1
|
Mota WM, Salles AG, Remigio AFDN, Gemperli R, Alonso N. Microneedling in the Treatment of Post-burn Hypertrophic Scars. Aesthetic Plast Surg 2024; 48:2321-2329. [PMID: 38238571 DOI: 10.1007/s00266-023-03820-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/14/2023] [Indexed: 07/10/2024]
Abstract
INTRODUCTION Post-burn hypertrophic scars are an important cause of physical discomfort, limitation of movements, psychological disorders, low self-esteem and reduced quality of life. Treatment for this condition is complex and involves several options. Microneedling, also known as minimally invasive percutaneous collagen induction, is an affordable minimally invasive option that can be combined with other treatments, including ablative ones. OBJECTIVE The goal of this study was to present our microneedling approach for the treatment of hypertrophic scars after burns. METHOD A prospective study of 15 patients with post-burn hypertrophic scars was conducted between October 2016 and June 2022. All patients were treated with microneedling and drug delivery of triamcinolone. Scars were evaluated using Vancouver Scar Scale (VSS), Burn Scar Assessment Scale (BSAS) and angle measurement for amplitude of movement evaluation of joints. RESULTS A significant improvement in the VSS score was obtained after microneedling (8.8 ± 0.44 to 4.1 ± 0.98; p = 0.012), especially in the acute group (less than 1 year after burns): 9.3 ± 0.49 to 3.5 ± 1.36; p = 0.041. There was a significant and progressive improvement of the scars throughout the treatment sessions in all criteria evaluated and in the ranges of joint movement (p = 0.012). CONCLUSION Our microneedling protocol promoted a significant improvement of post-burn scars, especially in acute hypertrophic scars, and in the amplitude of joint motion. Sequential treatments provided progressive improvement. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Wellington Menezes Mota
- Division of Plastic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil
- Sociedade Brasileira de Cirurgia Plástica (SBCP), São Paulo, Brazil
| | - Alessandra Grassi Salles
- Division of Plastic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil.
- Sociedade Brasileira de Cirurgia Plástica (SBCP), São Paulo, Brazil.
| | - Adelina Fátima do Nascimento Remigio
- Division of Plastic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil
- Sociedade Brasileira de Cirurgia Plástica (SBCP), São Paulo, Brazil
| | - Rolf Gemperli
- Division of Plastic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil
- Sociedade Brasileira de Cirurgia Plástica (SBCP), São Paulo, Brazil
| | - Nivaldo Alonso
- Division of Plastic Surgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Av. Dr. Enéas de Carvalho Aguiar, 255, São Paulo, 05403-000, Brazil
- Sociedade Brasileira de Cirurgia Plástica (SBCP), São Paulo, Brazil
| |
Collapse
|
2
|
Wang C, Jiang D. Exogenous PRAS40 reduces KLF4 expression and alleviates hypertrophic scar fibrosis and collagen deposition through inhibiting mTORC1. Burns 2024; 50:936-946. [PMID: 38369439 DOI: 10.1016/j.burns.2024.01.026] [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: 07/31/2023] [Revised: 01/12/2024] [Accepted: 01/30/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND To identify the anti-fibrosis effect of PRAS40 in scar, and its potential mechanism. METHODS We constructed a rat model of hypertrophic scarthat was locally injected the PRAS40 overexpression adenoviruses, mTORC1 inhibitor MHY1485 and activator rapamycin, and further observed the pathological changes of skin tissue and the severity of fibrosis by HE, Masson and sirius red staining, and analyzed the deposition of a-SMA and collagen I by western blot and immunofluorescence test. Meanwhile, the co-localization of KLF4 with a-SMA and type I collagen was analyzed, as well as the regulatory effect of PRAS40 on KLF4. In addition, we also verified whether the inhibition of scar fibrosis by PRAS40 is related to mTORC1, and whether the upregulation of KLF4 is related to mTORC1. RESULTS The results showed that the expression of PRAS40 was low and p-PRAS40 was high in scar skin tissue. After local injection of PRAS40 overexpression adenovirus, the expression of PRAS40 in skin tissue was increased. The overexpression of PRAS40 can inhibit scar skin fibrosis and reduce the content of a-SMA and collagen I. Further mechanism analysis confirms that the inhibitory effect of PRAS40 on skin fibrosis is related to mTORC1, and PRAS40 inhibits the activation of mTORC1. The expression of KLF4 is relatively low in scar tissue. PRAS40 administration upregulated the expression of KLF4, which is related to mTORC1 CONCLUSIONS: PRAS40 significantly improves fibrosis of scar skin tissue and increases the expression of KLF4 in scars. The anti-fibrotic effect of PRAS40 depends on mTORC1.
