Management of Surgical Scars

[Assessment tool's validation study for a simulation-based skin suturing skill]

CONTEXT

Health simulation is a recognized educational method for teaching and validating surgical procedural skills. The latter requires the development of adapted assessment tools, reaching different validity criteria. The aim of this study was to validate a multimodal assessment tool for a complex skin suturing exercise, combining a manual knot, an intradermal linear suturing and a needle holder tied knot.

METHODOLOGY

The suturing exercise was realized on a synthetic skin model by voluntary participants after having obtained their written consent, including 9 postgraduate medical students, 40 surgical residents of different levels of experience, and a group of 9 senior surgeons. The multimodal assessment tool (MAT) combined a checklist, a speed score and a global rating scale. Each exercise was scored by two evaluators. Medical students' performances were filmed anonymously so that they could be scored iteratively. Content validity was tested through a satisfaction questionnaire randomly completed by participants.

RESULTS

The MAT was considered relevant or very relevant by 98% of the participants, with a better appreciation for the checklist than for the global rating scale. Internal consistency was strong with a Cronbach α coefficient at 0.78, and a good correlation between the results of the checklist and the global rating scale (r=0.79, P<0.0001). The MAT showed continuous improvement in mean scores from 34.4±3.6 for novices to 47.4±2.5/50 points for experts, passing through three intermediate levels groups, and allowed for significant discrimination between groups. The MAT was reliable, with a coefficient of correlation set at 0.88 for intra-observer reliability, and 0.72 for inter-observer reliability. On sub score analysis, the global rating scale and the speed score better discriminated between groups than the checklist, the latter moreover showing slightly lower reliability than the global rating scale.

CONCLUSION

Despite its banality in any surgeon's practice and the fact that it is taught from the 2nd cycle of medical studies, suturing and its technical components have rarely been the subject of publications dedicated to the validation of specific assessment tools. Hence, this work on the MAT and its sub scores made it possible to validate them on many validity and reliability criteria. They can therefore be proposed to surgical teachers for evaluating a complex suturing exercise, with a checklist that is easier to use even for novices and a global rating scale showing better discrimination capacity.

Global proteomic analysis reveals lysine succinylation is involved in the pathogenesis of hypertrophic scar

Lysine succinylation (Ksucc) is a recently identified posttranslational modification that is involved in many diseases. This study examined the role of Ksucc in the pathogenesis of hypertrophic scar (HS). The presence of Ksucc in human skin was measured by immunoblotting. Ksucc occurs in many skin proteins ranging from 25 to 250 kDa, and higher levels of Ksucc are found in HS skin than in normal skin. An immunoaffinity approach coupled with LC-MS/MS was used to characterize the first succinylome of human skin, and 159 Ksucc sites in 79 proteins were identified. Among these, there were 38 increased succinylated sites in 29 proteins but no decreased succinylated sites in HS compared with normal skin. A parallel reaction monitoring assay was performed to validate the results of the succinylome and showed that the levels of Ksucc in decorin and collagens, which are involved in the pathogenesis of HS, were increased in HS than in normal skin. In addition, increasing the level of Ksucc enhanced cell proliferation and upregulated the expression of fibrosis markers (α-SMA, COL1, and COL3) in human skin fibroblasts. Our results provide global insights into the functional role of Ksucc in hypertrophic scarring.

Morphological characteristics of facial scars: A retrospective analysis according to scar location, onset, age, and cause

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.

Practical management of hypertrophic scarring: the mayo clinic experience

Hypertrophic scarring is a potential consequence of wound healing that causes functional and aesthetic disability. Common treatments include intralesional pharmacotherapy (e.g., triamcinolone), surgical excision, and energy-based laser devices. While numerous treatment methods have been described for hypertrophic scarring, an optimal treatment strategy has yet to be established given variability in clinical presentation. This study aims to identify patient- and provider-preferred treatment patterns. This is a single-center, retrospective study of adult patients that developed post-surgical hypertrophic scarring between 2007 and 2017. Specifically, trends in procedural management for hypertrophic scarring among this cohort were examined. A total of 442 procedures (intralesional steroid injection, surgical excision, laser-based treatment) were identified in 218 patients with a clinical diagnosis of hypertrophic scarring. Approximately 73% were female; 87% were Caucasian. The median age at first procedure was 45.6 years (SD = 17.4). The most frequent anatomical locations for procedures were the trunk (n = 242; 54.8%), followed by head/neck (n = 86; 19.5%), upper extremities (n = 67; 15.2%), and lower extremities (n = 45; 10.2%). Procedural therapies included intralesional steroid injection (n = 221; 50%), surgical excision (n = 112; 25.3%) and laser (fractional non-ablative laser vs. pulsed dye laser; n = 109; 24.5%). Treatment modality varied by stage of treatment, scar anatomical location, and scar size. This single-center series of patients with hypertrophic scarring highlights a patient-centered management approach and offers clinical guidelines for provider-patient shared decision making.

