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Slavinsky V, Wong JH, Carney BC, Lee DT, Allely R, Shupp JW, Tejiram S, Travis TE. Addressing Burn Hypertrophic Scar Symptoms Earlier: Laser Scar Revision May Begin as Early as 3-6 Months After Injury. Lasers Surg Med 2024; 56:632-641. [PMID: 38973144 DOI: 10.1002/lsm.23822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 05/03/2024] [Accepted: 06/10/2024] [Indexed: 07/09/2024]
Abstract
OBJECTIVES Fractional ablative CO2 laser (FLSR) is used to treat hypertrophic scars (HTSs) resulting from burn injuries, which are characterized by factors, such as erythema, contracture, thickness, and symptoms of pain and itch. Traditionally, waiting a year after injury for scar maturation before starting laser treatment has been recommended; however, the potential benefits of earlier intervention have gained popularity. Still, the optimal timing for beginning laser intervention in patients with HTSs remains uncertain. This study aims to evaluate the ideal timing for the initiation of FLSR for HTSs using several qualitative and quantitative assessment measures. It was hypothesized that early intervention would lead to similar improvement trends as later intervention, however, would be more ideal due to the shortened time without symptom relief for patients. METHODS Patients who received three or more laser treatment sessions and completed both pre- and posttreatment evaluations were included in this analysis (n = 69). FLSR treatment was administered at 4-8-week intervals. Patients starting treatment before 6 months after injury were classified as the early-stage intervention group and those beginning treatment at 6-12 months after injury were classified as the late-stage intervention group. Demographic data, including the age of patients at the time of first treatment, age of scars at the time of first treatment, biological sex, ethnicity, Fitzpatrick skin type, and use of laser-assisted drug delivery, were collected by retrospective chart review. Patients were evaluated on six subjective scales and objectively for scar stiffness with durometry. For all scales, higher scores indicate worse scars. A two-way ANOVA, Student's t-test, and Mann-Whitney U-test were used to compare scores from the pre- to posttreatment evaluations. RESULTS There were no significant differences between the groups for any of the demographic or scar-specific variables; thus, differences in outcome can be attributed to the timing of intervention. Both groups demonstrated an improvement in scars with treatment over time (p < 0.05). Both early- and middle-stage initiation showed scar symptom improvement in five out of six scales. In the late-stage intervention, the Patient and Observer Scar Assessment Scale-Patient average score did not show improvement. In the early-stage intervention, the Vancouver Scar Scale total did not show improvement. Quantitative evaluation of scar stiffness by durometry did not show symptom improvement in either group. The Scar Comparison Scale demonstrated the greatest improvement across groups. CONCLUSION Laser treatment led to scar improvement in at least one scale at each stage of initiation. Both intervention timelines resulted in equivalent outcomes, and early intervention should be considered when initiating FLSR treatment in burn scars to alleviate symptoms earlier.
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Affiliation(s)
- Victoria Slavinsky
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Jasmine H Wong
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- Georgetown University School of Medicine, Washington, DC, USA
| | - Bonnie C Carney
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- Department of Biochemistry, Georgetown University School of Medicine, Washington, DC, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Davon T Lee
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- Howard University College of Medicine, Washington, DC, USA
| | - Rebekah Allely
- Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC, USA
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- Department of Biochemistry, Georgetown University School of Medicine, Washington, DC, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
- Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Shawn Tejiram
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
- Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Taryn E Travis
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
- Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, DC, USA
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Menashe S, Heller L. Keloid and Hypertrophic Scars Treatment. Aesthetic Plast Surg 2024; 48:2553-2560. [PMID: 38453710 DOI: 10.1007/s00266-024-03869-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/24/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Hypertrophic scars are contained within the site of injury and may regress over time, while keloids spread beyond the borders of the initial injury and do not regress. On histologic examination, hypertrophic scars tend to have collagen in a wavy, regular pattern, whereas keloids have no distinct pattern of collagen. OBJECTIVE To retrospectively analyze improvement in keloid and hypertrophic scars characteristics following treatment with Ablative 10600 nm and a non-Ablative 1570 nm Hybrid Laser Device. METHODS Treatment parameters with the ProScan Hybrid Mode were 40 W/1.3-1.5 ms for the CO2 and 12 W/4 ms for the 1570 nm in a 1:1 ratio. Outcomes were assessed based on physician scar grading as measured by the Vancouver Scar Scale and patient-reported satisfaction. Excel was used for data analysis, and a p value < 0.05 was considered statistically significant. Adverse events and patient pain were also recorded. RESULTS A total of 31 hypertrophic scars and 30 keloid scars were treated. There was a significant reduction in Vancouver Scar Scale scores for both hypertrophic and keloid scars (62% ± 8% and 58% ± 7%; p = 2.6E-17 and p = 8.29E-26, respectively). In a scar-based comparison, a statistically significant difference was observed for all measures reflecting favorable outcomes for hypertrophic scars (VSS, p = 1.1E-05; satisfaction, p = 0.0112; pain, p = 0.00081). Only one adverse event was reported, a superficial burn treated with topical antibiotics. CONCLUSIONS The device was found to be safe and effective, with promising results for the treatment of hypertrophic and keloid scars. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Shaked Menashe
- The Department of Adult and Pediatric Plastic, Aesthetic and Reconstructive Surgery, Shamir Medical Center Be'er Ya'akov, Shamir Medical Center Assaf Harofeh, Tel Aviv, Israel.
| | - Lior Heller
- The Department of Adult and Pediatric Plastic, Aesthetic and Reconstructive Surgery, Shamir Medical Center Be'er Ya'akov, Shamir Medical Center Assaf Harofeh, Tel Aviv, Israel
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Li J, Duan F, Kuang J, Liu X, Pan J, Wei J, Zhao J. Fractional picosecond laser treatment of non-acne atrophic scars and scar erythema in Chinese patients. Skin Res Technol 2024; 30:e13856. [PMID: 39031924 PMCID: PMC11259539 DOI: 10.1111/srt.13856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 06/22/2024] [Indexed: 07/22/2024]
Abstract
BACKGROUND Fractional picosecond lasers (FPL) are reported to be effective and safe for atrophic acne scars and post-acne erythema. However, there is no evidence regarding the effectiveness and safety of FPL treatment for non-acne atrophic scars and scar erythema among Chinese patients. METHODS In this retrospective study, 12 Chinese patients with non-acne atrophic scars, including nine with scar erythema, were treated with one to three sessions of 1064 nm FPL treatment. Clinical improvement was objectively assessed through blinded evaluations by external physicians. A modified Manchester Scar Scale (mMSS) and the Clinician Erythema Assessment Scale (CEAS) were individually used to evaluate atrophic scars and scar erythema based on photographs. Physician-assessed and subject-assessed Global Aesthetic Improvement Scale (GAIS) were used to assess changes before and after FPL treatment. Patient satisfaction and adverse events were also documented. RESULTS Total mMSS scores, as well as three parameters (color, distortion, and texture), were significantly decreased after FPL treatment, with a mean reduction of 3.18 ± 1.60 in total scores (p < 0.05). The CEAS scores were significantly reduced from 2.41 ± 0.98 before treatment to 0.41 ± 0.40 at the final visit (p < 0.05). Based on physician-assessed and subject-assessed GAIS scores, 11 (91.7%) patients were improved after FPL treatment. 33.3% of patients were very satisfied, and 41.7% were satisfied. No serious, prolonged (> 3 weeks) adverse events were observed. CONCLUSION Our study suggests that 1064 nm FPL treatment may be a promising option for non-acne atrophic scars, especially with scar erythema. Further studies are needed to confirm our results.
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Affiliation(s)
- Jing Li
- Department of DermatologyBeijing Jishuitan HospitalCapital Medical UniversityBeijingP.R. China
- Fourth Medical College of Peking UniversityBeijingP.R. China
| | - Fangfang Duan
- Fourth Medical College of Peking UniversityBeijingP.R. China
- Clinical Epidemiology Research CenterBeijing Jishuitan HospitalCapital Medical UniversityBeijingP.R. China
| | - Jie Kuang
- Department of DermatologyBeijing Jishuitan HospitalCapital Medical UniversityBeijingP.R. China
- Fourth Medical College of Peking UniversityBeijingP.R. China
| | - Xiao Liu
- Department of DermatologyBeijing Jishuitan HospitalCapital Medical UniversityBeijingP.R. China
- Fourth Medical College of Peking UniversityBeijingP.R. China
| | - Jing Pan
- Department of DermatologyBeijing Jishuitan HospitalCapital Medical UniversityBeijingP.R. China
- Fourth Medical College of Peking UniversityBeijingP.R. China
| | - Jia Wei
- Department of DermatologyBeijing Jishuitan HospitalCapital Medical UniversityBeijingP.R. China
- Fourth Medical College of Peking UniversityBeijingP.R. China
| | - Jinghui Zhao
- Department of DermatologyBeijing Jishuitan HospitalCapital Medical UniversityBeijingP.R. China
- Fourth Medical College of Peking UniversityBeijingP.R. China
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Bronte J, Zhou C, Vempati A, Tam C, Khong J, Hazany S, Hazany S. A Comprehensive Review of Non-Surgical Treatments for Hypertrophic and Keloid Scars in Skin of Color. Clin Cosmet Investig Dermatol 2024; 17:1459-1469. [PMID: 38911337 PMCID: PMC11193462 DOI: 10.2147/ccid.s470997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/02/2024] [Indexed: 06/25/2024]
Abstract
Hypertrophic and keloid scars are fibroproliferative growths resulting from aberrant wound healing. Individuals with Fitzpatrick skin types (FSTs) IV-VI are particularly predisposed to hypertrophic and keloid scarring, yet specific guidelines for these populations are still lacking within the literature. Therefore, this comprehensive review provides a list of various treatments and considerations for hypertrophic and keloid scarring in patients with skin of color. We constructed a comprehensive PubMed search term and performed quadruple-blinded screening on all resulting studies to achieve this objective. Our findings demonstrate 1) the lack of efficacious treatments for raised scars within this population and 2) the need to empirically investigate individualized and multimodal therapeutic options for those with skin of color.
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Affiliation(s)
- Joshua Bronte
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Crystal Zhou
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Abhinav Vempati
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Curtis Tam
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey Khong
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sanam Hazany
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
| | - Salar Hazany
- Department of Research, Scar Healing Institute, Los Angeles, CA, USA
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Azzopardi E, Boyce D, Azzopardi E, Sadideen H, Mosahebi A. Unveiling the language of scars: A patient-centric themed framework for comprehensive scar morphology. Burns 2024; 50:1269-1276. [PMID: 38480059 DOI: 10.1016/j.burns.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/25/2024] [Accepted: 02/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Scarring, a pervasive issue spanning across medical disciplines, lacks a comprehensive terminology for effective communication, patient engagement, and outcome assessment. Existing scar classification systems are constrained by specific pathologies, physician-centric features, and inadequately account for emerging technologies. This study refrains from proposing yet another classification system and instead revisits the foundational language of scar morphology through a theme analysis of primary patient complaints. METHOD Data encompassing five years of a high-volume scar practice was analysed. Primary complaints were aggregated into collective descriptors and further organized into theme domains. The resulting hierarchical map of presenting complaints revealed five key domains: Loss of Function, Contour, Texture, Vector, and Colour Presenting complaints were codified into 42 items, which were then categorised into 14 collective descriptor terms. The latter were in turn organised into five overarching themes. RESULT Loss of Function, accounting for 10% of primary concerns, signifies reduced function attributed solely to the scar. Contour, encompassing 41% of concerns, pertains to scar height, shape, and depth. Texture, representing 12% of concerns, denotes tactile variations such as hardness, roughness, and moisture. Vector, comprising 13% of concerns, refers to scar tissue tension and associated distortions. Colour, the concern in 24% of cases, encompasses variations in pigmentation, vascularity, and exogenous pigments. DISCUSSION Standardized terminology enhances patient care, communication, and research. This study underscores the fundamental question of "what bothers the patient," reviving a patient-centred approach to scar management. By prioritizing themes based on patient complaints, this study innovatively integrates function, aesthetics, and patient experience. In conclusion, this study pioneers a paradigm shift in scar management by presenting a patient-driven theme framework that offers a common language for healthcare professionals and patients. Embracing this language harmonizes scar treatment, fosters innovation, and transforms scars from silent reminders into stories of resilience and healing.