Collapse
Affiliation(s)
- Chao Wang
- Department of Burn and Plastic Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China
| | - Duyin Jiang
- Department of Burn and Plastic Surgery, The Second Hospital of Shandong University, Jinan, Shandong, 250033, China.
| |
Collapse
|
3
|
Denadai R, Araujo KM, Campos RL, Lo CC, Seo HJ, Sato N, Tu JCY, Chou PY, Lo LJ. Scar Outcome in Unilateral Complete Cleft Lip Repair: A Comparative Analysis of Vertical Lip Lengthening Strategies Using the Rotation-Advancement Concept. Cleft Palate Craniofac J 2024:10556656241247625. [PMID: 38646778 DOI: 10.1177/10556656241247625] [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: 04/23/2024] Open
Abstract
OBJECTIVE To assess the differences in scar outcomes between modified rotation-advancement techniques proposed by Drs. Mohler and Noordhoff, designed to address issues such as inadequate vertical lip length and scarring on the upper third of the lip in the original rotation-advancement technique. DESIGN Retrospective single-surgeon (RD) study. PATIENTS Consecutive non-syndromic children (n = 68) with unilateral complete cleft lip and palate. INTERVENTIONS Modified Mohler (columellar backcut reconstructed with C flap; n = 34) and modified Noordhoff (lower, medially-created backcut reconstructed with laterally-based triangular skin flap; n = 34) repairs. MEAN OUTCOME MEASURES Using 12-month postoperative frontal photographs, scar evaluations (overall and superior, middle, and inferior portions of the lip) were appraised by an assessment panel composed by independent professional and nonprofessional raters employing four validated qualitative scar assessment scales: Manchester Scar Scale, modified Scar-Rating Scale, Stony Brook Scar Evaluation Scale, and Visual Analog Scale. Quantitative computerized photogrammetric scar widths of the superior, middle, and inferior portions of the upper lip were also measured. RESULTS The modified Noordhoff method showed significantly (all P < .001) better scar quality for the overall scar and superior portion of the scar in all four scales compared to the modified Mohler method, with no significant (all P > .05) difference for the middle and lower portions. No significant difference (all P > .05) was observed for photogrammetric scar width measurements. CONCLUSION The modified Noordhoff technique provided better qualitative results for unilateral complete cleft lip-related scars compared to the modified Mohler technique.