The impact on quality-of-life following treatment of surgical facial scars with laser-based therapy: a scoping review

Post-surgical scarring impacts quality of life (QOL) and is a significant source of morbidity. Existing treatments targeted at improving the appearance and morbidity of scarring include laser-based therapies. Although lasers are frequently used to improve scar appearance, the effects on QOL are unclear. A scoping review was conducted to assess the impact of laser-based therapy for patients with surgical facial scarring on QOL. Throughout literature review was conducted with the guidance of a medical librarian. Relevant articles underwent two rounds of screening by two, independent reviewers. Data were extracted from each article and later analyzed. Of the four articles analyzed, laser-based therapies were demonstrated as effective in improving QOL for patients with facial scars resultant from surgical intervention. Laser-based therapy should be considered when treating facial scarring resultant from surgical intervention, as it has been shown to improve patient QOL. Standardization of QOL assessment and further studies expanding scar inclusion should be pursued given the paucity of information found through this review.

Exosome Derived from Mesenchymal Stem Cells Alleviates Hypertrophic Scar by Inhibiting the Fibroblasts via TNFSF-13/HSPG2 Signaling Pathway

Background

Mesenchymal stem cell-derived exosomes (MSC-exo) have been shown to have significant potential in wound healing and scar relief processes. According to reports, TNFSF13 and HSPG2 are associated with various fibrotic diseases. The aim of this study is to investigate how TNFSF13 and HSPG2 affect the formation of hypertrophic scar (HS) and the mechanism by which exosomes regulate HS.

Methods

Immunohistochemistry, qRT-PCR, Western blot, and immunofluorescence were performed to measure TNFSF13 expression in HS skin tissues and hypertrophic scar fibroblast (HSF). HSF were treated with recombinant TNFSF13 protein and TNFSF13 siRNAs to probe the effect of TNFSF13 on the activity of HSF. The CCK-8, EdU, Transwell, and Western blot were used to investigate the role of TNFSF13 in viability, proliferation and inflammation. The influence of MSC-exo on the proliferation and function of HSF was determined by scratch and Western blot.

Results

TNFSF13 was dramatically up-regulated in HS skin tissues and HSF. Recombinant TNFSF13 protein increased cell viability, proliferation, migration, fibrosis, inflammation, and the binding between TNFSF13 and HSPG2 of HSF. The opposite results were obtained in TNFSF13 siRNAs transferred HSF. Furthermore, TNFSF13 activated the nuclear factor-κB (NF-κB) signaling pathway. Silencing of HSPG2 and inhibition of NF-κB remarkably eliminated the promoting effects of TNFSF13 on cell viability, proliferation, migration, fibrosis and inflammation of HSF. MSC-exo reduced α-SMA and COL1A1 inhibited the proliferation and migration of HSF by inhibiting TNFSF13 and HSPG2.

Conclusion

TNFSF13 activates NF-κB signaling pathway by interacting with HSPG2, which regulates the proliferation, migration, fibrosis and inflammatory response of HSF. Through the above mechanisms, knocking out TNFSF13 can inhibit the proliferation, migration, fibrosis and inflammatory response of HSF, whereas MSC-exo could reverse this process. These results suggest that MSC-exo alleviates HS by inhibiting the fibroblasts via TNFSF-13/HSPG2 signaling pathway.

Role of Prehabilitation and Rehabilitation on Functional Recovery and Quality of Life in Thyroid Cancer Patients: A Comprehensive Review

BACKGROUND

This narrative review aims to provide a comprehensive overview of the current prehabilitation and rehabilitation strategies for thyroid cancer survivors to optimize functional outcomes and enhance their quality of life.

METHODS

The review follows the SANRA quality criteria and includes an extensive literature search conducted in PubMed/Medline, Web of Science, and Scopus.

