treatment session, and their scars were assessed. In all groups, significant improvement was revealed in the Vancouver scar scale (VSS) score, the color of scar, vascular bed in the scar, the and height of scar and its pliability; however, the improvement in each item was more highlighted in the group receiving a combination therapy with PDL and AFCL techniques. In this regard, the highest improvement was found in vascular bed and pliability in the combination therapy group as compared to other groups. Although the superiority of the combined group was not statistically significant, due to the high percentage of improvement in total VSS and most of its indicators, it can be clinically significant. The efficacy of the treatment protocols was different considering subgroups of mature and immature scars (less than 1 year), so that more improvement in pliability of scar, vascularity, and color of scar was found in the group scheduling for PDL + AFCL as compared to those who were treated with PDL alone in immature scar group but not in mature scar group. Combined treatment can be much more effective in improving the appearance and pathological characteristics of scars than each individual treatment. This effectiveness can be seen mainly in immature scars.
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Affiliation(s)
- Maedeh Karimi Kivi
- Medical Students Association, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Alireza Jafarzadeh
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Fatemeh Sadat Hosseini-Baharanchi
- Minimally Invasive Surgery Research Center & Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sadaf Salehi
- Medical Students Association, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
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12
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Jiang H, Hu X, Xiang H, Kou H, Zhang J, Zhang X, Li X, He K, Lu Y. Efficacy and safety of fractional carbon dioxide laser followed by 5-aminolevulinic acid photodynamic therapy for keloids. Photodiagnosis Photodyn Ther 2024; 45:103979. [PMID: 38242189 DOI: 10.1016/j.pdpdt.2024.103979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND Keloids are aggressive fibroproliferative disorders that cause aesthetic and functional damage. Photodynamic therapy (PDT) has shown promise as a novel treatment for keloids. However, the limited penetration of 5-aminolevulinic acid (ALA) and unsatisfactory outcomes in dense scars hinder its effectiveness as a monotherapy. The objective of this study is to assess the efficacy and safety of fractional CO2 laser followed by 5-ALA PDT for keloids. METHODS A total of 12 patients with keloid were included in our study. Each lesion was pretreated by fractional CO2 laser with 26-28 W to create microthermal zones. After topical application of 5-ALA solution, an irradiation of 635 nm red light with 120 J/cm2 was performed. The treatment was repeated at least every 2 weeks. Efficacy and safety were evaluated using the Vancouver Scar Scale (VSS), the Visual Analogue Scale (VAS) for keloid-related symptoms and documentation of postoperative complications. Statistical analysis was performed to compare VSS and keloid-related symptom VAS scores of the baseline and final treatment sessions. RESULTS The final treatment resulted in a statistically significant decrease in all parameters of VSS and VAS for pruritus and pain compared to the baseline. Except for postoperative hyperpigmentation, no infections, scar aggravation, or recurrence were observed during at least 6 months of follow-up. Overall, patients expressed a high level of satisfaction with the treatment outcome. CONCLUSIONS Fractional CO2 laser followed by 5-ALA PDT is a promising method for treating keloids. However, its synergetic effects need to be validated through clinical trials involving larger patient cohorts.
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Affiliation(s)
- Hao Jiang
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Xiuhua Hu
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Haiyan Xiang
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Huiling Kou
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Junbo Zhang
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Xingcun Zhang
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Xinying Li
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Kunqian He
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China
| | - Yuangang Lu
- Department of Plastic and Cosmetic Surgery, Daping Hospital, Army Medical University, No.10 Changjiang Branch Street, Yuzhong District, Chongqing 400042, China.
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13
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Yang J, Zhang L, Sun S, Zhang S, Ding Q, Chai G, Yu W, Zhao T, Shen L, Gao Y, Liu W, Ding C. A dihydromyricetin-loaded phellinus igniarius polysaccharide/l-arginine modified chitosan-based hydrogel for promoting wound recovery in diabetic mice via JNK and TGF-β/Smad signaling pathway. Int J Biol Macromol 2024; 259:129124. [PMID: 38176509 DOI: 10.1016/j.ijbiomac.2023.129124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
The wound of diabetes has long-term excessive inflammation leading to wound fibrosis and scar formation. In the process of diabetic wound healing, good wound dressing is required for intervention. In this study, we designed a dihydromyricetin-loaded hydrogel (PCD) based on phellinus igniarius polysaccharide and l-arginine modified chitosan as an alternative material to promote diabetes wound healing. PCD had a uniform porous structure, good thermal stability, excellent mechanical properties, high water absorption, excellent antioxidant and anti-inflammatory activities and good biocompatibility and biodegradability. In addition, in the full-thickness skin trauma model of diabetes, PCD significantly inhibited the JNK signaling pathway to reduce inflammatory response, and significantly down-regulated the expression of TGF-β1, Smad2, Smad3 and Smad4 to directly inhibit the TGF-β/Smad signaling pathway to accelerate wound healing and slow down scar formation in diabetes mice. Therefore, PCD has a broad application prospect in promoting diabetes wound healing.
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Affiliation(s)
- Jiali Yang
- College of Traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Lifeng Zhang
- College of Traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Shuwen Sun
- College of Traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Shuai Zhang
- College of Traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Qiteng Ding
- College of Traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Guodong Chai
- College of Traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Weimin Yu
- College of Traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Ting Zhao
- College of Traditional Chinese Medicine, Jilin Agriculture Science and Technology College, Jilin 132101, China
| | - Liqian Shen
- Jilin Province Jianwei Natural Biotechnology Co., Ltd., Baishan 134600, China
| | - Yang Gao
- Jilin Province Jianwei Natural Biotechnology Co., Ltd., Baishan 134600, China
| | - Wencong Liu
- School of Food and Pharmaceutical Engineering, Wuzhou University, Wuzhou 543002, China.
| | - Chuanbo Ding
- College of Traditional Chinese Medicine, Jilin Agriculture Science and Technology College, Jilin 132101, China.
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14
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Wang ZN, Ma JC, Xi MF, Yin D, Jiang LIF, Qi J. Effects of nanoparticle-mediated dihydromyricelin to diabetic wounds: An in vivo study. J Burn Care Res 2024:irae003. [PMID: 38236154 DOI: 10.1093/jbcr/irae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Indexed: 01/19/2024]
Abstract
Diabetic wound is one of the serious complications of diabetes, and the wound is persistent and easily recurring, which seriously endangers the health and life of patients. How to effectively promote the healing of diabetic wounds has been a hot spot and difficult area of clinical research. Some previous studies have shown that dihydromyricetin has the effects of regulating blood glucose, controlling the severity and inhibiting scarring. In the present study, we used PLGA nanoparticles as a carrier to load dihydromyricetin to make drug-loaded nanoparticles and applied them dropwise (200 µL) to diabetic mice wounds by topical application to observe the healing and scar formation of diabetic wounds. We found that the healing rate of the diabetic mice was faster and the scar formation was less obvious. In addition, the elevated blood glucose level and weight loss of the mice in the treatment group were also reduced. Therefore, nanoparticle-mediated dihydromyricetin may be an effective treatment for diabetic wounds.
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Affiliation(s)
- Zhao-Nan Wang
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong Jiangsu, 226000, P.R. China
- Nantong University Medical School, Nantong Jiangsu, 226000, P.R. China
- Nanjing Drum Tower Hospital Group Suqian Hospital, 223800, P.R. China
| | - Jiu-Cheng Ma
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong Jiangsu, 226000, P.R. China
- Nantong University Medical School, Nantong Jiangsu, 226000, P.R. China
| | - Ming-Fan Xi
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong Jiangsu, 226000, P.R. China
- Nantong University Medical School, Nantong Jiangsu, 226000, P.R. China
| | - Dong Yin
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong Jiangsu, 226000, P.R. China
- Nantong University Medical School, Nantong Jiangsu, 226000, P.R. China
| | - L I-Fan Jiang
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong Jiangsu, 226000, P.R. China
- Nantong University Medical School, Nantong Jiangsu, 226000, P.R. China
| | - Jun Qi
- Department of Burn and Plastic Surgery, Affiliated Hospital of Nantong University, Nantong Jiangsu, 226000, P.R. China
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15
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van den Bosch CH, van de Ven CP, Hulsker CCC, Bökkerink GMJ, Terwisscha-van Scheltinga CEJ, van de Wetering MD, Koopman MMW, van der Pal HJH, Wijnen MWHA, van der Steeg AFW. Satisfaction of Paediatric Oncology Patients, Survivors, and Nurses with the Position of Their Totally Implantable Venous Access Port (SPACE-Study). J Pediatr Surg 2024:S0022-3468(24)00003-4. [PMID: 38212153 DOI: 10.1016/j.jpedsurg.2023.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/12/2023] [Accepted: 12/25/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND To compare paediatric oncologic vascular access ports located on the anterior thoracic wall to ports on the lower lateral thoracic wall, in terms of perceived port-related hindrance and scar-quality. METHODS A cross-sectional survey study including paediatric oncology patients (≥8-<19 yrs), caregivers (in patients <8 yrs), survivors (>22 yrs with only anterior ports) and nurses of the Princess Máxima Center, the Netherlands, was performed. The survey consisted of questions regarding satisfaction, hindrance during daily life, and port position preference. For survivors, scar-quality was assessed using the validated Patient and Observer Scar Assessment Scale (POSAS 2.0); a high score (i.e., a displeasing scar) was defined as a score higher than the third quartile of the median for that question. RESULTS In total, 147 participants were included; 83 patients/caregivers, 31 survivors, and 33 nurses. Overall, 81 % was satisfied with the position of their port. Satisfaction, hindrance and complications did not differ between anterior and lower lateral ports. For the anterior position, minimal pressure on the port during daily life was a mentioned reason to prefer this position. For the lower lateral position, less visibility of the scar and easiest access were mentioned. Of all survivors with an anterior port scar, one in five had a displeasing scar and all scars observed were widened. Female patients preferred a lower lateral port, and scar-quality was better for left-sided port scars. CONCLUSION The port position should be chosen together with patients/caregivers based on the (dis-)advantages of each position, as identified by this study. LEVEL OF EVIDENCE II.
