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Coghlan N, Copley J, Aplin T, Strong J. The experience of wearing compression garments after burn injury: “On the inside it is still me”. Burns 2019; 45:1438-1446. [DOI: 10.1016/j.burns.2018.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/27/2018] [Accepted: 08/07/2018] [Indexed: 10/26/2022]
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Hu CH, Tseng YW, Chiou CY, Lan KC, Chou CH, Tai CS, Huang HD, Hu CW, Liao KH, Chuang SS, Yang JY, Lee OK. Bone marrow concentrate-induced mesenchymal stem cell conditioned medium facilitates wound healing and prevents hypertrophic scar formation in a rabbit ear model. Stem Cell Res Ther 2019; 10:275. [PMID: 31462299 PMCID: PMC6714083 DOI: 10.1186/s13287-019-1383-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 08/10/2019] [Accepted: 08/13/2019] [Indexed: 02/07/2023] Open
Abstract
Background Hypertrophic scars (HSs) are formed via an aberrant response to the wound healing process. HSs can be cosmetic or can result in functional problems. Prolonged proliferation and remodeling phases disrupt wound healing, leading to excessive collagen production and HS formation. However, there are currently no satisfactory drugs to prevent HS formation. Mesenchymal stem cell (MSC) conditioned medium (CM) has therapeutic effects on wound healing and preventing HS formation. Bone marrow concentrate (BMC) contains various growth factors and cytokines that are crucial for regeneration and has been applied in the clinical setting. In this study, we evaluated the effects of BMC-induced MSC CM on HS formation in a rabbit ear model. Methods We established a rabbit ear wound model by generating full-thickness wounds in the ears of rabbits (n = 12) and treated wounds with MSC CM, BMC CM, or BMC-induced MSC CM. Dermal fibroblasts from human hypertrophic scar were stimulated with transforming growth factor beta 1 (TGF-β1) for 24 h and cultured in each culture medium for 72 h. We measured the hypertrophic scar (HS) formation during the skin regeneration by measuring the expression of several remodeling molecules and the effect of these conditioned media on active human HS fibroblasts. Results Our results showed that BMC-induced MSC CM had greater antifibrotic effects than MSC CM and BMC CM significantly attenuated HS formation in rabbits. BMC-induced MSC CM accelerated wound re-epithelization by increasing cell proliferation. Additionally, BMC-induced MSC CM also inhibited fibrosis by decreasing profibrotic gene and protein expression, promoting extracellular matrix turnover, inhibiting fibroblast contraction, and reversing myofibroblast activation. Conclusions BMC-induced MSC CM modulated the proliferation and remodeling phases of wound healing, representing a potential wound healing agent and approach for preventing HS formation. Electronic supplementary material The online version of this article (10.1186/s13287-019-1383-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ching-Hsuan Hu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Stem Cell Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Wen Tseng
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Stem Cell Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Yung Chiou
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kuan-Chun Lan
- Institute of Molecular Medicine and Bioengineering, National Chiao Tung University, Hsinchu, 300, Taiwan
| | - Chih-Hung Chou
- Department of Biological Science and Technology, Center for Intelligent Drug Systems and Smart Bio-devices (IDS²B), National Chiao Tung University, Hsinchu, 300, Taiwan
| | - Chun-San Tai
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, 300, Taiwan
| | - Hsien-Da Huang
- Warshel Institute for Computational Biology, School of Life and Health Sciences, School of Sciences and Engineering, The Chinese University of Hong Kong, Shenzhen, 518172, China
| | - Chiung-Wen Hu
- Department of Public Health, Chung Shan Medical University, Taichung, 402, Taiwan
| | - Ko-Hsun Liao
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shiow-Shuh Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Jui-Yung Yang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taoyuan, Taiwan
| | - Oscar K Lee
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Stem Cell Research Center, National Yang-Ming University, Taipei, Taiwan
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Treatment of burned children using dermal regeneration template with or without negative pressure. Burns 2019; 45:1075-1080. [DOI: 10.1016/j.burns.2018.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/21/2018] [Accepted: 08/07/2018] [Indexed: 01/10/2023]
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Karakan T, Ozcan S, Bagcioglu M, Aydın A, Doluoglu OG, Yucel MO, Adalı Y, Yagli OF. The effect of intraurethral dexpanthenol in hypospadias repair: experimental rabbit study. J Pediatr Urol 2019; 15:375.e1-375.e5. [PMID: 31040076 DOI: 10.1016/j.jpurol.2019.04.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 03/24/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION In this study, the authors aimed to research the histopathologic effects of intraurethral use of dexpanthenol for hypospadias repair. Dexpanthenol is a derivative of pantothenic acid, a B complex vitamin. Pantothenic acid is a molecule contributing in the structure of coenzyme A. It decreases the release of myeloperoxidase from granulocytes and inhibits the formation of free oxygen radicals, and it exhibits an anti-inflammatory effect by increasing mitotic activity. OBJECTIVE The objective of this study is to evaluate the use of dexpanthenol after a tubularized incised plate urethroplasty (TIP) on wound healing, inflammation, and fibrosis. STUDY DESIGN In this study, 18 healthy male New Zealand white rabbits weighing 2500-3000 g were used. The 18 rabbits were randomly divided into 3 groups. For the hypospadias model, rabbits had a urethral catheter inserted in the urethra and a ventral midline incision was made from the glans tip to the central line of the penis. Afterward, the incision was closed with Vicryl (7/0) using the continuous suture technique, and urethroplasty was completed. For fourteen days, group I had 0.9% saline solution administered intraurethrally twice per day with a 22G catheter sleeve (control group), group II had one dose of 500 mg/kg dexpanthenol (Bepanthene®; Bayer Turk Chemical Industry Limited Company, Turkey) ampoule and one dose of saline solution administered in the same way, and group III had two doses of 500 mg/kg dexpanthenol ampoule administered. On the fifteenth day, the penis was degloved and rabbits had penectomy performed with samples sent to the pathology department for histopathological assessment. RESULTS The degree of fibrosis and inflammation in group I (control group) was more severe than groups II and III. The differences between groups I and II were statistically significantly different for both fibrosis and inflammation (P = 0.018 and P = 0.041, respectively). The differences between groups I and III were also statistically significantly different for both fibrosis and inflammation (P = 0.019 and P = 0.011, respectively). Groups II and III were not different significantly for fibrosis and inflammation (P > 0.05). DISCUSSION This study shows that intraurethral dexpanthenol application has positive effects on fibrosis and inflammation. The main limitations of the study are that the hypospadias model was created surgically and long-term follow-up for fistula formation was not assessed. CONCLUSIONS Administration of intraurethral dexpanthenol after hypospadias repair has positive effects on fibrosis and inflammation.
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Affiliation(s)
- T Karakan
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey.
| | - S Ozcan
- Department of Urology, İzmir Katip Çelebi University, İzmir, Turkey
| | - M Bagcioglu
- Urology Department, Kafkas University Faculty of Medicine, Kars, Turkey
| | - A Aydın
- Department of Urology, Faculty of Medicine, Necmettin Erbakan University Meram, Konya, Turkey
| | - O G Doluoglu
- Department of Urology, Ankara Training and Research Hospital, Ankara, Turkey
| | - M O Yucel
- Department of Urology, Adiyaman University, Faculty of Medicine, Adiyaman, Turkey
| | - Y Adalı
- Department of Pathology, Kafkas University, Faculty of Medicine, Kars, Turkey
| | - O F Yagli
- Department of Urology, Kartal Yavuz Selim State Hospital, Istanbul, Turkey
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Zhang J, Zhou Q, Wang H, Huang M, Shi J, Han F, Cai W, Li Y, He T, Hu D. MicroRNA-130a has pro-fibroproliferative potential in hypertrophic scar by targeting CYLD. Arch Biochem Biophys 2019; 671:152-161. [PMID: 31283910 DOI: 10.1016/j.abb.2019.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/26/2019] [Accepted: 07/04/2019] [Indexed: 02/08/2023]
Abstract
Hypertrophic scars are dermal fibrosis diseases that protrude from the surface of the skin and irregularly extend to the periphery, seriously affecting the appearance and limb function of the patient. In this study, we found that microRNA-130a (miR-130a) was increased in hypertrophic scar tissues and derived primary fibroblasts, accompanied by up-regulation of collagen1/3 and α-SMA. Inhibition of miR-130a in hypertrophic scars fibroblasts suppressed the expression of collagen1/3 and α-SMA as well as the cell proliferation. Bioinformatics analysis combined with luciferase reporter gene assay results indicated that CYLD was a target gene of miR-130a, and the miR-130a mimic could reduce the level of CYLD. In contrast to miR-130a, the expression of CYLD was downregulated in hypertrophic scars and their derived fibroblasts. Overexpressing CYLD inhibited the expression of collagen 1/3 and α-SMA, slowed cell proliferation, and inhibited Akt activity. As expected, further study showed that the overexpression of CYLD could prevent the pro-fibroproliferative effects of miR-130a. Consistent with the in vitro results, the inhibitor of miR-130a effectively ameliorated excessive collagen deposition in bleomycin-induced skin fibrosis mouse model. Taken together, our results indicate that miR-130a promotes collagen secretion, myofibroblast transformation and cell proliferation by targeting CYLD and enhancing Akt activity. Therefore, the miR-130a/CYLD/Akt pathway may serve as a novel entry point for future skin fibrosis research.
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Affiliation(s)
- Jian Zhang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Qin Zhou
- Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Hongtao Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Meiling Huang
- Department of Thyroid, Breast and Vascular Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Jihong Shi
- Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Fu Han
- Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Weixia Cai
- Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Yan Li
- Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Ting He
- Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, The Fourth Military Medical University, Xi'an, Shaanxi, 710032, PR China.
