Targeting Diverse Wounds and Scars: Recent Innovative Bio-design of Microneedle Patch for Comprehensive Management

Wounds and the subsequent formation of scars constitute a unified and complex phased process. Effective treatment is crucial; however, the diverse therapeutic approaches for different wounds and scars, as well as varying treatment needs at different stages, present significant challenges in selecting appropriate interventions. Microneedle patch (MNP), as a novel minimally invasive transdermal drug delivery system, has the potential for integrated and programmed treatment of various diseases and has shown promising applications in different types of wounds and scars. In this comprehensive review, the latest applications and biotechnological innovations of MNPs in these fields are thoroughly explored, summarizing their powerful abilities to accelerate healing, inhibit scar formation, and manage related symptoms. Moreover, potential applications in various scenarios are discussed. Additionally, the side effects, manufacturing processes, and material selection to explore the clinical translational potential are investigated. This groundwork can provide a theoretical basis and serve as a catalyst for future innovations in the pursuit of favorable therapeutic options for skin tissue regeneration.

Effective keloid management using a combinatorial continuous-wave and repeat fractionated ablative CO2 laser regimen

BACKGROUND

Keloids are benign proliferative scars that form as a result of dysregulated growth and collagen deposition in response to cutaneous injury. Laser therapies have emerged as promising options for the treatment of keloids, with performance varying by laser type and lesion characteristics.

PURPOSE

To assess the combined continuous wave and repetitive fractionated CO2 laser treatment of keloids.

METHODS

A retrospective chart review of 22 cases of keloid scars treated with combined CO2 laser modes. A single session of continuous wave followed by five sessions of fractional delivery. Efficacy was assessed using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale. The Numeric Rating Scale was used to assess patient satisfaction and pain.

RESULTS

Most patients were female (77.3%) with skin type IV (72.7%), age was 24.3 ± 9.3 years, most keloids were located on the earlobe (56.5%) or arm or hand (17.4%), size ranged from 5 to 10 cm, and time since injury ranged from 3 months to 35 years. No serious adverse events were reported. At 6 months, significant improvements from baseline occurred in all characteristics, scar color (4.8 ± 2.8 to 1.9 ± 1.1), rigidity (5.0 ± 2.8 vs. 5.4 ± 2.8), thickness (5.4 ± 2.8 vs. 2.0 ± 1.1), and irregularity (5.9 ± 2.4 vs. 1.9 ± 0.9). The Vancouver scores followed a similar trend. Patient-rated overall improvement from 37 ± 17.6 at baseline to 16.1 ± 8.5 at 6 months, and improvement in associated pain and pruritus.

CONCLUSION

Combination of two ablative laser delivery modes within a single laser platform provided for effective and safe keloid management and left patients highly satisfied.

The Effectiveness of 595-nm Pulsed Dye Laser for the Treatment of Bilateral Cleft-Lip Scars in Asian Patients: A 6-Month Prospective, Randomized, Self-Controlled Trial

Objective: This study is the first prospective within-patient self-controlled research seeking to investigate the safety and efficacy of 595 nm pulsed-dye laser (PDL) for the treatment of cleft-lip scars. Approach: This prospective, randomized, self-controlled study is based on the clinical records of the patients who received laser-assisted treatment due to bilateral cleft-lip scars. The bilateral scars were randomly assigned to the 595 nm PDL group with five consecutive sessions at 2-week intervals or control group in a blinded manner of evaluators, with subsequent follow-up for 6 months after the final treatment. Clinical efficacy and safety outcomes were evaluated by Vancouver Scar Scale (VSS), Patient Scar Assessment Questionnaire (PSAQ), and other objective evaluations. Results: A total of 18 patients were included. The 595 nm PDL-treated sides showed statistically significant improvement in VSS after treatment at follow-up compared with the baseline (p < 0.05). Interestingly, the 595 nm-PDL-treated side achieved significantly better improvement in scar pigmentation and pliability (p < 0.05). Though there was statistically significant difference between two groups (p < 0.05), the gap in overall PSAQ is not obvious. And comparison by area and coloring evaluation (E/M index) also suggests that the responses of scars to treatment by PDL were slightly improved (p < 0.05). Innovation and Conclusion: It is the first time to apply the 595nm PDL for cleft-lip scars. It would be a better choice for the early treatment of red scar with proliferative tendency after cleft-lip surgery.

Postoperative Scar Management Using Laser Therapy for Breast Reconstruction With Latissimus Dorsi Flap

BACKGROUND

Postoperative scar formation is inevitable, and a gold standard management has not been established to date. Due to the fact long and large scar formation occurs in reconstructive surgery, this study analyzed the relationship between various factors in patients who received breast reconstruction using latissimus dorsi (LD) flap to investigate appropriate and effective management approaches.

PATIENTS AND METHODS

Twenty-seven patients who underwent breast reconstruction between June 2014 and January 2015 received laser therapy on their LD donor site at the Kyungpook National University Chilgok Hospital. Scar evaluation was performed on both the surgical scar and intact skin on the contralateral side. Scar evaluation was conducted at five specific points, 2 cm from the midpoint of the scar on each side. Laser treatment was performed at 4-week intervals, and patients were then followed-up for 6 months. To assess scars, gross images were taken using the same settings. In addition, spectrophotometry was used for color assessment, durometer for texture and pressure evaluation, and Vernier calipers and height gauges for a more precise and objective approach.

RESULTS

The mean age of the participants was 45.7 years, and the mean body mass index was 22.1 kg/m2 The operator-evaluated scar scale scores were 107.2 and 97.3 in the experimental and control groups, respectively. In the patient-rated questionnaire, the scores were 62.3 and 59.4 in the experimental and control groups, respectively.

CONCLUSION

When analyzing early-stage postoperative scars based on various factors, laser therapy is considered a very useful scar management approach. Additionally, when performing reconstructive surgery, tension force is regarded as a significant factor to take into account since it affects scar widening.

Effects of botulinum toxin type A in the prevention and treatment of facial hypertrophic scars: A meta-analysis

A meta-analysis was conducted to comprehensively evaluate the prophylactic and therapeutic efficacy of botulinum toxin type A (BTX-A) in the treatment of facial hypertrophic scars. Computerised searches were performed in databases, from their inception to November 2023, including Embase, Google Scholar, Cochrane Library, Wanfang, PubMed and China National Knowledge Infrastructure databases, focusing on randomised controlled trials (RCTs) that investigated the use of BTX-A for treating facial hypertrophic scars. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Seventeen RCTs were ultimately included, involving 1605 patients who underwent facial cosmetic surgery. The analysis revealed that compared with conventional treatments, BTX-A significantly reduced visual analogue scale (VAS) scores (standardized mean difference [SMD]: -3.50, 95% confidence interval [CI]: -5.16 to -1.84, p < 0.001) and Vancouver scar scale (VSS) scores (SMD: -2.86, 95% CI: -4.03 to -1.68, p < 0.001), and narrowed scar width (SMD: -1.80, 95% CI: -2.48 to -1.13, p < 0.001), while also enhancing the overall effectiveness of the treatment. This study indicates that BTX-A is an effective modality in the prophylaxis and treatment of facial hypertrophic scars, significantly alleviating scar-related pain and preventing scar widening, and is thus worthy of broader clinical application.

Advances in laser therapies for the scar

Scars are classified into 5 types: Superficial scars, hypertrophic scars, atrophic scars, depressed scars, and keloid. These types are primarily characterized by abnormal production of fibroblasts and collagen, as well as the disorderly arrangement of connective tissue. Laser treatment for scars involves the coordinated activation of various signaling pathways and cytokines. However, the exact pathological mechanism for scar formation remains unclear, leading to a lack of radical treatment. Recently, laser treatment has gained popularity as a new minimally invasive approach for scar treatment. The emergence of new theories such as fractional, picosecond laser, and laser-assisted drug delivery has led to continuous advance in laser treatment. Up to now, it has been developed numerous novel treatments, including combined with drug, physical, and other treatments, which have shown superior therapeutic effects. In order to optimize laser treatment in the future, it is crucial to combine new materials with postoperative care. This will help clinicians develop more comprehensive treatment strategies. Therefore, it is important to explore treatment options that have broader applicability.