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Affiliation(s)
- Ernest Azzopardi
- London Welbeck Hospital, UK; Consultant Surgeon in Private Practice, UK; University of Malta, Faculty of Medicine and Surgery, UK; University College London, Division of Surgery and Interventional Science, UK; Skinsurgeon Laser Suite, Malta.
| | - Dean Boyce
- Swansea Bay University Local Health Board, UK
| | - Elayne Azzopardi
- Department of Speech and Language Therapy, Department of Health Malta, UK
| | - Hazim Sadideen
- Consultant Surgeon in Private Practice, UK; Imperial College, London, UK
| | - Afshin Mosahebi
- Consultant Surgeon in Private Practice, UK; University College London, Division of Surgery and Interventional Science, UK; Royal Free Hospital Hampstead, UK
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Meng F, Fu Q, Zhou G, Chen M. Efficacy of Fractional Micro-plasma Radio Frequency Technology in Treating Hypertrophic Burn Scars in Asian Patients Under General Anesthesia: A Retrospective Study of 104 Cases. Aesthetic Plast Surg 2024:10.1007/s00266-024-04018-w. [PMID: 38744686 DOI: 10.1007/s00266-024-04018-w] [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: 01/28/2024] [Accepted: 03/11/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Laser and other energy devices have been widely used in the minimally invasive treatment of scars. Among various technologies, Fractional Micro-Plasma Radio Frequency Technology (FMRT) has gained extensive consensus in the treatment of various types of scars and skin disorders, such as wrinkles, skin laxity, and pigmentation. OBJECTIVE This study is a retrospective clinical trial aimed at assessing the effectiveness and safety of FMRT for hypertrophic burn scars treatment in the Asian population under different anesthesia methods. METHODS A total of 104 patients with hypertrophic burn scars treated in our department from May 2018 to May 2022 were selected. Scar assessment scales were applied to observe changes in scars before and after FMRT treatment. RESULTS A prospective study of 104 patients found that female patients were more likely to undergo laser treatment under general anesthesia (P < 0.05). Postoperative VSS total score, VSS total score difference, and immediate postoperative pain score were all better with general anesthesia compared to local anesthesia (P < 0.05). There were more significant improvements in scar color, vascular distribution, and flexibility (P < 0.05). When comparing the treatment outcomes between females and males, it was found that general anesthesia patients were superior to local anesthesia patients in terms of color score, vascular distribution score, flexibility score, and postoperative VSS total score 6 months after the final treatment. General anesthesia patients had a shorter hospital stay. Overall treatment evaluation was better for female general anesthesia patients than male patients. CONCLUSION General anesthesia combined with FMRT is an effective, safe, and more acceptable treatment method for hypertrophic burn scars in the Asian population. BULLET POINTS In the Asian population, the combined use of general anesthesia and Fractional Micro-Plasma Radio Frequency Technology (FMRT) is an effective, safe, and accepted method for treating skin scars. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Fanting Meng
- Department of Plastic and Reconstructive Surgery, Senior Department of Burns and Plastic Surgery, The Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 10048, China
| | - Qiang Fu
- Department of Plastic and Reconstructive Surgery, Senior Department of Burns and Plastic Surgery, The Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 10048, China
| | - Guiwen Zhou
- Department of Plastic and Reconstructive Surgery, Senior Department of Burns and Plastic Surgery, The Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 10048, China
| | - Minliang Chen
- Department of Plastic and Reconstructive Surgery, Senior Department of Burns and Plastic Surgery, The Forth Medical Center of Chinese PLA General Hospital, No. 51 Fucheng Road, Haidian District, Beijing, 10048, China.
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Rutnin S, Yongpisarn T, Sakpuwadol N, Namasondhi A, Pomsoong C, Rattananukrom T, Thadanipon K. Efficacy and safety of 1064-nm fractional picosecond laser for the treatment of postmastectomy scars in transgender men: A randomized controlled trial. Lasers Surg Med 2024; 56:337-345. [PMID: 38436118 DOI: 10.1002/lsm.23775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/30/2024] [Accepted: 02/17/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES Subcutaneous mastectomy is a crucial component of gender affirmation therapy for transgender men (TM), but the scars that result from this procedure can frequently impair their quality of life. This study aimed to assess the efficacy and safety of 1064-nm fractional picosecond laser (FxPico) treatment for hypertrophic and atrophic postmastectomy scars in TM. METHODS Twenty-two patients with a total of 35 pairs of bilateral symmetric mastectomy scars were enrolled. One of each pair of symmetric scars was randomly assigned to receive four FxPico treatments at 4-week intervals. All scars were evaluated using the modified Vancouver Scar Scale (mVSS) and three-dimensional imaging for scar roughness, melanin index, and hemoglobin index before each treatment session and at 1, 3, and 6 months following the last treatment. Additionally, participant-rated scar satisfaction (PSS) and scar improvement (Global Assessment Score, GAS), as well as adverse events were recorded. RESULTS During the 6-month follow-up period after the end of laser treatment sessions, the treated scars showed significant reductions in the mVSS compared to the untreated controls (p < 0.001), whereas the melanin index and hemoglobin index were not significantly different. Subgroup analysis of hypertrophic scars demonstrated statistically significant reductions in mVSS at 1 (p = 0.003) and 3 months (p = 0.041) after the end of laser treatments. PSS was significantly higher on the laser-treated scars than the controls (p = 0.008), and a participant-rated GAS of 2.95 ± 0.65 was found. There were no serious adverse events reported. CONCLUSIONS 1064-nm FxPico could be utilized to treat mastectomy scars among TM, particularly the hypertrophic type.
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Affiliation(s)
- Suthinee Rutnin
- Division of Dermatology, Mahidol University, Bangkok, Thailand
| | | | | | | | | | | | - Kunlawat Thadanipon
- Division of Dermatology, Mahidol University, Bangkok, Thailand
- Department of Clinical Epidemiology and Biostatistics, Mahidol University, Bangkok, Thailand
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Kim GH, Lee WJ, Jung JM, Won CH, Chang SE, Lee MW, Moon IJ. Morphological characteristics of facial scars: A retrospective analysis according to scar location, onset, age, and cause. Int Wound J 2024; 21:e14453. [PMID: 38058010 PMCID: PMC10958093 DOI: 10.1111/iwj.14453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/11/2023] [Accepted: 10/11/2023] [Indexed: 12/08/2023] Open
Abstract
The morphology of facial scars shows a wide variation in terms of texture and colour. To date, there are no reliable predictors of aberrant scarring. We conducted a retrospective analysis to identify factors associated with specific scar features and types. Photographs and medical records of 428 patients with facial scars were retrospectively reviewed. Patients with keloids were excluded. The mean age of the patients was 45.43 ± 23.13 years with a male-to-female ratio of 1:1.36. Atrophic scars were the most common (42.8%), followed by flat scars (38.7%) and hypertrophic scars (18.5%). Scars on the forehead were more likely to be atrophic, whereas scars on the chin/jaw and around the mouth were more likely to be hypertrophic. Hypopigmentation was significantly more common in scars located on the forehead. Redness (erythema) was significantly more common in scars located on the chin/jaw. Old scars were less likely to be erythematous, and hypertrophic. Atrophic scars were more common in younger patients. Scars caused by dermatologic conditions, such as acne, were more likely to be atrophic, whereas surgical scars had the lowest risk of being atrophic or hypertrophic. In conclusion, the location, onset, and cause of facial scars were associated with specific features of scars.
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Affiliation(s)
- Gyeong Hoon Kim
- Department of Dermatology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Woo Jin Lee
- Department of Dermatology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Joon Min Jung
- Department of Dermatology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Chong Hyun Won
- Department of Dermatology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Sung Eun Chang
- Department of Dermatology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Mi Woo Lee
- Department of Dermatology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
| | - Ik Jun Moon
- Department of Dermatology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulKorea
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Wiinberg M, Andresen TL, Haedersdal M, Olesen UH. Ablative fractional CO 2 laser treatment promotes wound healing phenotype in skin macrophages. Lasers Surg Med 2024; 56:270-278. [PMID: 38409449 DOI: 10.1002/lsm.23772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 02/28/2024]
Abstract
OBJECTIVES Ablative fractional laser (AFL) treatment is a well-established method for reducing signs of skin photoaging. However, the biological mechanisms underlying AFL-induced healing responses and skin rejuvenation remain largely unknown. It is known that macrophages play an important role in orchestrating healing, normalization, and remodeling processes in skin. Macrophage phenotypes are characterized by inflammatory markers, including arginase-1 (Arg1), major histocompatibility class II molecules (MHC II), and CD206. This study aims to explore AFL's effect on macrophage phenotype by evaluating changes in inflammatory markers and the potential concurrent accumulation of Arg1 in the skin. METHODS Mice (n = 9) received a single AFL treatment on the left side of the back skin (100 mJ/microbeam, 5% density) while the right side of the back remained untreated as control. Treated and untreated skin from each mouse were collected Day 5 posttreatment for flow cytometry and histology analysis. Flow cytometry evaluated the immune infiltration of macrophages and the expression of macrophage inflammatory markers (Arg1, MHC II, and CD206). In addition, Arg1 presence in the skin was evaluated through antibody staining of histology samples and quantification was performed using QuPath image analysis software. RESULTS Following AFL, the number of macrophages increased 11-fold (p = 0.0053). Phenotype analysis of AFL-treated skin revealed an increase in the percentage of macrophages positive for Arg1 (p < 0.0001) and a decrease in the percentage of macrophages positive for MHC II (p < 0.0001) compared to untreated skin. No significant differences were observed in percentage of CD206-positive macrophages (p = 0.8952). Visualization of AFL-treated skin demonstrated a distinct pattern of Arg1 accumulation that correlated with the microscopic treatment zones (MTZ). Quantification of the percentage of Arg1-positive area in epidermis and dermis showed a significant increase from 3.5% ± 1.2% to 5.2% ± 1.7 (p = 0.0232) and an increase from 2.2% ± 1.2% to 9.6% ± 3.3 (p < 0.0001) in whole skin samples. CONCLUSION AFL treatment polarizes macrophages toward a wound healing phenotype and induces Arg1 accumulation in the MTZ. We propose that the polarized wound healing macrophages are a major source for the increased Arg1 levels observed in the skin following treatment.
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Affiliation(s)
- Martin Wiinberg
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Thomas L Andresen
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
| | - Uffe H Olesen
- Department of Dermatology, Copenhagen University Hospital-Bispebjerg, Copenhagen, Denmark
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10
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Chen Y, Wei W, Li X. Clinical efficacy of CO 2 fractional laser in treating post-burn hypertrophic scars in children: A meta-analysis: CO 2 fractional laser in treating post-burn hypertrophic scars in children. Skin Res Technol 2024; 30:e13605. [PMID: 38332516 PMCID: PMC10853576 DOI: 10.1111/srt.13605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To evaluate and explore the efficacy of CO2 fractional laser in treating post-burn hypertrophic scars in children through Meta-analysis. METHODS English databases (PubMed, Web of Science and The National Library of Medicine), as well as Chinese databases (China National Knowledge Infrastructure and Wanfang Data) were searched. RevMan 5.3 software was used to data analysis. RESULTS A total of 10 pieces of literature were included, involving 413 children. Meta-analysis showed that: (1) The average Vancouver Scar Scale after surgery was significantly lower than that before surgery [weight mean difference (WMD) = -3.56, 95% confidence interval (CI):-4.53,-2.58, p < 0.001]; (2) After CO2 fractional laser, pigmentation [WMD = -0.74, 95% CI:-1.10,-0.38, p < 0.001], pliability [WMD = -0.92, 95% CI:-1.20,-0.65, p < 0.001], vascularity [WMD = -0.77, 95% CI:-1.09,-0.46, p < 0.001], height [WMD = -0.57, 95% CI:-0.95,-0.19, p < 0.001] were improved compared with those before surgery. (3) The average Visual Analogue Scale (VAS) after surgery was significantly lower than that before surgery [WMD = -3.94, 95% CI:-5.69,-2.22, p < 0.001]. (4) Both Patient and Observer Scar Assessment Scale (POSAS)-Observer [WMD = -3.98, 95% CI:-8.44,0.47, p < 0.001] and POSAS-Patient [WMD = -4.98, 95% CI:-8.09,-1.87, p < 0.001] were significantly lower than those before surgery. (5) Erythema and vesicles were the most common complications after CO2 fractional laser therapy, with an incidence of 4.09%. CONCLUSION CO2 fractional laser is beneficial to the recovery of hypertrophic scar after burn in children, and can effectively improve the scar symptoms and signs in children, with desirable clinical efficacy.