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NATURAL RUBBER - PROPOLIS MEMBRANE IMPROVES WOUND HEALING IN SECOND-DEGREE BURNING MODEL. Int J Biol Macromol 2019; 131:980-988. [DOI: 10.1016/j.ijbiomac.2019.03.147] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/12/2019] [Accepted: 03/21/2019] [Indexed: 11/21/2022]
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Zhang H, Wang HY, Wang DL, Zhang XD. Effect of pressure therapy for treatment of hypertrophic scar. Medicine (Baltimore) 2019; 98:e16263. [PMID: 31261594 PMCID: PMC6617428 DOI: 10.1097/md.0000000000016263] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 06/10/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Pressure therapy (PST) has been reported for the treatment of hypertrophic scar (HS) effectively. However, no study has assessed its effect and safety systematically. Therefore, this study will investigate its effect and safety for patients with HS. METHODS A comprehensive literature search will be performed from the electronic databases and grey literatures. The electronic databases include MEDILINE, EMBASE, Cochrane Library, Web of Science, Allied and Complementary Medicine Database, Chinese Biomedical Literature Database, and China National Knowledge Infrastructure. All of them will be searched from inception to the present without language restrictions. Any randomized controlled trials on assessing the effect and safety of PST on HS will be considered for inclusion. In addition, we will also search grey literature to avoid missing any potential studies. RevMan V.5.3 software will be utilized for statistical analysis. RESULTS This study will provide the most recent evidence of PST on HS by evaluating primary outcomes of scar pruritus and improvement of scar; and secondary outcomes of scar blood flow, elasticity, volume, pain and burning. In addition, we will also evaluate adverse events. CONCLUSION This study will provide up-to-date evidence of PST in patients with HS.Systematic review registration: PROSPERO CRD42019136627.
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Affiliation(s)
- Hao Zhang
- Department of Plastic Burn and Cosmetic Center
| | | | - Da-li Wang
- Department of Ophthalmology, First Affiliated Hospital of Jiamusi University, Jiamusi, China
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Meseci E. Assessment of topical corticosteroid ointment on postcesarean scars prevention: A prospective clinical trial. Pak J Med Sci 2019; 35:309-314. [PMID: 31086506 PMCID: PMC6500814 DOI: 10.12669/pjms.35.2.553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To evaluate the effectiveness of corticosteroid ointment in hypertrophic scars prevention following Cesarean section. Methods This study was conducted between June 2017-May 2018 in Acıbadem Kozyatagı Hospital. Sixty-one patients (31 treatment and 30 control patients) took part in the current study which evaluated wound outcomes and patient satisfaction. All patients' wound characteristics were assessed via the modified Vancouver Scar Scale (MVSS) score (height, pigmentation, vascularity, and pliability) at baseline (post-op 10th day), three months and six months. The treatment group received corticosteroid cream every other day for three months. Comparative evaluations and time-bound changes were evaluated in both groups. Results The mean age of the subjects was 31.28 ± 3.95 years. While the height and vascularity subsection scores of corticosteroid recipients were significantly reduced compared to those without treatment at three months, the scores were similar at six months. Furthermore, pliability and pigmentation decreased equally in both groups. There was high satisfaction with scar healing in the experimental group (20%, n=6), while 12.9% (n=4) of the patients were satisfied in the control group. Two patients reported itching after treatment. Conclusions The clinical outcomes in both groups were similar. Although vascularity and height parameters improved in three months, similar results were also observed in the group that did not receive treatment after the end of six months. This may have been due to the fact that treatment was stopped after three months. We recommend that the hypothesis be tested in larger series in future studies.
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Affiliation(s)
- Elif Meseci
- Elif Meseci, MD. Acıbadem Kozyatagı Hospital, Department of Obstetrics and Gynecology, Inonu Caddesi, Okur Sokak, No:20 Kozyatagi, 34742, Istanbul, Turkey
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Song KX, Liu S, Zhang MZ, Liang WZ, Liu H, Dong XH, Wang YB, Wang XJ. Hyperbaric oxygen therapy improves the effect of keloid surgery and radiotherapy by reducing the recurrence rate. J Zhejiang Univ Sci B 2019; 19:853-862. [PMID: 30387335 DOI: 10.1631/jzus.b1800132] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Keloids are exuberant cutaneous scars that form due to abnormal growth of fibrous tissue following an injury. The primary aim of this study was to assess the efficacy and mechanism of hyperbaric oxygen therapy (HBOT) to reduce the keloid recurrence rate after surgical excision and radiotherapy. METHODS (1) A total of 240 patients were randomly divided into two groups. Patients in the HBOT group (O group) received HBOT after surgical excision and radiotherapy. Patients in the other group were treated with only surgical excision and radiotherapy (K group). (2) Scar tissue from recurrent patients was collected after a second operation. Hematoxylin and eosin (H&E) staining was used to observe keloid morphology. Certain inflammatory factors (interleukin-6 (IL-6), hypoxia-inducible factor-1α (HIF-1α), tumor necrosis factor-α (TNF-α), nuclear factor κB (NF-κB), and vascular endothelial growth factor (VEGF)) were measured using immunohistochemical staining. RESULTS (1) The recurrence rate of the O group (5.97%) was significantly lower than that of the K group (14.15%), P<0.05. Moreover, patients in the O group reported greater satisfaction than those in the K group (P<0.05). (2) Compared with the recurrent scar tissue of the K group, the expression levels of the inflammatory factors were lower in the recurrent scar tissue of the O group. CONCLUSIONS Adjunctive HBOT effectively reduces the keloid recurrence rate after surgical excision and radiotherapy by improving the oxygen level of the tissue and alleviating the inflammatory process.
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Affiliation(s)
- Ke-Xin Song
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Shu Liu
- School of Medicine, North China University of Science and Technology, Tangshan 063000, China
| | - Ming-Zi Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Wei-Zhong Liang
- Department of Plastic Surgery, China Meitan General Hospital, Beijing 100028, China
| | - Hao Liu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Xin-Hang Dong
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - You-Bin Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
| | - Xiao-Jun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing 100730, China
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Wang J, Liao Y, Xia J, Wang Z, Mo X, Feng J, He Y, Chen X, Li Y, Lu F, Cai J. Mechanical micronization of lipoaspirates for the treatment of hypertrophic scars. Stem Cell Res Ther 2019; 10:42. [PMID: 30678729 PMCID: PMC6345005 DOI: 10.1186/s13287-019-1140-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/31/2018] [Accepted: 01/07/2019] [Indexed: 12/31/2022] Open
Abstract
Background Hypertrophic scars cause cosmetic and functional problems for patients, and their treatment remains challenging. Mechanical micronization of adipose tissue can remove adipocytes and concentrate functional cells. Stromal vascular fraction (SVF)-gel is obtained by a series of simple mechanical processes, including shifting between syringes and centrifugation. This study aimed to assess the therapeutic effect of SVF-gel on hypertrophic scars. Methods A model of hypertrophic scars was established in rabbit ears. SVF-gel and SVF cells were obtained from rabbit inguinal fat pads and injected into scars. Phosphate-buffered saline (PBS) was used as a control. Scars were structurally characterized by histologic and immunohistochemical analyses. Expression of inflammatory and fibrogenic genes was evaluated. Results Hypertrophic scars became less visible and softer following injection of SVF-gel or SVF cells. Dermal thickness was significantly lower in the groups treated with SVF-gel and SVF cells than in the PBS-treated group. Treatment with SVF-gel restored subcutaneous fat tissue in scars, while treatment with SVF cells and PBS did not. Injection of SVF-gel and SVF cells reduced macrophage infiltration in the dermal layer and decreased mRNA expression of interleukin-6 and monocyte chemoattractant protein-1. In addition, the level of myofibroblasts and collagen deposition were reduced in the groups treated with SVF-gel and SVF cells. Conclusions SVF-gel has therapeutic effects on hypertrophic scars. Injection of SVF-gel into hypertrophic scars restores subcutaneous fat tissue and reduces the levels of macrophages and myofibroblasts; thus, it decreased the dermal thickness of the scar.
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Affiliation(s)
- Jing Wang
- Department of Plastic and Reconstructive Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yunjun Liao
- Department of Plastic and Reconstructive Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jing Xia
- Department of Plastic and Reconstructive Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Zijue Wang
- Department of Plastic and Reconstructive Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xiaopei Mo
- Department of Plastic and Reconstructive Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jingwei Feng
- Department of Plastic and Reconstructive Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yunfan He
- Department of Plastic and Reconstructive Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Xihang Chen
- Department of Plastic and Reconstructive Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Ye Li
- Department of Plastic and Reconstructive Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Feng Lu
- Department of Plastic and Reconstructive Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Junrong Cai
- Department of Plastic and Reconstructive Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Mehta S, Coffey R, Jones LM, Powell HM, Bailey JK. Survey of national and local practice of compression therapy timing for burn patients in the United States. Burns 2019; 45:1215-1222. [PMID: 30630635 DOI: 10.1016/j.burns.2018.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/27/2018] [Accepted: 12/22/2018] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Compression therapy (CT) has been an important, but debated, treatment for burn scars. To better understand one source of variation in observed outcomes after CT, an evaluation of CT timing of application is needed. MATERIALS AND METHODS Following IRB approval, 126 burn centers were contacted to complete a 17-question survey regarding the center's practice pattern for compression garment therapy. Locally, study subjects were identified between March 1, 2014 and December 31, 2015 and medical records examined for timing of garment ordering, delivery and fitting. RESULTS The majority believed that compression therapy is beneficial. Most centers reported using custom-fit and pre-fabricated garments, and a goal time of application between 2-4 weeks (42%) and 4-6 weeks (36%). After the garments are ordered, 61% of centers estimate that it takes 2-4 weeks for them to arrive. No significant differences in practices were found among centers treating pediatric patients only, adults only or both. Locally, the mean number of weeks between the date of original injury and garment order placement was 9.1 weeks with an additional 8.7 weeks between the date of order and date of delivery. CONCLUSIONS The current study identified that although the national reporting of time to garment application is estimated to be between 2-6 weeks at the majority of burn centers including our own, we found our center to be well in excess of 17 weeks. The findings offer an opportunity for local improvement, and raise the possibility of similar incongruity between goals and practice at other centers.
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Affiliation(s)
- Saurabh Mehta
- Division of Trauma, Critical Care, and Burn, Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Rebecca Coffey
- Division of Trauma, Critical Care, and Burn, Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Larry M Jones
- Division of Trauma, Critical Care, and Burn, Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, United States
| | - Heather M Powell
- Department of Materials Science and Engineering, Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, United States; Research Department, Shriners Hospitals for Children, Cincinnati, Ohio, United States
| | - J Kevin Bailey
- Division of Trauma, Critical Care, and Burn, Department of Surgery, College of Medicine, The Ohio State University, Columbus, Ohio, United States; Research Department, Shriners Hospitals for Children, Cincinnati, Ohio, United States.