Atrophic Postacne Scar Treatment: Narrative Review

Acne scarring is a frequent complication of acne. Scars negatively impact psychosocial and physical well-being. Optimal treatments significantly improve the appearance, quality of life, and self-esteem of people with scarring. A wide range of interventions have been proposed for acne scars. This narrative review aimed to focus on facial atrophic scarring interventions. The management of acne scarring includes various types of resurfacing (chemical peels, lasers, and dermabrasion); the use of injectable fillers; and surgical methods, such as needling, punch excision, punch elevation, or subcision. Since the scarred tissue has impaired regeneration abilities, the future implementation of stem or progenitor regenerative medical techniques is likely to add considerable value. There are limited randomized controlled trials that aimed to determine which treatment options should be considered the gold standard. Combining interventions would likely produce more benefit compared to the implementation of a single method.

Non-invasive imaging of pathological scars using a portable handheld two-photon microscope

BACKGROUND

Pathological scars are a disorder that can lead to various cosmetic, psychological, and functional problems, and no effective assessment methods are currently available. Assessment and treatment of pathological scars are based on cutaneous manifestations. A two-photon microscope (TPM) with the potential for real-time non-invasive assessment may help determine the under-surface pathophysiological conditions in vivo . This study used a portable handheld TPM to image epidermal cells and dermal collagen structures in pathological scars and normal skin in vivo to evaluate the effectiveness of treatment in scar patients.

METHODS

Fifteen patients with pathological scars and three healthy controls were recruited. Imaging was performed using a portable handheld TPM. Five indexes were extracted from two dimensional (2D) and three dimensional (3D) perspectives, including collagen depth, dermo-epidermal junction (DEJ) contour ratio, thickness, orientation, and occupation (proportion of collagen fibers in the field of view) of collagen. Two depth-dependent indexes were computed through the 3D second harmonic generation image and three morphology-related indexes from the 2D images. We assessed index differences between scar and normal skin and changes before and after treatment.

RESULTS

Pathological scars and normal skin differed markedly regarding the epidermal morphological structure and the spectral characteristics of collagen fibers. Five indexes were employed to distinguish between normal skin and scar tissue. Statistically significant differences were found in average depth ( t = 9.917, P <0.001), thickness ( t = 4.037, P <0.001), occupation ( t = 2.169, P <0.050), orientation of collagen ( t = 3.669, P <0.001), and the DEJ contour ratio ( t = 5.105, P <0.001).

CONCLUSIONS

Use of portable handheld TPM can distinguish collagen from skin tissues; thus, it is more suitable for scar imaging than reflectance confocal microscopy. Thus, a TPM may be an auxiliary tool for scar treatment selection and assessing treatment efficacy.

Pressure Masks for Facial Scar Treatment after Oncological Reconstruction: Long-Term Patient Satisfaction and Quality of Life

INTRODUCTION

 With increasing incidence of facial skin cancer, more patients undergo facial reconstruction following Mohs micrographic surgery (MMS). Aesthetically unpleasing, thickened facial flaps, and disturbing scars can be treated with a pressure mask with inner silicone lining to help improve functional and aesthetic outcomes. However, data on long-term patient satisfaction and quality of life (QoL) following this treatment are lacking.

METHODS

 We aimed to assess long-term satisfaction and QoL of patients who underwent local flap reconstruction following MMS. Patients treated between January 2012 and October 2020 were invited to answer FACE-Q and SCAR-Q questionnaires. Demographic data, skin cancer type and location, type of reconstruction, postoperative complications, duration of pressure mask therapy, daily compliance, and additional scar treatment were collected to explore possible predictors.

RESULTS

 Of 92 eligible patients, 50 responded. Eighteen respondents were male (36%) and 32 were female (64%). Mean duration of pressure mask therapy was 10.20 ± 4.61 months. Patients were 61.14 ± 32.91 months after completion of pressure mask therapy upon participation. Patients whose reconstruction consisted of multiple flaps had significantly worse outcomes in social function (p = 0.012), scar appearance (p = 0.045), and scar symptoms (p = 0.008). A trend of increasing time since therapy completion predicting better outcomes was observed for all scales, and it was a significant predictor for better scar appearance (p = 0.001) and less scar symptoms (p = 0.001).

CONCLUSION

 Pressure mask treatment for facial flaps and scars following MMS results in good long-term patient satisfaction and QoL. Multiple local flaps, reflecting a larger skin defect postexcision, is a predictor for worse outcomes in social function, scar appearance, and symptoms. Increasing time is associated with increasing satisfaction, which reflects satisfactory and stable long-term effects of treatment, possibly combined with more acceptance of the result over time.

Exploring the Multifaceted Impact of Acne on Quality of Life and Well-Being

A suitable portion of the total population still suffers through acne vulgaris, a widespread dermatological illness that mostly affects teens and young adults. Although acne is typically considered to be a cosmetic problem, recent research has concluded that certainly it has a significant role on impacting many physiological aspects of human health. This thorough investigation attempts to examine the intricate effects of acne on human physiology, taking into consideration both systemic and local effects. The study synthesizes research from a number of scientific disciplines, including dermatology, endocrinology, immunology, and psychoneuroimmunology. It investigates the complex interrelationships between several factors, such as sebum production, follicular hyperkeratinization, hormone imbalance, and Propionibacterium acnes colonisation, that lead to the development of acne. The study also sheds information on the intricate physiological mechanisms, oxidative stress, and immune response that contribute to the aetiology of acne. Along with it, the review investigates the relationship between endocrine problems and acne, emphasizing hormonal anomalies and their possible role in acne severity. The psychological effects of acne are also discussed, including the psychological problems, concerns with self-esteem, and decreased quality of life that acne sufferers encounter. On comprehensively examining the diverse physiological aspects affected by acne, this review provides a foundation for future research endeavours and informs the development of targeted therapeutic interventions. Ultimately, the integration of multidisciplinary approaches will enable healthcare professionals to address the physiological complexities of acne and improve the overall well-being of individuals affected by this common skin condition.

Psychometric Performance of the Stony Brook Scar Evaluation Scale and SCAR-Q Questionnaire in Dutch Children after Pediatric Surgery

Introduction: The growing population of survivors following pediatric surgery emphasizes the importance of long-term follow-up. The impact of surgical scars on daily life can be evaluated through patient-reported outcome measurements. The Stony Brook Scar Evaluation Scale (SBSES) and SCAR-Q questionnaire are two interesting instruments for this purpose. We evaluated their psychometric performance in Dutch children after pediatric surgery. Methods: After English-Dutch translation, we evaluated-following the COSMIN guidelines-the feasibility, reliability (internal and external), and validity (construct, criterion, and convergent) of the SBSES and SCAR-Q in Dutch patients < 18 years old with surgical scars. Results: Three independent observers completed the SB for 100 children (58% boys, median age 7.3 (IQR 2.5-12.1) years) in whom surgery had been performed a median of 2.8 (0.5-7.9) years ago. Forty-six of these children (61% boys, median age 12.1 (9.3-16.2) years) completed the SCAR-Q. Feasibility and internal reliability (Cronbach's alpha > 0.7) was good for both instruments. For the SB, external reliability was poor to moderate (interobserver variability: ICC 0.46-0.56; intraobserver variability: ICC 0.74). For the SCAR-Q, external reliability was good (test-retest agreement: ICC 0.79-0.93). Validity tests (construct, criterion, and convergent) showed poor to moderate results for both instruments. Conclusions: The Dutch-translated SBSES and SCAR-Q showed good feasibility and internal reliability. External reliability and validity were likely affected by differences in conceptual content between the questionnaires. Combining them would provide insight in the impact of scars on patients. Implementation of these instruments in longitudinal follow-up programs could provide new insights into the long-term psychological outcome after pediatric surgery.