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Affiliation(s)
- Yuan Chen
- Department of Burn and Plastic SurgeryGuangzhou Red Cross HospitalGuangzhouChina
| | - Wenlong Wei
- Department of Burn and Plastic SurgeryGuangzhou Red Cross HospitalGuangzhouChina
| | - Xiaojian Li
- Department of Burn and Plastic SurgeryGuangzhou Red Cross HospitalGuangzhouChina
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11
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Wang Z, Chen Y, Yang X, Pan B, Xie H, Bi H. Safety and Effectiveness of Laser or Intense Pulsed Light Treatment for Early Surgical Scar: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2024; 48:228-235. [PMID: 37620564 DOI: 10.1007/s00266-023-03590-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/19/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVE We aimed to investigate the safety and efficacy of laser or intense pulsed light therapy for early treatment of surgical scar. METHODS A literature search was conducted for relevant prospective, randomized controlled trials published in PubMed, Embase, Web of Science, Cochrane Library, CNKI, WanFang Database, and VTTMS between January 2006 and January 2022. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used to extract literature data. The risk of bias was assessed by RevMan. Safety was assessed based on the presence of serious adverse reactions (blisters, infections, burns above the second degree), while effectiveness was assessed using the Vancouver Score Scale. RESULTS 1512 related articles were preliminarily retrieved, including 1211 English articles and 301 Chinese articles. According to the inclusion criteria and exclusion criteria, 12 articles were selected for this analysis. In total, 475 patients were included (laser group, 238; control group, 236). All studies confirmed that the laser group was superior to the control group. In the subgroup analysis of 7 articles, the standardized mean difference was 1.99 (P = 0.0001). CONCLUSIONS This meta-analysis demonstrates that laser or intense pulsed light therapy is a safe and effective approach for early surgical scar treatment, resulting in improved scar appearance and minimal adverse reactions. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- ZheHui Wang
- Department of Plastic Surgery, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - YuJie Chen
- Department of Plastic Surgery, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - Xin Yang
- Department of Plastic Surgery, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - BaiLin Pan
- Department of Plastic Surgery, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China
| | - HongBin Xie
- Department of Plastic Surgery, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
| | - HongSen Bi
- Department of Plastic Surgery, Peking University Third Hospital, No. 49 North Garden Road, Haidian District, Beijing, 100191, China.
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12
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Menashe S, Heller L. Striae distensae treatment: evaluating laser efficacy and safety. Int J Dermatol 2024; 63:46-50. [PMID: 37971397 DOI: 10.1111/ijd.16914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/30/2023] [Accepted: 11/07/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Striae distensae (SD) are common skin lesions that are difficult to treat and affect quality of life. Laser and light are emerging non-invasive therapies that have proven successful in treating SD. Recently, hybrid laser devices offering simultaneous fractional ablative and non-ablative laser treatment have been reported to benefit various skin conditions. OBJECTIVE To evaluate the improvement of SD treated with a hybrid laser system and to analyze associations with patient characteristics. METHODS We performed a retrospective study in which 28 adults with SD were treated with a hybrid laser device. Efficacy was evaluated by the assessment of aesthetic improvement by the Global Aesthetic Improvement Scale (GAIS) of 1-10 and by patients' satisfaction using a scale of 0-10 satisfaction scale. Pain and adverse events were monitored. Statistical analysis was used to examine the potential impact of various factors on treatment outcomes. RESULTS The mean GAIS score was 7.36 ± 1.06 with a positive correlation with patient satisfaction (r = 0.685) and a weak negative correlation with patient age (r = -0.0057). Skin type and body area did not show significant associations with GAIS scores (P > 0.05 for both). No adverse events were observed. CONCLUSION This study demonstrates the potential of the hybrid laser system as a safe and effective method to achieve satisfactory aesthetic results with minimal downtime, making it a promising treatment approach for SD. Treatment outcomes were independent of patient characteristics, further supporting its widespread use.
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Affiliation(s)
- Shaked Menashe
- The Department of Adult and Pediatric Plastic, Aesthetic and Reconstructive Surgery at the Shamir Medical Center, Be'er Ya'akov, Israel
| | - Lior Heller
- The Department of Adult and Pediatric Plastic, Aesthetic and Reconstructive Surgery at the Shamir Medical Center, Be'er Ya'akov, Israel
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13
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Raborn LN, Janis JE. Prevention and Treatment of Burn Scar Contracture: A Practical Review. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5333. [PMID: 38250207 PMCID: PMC10798744 DOI: 10.1097/gox.0000000000005333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 08/31/2023] [Indexed: 01/23/2024]
Abstract
Burn contracture affects close to one-third of all burn patients, leading to significant functional impairment and costs. Effective prevention and treatment strategies are necessary to decrease morbidity and unnecessary costs. This scoping review aimed to summarize prevention and treatment strategies used for management of burn scar contractures published in the literature since 2000. A comprehensive PubMed review was performed in October 2022 to identify methods of burn contracture prevention and treatments. Non-English, duplicate, and unavailable articles were excluded. Data were extracted including publication year, techniques, and outcomes. A total of 327 publications met criteria for inclusion. Most articles were published in 2011 (n = 22). Treatment strategies were discussed in 82.9% of studies, prevention in 16.5%, and both in 0.6%. The most common areas discussed included the upper extremity (n = 127) and neck (n = 102). Flaps were the most frequently used method (n = 208), followed by autografts (n = 89). Most preventative therapies were still in early stages of development. Burn contracture management requires a highly individualized approach with many available reconstructive techniques available. Further research is needed to improve prevention techniques and decrease morbidity and cost to patients.
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Affiliation(s)
- Layne N. Raborn
- From the Division of Plastic Surgery, University of Rochester Medical Center, Rochester, N.Y
| | - Jeffrey E. Janis
- Department of Plastic and Reconstructive Surgery, Ohio State University, Wexner Medical Center Columbus, Ohio
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14
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Patel AD, Chopra R, Avram M, Sakamoto FH, Kilmer S, Anderson RR, Ibrahimi OA. Updates on Lasers in Dermatology. Dermatol Clin 2024; 42:33-44. [PMID: 37977682 DOI: 10.1016/j.det.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The introduction of selective photothermolysis by Drs. John Parrish and Rox Anderson in 1983 revolutionized how lasers are used in dermatology. The theory allowed for lasers to be used in a variety of applications both safe and effectively, and the number of applications has only expanded with time. From the first application on vascular birthmarks to more recent applications for acne, this review covers the evolution of lasers from the beginning to where we are headed.
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Affiliation(s)
- Ashaki D Patel
- Department of Dermatology, Massachusetts General Hospital Laser and Cosmetic Center, 50 Staniford Street, Suite 250, Boston, MA 02114, USA; Wellman Center for Photomedicine, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center - Suite 435, Boston, MA 02114, USA.
| | - Rishi Chopra
- Department of Dermatology, Massachusetts General Hospital Laser and Cosmetic Center, 50 Staniford Street, Suite 250, Boston, MA 02114, USA; Wellman Center for Photomedicine, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center - Suite 435, Boston, MA 02114, USA
| | - Mathew Avram
- Department of Dermatology, Massachusetts General Hospital Laser and Cosmetic Center, 50 Staniford Street, Suite 250, Boston, MA 02114, USA; Wellman Center for Photomedicine, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center - Suite 435, Boston, MA 02114, USA
| | - Fernanda H Sakamoto
- Department of Dermatology, Massachusetts General Hospital Laser and Cosmetic Center, 50 Staniford Street, Suite 250, Boston, MA 02114, USA; Wellman Center for Photomedicine, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center - Suite 435, Boston, MA 02114, USA
| | - Suzanne Kilmer
- Wellman Center for Photomedicine, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center - Suite 435, Boston, MA 02114, USA; Laser & Skin Surgery Center of Northern California, 3837 J Street, Sacramento, CA 95816, USA
| | - Richard Rox Anderson
- Department of Dermatology, Massachusetts General Hospital Laser and Cosmetic Center, 50 Staniford Street, Suite 250, Boston, MA 02114, USA; Wellman Center for Photomedicine, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center - Suite 435, Boston, MA 02114, USA
| | - Omar A Ibrahimi
- Wellman Center for Photomedicine, Massachusetts General Hospital, 15 Parkman Street, Wang Ambulatory Care Center - Suite 435, Boston, MA 02114, USA; Connecticut Skin Institute, Stamford, CT, USA
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15
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Abstract
Wound healing occurs as a response to disruption of the epidermis and dermis. It is an intricate and well-orchestrated response with the goal to restore skin integrity and function. However, in hundreds of millions of patients, skin wound healing results in abnormal scarring, including keloid lesions or hypertrophic scarring. Although the underlying mechanisms of hypertrophic scars and keloid lesions are not well defined, evidence suggests that the changes in the extracellular matrix are perpetuated by ongoing inflammation in susceptible individuals, resulting in a fibrotic phenotype. The lesions then become established, with ongoing deposition of excess disordered collagen. Not only can abnormal scarring be debilitating and painful, it can also cause functional impairment and profound changes in appearance, thereby substantially affecting patients' lives. Despite the vast demand on patient health and the medical society, very little progress has been made in the care of patients with abnormal scarring. To improve the outcome of pathological scarring, standardized and innovative approaches are required.
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Affiliation(s)
- Marc G Jeschke
- Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
| | - Fiona M Wood
- Burns Service of Western Australia, Fiona Stanley Hospital, Perth Children's Hospital, Perth, Western Australia, Australia
- Burn Injury Research Unit, University of Western Australia, Perth, Western Australia, Australia
| | - Esther Middelkoop
- Burn Center, Red Cross Hospital, Beverwijk, Netherlands
- Association of Dutch Burn Centers (ADBC), Beverwijk, Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Movement Sciences (AMS) Institute, Amsterdam UMC, Amsterdam, Netherlands
| | - Ardeshir Bayat
- Medical Research Council Wound Healing Unit, Hair and Skin Research Lab, Division of Dermatology, Department of Medicine, University of Cape Town & Groote Schuur Hospital, Cape Town, South Africa
| | - Luc Teot
- Department of Plastic Surgery, Burns, Wound Healing, Montpellier University Hospital, Montpellier, France
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Gerd G Gauglitz
- Department of Dermatology and Allergy, Ludwig-Maximilian University Munich, Munich, Germany
- Haut- und Laserzentrum Glockenbach, Munich, Germany
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16
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Waibel JS, Waibel H, Sedaghat E. Scar Therapy of Skin. Facial Plast Surg Clin North Am 2023; 31:453-462. [PMID: 37806679 DOI: 10.1016/j.fsc.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Scar therapy is truly important in medicine. Patients experience great loss in quality of life with scars. There are many treatment modalities that help treat scars, including topical, intralesional, surgical, and energy-based devices. In addition, early intervention can help mitigate scar formation. Lasers represent a major innovation in the treatment of all types of scars. Treating scars is a multimodal and multispecialty endeavor. This article highlights the use of many therapies to treat scars and scar symptoms including pruritus, pain, and range of motion. This also highlights key literature including multiple recent consensus guidelines in treating scars.