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Shi J, Wu Y, Guo S, Zhang H, Chen G, Xu X. The efficacy of anti-VEGF antibody-modified liposomes loaded with paeonol in the prevention and treatment of hypertrophic scars. Drug Dev Ind Pharm 2018; 45:439-455. [DOI: 10.1080/03639045.2018.1546315] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Jun Shi
- Department of Chinese medicine, Guangdong Pharmaceutical University of China, Guangzhou, Guangdong, China
| | - Yanting Wu
- Department of Chinese medicine, Guangdong Pharmaceutical University of China, Guangzhou, Guangdong, China
| | - Siyi Guo
- Department of Chinese medicine, Guangdong Pharmaceutical University of China, Guangzhou, Guangdong, China
| | - Huidi Zhang
- Department of Chinese medicine, Guangdong Pharmaceutical University of China, Guangzhou, Guangdong, China
| | - Guitian Chen
- Department of Chinese medicine, Guangdong Pharmaceutical University of China, Guangzhou, Guangdong, China
| | - Xiaoqi Xu
- Department of Chinese medicine, Guangdong Pharmaceutical University of China, Guangzhou, Guangdong, China
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Kwon JY, Yun HG, Park IY. n-Butyl-2-cyanoacrylate tissue adhesive (Histoacryl) vs. subcuticular sutures for skin closure of Pfannenstiel incisions following cesarean delivery. PLoS One 2018; 13:e0202074. [PMID: 30216337 PMCID: PMC6157826 DOI: 10.1371/journal.pone.0202074] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 07/29/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tissue adhesives are now routinely used for skin closure in various surgeries. This study aimed to evaluate the safety and efficacy of n-butyl-2-cyanoacrylate (NBCA) tissue adhesive in cesarean delivery by comparing it with the safety and efficacy of subcuticular suture closure. METHODS AND FINDINGS A retrospective chart review was undertaken of all patients who underwent cesarean delivery via Pfannenstiel skin incision. During the study period, a total of 209 patients had NBCA (Histoacryl®) closure and 208 patients had suture closure. Wound complications and Vancouver scar scale (VSS) scores were compared between the 2 groups. RESULTS There were no significant differences between the two groups in indications for cesarean deliveries or number of previous cesarean deliveries. Incidences of wound disruption and infection were also similar between the two closure groups (p = 0.322 and 0.997, respectively). The rate of wound complications was 3.4% in the NBCA group and 5.3% in the suture group. All complications healed uneventfully with topical antibiotics or closure strips. VSS scores at 6-8 weeks after operation were not significantly different between the two groups (p = 0.858). These results were corroborated by propensity score-matching analysis. CONCLUSIONS NBCA may be a useful skin closure of Pfannenstiel skin incisions after cesarean delivery.
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Affiliation(s)
- Ji Young Kwon
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea
| | - Hang Goo Yun
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea
| | - In Yang Park
- Department of Obstetrics and Gynecology, The Catholic University of Korea, Seoul, Korea
- * E-mail:
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Li P, Li-Tsang CWP, Deng X, Wang X, Wang H, Zhang Y, Tan Z, He C. The recovery of post-burn hypertrophic scar in a monitored pressure therapy intervention programme and the timing of intervention. Burns 2018; 44:1451-1467. [DOI: 10.1016/j.burns.2018.01.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 12/09/2017] [Accepted: 01/08/2018] [Indexed: 12/14/2022]
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65
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Zhao C, Dai L, Wang J, Jian Y, Mei Z, Pei X, Xiong X, Yuan W, Wu F. Beneficial Effects of Lipoic Acid on Post-burn Hypertrophic
Scarring Model. INT J PHARMACOL 2018. [DOI: 10.3923/ijp.2018.733.739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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66
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Monsuur HN, van den Broek LJ, Koolwijk P, Niessen FB, Gibbs S. Endothelial cells enhance adipose mesenchymal stromal cell-mediated matrix contraction via ALK receptors and reduced follistatin: Potential role of endothelial cells in skin fibrosis. J Cell Physiol 2018; 233:6714-6722. [PMID: 29345319 PMCID: PMC6056025 DOI: 10.1002/jcp.26494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 01/17/2018] [Indexed: 12/18/2022]
Abstract
Abnormal cutaneous wound healing can lead to formation of fibrotic hypertrophic scars. Although several clinical risk factors have been described, the cross‐talk between different cell types resulting in hypertrophic scar formation is still poorly understood. The aim of this in vitro study was to investigate whether endothelial cells (EC) may play a role in skin fibrosis, for example, hypertrophic scar formation after full‐thickness skin trauma. Using a collagen/elastin matrix, we developed an in vitro fibrosis model to study the interaction between EC and dermal fibroblasts or adipose tissue‐derived mesenchymal stromal cells (ASC). Tissue equivalents containing dermal fibroblasts and EC displayed a normal phenotype. In contrast, tissue equivalents containing ASC and EC displayed a fibrotic phenotype indicated by contraction of the matrix, higher gene expression of ACTA2, COL1A, COL3A, and less secretion of follistatin. The contraction was in part mediated via the TGF‐β pathway, as both inhibition of the ALK4/5/7 receptors and the addition of recombinant follistatin resulted in decreased matrix contraction (75 ± 11% and 24 ± 8%, respectively). In conclusion, our study shows that EC may play a critical role in fibrotic events, as seen in hypertrophic scars, by stimulating ASC‐mediated matrix contraction via regulation of fibrosis‐related proteins.
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Affiliation(s)
- Hanneke N Monsuur
- Department of Dermatology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Lenie J van den Broek
- Department of Dermatology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Pieter Koolwijk
- Department of Physiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, Amsterdam, The Netherlands
| | - Frank B Niessen
- Department of Plastic, Reconstructive and Hand Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Susan Gibbs
- Department of Dermatology, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Oral Cell Biology, Academic Center for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
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67
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Patient Experience of Wearing Compression Garments Post Burn Injury: A Review of the Literature. J Burn Care Res 2018; 38:260-269. [PMID: 28221300 DOI: 10.1097/bcr.0000000000000506] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review was conducted to critically appraise the literature regarding the patient's lived experience of, and adherence to, wearing compression garments post burn injury. Scholarly articles were identified from searches of the following databases: Pubmed, Cochrane Central, CINAHL, PsycINFO, and OT Seeker. Combinations of key words including compression therapy/garment, pressure therapy/garment, burn(s), adherence, and patient experience were utilized. Retrieved studies were included in the review if they were written in English, reported on adult burn populations, and the patient's lived experience of wearing compression garments. Included studies were critically appraised and content analysis was completed on the results sections of the two qualitative studies. Nine studies investigating patient's lived experiences were retained: one systematic review, one randomized controlled trial, five cross-sectional surveys, and two qualitative studies. An adherence framework provided a conceptual basis to categorize reported patient's lived experiences. Results identified a strong focus on patient and treatment-related experiences with limited investigation of condition, patient-provider and health care system experiences. Minimal investigation has been completed regarding the impact of these patient's lived experiences on the adherence to wearing compression garments. Additional research using qualitative methods is required to gain a deep understanding of patient's experiences and perspectives of wearing compression garments and how these experiences influence on their adherence to wearing them. Identification of key experiences that lead to patients removing their compression garments may lead to modification of treatment and system approaches to better align with patients' needs and development of potential interventions that promote adherence.
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Hibbard JC, Friedstat JS, Thomas SM, Edkins RE, Hultman CS, Kosorok MR. LIBERTI: A SMART study in plastic surgery. Clin Trials 2018; 15:286-293. [PMID: 29577741 DOI: 10.1177/1740774518762435] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Laser treatment of burns scars is considered by some providers to be standard of care. However, there is little evidence-based research as to the true benefit. A number of factors hinder evaluation of the benefit of laser treatment. These include significant heterogeneity in patient response and possible delayed effects from the laser treatment. Moreover, laser treatments are often provided sequentially using different types of equipment and settings, so there are effectively a large number of overall treatment options that need to be compared. We propose a trial capable of coping with these issues and that also attempts to take advantage of the heterogeneous response in order to estimate optimal treatment plans personalized to each individual patient. It will be the first large-scale randomized trial to compare the effectiveness of laser treatments for burns scars and, to our knowledge, the very first example of the utility of a Sequential Multiple Assignment Randomized Trial in plastic surgery. METHODS We propose using a Sequential Multiple Assignment Randomized Trial design to investigate the effect of various permutations of laser treatment on hypertrophic burn scars. We will compare and test hypotheses regarding laser treatment effects at a general population level. Simultaneously, we hope to use the data generated to discover possible beneficial personalized treatment plans, tailored to individual patient characteristics. RESULTS We show that the proposed trial has good power to detect laser treatment effect at the overall population level, despite comparing a large number of treatment combinations. The trial will simultaneously provide high-quality data appropriate for estimating precision-medicine treatment rules. We detail population-level comparisons of interest and corresponding sample size calculations. We provide simulations to suggest the power of the trial to detect laser effect and also the possible benefits of personalization of laser treatment to individual characteristics. CONCLUSION We propose, to our knowledge, the first use of a Sequential Multiple Assignment Randomized Trial in surgery. The trial is rigorously designed so that it is reasonably straightforward to implement and powered to answer general overall questions of interest. The trial is also designed to provide data that are suitable for the estimation of beneficial precision-medicine treatment rules that depend both on individual patient characteristics and on-going real-time patient response to treatment.