Platelet-Rich Plasma (PRP) in Dermatology: Cellular and Molecular Mechanisms of Action

Platelet-rich plasma (PRP) therapy has gained attention in the scientific field due to its potential regenerative effects and great benefit-risk ratio. This review extensively explores the most studied mechanisms of this therapy according to the etiopathogenesis of skin diseases: cellular proliferation, matrix formation, regulation of inflammation, angiogenesis, collagen synthesis, and the remodeling of new tissue. Moreover, it draws on newly reported and lesser-known effects of PRP: its anti-apoptotic effects, immunological suppression, decrease in melanin synthesis, anti-microbial effects, overexpression of miR-155, antioxidant effects, and their involved pathways. This work aims to provide a complete update for understanding PRP's benefits and clinical relevance in wound healing, alopecia, pigmentary disorders, scars, rejuvenation, lichen sclerosus, and other inflammatory dermatoses, based on the current evidence. Furthermore, recent reports with novel indications for PRP therapy are highlighted, and new potential pathways correlated with the pathogenesis of skin diseases are explored.

Autologous adipose-derived stromal vascular fraction (SVF) in scar treatment among patients with keloids and hypertrophic scars: a systematic review and meta-analysis of current practices and outcomes

BACKGROUND

Keloids and hypertrophic scars are some of the most common skin conditions globally, associated with poor treatment response and high recurrence rates. Autologous adipose-derived stromal vascular fraction (SVF) is increasingly recognized as an emerging therapy albeit limited literature on its outcome in scar treatment. This review aimed to describe the current practices and outcomes of adipose-derived stromal Vascular Fraction in scar treatment.

METHODS

This systematic review assessed articles describing the use of SVF in scar treatment published between 2000 and 2023. Article searches of Medline/PubMed, Cochrane Library, and Embase databases using Mesh terms and the Boolean operators ("AND", "OR") by two independent researchers were done whilst following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Clinical studies assessing SVF in scar treatment with a primary outcome measure being an improvement in scar characteristics including the thickness, scar assessment scores were included.

RESULTS

Among the 1425 studies identified in the search, 20 studies met the inclusion criteria with a total of 493 patients included. Eight of these were clinical trials with the rest being observational studies. Follow-up ranged from 3 months to 24 months. In all studies, there was an improvement in scar characteristics following single-dose treatment with SVF or its equivalent. All studies reported SVF to be safe.

CONCLUSION

The review found that autologous adipose-derived SVF is a clinically effective therapy for keloids and scar treatment.

Ultrapulse carbon dioxide dot matrix laser for facial scar treatment: A meta-analysis

A meta-analysis was performed to investigate the efficacy of ultrapulse carbon dioxide dot matrix laser treatment for patients with facial scars. PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, China Biomedical Literature Database, and Wanfang Database were systematically searched for randomised controlled trials (RCTs) investigating ultrapulse carbon dioxide dot matrix laser treatment for facial scars, and the search was conducted from the time of database inception to July 2023. The retrieved literature was screened independently by two researchers, and data extraction and quality assessments were performed. The meta-analysis was conducted using RevMan 5.4 software. Outcome metrics included overall treatment effectiveness, complication rate, and Echelle d'évaluation clinique des cicatrices d'acné (ECCA) scores. Seventeen RCTs comprising 3703 patients were included, with 1853 patients in the experimental group and 1850 in the control group. The results showed that the experimental group had significantly increased overall treatment efficacy rates (odds ratio [OR]: 3.84, 95% confidence interval [CI]: 3.02-4.90, p < 0.001), reduced complication rates (OR: 0.35, 95% CI: 0.27-0.44, p < 0.001), and improved ECCA scores (standardised mean difference: -1.79, 95% CI: -2.53 to -1.05, p < 0.001) compared with the control group. In conclusion, as the primary treatment modality for facial acne depression scars, ultrapulse carbon dioxide dot matrix laser can significantly increase the overall treatment efficacy rate and ECCA scores and reduce the incidence of complications; however, higher-quality studies are needed for further validation.

Cellular and Molecular Processes in Wound Healing

This review summarizes the recent knowledge of the cellular and molecular processes that occur during wound healing. However, these biological mechanisms have yet to be defined in detail; this is demonstrated by the fact that alterations of events to pathological states, such as keloids, consisting of the excessive formation of scars, have consequences yet to be defined in detail. Attention is also dedicated to new therapies proposed for these kinds of pathologies. Awareness of these scientific problems is important for experts of various disciplines who are confronted with these kinds of presentations daily.

Treatment and Improvement of Healing after Surgical Intervention

The development of abnormal scars has a great impact on people's well-being, and improving scarring outcomes after surgery is a field that currently lacks consensus. This review aims to identify newly researched approaches to improving the quality of surgical scars. A systematic search of PubMed, Scopus, Web of Science, and ScienceDirect was conducted between 13 May 2023 and 17 May 2023, in accordance with the recommendations of the PRISMA Statement. Study selection and analysis of methodological quality were performed in parts, independently and blindly, based on eligibility criteria. The 21 prospective, comparative, and randomized studies reviewed included 1057 subjects and studied approaches such as topical applications of creams with herbal extracts and silicone gels, growth factors, negative pressure dressings, oligonucleotides, intralesional injection of compounds such as botulinum toxin, skin closure techniques such as suturing and tissue adhesive, and laser treatments. There are recent research techniques that generate good results and are really promising to improve the results of surgical scars; however, the available evidence is extremely limited in some cases, and it is necessary to deepen its analysis to obtain reliable action protocols in each type of surgery.

Lipofilling-A Regenerative Alternate for Remodeling Burn Scars: A Clinico-Immunohistopathological Study

Introduction  Any injury involving the dermis will lead to scarring. Scar tissue can cause functional limitations, cosmetic impairments, pain, and itch. Adipose-derived stem cells have also been shown to play a role in scar modulation. This study evaluates changes in lipofilled scar over the period of time and compares it with non-lipofilled scar tissue. Materials and Methods  A prospective case-control study with intraindividual follow-up was performed on 30 adult patients with post-burn scars from November 2016 to May 2019. Clinical, histopathological, and immunohistochemical parameters were assessed among the case and control regions of the scar. Results  Mean age of the study population was 30.6 years. The duration of the scar included in this study ranged from 1 to 28 years, with a mean duration of 5.91 years. There was a significant reduction in pain, itch, stiffness, and an increase in the pliability of the scar, and a substantial improvement in the modified Vancouver Scar Score in the lipofilled group. In histopathological analysis, the case group showed organized parallel collagen fibers, a significant reduction in melanocytes, improvement in vascularity, and a significantly increased amount of collagen fibers at the reticular dermis. Immunohistochemical analysis indicated new cell synthesis in the scar tissue and reduced melanocytes. Conclusion  The remodeling effect of adipocyte-derived stem cells is long-lasting, and there is a gradual improvement in most of the parameters. Lipofilling has regenerative capacity, which leads to the improved overall appearance of scar and improvement at the cellular level.