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Affiliation(s)
| | - Hannah Waibel
- Southern Methodist University; Private Practice: Miami Dermatology and Laser Institute, 7800 Southwest 87th Avenue Suite B200, Miami, FL 33173, USA; Baptist Hospital, Miami, FL, USA; Dermatology Faculty, Miller School of Medicine, University of Miami
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17
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Bharadia SK, Burnett L, Gabriel V. Hypertrophic Scar. Phys Med Rehabil Clin N Am 2023; 34:783-798. [PMID: 37806697 DOI: 10.1016/j.pmr.2023.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Hypertrophic scars frequently develop post-burn, and are characterized by their pruritic, painful, raised, erythematous, dyschromic, and contractile qualities. This article aims to synthesize knowledge on the clinical and molecular development, evolution, management, and measurement of hypertrophic burn scar for both patient and clinician knowledge.
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Affiliation(s)
- Shyla Kajal Bharadia
- Cumming School of Medicine, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada
| | - Lindsay Burnett
- Alberta Health Services, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada
| | - Vincent Gabriel
- Department of Clinical Neurosciences, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada; Department of Surgery, University of Calgary, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada; Medical Director, Calgary Firefighters Burn Treatment Centre, Foothills Medical Centre, 1403-29 Street Northwest, Calgary, Alberta T2N 2T9, Canada.
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18
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Liu C, Tang L, Hou C, Zhang J, Li J. Intralesional Axitinib Injection Mitigates Hypertrophic Scar by Inhibiting Angiogenesis Pathway: A Preliminary Study in a Rabbit Ear Model. Clin Cosmet Investig Dermatol 2023; 16:3023-3034. [PMID: 37901151 PMCID: PMC10612514 DOI: 10.2147/ccid.s430852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 10/13/2023] [Indexed: 10/31/2023]
Abstract
Objective High levels of VEGF and excessive angiogenesis contribute significantly to hypertrophic scar (HS) formation. Our study aimed to preliminarily investigate the effect of axitinib, a selective VEGF receptor tyrosine kinase inhibitor, on angiogenesis of HS and to explore its possible mechanism in a rabbit ear model. Methods Ten male New Zealand white rabbits were used to establish HS models and then randomised to the control and axitinib groups. The scar tissues in the two groups were injected with axitinib or normal saline, and they were evaluated after one month of treatment. Macroscopic scar thickness, vascularity and pliability, as well as histopathological analysis including HE staining and Masson staining and scar elevation index (SEI) between two groups were compared. Immunohistochemical staining of CD31 in two groups was conducted to assess the degree of angiogenesis in HS tissue. The protein expression of protein kinase B (AKT) and ribosomal protein S6 kinase (p70S6K) and their phosphorylation levels in both groups were examined by Western blot analysis. Results The macroscopic and histological observation showed intralesional axitinib injection significantly reduced scar thickness, vascularity and pliability of HS in the rabbit ear model. The value of SEI in HE assessment was also significantly declined in the axitinib group. Furthermore, immunohistochemical analysis revealed that axitinib suppressed the expression of CD31 in HS tissue, and the mean IOD for blood vessels was significantly lower in the axitinib-treated group. Additionally, axitinib effectively attenuated the protein expression of p70S6K, p-AKT and p-p70S6K by Western blot analysis. Conclusion Our study suggests that intralesional injection of axitinib can effectively attenuate HS by reducing angiogenesis in the rabbit ear model, and this inhibitory effect may be mediated by suppression of AKT/p70S6K signaling pathway. It indicates that axitinib may be a promising option for the treatment of HS in the future.
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Affiliation(s)
- Chuanbo Liu
- Department of Plastic and Cosmetic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Liang Tang
- Department of Plastic and Cosmetic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Chunsheng Hou
- Department of Plastic and Cosmetic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Jufang Zhang
- Department of Plastic and Cosmetic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
| | - Jinsheng Li
- Department of Plastic and Cosmetic Surgery, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of China
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19
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Drake VE, Moyer JS. The Measure of a Scar: Patient Perceptions and Scar Optimization after Skin Cancer Reconstruction. Facial Plast Surg 2023; 39:501-507. [PMID: 37290453 DOI: 10.1055/s-0043-1769807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
In facial reconstruction after skin cancer resection, management and optimization of postoperative scar is a complex paradigm. Every scar is unique and presents a different challenge-whether due to anatomic, aesthetic, or patient-specific factors. This necessitates a comprehensive evaluation and an understanding of the tools at hand to improve its appearance. How a scar looks is meaningful to patients, and the facial plastic and reconstructive surgeon is tasked with its optimization. Clear documentation of a scar is critical to assess and determine optimal care. Scar scales such as the Vancouver Scar Scale, the Manchester Scar Scale, the Patient and Observer Assessment Scale, the Scar Cosmesis Assessment and Rating "SCAR" Scale, and FACE-Q, among others, are reviewed here in the context of evaluating postoperative or traumatic scar. Measurement tools objectively describe a scar and may also incorporate the patient's assessment of their own scar. In addition to physical exam, these scales quantify scars that are symptomatic or visually unpleasant and would be best served by adjuvant treatment. The current literature regarding the role of postoperative laser treatment is also reviewed. While lasers are an excellent tool to assist in blending of scar and decreasing pigmentation, studies have failed to evaluate laser in a consistent, standardized way that allows for quantifiable and predictable improvement. Regardless, patients may derive benefit from laser treatment given the finding of subjective improvement in their own perception of scar, even when there is not a significant change to the clinician's eye. This article also discusses recent eye fixation studies which demonstrate the importance of careful repair of large and central defects of the face, and that patients value the quality of the reconstruction.
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Affiliation(s)
- Virginia E Drake
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Livonia, Michigan
| | - Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Livonia, Michigan
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20
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Zhang J, Ge J, Chen C, Shi F, Wang Y, Zhang J, Liang W. The Effectiveness of Using CO 2 Fractional Laser and Mebo Burn Ointment Together in Treating Scars on the Face after Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5254. [PMID: 37736070 PMCID: PMC10511033 DOI: 10.1097/gox.0000000000005254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 07/21/2023] [Indexed: 09/23/2023]
Abstract
Background This study aimed to investigate the efficacy and safety of CO2 fractional laser combined with Mebo burn ointment in treating facial postoperative scars. Methods Sixty patients with facial postoperative scars in the department of plastic surgery of Sun Yat-sen Memorial Hospital from January 2020 to June 2022 were divided into a control group (30 cases) and a study group (30 cases). Both groups received CO2 fractional laser treatment, but the study group also received Mebo burn ointment application. Results The study found that both methods resulted in a significant decrease in Sawada score and a significant increase in Investigator Global Assessment score after treatment (P < 0.05), with the study group showing a more significant improvement and higher patient satisfaction (P < 0.05). All patients experienced varying degrees of bleeding, swelling, and erythema immediately after treatment, with two cases of pigmentation and two cases of persistent erythema in the control group, and one case of pigmentation and one case of persistent erythema in the study group. Adverse reactions were minimal, with the study group showing better tolerance. Conclusions The study suggests that CO2 fractional laser combined with Mebo burn ointment is an effective and safe treatment for facial postoperative scars.
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Affiliation(s)
- Jiaqi Zhang
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jun Ge
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Chen Chen
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fen Shi
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yongzhen Wang
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jinming Zhang
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weiqiang Liang
- From the Department of Plastic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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21
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Kheir WJ, Khalil AA, Ibrahim P, Rashid E, El Moussawi Z, El Hadi D, Kahale F, Awwad S, Bou Ghannam A, Alameddine RM. Ophthalmic injuries from the beirut blast: Managing long-term consequences. Exp Eye Res 2023:109546. [PMID: 37394086 DOI: 10.1016/j.exer.2023.109546] [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: 02/06/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
The 2020 Beirut Port explosion was one of the largest non-nuclear urban explosions in history, and resulted in a plethora of oculofacial injuries. In this retrospective study, we present the two year follow up ophthalmic outcomes of the survivors of the blast. Only 16 out of 39 patients continued follow up at our center, with 13 having delayed complications and 7 requiring further surgery. The most common delayed complications related to the eyelid, lacrimal system, and orbit. Treatment of disfiguring facial and peri-ocular scarring with laser-assisted drug delivery of topical 5-fluorouracil showed great promise and significantly improved patients' functional and well as cosmetic outcomes.
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Affiliation(s)
- Wajiha J Kheir
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Ali A Khalil
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Perla Ibrahim
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Elza Rashid
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Zeinab El Moussawi
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Dalia El Hadi
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Francesca Kahale
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Shady Awwad
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Alaa Bou Ghannam
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon
| | - Ramzi M Alameddine
- Department of Ophthalmology, American University of Beirut Medical Center, Lebanon.
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22
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Disphanurat W, Charutanan N, Sitthiwatthanawong P, Suthiwartnarueput W. Efficacy and safety of fractional 1064-nm picosecond laser for atrophic traumatic and surgical scars: A randomized, single-blinded, split-scar-controlled study. Lasers Surg Med 2023. [PMID: 37130437 DOI: 10.1002/lsm.23675] [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: 01/03/2023] [Revised: 04/05/2023] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE A fractional 1064-nm picosecond laser is an efficient and safe treatment for atrophic acne scars. However, evidence of using a picosecond laser for atrophic posttraumatic and surgical scar therapy is lacking. This study aimed to evaluate the efficacy and safety of using a 1064-nm picosecond laser with a microlens array (MLA) for the treatment of atrophic posttraumatic and surgical scars. METHODS This was a prospective, intraindividual, single-blinded, randomized split-lesion-controlled trial. Twenty-five subjects with atrophic traumatic or surgical scars that existed for more than 1 year were enrolled. All atrophic scars were divided at the midline into two halves and randomly assigned to a treatment or control side. The treatment group was treated with a 1064-nm picosecond laser with an MLA handpiece (spot size: 6-8 mm, fluence: 1.0-1.2 J/cm2 , repetition rate: 5 Hz, three passes) for 3 monthly sessions. The scar volumes were objectively measured using a three-dimensional (3D) photograph at baseline, 1 month after the first and second treatments, and 3 and 6 months after the final treatment. Subjective assessments were conducted by a blinded dermatologist and patients' self-assessment to evaluate improvements at 3 months after the final treatment. RESULTS The treated sides exhibited a significant volume reduction, with statistically significant improvements over the control group at 1 month after the first and second treatments and at 3 months after the final treatment (p = 0.024, 0.005, and 0.019, respectively). At 3 months after the final treatment, a blinded dermatologist correctly identified the treated side in 24 of 25 patients (96%). The patients rated the improvements as excellent (>75%) and marked (50%-75%) in 36% and 48% of patients, respectively. CONCLUSION At 3 months, the 1064-nm picosecond laser with a fractionated MLA can significantly reduce the posttraumatic and postsurgical atrophic scar volume in patients with Fitzpatrick skin types III-V. Insufficient data preclude inferences regarding efficacy at 6 months.
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Affiliation(s)
- Wareeporn Disphanurat
- Department of Medicine, Division of Dermatology, Thammasat University, Pathum Thani, Thailand
| | - Nipathorn Charutanan
- Department of Medicine, Division of Dermatology, Thammasat University, Pathum Thani, Thailand
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23
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Carney BC, Bailey JK, Powell HM, Supp DM, Travis TE. Scar Management and Dyschromia: A Summary Report from the 2021 American Burn Association State of the Science Meeting. J Burn Care Res 2023; 44:535-545. [PMID: 36752791 DOI: 10.1093/jbcr/irad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Indexed: 02/09/2023]
Abstract
Burn scars, and in particular, hypertrophic scars, are a challenging yet common outcome for survivors of burn injuries. In 2021, the American Burn Association brought together experts in burn care and research to discuss critical topics related to burns, including burn scars, at its State of the Science conference. Clinicians and researchers with burn scar expertise, as well as burn patients, industry representatives, and other interested stakeholders met to discuss issues related to burn scars and discuss priorities for future burn scar research. The various preventative strategies and treatment modalities currently utilized for burn scars were discussed, including relatively noninvasive therapies such as massage, compression, and silicone sheeting, as well as medical interventions such as corticosteroid injection and laser therapies. A common theme that emerged is that the efficacy of current therapies for specific patient populations is not clear, and further research is needed to improve upon these treatments and develop more effective strategies to suppress scar formation. This will necessitate quantitative analyses of outcomes and would benefit from creation of scar biobanks and shared data resources. In addition, outcomes of importance to patients, such as scar dyschromia, must be given greater attention by clinicians and researchers to improve overall quality of life in burn survivors. Herein we summarize the main topics of discussion from this meeting and offer recommendations for areas where further research and development are needed.