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Affiliation(s)
- C H van den Bosch
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands.
| | - C P van de Ven
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - C C C Hulsker
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - G M J Bökkerink
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | | | - M D van de Wetering
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - M M W Koopman
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - H J H van der Pal
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - M W H A Wijnen
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
| | - A F W van der Steeg
- Princess Máxima Center for Paediatric Oncology, Heidelberglaan 25, 3584 CS, Utrecht, the Netherlands
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16
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Chmielewska D, Malá J, Opala-Berdzik A, Nocuń M, Dolibog P, Dolibog PT, Stania M, Kuszewski M, Kobesova A. Acupuncture and dry needling for physical therapy of scar: a systematic review. BMC Complement Med Ther 2024; 24:14. [PMID: 38167051 PMCID: PMC10759514 DOI: 10.1186/s12906-023-04301-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/10/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND There is a continuing interest in finding effective methods for scar treatment. Dry needling is gaining popularity in physiotherapy and is defined by Western medicine as a type of acupuncture. The terms acupuncture and dry needling have been used interchangeably so we have focused on the efficacy of dry needling or acupuncture in scar treatment. OBJECTIVE The aim of this systematic review was to determine the usefulness of dry needling or local acupuncture for scar treatment. In our search process, we used the terms 'acupuncture,' 'needling,' or 'dry needling' to identify all relevant scientific papers. We have focused on the practical aspects of local management of different scar types with dry needling or acupuncture. SEARCH STRATEGY The search strategy included different combinations of the following keywords: 'scar', 'keloid', 'dry needling', 'needling', 'acupuncture', 'treatment', 'physical therapy'. This systematic review was conducted in accordance with PRISMA guidelines. MEDLINE (PubMed, EBSCOHost and Ovid), EMBASE (Elsevier), and Web of Science databases were searched for relevant publications from inception through October 2023. INCLUSION CRITERIA The studies that investigated the effectiveness of dry needling or acupuncture for scar treatment were included. DATA EXTRACTION AND ANALYSIS The main extraction data items were: the needling technique; needle: diameter, length; needling locations; manual needling manipulation; number of sessions; settings; outcomes and results. RESULTS As a result of a comprehensive search, 11 manuscripts were included in the systematic review, of which eight were case reports, two were randomized trials and one study concerned case series. Two case reports scored 2-4 out of 8 points on the JBI checklist, five studies scored 5-7, and one study scored 8 points. The methodological quality of the two clinical trials was rated as good or fair on the PEDro scale. The case series study scored 7 of 10 points on the JBI checklist. A meta-analysis was not possible as only two randomized trials, eight case reports, and one case series were eligible for review; also, scar assessment scales and pain severity scales were highly heterogeneous. CONCLUSIONS The studies differed regarding the delivery of dry needling or local acupuncture for scar treatment. Differences included treatment frequency, duration, number of treatments, selection of needle insertion sites, number of needles used, angle of needle placement, and use of manual needling manipulation. SYSTEMATIC REVIEW REGISTRATION INPLASY no. 202310058.
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Affiliation(s)
- Daria Chmielewska
- Electromyography and Pelvic Floor Muscles Laboratory, Department of Physical Medicine, Institute of Physiotherapy and Health Sciences, Academy of Physical Education in Katowice, Mikołowska 72 street, Katowice, 40-065, Poland.
| | - Jitka Malá
- Physiotherapy Department, Faculty of Physical Education and Sport, Charles University in Prague, José Martího 31, Prague 6, 162 52, Czech Republic
| | - Agnieszka Opala-Berdzik
- Institute of Physiotherapy and Health Sciences, Department of Physiotherapy in Internal Diseases, Academy of Physical Education in Katowice, Mikołowska 72 street, Katowice, 40-065, Poland
| | - Magdalena Nocuń
- Students Scientific Association "IMPULSE" of the Institute of Electromyography and Pelvic Floor Muscles Laboratory, Department of Physical Medicine, Physiotherapy and Health Sciences, Academy of Physical Education in Katowice, Mikołowska 72 street, Katowice, 40-065, Poland
| | - Patrycja Dolibog
- Department of Medical Biophysics, Faculty of Medical Sciences, Medical University of Silesia, Medyków 18 street, 40-752, Katowice, Poland
| | - Paweł T Dolibog
- Department of Biophysics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Jordana 19 street, Zabrze, 41-808, Poland
| | - Magdalena Stania
- Institute of Sport Sciences, Academy of Physical Education in Katowice, Mikołowska 72 street, Katowice, 40-065, Poland
| | - Michał Kuszewski
- Institute of Physiotherapy and Health Sciences, Academy of Physical Education in Katowice, Mikołowska 72 street, Katowice, 40-065, Poland
| | - Alena Kobesova
- Department of Rehabilitation and Sports Medicine, 2nd Faculty of Medicine, Charles University and University Hospital Motol in Prague, V Úvalu 84, Prague 5, 150 06, Czech Republic
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17
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Kennedy DL, Hettiaratchy S, Alexander CM. Clinical evaluation of post-surgical scar hyperaesthesia: a longitudinal observational pilot study. Scars Burn Heal 2024; 10:20595131241230742. [PMID: 38450365 PMCID: PMC10916468 DOI: 10.1177/20595131241230742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Introduction The mechanisms underlying persistent scar pain are not fully elucidated and evidence for the clinical evaluation of scar pain is limited. This pilot observational study investigated participation data and sought to identify objective clinical scar evaluation measures for future trials. Methods With ethical approval and consent, adults undergoing planned hand surgery were enrolled from one NHS hospital. At 1- and 4-months post-surgery scar thermal and mechanical pain thresholds were evaluated with quantitative sensory testing; peri-scar inflammation with infrared thermometry and pliability with durometry. Participation data were analysed with descriptive statistics; the association of clinical measures with patient reported scar pain was analysed. Results Twenty-one participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No adverse events or dropouts resulted from clinical scar evaluation. Seventy percent of participants reported undertaking topical, nonprescription scar treatment independently. Neuropathic Pain Symptom Inventory (NPSI) scores were dispersed across the score range, capturing variability in participant-reported scar symptoms. Scar morphology, pliability and inflammation were not associated with scar pain. Differences between scar and contralateral skin in thermal and mechanical pain sensitivity were identified. Conclusion People with acute hand scars participate in clinical research and independently initiate scar treatment. Clinical testing of acute post-surgical hand scars is well tolerated. The NPSI demonstrates utility for exploring scar pain symptoms and may support the elucidation of mechanisms of persistent scar pain. Clinical tests of thermal and mechanical and sensitivity are promising candidate clinical measures of scar pain for future trials. Lay Summary Background: it is unknown why some scars remain painful long-term. We do not know if scar flexibility, inflammation or sensitivity to temperature or pressure relate to scar pain. We investigated if patients would enrol in scar research, if scar testing was tolerated and if clinical tests are useful for future scar studies. Study conduct: with ethical approval and consent, adult hand surgery patients were enrolled from one NHS hospital. Scar pain, inflammation and response to thermal, sharp and pressure tests were assessed at 1- and 4-months after surgery. Statistically, we analysed study participation, tolerance for clinical scar tests and if the scar tests related to scar pain. Findings: 21 participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No participants were injured due to scar testing. 70% of participants reported treating their scar independently. Neuropathic Pain Symptom Inventory (NPSI) allows participants to give a broad range of answers about their scar symptoms. Scores for clinical tests of scar flexibility and inflammation did not relate to participant-reported scar pain. Scars were more sensitive to tests of pin prick and cold than unaffected skin. What we learned: people with new hand scars participate in research and independently initiate scar treatment. Clinical testing of post-surgical hand scars is well tolerated. The NPSI is useful for exploring scar pain symptoms and may help us to learn about persistent scar pain. Pinprick and cold clinical tests may be useful objective pain tests for future scar research.
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Affiliation(s)
- Donna L. Kennedy
- Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Human Performance Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Shehan Hettiaratchy
- Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Caroline M. Alexander
- Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Human Performance Group, Department of Surgery and Cancer, Imperial College London, London, UK
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18
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Bae JS, Park ES, Nam SM, Cha HG, Choi CY. Dermal hinge flap with adjuvant corticosteroid injection for ear keloid. J Cosmet Dermatol 2024; 23:76-78. [PMID: 37530091 DOI: 10.1111/jocd.15949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 07/18/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Affiliation(s)
- Joon Suk Bae
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Eun Soo Park
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Seung Min Nam
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Han Gyu Cha
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Chang Yong Choi
- Department of Plastic and Reconstructive Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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19
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Song Z, Yu T, Ge C, Shen X, Li P, Wu J, Tang C, Liu T, Zhang D, Li S. Advantage effect of Dalbergia pinnata on wound healing and scar formation of burns. J Ethnopharmacol 2023; 317:116872. [PMID: 37393027 DOI: 10.1016/j.jep.2023.116872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/21/2023] [Accepted: 06/28/2023] [Indexed: 07/03/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Dalbergia pinnata, as a natural and ethnic medicine in China, has been used for burns and wounds with a long history, which has the effect of invigorating blood and astringent sores. However, there were no reports on the advantage activity of burns. AIM OF STUDY The purpose of this study was to screen out the best active extract part of Dalbergia pinnata and investigate its therapeutic effect on wound healing and scar resolution. MATERIALS AND METHODS Rat burn model was established and the healing effects of extracts from Dalbergia pinnata on burn wounds were evaluated by the percentage of wound contraction and period of epithelialization. Histological observation, immunohistochemistry, immunofluorescence and ELISA were used for the examination of inflammatory factors, TGF-β1, neovascularization and collagen fibers through the period of epithelialization. In addition, the effect of the optimal extraction site on fibroblast cells was evaluated by cell proliferation and cell migration assays. The extracts of Dalbergia pinnata were analyzed by UPLC-Q/TOF-MS or GC-MS technique. RESULTS Compared to the model group, there were better wound healing, suppressed inflammatory factors, more neovascularization as well as newly formed collagen in the ethyl acetate extract (EAE) and petroleum ether extract (PEE) treatment groups. The ratio of Collagen I and Collagen III was lower in the EAE and PEE treatment groups, suggesting a potential for reduced scarring. Furthermore, EAE and PEE could repair wounds by up-regulating TGF-β1 in the early stage of wound repair and down-regulating TGF-β1 in the late stage. In vitro studies showed that both EAE and PEE were able to promote NIH/3T3 cells proliferation and migration compared with the control group. CONCLUSIONS In this study, EAE and PEE were found to significantly accelerate wound repair and might have an inhibitory effect on the generation of scars. It was also hypothesized that the mechanism might be related to the regulation of TGF-β1 secretion. This study provided an experimental basis for the development of topical drugs for the treatment of burns with Dalbergia pinnata.
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Affiliation(s)
- Zhuoyue Song
- Institute of Biological and Medical Engineering, Guangdong Academy of Sciences, Guangzhou, 510006, Guangdong, PR China; Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, PR China.
| | - Tian Yu
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, PR China.
| | - Chengcheng Ge
- The First Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, 510405, Guangdong, PR China.
| | - Xiuting Shen
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, PR China.
| | - Pan Li
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, PR China.
| | - Jinchuan Wu
- Institute of Biological and Medical Engineering, Guangdong Academy of Sciences, Guangzhou, 510006, Guangdong, PR China.
| | - Chunzhi Tang
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, PR China.
| | - Tao Liu
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, PR China.
| | - Danyan Zhang
- School of Pharmaceutical Sciences, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, PR China.
| | - Shijie Li
- Clinical Medical College of Acupuncture Moxibustion and Rehabilitation, Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, PR China.