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Affiliation(s)
- Jonathan C Hibbard
- 1 Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,2 School of Mathematics, Institute for Advanced Study, Princeton, NJ, USA
| | - Jonathan S Friedstat
- 3 Division of Burns, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Renee E Edkins
- 5 Division of Plastic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C Scott Hultman
- 5 Division of Plastic Surgery, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michael R Kosorok
- 1 Department of Biostatistics, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Kim JH, Jeong JJ, Lee YI, Lee WJ, Lee C, Chung WY, Nam KH, Lee JH. Preventive effect of polynucleotide on post-thyroidectomy scars: A randomized, double-blinded, controlled trial. Lasers Surg Med 2018; 50:755-762. [PMID: 29574803 DOI: 10.1002/lsm.22812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVE Polynucleotide (PN) provides a structural scaffold to induce anti-inflammatory and enhanced wound healing properties, and this study aimed to assess the efficacy of PN administration in the prevention of post-operative scars after conventional open total thyroidectomy. STUDY DESIGN MATERIALS AND METHODS Forty-two patients with thyroid carcinoma who underwent total thyroidectomy were randomly assigned to the study (PN administration) or control (normal saline) group. All patients underwent a single session of combined ablative and non-ablative fractional laser. The Vancouver Scar Scale (VSS), global photographic assessment, and objective scar were assessed using three-dimensional (3D) camera at baseline and at 2, 4, 8, and 16 weeks after surgery. RESULTS Patients who underwent PN injection demonstrated better surgical scar quality outcome. Participants in the PN administration group had lower VSS scores than the control group (2.09 ± 0.47 vs. 4.01 ± 0.55, respectively) and lower scar height (0.23 ± 0.03 vs. 0.29 ± 0.03, respectively), as measured using 3D imaging. Furthermore, in the PN injected group, the degree of erythema, and pigmentation of the scar were less prominent. No patient developed hypertrophic scar or keloids on the surgical site. No other adverse events, including post-inflammatory hyperpigmentation, scarring, or infection, were observed. CONCLUSION Adjuvant administration of PN along with conventional fractional laser treatment led to more favorable effect in wound healing and post-operative scar prevention after thyroidectomy. Lasers Surg. Med. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Ji Hee Kim
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Scar Laser and Plastic Surgery Center, Yonsei University College of Medicine, Yonsei Cancer Hospital, Seoul, Korea
| | - Jong Ju Jeong
- Department of Surgery, Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Young In Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jai Lee
- Scar Laser and Plastic Surgery Center, Yonsei University College of Medicine, Yonsei Cancer Hospital, Seoul, Korea
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, Seoul, Korea
| | - Chorok Lee
- Department of Surgery, Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Youn Chung
- Department of Surgery, Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Kee-Hyun Nam
- Department of Surgery, Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Ju Hee Lee
- Department of Dermatology and Cutaneous Biology Research Institute, Yonsei University College of Medicine, Seoul, Korea
- Scar Laser and Plastic Surgery Center, Yonsei University College of Medicine, Yonsei Cancer Hospital, Seoul, Korea
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Carney BC, Liu Z, Alkhalil A, Travis TE, Ramella-Roman J, Moffatt LT, Shupp JW. Elastin Is Differentially Regulated by Pressure Therapy in a Porcine Model of Hypertrophic Scar. J Burn Care Res 2018; 38:28-35. [PMID: 28009695 DOI: 10.1097/bcr.0000000000000413] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Beneficial effects of pressure therapy for hypertrophic scars have been reported, but the mechanisms of action are not fully understood. This study evaluated elastin and its contribution to scar pliability. The relationship between changes in Vancouver Scar Scale (VSS) scores of pressure-treated scars and differential regulation of elastin was assessed. Hypertrophic scars were created and assessed weekly using VSS and biopsy procurement. Pressure treatment began on day 70 postinjury. Treated scars were compared with untreated shams. Treatment lasted 2 weeks, through day 84, and scars were assessed weekly through day 126. Transcript and protein levels of elastin were quantified. Pressure treatment resulted in lower VSS scores compared with sham-treated scars. Pliability (VSSP) was a key contributor to this difference. At day 70 pretreatment, VSSP = 2. Without treatment, sham-treated scars became less pliable, while pressure-treated scars became more pliable. The percentage of elastin in scars at day 70 was higher than in uninjured skin. Following treatment, the percentage of elastin increased and continued to increase through day 126. Untreated sham scars did not show a similar increase. Quantification of Verhoeff-Van Gieson staining corroborated the findings and immunofluorescence revealed the alignment of elastin fibers. Pressure treatment results in increased protein level expression of elastin compared with sham-untreated scars. These findings further characterize the extracellular matrix's response to the application of pressure as a scar treatment, which will contribute to the refinement of rehabilitation practices and ultimately improvements in functional and psychosocial outcomes for patients.
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Affiliation(s)
- Bonnie C Carney
- From the *Firefighters' Burn and Surgical Research Laboratory, Washington, DC; †Department of Biochemistry, Georgetown University, Washington, DC; ‡The Burn Center, MedStar Washington Hospital Center, Washington, DC; and §Department of Biomedical Engineering, Florida International University, Miami
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Yang L, Liu L, Ying H, Yu Y, Zhang D, Deng H, Zhang H, Chai J. Acute downregulation of miR-155 leads to a reduced collagen synthesis through attenuating macrophages inflammatory factor secretion by targeting SHIP1. J Mol Histol 2018; 49:165-174. [PMID: 29330743 DOI: 10.1007/s10735-018-9756-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 01/08/2018] [Indexed: 12/15/2022]
Abstract
Fibrosis, tightly associated with fibroblasts collagen synthesis, is related closely with inflammatory response. Our previously study found that acute downregulation of miR-155 at wound sites leads to a reduced fibrosis, however its particular mechanism is unclear. Herein, we aimed to explore the mechanism of miR-155 in reducing fibrosis. We first found that down-regulation of miR-155 inhibited macrophages transforming growth factor-β1 (TGF-β1) and IL-1β secretion. Next, we found that co-cultured with macrophages increased the proliferation and collagen synthesis of fibroblasts, and downregulation of miR-155 in macrophages could effectively attenuate the accelerative effects. We further identified SH2 domain containing inositol-5-phosphatase 1 (SHIP1) as a direct target of miR-155 in macrophages, and the expression of SHIP1 was negatively correlated with the level of miR-155. We further confirmed that PI3K/Akt pathway was involved in this process. Last, we found that downregulation of miR-155 leads to a reduced fibrosis in sever burn rat. Taken together, these results indicate that down-regulation of miR-155 leads to a reduced fibroblasts proliferation and collagen synthesis through attenuating macrophages TGF-β1 and IL-1β secretion by targeting SHIP1 via PI3K/Akt pathway, suggesting its potential therapeutic effects on the treatment of skin fibrosis.
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Affiliation(s)
- Longlong Yang
- Department of Burn & Plastic Surgery, Burns Institute, the First Affiliated Hospital to PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Lingying Liu
- Department of Burn & Plastic Surgery, Burns Institute, the First Affiliated Hospital to PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Huinan Ying
- Department of Burn & Plastic Surgery, Burns Institute, the First Affiliated Hospital to PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Yonghui Yu
- Department of Burn & Plastic Surgery, Burns Institute, the First Affiliated Hospital to PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Donghai Zhang
- Department of Burn & Plastic Surgery, Burns Institute, the First Affiliated Hospital to PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Huping Deng
- Department of Burn & Plastic Surgery, Burns Institute, the First Affiliated Hospital to PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Haijun Zhang
- Department of Burn & Plastic Surgery, Burns Institute, the First Affiliated Hospital to PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, China
| | - Jiake Chai
- Department of Burn & Plastic Surgery, Burns Institute, the First Affiliated Hospital to PLA General Hospital, 51 Fucheng Road, Haidian District, Beijing, 100048, China.
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72
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Oh H, Boo S. Assessment of burn-specific health-related quality of life and patient scar status following burn. Burns 2017; 43:1479-1485. [DOI: 10.1016/j.burns.2017.03.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/22/2017] [Accepted: 03/24/2017] [Indexed: 11/30/2022]
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Burn Eschar Stimulates Fibroblast and Adipose Mesenchymal Stromal Cell Proliferation and Migration but Inhibits Endothelial Cell Sprouting. Int J Mol Sci 2017; 18:ijms18081790. [PMID: 28820426 PMCID: PMC5578178 DOI: 10.3390/ijms18081790] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 07/31/2017] [Accepted: 08/12/2017] [Indexed: 12/03/2022] Open
Abstract
The majority of full-thickness burn wounds heal with hypertrophic scar formation. Burn eschar most probably influences early burn wound healing, since granulation tissue only forms after escharotomy. In order to investigate the effect of burn eschar on delayed granulation tissue formation, burn wound extract (BWE) was isolated from the interface between non-viable eschar and viable tissue. The influence of BWE on the activity of endothelial cells derived from dermis and adipose tissue, dermal fibroblasts and adipose tissue-derived mesenchymal stromal cells (ASC) was determined. It was found that BWE stimulated endothelial cell inflammatory cytokine (CXCL8, IL-6 and CCL2) secretion and migration. However, BWE had no effect on endothelial cell proliferation or angiogenic sprouting. Indeed, BWE inhibited basic Fibroblast Growth Factor (bFGF) induced endothelial cell proliferation and sprouting. In contrast, BWE stimulated fibroblast and ASC proliferation and migration. No difference was observed between cells isolated from dermis or adipose tissue. The inhibitory effect of BWE on bFGF-induced endothelial proliferation and sprouting would explain why excessive granulation tissue formation is prevented in full-thickness burn wounds as long as the eschar is still present. Identifying the eschar factors responsible for this might give indications for therapeutic targets aimed at reducing hypertrophic scar formation which is initiated by excessive granulation tissue formation once eschar is removed.
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Jaspers M, Stekelenburg C, Simons J, Brouwer K, Vlig M, van den Kerckhove E, Middelkoop E, van Zuijlen P. Assessing blood flow, microvasculature, erythema and redness in hypertrophic scars: A cross sectional study showing different features that require precise definitions. Burns 2017; 43:1044-1050. [DOI: 10.1016/j.burns.2017.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/11/2016] [Accepted: 01/07/2017] [Indexed: 11/28/2022]
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Wallace HJ, Fear MW, Crowe MM, Martin LJ, Wood FM. Identification of factors predicting scar outcome after burn injury in children: a prospective case-control study. BURNS & TRAUMA 2017; 5:19. [PMID: 28680887 PMCID: PMC5494810 DOI: 10.1186/s41038-017-0084-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 05/27/2017] [Indexed: 11/15/2022]
Abstract
Background There is a lack of rigorous research investigating the factors that influence scar outcome in children. Improved clinical decision-making to reduce the health burden due to post-burn scarring in children will be guided by evidence on risk factors and risk stratification. This study aimed to examine the association between selected patient, injury and clinical factors and the development of raised scar after burn injury. Novel patient factors were investigated including selected immunological co-morbidities (asthma, eczema and diabetes type 1 and type 2) and skin pigmentation (Fitzpatrick skin type). Methods A prospective case-control study was conducted among 186 children who sustained a burn injury in Western Australia. Logistic regression was used to explore the relationship between explanatory variables and a defined outcome measure: scar height measured by a modified Vancouver Scar Scale (mVSS). Results The overall correct prediction rate of the model was 80.6%; 80.9% for children with raised scars (>1 mm) and 80.4% for children without raised scars (≤1 mm). After adjustment for other variables, each 1% increase in % total body surface area (%TBSA) of burn increased the odds of raised scar by 15.8% (95% CI = 4.4–28.5%). Raised scar was also predicted by time to healing of longer than 14 days (OR = 11.621; 95% CI = 3.727–36.234) and multiple surgical procedures (OR = 11.521; 1.994–66.566). Conclusions Greater burn surface area, time to healing of longer than 14 days, and multiple operations are independently associated with raised scar in children after burn injury. Scar prevention strategies should be targeted to children with these risk factors.