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Affiliation(s)
- Bonnie C Carney
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- Department of Biochemistry, Georgetown University School of Medicine, Washington, DC, USA
| | - John K Bailey
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Heather M Powell
- The Ohio State University, Departments of Materials Science and Engineering and Biomedical Engineering, Columbus, OH, USA
- Scientific Staff, Shriners Children's Ohio, Dayton, OH, USA
| | - Dorothy M Supp
- Scientific Staff, Shriners Children's Ohio, Dayton, OH, USA
- The University of Cincinnati College of Medicine, Department of Surgery, Cincinnati, OH, USA
| | - Taryn E Travis
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
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24
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Buta MR, Hultman CS, Bojovic B, Schulz JT, Goverman JM. Laser therapy of burn scars: CPT coding and reimbursement challenges. Lasers Surg Med 2023. [PMID: 37125496 DOI: 10.1002/lsm.23674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/21/2023] [Indexed: 05/02/2023]
Affiliation(s)
- Martin R Buta
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Charles Scott Hultman
- Department of Plastic and Reconstructive Surgery, WakeMed Health and Hospitals, Raleigh, North Carolina, USA
| | - Branko Bojovic
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - John T Schulz
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Jeremy M Goverman
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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25
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Wang YX, Wang Y, Zhang Q, Zhang RD. Current Research of Botulinum Toxin Type A in Prevention and Treatment on Pathological Scars. Dermatol Surg 2023; 49:S34-S40. [PMID: 37115998 DOI: 10.1097/dss.0000000000003770] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Dermatologists have been looking for ways to improve wound healing and postoperative scar appearance. The safety and efficacy of botulinum toxin type A (BTXA) in the prevention and treatment on pathological scars have become the current research hotspot since it was approved by the US FDA in medical cosmetology in 2002. PURPOSE This article aims to provide an overview of the clinical research, limitations, and application prospects of BTXA in the prevention and treatment of traumatic or postoperative pathological scars, which can provide a reference and better understanding of relevant studies. METHODS The current research progress was summarized and discussed, with new problems and research ideas being proposed ranging from the molecular mechanism of BTXA in preventing and treating pathological scars to its clinical application via investigation and reference research. RESULTS BTXA is effective in relieving itching and pain associated with pathological scars, limiting scar hyperplasia along with preventing scar contracture, but the specific mechanism is still not clear. CONCLUSION Most of the clinicians have confirmed the clinical effectiveness of BTXA in the prevention and treatment of pathological scars, yet its mode of action and combination therapy need more research.
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Affiliation(s)
- Yi-Xin Wang
- Department of Dermatological Surgery, Hospital for Skin Diseases, Institute of Dermatology, Chinese Academy of Medical Science, Peking Union Medical College, Nanjing, Jiangsu, China
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26
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Li S, Ding H, Yang Y, Yu B, Chen M. Global research status of pathological scar reported over the period 2001-2021: A 20-year bibliometric analysis. Int Wound J 2023; 20:1725-1738. [PMID: 36274191 PMCID: PMC10088839 DOI: 10.1111/iwj.13988] [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: 07/29/2022] [Accepted: 10/09/2022] [Indexed: 04/12/2023] Open
Abstract
Pathological scar is a classic problem in plastic and reconstructive surgery. Although the researches on pathological scar have been conducted for decades, the way to go to address this thorny problem still remains challenging. To the best of our knowledge, few bibliometric analysis concerning pathological scar have been reported. In this study, we set out to employ bibliometric and visual analysis to offer research status and trends of pathological scar over the period 2001-2021. All publications covering pathological scar during 2001-2021 were retrieved and extracted from the Web of Science database. We applied VOSviewer software to evaluate the keywords and research hotpots, and the online tool (http://bibliometric.com/) was used to carried out the publication trends analysis. A total of 2221 pathological scar-related articles were identified over the period 2001-2021. China is the country which had the largest volume of publications (819, 36.87%), followed by the United States (416, 18.73%), Japan (144, 6.48%), Korea (142, 6.39%), and England (118, 5.31%). Among the institutions and journals, Shanghai Jiao Tong University (167) and Wound Repair and Regeneration (85) accounted for the most papers related to pathological scar, respectively. Professor Bayat A, who had the most citation frequency (2303), made great contribution in pathological scar field. "Fibroblast", "expression", and "proliferation" were identified as the pathological scar research hotspot through analysis of the keywords. In terms of publication, China ranked first all over the world, but the numbers of publication are inconsistent with the citation frequency, ranking first and second, respectively. Shanghai Jiao Tong University and journal Wound Repair and Regeneration stand for the highest level of research in this field to a certain extent. In the early stage, the research focus was mainly on the prevention, treatment, and risk factors for recurrence of pathological scar from cases. In the later stage, the research focus was on the comprehensive management, in which the mechanism research was in-depth to the molecular and gene level.
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Affiliation(s)
- Shiyi Li
- Senior Department of Burns and Plastic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Hongfan Ding
- Senior Department of Burns and Plastic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Yi Yang
- Senior Department of Burns and Plastic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Boya Yu
- Senior Department of Burns and Plastic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Minliang Chen
- Senior Department of Burns and Plastic Surgery, the Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
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Fernández-Guarino M, Bacci S, Pérez González LA, Bermejo-Martínez M, Cecilia-Matilla A, Hernández-Bule ML. The Role of Physical Therapies in Wound Healing and Assisted Scarring. Int J Mol Sci 2023; 24:7487. [PMID: 37108650 PMCID: PMC10144139 DOI: 10.3390/ijms24087487] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Wound healing (WH) is a complex multistep process in which a failure could lead to a chronic wound (CW). CW is a major health problem and includes leg venous ulcers, diabetic foot ulcers, and pressure ulcers. CW is difficult to treat and affects vulnerable and pluripathological patients. On the other hand, excessive scarring leads to keloids and hypertrophic scars causing disfiguration and sometimes itchiness and pain. Treatment of WH includes the cleaning and careful handling of injured tissue, early treatment and prevention of infection, and promotion of healing. Treatment of underlying conditions and the use of special dressings promote healing. The patient at risk and risk areas should avoid injury as much as possible. This review aims to summarize the role of physical therapies as complementary treatments in WH and scarring. The article proposes a translational view, opening the opportunity to develop these therapies in an optimal way in clinical management, as many of them are emerging. The role of laser, photobiomodulation, photodynamic therapy, electrical stimulation, ultrasound therapy, and others are highlighted in a practical and comprehensive approach.
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Affiliation(s)
- Montserrat Fernández-Guarino
- Dermatology Service, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Stefano Bacci
- Research Unit of Histology and Embryology, Department of Biology, University of Florence, 50121 Firenze, Italy
| | - Luis Alfonso Pérez González
- Dermatology Service, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Mariano Bermejo-Martínez
- Specialist Nursing in Wound Healing, Angiology and Vascular Service, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Almudena Cecilia-Matilla
- Diabetic Foot Unit, Angiology and Vascular Service, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Maria Luisa Hernández-Bule
- Bioelectromagnetic Lab, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Hospital Ramón y Cajal, 28034 Madrid, Spain
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Kurup S, Travis TE, Shafy RAE, Shupp JW, Carney BC. Treatment of burn hypertrophic scar with fractional ablative laser-assisted drug delivery can decrease levels of hyperpigmentation. Lasers Surg Med 2023. [PMID: 37051876 DOI: 10.1002/lsm.23662] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/06/2023] [Accepted: 03/31/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Laser treatments have been used to treat a variety of scar symptoms, including the appearance of scars following burn injury. One such symptom is hyperpigmentation. There are several qualitative and quantitative measures of assessing improvement in hyperpigmentation over time. The Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS) are two scales that describe characteristics of scar such as pigmentation level. These scales are limited by their qualitative nature. On the other hand, spectrophotometers provide quantitative measures of pigmentation. Prior studies have reported that laser can change scar pigmentation, but no quantitative values have been reported. The current study examines changes in scar melanin index after CO2 fractional ablative laser scar revision (FLSR) via noninvasive probe measurement in patients of various Fitzpatrick skin types (FST). MATERIALS AND METHODS Patients with scars of various sizes and etiologies were treated with FLSR. A database was constructed including 189 patients undergoing laser treatment. From this pool, individuals were selected based on the criteria that they completed at least two laser sessions and had Melanin index measurements for both of these sessions and the pre-operative visit. This criteria resulted in 63 patients of various FST in the cohort. Melanin index, POSAS-Observer (O) and -Patient (P) pigmentation and color scores and VSS-pigmentation scores were examined over time. Demographic information (age of patient at time of first treatment, age of scar at time of first treatment, use of laser-assisted drug delivery (LADD), gender, FST, and Ethnicity) were collected from the medical record. Patients were grouped as "responder" if their Melanin index indicated decreased levels of hyperpigmentation after FLSR treatment in more than half of their total number of visits and "nonresponder" if it did not. RESULTS The majority of patients were responders (41/63). In responder patients, measurements of Melanin index showed significantly improved levels of hyperpigmentation in hypertrophic scars after two FLSR sessions (p < 0.05). Age of patient, gender, FST, age of scar, ethnicity, or type of drug delivered by LADD did not predict responder grouping. POSAS-O and -P pigmentation/color scores showed improved scores after two FLSR sessions within the responder group. POSAS-P color scores showed improved scores after two and three FLSR sessions in the nonresponder group. VSS pigmentation scores showed improved scores after three FLSR sessions in the responder group only. CONCLUSION Based on Melanin index values, FLSR leads to improvements in hyperpigmentation in certain patients.
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Affiliation(s)
- Sanjana Kurup
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- Howard University College of Medicine, Washington, District of Columbia, USA
| | - Taryn E Travis
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Rahma Abd El Shafy
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- Howard University College of Medicine, Washington, District of Columbia, USA
| | - Jeffrey W Shupp
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Surgery, The Burn Center, MedStar Washington Hospital Center, Washington, District of Columbia, USA
- Department of Plastic and Reconstructive Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Biochemistry, Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Bonnie C Carney
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, District of Columbia, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, District of Columbia, USA
- Department of Biochemistry, Georgetown University School of Medicine, Washington, District of Columbia, USA
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29
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Ge X, Sun Y, Tang Y, Zhou F, Yao G, Su X. Flexible application of scar tissue flaps in scar contracture release surgery: A retrospective study. J Cosmet Dermatol 2023; 22:907-912. [PMID: 36374624 DOI: 10.1111/jocd.15505] [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: 08/24/2022] [Revised: 10/03/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Complete release of scar contracture often relies on surgery, but if the surgery injures normal skin tissue triggers new wounds and scarring, which adds insult to injury for the patient. OBJECTIVE To explore a method that uses scar tissue to repair the defect after the release of scars and try to avoid damage to normal skin tissue. MATERIALS AND METHODS Forty-eight scar contracture patients admitted to our hospital from October 2014 to October 2019 were treated with scar tissue flaps (including Subcutaneous pedicle rhomboid flap, Z-plasty flap, 5-flap, and their combination model) and minor defects in combination with little scattered skin grafts. Medical and demographic data were collected on each patient. Assessed the joint range of motion (ROM) preoperatively and postoperatively, and complication was recorded. The rate of scar contracture recurrence was recorded at a follow-up of 6-24 months. RESULTS Twenty-eight cases of scar contracture located in the joint sites, 20 in the trunk. All the surgical outcomes were satisfied, with significant improvement in contracture scarring and joint status. Postoperative joint range of motion (ROM) showed a significant improvement in comparison with preoperative mobility, whereas the difference was statistically significant (p < 0.05). After 24 months of follow-up, five joints showed recontraction, with a recurrence rate of 10.42%. CONCLUSION Scar contracture could be efficiently treated by properly designing incisions and making the most of the scar tissue flap, to minimize and avoid damage to the normal skin.