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Bharadia SK, Horch J, Burnett L, Yu Z, Shen H, Gabriel V. Preoperative expectations, postoperative satisfaction and patient directed priorities for clinical burn research. Burns 2023; 49:1833-1844. [PMID: 37827937 DOI: 10.1016/j.burns.2023.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/01/2023] [Accepted: 04/15/2023] [Indexed: 10/14/2023]
Abstract
INTRODUCTION Burn patients receiving split thickness skin grafting are left with scarring and chronically dysfunctional grafted skin. Given evidence that patients' preoperative expectations mediate postoperative outcomes and satisfaction, we described burn patients' experience, expectations, and satisfaction with their skin graft, their views towards a cell based clinical trial to improve their graft and identified graft outcome measures for use in future studies. METHODS Data were collected via questionnaires preoperatively, one, and three months postoperatively. Longitudinal analyses assessed change over time. RESULTS Expectations of graft function were consistent pre- and postoperatively. Expectations of graft appearance showed significant decrease over time (β1 = -0.290, p = 0.008). Significant improvements in skin function (β1 = 0.579, p = 0.000) and appearance (β1 = 0.247, p = 0.025) at the wound site during recovery were observed. Patients noted great difference between grafted and normal skin. Patient satisfaction with their graft did not change significantly over time. Patients were willing to participate in a cell based clinical trial to improve graft symptomology and prioritized improvements in scarring, redness, sensation, and elasticity. CONCLUSIONS Outcome measures in trials advancing skin grafting should reflect chronic, patient prioritized limitations. We recommend preoperative educational interventions for burn patients receiving grafting to improve postoperative satisfaction.
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Affiliation(s)
- Shyla Kajal Bharadia
- Cumming School of Medicine, University of Calgary, Alberta, Canada; Foothills Medical Centre, 1403-29 Street NW, Calgary, AB T2N 2T9, Canada.
| | - Jenny Horch
- Foothills Medical Centre, 1403-29 Street NW, Calgary, AB T2N 2T9, Canada; Alberta Health Services, Canada.
| | - Lindsay Burnett
- Foothills Medical Centre, 1403-29 Street NW, Calgary, AB T2N 2T9, Canada; Alberta Health Services, Canada; Adjunct Clinical Assistant, University of Calgary, Alberta, Canada.
| | - Zheng Yu
- University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.
| | - Hua Shen
- Statistics and Actuarial Science, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada.
| | - Vincent Gabriel
- Departments of Clinical Neurosciences and Surgery, University of Calgary, Alberta, Canada; Calgary Firefighters' Burn Treatment Centre, Foothills Medical Centre, 1403-29 Street NW, Calgary, AB T2N 2T9, Canada.
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Yang B, Lin Y, Huang Y, Zhu N, Shen YQ. Extracellular vesicles modulate key signalling pathways in refractory wound healing. Burns Trauma 2023; 11:tkad039. [PMID: 38026441 PMCID: PMC10654481 DOI: 10.1093/burnst/tkad039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 05/10/2023] [Accepted: 06/22/2023] [Indexed: 12/01/2023]
Abstract
Chronic wounds are wounds that cannot heal properly due to various factors, such as underlying diseases, infection or reinjury, and improper healing of skin wounds and ulcers can cause a serious economic burden. Numerous studies have shown that extracellular vesicles (EVs) derived from stem/progenitor cells promote wound healing, reduce scar formation and have significant advantages over traditional treatment methods. EVs are membranous particles that carry various bioactive molecules from their cellular origins, such as cytokines, nucleic acids, enzymes, lipids and proteins. EVs can mediate cell-to-cell communication and modulate various physiological processes, such as cell differentiation, angiogenesis, immune response and tissue remodelling. In this review, we summarize the recent advances in EV-based wound healing, focusing on the signalling pathways that are regulated by EVs and their cargos. We discuss how EVs derived from different types of stem/progenitor cells can promote wound healing and reduce scar formation by modulating the Wnt/β-catenin, phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin, vascular endothelial growth factor, transforming growth factor β and JAK-STAT pathways. Moreover, we also highlight the challenges and opportunities for engineering or modifying EVs to enhance their efficacy and specificity for wound healing.
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Affiliation(s)
- Bowen Yang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renmin South Road, Wuhou District, Chengdu 610041, China
| | - Yumeng Lin
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renmin South Road, Wuhou District, Chengdu 610041, China
| | - Yibo Huang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renmin South Road, Wuhou District, Chengdu 610041, China
| | - Nanxi Zhu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renmin South Road, Wuhou District, Chengdu 610041, China
| | - Ying-Qiang Shen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Chinese Academy of Medical Sciences Research Unit of Oral Carcinogenesis and Management, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, Renmin South Road, Wuhou District, Chengdu 610041, China
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22
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Kurnaz SÇ, Tahir E, Uştu EK, Ertuğrul T, Tütüncü Ş. Histological Effect of Emodin on Acute Vocal Fold Injury in a Rat Model. J Voice 2023:S0892-1997(23)00300-4. [PMID: 37951816 DOI: 10.1016/j.jvoice.2023.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Emodin has beneficial effects on wound healing and reduces excessive fibrosis during tissue regeneration. Its positive effects on the wound-healing process were demonstrated on human fibroblasts. The aim of the present study was to evaluate the effectiveness of emodin application on acute vocal fold injury. MATERIALS AND METHODS Twenty-four Wistar albino rats were divided into three groups: control, sham, and emodin group. The glottis was examined using a 30°-2.7 mm diameter telescope, and vocal folds was unilaterally wounded by a microscissor through the entire layer of the lamina propria down to the vocalis muscle. While no procedure(no acute injury of the vocal fold or an injection of saline/emodin) was applied to the control group, 0.5 cc of saline was injected into the sham group and 0.5 cc of emodin in the emodin group, just lateral to the vocal folds, with 27 gauge injectors. Animals were sacrificed on the 21st day after the procedure. After excised larynx experiments, serial sections were prepared from the vocal fold. Hematoxylin eosin and immunohistochemical staining were performed and fibroblast density, lamina propria thickness, and vessel formation were graded from 0 (none) to 3 (severe reaction). Transforming growth factor-beta 1 (TGF-β1) and matrix metalloproteinase-9 (MMP-9) staining was used for immunohistochemical examinations. Four-point scoring scale for intensity being scored as 0 (no staining) to 3 (severeley stained) to quantify immonuhistochemical reaction. This scoring system was applied to vocal fold epithelium, lamina propria, vessel wall, and vocalis muscle tissues. The groups were compared with the Kruskal Wallis and Dunn tests. RESULTS Histologically, there was no significant difference (P > 0.05) between the sham group and the emodin group in terms of fibroblast density, vessel formation, and lamina propria thickness. These parameters were higher (P < 0.05) in both groups compared to the control group. In the lamina propria and vessel wall, MMP-9 staining was more intense in the emodin group than in the sham group. TGF-β1 staining of lamina propria, epithelial tissue, and vocalis muscle was significantly more intense in the emodin group than in the other groups. CONCLUSION Emodin induced MMP-9 and TGF-1 staining in the vocalis muscle and epithelium, as well as TGF-1 staining in the lamina propria. In terms of fibroblast density, new vascular creation, and LP thickness in acute vocal fold damage, there was no difference between saline administration and emodin injection. It may increase fibroblast activation in the acute phase of wound healing, but its long-term effects should be further investigated.
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Affiliation(s)
- Senem Ç Kurnaz
- Ondokuz Mayıs University Faculty of Medicine Department of Otolaryngology, Samsun, Türkiye
| | - Emel Tahir
- Ondokuz Mayıs University Faculty of Medicine Department of Otolaryngology, Samsun, Türkiye.
| | - Esra K Uştu
- Ondokuz Mayıs University Faculty of Medicine Department of Otolaryngology, Samsun, Türkiye
| | - Tuğrul Ertuğrul
- Ondokuz Mayıs University Faculty of Veterinary Medicine Department of Histology, Samsun, Türkiye
| | - Şerife Tütüncü
- Ondokuz Mayıs University Faculty of Veterinary Medicine Department of Histology, Samsun, Türkiye
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23
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Sun Q, Tang L, Zhang D. Molecular mechanisms of uterine incision healing and scar formation. Eur J Med Res 2023; 28:496. [PMID: 37941058 PMCID: PMC10631001 DOI: 10.1186/s40001-023-01485-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 10/30/2023] [Indexed: 11/10/2023] Open
Abstract
Wound healing is a tandem process involving inflammation, proliferation, and remodeling, through which damage is repaired and ultimately scar tissue is formed. This process mainly relies on the complex and extensive interaction of growth factors and cytokines, which coordinate the synthesis of various cell types. The loss of normal regulation in any part of this process can lead to excessive scarring or unhealed wounds. Recent studies have shown that it is possible to improve wound healing and even achieve scar-free wound healing through proper regulation of cytokines and molecules in this process. In recent years, many studies have focused on accelerating wound healing and reducing scar size by regulating the molecular mechanisms related to wound healing and scar formation. We summarized the role of these factors in wound healing and scar formation, to provide a new idea for clinical scar-free healing treatment of uterine incisions.
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Affiliation(s)
- Qing Sun
- Shenyang Women's and Children's Hospital, Shenyang, 110000, China
| | - Le Tang
- Shenyang Women's and Children's Hospital, Shenyang, 110000, China
| | - Dan Zhang
- Obstetric Department, Shenyang Women's and Children's Hospital, Shenyang, 110000, China.
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24
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Bik L, Elmzoon I, Wolkerstorfer A, Prens EP, van Doorn MBA. Needle-free electronically controlled jet injection with corticosteroids in recalcitrant keloid scars: a retrospective study and patient survey. Lasers Med Sci 2023; 38:250. [PMID: 37917309 PMCID: PMC10622365 DOI: 10.1007/s10103-023-03891-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/24/2023] [Indexed: 11/04/2023]
Abstract
First-line treatment of keloids consists of intralesional needle injections with corticosteroids, but generally entails multiple painful sessions, resulting in variable clinical outcomes. Novel needle-free jet injectors may facilitate more effective and patient-friendly dermal drug delivery. Here, we evaluated the effectiveness, tolerability and patient satisfaction of intralesional triamcinolone-acetonide (TCA) treatment in recalcitrant keloids using an electronically controlled pneumatic injector (EPI). A retrospective study was conducted in recalcitrant keloid patients with a history of severe pain during needle injections who received three sessions of EPI + TCA. Outcome measures included Patient and Observer Scar Assessment Scale (POSAS), Global Aesthetic Improvement Scale (GAIS), treatment-related pain (NRS), adverse effects, and patient satisfaction (survey). Ten patients with in total 283 keloids were included. The POSAS score significantly improved at follow-up and GAIS was reported as '(very) improved' for all patients. EPI + TCA was well-tolerated with a significantly lower NRS pain score compared to needle + TCA (pilot treatment). Only minor adverse effects occurred, and 90% of patients preferred EPI over needle treatment. EPI + TCA is an effective and tolerable treatment for patients with recalcitrant keloids. The minimal treatment-related pain and high patient satisfaction makes it a promising treatment for patients with needle-phobia and/or severe pain during needle injections.