Collapse
Affiliation(s)
- Rafael Denadai
- Plastic and Cleft-Craniofacial Surgery, A&D DermePlastique, Sao Paulo, Brazil
| | | | | | - Chi-Chin Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Hyung Joon Seo
- Department of Plastic and Reconstructive Surgery, Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Nobuhiro Sato
- Department of Plastic and Reconstructive Surgery, Showa University Fujigaoka Hospital, Kanagawa, Japan
| | - Junior Chun-Yu Tu
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Pang-Yung Chou
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| | - Lun-Jou Lo
- Department of Plastic and Reconstructive Surgery, Craniofacial Research Center, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan
| |
Collapse
|
4
|
Meikle B, Simons M, Mahoney T, Reddan T, Dai B, Kimble RM, Tyack Z. Ultrasound measurement of traumatic scar and skin thickness: a scoping review of evidence across the translational pipeline of research-to-practice. BMJ Open 2024; 14:e078361. [PMID: 38594186 PMCID: PMC11015304 DOI: 10.1136/bmjopen-2023-078361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES To identify the ultrasound methods used in the literature to measure traumatic scar thickness, and map gaps in the translation of these methods using evidence across the research-to-practice pipeline. DESIGN Scoping review. DATA SOURCES Electronic database searches of Ovid MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature and Web of Science. Grey literature searches were conducted in Google. Searches were conducted from inception (date last searched 27 May 2022). DATA EXTRACTION Records using brightness mode (B-mode) ultrasound to measure scar and skin thickness across the research-to-practice pipeline of evidence were included. Data were extracted from included records pertaining to: methods used; reliability and measurement error; clinical, health service, implementation and feasibility outcomes; factors influencing measurement methods; strengths and limitations; and use of measurement guidelines and/or frameworks. RESULTS Of the 9309 records identified, 118 were analysed (n=82 articles, n=36 abstracts) encompassing 5213 participants. Reporting of methods used was poor. B-mode, including high-frequency (ie, >20 MHz) ultrasound was the most common type of ultrasound used (n=72 records; 61% of records), and measurement of the combined epidermal and dermal thickness (n=28; 24%) was more commonly measured than the epidermis or dermis alone (n=7, 6%). Reliability of ultrasound measurement was poorly reported (n=14; 12%). The scar characteristics most commonly reported to be measured were epidermal oedema, dermal fibrosis and hair follicle density. Most records analysed (n=115; 97%) pertained to the early stages of the research-to-practice pipeline, as part of research initiatives. CONCLUSIONS The lack of evaluation of measurement initiatives in routine clinical practice was identified as an evidence gap. Diverse methods used in the literature identified the need for greater standardisation of ultrasound thickness measurements. Findings have been used to develop nine methodological considerations for practitioners to guide methods and reporting.
Collapse
Affiliation(s)
- Brandon Meikle
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
| | - Megan Simons
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Occupational Therapy, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Tamsin Mahoney
- Surgical, Treatment and Rehabilitation Services (STARS), Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Tristan Reddan
- Medical Imaging and Nuclear Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bryan Dai
- The University of Queensland, Saint Lucia, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Zephanie Tyack
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Australian Centre for Health Service Innovation (AusHI), Centre for Healthcare Transformation, and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
5
|
Kennedy DL, Hettiaratchy S, Alexander CM. Clinical evaluation of post-surgical scar hyperaesthesia: a longitudinal observational pilot study. Scars Burn Heal 2024; 10:20595131241230742. [PMID: 38450365 PMCID: PMC10916468 DOI: 10.1177/20595131241230742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Introduction The mechanisms underlying persistent scar pain are not fully elucidated and evidence for the clinical evaluation of scar pain is limited. This pilot observational study investigated participation data and sought to identify objective clinical scar evaluation measures for future trials. Methods With ethical approval and consent, adults undergoing planned hand surgery were enrolled from one NHS hospital. At 1- and 4-months post-surgery scar thermal and mechanical pain thresholds were evaluated with quantitative sensory testing; peri-scar inflammation with infrared thermometry and pliability with durometry. Participation data were analysed with descriptive statistics; the association of clinical measures with patient reported scar pain was analysed. Results Twenty-one participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No adverse events or dropouts resulted from clinical scar evaluation. Seventy percent of participants