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Affiliation(s)
- Xiaojing Ge
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yute Sun
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Youzhi Tang
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fang Zhou
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gang Yao
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xin Su
- Department of Plastic and Burn Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Flores R, Valenzuela F. Cicatrices de quemaduras y la utilidad de la terapia láser en su manejo. REVISTA MÉDICA CLÍNICA LAS CONDES 2023. [DOI: 10.1016/j.rmclc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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31
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Frech FS, Hernandez L, Urbonas R, Zaken GA, Dreyfuss I, Nouri K. Hypertrophic Scars and Keloids: Advances in Treatment and Review of Established Therapies. Am J Clin Dermatol 2023; 24:225-245. [PMID: 36662366 DOI: 10.1007/s40257-022-00744-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 01/21/2023]
Abstract
Hypertrophic scars and keloids can have significant detrimental effects on patients both psychosocially and functionally. A careful identification of patient risk factors and a comprehensive management plan are necessary to optimize outcomes. Patients with a history of dystrophic scarring should avoid unnecessary procedures and enhance the wound-healing process using various preventive strategies. As there is no single, fully efficacious treatment modality, prevention remains the best approach in reducing aberrant scar formation. When prevention therapies fail, keloids have been shown to be respond to a variety of therapies including topical and injectable corticosteroids, 5-fluorouracil, radiotherapy, lasers, and surgical excision, all with varying efficacies. As such, management should be tailored to the individual patient's risk factors with the use of combination therapies to reduce recurrence rates. Still, keloid and hypertrophic scar therapies are widely diverse with novel treatment modalities providing alternatives for recurring lesions. Laser-assisted drug delivery, skin priming, and novel topical therapies may provide alternative options for the management of hypertrophic scars and keloids.
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Affiliation(s)
- Fabio Stefano Frech
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL, 33136, USA.
| | - Loren Hernandez
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL, 33136, USA
| | - Rebecca Urbonas
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Ghufran Abo Zaken
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL, 33136, USA
| | - Isabella Dreyfuss
- Nova Southeastern University, Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Keyvan Nouri
- Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, 1150 Northwest 14th Street, Miami, FL, 33136, USA
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Mony MP, Harmon KA, Hess R, Dorafshar AH, Shafikhani SH. An Updated Review of Hypertrophic Scarring. Cells 2023; 12:cells12050678. [PMID: 36899815 PMCID: PMC10000648 DOI: 10.3390/cells12050678] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/01/2023] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
Hypertrophic scarring (HTS) is an aberrant form of wound healing that is associated with excessive deposition of extracellular matrix and connective tissue at the site of injury. In this review article, we provide an overview of normal (acute) wound healing phases (hemostasis, inflammation, proliferation, and remodeling). We next discuss the dysregulated and/or impaired mechanisms in wound healing phases that are associated with HTS development. We next discuss the animal models of HTS and their limitations, and review the current and emerging treatments of HTS.
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Affiliation(s)
- Manjula P. Mony
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Kelly A. Harmon
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Ryan Hess
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Amir H. Dorafshar
- Department of Surgery, Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL 60612, USA
| | - Sasha H. Shafikhani
- Department of Medicine, Division of Hematology and Oncology and Cell Therapy, Rush University Medical Center, Chicago, IL 60612, USA
- Cancer Center, Rush University Medical Center, Chicago, IL 60612, USA
- Correspondence:
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Pestoni Porvén C, Novo Lens R, Vieira Dos Santos V, Del Pozo Losada J. Dramatic Reduction of Pain and Rapid Reepithelialization in an Acute Burn Wound Treated With Fractional CO 2 Laser After 11 Days of Injury. Dermatol Surg 2023; 49:209-211. [PMID: 36574618 DOI: 10.1097/dss.0000000000003685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/03/2022] [Indexed: 12/28/2022]
Affiliation(s)
- Carmela Pestoni Porvén
- Salud Galicia, Dermatología y laserterapia, Rúa Benito Blanco Rajoy nº 9, 1ºB, 15006, A Coruña, Spain
| | - Raquel Novo Lens
- Hospital Universitario HM Monte Príncipe, Bohadilla del Monte 28660, Madrid, Spain
| | - Vanesa Vieira Dos Santos
- Salud Galicia, Dermatología y laserterapia, Rúa Benito Blanco Rajoy nº 9, 1ºB, 15006, A Coruña, Spain
| | - Jesús Del Pozo Losada
- Salud Galicia, Dermatología y laserterapia, Rúa Benito Blanco Rajoy nº 9, 1ºB, 15006, A Coruña, Spain
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34
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Optimal Timing of Fractional CO 2 Laser on Cleft Lip Scars: A Single-Blind Randomized Controlled Cohort Study. Dermatol Surg 2023; 49:145-148. [PMID: 36689573 DOI: 10.1097/dss.0000000000003688] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/23/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine the optimal time to apply a fractional CO 2 laser for the treatment of postsecondary repair scars in patients with cleft lip. METHODS Forty-two patients with linear scarring after cleft lip repair were recruited from November 2021 to October 2022. A single-blind, randomized, controlled cohort study was conducted to examine the impact of fractional CO 2 laser treatment compared with conventional conservative treatment. Thirty patients started laser treatment at 1 month ( n = 10), 3 months ( n = 10), and 6 months ( n = 10) postoperatively, and 12 patients were in the control group. Each patient was treated with high-energy low-density fractional CO 2 laser treatment 3 times at an interval of 1 month. The Vancouver Scar Scale (VSS) was used for scar evaluation to determine vascularity, pigmentation, pliability, and height. RESULTS The VSS scores decreased significantly after laser treatment ( p < .05), with the most significant improvement in scars in the group that started treatment 1 month after the surgery. CONCLUSION Early postoperative fractional CO 2 laser treatment of cleft lip scars is more effective than later treatment.
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Wang TY, Ye ZQ, Xie W. Clinical Observation of Sequential Laser Therapy Combined with Tension Reducer for Postoperative Tension Incision Scar Growth. Clin Cosmet Investig Dermatol 2023; 16:59-65. [PMID: 36643387 PMCID: PMC9832926 DOI: 10.2147/ccid.s392461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/14/2022] [Indexed: 01/09/2023]
Abstract
Objective To investigate the clinical effectiveness of laser and secure wound-closure system (Tension reducer) in the treatment of postoperative scarring after tension incision. Methods A retrospectively observational study was conducted. Twenty-six patients who underwent surgical treatment in our department between June 2017 and December 2021 were selected, and those treated with laser and tension reducer were treated as a combined treatment group, and those treated with laser were treated as a conventional treatment group. Fifteen patients in the conventional group were treated with the pulsed dye laser and CO2 fractional laser at 1-2 month intervals. Eleven people in the combined treatment group were treated with the laser in addition to a tension reducer for 3-6 months. The scar width, scar thickness, scar hardness, pruritus score, modified Vancouver scar scale and complication rates between the two treatment modalities were compared between the two groups at 6 months postoperatively. Results The scar thickness, scar hardness and modified Vancouver scar scale of 1.25 (0.14, 1.90) mm, 31.80 (21.00, 37.20) HA, (6.00 ± 2.17) in patients in the combined treatment group were less than those of patients in the conventional treatment group of 5.50 (4.00, 11.50) mm, 42.60 (32.50, 47.00) HA, (8.25±1.91), (Z=2.883, 2.718, t=2.904, p<0.05). The scar width and pruritus score in the combined treatment group, were 8.00 (5.00, 18.00) mm and 0 (0, 1) respectively, while the scar score and pruritus score in the conventional treatment group, were 5.50 (4.00, 11.50) mm respectively, with no statistically significant difference between the two groups. The complication rate was 55% in the combined treatment group and no adverse reactions occurred in the control group. Conclusion Sequential laser combined with tension reducer treatment can effectively inhibit the proliferation of postoperative tension incision scar.
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Affiliation(s)
- Ting-Yu Wang
- Department of Burns, Tongren Hospital of WuHan University & WuHan Third Hospital, WuHan, People’s Republic of China
| | - Zi-Qing Ye
- Department of Burns, Tongren Hospital of WuHan University & WuHan Third Hospital, WuHan, People’s Republic of China,Correspondence: Zi-Qing Ye; Weiguo Xie, Department of Burns, Tongren Hosptial of WuHan Unversity & WuHan Third Hospital, 241 Pengliuyang Road, Wuchang District, WuHan, 430074, People’s Republic of China, Tel +86 13277933698; +86 18071085225, Email ;
| | - Weiguo Xie
- Department of Burns, Tongren Hospital of WuHan University & WuHan Third Hospital, WuHan, People’s Republic of China
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Shumaker PR. Laser Therapy as a Treatment for Chronic Radiation Fibrosis A Commentary. Lasers Surg Med 2023; 55:9-11. [PMID: 36571167 DOI: 10.1002/lsm.23625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 12/06/2022] [Indexed: 12/27/2022]
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McNamara CT, Iorio ML, Greyson M. Concepts in soft-tissue reconstruction of the contracted hand and upper extremity after burn injury. Front Surg 2023; 10:1118810. [PMID: 37206342 PMCID: PMC10188946 DOI: 10.3389/fsurg.2023.1118810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 04/12/2023] [Indexed: 05/21/2023] Open
Abstract
Burns and their subsequent contracture result in devastating functional and aesthetic consequences which disproportionally affect the upper extremity. By focusing on reconstruction with analogous tissue and utilizing the reconstructive elevator, function can be restored concomitantly with form and aesthetic appearance. General concepts for soft-tissue reconstruction after burn contracture are presented for different sub-units and joints.
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Zhang ZB, Zhou ZL, Xing FX, Li Y, Sun XC, Zhao YT, Zhang XZ, Liu JS. Analysis of Energy and Density in Treating Hypertrophic Scar After Burn in Children with CO 2 Dot Matrix Laser. INT J LOW EXTR WOUND 2022:15347346221144152. [PMID: 36536604 DOI: 10.1177/15347346221144152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
Objective: To analyze and compare the effect of the combination of energy and density parameters of CO2 dot matrix laser in the hyperplastic stage of pediatric burn. Materials and Methods: A total of 160 pediatric patients with hypertrophic scar after limb burn from 2017 to 2020 were randomly divided into four parameter groups (n = 40). The patients were treated with ablative fraction carbon dioxide laser, once every 10 weeks. During the interval of laser treatment, Compound Heparin Sodium and Allantoin Gel (Contractubex) was applied externally, tid, and elastic cover or elastic bandage is attached to the affected limb. Scoring based on the Vancouver Scar Scale is performed before each laser treatment, The score before the first treatment was the initial score, which was scored by two people separately, and the average score was calculated. Subsequently, the patients were treated four times and scored. The differences between each treatment and the first score of each parameter group were compared. Under the same energy and different treatment density, the scores after each treatment were compared. Under the same density and different energy, the scores after each treatment were compared. The bleeding and pigmentation of each parameter group were compared. Results: The increase of density can show the therapeutic effect earlier than the increase of energy, and 25mj energy and 10% density have better intervention effect. With the course of disease and the progress of treatment, the correlation between intervention effect and parameters tends to weaken. Comparing the number of cases with different scores between each treatment and the first time, the score in the 5% density group was lower than that in the 10% density group, but there was no significant difference between the 25mj and 17.5mj energy levels in the same density group. The intervention effect of the increase of density on scar was better than that of energy, and the increase of energy and density could aggravate the pain. Conclusion: In pediatric burn hypertrophic scars treated by CO2 dot matrix laser in exfoliation mode, the intervention effect of increasing density is better than that of energy. When setting laser treatment parameters, we should give priority to increasing density and adjust energy according to the effect of treatment and the condition of pain, bleeding and color precipitation. In this study, the best combination of parameters is 17.5mj/10%.