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Affiliation(s)
- Liora Bik
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - Ixora Elmzoon
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Dermatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Albert Wolkerstorfer
- Department of Dermatology, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Errol P Prens
- Department of Dermatology, Erasmus Medical Centre, Rotterdam, The Netherlands
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25
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Chen Z, Ma X, Gao Y, Wu S, Xu N, Chen F, Song Y, Li C, Lu M, Dai Y, Gold MR, Zhao S, Chen K. Cardiac magnetic resonance-derived myocardial scar is associated with echocardiographic response and clinical prognosis of left bundle branch area pacing for cardiac resynchronization therapy. Europace 2023; 25:euad326. [PMID: 37926926 PMCID: PMC10639094 DOI: 10.1093/europace/euad326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023] Open
Abstract
AIMS Left bundle branch area pacing (LBBAP) is a novel approach for cardiac resynchronization therapy (CRT), but the impact of myocardial substrate on its effect is poorly understood. This study aims to assess the association of cardiac magnetic resonance (CMR)-derived scar burden and the response of CRT via LBBAP. METHODS AND RESULTS Consecutive patients with CRT indications who underwent CMR examination and successful LBBAP-CRT were retrospectively analysed. Cardiac magnetic resonance late gadolinium enhancement was used for scar assessment. Echocardiographic reverse remodelling and composite outcomes (defined as all-cause death or heart failure hospitalization) were evaluated. The echocardiographic response was defined as a ≥15% reduction of left ventricular end-systolic volume. Among the 54 patients included, LBBAP-CRT resulted in a 74.1% response rate. The non-responders had higher global, septal, and lateral scar burden (all P < 0.001). Global, septal, and lateral scar percentage all predicted echocardiographic response [area under the curve (AUC): 0.857, 0.864, and 0.822; positive likelihood ratio (+LR): 9.859, 5.594, and 3.059; and negative likelihood ratio (-LR): 0.323, 0.233, and 0.175 respectively], which was superior to QRS morphology criteria (Strauss left bundle branch abnormality: AUC: 0.696, +LR 2.101, and -LR 0.389). After a median follow-up time of 20.3 (11.5-38.7) months, higher global, lateral and septal scar burdens were all predictive of the composite outcome (hazard ratios: 4.996, 7.019, and 4.741, respectively; P's < 0.05). CONCLUSION Lower scar burden was associated with higher response rate of LBBAP-CRT. The pre-procedure CMR scar evaluation provides further useful information to identify potential responders and clinical outcomes.
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Affiliation(s)
- Zhongli Chen
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Rd, Xicheng District, Beijing 100037, China
| | - Xuan Ma
- Department of Magnetic Resonance Imaging, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Rd, Xicheng District, Beijing 100037, China
| | - Yuan Gao
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Rd, Xicheng District, Beijing 100037, China
| | - Sijin Wu
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Rd, Xicheng District, Beijing 100037, China
| | - Nan Xu
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Rd, Xicheng District, Beijing 10037, China
| | - Feng Chen
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Rd, Xicheng District, Beijing 100037, China
| | - Yanyan Song
- Department of Magnetic Resonance Imaging, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Rd, Xicheng District, Beijing 100037, China
| | - Chongqiang Li
- Catheterization Laboratory, National Center for Cardiovascular Diseases, Fuwai Hospotal, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Rd, Xicheng District, Beijing 10037, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Rd, Xicheng District, Beijing 100037, China
| | - Yan Dai
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Rd, Xicheng District, Beijing 100037, China
| | - Michael R Gold
- Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Rd, Xicheng District, Beijing 100037, China
| | - Keping Chen
- State Key Laboratory of Cardiovascular Disease, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167 North Lishi Rd, Xicheng District, Beijing 100037, China
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Jia L, Guo R, Ying J, Xiong J, Jiang H. A bibliometric and visualized research on global trends of scar, 2011-2021. Burns 2023; 49:1557-1565. [PMID: 37217380 DOI: 10.1016/j.burns.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 03/29/2023] [Accepted: 04/28/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Pathological scars are the results of abnormal wound healing, which not only affect the appearance, but may also be accompanied by significant psychosocial burdens. In this study, we aimed to conduct a bibliometric and visualized analysis on pathological scars and provide directions for future research. METHODS The articles on scar research from 2011 to 2021 in the Web of Science Core Collection database were collected. The bibliometrics records were retrieved and analyzed with Excel, CiteSpace V and VOSviewer. RESULTS A total of 944 scar research records published between 2011 and 2021 were collected. Publication output has shown an upward trend as a whole. China ranked first in terms of country contributions (418 publications, 5176 citations), while Germany, with only 22 studies published, had the highest average citation rate (57.18). Shanghai Jiaotong University was the institution with the largest number of related articles published, followed by the fourth military medical university, the University of Alberta and the Second military medical university. Wound repair and regeneration, Burns, Journal of Burn Care & Research, Journal of Cosmetic Dermatology published the most research in this field. Dahai Hu was the most prolific author, while Rei Ogawa was the most cited. The cluster analysis of the reference contributions and keywords indicated that current research hotspots mainly include pathogenesis, treatment strategies, and the safety evaluation of new scar treatment options. CONCLUSION This study provides a comprehensive summary and analysis of the current status and research trends of pathological scars. International research interest in pathological scars is on the rise, and high-quality studies related to the field have also increased in the last decade. The pathogenesis of pathological scars, treatment strategies, such as fractional ablative CO2 laser and molecular targeted therapy, and the safety evaluation of new treatment options will be the focus of future research.
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Affiliation(s)
- Lingling Jia
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China
| | - Rong Guo
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China
| | - Jianghui Ying
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China
| | - Jiachao Xiong
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China.
| | - Hua Jiang
- Department of Plastic Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Road, Shanghai 200120, China.
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Song MS, Woo SH. Endoscope-Assisted Hairline Approach for Head and Neck Masses: A Review. Clin Exp Otorhinolaryngol 2023; 16:317-325. [PMID: 37536749 DOI: 10.21053/ceo.2022.01634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 07/29/2023] [Indexed: 08/05/2023] Open
Abstract
Conventional surgery through a transcervical incision is indicated for the treatment of certain tumors in the head and neck. However, this method can cause multiple problems, including scarring and cosmetic concerns. The endoscope-assisted hairline approach, which serves as an alternative to conventional surgical procedures, is gaining popularity due to its excellent cosmetic and functional outcomes. However, given the anatomical complexity involved, the endoscope-assisted hairline technique is not frequently employed in head and neck surgery. The evolution of the hairline surgical approach has been influenced by changes in disease conditions and recent advances in surgical tools. This review article discusses the use of endoscope-assisted hairline approaches in the resection of head and neck masses, focusing on the surgical procedure and postoperative clinical outcomes.
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Affiliation(s)
- Min Seok Song
- Department of Otolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Seung Hoon Woo
- Department of Otolaryngology-Head and Neck Surgery, Dankook University College of Medicine, Cheonan, Korea
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28
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Kenny FN, Marcotti S, De Freitas DB, Drudi EM, Leech V, Bell RE, Easton J, Díaz-de-la-Loza MDC, Fleck R, Allison L, Philippeos C, Manhart A, Shaw TJ, Stramer BM. Autocrine IL-6 drives cell and extracellular matrix anisotropy in scar fibroblasts. Matrix Biol 2023; 123:1-16. [PMID: 37660739 PMCID: PMC10878985 DOI: 10.1016/j.matbio.2023.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/31/2023] [Accepted: 08/26/2023] [Indexed: 09/05/2023]
Abstract
Fibrosis is associated with dramatic changes in extracellular matrix (ECM) architecture of unknown etiology. Here we exploit keloid scars as a paradigm to understand fibrotic ECM organization. We reveal that keloid patient fibroblasts uniquely produce a globally aligned ECM network in 2-D culture as observed in scar tissue. ECM anisotropy develops after rapid initiation of a fibroblast supracellular actin network, suggesting that cell alignment initiates ECM patterning. Keloid fibroblasts produce elevated levels of IL-6, and autocrine IL-6 production is both necessary and sufficient to induce cell and ECM alignment, as evidenced by ligand stimulation of normal dermal fibroblasts and treatment of keloid fibroblasts with the function blocking IL-6 receptor monoclonal antibody, tocilizumab. Downstream of IL-6, supracellular organization of keloid fibroblasts is controlled by activation of cell-cell adhesion. Adhesion formation inhibits contact-induced cellular overlap leading to nematic organization of cells and an alignment of focal adhesions. Keloid fibroblasts placed on isotropic ECM align the pre-existing matrix, suggesting that focal adhesion alignment leads to active anisotropic remodeling. These results show that IL-6-induced fibroblast cooperativity can control the development of a nematic ECM, highlighting both IL-6 signaling and cell-cell adhesions as potential therapeutic targets to inhibit this common feature of fibrosis.
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Affiliation(s)
- Fiona N Kenny
- Randall Centre for Cell and Molecular Biophysics, King's College London, London, UK
| | - Stefania Marcotti
- Randall Centre for Cell and Molecular Biophysics, King's College London, London, UK
| | | | - Elena M Drudi
- Centre for Inflammation Biology & Cancer Immunology, Department of Inflammation Biology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Vivienne Leech
- Department of Mathematics, University College London, UK
| | - Rachel E Bell
- Centre for Inflammation Biology & Cancer Immunology, Department of Inflammation Biology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | - Jennifer Easton
- Centre for Inflammation Biology & Cancer Immunology, Department of Inflammation Biology, School of Immunology & Microbial Sciences, King's College London, London, UK
| | | | - Roland Fleck
- Centre for Ultrastructure Imaging, King's College London, UK
| | - Leanne Allison
- Centre for Ultrastructure Imaging, King's College London, UK
| | - Christina Philippeos
- Centre for Stem Cells and Regenerative Medicine, King's College London, London, UK
| | - Angelika Manhart
- Department of Mathematics, University College London, UK; Faculty of Mathematics, University of Vienna, Vienna, Austria
| | - Tanya J Shaw
- Centre for Inflammation Biology & Cancer Immunology, Department of Inflammation Biology, School of Immunology & Microbial Sciences, King's College London, London, UK.
| | - Brian M Stramer
- Randall Centre for Cell and Molecular Biophysics, King's College London, London, UK.
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Rivas E, Foster J, Crandall CG, Finnerty CC, Suman-Vejas OE. Key Exercise Concepts in the Rehabilitation from Severe Burns. Phys Med Rehabil Clin N Am 2023; 34:811-824. [PMID: 37806699 PMCID: PMC10731385 DOI: 10.1016/j.pmr.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
This article presents information on the benefits of exercise in counteracting the detrimental effects of bed rest, and/or severe burns. Exercise is key for maintaining physical function, lean body mass, metabolic recovery, and psychosocial health after major burn injuries. The details of an exercise training program conducted in severely burned persons are presented, as well as information on the importance of proper regulation of body temperature during exercise or physical activity. The sections on exercise and thermoregulation are followed by a section on the role of exercise in scarring and contractures. Finally, gaps in the current knowledge of exercise, thermoregulation, and contractures are presented.