RESULTS

The review emphasizes the role of a comprehensive rehabilitation approach in targeting the different domains that generate disability in thyroid cancer patients. In this context, physical activity, range of motion exercises, myofascial release, joint mobilization, and postural exercises are crucial for improving functional outcomes and reducing treatment-related discomfort and disability. Moreover, tailored rehabilitative management addressing dysphonia and dysphagia might have a positive impact on the quality of life of these patients. Despite these considerations, several barriers still affect the implementation of a multimodal rehabilitative approach in common clinical practice. Thus, sustainable and effective strategies like digital innovation and patient-centered approaches are strongly needed in order to implement the rehabilitative treatment framework of these subjects.

CONCLUSIONS

This narrative review provides valuable insights into the current prehabilitation and rehabilitation strategies to treat thyroid cancer survivors, addressing physical, psychological, and vocational needs to optimize functional outcomes and enhance their quality of life.

Treatment and Improvement of Healing after Surgical Intervention

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

Reducing Risks of Facial Scarring

Risk factors for the formation of facial scars include skin type, ethnicity, scar location, and certain medical conditions that contribute to poor or delayed healing. Risk of scar can be reduced with appropriate surgical planning, including proper placement and design of incisions, meticulous skin closure, aseptic technique, and wound care to improve healing. Common pathologic scars include hypertrophic scars and keloid scars, each of which has unique approaches to surgical revision and medical treatment due to their respective risks of recurrence. Topical scar therapies, medical therapies, and surgical revision techniques for improvement in final scar appearance are discussed.

The Efficacy of Fractional Carbon Dioxide Laser in Surgical Scars Treatment: A system Review and Meta-analysis

BACKGROUND

Surgical scars seriously affect a patient's quality of life, and they have a strong impact on individuals. Many studies have reported the results of using fractional carbon dioxide (CO₂) laser to treat surgical scars and have generally found it to be effective.

OBJECTIVES

We conducted a meta-analysis with the objective of evaluating and proving the efficacy of fractional CO₂ laser therapy for surgical scars.

METHODS

We performed a search of databases including PubMed, Web of Science, Embase and the Cochrane Library. The outcomes of the meta-analysis were overall scores on the Vancouver Scar Scale (VSS) and its four dimensions (pigmentation, vascularity, pliability and height). Statistical analysis was performed using RevMan 5.4 software.

RESULTS

A total of ten studies were included in this meta-analysis, including six randomized controlled trials (RCTs) and four nonrandomized controlled trials (N-RCTs). In the meta-analysis of RCTs and N-RCTs, similar results were obtained, and fractional CO₂ laser irradiation significantly decreased VSS scores (P < 0.00001). In addition, fractional CO₂ laser irradiation also had a significant effect on scores on the pigmentation (P = 0.08), vascularity (P = 0.001), flexibility (P = 0.005) and height (P = 0.008) dimensions. Except for mild pain during treatment and temporary erythema after treatment, most patients had no obvious adverse reactions.

CONCLUSION

Our study found that fractional CO₂ laser exhibits excellent efficacy and safety in terms of surgical scar treatment. Thus, we hope it becomes more widely available to patients with surgical scars.

LEVEL OF EVIDENCE III

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 .

Patient-reported physical and psychosocial significance of abdominal scarring in anorectal malformations

Background Abdominal scarring in patients with anorectal malformations (ARM) is a permanent visible sign of a chronic congenital condition. The study's aims were to assess the physical and psychosocial significance of abdominal scarring in ARM and to propose a scar treatment approach. Methods A patient- and observer reported cross-sectional study of ARM patients with previous colostomies surgically treated 1997-2015 with minimum 4 years' follow-up after stoma closure. A maximum of 3 patient-selected scars per patient were evaluated by a) the Patient and Observer Scar Assessment Scale (POSAS; 11= no symptoms, 110=worst symptoms), b) pictorial scar treatment assessment by a plastic surgeon, c) questionnaire evaluation of the scarring's psychosocial aspects, bowel- and urinary function and quality of life. Descriptive statistics were presented in median (range) and percent (%), and Pearson's r was used to evaluate linear correlations. Ethical approval and written consents were obtained. Results Twenty-seven patients (48% females) aged 12 (5-24) years old were included. Two (1-3) scars were evaluated per patient with a median POSAS score of 44 (15-78). Six patients (22%) reported scar pain, five (19%) scar pruritus and nine (33%) affected behavior, e.g. always wearing full-covered clothing in public places. Higher (worse) POSAS score and increasing age correlated (r = 0.40, p = 0.04). According to the plastic surgeon's assessment, 21 patients (78%) were suitable candidates for surgical scar treatment, among whom eight patients (30%) requested scar treatment. Conclusions Postoperative abdominal scarring should require attention in clinical ARM follow-up programs including potential corrective plastic surgery for selected patients.