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Affiliation(s)
- Hilary J Wallace
- Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA Australia.,Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, M318, 35 Stirling Highway, Crawley, 6009 WA Australia
| | - Mark W Fear
- Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA Australia
| | - Margaret M Crowe
- Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, WA Australia
| | - Lisa J Martin
- Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, WA Australia
| | - Fiona M Wood
- Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA Australia.,Burns Service of Western Australia, Princess Margaret Hospital for Children and Fiona Stanley Hospital, Perth, WA Australia
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Mokos ZB, Jović A, Grgurević L, Dumić-Čule I, Kostović K, Čeović R, Marinović B. Current Therapeutic Approach to Hypertrophic Scars. Front Med (Lausanne) 2017; 4:83. [PMID: 28676850 PMCID: PMC5476971 DOI: 10.3389/fmed.2017.00083] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/06/2017] [Indexed: 01/07/2023] Open
Abstract
Abnormal scarring and its accompanying esthetic, functional, and psychological sequelae still pose significant challe nges. To date, there is no satisfactory prevention or treatment option for hypertrophic scars (HSs), which is mostly due to not completely comprehending the mechanisms underlying their formation. That is why the apprehension of regular and controlled physiological processes of scar formation is of utmost importance when facing hypertrophic scarring, its pathophysiology, prevention, and therapeutic approach. When treating HSs and choosing the best treatment and prevention modality, physicians can choose from a plethora of therapeutic options and many commercially available products, among which currently there is no efficient option that can successfully overcome impaired skin healing. This article reviews current therapeutic approach and emerging therapeutic strategies for the management of HSs, which should be individualized, based on an evaluation of the scar itself, patients’ expectations, and practical, evidence-based guidelines. Clinicians are encouraged to combine various prevention and treatment modalities where combination therapy that includes steroid injections, 5-fluorouracil, and pulsed-dye laser seems to be the most effective. On the other hand, the current therapeutic options are usually empirical and their results are unreliable and unpredictable. Therefore, there is an unmet need for an effective, targeted therapy and prevention, which would be based on an action or a modulation of a particular factor with clarified mechanism of action that has a beneficial effect on wound healing. As the extracellular matrix has a crucial role in cellular and extracellular events that lead to pathological scarring, targeting its components mostly by regulating bone morphogenetic proteins may throw up new therapeutic approach for reduction or prevention of HSs with functionally and cosmetically acceptable outcome.
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Affiliation(s)
- Zrinka Bukvić Mokos
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Anamaria Jović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Lovorka Grgurević
- Laboratory for Mineralized Tissues, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Ivo Dumić-Čule
- Laboratory for Mineralized Tissues, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Krešimir Kostović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Romana Čeović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Branka Marinović
- Department of Dermatology and Venereology, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
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Proksch E, de Bony R, Trapp S, Boudon S. Topical use of dexpanthenol: a 70th anniversary article. J DERMATOL TREAT 2017; 28:766-773. [PMID: 28503966 DOI: 10.1080/09546634.2017.1325310] [Citation(s) in RCA: 73] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Approximately 70 years ago, the first topical dexpanthenol-containing formulation (Bepanthen™ Ointment) has been developed. Nowadays, various topical dexpanthenol preparations exist, tailored according to individual requirements. Topical dexpanthenol has emerged as frequently used formulation in the field of dermatology and skin care. Various studies confirmed dexpanthenol's moisturizing and skin barrier enhancing potential. It prevents skin irritation, stimulates skin regeneration and promotes wound healing. Two main directions in the use of topical dexpanthenol-containing formulations have therefore been pursued: as skin moisturizer/skin barrier restorer and as facilitator of wound healing. This 70th anniversary paper reviews studies with topical dexpanthenol in skin conditions where it is most frequently used. Although discovered decades ago, the exact mechanisms of action of dexpanthenol have not been fully elucidated yet. With the adoption of new technologies, new light has been shed on dexpanthenol's mode of action at the molecular level. It appears that dexpanthenol increases the mobility of stratum corneum molecular components which are important for barrier function and modulates the expression of genes important for wound healing. This review will update readers on recent advances in this field.
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Affiliation(s)
- Ehrhardt Proksch
- a Department of Dermatology , University of Kiel , Kiel , Germany
| | | | - Sonja Trapp
- b Bayer Consumer Care AG , Basel , Switzerland
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Evidence-Based Scar Management: How to Improve Results with Technique and Technology. Plast Reconstr Surg 2017; 138:165S-178S. [PMID: 27556757 DOI: 10.1097/prs.0000000000002647] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Scars represent the visible sequelae of trauma, injury, burn, or surgery. They may induce distress in the patient because of their aesthetically unpleasant appearance, especially if they are excessively raised, depressed, wide, or erythematous. They may also cause the patient symptoms of pain, tightness, and pruritus. Numerous products are marketed for scar prevention or improvement, but their efficacy is unclear. METHODS A literature review of high-level studies analyzing methods to prevent or improve hypertrophic scars, keloids, and striae distensae was performed. The evidence from these articles was analyzed to generate recommendations. Each intervention's effectiveness at preventing or reducing scars was rated as none, low, or high, depending on the strength of the evidence for that intervention. RESULTS For the prevention of hypertrophic scars, silicone, tension reduction, and wound edge eversion seem to have high efficacy, whereas onion extract, pulsed-dye laser, pressure garments, and scar massage have low efficacy. For the treatment of existing hypertrophic scars, silicone, pulsed-dye laser, CO2 laser, corticosteroids, 5-fluorouracil, bleomycin, and scar massage have high efficacy, whereas onion extract and fat grafting seem to have low efficacy. For keloid scars, effective adjuncts to excision include corticosteroids, mitomycin C, bleomycin, and radiation therapy. No intervention seems to have significant efficacy in the prevention or treatment of striae distensae. CONCLUSION Although scars can never be completely eliminated in an adult, this article presents the most commonly used, evidence-based methods to improve the quality and symptoms of hypertrophic scars, as well as keloid scars and striae distensae.
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Agabalyan NA, Su S, Sinha S, Gabriel V. Comparison between high-frequency ultrasonography and histological assessment reveals weak correlation for measurements of scar tissue thickness. Burns 2017; 43:531-538. [DOI: 10.1016/j.burns.2016.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/09/2016] [Accepted: 09/11/2016] [Indexed: 10/20/2022]
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80
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McGoldrick RB, Theodorakopoulou E, Azzopardi EA, Murison M. Lasers and ancillary treatments for scar management Part 2: Keloid, hypertrophic, pigmented and acne scars. Scars Burn Heal 2017; 3:2059513116689805. [PMID: 29799579 PMCID: PMC5965340 DOI: 10.1177/2059513116689805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The formation of a wide range of excessive scars following various skin injuries is a natural consequence of healing. Scars resulting from surgery or trauma affect approximately 100 million people per annum in the developed world and can have profound physical, aesthetic, psychological and social consequences. Thus, scar treatment is a priority for patient and physician alike. Laser treatment plays an important role in scar management with additional support from ancillary modalities. Subsequent to part 1: Burns scars, part 2 focuses on our strategies and literature review of treatment of keloid, hypertrophic, pigmented and acne scars where lasers are used in conjunction with other measures, and illustrated with case studies.
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Affiliation(s)
- Rory Boyd McGoldrick
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
| | - Evgenia Theodorakopoulou
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
| | | | - Maxwell Murison
- Welsh Regional Burns, Plastic, Reconstructive Surgery and Laser Unit, Morriston Hospital, Swansea, Wales, UK
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Percutaneous collagen induction as an additive treatment for scar formation following thermal injuries: Preliminary experience in 47 children. Burns 2017; 43:1097-1102. [PMID: 28283308 DOI: 10.1016/j.burns.2017.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/24/2017] [Accepted: 02/15/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Thermal injuries are one of the most physically and psychologically devastating causes of pediatric trauma. Post-traumatic sequelae such as hypertrophic scars and contractures often result in long lasting morbidity and disfigurement. Conservative therapy, including pressure garments and silicone, is the gold standard for scar management in the pediatric population. Most recently percutaneous collagen induction (PCI) was introduced as an alternative treatment in adults. The aim of this report was to share our experience with PCI in children and adolescents in scar management following thermal injuries. PATIENTS AND METHODS Between July 2013 and February 2016, a total of 99 PCI treatments were performed on forty-seven children and adolescents for scar formation following thermal injuries in this retrospective study. A medical roller device (Dermaroller®, Dermaroller GmbH, Wolfenbüttel, Germany) with 2.5mm long needles was used. All procedures were carried out under general anesthesia. At the end of the operation vitamin A and vitamin C oil (ENVIRON® AVST Body Oil; Environ Skin Care, Pty. Ltd., Cape Town, South Africa) was applied topically. Photographs were taken before and a minimum of 4 weeks after the first PCI in order to document the effect on scar tissue. These images were graded according to the Vancouver Scar Scale (VSS). RESULTS The median age at the time of the first PCI was 8.3 years (range, 0.8-21.2 years). The median time interval between the injury and PCI was 18 months (range, 4-170 months). There were no intraoperative problems noted. Minor postoperative complications occurred in 2 patients (4.3%). All patients reported subjective improvement and were satisfied with the procedure and the results. Pre- and post-treatment photographs were available in 40 patients, and overall VSS scores improved post-treatment in all patients. Following a single PCI treatment, scar vascularity, pliability and height all improved, however there was no statistically significant effect on pigmentation. CONCLUSIONS PCI is an enrichment of the armamentarium for scar treatment following thermal injuries in children and adolescents. Further prospective studies are recommended regarding the optimal timing for this treatment and long term outcome in the pediatric population.