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Affiliation(s)
- Eric Rivas
- Microgravity Research, In-Space Solutions, Axiom Space Headquarters, 1290 Hercules Avenue, Houston, TX 77058, USA
| | - Josh Foster
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine (IEEM), Texas Health Presbyterian Hospital Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
| | - Craig G Crandall
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Institute for Exercise and Environmental Medicine (IEEM), Texas Health Presbyterian Hospital Dallas, 7232 Greenville Avenue, Suite 435, Dallas, TX 75231, USA
| | - Celeste C Finnerty
- Department of Surgery, Division of Surgical Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1220, USA
| | - Oscar E Suman-Vejas
- Department of Surgery, Division of Surgical Sciences, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1220, USA.
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Ameer A, Mirza MB, Talat N. The Outcome of Purse-string Versus Conventional Wound Closure Techniques in Patients Undergoing Stoma Reversal: A Randomized Controlled Trial. J Pediatr Surg 2023:S0022-3468(23)00672-3. [PMID: 37978002 DOI: 10.1016/j.jpedsurg.2023.10.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/14/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Patients undergoing stoma reversal may experience surgical site infections and poor scarring. A purse-string closure approach may lower the incidence of surgical site infections due to its inherent ability to drain wound exudates. This study compared the frequency of surgical site infections and the cosmetic outlook of the scar among patients undergoing stoma reversal with linear and purse-string skin closure techniques. SETTING AND DURATION Department of Pediatric Surgery, University of Child Health Sciences Lahore with a duration of one year (June 2021 to June 2022). METHODS This randomized controlled trial (TCTR20210417001) was conducted with IRB approval. A total of 124 patients undergoing stoma reversal were randomly assigned to two groups (62 in each): Group A received conventional linear skin closure, while Group B received purse-string wound closure. The study evaluated surgical site infection, cosmetic outcome, and length of stay. RESULTS Both groups had similar age, gender ratio, indication for surgery, and length of stay. The purse-string group had a significantly lower incidence of SSI (38.7 % vs. 14.5 %; p = 0.002) and better scar quality (Manchester scar scale showed 'good' scar quality in 63 % of patients vs. 22.6 % in the linear closure group, p-value <0.0001). CONCLUSION The purse-string technique for skin closure resulted in fewer surgical site infections and improved scar appearance.
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Affiliation(s)
- Assad Ameer
- Department of Pediatric Surgery, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
| | - Muhammad Bilal Mirza
- Department of Pediatric Surgery, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan.
| | - Nabila Talat
- Department of Pediatric Surgery, University of Child Health Sciences, The Children's Hospital, Lahore, Pakistan
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31
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Jeong JY, Park KN, Lee SW. A Novel Intervention That Prevents Vocal Fold Scarring. J Voice 2023:S0892-1997(23)00250-3. [PMID: 37806901 DOI: 10.1016/j.jvoice.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVES We evaluated the preventive efficacy of stromal vascular fraction (SVF) for vocal fold scar in a rabbit model. STUDY DESIGN Animal model. METHODS The study included 40 male New Zealand white rabbits: 20 received vocal fold scar surgery served as normal controls (control group). The other 20 received the same vocal fold scar surgery with SVF injection (SVF group) Histological and high-speed video analyses of vocal fold vibration were performed 4 weeks after scar surgery and SVF injection. The maximum amplitude of vocal fold vibration was used to assess vocal fold vibration. A real-time PCR study was also performed to evaluate the scar regeneration and remodeling including TGF-ß1, IL-6, procollagen-1, MMP-2, 9, and HAS-2, 3. RESULTS Vocal fold vibration analyses indicated that the maximum amplitude differences in the vibration of the SVF group were significantly higher than the control group. The histological findings showed that the collagen density ratio were significantly lower in the SVF group compared to the control group. Real-time Polymerase Chain Reaction (PCR) study showed significant increases of MMP-2, 9 and HAS-2, 3, and a decrease of TGF-ß1, IL-6, procollagen-1 in the SVF group compared to the control group. CONCLUSIONS Based on the vocal fold vibration study, histological findings, and real-time PCR study, SVF injection showed preventive activity and improvement of vocal fold vibration for vocal fold scar in a rabbit model.
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Affiliation(s)
- Jun-Yeong Jeong
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Ki-Nam Park
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Seung-Won Lee
- Department of Otolaryngology-Head and Neck Surgery, Soonchunhyang University College of Medicine, Bucheon, South Korea.
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AlAli KF. Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation: step-by-step technical description with safe scar dissection. J Orthop Surg Res 2023; 18:755. [PMID: 37798790 PMCID: PMC10552325 DOI: 10.1186/s13018-023-04226-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 09/22/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Recurrent lumbar disc herniation (RLDH) is one of the most common reasons for re-operation after primary lumbar disc herniation with an incidence ranging from 5 to 23%. Numerous RLDH studies have been conducted; however, no available studies have provided a specific description of the use of the tubular retractor discectomy technique for RLDH emphasizing safe scar dissection. The objective of this study is to describe a detailed step-by-step technique for RLDH. MATERIAL AND METHODS A surgical technique reporting on our experience from the year 2013-2021 in 9 patients with RLDH at the same level and same side was included in the study. Clinical outcomes were assessed using the visual analog score (VAS) for leg pain before and three months after surgery. RESULTS A significant improvement was observed between the preoperative and postoperative VASs [mean (SD): 9.2 (1) vs. 1.5 (1)] for all patients. We did not report any incidental durotomy, neurological deficits or mortality in this study. One patient had superficial wound infection. The study is limited by small population, short follow-up and not reporting stability or spondylolisthesis. CONCLUSION A modified tubular discectomy technique with safe scar dissection is effective for RLDH treatment. Technically, the only scar needed to be dissected is the scar lateral to the exposed normal dura and the scar extended caudally till the level of the superior end plate of the targeted disc space where the scar can be entered ventrally and the disc fragment retrieved. Adherence to the step-by-step procedure described in our study will help surgeons operate with more confidence and minimize complications of recurrent lumbar disc herniation.
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Affiliation(s)
- Khaled Fares AlAli
- Department of Neurosurgery, Zayed Military Hospital, Abu Dhabi, United Arab Emirates.
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Roohaninasab M, Khodadad F, Sadeghzadeh-Bazargan A, Atefi N, Zare S, Jafarzadeh A, Rahimi ST, Nouri M, Nilforoushzadeh MA, Behrangi E, Goodarzi A. Efficacy of fractional CO 2 laser in combination with stromal vascular fraction (SVF) compared with fractional CO 2 laser alone in the treatment of burn scars: a randomized controlled clinical trial. Stem Cell Res Ther 2023; 14:269. [PMID: 37742019 PMCID: PMC10518108 DOI: 10.1186/s13287-023-03480-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 08/29/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND The appearance of skin scars is known as one of the main side effects of skin burns. Stromal vascular fraction (SVF), as a rich source of cell populations with tissue regeneration properties, plays an important role in the healing of skin lesions. Fractional CO2 lasers have occupied a special place in treating skin lesions, particularly skin scars, since their introduction. Our study aimed to compare the combination of SVF and fractional CO2 laser with fractional CO2 laser alone in the treatment of burn scars. METHOD This double-blind clinical trial study was conducted on ten patients with burn scars that were treated three times with a fractional CO2 laser at site of burn lesions, and one of the two areas studied was randomly injected with SVF. Two months after completion of the procedure, patients' scars were assessed using the Vancouver scar scale (VSS), biometric criteria, and physician and patient satisfaction ratings. RESULTS The results confirmed a significant improvement in VSS, cutometry, R7 criteria, complete density sonography, and skin density sonography in the fractional CO2 laser-treated group. The VSS criteria, epidermal thickness sonography, complete density sonography, and skin density sonography in the group treated with the combination of fractional CO2 laser and SVF also showed significant improvement. The VSS criteria and melanin index of Mexameter in the group treated with SVF in combination with fractional CO2 laser were significantly better than the group treated with fractional CO2 laser alone. Also, physician and patient satisfaction in the group treated with SVF injection in combination with fractional CO2 laser was significantly higher than the other group. CONCLUSION The results confirm the efficacy of SVF injection in combination with fractional CO2 laser in the treatment of burn scars and can be considered as a treatment option for better management of these lesions. TRIAL REGISTRATION The study protocol was retrospectively registered at Iranian Registry of Clinical Trials with code: IRCT20210515051307N1, Registration date: 2021-11-14, URL: https://www.irct.ir/trial/56337 .
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Affiliation(s)
- Masoumeh Roohaninasab
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Khodadad
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Afsaneh Sadeghzadeh-Bazargan
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmolsadat Atefi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Sona Zare
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Laser Application in Medical Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Stem Cell and Regenerative Medicine Institute, Sharif University of Technology, Tehran, Iran
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Alireza Jafarzadeh
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Seyyedeh Tahereh Rahimi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
| | - Maryam Nouri
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Nilforoushzadeh
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Skin Repair Research Center, Jordan Dermatology and Hair Transplantation Center, Tehran, Iran.
| | - Elham Behrangi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran.
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Azadeh Goodarzi
- Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Wang YF, Yang YT, Chen ZA, Wu XL. The running barbed tension-offloading suture: An updated technique update on tension wound closure. Asian J Surg 2023; 46:3773-3776. [PMID: 37308388 DOI: 10.1016/j.asjsur.2023.05.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 05/18/2023] [Accepted: 05/25/2023] [Indexed: 06/14/2023] Open
Abstract
TECHNIQUE The CHN•WU wound suture technique uses barbed sutures. The needle is inserted from the basal part of the superficial fascia at the left edge of the wound and passed through half of the reticular dermis to reach a point (1A) approximately 0.5-2 cm away from the wound edge. Occlusion is achieved at 1A at the level of the reticular dermis, and if done correctly, a shallow concavity will appear at the occlusion point on the skin. The needle is then walked along the natural curvature until it reaches the center of the wound and then moved out from the junction between the dermis and subcutaneous tissue. On the other side of the incision, the needle is inserted into the contralateral position at the junction between the dermis and subcutaneous tissue and moved along its natural curvature to achieve occlusion at the mirror site of 1A in the reticular dermis. This process is repeated until the entire wound is closed. In the end, two stitches should be applied in the opposite direction. The left barbed suture is cut and thrown. RESULTS This technique does not break through the epidermis, has high suture efficiency and satisfactory cosmetic appearance, disperses mechanical tension, and maintains wound tensile strength. CONCLUSION This technique was especially effective in closing high-tension wounds in the chest and extremities where the blood supply to both sides of the wound was not affected after suturing, and wound closure could be performed quickly and efficiently in one stage.