Magnetic Resonance Imaging under Image Enhancement Algorithm to Analyze the Clinical Value of Placement of Drainage Tube on Incision Healing after Hepatobiliary Surgery

This study was aimed at exploring the application value of magnetic resonance imaging (MRI) based on image enhancement algorithm in analyzing the placement of drainage tubes in the healing of incisions after hepatobiliary surgery. A total of 70 patients with liver cancer undergoing laparoscopic hepatobiliary surgery were selected, including 34 males and 36 females. According to the detection method of postoperative recovery, they were divided into a group A (conventional MRI detection) and a group B (MRI detection based on Retinex algorithm). Patients were divided into two groups according to whether subcutaneous drainage tubes were placed: group C (no subcutaneous drainage tubes were placed) and group D (subcutaneous drainage tubes were placed), with 35 patients in each group. The results showed that there was no significant difference between group A and group B in tumor residual or recurrence. The detection rate of tumor capsule in group B was significantly higher than that in group A (P < 0.05). The sensitivity, specificity, and accuracy of group A for the detection of recurrent lesions were 63.40%, 86.90%, and 78.60%, respectively; those in group B were 82.70%, 98.50%, and 93.20%, respectively. Therefore, the difference between the two groups was statistically significant (P < 0.05). The incidence of poor wound healing and infection in group C were significantly lower than those in group D (P < 0.05). Therefore, the effect of MRI detection based on image enhancement algorithm was more conducive to the evaluation of postoperative recovery due to the traditional MRI detection. In addition, the drainage tube was helpful to the postoperative wound healing and showed high clinical value.

Local steroid hormone injections into hypertrophic scars resulted in depression of the lesion site and radiated linear depigmentation and atrophy surrounding the lesion: A case report

BACKGROUND

Local steroid hormone injections into hypertrophic scars resulted in depression of the lesion site and radiated linear depigmentation and atrophy surrounding the lesion, which is extremely rare. We reported a case.

AIM

Our report was designed to explore the causes of this adverse reaction.

METHOD

We reported a case of strange adverse reactions after steroid hormone injection for hyperplastic scars: depression of the lesion and linear-like depigmentation and atrophy of the skin around the lesion, which did not improve after 1 year of topical drug treatment.

RESULTS

We considered that the injection was too deep. Steroid crystals are deposited in normal skin tissue and absorbed by the lymphatic vessel network responsible for removing macromolecules in the interstitial tissue, resulting in linear discoloration and atrophy along the lymphatic vessels.

CONCLUSION

When treating hyperplastic scarring, the doctor needs to strictly grasp the depth, level, and dosage of the injection and avoid such adverse reactions.

A prospective randomized pilot study evaluating the scar outcome after gluteal dermis fat graft with and without kinesiotaping

Purpose

To compare gluteal wound healing after dermis fat graft (DFG) implantation in patients with and without local application of kinesiotapes.

Methods

In this prospective, single-center analysis, 16 patients who underwent DFG implantation were randomized in two groups. Wound healing was compared 4–6 weeks after therapy and 3 months later (after application of 2 cycles of kinesiotaping for 2–3 weeks in the case and no specific therapy in the control group). Demographic data, patient content and wound healing were assessed. Scarring was graded (0–3) by evaluation of photodocumentation by 2 blinded, independent observers.

Results

Mean scar grading by both observers decreased from 2.31 ± 0.48 to 1.13 ± 0.72 in the case and from 2.38 ± 0.52 to 1.44 ± 0.50 in the control group with interobserver agreement on scar grading being substantial to almost perfect in both groups. Scar length decreased significantly in both groups (p = 0.008). Scar prominence decreased in 2/3 of cases in the case and 1/3 in the control group. Scar coloring significantly improved in the case group alone (p = 0.031).