reported undertaking topical, nonprescription scar treatment independently. Neuropathic Pain Symptom Inventory (NPSI) scores were dispersed across the score range, capturing variability in participant-reported scar symptoms. Scar morphology, pliability and inflammation were not associated with scar pain. Differences between scar and contralateral skin in thermal and mechanical pain sensitivity were identified. Conclusion People with acute hand scars participate in clinical research and independently initiate scar treatment. Clinical testing of acute post-surgical hand scars is well tolerated. The NPSI demonstrates utility for exploring scar pain symptoms and may support the elucidation of mechanisms of persistent scar pain. Clinical tests of thermal and mechanical and sensitivity are promising candidate clinical measures of scar pain for future trials. Lay Summary Background: it is unknown why some scars remain painful long-term. We do not know if scar flexibility, inflammation or sensitivity to temperature or pressure relate to scar pain. We investigated if patients would enrol in scar research, if scar testing was tolerated and if clinical tests are useful for future scar studies. Study conduct: with ethical approval and consent, adult hand surgery patients were enrolled from one NHS hospital. Scar pain, inflammation and response to thermal, sharp and pressure tests were assessed at 1- and 4-months after surgery. Statistically, we analysed study participation, tolerance for clinical scar tests and if the scar tests related to scar pain. Findings: 21 participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No participants were injured due to scar testing. 70% of participants reported treating their scar independently. Neuropathic Pain Symptom Inventory (NPSI) allows participants to give a broad range of answers about their scar symptoms. Scores for clinical tests of scar flexibility and inflammation did not relate to participant-reported scar pain. Scars were more sensitive to tests of pin prick and cold than unaffected skin. What we learned: people with new hand scars participate in research and independently initiate scar treatment. Clinical testing of post-surgical hand scars is well tolerated. The NPSI is useful for exploring scar pain symptoms and may help us to learn about persistent scar pain. Pinprick and cold clinical tests may be useful objective pain tests for future scar research.
Collapse
Affiliation(s)
- Donna L. Kennedy
- Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Human Performance Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Shehan Hettiaratchy
- Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Caroline M. Alexander
- Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Human Performance Group, Department of Surgery and Cancer, Imperial College London, London, UK
| |
Collapse
|
6
|
Doomen MCHA, Rijpma D, Pijpe A, Meij-de Vries A, Niessen FB, Karaoglu S, de Vet HCW, Gevers T, van Zuijlen PPM. A clinimetric assessment of the validity and reliability of 3D technology for scar surface area measurement. Burns 2022; 49:583-594. [PMID: 36764836 DOI: 10.1016/j.burns.2022.12.008] [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: 11/11/2021] [Revised: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The quality of scars has become an important outcome of burn care. Objective scar assessment through scar surface area measurement enables quantification of scar formation and evaluation of treatment efficacy. 3D technology has proven valid and reliable but often remains cumbersome, expensive, and time-consuming. 3D technology with depth sensors on mobile devices has become available and might surpass these limitations. This study provides a clinimetric assessment of the validity and reliability of a 3D system with a depth sensor for scar surface area measurement. METHODS A technology involving a depth sensor mounted on a mobile device was used. Images and analyses were made with a custom-made software application. A standardized one-keyframe image capturing procedure was followed. To assess validity, stickers with predefined dimensions (8.01 cm2 - 77.70 cm2) were imaged in a single observer setting on various body parts of healthy volunteers. To assess reliability, hypertrophic scars, keloids, and normotrophic scars were imaged and rated by two observers independently. Data are expressed as mean (+/-SD), Coefficient of Variation (CV), Intraclass Correlation Coefficients (ICC), and Limits of Agreements (LoA). RESULTS Eighty stickers placed on 20 healthy volunteers showed validity with CV between 0.62%- 1.67% for observer A and 0.75%- 1.19% for observer B. For the reliability study, 69 scars on 36 patients were included. Mean scar surface area ranged from 0.83 cm2 to 155.59 cm2. Mean scar surface area measurement was 13.83 cm2 (SD 23.06) for observer A and 13.59 cm2 (SD 23.31) for observer B. Adjusted interobserver CV for trained observers is estimated as 5.59%, with corresponding LoA = 0 ± 0.15 x mean surface area. Interobserver ICCs were 0.99-1.00. CONCLUSION This 3D technology with a depth sensor for measuring scar surface area provides valid and reliable data and thereby surpasses expensive and time-consuming 3D cameras.