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Affiliation(s)
- Yong-Fei Wang
- Department of Hand and Foot Microsurgery, The Second Affiliated Hospital of Inner Mongolia Medical University, Inner Mongolia, China
| | - Ya-Ting Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zong-An Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Li Wu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Lewis CJ, Douglas H, Martin L, Deng Z, Melton P, Fear MW, Wood FM, Rea S. Carbon dioxide laser treatment of burn-related scarring: Results of the ELIPSE (Early Laser Intervention Promotes Scar Evolution) prospective randomized controlled trial. J Plast Reconstr Aesthet Surg 2023; 84:368-376. [PMID: 37393760 DOI: 10.1016/j.bjps.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023]
Abstract
AIM To investigate the impact of ablative fractional carbon dioxide laser (AFCO2L) on patient-reported outcomes measures, subjective scar appearance, dermal architecture, and gene transcription in early burn scars. METHODS Fifteen adult patients with a burn-related scar were recruited. Inclusion criteria were two non-contiguous scar areas of 1% total body surface area, similar baseline Vancouver scar scale (VSS) score and 3months since the time of injury. All participants acted as their own control. Scars were randomized to treatment or control. Treatment scars received three AFCO2L treatments at 6-week intervals. Outcome measures were recorded at baseline, 3, 6, and 12-months post-treatment. Measures included blinded VSS, Patient Observer Scar Assessment Scale (POSAS), Brisbane Burn Scar Impact Profile (BBSIP), blinded scar photo assessment, histological tissue analysis, and RNA sequencing analysis. RESULTS No significant difference was found in VSS, scar erythema, or pigmentation. Patient POSAS improved in scar thickness and texture following AFCO2L. All elements of BBSIP improved in control and laser groups. AFCO2L-treated scars were scored better than control scars by blinded raters. RNA sequencing illustrated that AFCO2L induced sustained changes in fibroblast gene expression. CONCLUSIONS AFCO2L treated scars had significantly altered scar thickness and texture 6 months post-laser and were rated better than controls on blinded photo analysis after 3 treatments. RNASeq results suggest laser treatment alters the transcriptome of treated fibroblasts for at least 3 months after treatment. Expansion of this research to study in more depth fibroblast changes in response to laser, as well as assessing the impact on daily activity and quality of life, will be beneficial.
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Affiliation(s)
- Christopher J Lewis
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia.
| | - Helen Douglas
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia
| | - Lisa Martin
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Zhenjun Deng
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Phillip Melton
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; School of Global and Population Health, University of Western Australia, Crawley, WA, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Fiona M Wood
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia; Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Suzanne Rea
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia; Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
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Zheng H, Cheng X, Jin L, Shan S, Yang J, Zhou J. Recent advances in strategies to target the behavior of macrophages in wound healing. Biomed Pharmacother 2023; 165:115199. [PMID: 37517288 DOI: 10.1016/j.biopha.2023.115199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
Chronic wounds and scar formation are widespread due to limited suitable remedies. The macrophage is a crucial regulator in wound healing, controlling the onset and termination of inflammation and regulating other processes related to wound healing. The current breakthroughs in developing new medications and drug delivery methods have enabled the accurate targeting of macrophages in oncology and rheumatic disease therapies through clinical trials. These successes have cleared the way to utilize drugs targeting macrophages in various disorders. This review thus summarizes macrophage involvement in normal and pathologic wound healing. It further details the targets available for macrophage intervention and therapeutic strategies for targeting the behavior of macrophages in tissue repair and regeneration.
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Affiliation(s)
- Hongkun Zheng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xinwei Cheng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Lu Jin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China; School of Life Science and Technology, ShanghaiTech University, Shanghai, China
| | - Shengzhou Shan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jun Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
| | - Jia Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
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Worley B, Kim K, Jain-Poster K, Reynolds KA, Merkel EA, Kang BY, Dirr MA, Anvery N, Christensen RE, Hisham FI, Ibrahim SA, Asadbeigi SN, Poon E, Alam M. Treatment of traumatic hypertrophic scars and keloids: a systematic review of randomized control trials. Arch Dermatol Res 2023; 315:1887-1896. [PMID: 36781457 DOI: 10.1007/s00403-023-02535-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 12/08/2022] [Accepted: 01/12/2023] [Indexed: 02/15/2023]
Abstract
Exaggerated healing and remodeling after skin injury may cause hypertrophic and keloidal scars, which are associated with functional and quality of life impairment. There is limited guidance available regarding the relative effectiveness of therapies for hypertrophic scars and keloids. In this review, we aim to compare the effectiveness of treatments for hypertrophic scars and keloids. MEDLINE, Embase, Scopus, and the Cochrane Collaboration database were searched from inception to March 2019 for randomized control trials of treatments for hypertrophic and keloid scars that included 20 or more patients. Outcomes evaluated included the standardized mean reduction in scarring and adverse events. The type of scar and the demographic features were analyzed for their effect on clinical outcome. Based on 25 included clinical trials, intralesional injection (64.1% [95% CI 60.8-67.5%]) may be more effective than physical (29.9% [95% CI 28.9-30.9%]) or topical treatments (34% [95% CI 31.8-36.8%]). Combination of 5-fluorouracil and triamcinolone (9:1 dilution) appeared superior among intralesional treatments for keloids. Ablative laser and pulsed-dye laser were the most useful laser treatments. Regression modeling showed laser treatment response was linked to Fitzpatrick skin type (p = 0.002). Adverse events were uncommon for all treatments and mostly transient. Intralesional treatments for keloid and hypertrophic scars may be the most reliable treatment option to improve pathologic scars, while laser treatment may have specific benefits for Fitzpatrick skin types I-III over types IV-VI. Management of pathological scars is an area of critical need, where appropriate treatment can have a significant impact on quality of life.
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Affiliation(s)
- Brandon Worley
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Kathyrn Kim
- University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Ketan Jain-Poster
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Kelly A Reynolds
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Emily A Merkel
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - McKenzie A Dirr
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Noor Anvery
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Rachel E Christensen
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Farhana Ikmal Hisham
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Sepideh Nikki Asadbeigi
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, 676 N Saint Clair, Suite 1600, Chicago, IL, 60611, USA.
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Burshtein J, Strunk A, Joo JS, Sharon VR. Porcine xenograft and second intention healing on the lower extremities after Mohs surgery: a descriptive case series. Arch Dermatol Res 2023; 315:2155-2157. [PMID: 36856857 DOI: 10.1007/s00403-023-02568-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/19/2023] [Accepted: 02/07/2023] [Indexed: 03/02/2023]
Abstract
There is limited data on benefits of healing after Mohs surgery using porcine xenografts (PXs) compared to second intention (SI). This case series sought to describe healing time, scar size, cosmetic outcome, pain, and infection rates in patients treated with PX or SI for wounds on lower extremities. 14 patients were enrolled. Six patients received treatment with SI, and eight patients received PX. 11 patients (4 SI, 7 PX) completed follow-up visit after 3 months (79% follow-up rate) when primary outcome measure was assessed. 64% of patients took > 3 months to heal. 72% of patients healed within 6 months post-surgery. Scars contracted by > 50% in 7/11 patients completing follow-up. In SI group, 3/5 patients self-reported pain level > 1 out of 10 at 1-week post-surgery compared to 3/8 in the PX group. Two patients in each group developed post-operative wound infection and three patients in PX group experienced other adverse events. These results suggest that healing with PX or SI resulted in small scar size, low post-operative pain level, and low rate of adverse events. Both groups had longer healing times than expected.
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Affiliation(s)
- Joshua Burshtein
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Andrew Strunk
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Jayne S Joo
- Department of Dermatology, University of California, Davis, School of Medicine, Sacramento, CA, USA
| | - Victoria R Sharon
- Department of Dermatology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 1991 Marcus Avenue, Suite 300, New Hyde Park, NY, 11042, USA.
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Abelleyra Lastoria DA, Benny CK, Hing CB. Subjective scar assessment scales in orthopaedic surgery and determinants of patient satisfaction: A systematic review of the literature. Chin J Traumatol 2023; 26:276-283. [PMID: 36804261 PMCID: PMC10533518 DOI: 10.1016/j.cjtee.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 12/31/2022] [Accepted: 01/20/2023] [Indexed: 02/23/2023] Open
Abstract
PURPOSE Scar assessment tools can be utilized during the post-operative period to monitor scar progress. The primary aim of this systematic review was to evaluate current subjective scar assessment scales utilized in orthopaedic surgery. The secondary aim was to identify determinants of patients' satisfaction with their scars and evaluate current measurement scales. METHODS The preferred reporting items for systematic reviews and meta-analyses checklist was followed. Electronic databases, currently registered studies, conference proceedings and the reference lists of included studies were searched. There were no constraints based on language or publication status. A narrative synthesis provided a description and evaluation of scales utilized in orthopaedic surgery. Determinants of patient satisfaction were identified along with the scales used to measure satisfaction. RESULTS A total of 6059 records were screened in the initial search. Twenty-six articles satisfied the inclusion criteria, assessing 7130 patients. In the literature, six validated subjective scar scales were identified, including the Vancouver scar scale, patient and observer scar assessment scale, Manchester scar scale, Stony Brook scar evaluation scale, visual analogue scale, and Hollander wound evaluation scale. Studies utilizing these scales to evaluate scars following orthopaedic procedures did so successfully. These were total hip arthroplasty, total knee arthroplasty, and limb reconstruction. The scales demonstrated satisfactory validity. Functional outcomes such as restoration of movement ranked among patients' highest concerns. Scar cosmesis was found to be amongst patients' lowest priorities. CONCLUSIONS Subjective scar assessment scales identified in the literature were not designed specifically for orthopaedic surgery. However, these were able to appropriately assess scars in the studies identified in this review. Current evidence suggests the effect of scar cosmesis on patient satisfaction with orthopaedic procedures is limited.
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Affiliation(s)
- Diego A Abelleyra Lastoria
- Institute for Medical and Biomedical Education, St George's University of London, London, SW17 0RE, United Kingdom.
| | - Clerin K Benny
- Faculty of Medicine, Medical University of Sofia, Sofia, 1641, Bulgaria
| | - Caroline B Hing
- Department of Trauma and Orthopaedics, St George's University Hospitals NHS Foundation Trust, London, SW17 0QT, United Kingdom
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Restrepo S, Rojas S, Sanabria A. Satisfaction With Head and Neck Scar Appearance in Latin American Patients: A Cross-Sectional Study. Eplasty 2023; 23:e56. [PMID: 37743968 PMCID: PMC10517663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background Surgical scars have been related to poor quality of life, and this is important for head and neck scars. There is a paucity of data about the effect of scars on appearance in Latin American patients. The objective of this study was to describe the self-assessment of patient scars using the Patient Scar Assessment Questionnaire (PSAQ). Methods This is a cross-sectional study. The validated Spanish version of the PSAQ was used. Adult patients who underwent elective head and neck surgery were included. Demographic and clinical data were obtained from clinical charts. Univariate and multivariate analysis using a forward logistic regression was planned to assess the weight of specific subscale items on the overall subscale score for appearance and satisfaction with appearance. Results 180 patients were recruited. A total of 144 (80%) patients were female, and the most frequent type of surgery was thyroidectomy. The global appearance, the global scar consciousness and the global scar appearance satisfaction was classified as excellent/good in 72.2%, 93.9% and 87.8% of patients, respectively. The multivariate analysis showed that color (OR 5.9, 95% CI 1.7-20.8), width (OR 58.9, [4.3-807.6]), and flatness (OR 5.7, [1.3-23.6]) were the items statistically associated with a regular/bad result in the appearance subscale. Conclusions There is a high level of satisfaction with head and neck scar appearance, and these data should be used to assess the impact of surgical interventions on cosmesis. The intrinsic characteristics of scars are the most relevant for defining scar satisfaction.