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Sari E, Bakar B, Dincel GC, Budak Yildiran FA. Effects of DMSO on a rabbit ear hypertrophic scar model: A controlled randomized experimental study. J Plast Reconstr Aesthet Surg 2017; 70:509-517. [PMID: 28216321 DOI: 10.1016/j.bjps.2017.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 10/21/2016] [Accepted: 01/04/2017] [Indexed: 02/07/2023]
Abstract
Dimethyl sulfoxide (DMSO) is an anti-inflammatory, antibacterial, analgesic drug widely used to treat several diseases as reported in the literature. It has a detractive effect on collagen deposition in the abnormal tissue. This study aimed to investigate the possible therapeutic effects of DMSO on hypertrophic scar formation in rabbits. Twenty-four New Zealand male albino rabbits were randomly divided into four groups: control, sham, DMSO, and TRA (triamcinolone acetonide). Except the control group, punch biopsy defects were created on each animal's right ear. Following the hypertrophic scar formation on day 28, intralesional DMSO and triamcinolone acetonide were administered once a week for 4 weeks into these scars of the DMSO and TRA groups, respectively. No therapeutic agent was administered to the control and sham groups. One week after the last injection, ear samples were collected for histopathological, immunohistochemical, and real-time polymerase chain reaction gene expression analyses. Histopathological examination revealed that the epithelium in the DMSO group was thicker than that in the control and TRA groups, but thinner than that in the sham group. Connective tissue thickness and vascularity level of the sham group were higher than those of the control, DMSO, and TRA groups. The collagen type I immunoreactivity level of the sham and TRA groups was higher than those of the control and DMSO groups. The collagen type III immunoreactivity level was higher in the sham group than in all other groups. Collagen type I/type III immunoreactivity ratios were lower in the DMSO group. The alignment of collagen fibers was normal in the DMSO group, but was irregular in the sham and TRA groups. The collagen type I gene expression levels of the DMSO and TRA groups were lower than that of the sham group. Collagen type III and IFN-γ mRNA expression levels were almost similar among the groups. TGF-1β mRNA expression levels were higher in the DMSO and TRA groups than in the control and sham groups. On the basis of the results, it can be concluded that intralesional administration of DMSO decreases hypertrophic scar formation easily and safely.
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Affiliation(s)
- Elif Sari
- Kirikkale University Faculty of Medicine, Department of Plastic, Reconstructive and Aesthetic Surgery, Kirikkale, Turkey.
| | - Bulent Bakar
- Kirikkale University Faculty of Medicine, Department of Neurosurgery, Kirikkale, Turkey
| | - Gungor Cagdas Dincel
- Aksaray University, Eskil Vocational High School, Laboratory and Veterinary Science, Aksaray, Turkey
| | - Fatma Azize Budak Yildiran
- Kirikkale University, Vocational High School of Health Services, Department of Medical Services and Techniques, Kirikkale, Turkey
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Ai JW, Liu JT, Pei SD, Liu Y, Li DS, Lin HM, Pei B. The effectiveness of pressure therapy (15-25 mmHg) for hypertrophic burn scars: A systematic review and meta-analysis. Sci Rep 2017; 7:40185. [PMID: 28054644 PMCID: PMC5215680 DOI: 10.1038/srep40185] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/02/2016] [Indexed: 11/29/2022] Open
Abstract
Although pressure therapy (PT) represents the standard care for prevention and treatment of hypertrophic scar (HS) from burns, its practice is largely based on empirical evidence and its effectiveness remains controversial. To clarify the effect of PT (15-25 mmHg) for HS, we performed the systematic review and meta-analysis. Several electronic databases were screened to identify related randomized controlled trials (RCTs). 12 RCTs involving 710 patients with 761 HS resulting from burn injuries were included. Compared with non/low-PT, cases treated with PT (15-25 mmHg) showed significant differences in Vancouver Scar Scale score (MD = -0.58, 95% CI = -0.78--0.37), thickness (SMD = -0.25, 95% CI = -0.40--0.11), brightness (MD = 2.00, 95% CI = 0.59-3.42), redness (MD = -0.79, 95% CI = -1.52--0.07), pigmentation (MD = -0.16, 95% CI = -0.32--0.00) and hardness (SMD = -0.65, 95% CI = -1.07--0.23). However, there was no difference in vascularity (MD = 0.03, 95% CI = -0.43-0.48). Our analysis indicated that patients with HS who were managed with PT (15-25 mmHg) showed significant improvements. Due to limitations, more large and well-designed studies are needed to confirm our findings and the side-effects of the PT may also need to be evaluated.
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Affiliation(s)
- Jin-Wei Ai
- Evidence-Based Medicine Center, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, P.R. China
- Department of Plastic Surgery, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, P.R. China
| | - Jiang-tao Liu
- Department of Plastic Surgery, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, P.R. China
| | - Sheng-Duo Pei
- School of Life Sciences, Central China Normal University, Wuhan 430079, P.R. China
| | - Yu Liu
- Department of Plastic Surgery, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, P.R. China
| | - De-Sheng Li
- Department of Plastic Surgery, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, P.R. China
| | - Hong-ming Lin
- Department of Plastic Surgery, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, P.R. China
| | - Bin Pei
- Evidence-Based Medicine Center, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, P.R. China
- Department of Plastic Surgery, Xiangyang Hospital, Hubei University of Medicine, Xiangyang 441000, P.R. China
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Rahimnejad M, Derakhshanfar S, Zhong W. Biomaterials and tissue engineering for scar management in wound care. BURNS & TRAUMA 2017; 5:4. [PMID: 28127573 PMCID: PMC5251275 DOI: 10.1186/s41038-017-0069-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 01/12/2017] [Indexed: 04/24/2023]
Abstract
Scars are a natural and unavoidable result from most wound repair procedures and the body's physiological healing response. However, they scars can cause considerable functional impairment and emotional and social distress. There are different forms of treatments that have been adopted to manage or eliminate scar formation. This review covers the latest research in the past decade on using either natural agents or synthetic biomaterials in treatments for scar reduction.
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Affiliation(s)
| | | | - Wen Zhong
- University of Manitoba, Winnipeg, MB Canada
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85
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Mohammadi AA, Eskandari S, Johari HG, Rajabnejad A. Using Amniotic Membrane as a Novel Method to Reduce Post-burn Hypertrophic Scar Formation: A Prospective Follow-up Study. J Cutan Aesthet Surg 2017; 10:13-17. [PMID: 28529415 PMCID: PMC5418975 DOI: 10.4103/jcas.jcas_109_16] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: Several studies have shown that the application of amniotic membrane as a biological dressing in the management of burns is accompanied by rapid re-epithelialisation. In this follow-up study, we aimed to evaluate the possible role of amniotic membrane as an adjunct to split thickness skin grafting on reducing itching and severity of hypertrophic scar formation. Materials and Methods: From October 2013 to January 2015, in a prospective follow-up study, 54 patients (108 limbs) with second and third degree burns, covering 4%–15% of total body surface area (TBSA), were included in the study. All patients needed split-thickness skin grafts for burn-wound coverage. Selected patients had symmetric burns on two (upper or lower) extremities. Then, in every patient, the extremities were randomly divided into two groups: In one limb, the skin graft was traditionally fixed with skin staples (control group) and in the other limb, the skin graft was covered with an amniotic membrane (amnion group). Therefore, in every patient, the graft was covered with an amniotic membrane in one extremity and fixed with skin staples in the other extremity. Finally, after 6 months, the degree of itching and hypertrophic scar formation was compared between the two groups. Results: The study group was composed of 108 limbs in 54 patients (27 males and 27 females) with a mean age of 23.54 ± 4.9 years and burn 9.03 ± 2.69% TBSA. The patients were divided into two groups: 54 limbs in amnion group and 54 limbs in control group. In 59.25% of the cases, patient had less itching in the extremity covered with amniotic membrane. Furthermore, in 64.81% of the cases, patients had less hypertrophic scar formation in the extremity covered with amniotic membrane. These differences were statistically significant (P < 0.001). Conclusions: Amniotic membrane used as an adjunct in split thickness skin grafting is a novel modality which significantly reduces scar formation and itching that can be greatly distressing to burn patients. However, still more prospective well designed studies are needed to prove it.
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Affiliation(s)
- Ali Akbar Mohammadi
- Plastic and Reconstructive Surgery Ward, Burn and Wound Healing Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shima Eskandari
- Department of Anesthesiology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamed Ghoddusi Johari
- Department of General Surgery, Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ata'ollah Rajabnejad
- Vascular and Endovascular Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Klotz T, Munn Z, Aromataris E, Greenwood J. The effect of moisturizers or creams on scars. ACTA ACUST UNITED AC 2017; 15:15-19. [DOI: 10.11124/jbisrir-2016-002975] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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87
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Abstract
Tissue adhesives have been introduced as a promising alternative for the traditional wound closure method of suturing.
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Affiliation(s)
| | - Wen Zhong
- Department of Biosystem Engineering
- University of Manitoba
- Canada
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88
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Chen YY, Lu YH, Ma CH, Tao WW, Zhu JJ, Zhang X. A novel elastic liposome for skin delivery of papain and its application on hypertrophic scar. Biomed Pharmacother 2016; 87:82-91. [PMID: 28040601 DOI: 10.1016/j.biopha.2016.12.076] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 12/06/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022] Open
Abstract
This study aims to investigate the therapeutic effects of papain elastic liposomes (PEL) on hypertrophic scar through topical application. PEL were prepared using the reverse-phase evaporation method and optimized by response surface methodology. The transdermal absorption of optimized PEL was tested by vertical Franz diffusion cells in vitro. The effects of PEL were investigated in rabbit model of hypertrophic scar in vivo, histological analysis and scar-related proteins were detected to reveal potential scar repair mechanism. The best formulation of PEL had EE (43.8±1.4%), particle size (100.9±2.2nm), PDI (0.037±0.003), zeta potential (-26.3±1.3mV), and DI (21.9±3.1). PEL gave the cumulative amounts and steady state fluxes in the receiver solution of 381.9±32.4μg/cm2, 11.4±1.5μg/cm2/h, and showed drug deposition in skin of 19.1±3.2% after 24h. After topical application, the scar elevation index, microvascular density, and collagen fiber were significantly decreased with regular arrangement. The expressions of TGF-β1, P-Smad-3, P-NF-κB p65, and P-IKBa in hypertrophic scar were significantly down regulated in contrast with those in model group. PEL were proven as an excellent topical preparation for hypertrophic scar treatment.