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Affiliation(s)
- Zhi-Bo Zhang
- Department of Burn and plastic surgery, the third people's Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Zhu-Liang Zhou
- Department of Burn and plastic surgery, the third people's Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Fu-Xi Xing
- Department of Burn and plastic surgery, the third people's Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Yong Li
- Department of Burn and plastic surgery, the third people's Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Xing-Chen Sun
- Department of Burn and plastic surgery, the third people's Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Yu-Ting Zhao
- Department of Burn and plastic surgery, the third people's Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Xiang-Zhou Zhang
- Department of Burn and plastic surgery, the third people's Hospital of Bengbu Medical College, Bengbu, Anhui, China
| | - Ji-Song Liu
- Department of Burn and plastic surgery, the third people's Hospital of Bengbu Medical College, Bengbu, Anhui, China
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Shupp JW, Holmes JH, Moffatt LT, Phelan HA, Sousse L, Romanowski KS, Jeschke M, Kowalske KJ, Badger K, Allely R, Cartotto R, Burmeister DM, Kubasiak JC, Wolf SE, Wallace KF, Gillenwater J, Schneider DM, Hultman CS, Wiechman SA, Bailey JK, Powell HM, Travis TE, Supp DM, Carney BC, Johnson LS, Johnson LS, Chung KK, Chung KK, Kahn SA, Gibson ALF, Christy RJ, Carter JE, Carson JS, Palmieri TL, Kopari NM, Blome-Eberwein SA, Hickerson WL, Parry I, Cancio JM, Suman O, Schulman CI, Lamendella R, Hill DM, Wibbenmeyer LA, Nygaard RM, Wagner AL, Carter ADW, Greenhalgh DG, Lawless MB, Carlson DL, Harrington DT. Proceedings of the 2021 American Burn Association State and Future of Burn Science Meeting. J Burn Care Res 2022; 43:1241-1259. [PMID: 35988021 DOI: 10.1093/jbcr/irac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Periodically, the American Burn Association (ABA) has convened a State of the Science meeting on various topics representing multiple disciplines within burn care and research. In 2021 at the request of the ABA President, meeting development was guided by the ABA's Burn Science Advisory Panel (BSAP) and a subgroup of meeting chairs. The goal of the meeting was to produce both an evaluation of the current literature and ongoing studies, and to produce a research agenda and/or define subject matter-relevant next steps to advance the field(s). Members of the BSAP defined the topics to be addressed and subsequently solicited for nominations of expert speakers and topic leaders from the ABA's Research Committee. Current background literature for each topic was compiled by the meeting chairs and the library then enhanced by the invited topic and breakout discussion leaders. The meeting was held in New Orleans, LA on November 2nd and 3rd and was formatted to allow for 12 different topics, each with two subtopics, to be addressed. Topic leaders provided a brief overview of each topic to approximately 100 attendees, followed by expert-lead breakout sessions for each topic that allowed for focused discussion among subject matter experts and interested participants. The breakout and topic group leaders worked with the participants to determine research needs and associated next steps including white papers, reviews and in some cases collaborative grant proposals. Here, summaries from each topic area will be presented to highlight the main foci of discussion and associated conclusions.
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Staubach R, Glosse H, Fennell S, Loff S. A Single-Institution Experience About 10 Years With Children Undergoing Fractional Ablative Carbon Dioxide Laser Treatment After Burns: Measurement of Air Pressure-Induced Skin Elevation and Retraction Time (Dermalab) Including Standardized Subjective and Objective Scar Evaluation. J Burn Care Res 2022; 44:655-669. [PMID: 36155789 DOI: 10.1093/jbcr/irac125] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Laser treatment has gained more and more importance in the therapy of scars during the last years. Scientific work, especially in children, is scarce on this topic and mostly with an insufficient number of cases or only subjective descriptions. Our study included 77 children from 2012 to 2022 with scars after thermal injury. These were treated at least three times or more by CO2 laser or in combination with pulsed dyed laser (PDL). Beforehand, scar texture and elasticity were determined by a skin elasticity analysis system. Regarding the subjective evaluation, a questionnaire was given to the patients or their parents. Further criteria were the Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS). A statistically significant improvement in elasticity was demonstrated in all scars of any age after each laser treatment. In addition, a significant correlation was found between the number of laser treatments and an increase in elasticity. The assessments of scars after one or more laser sessions by the observer as well as the patient showed a decreasing score in all categories with an increase in the number of laser therapies. The VSS score also improved significantly after each laser session. The mean score before treatment was about 7, after the first laser session, the mean score was already below 6 with a statistical significance. Ninety-six percent of the patients or their parents were satisfied with the laser therapy, and 90% wished to repeat the procedure. This work confirms, by means of the objectification by the scar measurement, the previous scientific works concerning a scar therapy by laser and emphasizes particularly that this can also be used without problems with children with symptomatic scars, contractures, or with cosmetically relevant scars.
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Affiliation(s)
- Raphael Staubach
- Department for Pediatric Surgery, Klinikum Stuttgart/Olgahospital, Germany
| | - Helen Glosse
- Department for Pediatric Surgery, Klinikum Stuttgart/Olgahospital, Germany
| | - Sarah Fennell
- Department for Pediatric Surgery, Klinikum Stuttgart/Olgahospital, Germany
| | - Steffan Loff
- Department for Pediatric Surgery, Klinikum Stuttgart/Olgahospital, Germany
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Ghaoui N, Abi Zeid Daou C, Saade D. When no plan is still a good plan: treating injuries, physical and otherwise, of the non-nuclear ammonium nitrate 2020 Beirut explosion. Int J Dermatol 2022; 61:1034-1038. [PMID: 35856735 DOI: 10.1111/ijd.16295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/05/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Nohra Ghaoui
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Christophe Abi Zeid Daou
- Department of Otorhinolaryngology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Dana Saade
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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Zhang J, Zhou S, Xia Z, Peng Z, Luo W, Cheng X, Yang R. Effectiveness of artesunate combined with fractional CO2 laser in a hypertrophic scar model with underlying mechanism. Burns 2022; 48:662-671. [PMID: 34103199 DOI: 10.1016/j.burns.2021.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 05/08/2021] [Accepted: 05/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Both artesunate and fractional CO2 laser have been proved effective in the treatment of hypertrophic scars, yet little data are available for the efficacy of artesunate combined with fractional CO2 laser. In order to assess the pre-clinical significance and the underlying mechanism of this combined treatment profile, we attempted to observe the effectiveness of this therapy in rabbit models through determining the expression of BMP-7 and Fas. MATERIALS AND METHODS Twenty-Four New Zealand white rabbits with established hypertrophic scar samples were randomly divided into control group and three treatment groups. Artesunate (20 μl/cm2) was injected into the rat's scar of artesunate and combination groups, while fractional CO2 laser (Combo mode, deep energy:10 mJ, super energy: 50 mJ) was applied to rats in fractional CO2 laser and combination groups at week 4 after model establishment. All rabbits underwent a total of 3 sessions of treatment once every 2 weeks. Histological and immunohistochemistry study, Western blot assay, cell viability, ELISA and RT-QPCR were performed at week 10 to observe the aspects of hypertrophic scar sample changes and expression of BMP-7 and Fas in the scar tissues. RESULTS Compared with control group, hypertrophic scars and the collagen fibers were significantly inhibited after treatment, and higher inhibition was seen in the samples in combination group compared to that in artesunate and fractional CO2 laser groups (P < 0.01). Meanwhile, BMP-7 and Fas expressions were both notably increased in all treatment groups, and upregulation of the two proteins was dominant in combination group (P < 0.01). CONCLUSIONS Artesunate combined with fractional CO2 laser is effective in hypertrophic scarring in this rabbit model. Our findings can serve as a potential alternative strategy to treatment of hypertrophic scar in clinical practice.
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Affiliation(s)
- Jinxia Zhang
- Seventh Medical Center of PLA General Hospital, Beijing, 100700 China
| | - Shuanglin Zhou
- Seventh Medical Center of PLA General Hospital, Beijing, 100700 China
| | - Zhikuan Xia
- Seventh Medical Center of PLA General Hospital, Beijing, 100700 China
| | - Zhuoying Peng
- Seventh Medical Center of PLA General Hospital, Beijing, 100700 China
| | - Wanting Luo
- Seventh Medical Center of PLA General Hospital, Beijing, 100700 China
| | - Xiaoxian Cheng
- Seventh Medical Center of PLA General Hospital, Beijing, 100700 China
| | - Rongya Yang
- Seventh Medical Center of PLA General Hospital, Beijing, 100700 China.
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Zhang J, Luo W, Han M, Wu L, Peng Z, Xia Z, Yang R. Verifying the outcomes of artesunate plus 595-nm PDL in hypertrophic scars via determining BMP-7 and Fas level in model rabbits. Lasers Surg Med 2022; 54:716-724. [PMID: 35234299 DOI: 10.1002/lsm.23518] [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: 01/04/2021] [Revised: 01/03/2022] [Accepted: 01/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Single-use of artesunate (ART) or 595-nm pulsed-dye laser (PDL) has proven clinical efficacy in the treatment of hypertrophic scars (HSs), yet little research has been done on the combined use of ART and PDL. Bone morphogenetic protein-7 (BMP-7) and Fas are recognized to be two important proteins in reducing scar formation. This study was designed to observe the effect of ART combined with 595-nm PDL in the treatment of HS in rabbit models, and investigate the effect of such protocol on the expression of BMP-7 and Fas in rabbit models. STUDY DESIGN/MATERIALS AND METHODS Twenty-four New Zealand white rabbits were randomly divided into the control group, ART group, PDL group, and combined treatment (ART + PDL) group. ART was respectively applied to the ART group and combined treatment group. Treatment was once every 2-week for a total of three sessions for both groups. Animals in the PDL group were simply treated with 595-nm PDL. Then, hematoxylin & eosin and Van Gieson straining, immunohistochemical study, enzyme-linked immunosorbent assay (ELISA), Cell counting kit-8 test, western blot assay, and real-time polymerase chain reaction (RT-PCR) were carried out to observe the development of HS samples and expression of BMP-7 and Fas proteins in the sample tissues. RESULTS After treatment, the scar samples grew lower and flatter, which was particularly evident in the combined treatment group, with notably inhibited fibroblast and collagen compared to other groups (p < 0.001). Western blot assay and RT-PCR demonstrated that the expression of BMP-7 was most increased in scar samples treated by ART + PDL. BMP-7 level was correspondingly and notably upregulated in treatment groups, especially in the ART + PDL group. In addition, relevant expression of Fas was also higher after treatment, especially in the ART + PDL group compared to either ART or 595-nm PDL group. The difference was significant among groups (p < 0.001). CONCLUSIONS Combined use of ART and 595-nm PDL can inhibit HSs in rabbit models via inhibiting extra fibroblast and collagens. The potential mechanism may be involved in enhanced BMP-7 and Fas expression. Our observations may create an alternative therapeutic strategy for HSs in the clinic.
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Affiliation(s)
- Jinxia Zhang
- Department of Dermatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Wanting Luo
- Department of Dermatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Minna Han
- Department of Dermatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Lili Wu
- Department of Dermatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Zhuoying Peng
- Department of Dermatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Zhikuan Xia
- Department of Dermatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Rongya Yang
- Department of Dermatology, The Seventh Medical Center of PLA General Hospital, Beijing, China
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Abstract
BACKGROUND Despite history of multiple treatment modalities, repigmentation of hypopigmented scars remains a difficult clinical problem. OBJECTIVE The purpose of this review is to evaluate the literature on laser and combination laser plus adjunct topical therapy for hypopigmented burn and traumatic scars. MATERIALS AND METHODS A search on PubMed and on Oxford Academic was conducted with additional relevant literature obtained from reference lists. RESULTS Treatment regimens that address hypopigmentation within scars were reviewed. A combination of nonablative fractional or ablative fractional laser treatment with topical prostaglandin analogue with or without topical retinoid were found to result in superior repigmentation. CONCLUSION Reliable improvement of hypopigmentation in scars after laser treatment is challenging. Laser can achieve success in some cases. Ultraviolet laser can achieve modest repigmentation; however, results are short-lived and require continued re-treatment. Modest improvement in pigmentation is seen with nonablative fractional laser or ablative fractional laser alone and enhanced repigmentation is demonstrated when combining fractional laser resurfacing with topical application of synthetic prostaglandin analogues and other known modulators of melanogenesis.