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Affiliation(s)
- Santiago Restrepo
- Department of Surgery, Universidad de Antioquia School of Medicine, Medellin, Colombia
| | - Santiago Rojas
- Department of Surgery, Universidad de Antioquia School of Medicine, Medellin, Colombia
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia School of Medicine, Medellin, Colombia
- Head and Neck Service, Fundación Colombiana de Cancerología- Clínica Vida, Medellín, Colombia
- Centro de Excelencia en Enfermedades de Cabeza y Cuello, CEXCA, Medellín, Colombia
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Wang Z, Knight R, Stephens P, Ongkosuwito EM, Wagener FADTG, Von den Hoff JW. Stem cells and extracellular vesicles to improve preclinical orofacial soft tissue healing. Stem Cell Res Ther 2023; 14:203. [PMID: 37580820 PMCID: PMC10426149 DOI: 10.1186/s13287-023-03423-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 07/20/2023] [Indexed: 08/16/2023] Open
Abstract
Orofacial soft tissue wounds caused by surgery for congenital defects, trauma, or disease frequently occur leading to complications affecting patients' quality of life. Scarring and fibrosis prevent proper skin, mucosa and muscle regeneration during wound repair. This may hamper maxillofacial growth and speech development. To promote the regeneration of injured orofacial soft tissue and attenuate scarring and fibrosis, intraoral and extraoral stem cells have been studied for their properties of facilitating maintenance and repair processes. In addition, the administration of stem cell-derived extracellular vesicles (EVs) may prevent fibrosis and promote the regeneration of orofacial soft tissues. Applying stem cells and EVs to treat orofacial defects forms a challenging but promising strategy to optimize treatment. This review provides an overview of the putative pitfalls, promises and the future of stem cells and EV therapy, focused on orofacial soft tissue regeneration.
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Affiliation(s)
- Zhihao Wang
- Department of Dentistry, Orthodontics and Craniofacial Biology, Research Institute for Medical Innovation, Radboud University Medical Centre, 6525EX, Nijmegen, The Netherlands
| | - Rob Knight
- Stein Eye Institute, University of California Los Angeles, Los Angeles, CA, USA
| | - Phil Stephens
- Advanced Therapeutics Group, School of Dentistry, Cardiff University, Cardiff, Wales, UK
| | - E M Ongkosuwito
- Department of Dentistry, Orthodontics and Craniofacial Biology, Research Institute for Medical Innovation, Radboud University Medical Centre, 6525EX, Nijmegen, The Netherlands
| | - Frank A D T G Wagener
- Department of Dentistry, Orthodontics and Craniofacial Biology, Research Institute for Medical Innovation, Radboud University Medical Centre, 6525EX, Nijmegen, The Netherlands
| | - Johannes W Von den Hoff
- Department of Dentistry, Orthodontics and Craniofacial Biology, Research Institute for Medical Innovation, Radboud University Medical Centre, 6525EX, Nijmegen, The Netherlands.
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Assaf A, Mekhael M, Noujaim C, Chouman N, Younes H, Feng H, ElHajjar A, Shan B, Kistler P, Kreidieh O, Marrouche N, Donnellan E. Effect of fibrosis regionality on atrial fibrillation recurrence: insights from DECAAF II. Europace 2023; 25:euad199. [PMID: 37428891 PMCID: PMC10519620 DOI: 10.1093/europace/euad199] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/06/2023] [Indexed: 07/12/2023] Open
Abstract
AIMS The amount of fibrosis in the left atrium (LA) predicts atrial fibrillation (AF) recurrence after catheter ablation (CA). We aim to identify whether regional variations in LA fibrosis affect AF recurrence. METHODS AND RESULTS This post hoc analysis of the DECAAF II trial includes 734 patients with persistent AF undergoing first-time CA who underwent late gadolinium enhancement magnetic resonance imaging (LGE-MRI) within 1 month prior to ablation and were randomized to MRI-guided fibrosis ablation in addition to standard pulmonary vein isolation (PVI) or standard PVI only. The LA wall was divided into seven regions: anterior, posterior, septal, lateral, right pulmonary vein (PV) antrum, left PV antrum, and left atrial appendage (LAA) ostium. Regional fibrosis percentage was defined as a region's fibrosis prior to ablation divided by total LA fibrosis. Regional surface area percentage was defined as an area's surface area divided by the total LA wall surface area before ablation. Patients were followed up for a year with single-lead electrocardiogram (ECG) devices. The left PV had the highest regional fibrosis percentage (29.30 ± 14.04%), followed by the lateral wall (23.23 ± 13.56%), and the posterior wall (19.80 ± 10.85%). The regional fibrosis percentage of the LAA was a significant predictor of AF recurrence post-ablation (odds ratio = 1.017, P = 0.021), and this finding was only preserved in patients receiving MRI-guided fibrosis ablation. Regional surface area percentages did not significantly affect the primary outcome. CONCLUSION We have confirmed that atrial cardiomyopathy and remodelling are not a homogenous process, with variations in different regions of the LA. Atrial fibrosis does not uniformly affect the LA, and the left PV antral region has more fibrosis than the rest of the wall. Furthermore, we identified regional fibrosis of the LAA as a significant predictor of AF recurrence post-ablation in patients receiving MRI-guided fibrosis ablation in addition to standard PVI.
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Affiliation(s)
- Ala Assaf
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Tulane University School of Medicine, 1324 Tulane Avenue, Suite A128, New Orleans, LA 70112, USA
| | - Mario Mekhael
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Tulane University School of Medicine, 1324 Tulane Avenue, Suite A128, New Orleans, LA 70112, USA
| | - Charbel Noujaim
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Tulane University School of Medicine, 1324 Tulane Avenue, Suite A128, New Orleans, LA 70112, USA
| | - Nour Chouman
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Tulane University School of Medicine, 1324 Tulane Avenue, Suite A128, New Orleans, LA 70112, USA
| | - Hadi Younes
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Tulane University School of Medicine, 1324 Tulane Avenue, Suite A128, New Orleans, LA 70112, USA
| | - Han Feng
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Tulane University School of Medicine, 1324 Tulane Avenue, Suite A128, New Orleans, LA 70112, USA
| | | | - Botao Shan
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Tulane University School of Medicine, 1324 Tulane Avenue, Suite A128, New Orleans, LA 70112, USA
| | - Peter Kistler
- Clinical Electrophysiology Research Laboratory, Baker Heart and Diabetes Research Institute, Melbourne, Australia
| | - Omar Kreidieh
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Tulane University School of Medicine, 1324 Tulane Avenue, Suite A128, New Orleans, LA 70112, USA
| | - Nassir Marrouche
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Tulane University School of Medicine, 1324 Tulane Avenue, Suite A128, New Orleans, LA 70112, USA
| | - Eoin Donnellan
- Tulane Research Innovation for Arrhythmia Discovery (TRIAD), Tulane University School of Medicine, 1324 Tulane Avenue, Suite A128, New Orleans, LA 70112, USA
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Gratteri M, Marangi GF, Mirra C, Arcari L, Romano FD, Cimmino A, Cogliandro A, Cagli B, Segreto F, Persichetti P. Impact of Incisional Access Site in Primary Breast Augmentation: Evaluation of Patient Satisfaction with SCAR-Q. Aesthetic Plast Surg 2023:10.1007/s00266-023-03502-z. [PMID: 37495729 DOI: 10.1007/s00266-023-03502-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Scarring at the incision site represents one of the most impactful outcomes in breast augmentation surgery for both the patient and the surgeon. Few studies exist with the aim of assessing patient perception of scarring outcomes in primary breast augmentation. The aim of this study was to evaluate the impact on quality of life of scars by submitting the SCAR-Q in patients who underwent primary augmentation mammoplasty. METHODS The SCAR-Q was administered at one and at 6 months after surgery to 54 consecutive patients underwent primary breast augmentation with inferior hemi-periareolar or inframammary incision. A total of 50 patients were divided into two groups of 21 patients with inferior hemi-periareolar incision and 29 patients with inframammary fold incision, respectively. Statistical analysis was performed with Prism 9. RESULTS All mean values of the three SCAR-Q scales tend to decrease at the second administration meaning that the perception of the scar is better at time 6 from the patient perspective. In the "Psychosocial scale," lower values at both 1 month and 6 months for group 2 compared to group 1 were shown. Unpaired T tests with Welch's correction showed significance for delta values variations between the two groups with P values <0.0001. CONCLUSION Data show that patients undergoing primary breast augmentation have a scar that has no significant impact. Patients with inframammary fold scar have less psychosocial impact than those with inferior hemi-periareolar scar. There were no statistically significant differences in scar-related symptoms and scar appearance between scar along the inframammary groove and inferior hemi-periareolar scar. LEVEL OF EVIDENCE IV Case series study. 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)
- Marco Gratteri
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Carlo Mirra
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy.
| | - Lucrezia Arcari
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Fara Desiree Romano
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Andrea Cimmino
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Annalisa Cogliandro
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Barbara Cagli
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
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Shah NR, Palackic A, Brondeel KC, Walters ET, Wolf SE. The Burn Wound. Surg Clin North Am 2023; 103:453-462. [PMID: 37149381 DOI: 10.1016/j.suc.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Skin serves as a protective barrier against infection, prevents excessive fluid and electrolyte losses, performs crucial thermoregulation, and provides tactile feedback of surroundings. The skin also plays an essential role in human perception of body image, personal appearance, and self-confidence. With these many diverse functions, understanding normal anatomic composition of skin is pivotal to evaluating the extent of its disruption from burn injury. This article discusses the pathophysiology, initial evaluation, subsequent progression, and healing of burn wounds. By delineating the various microcellular and macrocellular alterations of burn injury, this review also augments providers' capacity to deliver patient-centered, evidence-based burn care.
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Affiliation(s)
- Nikhil R Shah
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Alen Palackic
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Kimberley C Brondeel
- John Sealy School of Medicine, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Elliot T Walters
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA
| | - Steven E Wolf
- Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA.
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Liu T, Chen J, Wei B, Nie F, Zhu G. Safety and efficacy of autologous skin tissue cells grafting for facial sunken or flat scars. Heliyon 2023; 9:e16992. [PMID: 37484283 PMCID: PMC10361016 DOI: 10.1016/j.heliyon.2023.e16992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 05/02/2023] [Accepted: 06/02/2023] [Indexed: 07/25/2023] Open
Abstract
Importance It is necessary to determine whether safety and efficacy of autologous skin tissue cells grafting for facial sunken or flat scars. Objective To identify autologous skin tissue cells grafting can reduce facial sunken or flat scars. Design setting and participants In this retrospective cross-sectional study, a total of 128 patients with scar (exclude pathological scar patients), who were receiving autologous skin tissue cells grafting therapy from January 1, 2016, to December 31, 2019. Interventions Autologous skin tissue cells grafting. Main outcomes and measures Changes in scar severity, color changes in the scar area, infection rate and patient satisfaction. Results A total of 128 patients with scar (89 females [69.5%]; mean [SD] age, 30.6 [13.12] years) received autologous skin tissue cells grafting therapy. SCAR (Scar Cosmesis Assessment and Rating), with scores ranging from 0 (best possible scar) to 15 (worst possible scar). After treatment 12 months, the mean [SD] of SCAR score went down from 9.85 [1.33] to 2.67 [1.21]. No infection was observed during treatment or recovery, and the main drawback after autologous skin tissue cells grafting is that the color recovery time is longer. The patient satisfaction 6 months after treatment was 85.2%, furthermore 12 months after treatment patient satisfaction was 94.7%. Conclusions and relevance In this study, autologous skin tissue cells grafting was safe and effective to treat facial scars. Therefore, autologous skin tissue cells grafting may be recommended as a reliable treatment for facial scar.