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Affiliation(s)
- Yan-Yan Chen
- College of Basic Medical, Nanjing University of Chinese Medicine, Nanjing 210023, China; Yunnan Baiyao Group Wuxi Pharmaceutical Co., Ltd., Wuxi 214028, China
| | - Ye-Hui Lu
- Yunnan Baiyao Group Wuxi Pharmaceutical Co., Ltd., Wuxi 214028, China; Yunnan Institute of Materia Medica, Yunnan 650111, China
| | - Chun-Hua Ma
- College of Basic Medical, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Wei-Wei Tao
- College of Basic Medical, Nanjing University of Chinese Medicine, Nanjing 210023, China
| | - Jing-Juan Zhu
- College of Basic Medical, Nanjing University of Chinese Medicine, Nanjing 210023, China; Yunnan Baiyao Group Wuxi Pharmaceutical Co., Ltd., Wuxi 214028, China
| | - Xu Zhang
- College of Basic Medical, Nanjing University of Chinese Medicine, Nanjing 210023, China.
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Physical and Mechanical Evaluation of Silicone-Based Double-Layer Adhesive Patch Intended for Keloids and Scar Treatment Therapy. Polymers (Basel) 2016; 8:polym8110398. [PMID: 30974684 PMCID: PMC6431886 DOI: 10.3390/polym8110398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/26/2016] [Accepted: 11/09/2016] [Indexed: 11/28/2022] Open
Abstract
Growing interest in silicone elastomers for pharmaceutical purposes is due to both their beneficial material effect for scar treatment and their potential as drug carriers. Regarding their morphological structure, silicone polymers possess unique properties, which enable a wide range of applicability possibilities. The present study focused on developing a double-layer adhesive silicone film (DLASil) by evaluating its physical and mechanical properties, morphology, and stability. DLASil suitability for treatment of scars and keloids was evaluated by measurement of tensile strength, elasticity modulus, and elongation. The results indicated that mechanical and physical properties of the developed product were satisfying.
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Martin L, Byrnes M, McGarry S, Rea S, Wood F. Social challenges of visible scarring after severe burn: A qualitative analysis. Burns 2016; 43:76-83. [PMID: 27576930 DOI: 10.1016/j.burns.2016.07.027] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/27/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Visible scarring after burn causes social challenges which impact on interpersonal connection. These have health impacts which may worsen outcomes for burn patients and reduce the potential for posttraumatic growth (PTG). AIM The aim of the study was to investigate adult burn survivors' experiences of interpersonal relationships as potential barriers to posttraumatic recovery following hand or face burns. METHOD This qualitative study explored patient experiences of interpersonal situations. A purposive sample (n=16) who had visible burn scarring were interviewed more than two years after their burn. RESULTS Emotional barriers included the fear of rejection, feelings of self-consciousness, embarrassment and humiliation. Situational barriers included inquisitive questions, comments and behaviours of others. Responses depended on the relationship with the person, how they were asked and the social situation. Active coping strategies included positive reframing, humour, changing the self, and pre-empting questions. Avoidant coping strategies included avoidance of eye contact, closed body language, hiding scars, and learning to shut down conversations. CONCLUSION Emotional and situational barriers reduced social connection and avoidant coping strategies reduced the interaction of people with burns with others. Active coping strategies need to be taught to assist with social reintegration. This highlights the need for peer support, family support and education, and social skills training.
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Affiliation(s)
- Lisa Martin
- University of Western Australia, Burn Injury Research Unit, 35 Stirling Highway, Crawley, Western Australia 6009, Australia.
| | - Michelle Byrnes
- University of Western Australia, Clinical Psychology Research Unit, Western Australian Neuroscience Research Institute, Level 4, A Block, QEII Medical Centre, Nedlands, Western Australia 6009, Australia
| | - Sarah McGarry
- Fiona Wood Foundation, Fiona Stanley Hospital, MNH (B) Main Hospital, Level 4, Burns Unit, 102-118 Murdoch Drive, Murdoch, Western Australia 6150, Australia; Burn Service of Western Australia, Fiona Stanley Hospital, MNH (B) Main Hospital, Level 4, Burns Unit, 102-118 Murdoch Drive, Murdoch, Western Australia 6150, Australia
| | - Suzanne Rea
- University of Western Australia, Burn Injury Research Unit, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; Fiona Wood Foundation, Fiona Stanley Hospital, MNH (B) Main Hospital, Level 4, Burns Unit, 102-118 Murdoch Drive, Murdoch, Western Australia 6150, Australia; Burn Service of Western Australia, Fiona Stanley Hospital, MNH (B) Main Hospital, Level 4, Burns Unit, 102-118 Murdoch Drive, Murdoch, Western Australia 6150, Australia
| | - Fiona Wood
- University of Western Australia, Burn Injury Research Unit, 35 Stirling Highway, Crawley, Western Australia 6009, Australia; Fiona Wood Foundation, Fiona Stanley Hospital, MNH (B) Main Hospital, Level 4, Burns Unit, 102-118 Murdoch Drive, Murdoch, Western Australia 6150, Australia; Burn Service of Western Australia, Fiona Stanley Hospital, MNH (B) Main Hospital, Level 4, Burns Unit, 102-118 Murdoch Drive, Murdoch, Western Australia 6150, Australia
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Comparing Two Methods of Cryotherapy and Intense Pulsed Light with Triamcinolone Injection in the Treatment of Keloid and Hypertrophic Scars: A Clinical Trial. Osong Public Health Res Perspect 2016; 7:313-319. [PMID: 27812490 PMCID: PMC5079190 DOI: 10.1016/j.phrp.2016.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/18/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives Keloid and hypertrophic scars are abnormal manifestations of wounds that occur following skin injuries in the form of local proliferation of fibroblasts and increased production of collagen. There are several ways to cure these scars; treatment must be selected based on the nature of the scars. In this clinical trial, two methods—cryotherapy and intense pulsed light (IPL)—are compared in the treatment of scars, and the results are presented in terms of improvement level, complications, and patient satisfaction. Methods This clinical trial was conducted in southeastern Iran. The intervention group included scars that underwent the IPL method and the control group, which consisted of scars that were subjected to cryotherapy. In both methods, intralesional corticosteroid injection was administered. To select samples, the easy sampling method was used. To determine the expected outcomes, the criteria determined in the Vancouver scar scale were used. Data were analyzed using the Mix Model, chi-square test, and t test. Results In this study, 166 samples of keloid and hypertrophic scars were cured using two methods (Cryotherapy, 83; IPL, 83). The recovery rate was higher in the Cryotherapy group than in the IPL group (p > 0.05), and the incidence of complications was also higher in the Cryotherapy group (14.5% vs. 12%). Moreover, patients were more satisfied, although not significantly so, with the cryotherapy method (p = 0.09). Conclusion Both methods were highly successful in curing scars; participants were totally satisfied with both methods.
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Abstract
Burn is still a frequent accident in children and particularly occurs in young children under 4years. The majority were caused by hot liquids (scalds) with mixed-dermal burns and is commonly treated conservatively with surgery performed at 10-15 days post-injury after healing of superficial burn. Patients with burns greater than 10% need early fluid resuscitation and adequate nutritional support to avoid deepening with infection, improve healing and survival. Hypovolemic shock could be very abrupt in children. Prophylactic prevention of infection and optimization of healing before 21 days improve quality of scar. Management with rehabilitation team is more important in children than in adults because hypertrophic scar and retraction can restrain growth and function particularly for palmar hand burns occurring at the beginning of walking. Follow-up is essential during the growth to assess scar tension requiring secondary surgery. Better knowledge of injury mechanisms should facilitate education and prevention programs and decrease the incidence.
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93
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Zhao J, Shu B, Chen L, Tang J, Zhang L, Xie J, Liu X, Xu Y, Qi S. Prostaglandin E2 inhibits collagen synthesis in dermal fibroblasts and prevents hypertrophic scar formation in vivo. Exp Dermatol 2016; 25:604-10. [PMID: 26997546 DOI: 10.1111/exd.13014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2016] [Indexed: 01/07/2023]
Abstract
Hypertrophic scarring is a common dermal fibroproliferative disorder characterized by excessive collagen deposition. Prostaglandin E2 (PGE2 ), an important inflammatory product synthesized via the arachidonic acid cascade, has been shown to act as a fibroblast modulator and to possess antifibroblastic activity. However, the mechanism underlying the antifibrotic effect of PGE2 remains unclear. In this study, we explored the effects of PGE2 on TGF-β1-treated dermal fibroblasts in terms of collagen production and to determine the regulatory pathways involved, as well as understand the antiscarring function of PGE2 in vivo. We found that PGE2 inhibited TGF-β1-induced collagen synthesis by regulating the balance of matrix metalloproteinases (MMPs) and tissue inhibitor of metalloproteinase (TIMP). It did so by upregulating cAMP through the E prostanoid (EP)2 receptor. We determined that inhibition of the TGF-β1/Smad pathway by PGE2 is associated with its ability to inhibit collagen synthesis. An in vivo study further confirmed that PGE2 inhibits hypertrophic scar formation by decreasing collagen production. Our results demonstrate that the novel anti-scarring function of PGE2 is achieved by balancing MMPs/TIMP expression and decreasing collagen production.