Advances in Immunomodulatory Mechanisms of Mesenchymal Stem Cells-Derived Exosome on Immune Cells in Scar Formation

Pathological scars are the result of over-repair and excessive tissue proliferation of the skin injury. It may cause serious dysfunction, resulting in psychological and physiological burdens on the patients. Currently, mesenchymal stem cells-derived exosomes (MSC-Exo) displayed a promising therapeutic effect on wound repair and scar attenuation. But the regulatory mechanisms are opinions vary. In view of inflammation has long been proven as the initial factor of wound healing and scarring, and the unique immunomodulation mechanism of MSC-Exo, the utilization of MSC-Exo may be promising therapeutic for pathological scars. However, different immune cells function differently during wound repair and scar formation. The immunoregulatory mechanism of MSC-Exo would differ among different immune cells and molecules. Herein, this review gave a comprehensive summary of MSC-Exo immunomodulating different immune cells in wound healing and scar formation to provide basic theoretical references and therapeutic exploration of inflammatory wound healing and pathological scars.

Prospective Study of Flap Surgery-Related Complications in Cutaneous Tumors: A Tertiary Care Institutional Experience of 6 Years

Introduction

Flap surgeries are the standard choice for reconstruction of defects post excision of cutaneous tumours. Complications following these surgeries predominantly result as a consequence of bleeding, tension, ischemia, infection.

Study Design

A Prospective study of patients treated for tumor excision and flap reconstruction between the period of 2014 and 2020 were followed up and complications encountered were analysed.

Results

A total of 70 patients with cutaneous malignancies underwent flap surgeries. Complications encountered were bleeding, hematoma, infection, necrosis, pincushioning, keloid, hypertrophic scars.

Conclusion

Successful outcome depends on pre operative evaluation, appropriate technique selection based on site of tumor, intraoperative care, post operative care and timely management of complications if any.

A Free Fatty Acid Synthetic Agonist Accelerates Wound Healing and Improves Scar Quality in Mice

BACKGROUND

Impaired wound healing is a health problem around the world, and the search for a novel product to repair wounded skin is a major topic in the field. GW9508 is a synthetic molecule described as a selective agonist of free fatty acid receptors (FFARs) 1 and 4, and there is evidence of its anti-inflammatory effects on several organs of the body.

PURPOSE

Here, we aimed to evaluate the effects of topical GW9508 on wound healing in mice.

RESEARCH DESIGN

First, we used bioinformatic methods to determine the expression of FFAR1 and FFAR4 mRNA in the skin from a human cell atlas assembled with single-cell transcriptomes. Next, we employed 6-week-old C57BL6J mice with 2 wounds inflicted in the back. The mice were randomly divided into 2 groups, a control group, which received topical vehicle, and a treatment group, which received GW9508, for 12 days. The wound was monitored by photographic documentation every 2 days, and samples were collected at day 6 and 12 post injury for RT-PCR, western blot and histology analyses.

RESULTS

FFAR1 and FFAR4 mRNA are expressed in skin cells in similar amounts to those in other tissues. Topical GW9508 accelerated wound healing and decreased gene expression of IL-10 and metalloproteinase 9 on days 6 and 12 post injury. It increased the quantity of Collagen I and improved the organization of collagen fibres. Conclusions: Our results show that GW9508 could be an attractive drug treatment for wounded skin. Future studies need to be performed to assess the impact of GW9508 in chronic wound models.

Effectiveness of iliac cancellous bone grafting in alveolar cleft repair and analysis of factors affecting it

OBJECTIVES

To review the effectiveness of secondary alveolar bone grafting using iliac cancellous bone in patients with unilateral complete alveolar cleft and to investigate the factors influencing it.

METHODS

A retrospective study of 160 patients with unilateral complete alveolar clefts who underwent iliac cancellous bone graft repair at the Department of Cleft Lip and Palate Surgery, West China Hospital of Stomatology, Sichuan University, was conducted. Eighty patients in the young age group (6-12 years) and 80 in the old age group (≥13 years) were included. Bone bridge formation was determined using Mimics software, and the volume was measured to calculate the iliac implantation rate, residual bone filling rate, and resorption rate. The factors that affected bone grafting in both subgroups were investigated.

RESULTS

Using bone bridge formation as the clinical success criterion, the success rate for the entire population was 71.25%, with a significant difference of 78.75% and 63.75% for the young and old age groups, respectively (P=0.036). The gap volume in the latter was significantly larger than that in the former (P<0.001). The factors that influenced bone grafting in the young group were the palatal bone wall (P=0.006) and history of cleft palate surgery (P=0.012), but only the palatal bone wall affected the outcome in the old age group (P=0.036).

CONCLUSIONS

The results of alveolar bone grafting for the old age group were worse than those for the young age group. The palatal bone wall was an important factor that affected alveolar bone grafting, and alveolar bone grafting in the young patients was influenced by the history of cleft palate surgery.

Lightning scars on tropical trees-Evidence and opportunities

Lightning strikes are a significant cause of tree mortality and damage in some regions of the tropics. Formation of lightning scars on tropical trees, however, is considered rare and therefore of little relevance in identifying trees struck by lightning. Here, we suggest, based on observations made in the Bwindi Impenetrable National Park (Uganda), that lightning scars can be frequent and may be a useful diagnostic feature to aid in identifying trees struck by lightning.

Becoming Experts in Their Own Treatment: Child and Caregiver Engagement With Burn Scar Treatments

Children who experience a severe burn injury not only require acute medical care but may also need ongoing rehabilitation. To mitigate the potential long-term consequences of scarring and the impact of scarring on their everyday lives, children may be expected to use a variety of time-consuming and multi-component non-invasive scar treatments (such as pressure garments and silicone gels). These treatments may pose unique challenges for children and their caregivers. With limited research previously addressing how Australian children navigate the use of scar treatments at home, this study aimed to develop a grounded theory of children and their caregivers' engagement with non-invasive burn scar treatments. Using a constructivist grounded theory approach, interviews were completed with 20 caregivers and 7 children, and a theory of children and their caregivers becoming experts in the use of non-invasive burn scar treatments was developed. Through persistence and flexibility, they continued to develop expertise. Engaging with scar treatments was an evolving process over time for children with burns and their caregivers. Theoretical categories identified included 'making it work', 'finding the balance' and 'seeking reassurance' and highlighted the remarkable strengths and adaptability of children and their caregivers. Through trial and error, children and their caregivers developed their own unique strategies for engaging with scar treatments. These insightful results may inform the development of interventions to support children and their caregivers' day-to-day engagement with non-invasive burn scar treatments and guide health professionals recommending these treatments.

Safety and feasibility of autologous adipose-derived stromal vascular fraction in the treatment of keloids: a phase one randomized controlled pilot trial

INTRODUCTION

Autologous adipose-derived stromal vascular fraction (SVF) has been described to have therapeutic benefits in the treatment of keloids. However, most of the evidence on its efficacy is based on observational studies the majority of which are conducted in high-income countries and yet the highest burden of keloids is in low- and middle-income countries (LMICs).

OBJECTIVES

We set out to determine the safety and feasibility of using autologous adipose derived stromal vascular fraction in the treatment of keloids in LMICs.

METHODS

In this phase II randomized controlled pilot clinical trial conducted in the Plastic Surgery Unit of Kirruddu National Referral Hospital in Kampala Uganda, 8 patients were assigned a 1:1 ratio to either SVF or triamcinolone acetonide (TAC) arms. In the SVF arm, a median (Inter quartile range) amount of stromal cell infiltration of 2.7×10⁶ (11×10⁶) was administered, while the controls received 10 mg/ml TAC at a ratio of 1:1 TAC to keloid volume. Primary endpoints were adverse event development based on the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 tool and feasibility assessment based on ≥ 70% recruitment feasibility and ≥ 80% interventional feasibility rates.

RESULTS

The participants' mean age was 27.9 (±6.5) years, with a female predilection of 5 (63%). Overall, no adverse events were reported in the SVF arm, while ulceration in a single patient in the TAC arm, which was a grade II adverse event, was reported. Recruitment feasibility of 80% and interventional feasibility with 100% completion were reported.

CONCLUSION

Based on our findings, an autologous adipose-derived stromal vascular fraction is feasible and safe for the treatment of keloids in LMICs.