Collapse
Affiliation(s)
- M C H A Doomen
- Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Association of Dutch Burn Centers, Beverwijk 1941 AJ, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, the Netherlands
| | - D Rijpma
- Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, the Netherlands.
| | - A Pijpe
- Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, the Netherlands
| | - A Meij-de Vries
- Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Department of Surgery, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location University of Amsterdam, Paediatric Surgical Centre, Emma Children's Hospital, Meibergdreef 9, Amsterdam, Netherlands
| | - F B Niessen
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, Netherlands
| | - S Karaoglu
- 3DUniversum, 1098 XH Amsterdam, the Netherlands
| | - H C W de Vet
- Amsterdam UMC location Vrije Universiteit Amsterdam, Epidemiology and Data Science, De Boelelaan1117, Amsterdam, the Netherlands
| | - T Gevers
- 3DUniversum, 1098 XH Amsterdam, the Netherlands
| | - P P M van Zuijlen
- Burn Center, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Plastic Reconstructive and Hand Surgery, De Boelelaan 1117, Amsterdam, Netherlands; Amsterdam UMC location University of Amsterdam, Paediatric Surgical Centre, Emma Children's Hospital, Meibergdreef 9, Amsterdam, Netherlands; Department of Plastic, Reconstructive & Hand Surgery, Red Cross Hospital, Beverwijk, the Netherlands; Amsterdam Movement Sciences, Tissue Function and Regeneration, Amsterdam, the Netherlands.
| |
Collapse
|
7
|
Li S, Zhang M, Long X, Wang X. Relative perfusion index: An objective, quantitative and noninvasive method for evaluating the severity of keloids. Lasers Surg Med Suppl 2022; 54:1071-1081. [PMID: 35822861 DOI: 10.1002/lsm.23579] [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: 01/20/2022] [Revised: 05/11/2022] [Accepted: 06/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Keloids are the result of abnormal wound healing, and they differ from the normal skin of the patient in the level of blood perfusion and the degrees of inflammation, hypoxia, regeneration of vessels, and expression of sensory receptors. However, there is no objective assessment method to accurately characterize the severity of keloids. OBJECTIVES The purpose of this study was to evaluate the perfusion levels of keloids and the expression levels of various internal cytokines, including hypoxia-induced factor-1α (HIF-1α), vascular endothelial growth factor (VEGF), interleukin-17 (IL-17), HT2A receptor subtype (5-HT2A R), and H1R, in keloids and nonadjacent normal skin and to propose a laser speckle contrast imaging (LSCI)-based relative perfusion index (RPI), through which keloids can be divided into five grades to objectively characterize their severity. METHODS This population-based cross-sectional study included 70 untreated keloid patients who each had only one keloid on the chest. LSCI was used to measure the area of each patient's keloid ( K area ${K}_{\mathrm{area}}$ ) and the perfusion level of each patient's keloid ( K perfusion ${K}_{\mathrm{perfusion}}$ ) and normal skin ( N perfusion ${N}_{\mathrm{perfusion}}$ ). The Vancouver Scar Scale (VSS) and Visual Analog Scale (VAS) for pain and pruritus were also used to assess each keloid. Immunohistochemistry and Western blot were used to detect the expression levels of various internal cytokines in keloids and normal skin. We compared the perfusion and expression levels of intrinsic cytokines between keloids and normal skin. We established the RPI to grade the severity of keloids and applied different methods to test the utility of the RPI. RESULTS The mean perfusion level of keloids was significantly higher than that of normal skin (p < 0.001). The expression levels of HIF-1α, VEGF, IL-17, 5-HT2A R, and H1R in keloids were significantly higher than those in normal skin (p < 0.05). RPI was defined as: [ ( K perfusion - N perfusion ) × 0.03 + K area × 0.001 ] . $[({K}_{\mathrm{perfusion}}-{N}_{\mathrm{perfusion}})\times 0.03+{K}_{\mathrm{area}}\times 0.001].$ The severity of keloids could be divided into five grades based on RPI. The RPI had a higher correlation with the pain-VAS, pruritus-VAS, and the expression levels of internal cytokines in keloids than blood perfusion levels and the VSS. T-SNE (t-distributed stochastic neighbor embedding) was also used to verify the clinical discriminatory abilities of this RPI model. CONCLUSIONS The proposed RPI based on LSCI showed the highest accuracy, unlike the VSS and assessment of perfusion, and can be utilized as a reliable, objective, quantitative, and noninvasive tool to evaluate the severity of keloids.