Conclusion

No functionally impairing or painful scar developed. No adverse effects occurred after kinesiotaping. Gluteal scars shortened significantly over time and were significantly paler in the case group. Kinesiotaping may improve scar elevation over no specific scar therapy.

The effect of a silver hydrogel sheet dressing on postsurgical incision healing after foot and ankle surgery

Introduction

Silver hydrogel dressings are antimicrobial dressings with the potential to aid post-surgical healing. The purpose of this study is to evaluate the effects of a silver hydrogel dressing on postoperative scarring and complications.

Methods

40 foot and ankle patients (48.43 ± 16.82 years) were included in the study with 20 patients in each group. Postoperatively, the treatment group was treated with a silver hydrogel sheet dressing, and the control group was treated with a standard petroleum-based dressing. Follow-up was performed at two, six, and 12 weeks. Postoperative scarring and complications were evaluated and compared between groups. Scarring was evaluated using the Patient and Observer Scar Assessment Scale (POSAS). Scar length and width were measured using digital calipers and used to compute scar area.

Results

The treatment group demonstrated statistically significant improvements in the POSAS observer score and observer opinion at six and 12 weeks (p < 0.001). Additionally, patient reported pain was significantly lower for the treatment group than the control group at 12 weeks (p < 0.001). Patient reported itch declined across time for both groups (p < 0.001) with significantly less itching reported by the treatment group (p = 0.027). Scar area was also significantly lower for the treatment group than the control group at six weeks and 12 weeks (p ≤ 0.002). Neither group experienced any postoperative complications.

Conclusion

These results suggest that the inherent properties of the silver hydrogel dressing may improve postsurgical scarring.

Lay Summary

Surgical incisions result in scar, which can present both cosmetic and rehabilitation concerns after foot or ankle surgery. It is standard to use a petroleum-based dressing on incisions after surgery, however, advancements in incisional dressings have been made over the past 20 years. One such advancement is silver-impregnated hydrogel sheet dressings which have been shown to maintain a moist wound environment conducive to healing, while decreasing the chance of infection through its antimicrobial properties. This paper evaluates scar healing after foot or ankle surgery in patients treated with either the standard petroleum-based dressing, or the silver hydrogel sheet dressing. Patients who were treated with the silver hydrogel dressing had less itching and pain, as well as a smaller scar area than patients in the standard dressing group. Therefore, our results suggest that the silver hydrogel dressing may improve scarring after surgery.

Efficacy and safety of pulsed dye laser for the treatment of surgical scars: a systematic review and meta-analysis

Various clinical trials have explored whether the pulsed dye laser (PDL) method is safe to treat scars, especially surgical scars. However, comprehensive evidence confirming the exact outcomes of PDL for treating surgical scars is lacking. The efficacy and safety of PDL in the treatment of surgical scars were determined through a review of several studies. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched, and the main clinical outcomes were Vancouver Scar Scale (VSS) scores in terms of pigmentation, vascularity, pliability, and height. Review Manager 5.4 software was used for statistical analyses of the data; we chose a standardized mean difference (SMZ) to present the results with 95% confidence interval (CI). Overall, seven randomized controlled trials were used for this meta-analysis, all of these papers used 585 nm or 595 nm PDL with 7 mm or 10 mm spot size and a fluence of 3.5 to 10 J/cm² for treating surgical scars; besides, the pulse duration ranged from 450 μs to 10 ms. We found that PDL significantly resulted in decreased VSS scores (P = 0.02) in four aspects: pigmentation (P = 0.0002), vascularity (P < 0.00001), pliability (P = 0.0002), and height (P = 0.0002). Moreover, scar improvement was similar when using 585 nm and 595 nm PDL in terms of pigmentation (P = 0.76), vascularity (P = 0.34), pliability (P = 0.64), and height (P = 0.57). Furthermore, our review indicated that PDL has no obvious adverse effects for most people, except transitory erythema and purpura. The meta-analysis showed that both 585 nm and 595 nm PDL therapy can effectively reduce the VSS score, suggesting that PDL can be a safe and effective method for the treatment of surgical scars.