A Study of Cutaneous Adverse Drug Reactions at a Tertiary Care Center in Andhra Pradesh, India

INTRODUCTION

Practically all physicians encounter a diverse range of suspected cutaneous adverse drug reactions (CADRs) in their daily clinical practice. The skin and mucosa are the most often encountered areas for the early presentation of numerous adverse drug reactions. Cutaneous adverse drug reactions are classified as benign or severe. The clinical manifestations of drug eruptions can range from mild maculopapular exanthema to severe cutaneous adverse drug reactions (SCARs).

OBJECTIVE

To determine the varied clinical and morphological presentations of CADRs and to identify the culprit drug and common drugs causing CADRs.

MATERIALS AND METHODS

Patients with clinical features suspected of CADRs presenting to the outpatient department (OPD) of dermatology, venereology, and leprosy (DVL) between December 2021 to November 2022 at Great Eastern Medical School and Hospital (GEMS), Srikakulam, Andhra Pradesh, India, were considered for the study. This was a cross-sectional, observational study. The patient's clinical history was taken in detail. This included chief complaints (symptoms, site of onset, duration, drug history, latency time between drug administration and the appearance of cutaneous lesions), family history, associated diseases, the morphology of lesions, and mucosal examination. Upon drug discontinuation, improvement in cutaneous lesions and systemic features were noted. A complete general examination, systemic examination, dermatological tests, and mucosal examination were performed.

RESULTS

A total of 102 patients were involved in the study, of whom 55 were males and 47 were females. The male-to-female ratio was 1.17:1, with a slight male majority. The most common age group was 31 to 40 years for both males and females. Itching was the predominant complaint in 56 patients (54.9%). The mean latency period was shortest in urticaria (2.13+/- 0.99 hours) and longest in lichenoid drug eruption (4.33+/- 3.93 months). Most patients developed symptoms after a week of taking the drug (53.92%). A history of similar complaints was present in 38.23% of patients. Analgesics and antipyretics (39.2%) were the most common culprit drugs followed by antimicrobials (29.4%). Among analgesics and antipyretics, aceclofenac (24.5%) was the commonest culprit drug. Benign CADRs were observed in 89 patients (87.25%), and severe cutaneous adverse reactions (SCARs) were observed in 13 patients (12.74%). The common CADRs presented were drug-induced exanthem (27.4%). Imatinib-induced psoriasis vulgaris and lithium-induced scalp psoriasis were observed in one patient each. Severe cutaneous adverse reactions were observed in 13 patients (12.74%). Anticonvulsants, nonsteroidal anti-inflammatory drugs (NSAIDs), and antimicrobials were the culprit drugs for SCARs. Eosinophilia was present in three patients, deranged liver enzymes was present in nine patients, a deranged renal profile was present in seven patients, and death occurred in one patient with toxic epidermal necrolysis (TEN) of SCARs.

CONCLUSION

Before prescribing any drug to a patient, a detailed drug history and family history of drug reactions need to be obtained. Patients should be advised to avoid over-the-counter usage of medications and self-administration of drugs. If adverse drug reactions occur, it is advised to avoid readministration of the culprit drug. Drug cards must be prepared and given to the patient, mentioning the culprit drug as well as the cross-reacting drugs.

The Importance of Psychometric and Physical Scales for the Evaluation of the Consequences of Scars-A Literature Review

BACKGROUND

Scars affect patients after trauma, burns, or surgical procedures and can generate both physical and psychosocial changes. The aesthetic damage represents the modification of a person's physical appearance, in its bodily integrity, causing numerous sufferings and determining social or economic consequences. The aim of this research is to evaluate the advantages and disadvantages offered by the available psychosocial and physical scar scales in assessing the physical, aesthetic, psychosocial, and juridical consequences of scars. This will aid to inform medical examiners about the most valued existing scales to allow them to select the most appropriate instrument to manage their patient.

METHODS

A broad search of relevant scientific studies on the psychosocial determinants of post-traumatic and surgical scars was conducted by using the following international database tools: PsycINFO, MedLine Social Science Index, Scopus, Web of Science, published from 1960 until 2022.

RESULTS

We analyzed 63 scientific studies to assess the advantages and limits of several psychometric and physical scar evaluation scales.

CONCLUSIONS

The researchers analyzed in this review highlight the advantages and limitation of existing instruments, evidencing the demand for future scar evaluation instruments and a scar-assessing algorithm that takes into account the physical, aesthetic, psychosocial, and legal consequences of scars.

Effectiveness of various methods of manual scar therapy

BACKGROUND

The skin is a protective barrier of the body against external factors, and its damage leads to a loss of integrity. Normal wound healing results in a correct, flat, bright, and flexible scar. Initial skin damage and patient specific factors in wound healing contribute that many of these scars may progress into widespread or pathologic hypertrophic and keloid scars. The changes in cosmetic appearance, continuing pain, and loss of movement due to contracture or adhesion and persistent pruritis can significantly affect an individual's quality of life and psychological recovery post injury. Many different treatment methods can reduce the trauma and surgical scars. Manual scar treatment includes various techniques of therapy. The most effectiveness is a combined therapy, which has a multidirectional impact. Clinical observations show an effectiveness of manual scar therapy.

MATERIAL AND METHODS

The aim of this work was to evaluate effectiveness of the scar manual therapy combined with complementary methods on the postoperative scars. Treatment protocol included two therapies during 30 min per week for 8 weeks. Therapy included manual scar manipulation, massage, cupping, dry needling, and taping.

RESULTS

Treatment had a significant positive effect to influence pain, pigmentation, pliability, pruritus, surface area, and scar stiffness. Improvement of skin parameters (scar elasticity, thickness, regularity, color) was also noticed.

CONCLUSION

To investigate the most effective manual therapy strategy, further studies are needed, evaluating comparisons of different individual and combined scar therapy modalities.

High-Intensity Focused Ultrasound Thermotherapy for Scar Treatment

The formation of pathological scars is a common medical and aesthetic problem worldwide. Surgical interventions, burns and injuries are the most common cause. Treating these scars is a challenge for any surgeon. The Clinic of Plastic-Reconstructive and Aesthetic Surgery with Thermal Trauma and Imaging Diagnostics applied an innovative method of thermotherapy with high-intensity, focused ultrasound in 20 patients with hypertrophic scars and keloids of different age, etiology and parameters. After a series of procedures, we got excellent results, reducing scar size, pigmentation, pain and itching. This type of thermotherapy is successfully applied to pathological scars. In this way, a change in scar density is achieved by converting hard collagen into a gelatin-like mass.As a subsequent procedure, moderately compressive massages are applied for faster resorption of the pathological collection. Our results show that high-intensity focused ultrasound thermotherapy of pathological scars is a non-invasive method of treatment with reasonably good results as regards both aesthetic and functional aspects.

A retrospective study on the association of keloids with underlying health conditions in African-American Women

Keloids are disfiguring benign scars that develop due to an exaggerated response to cutaneous wound healing, growing beyond the boundaries of the cutaneous insult into normal, previously uninvolved skin. The association of keloids with other underlying health conditions has been postulated, but not well characterized.

Objective

This study aims to identify whether there is any association of keloids with underlying health conditions in African-American women.

Methods

This study was done via the use of the National Inpatient Sample, a subset of the Healthcare Cost and Utilization Project. African-American women with keloids who had undergone cesarean sections were compared with a control group of African-American women with no history of keloids who had undergone cesarean sections.

Results

A total of 301 African-American inpatient encounters with patients with keloids were compared with 37,144 encounters in the control group. The keloid patients had an increased association with peritoneal adhesions compared with the control group.

Limitations

results are limited to one race and restricted age range; also, unable to differentiate keloids from hypetrophic scarring with ICD-10 codes.

Conclusion

These findings suggest that keloids and peritoneal adhesions may have similar inflammatory processes.