Collapse
Affiliation(s)
- Shuo Li
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mingzi Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao Long
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
8
|
Pan Y, Jia K, Yan S, Jiang X. Effectiveness of VISIA system in evaluating the severity of rosacea. Skin Res Technol 2022; 28:740-748. [PMID: 35818722 PMCID: PMC9907647 DOI: 10.1111/srt.13194] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/19/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Rosacea is a facial chronic inflammatory skin disease with almost 5.5% prevalence. Although there are various scales of rosacea, they are objective and discordant among different dermatologists. Noninvasive objective measurements such as VISIA system might play essential roles in the diagnosis and evaluation of rosacea. Here, we intended to reveal the effectiveness of VISIA system in rosacea. MATERIALS AND METHODS A number of 563 participants diagnosed with facial rosacea were enrolled in study. They all received both full-face image-shoot by VISIA system with quantitative analysis software and physician's assessment via five different scales, including investigator global assessment (IGA), clinician erythema assessment (CEA), numerical score, the National Rosacea Society (NRS) grading system and telangiectasis. RESULTS Absolute score and percentile of red area had significant correlations with IGA and CEA, whereas red area had no significant correlation with numerical score, NRS and telangiectasis. Red area in erythematotelangiectatic rosacea patients demonstrated the highest correlation with IGA and CEA, especially in those aged between 51 and 60. Besides red area, pigmentation parameters in VISIA system (brown spot) also showed significant correlation with IGA and CEA. CONCLUSION VISIA system might be an effective measurement in the assessment of rosacea severity.
Collapse
Affiliation(s)
- Yu Pan
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Kaiyu Jia
- Laboratory of Dermatology, Clinical Institute of Inflammation and Immunology, Frontiers Science Center for Disease-related Molecular Network, West China Hospital, Sichuan University, Chengdu, China
| | - Sihan Yan
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| | - Xian Jiang
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
9
|
Li S, Wang H, Xiao Y, Zhang M, Yu N, Zeng A, Wang X. A Workflow for Computer-Aided Evaluation of Keloid Based on Laser Speckle Contrast Imaging and Deep Learning. J Pers Med 2022; 12:jpm12060981. [PMID: 35743764 PMCID: PMC9224605 DOI: 10.3390/jpm12060981] [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: 04/24/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
A keloid results from abnormal wound healing, which has different blood perfusion and growth states among patients. Active monitoring and treatment of actively growing keloids at the initial stage can effectively inhibit keloid enlargement and has important medical and aesthetic implications. LSCI (laser speckle contrast imaging) has been developed to obtain the blood perfusion of the keloid and shows a high relationship with the severity and prognosis. However, the LSCI-based method requires manual annotation and evaluation of the keloid, which is time consuming. Although many studies have designed deep-learning networks for the detection and classification of skin lesions, there are still challenges to the assessment of keloid growth status, especially based on small samples. This retrospective study included 150 untreated keloid patients, intensity images, and blood perfusion images obtained from LSCI. A newly proposed workflow based on cascaded vision transformer architecture was proposed, reaching a dice coefficient value of 0.895 for keloid segmentation by 2% improvement, an error of 8.6 ± 5.4 perfusion units, and a relative error of 7.8% ± 6.6% for blood calculation, and an accuracy of 0.927 for growth state prediction by 1.4% improvement than baseline.