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Affiliation(s)
- Tao Liu
- Department of General Surgery, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, China
| | - Jinxi Chen
- Department of Yongjia Jinxi Institute for Scar Repair, Zhejiang, China
| | - Bin Wei
- Department of General Surgery, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, China
| | - Fangfang Nie
- Department of Jiading District Central Hospital Affiliated Shanghai University of Medicine &Health Sciences, China
| | - Guanghui Zhu
- Department of General Surgery, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, China
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Chen W, Jiang T, Zhong Z, Wang X, Cao Y, Wu Y, Gai H, Zhang L, Yu Y. The effect of double W tension-reduced suture technique on the abdominal scars following the da Vinci robot-assisted gastrectomy for severely obese patients. BMC Surg 2023; 23:115. [PMID: 37161432 PMCID: PMC10170756 DOI: 10.1186/s12893-023-01979-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 03/30/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE To analyze the effect of a new type of tension-reduced suture named "double W tension-reduced suture technique" on the abdominal scars following the da Vinci robot-assisted gastrectomy for severely obese patients. METHODS 40 abdominal incisions following the da Vinci robot-assisted gastrectomy on severely obese patients from September 1st, 2021 to March 1st, 2022 were comprised in the study. 20 incisions were closed by the conventional full-thickness surgical suture as the control group, and 20 incisions were sewn up by double W tension-reduced suture as the double W group. The scars were assessed at the 1-month follow-up visit using the Vancouver scar scale (VSS), ultrasound and patient satisfaction. Meanwhile, digital photographs of scars were taken as well. RESULTS The VSS score was 6.80 ± 2.16 in the control group, while that of the double W group was 2.60 ± 1.89. The difference between groups was significant. Digital photographs showed that the scar color was not only light and close to the skin color, but also flat and soft in the double W group. Ultrasound showed that the fibers of subcutaneous tissue in the double W group were arranged neatly, the ultrasonic signal intensity was relatively uniform, and the tunnel was small without obvious lacunae. More patients were satisfied and very satisfied with scars in the double W group. CONCLUSION Double W tension-reduced suture technique could significantly improve the appearance and reduce comorbidities of scars following the da Vinci robot-assisted gastrectomy for severely obese patients.
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Affiliation(s)
- Wanying Chen
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, 130000, China
| | - Tao Jiang
- Hepatobiliary and pancreatic surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, 130000, China
| | - Ziming Zhong
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, 130000, China
| | - Xiaodong Wang
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, 130000, China
| | - Yang Cao
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, 130000, China
| | - Yujing Wu
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, 130000, China
| | - Haiyang Gai
- Department of Plastic Surgery, Jilin Academy of Traditional Chinese Medicine Sciences, Changchun, Jilin Province, 130021, China
| | - Lianbo Zhang
- Department of Plastic Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, 130000, China
| | - Yang Yu
- Hepatobiliary and pancreatic surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, 130000, China.
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D’Andrea A, Ilardi F, Palermi S, Riegler L, Miele T, Giallauria F, D’Alto M, Russo V, Cice G. Multimodality imaging in decompensated heart failure. Eur Heart J Suppl 2023; 25:C292-C300. [PMID: 37125293 PMCID: PMC10132613 DOI: 10.1093/eurheartjsupp/suad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Heart failure (HF) is usually suspected by clinical history, symptoms, physical examination, electrocardiogram findings, and natriuretic peptides' values. However, echocardiography and other imaging techniques play an essential role in supporting HF diagnosis. Thanks to its non-invasiveness and safety, transthoracic echocardiography is the first-level technique of choice to assess myocardial structure and function, trying to establish the diagnosis of HF with reduced, mildly reduced, and preserved ejection fraction. The role of echocardiography is not limited to diagnosis but it represents a crucial tool in guiding therapeutic decision-making and monitoring response to therapy. Over the last decades, several technological advancements were made in the imaging field, aiming at better understanding the morphofunctional abnormalities occurring in cardiovascular diseases. The purpose of this review article is to summarize the incremental role of imaging techniques (in particular cardiac magnetic resonance and myocardial scintigraphy) in HF, highlighting their essential applications to HF diagnosis and management.
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Affiliation(s)
- Antonello D’Andrea
- Corresponding author. Department of Translational Medical Sciences, Unit of Cardiology, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, 80131 Naples, Italy; Unit of Cardiology and Intensive Coronary Care, “Umberto I” Hospital, 84014 Nocera Inferiore, Italy.
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S. Pansini, 5, 80131 Naples, Italy
- Public Health Department, University of Naples Federico II, Via S. Pansini, 5, 80131 Naples, Italy
| | - Stefano Palermi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Via S. Pansini, 5, 80131 Naples, Italy
| | - Lucia Riegler
- Department of Cardiology, Umberto I Hospital, Via Alfonso de Nicola, 84014 Nocera Inferiore, Italy
| | - Tiziana Miele
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy
| | - Francesco Giallauria
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy
| | - Michele D’Alto
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy
| | - Vincenzo Russo
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy
| | - Gennaro Cice
- Department of Cardiology, Policlinico Casilino, Via Casilina, 1049, 00169 Rome
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Gomes De Pinho Q, Kotula R, Koubi M, Benyamine A, Rossi P, Granel B. [Tattoos too visible]. Rev Med Interne 2023; 44:266-267. [PMID: 37179053 DOI: 10.1016/j.revmed.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 05/15/2023]
Affiliation(s)
- Q Gomes De Pinho
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseillle, France
| | - R Kotula
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseillle, France
| | - M Koubi
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseillle, France
| | - A Benyamine
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseillle, France
| | - P Rossi
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseillle, France
| | - B Granel
- Service de médecine interne, hôpital Nord, Assistance publique-Hôpitaux de Marseille (AP-HM), chemin des Bourrely, 13015 Marseillle, France.
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Deitermann AM, Lin SK, Nugent ST, Raj LK, Beer J, Perz A, Shin TM, Sobanko JF, Etzkorn JR, Miller CJ. Tunneled island pedicle flap reconstruction for upper lateral cutaneous lip defects. J Plast Reconstr Aesthet Surg 2023; 81:119-121. [PMID: 37141785 DOI: 10.1016/j.bjps.2023.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 03/23/2023] [Accepted: 04/18/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Esthetic upper lateral cutaneous lip reconstruction preserves the apical triangle, nasolabial fold symmetry, and free margin position. The tunneled island pedicle flap (IPF) is a novel single-stage reconstruction to achieve these goals. OBJECTIVES Describe the technique and patient and surgeon-reported outcomes for the tunneled IPF reconstruction of upper lateral cutaneous lip defects. METHODS Retrospective chart review of consecutive tunneled IPF reconstruction following Mohs micrographic surgery (MMS) at a tertiary care center between 2014 and 2020. Patients rated their scars using the validated Patient Scar Assessment Scale (PSAS), and independent surgeons rated scars using the validated Observer Scar Assessment Scale (OSAS). Descriptive statistics were generated for patient demographics and tumor defect characteristics. RESULTS Twenty upper lateral cutaneous lip defects were repaired with the tunneled IPF. Surgeons rated scars with a composite OSAS score of 11.83 ± 4.29 (mean, SD) [scale of 5 (normal skin) to 50 (worst scar imaginable)] and an overall scar score of 2.81 ± 1.11 [scale of 1 (normal skin) to 10 (worst scar imaginable)]. Patients rated their scars with a composite PSAS score of 10 ± 5.39 [scale of 6 (best possible score) to 60 (worst)] and with an overall score of 2.2 ± 1.78 [scale of 1 (normal skin) and 10 (very different from normal skin)]. One flap was surgically revised for pincushioning, but none experienced necrosis, hematoma, or infection. CONCLUSIONS The tunneled IPF is a single-stage reconstruction for upper lateral cutaneous lip defects with favorable scar ratings by patients and observers.
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Affiliation(s)
- A M Deitermann
- University of Minnesota Medical School, Minneapolis, MN, United States
| | - S K Lin
- Donald & Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States
| | - S T Nugent
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - L K Raj
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | - J Beer
- Department of Dermatology, Tulane University School of Medicine, New Orleans, LA, United States
| | - A Perz
- Department of Dermatology, Boston University School of Medicine, Boston, MA, United States
| | - T M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - J F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - J R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States
| | - C J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia, PA, United States.
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50
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Kennedy DL, Chism-Balangue T, Furniss D. Reporting of scar outcomes in the hand and wrist; a state-of-the-art literature review. BMC Musculoskelet Disord 2023; 24:249. [PMID: 37004025 PMCID: PMC10064537 DOI: 10.1186/s12891-023-06296-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 03/07/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVES The aim of this literature review was to synthesise and report current practice in evaluation and reporting of scar outcomes in hand and wrist clinical research. METHODS A systematic search from inception to 2022 was conducted using three electronic databases. English language randomized controlled trials and observational cohort studies reporting standardised scar outcome measures and/or scar symptoms, appearance, impairment, function, or mental health outcomes in patients with hand and wrist scars were included. Two independent reviewers determined study eligibility and performed data extraction of a priori identified scar outcome domains. Data analysis included descriptive statistics and identification of discordance in taxonomy. RESULTS Fifty-nine studies were included. Elective surgery cohorts were the most frequently included clinical population (n = 28; 47%) followed by burns (n = 16; 27%). Six different standardised scar outcome measures were reported by 25% of studies however only 7% of studies utilised a patient-reported measure. Scar symptoms were the most frequently reported outcome domain (81%); but taxonomy was incongruous, constructs lacked working definitions required for generalisability and outcome measurement was variable and unreported. Nineteen different measures of scar appearance and structure were reported by 30 (51%) of studies however only nine (23%) were patient-reported. Seven different hand function PROMs were reported by 25 (43%) studies. Person-centred domains including scar acceptability (12%), mental health impact (5%), and social participation (4%) were rarely reported. CONCLUSIONS This review highlights that evaluation and reporting of hand and wrist scar outcomes is not standardised, assessment methods and measures are under-reported and there is discordance in taxonomy. Evaluation is not person-centred, rather it is dependent on clinician assessment. Domains including scar acceptability, mental health, and social participation are rarely addressed. A stakeholder consensus derived hand and wrist scar core outcome measurement set will promote standardisation and underpin improvements in clinical research quality, transparency, and rigour.
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Affiliation(s)
- Donna L Kennedy
- Therapy Department, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK.
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK.
| | | | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Science, University of Oxford, Botnar Research Centre, Oxford, UK
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