Koebner Phenomenon in Kaposi's Sarcoma: A Large Single-Center Case Series and Review of Current Knowledge

BACKGROUND

occasional case reports have described the appearance of Kaposi's sarcoma (KS) on previously unaffected skin after incidental or accidental injury, but the association is probably under-reported.

OBJECTIVES

to present a large case series of patients suffering from Koebner phenomenon (KP) in KS and describe their main epidemiological, clinical, and therapeutic features.

METHODS

we have retrospectively analyzed our clinical and photographic records of 524 patients who had been diagnosed with KS between 2009 and 2021.

RESULTS

31 of 524 (6%) KS patients developed KP. Among these 31 patients, 24 (77%) had KS lesions after surgery, 4 (13%) after electrochemotherapy, laser therapy and cryotherapy, and 3 (10%) on areas affected by bullous diseases.

CONCLUSIONS

trauma, including surgery or other medical procedures, can trigger KS, underlying the importance of treatment options which cause the least injury to the skin.

Scarring in Rough Rectangular Billiards

We study the mechanism of scarring of eigenstates in rectangular billiards with slightly corrugated surfaces and show that it is very different from that known in Sinai and Bunimovich billiards. We demonstrate that there are two sets of scar states. One set is related to the bouncing ball trajectories in the configuration space of the corresponding classical billiard. A second set of scar-like states emerges in the momentum space, which originated from the plane-wave states of the unperturbed flat billiard. In the case of billiards with one rough surface, the numerical data demonstrate the repulsion of eigenstates from this surface. When two horizontal rough surfaces are considered, the repulsion effect is either enhanced or canceled depending on whether the rough profiles are symmetric or antisymmetric. The effect of repulsion is quite strong and influences the structure of all eigenstates, indicating that the symmetric properties of the rough profiles are important for the problem of scattering of electromagnetic (or electron) waves through quasi-one-dimensional waveguides. Our approach is based on the reduction of the model of one particle in the billiard with corrugated surfaces to a model of two artificial particles in the billiard with flat surfaces, however, with an effective interaction between these particles. As a result, the analysis is conducted in terms of a two-particle basis, and the roughness of the billiard boundaries is absorbed by a quite complicated potential.

[Scars from Nonsuicidal Self-Injury - What Plastic Surgery Can Do]

Scars from Nonsuicidal Self-Injury - What Plastic Surgery Can Do Abstract. Objective: Nonsuicidal self-injury (NSSI) can induce characteristic scar patterns indicating the origin of these scars. This frequently results in the stigmatization of the involved patients with far-reaching consequences for their daily routine and quality of life. Despite patients being highly interested in scar correction, the potential of surgical therapy to alleviate NSSI-prone behavior and its help in destigmatizing surgical corrections and esthetic improvements in these situations are not well-known. Method: Over a period of 5 years, we analyzed 600 patients requesting NSSI scar treatment in our outpatient clinic. We collected data on the motivation for a scar correction, on the maturity of the scars, the involved body parts, and potential prior scar treatments as well as the amount, localization, and type of performed surgical procedures in our institution. Results: Stigmatization (57 %) and limitations in choice of clothing (18 %) were the most frequent reasons given for scar correction. We performed 358 dermabrasions and 55 serial excisions on these patients, nine combinations of both, and 13 other procedures. Conclusions: Plastic surgery offers multiple possibilities to reduce the stigmatization of patients with NSSI scars, who should thus be informed early about their choices.

A meta-ethnography of developing and living with post-burn scars

INTRODUCTION

Post-burn scarring is often cosmetically unappealing and create discomfort. This makes it crucial to understand the experience of individuals living with scars which can offer insights into their recovery. This review sought to develop an in-depth understanding of living with post-burn scars.

DESIGN

A systematic review and meta-ethnography approach were employed. We utilized an interpretive approach to inductively generate codes. These codes were examined iteratively using a constant comparison strategy following which they were re-interpreted to formulate themes which formed the basis of undertaking a narrative synthesis.

RESULTS

Twenty-five studies were retained. The analytical process yielded two themes: emergence of a new identity and living with the redefined self. The experience of living with scars is entwined with the initial trauma as the scars served as a permanent reminder of the injury. Emergence of a new identity involved a process of meaning making, mourning the loss of the old self, confronting the new self, reconciling the remains of the old self with the new, rebuilding a new identity, and navigating through functional restrictions. These processes were particularly challenging for persons involved in self-immolation. Positive coping and changing one's perspective emerged as strategies to facilitate living with the redefined self.

CONCLUSION

Living with scars is a challenging process which is more difficult for persons whose injuries are due to self-immolation (act of burning oneself). The findings highlight a latent yet ongoing process towards subjective recovery. Clinicians need to be aware of the processes and incorporate these into rehabilitation programmes.

CLINICAL RELEVANCE

Burn survivors need ongoing professional support to adjust to and live with the scars. Victims of self-immolation should be considered for early psychosocial support.

Potential genetic therapies based on m6A methylation for skin regeneration: Wound healing and scars/keloids

Skin wound healing is a complex and multistage process, where any abnormalities at any stage can result in the accumulation of non-functional fibrotic tissue, leading to the formation of skin scars. Epigenetic modifications play a crucial role in regulating gene expression, inhibiting cell fate determination, and responding to environmental stimuli. m6A methylation is the most common post-transcriptional modification of eukaryotic mRNAs and long non-coding RNAs. However, it remains unclear how RNA methylation controls cell fate in different physiological environments. This review aims to discuss the current understanding of the regulatory pathways of RNA methylation in skin wound healing and their therapeutic implications with a focus on the specific mechanisms involved.

'Scars: How Our Wounds Make Us Who We Are': Improving appearance-based stigma, conceptualisation of beauty and body esteem through a documentary

Introduction

Those with an altered appearance as a result of injury, health condition or treatment can face stigma, which may contribute to adverse psychosocial outcomes. However, current research tends to focus on supporting individuals themselves to cope, rather than targeting societal stigma. This study aimed to reduce societal stigma towards this group, through the use of a documentary about people with scars.

Methods

146 adults completed questionnaires before and after viewing the documentary.

Results

After viewing, participants had reduced self-reported intentions to behave in a stigmatising way towards those with visible differences, broader conceptualisation of beauty, and more positive body-esteem. Qualitative data also suggested further positive impacts.

Conclusion

Those with visible differences (for example scars) are subject to societal stigmatisation which perpetuates psychological and social problems. Therefore, alleviating social stigma through the media, as demonstrated through the documentary in this study, may improve the lives of those living with visible differences.

Lay Summary

People with an altered appearance or scars as a result of injury, health condition or treatment can face stigma, which may contribute to harmful psychological and social outcomes. However, current research tends to focus on supporting affected individuals themselves to cope, rather than targeting societal stigma. This study aimed to find out whether a documentary about people with scars was successful at reducing viewers' stigma towards this group. A group of 146 adults completed questionnaires before and after viewing the documentary. After viewing, questionnaires indicated that participants had reduced intentions to behave in a stigmatising way towards those with visible differences. Furthermore, they also viewed a broader range of appearances as beautiful and felt more positive about their own bodies. Comments and feedback from participants also suggested further positive impacts. Those with visible differences (for example scars) are subject to societal stigmatisation which can cause and worsen mental health problems. Therefore, alleviating social stigma through the media, as demonstrated through the documentary in this study, may improve the lives of those living with visible differences.