The connexin 43 carboxyl terminal mimetic peptide αCT1 prompts differentiation of a collagen scar matrix in humans resembling unwounded skin

Phase II clinical trials have reported that acute treatment of surgical skin wounds with the therapeutic peptide alpha Connexin Carboxy-Terminus 1 (αCT1) improves cutaneous scar appearance by 47% 9-month postsurgery. While Cx43 and ZO-1 have been identified as molecular targets of αCT1, the mode-of-action of the peptide in scar mitigation at cellular and tissue levels remains to be further characterized. Scar histoarchitecture in αCT1 and vehicle-control treated skin wounds within the same patient were compared using biopsies from a Phase I clinical trial at 29-day postwounding. The sole effect on scar structure of a range of epidermal and dermal variables examined was that αCT1-treated scars had less alignment of collagen fibers relative to control wounds-a characteristic that resembles unwounded skin. The with-in subject effect of αCT1 on scar collagen order observed in Phase I testing in humans was recapitulated in Sprague-Dawley rats and the IAF hairless guinea pig. Transient increase in histologic collagen density in response to αCT1 was also observed in both animal models. Mouse NIH 3T3 fibroblasts and primary human dermal fibroblasts treated with αCT1 in vitro showed more rapid closure in scratch wound assays, with individual cells showing decreased directionality in movement. An agent-based computational model parameterized with fibroblast motility data predicted collagen alignments in simulated scars consistent with that observed experimentally in human and the animal models. In conclusion, αCT1 prompts decreased directionality of fibroblast movement and the generation of a 3D collagen matrix postwounding that is similar to unwounded skin-changes that correlate with long-term improvement in scar appearance.

Scar Revisions

Scars pose a complex challenge to the reconstructive surgeon in the variability of their presentation and their effect on cosmesis and function. Numerous surgical and nonsurgical options exist for scar management, each with their respective advantages and disadvantages. Each treatment modality should be tailored to the patient to ensure enhanced outcomes. In this review, we discuss different scar presentations, scar management options, and the benefits and risks with undergoing these various treatment modalities.

Scar tissue I wish you saw: Patient expectations regarding scar treatment

Although many invasive and noninvasive approaches exist, management of keloids and hypertrophic scars remains challenging. By better understanding patient expectations regarding scar treatments, dermatologists can provide higher quality and more satisfying care. Survey patients age 18 to 80 years with a history of hypertrophic, keloid, or disfiguring scars. Overall, 187 participants completed the 25-question survey. Expectations and willingness were measured on a 1-5 Likert scale. Results were analyzed overall and by patient demographics. Older respondents more often expected scar reduction, while younger patients expected scar removal. Compared with Caucasians, Asian respondents were more symptomatic, more likely to have seen a physician, and more willing to undergo invasive therapies. Respondent willingness for treatment and their perceived efficacy significantly differed across gender, age, and race. This study explores a gap in the literature of what role patient expectations play in electing specific treatments. Although patient expectations are complex and context dependent, gaining more understanding of what therapies patients are willing to attempt, and their expectations from those therapies could help guide counseling with the goal setting realistic expectations to improve patient compliance and satisfaction.

Dynamics of the Activity of MAP-Kinase Cascades in the Healing Process of Postoperative Musculocutaneous Wounds

Background. Management of the reparative process is an urgent task of modern medicine. In our opinion, the development of pathogenetically grounded approaches to optimizing the repair process for managing the interrelations of stromal cells is promising. One of the promising areas in this regard is the impact on the MAPK-cascades.Aim: to study the expression of MAP-kinase mechanisms in the regulation of repair by the example of a musculocutaneous wound.Methods. A linear muscular skin wound was modeled using Wistar rats weighing 220–250 g at the age of 9 months (n = 24). Immunofluorescence staining was performed to detect the activity of p38, JNK, and ERK MAPK cascades from 1 to 30 days.Results. It was established that specific staining in the area of connective tissue formation during staining with p38 MAPK and its phosphorylated form was first observed on the 3rd day, and its maximum severity occurred at the same time. On the 7th and 14th day, small zones in the area of scar formation were minimally stained. The phosphorylated part of the JNK-cascade in the zone of traumatic injury was detected starting from the 1st day after the injury. Bright color persisted on the 3rd day. On the 7th day, the color was minimal, and by the 14th day a second wave of expression was observed. ERK-staining was observed from the 1st to the 14th day with a peak activity on the 3rd day.Conclusion. Thus, we revealed the simultaneous involvement of p38, JNK-, and ERK-cascades in the regulation of the reparative process in the conditions of a musculoskeletal wound. At the same time, it is noteworthy that the peak activity of all cascades coincides and falls on the 3rd day.