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Affiliation(s)
- Jingling Zhao
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bin Shu
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lei Chen
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinming Tang
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lijun Zhang
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Julin Xie
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xusheng Liu
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yingbin Xu
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Shaohai Qi
- Department of Burns, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Early leukocyte gene expression associated with age, burn size, and inhalation injury in severely burned adults. J Trauma Acute Care Surg 2016; 80:250-7. [PMID: 26517785 DOI: 10.1097/ta.0000000000000905] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the patient with burn injury, older age, larger percentage of total body surface area (TBS) burned, and inhalation injury are established risk factors for death, which typically results from multisystem organ failure and sepsis, implicating burn-induced immune dysregulation as a contributory mechanism. We sought to identify early transcriptomic changes in circulating leukocytes underlying increased mortality associated with these three risk factors. METHODS We performed a retrospective analysis of the Glue Grant database. From 2003 to 2010, 324 adults with 20% or greater TBS burned were prospectively enrolled at five US burn centers, and 112 provided blood samples within 1 week after burn. RNA was extracted from pooled leukocytes for hybridization onto Affymetrix HU133 Plus 2.0 GeneChips. A multivariate regression model was constructed to determine risk factors for mortality. Testing for differential gene association associated with age, burn size, and inhalation injury was based on linear models using a fold change threshold of 1.5 and false discovery rate of 0.05. RESULTS After adjusting for potential confounders, age greater than 60 years (relative risk [RR], 4.53; 95% confidence interval [CI], 2.93-6.99), burn size greater than 40% TBS (RR, 4.24; 95% CI, 2.61-6.91), and inhalation injury (RR, 2.08; 95% CI, 1.35-3.21) were independently associated with mortality. No genes were differentially expressed in association with age greater than 60 years or inhalation injury. Fifty-one probe sets representing 39 unique genes were differentially expressed in leukocytes from patients with burn size greater than 40% TBS; these genes were associated with platelet activation and degranulation/exocytosis, and gene-set enrichment analysis suggested increased cellular proliferation and down-regulation of proinflammatory cytokines. CONCLUSION Among adults with large burns, older age, increasing burn size, and inhalation injury have a modest effect on the leukocyte transcriptome in the context of the "genomic storm" induced by a 20% or greater than TBS burned. The 39-gene signature we identified may provide novel targets for the development of therapies to reduce morbidity and mortality associated with burns greater than 40% TBS. LEVEL OF EVIDENCE Epidemiologic study, level III.
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95
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Wangdell J, Fridén J. Rehabilitation After Spasticity-Correcting Upper Limb Surgery in Tetraplegia. Arch Phys Med Rehabil 2016; 97:S136-43. [DOI: 10.1016/j.apmr.2016.01.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 12/21/2015] [Accepted: 01/01/2016] [Indexed: 01/08/2023]
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96
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Trevatt AEJ, Kirkham EN, Allix B, Greenwood R, Coy K, Hollén LI, Young AER. Lack of a standardised UK care pathway resulting in national variations in management and outcomes of paediatric small area scalds. Burns 2016; 42:1241-56. [PMID: 27156791 DOI: 10.1016/j.burns.2016.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 10/12/2015] [Accepted: 04/01/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION There is a paucity of evidence guiding management of small area partial thickness paediatric scalds. This has prevented the development of national management guidelines for these injuries. This research aimed to investigate whether a lack of evidence for national guidelines has resulted in variations in both management and outcomes of paediatric small area scalds across England and Wales (E&W). METHODS A national survey of initial management of paediatric scalds ≤5% Total Body Surface Area (%TBSA) was sent to 14 burns services in E&W. Skin graft rates of anonymised burns services over seven years were collected from the international Burns Injury Database (iBID). Average skin grafting rates across services were compared. Length of stay and proportion of patients receiving general anaesthesia for dressing application at each service were also compared. RESULTS All 14 burns services responded to the survey. Only 50% of services had a protocol in place for the management of small area burns. All protocols varied in how partial thickness paediatrics scalds ≤5% TBSA should be managed. There was no consensus as to which scalds should be treated using biosynthetic dressings. Data from iBID for 11,917 patients showed that the average reported skin grafting rate across all burns services was 2.3% (95% CI 2.1, 2.6) but varied from 0.3% to 7.1% (P<0.001). Service provider remained associated with likelihood of skin grafting when variations in the %TBSA case mix seen by each service were controlled for (χ(2)=87.3, P<0.001). The use of general anaesthetics across services varied between 0.6 and 35.5% (P<0.001). The median length of stay across services varied from 1 to 3 days (P<0.001). DISCUSSION A lack of evidence guiding management of small-area paediatric scalds has resulted in variation in management of these injuries across E&W. There is also significant variation in outcomes for these injuries. Further research is indicated to determine if care pathways and outcomes are linked. An evidence-based national policy for the management of small area paediatric scalds would ensure that high quality, standardised care is delivered throughout E&W and variations in outcome are reduced.
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Affiliation(s)
- Alexander E J Trevatt
- St. George's University Hospitals NHS Foundation Trust, Blackshaw Road, London SW17 0QT, United Kingdom
| | | | - Bradley Allix
- Whipps Cross University Hospital, Whipps Cross Road, Leytonstone, London E11 1NR, United Kingdom
| | - Rosemary Greenwood
- Healing Foundation Children's Burn Research Centre, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, BS2 8BJ United Kingdom
| | - Karen Coy
- Healing Foundation Children's Burn Research Centre, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, BS2 8BJ United Kingdom
| | - Linda I Hollén
- Healing Foundation Children's Burns Research Centre, University of Bristol, Bristol BS8 2BN, United Kingdom
| | - Amber E R Young
- Healing Foundation Children's Burn Research Centre, Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust, BS2 8BJ United Kingdom.
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97
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Donovan ML, Muller MJ, Simpson C, Rudd M, Paratz J. Interim pressure garment therapy (4-6 mmHg) and its effect on donor site healing in burn patients: study protocol for a randomised controlled trial. Trials 2016; 17:214. [PMID: 27113487 PMCID: PMC4845345 DOI: 10.1186/s13063-016-1329-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 04/05/2016] [Indexed: 01/04/2023] Open
Abstract
Background Pressure garment therapy (PGT) is well accepted and commonly used by clinicians in the treatment of burns scars and grafts. The medium to high pressures (24–40 mmHg) in these garments can support scar minimisation, and evidence is well documented for this particular application. However, PGT specifically for burn donor sites, of which a sequela is also scarring, is not well documented. This study protocol investigates the impact of a low pressure (4–6 mmHg) interim garment on donor site healing and scarring. With a primary purpose of holding donor dressings in place, the application of the interim pressure garment (IPG) appears to have been twofold. IPGs for donor sites have involved inconsistent application with a focus on securing wound dressing rather than scar management. However, anecdotal and observational evidence suggests that IPGs also make a difference to some patient’s scar outcomes for donor sites. This study protocol outlines a randomised controlled trial designed to test the effectiveness of this treatment on reducing scarring to burn donor sites. Methods/design This study is a single-centre, single (assessor)-blinded, randomised control trial in patients with burns donor sites to their thighs. Patients will be randomly allocated to a control group (with no compression to donor sites) or to an experimental group (with compression to donor sites) as the comparative treatment. Groups will be compared at baseline regarding the important prognostic indicators: donor site location, depth, size, age, and time since graft (5 days). The IPG treatment will be administered post-operatively (on day 5). Follow-up assessments and garment replacement will be undertaken fortnightly for a period of 2 months. Discussion This study focuses on a unique area of burns scar management using a low-pressure tubular support garment for the reduction of donor site scars. Such therapy specifically for donor scar management is poorly represented in the literature. This study was designed to test a potentially cost-effective scar prevention for patients with donor sites to the thigh. No known studies of this nature have been carried out to date, and there is a need for rigorous clinical evidence for low-pressure support garments for donor site scar minimisation. Trial registration Australian New Zealand Clinical Trials Registry identifier ACTRN12610000127000. Registered 8 Mar 2010.
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Affiliation(s)
- Michelle L Donovan
- Occupational Therapy Department, Royal Brisbane and Women's Hospital, Level 2, Dr James Mayne Building, Herston, QLD, 4029, Australia. .,Burns, Trauma & Critical Care Research Centre, School of Medicine, University of Queensland, Herston, QLD, 4029, Australia.
| | - Michael J Muller
- Burns, Trauma & Critical Care Research Centre, School of Medicine, University of Queensland, Herston, QLD, 4029, Australia.,Professor Stuart Pegg Adult Burns Centre, Royal Brisbane & Women's Hospital, Level 4, Dr James Mayne Building, Herston, QLD, 4029, Australia
| | - Claire Simpson
- Professor Stuart Pegg Adult Burns Centre, Royal Brisbane & Women's Hospital, Level 4, Dr James Mayne Building, Herston, QLD, 4029, Australia
| | - Michael Rudd
- Burns, Trauma & Critical Care Research Centre, School of Medicine, University of Queensland, Herston, QLD, 4029, Australia.,Professor Stuart Pegg Adult Burns Centre, Royal Brisbane & Women's Hospital, Level 4, Dr James Mayne Building, Herston, QLD, 4029, Australia
| | - Jennifer Paratz
- Burns, Trauma & Critical Care Research Centre, School of Medicine, University of Queensland, Herston, QLD, 4029, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia
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Patient experiences of burn scars in adults and children and development of a health-related quality of life conceptual model: A qualitative study. Burns 2016; 42:620-32. [PMID: 26803365 DOI: 10.1016/j.burns.2015.11.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this study was to understand the impact of burn scars on health-related quality of life (HRQOL) from the perspective of adults and children with burn scars, and caregivers to inform the development of a conceptual model of burn scar HRQOL. METHOD Twenty-one participants (adults and children) with burn scars and nine caregivers participated in semi-structured, face-to-face interviews between 2012 and 2013. During the interviews, participants were asked to describe features about their (or their child's) burn scars and its impact on everyday life. Two coders conducted thematic analysis, with consensus achieved through discussion and review with a third coder. The literature on HRQOL models was then reviewed to further inform the development of a conceptual model of burn scar HRQOL. RESULTS Five themes emerged from the qualitative data: 'physical and sensory symptoms', 'impact of burn scar interventions', 'impact of burn scar symptoms', 'personal factors' and 'change over time'. Caregivers offered further insights into family functioning after burn, and the impacts of burn scars and burn scar interventions on family life. In the conceptual model, symptoms (sensory and physical) of burn scars are considered proximal to HRQOL, with distal indicators including functioning (physical, emotional, social, cognitive), individual factors and the environment. Overall quality of life was affected by HRQOL. CONCLUSION Understanding the impact of burn scars on HRQOL and the development of a conceptual model will inform future burn scar research and clinical practice.
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A Review of Monocytes and Monocyte-Derived Cells in Hypertrophic Scarring Post Burn. J Burn Care Res 2016; 37:265-72. [DOI: 10.1097/bcr.0000000000000312] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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100
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Development of a Best Evidence Statement for the Use of Pressure Therapy for Management of Hypertrophic Scarring. J Burn Care Res 2016; 37:255-64. [DOI: 10.1097/bcr.0000000000000253] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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