Therapeutic potential of adipose tissue-derivatives in modern dermatology

Stem cell-mediated therapies in combination with biomaterial and growth factor-based approaches in regenerative medicine are rapidly evolving with increasing application beyond the dermatologic field. Adipose-derived stem cells (ADSCs) are the more frequently used adult stem cells due to their abundance and easy access. In the case of volumetric defects, adipose tissue can take the shape of defects, restoring the volume and enhancing the regeneration of receiving tissue. When regenerative purposes prevail on volume restoration, the stromal vascular fraction (SVF) rich in staminal cells, purified mesenchymal stem cells (MSCs) or their cell-free derivatives grafting are favoured. The therapeutic efficacy of acellular approaches is explained by the fact that a significant part of the natural propensity of stem cells to repair damaged tissue is ascribable to their secretory activity that combines mitogenic factors, cytokines, chemokines and extracellular matrix components. Therefore, the secretome's ability to modulate multiple targets simultaneously demonstrated preclinical and clinical efficacy in reversing pathological mechanisms of complex conditions such atopic dermatitis (AD), vitiligo, psoriasis, acne and Lichen sclerosus (LS), non-resolving wounds and alopecia. This review analysing both in vivo and in vitro models gives an overview of the clinical relevance of adipose tissue-derivatives such as autologous fat graft, stromal vascular fraction, purified stem cells and secretome for skin disorders application. Finally, we highlighted the major disease-specific limitations and the future perspective in this field.

The Role of Hippo Signaling Pathway and ILK in the Pathophysiology of Human Hypertrophic Scars and Keloids: An Immunohistochemical Investigation

BACKGROUND

Keloids and hypertrophic scars are characterized by abnormal fibroblast activation and proliferation. While their molecular pathogenesis remains unclear, myofibroblasts have been associated with their development. Hippo pathway effectors YAP/TAZ promote cell proliferation and matrix stiffening. Integrin-linked kinase (ILK), a central component of focal adhesions that mediates cell-matrix interactions, has been linked to tissue repair and fibrosis. The aim of this study was to investigate the expression of key Hippo pathway molecules and ILK in hypertrophic scars and keloids.

METHODS

YAP/TAZ, TEAD4, ILK and a-SMA expression were evaluated by immunohistochemistry in keloids (n = 55), hypertrophic scars (n = 38) and normal skin (n = 14).

RESULTS

The expression of YAP/TAZ, TEAD4, ILK and a-SMA was higher in fibroblasts of keloids compared to hypertrophic scars while negative in normal skin. There was a significant positive correlation between the expression of ILK and Hippo pathway effectors.

CONCLUSIONS

Our results suggest that the deregulation of Hippo signaling and ILK are implicated in keloid and hypertrophic scar formation.

Role of burn severity and posttraumatic stress symptoms in the co-occurrence of itch and neuropathic pain after burns: A longitudinal study

Itch and pain are common after burns. Neuropathic mechanisms may underlie both modalities but remain not well-understood. This study aims to prospectively document neuropathic pain symptoms and to identify potential itch symptom profiles that differ regarding duration and co-occurrence with neuropathic pain which may inform underlying pathophysiological mechanisms and respond to different treatments. Adult burn survivors (n = 192) self-reported itch and neuropathic pain at 2 weeks post-discharge, 3, 6, 12, and 18 months post-burn. Based on the presence of itch and pain symptoms over time, participants were allocated to one itch profile: transient itch/pain, chronic itch, or chronic itch & pain. Profiles were compared on itch intensity over time using General Linear Modeling. Age, gender, burn severity, posttraumatic stress (PTS) symptoms and baseline itch intensity were examined as potential predictors of the profiles in a Multi-nominal regression analysis. Neuropathic pain occurred in 54% after discharge which decreased to 24% 18 months later. Itch intensity was highest in the chronic itch & pain profile. Compared to the transient itch profile, the chronic itch & pain profile was associated with higher burn severity and more PTS symptoms. Compared to the chronic itch profile, the chronic itch & pain profile was associated with more PTS symptoms. Findings suggest that biological and psycho-dermatological processes underlie both chronic neuropathic pain and itch processes in burn scars. Further research should elucidate the mechanisms underlying the different itch profiles, with specific focus on skin innervation and psychological factors.

The Spatial and Temporal Variations in the Superparasitism of Diachasmimorpha longicaudata Population Lines on Different Hosts After Field Release

Evaluating the behavior of the parasitoid Diachasmimorpha longicaudata (Ashmead) (Hymenoptera: Braconidae) in the field allows improving strategies for its release. Thus, the aim of this study was to evaluate spatial and temporal variations in the superparasitism of two populations of D. longicaudata on two fruit fly hosts after releasing them in a guava (Psidium guajava L.; cultivar 'Paluma') orchard. The two parasitoid populations used were CS and AS, which were reared on Ceratitis capitata (Wiedemann) and Anastrepha fraterculus (Wiedemann), respectively. Four releases were carried out without host choice. Host larvae were offered to the parasitoids in sentinel traps attached at varying heights on the plant, and in plants located at eight different directions and seven distances (7.0, 21.0, 35.0, 49.0, 59.4, 63.0, and 69.3 m) from the center of the parasitoid release point. The traps remained in the orchard for 24, 48, and 168 h after release. After removing the traps, they were taken to the laboratory for scar counting. The percentages of parasitism, superparasitism, mortality, and emergence of parasitoids were determined. Data were analyzed using the generalized linear mixed-effect model (GLMM). The AS females were more active, as they exerted higher parasitism and superparasitism at the first distance and 48 h after release, leaving a higher number of oviposition scars on the host A. fraterculus. Additionally, higher host mortality was observed in A. fraterculus at the closest points and the first 48 h. The highest percentage of parasitoid emergence was observed in C. capitata parasitized by AS females.

An Atlas of Optical Coherence Tomography (OCT): Elucidating In Vivo Differences of Scar Types Using OCT in Order to Guide Laser Treatment Parameters

OBJECTIVE

When using laser therapy to effectively treat scars, the choice of treatment parameters depends on the knowledge accuracy of the underlying scar pathology, which is often difficult to judge by gross physical exam. As such, more quantitative measures are needed. In recent years, optical coherencetomography (OCT) has shown promise as a real-time imaging technolgoy of skin microstructure. A key step in developing a methodology for utilizing OCT to develop a comprehensive 'atlas' of OCT characteristics of a wide variety of scar types. This atlas may then be used as a tool for selecting the optimal treatment modality and parameters for each scar type.

METHODS

One hundred and fifty scars of a wide range of anatomical locations were imaged using OCT, capturing both vascular and structural data. A variety of scar etiologies (e.g. burn, surgical, traumatic) and types (e.g. hypertrophic, keloidal, atrophic) were included. Comparator scans were also taken from normal, unscarred skin.

RESULTS

OCT revealed morphological differences in the epidermis and dermis between scars and normal tissue, and between scar subtypes. Features affected by scar pathology included epidermal thickness, skin surface texture, dermal epidermal junction rugosity, blood vessel density, vessel shape and diameter, vessel direction and vascular network, dermis scattering intensity and non-uniformity. Each scar subtype showed consistent characteristics distinct from other scar subtypes.

LIMITATIONS

This was a single-site study of a patient population in South Florida.

CONCLUSION

OCT is a powerful new objective tool for the clinician to utilize in the pursuit of effective laser treatment parameters by enabling personalized treatment based on individual scar characteristics in order to maximize treatment capabilities.

Adipose-derived stromal vascular fraction (SVF) in scar treatment: a systematic review protocol

BACKGROUND

Autologous adipose-derived stromal vascular fraction (SVF) is an emerging therapy that is being pioneered as a potential treatment for keloids and hypertrophic scars. Up to this point, there isn't a cure for keloids and hypertrophic scars yet they comprise the commonest benign skin disorders. Despite published studies reporting potential therapeutic benefits of SVF, their use and efficacy on scar improvement are not clearly described. The aim of this review is to describe the clinical practice involved in harvesting, processing, utilization of SVF, and associated efficacy in scar treatment.