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Affiliation(s)
- Erica G Baugh
- Department of Dermatology, University of California, Irvine, California
| | - Olive Anagu
- Department of Dermatology, University of California, Irvine, California
| | - Kristen M Kelly
- Department of Dermatology, University of California, Irvine, California
- Beckman Laser Institute, Laser Microbeam and Medical Program, University of California Irvine, Irvine, California
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45
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Ibrahim SA, Kang BY, Poon E, Alam M. Guidelines of care for clinical laser treatments: Why are they useful? J Cosmet Dermatol 2021; 21:867-868. [PMID: 34932863 DOI: 10.1111/jocd.14684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/04/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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46
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Ibrahim SA, Kang BY, Poon E, Alam M. Guidelines of care for clinical laser treatments: why are they useful? Lasers Med Sci 2021; 37:2555-2556. [PMID: 34850308 PMCID: PMC8631557 DOI: 10.1007/s10103-021-03473-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/15/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Sarah A Ibrahim
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bianca Y Kang
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Emily Poon
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. .,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
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Dastagir K, Obed D, Bucher F, Hofmann T, Koyro KI, Vogt PM. Non-Invasive and Surgical Modalities for Scar Management: A Clinical Algorithm. J Pers Med 2021; 11:jpm11121259. [PMID: 34945731 PMCID: PMC8703513 DOI: 10.3390/jpm11121259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/18/2021] [Accepted: 11/25/2021] [Indexed: 12/18/2022] Open
Abstract
Scars can lead to aesthetic and functional impairments. The treatment of scars requires meticulous planning and an individually adapted therapeutic strategy. A conceptual algorithm for scar treatment makes everyday clinical work easier for the practitioner and offers more safety for the patient. Based on a retrospective analysis of 1427 patients who presented for treatment of a variety of scars, we developed an algorithm for scar management and treatment. The treatments are presented using case descriptions. Additionally, an electronic search of MEDLINE, EMBASE, and ClinicalTrials.gov databases was performed utilizing combinations of relevant medical subject headings for "scar treatment", "hypertrophic scar treatment" and "keloid treatment". Reference lists of relevant articles and reviews were hand-searched for additional reports. Observed outcomes included: conservative scar therapy, minimally invasive scar therapy, and surgical scar therapy using local, regional and free flaps. With this work, we provide an algorithm for safe scar treatment. For better understanding, we have described a clinical case for each algorithm modality.
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48
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Nisticò SP, Bennardo L, Sannino M, Negosanti F, Tamburi F, Del Duca E, Giudice A, Cannarozzo G. Combined CO 2 and dye laser technique in the treatment of outcomes due to flap necrosis after surgery for basal cell carcinoma on the nose. Lasers Surg Med 2021; 54:523-529. [PMID: 34837404 DOI: 10.1002/lsm.23502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 11/03/2021] [Accepted: 11/16/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Basal cell carcinoma (BCC) is the most frequent cutaneous cancer worldwide, and the nasal area is the most commonly affected region. Skin flaps are usually performed to achieve radical results, but various adverse events often occur. The necrosis of the skin flap is one of the most frequently observed, resulting in scars and anti-aesthetic outcomes. Ablative and non-ablative lasers have been proposed to improve scars resulting from surgical failure and skin flap necrosis. STUDY DESIGN/MATERIALS AND METHODS This study aims to evaluate a new laser protocol combining ablative CO2 -laser with flashlamp pulsed dye laser for the treatment of nasal scars resulting from the necrosis of flap that occurred after surgery. Twelve patients were enrolled in the study, and a total of five laser sessions were planned, spaced from 14 days to 1 month apart. RESULTS Seven out of 12 patients underwent all the five laser sessions planned, while 5/12 patients achieved optimal cosmetic results within the fourth session. Eighty percent of the patients reported good/optimal cosmetic results, and no significant side effects were observed during the study. CONCLUSION Combining fractionated CO2 laser with flashlamp pulsed dye laser represents a new effective modality for treating skin flap necrosis after BBC removal, representing a valid alternative to other surgical procedures.
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Affiliation(s)
| | - Luigi Bennardo
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Mario Sannino
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Federica Tamburi
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Ester Del Duca
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Amerigo Giudice
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
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Salameh F, Shumaker PR, Goodman GJ, Spring LK, Seago M, Alam M, Al-Niaimi F, Cassuto D, Chan HH, Dierickx C, Donelan M, Gauglitz GG, Haedersdal M, Krakowski AC, Manuskiatti W, Norbury WB, Ogawa R, Ozog DM, Paasch U, Victor Ross E, Clementoni MT, Waibel J, Bayat A, Goo BL, Artzi O. Energy-based devices for the treatment of acne scars: 2021 international consensus recommendations. Lasers Surg Med 2021; 54:10-26. [PMID: 34719045 DOI: 10.1002/lsm.23484] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 10/03/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Acne scars are one of the most distressing and long-term consequences of acne vulgaris, with damaging effect on a person's physical, mental, and social well-being. Numerous treatment options are available including surgical and nonsurgical techniques, depending on the clinical presentation. Although considerable advances in the development of new treatment technologies and applications have been made in the last decade, international treatment guidelines and reimbursement schemes have not yet caught up with current knowledge and practice in many centers. The authors intend to highlight the potential utility of energy-based devices (EBDs) for acne scarring, offer recommendations for safe and efficacious treatment, and provide consensus-based EBD treatment options based on varying presentations demonstrated in a series of real-life clinical photographs. STUDY DESIGN/MATERIALS AND METHODS An international panel of 24 dermatologists and plastic surgeons from 12 different countries and a variety of practice backgrounds was self-assembled to develop updated consensus recommendations for the treatment of acne scars. A two-step modified Delphi method took place between March 2020 and February 2021 consisting of two rounds of emailed questionnaires. The panel members approved the final manuscript via email correspondence. RESULTS The manuscript includes a comprehensive discussion and panel recommendations regarding the following topics: 1. the role of EBD in mitigating and treating acne scars in a patient with active acne, 2. the use of various EBDs for the treatment of different acne scar types with special focus on commonly used laser platform such as vascular lasers, ablative fractional lasers (AFLs) and non-AFLs (NAFLs), 3. treatment combinations, and 4. acne scar treatments in skin of color. The last part comprised of 10 photos of real-life clinical cases with the panel recommendation treatment plan to achieve best aesthetic outcome. CONCLUSION Panel members were unanimous in their view that EBDs have a role in the management of acne scars, with AFLs, NAFLs, vascular lasers, and RF devices preferentially selected by most of the panel experts. EBDs are considered a first-line treatment for a variety of acne scar types and patients without access to these treatments may not be receiving the best available care for optimal cosmetic results. Future high-quality research and updated international treatment guidelines and reimbursement schemes should reflect this status.
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Affiliation(s)
- Fares Salameh
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Peter R Shumaker
- VA San Diego Healthcare System and University of California, San Diego, California, USA
| | - Greg J Goodman
- Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Leah K Spring
- Micrographic Surgery and Surgical Oncology, SkinCare Physicians, Chestnut Hill, Massachusetts, USA
| | - Meghan Seago
- VA San Diego Healthcare System and University of California, San Diego, California, USA.,Micrographic Surgery and Surgical Oncology, Scripps Clinic, La Jolla, California, USA
| | - Murad Alam
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | | | - Henry Hl Chan
- Private Practice and Department of Medicine (Dermatology), University of Hong Kong, People's Republic of China
| | | | - Matthias Donelan
- Department of Surgery, Massachusetts General Hospital, Shriners Hospitals for Children-Boston, Harvard Medical School, Boston, Massachusetts, USA
| | - Gerd G Gauglitz
- Department of Dermatology and Allergy, Ludwig Maximillian University, Munich, Germany
| | - Merete Haedersdal
- Department of Dermatology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Andrew C Krakowski
- Department of Dermatology, St. Luke's University Health Network, Easton, Pennsylvania, USA
| | | | - William B Norbury
- Department of Surgery, University of Texas Medical Branch, Shriners Hospital for Children-Galveston, Galveston, Texas, USA
| | - Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - David M Ozog
- Department of Dermatology, Henry Ford Hospital, Detroit, Michigan, USA
| | - Uwe Paasch
- Department of Dermatology, Venereology, and Allergy, University of Leipzig, Leipzig, Germany
| | | | | | - Jill Waibel
- Miami Dermatology and Laser Institute, Miami, Florida, USA
| | - Ardeshir Bayat
- Plastic & Reconstructive Surgery Research, Centre for Dermatology Research, NIHR Manchester Biomedical Research Centre, University of Manchester, England, UK.,MRC-SA Wound Healing Unit, Hair & Skin Research Laboratory, Division of Dermatology, University of Cape Town, Cape Town, South Africa
| | - Boncheol Leo Goo
- Naeum Dermatology and Aesthetic Clinic/Skin Rehabilitation Center, Seoul, Korea
| | - Ofir Artzi
- Department of Dermatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Zhang J, Zhou S, Xia Z, Peng Z, Cheng X, Yang X, Luo W, Yang R. 595-nm pulsed dye laser combined with fractional CO 2 laser reduces hypertrophic scar through down-regulating TGFβ1 and PCNA. Lasers Med Sci 2021; 36:1625-1632. [PMID: 34117539 DOI: 10.1007/s10103-020-03240-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 12/26/2020] [Indexed: 11/28/2022]
Abstract
595-nm pulsed dye laser and fractional CO2 laser have been demonstrated effective to treat hypertrophic scar. The underlying mechanism may involve transforming growth factor-beta1 (TGFβ1) and proliferating cell nuclear antigen (PCNA), but remains to be clarified. Our study was performed to investigate how 595-nm pulsed dye laser combined with fractional CO2 laser treats hypertrophic scars in a rabbit model through regulating the expression of TGFβ1 and PCNA. Twenty-four New Zealand white rabbits were randomly divided into control group, pulsed dye laser group, fractional CO2 laser group, and pulsed dye laser + fractional CO2 laser (combination) group. Surgical wounds were made and allowed to grow into hypertrophic scars at day 28. Next, 595-nm pulsed dye laser (fluence: 15 J/cm2; square: 7 mm; pulse duration: 10 ms) was used in pulsed dye laser and combination group, while fractional CO2 laser (combo mode, deep energy: 12.5 mJ; super energy: 90 mJ) in fractional CO2 laser and combination groups, once every 4 weeks for 3 times. The appearance and thickness of hypertrophic scar samples were measured with hematoxylin-eosin and Van Gieson's straining. The expressions of TGFβ1 and PCNA were evaluated by immunohistochemical and western blot analysis. A significant improvement was noted in the thickness, size, hardness, and histopathology of hypertrophic scar samples after laser treatment, especially in combination group. Scar Elevation Index (SEI), fiber density (NA), and collagen fiber content (AA) decreased most significantly in combination group (2.10 ± 0.14; 2506 ± 383.00; 22.98 ± 2.80%) compared to 595-nm pulsed dye laser group (3.35 ± 0.28; 4857 ± 209.40; 42.83 ± 1.71%) and fractional CO2 laser group (2.60 ± 0.25; 3995 ± 224.20; 38.33 ± 3.01%) (P < 0.001). Furthermore, TGFβ1 and PCNA expressions were more suppressed in combination group (8.78 ± 1.03; 7.81 ± 1.51) than in 595-nm pulsed dye laser (14.91 ± 1.68; 15.73 ± 2.53) and fractional CO2 laser alone group (15.96 ± 1.56; 16.13 ± 1.72) (P < 0.001). The combination of 595-nm pulsed dye laser with fractional CO2 laser can improve the morphology and histology of hypertrophic scars in a rabbit model through inhibiting the expression of TGFβ1 and PCNA protein. Our findings can pave the way for new clinical treatment strategies for hypertrophic scars.
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Affiliation(s)
- Jinxia Zhang
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Shuanglin Zhou
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Zhikuan Xia
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Zhuoying Peng
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Xiaoxian Cheng
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Xin Yang
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Wanting Luo
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China
| | - Rongya Yang
- Department of Dermatology, Seventh Medical Center of PLA General Hospital, Beijing, 100700, China.
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