METHODS

We shall include published clinical articles evaluating the efficacy of SVF on improving scar characteristics and assessment scores among adults with keloids or hypertrophic scars. Article search of Medline/PubMed, Cochrane Library and Embase using Mesh terms of "scars" and "stromal vascular fraction" combined with the Boolean operators ("AND", "OR") will be performed by two independent researchers following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) statement. The primary outcome measure will be the mean difference in the Scar characteristics including Scar assessment scores, scar thickness among others.

DATA SYNTHESIS

Descriptive data synthesis and mean differences between treatment arms will be calculated for the primary outcome of the scar assessment scores. In case more than three studies provide consistent characteristics of the scar assessment scores, a meta-analysis will be conducted.

DISCUSSION

Evidence obtained from the systematic review will form the foundation upon which further clinical trials research will be conducted in evaluating the efficacy of autologous adipose-derived stromal vascular fraction in keloid and hypertrophic scar. The systematic review has been submitted to the PROSPERO database and is currently under review.

Pharmaceutical Prophylaxis of Scarring with Emphasis on Burns: A Review of Preclinical and Clinical Studies

Significance: The worldwide estimate of burns requiring medical attention each year is 11 million. Each year in the United States, ∼486,000 burn injuries receive medical attention, including 40,000 hospitalizations. Scars resulting from burns can be disfiguring and impair functions. The development of prophylactic drugs for cutaneous scarring could improve the outcomes for burns, traumatic lacerations (>6 million/year treated in U.S. emergency rooms), and surgical incisions (∼250 million/year worldwide). Antiscar pharmaceuticals have been estimated to have a market of $12 billion. Recent Advances: Many small molecules, cells, proteins/polypeptides, and nucleic acids have mitigated scarring in animal studies and clinical trials, but none have received Food and Drug Administration (FDA) approval yet. Critical Issues: The development of antiscar pharmaceuticals involves the identification of the proper dose, frequency of application, and window of administration postwounding for the indicated wound. Risks of infection and impaired healing must be considered. Scar outcome needs to be evaluated after scars have matured. Future Directions: Once treatments have demonstrated safety and efficacy in rodent and/or rabbit and porcine wound models, human testing can begin, such as on artificially created wounds on healthy subjects and on bilateral-surgical wounds, comparing treatments versus vehicle controls on intrapatient-matched wounds, before testing on separate cohorts of patients. Given the progress made in the past 20 years, FDA-approved drugs for improving scar outcomes may be expected.

Quantum many-body scars and Hilbert space fragmentation: a review of exact results

The discovery of quantum many-body scars (QMBS) both in Rydberg atom simulators and in the Affleck-Kennedy-Lieb-Tasaki spin-1 chain model, have shown that a weak violation of ergodicity can still lead to rich experimental and theoretical physics. In this review, we provide a pedagogical introduction to and an overview of the exact results on weak ergodicity breaking via QMBS in isolated quantum systems with the help of simple examples such as the fermionic Hubbard model. We also discuss various mechanisms and unifying formalisms that have been proposed to encompass the plethora of systems exhibiting QMBS. We cover examples of equally-spaced towers that lead to exact revivals for particular initial states, as well as isolated examples of QMBS. Finally, we review Hilbert space fragmentation, a related phenomenon where systems exhibit a richer variety of ergodic and non-ergodic behaviors, and discuss its connections to QMBS.

Complex assessment of immunosuppression effects in prevention and treatment of adhesive disease, an experiment

The cause of all small bowel obstruction in 60-75% of cases is adhesive development. The first and main method for adhesion prevention is undoubtedly the surgical technique, but the prevention of adhesive development is still actual. We aimed to study macroscopic and microscopic peculiarities of the intestine, peritoneum, and scars of the anterolateral abdominal wall. Also, immunological blood changes were observed in rats with the experimental created adhesive disease on the background of azathioprine introduction. The experiment was conducted on 40 rats divided into 2 subgroups: 20 animals as an experimental group (EG1) and 20 as a control group (CG1). Animals from EG received azathioprine (Moshimerampreparaty named by N.A. Semashko, Russia) in a dosage of 1 mg/100g of weight once a day for the first 3 days (starting from the day of surgery). The control group did not receive any drugs. All 40 rats survived the postoperative period. Rats were removed from the experiment on the 7^th day after the operation. There were significant statistical differences in most indicators between the experimental and control groups. Phagocytic index (PI) was reduced by 4.55 due to the natural reaction of the rat organism to the surgery. Indicators of EG were a slight decrease in leukocytes and lymphocytes by 0.3 and 0.9, respectively, a moderate decrease in T-lymphocytes by no more than 2.0, and a decrease in phagocytic activity by 5.8. Immunosuppression with azathioprine significantly reduced the frequency and severity of the adhesive process of the abdominal cavity. Used in the recommended dose does not significantly inhibit important indicators of immunity and does not affect wound healing processes.

Microneedle fractional radiofrequency for atrophic acne scars: in vivo evaluation of results by 3D analysis and reflectance confocal microscopy

BACKGROUND

The efficacy of microneedle fractional radiofrequency (MFR) for the treatment of atrophic acne scars has been recently described, but accurate in vivo microscopic documentation of the processes occurring has never been reported.

AIMS

The aim of this study is to describe in vivo morphological atrophic acne scars' variations after treatment with MFR by means reflectance confocal microscopy (RCM) and three-dimensional (3D) imaging.

PATIENTS/METHODS

A total of 11 patients requiring treatment for atrophic facial acne scars were treated with four monthly sessions of MFR. 3D imaging and RCM were assessed at baseline and 1 months after last session. Clinical improvement, according to Global Assessment Improvement Scale (GAIS), and patients' satisfaction were evaluated.

RESULTS

Clinical improvement was observed in all the treated patients, although better results were obtained for boxcar scars (p= 0.043). 3D imaging revealed a significant improvement in terms of mean scars' depth (p<0.001). Otherwise, RCM highlighted collagen remodeling with restoration of a reticular structure.

CONCLUSIONS

Our study confirms the efficacy and safety of MFR in acne scars' treatment and provides the microscopic description of the results using RCM. This article is protected by copyright. All rights reserved.

Autologous Fat Grafting in Plastic and Reconstructive Surgery: An Historical Perspective

Autologous fat grafting (AFG or lipofilling) is a common technique used in plastic and reconstructive surgery that involves the transfer of autologous fat tissue from one region of the body to another. The indications and techniques of AFG have changed dramatically over the years. We recount the historic milestones to the current state.

Kinesio taping to address post-sternotomy scars in pediatric patients: A case report

Introduction

The role of postoperative scar tissue adhesion and its impact on motor control in infants with congenital heart disease has not been explored in the literature. Elastic therapeutic tapes, such as Kinesio tape, are designed to affect the integumentary system. This case report aims to demonstrate the safety and present the observations following use of Kinesio tape to treat scar tissue in a pediatric patient after open-heart surgery in conjunction with standard rehabilitation.

Method

This retrospective case report presents observations of an infant's sternotomy scar adhesion and gross motor development after six applications of Kinesio tape. The sternotomy and drain tube scars were treated with Kinesio tape fascia applications in addition to standard physical therapy (PT).

Discussion

Several domains showed positive changes. The scar mobility and appearance improved. The patient's motor skills improved, possibly due to skin stretch's role in motor learning. The taping application did not cause discomfort, and there were no adverse reactions.

Conclusion

In this infant, the three-month-old sternotomy scar improved in adherence and appearance after six applications of Kinesio Fingerprint tape; motor skills also increased in the presence of standard PT. There were no adverse reactions noted with the protocol. Kinesio tape may provide a safe adjunct to treat scar tissue adhesion in infants with median sternotomy scars.

Lay Summary

Issue being explored Sternotomy scars can cause physical and psychological harm. Sensors (receptors) in the skin help with movement and balance responses. The impact of scar stiffness (adhesion) on developing motor control has not been reported in infants. Treating the scar in the remodelling phase with elastic tape may improve the scar's appearance and ability to move, thereby improving development.