Collapse
Affiliation(s)
- Shuo Li
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (S.L.); (Y.X.); (M.Z.); (N.Y.); (A.Z.)
| | - He Wang
- Department of Neurological Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China;
| | - Yiding Xiao
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (S.L.); (Y.X.); (M.Z.); (N.Y.); (A.Z.)
| | - Mingzi Zhang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (S.L.); (Y.X.); (M.Z.); (N.Y.); (A.Z.)
| | - Nanze Yu
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (S.L.); (Y.X.); (M.Z.); (N.Y.); (A.Z.)
| | - Ang Zeng
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (S.L.); (Y.X.); (M.Z.); (N.Y.); (A.Z.)
| | - Xiaojun Wang
- Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China; (S.L.); (Y.X.); (M.Z.); (N.Y.); (A.Z.)
- Correspondence:
| |
Collapse
|
10
|
Gronovich Y, Maisel Lotan A. Treatment of scars with autologous fat grafting and 1540 nm non-ablative erbium laser. J COSMET LASER THER 2022; 24:80-83. [PMID: 35318875 DOI: 10.1080/14764172.2022.2055078] [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: 10/18/2022]
Abstract
Scars may be devastating for patients. Fat grafting and non-ablative lasers are available options for improvement. The former reshapes and improves scar quality by adding volume and regenerative adipose-derived stem cells, whereas the latter facilitates synthesis and deposition of new dermal collagen. The combination may be synergic, leading to better cosmetic outcome.This was a prospective study of 16 consecutive patients treated with autologous fat grafting and non-ablative 1540-nm erbium laser for facial scars between January 2015 and December 2015. Treatment protocol included fat injection followed by five treatments with 1540-nm erbium laser (ICONTM Cynosure; Westford, MA, USA) a month later. We evaluated patients before, after treatments, and 6 months after the final treatment.Sixteen patients participated in our study. Mean patient age was 42 years (range 16-59 years). Scars were either traumatic (73%) or acne induced (27%). Traumatic scars were mainly new scars, with the majority of patients were treated within 30 days of injury. There were no reported complications. Scars improved in both texture and appearance and patient satisfaction was high in all cases.Treatment of scars with autologous fat grafting and fractional non-ablative 1540-nm erbium laser is safe and efficient and results in improved scar appearance and texture.
Collapse
Affiliation(s)
- Yoav Gronovich
- Hebrew University, Jerusalem, Israel.,Department of Plastic and Reconstructive Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Adi Maisel Lotan
- Hebrew University, Jerusalem, Israel.,Department of Plastic and Reconstructive Surgery, Shaare Zedek Medical Center, Jerusalem, Israel
| |
Collapse
|
11
|
Ud-Din S, Bayat A. Noninvasive Objective Tools for Quantitative Assessment of Skin Scarring. Adv Wound Care (New Rochelle) 2022; 11:132-149. [PMID: 33966482 DOI: 10.1089/wound.2020.1387] [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: 11/13/2022] Open
Abstract
Significance: Many treatments are utilized in the management of skin scarring; however, difficulties arise due to the high rates of recurrence and the identification of treatment efficacy in each patient, in particular, in the case of raised dermal scarring. Therefore, evaluation of treatments and the provision of objective scar assessment pre-therapy and post-therapy is of paramount importance to identify changes in scar characteristics using noninvasive devices. Recent Advances: There have been a number of emerging noninvasive objective quantitative devices, which assess specific scar parameters such as pliability, volume, color, perfusion, and depth. These can include three-dimensional imaging, optical coherence tomography, in vivo confocal microscopy, full-field laser perfusion imaging, and spectrophotometric intracutaneous analysis. Critical Issues: Clinical assessment and grading scales are most commonly used to assess scarring; however, there is a need for more objective quantitative measures to monitor their maturation and response to therapy. Currently, there is no consensus as to which objective measuring device is most optimal when assessing skin scarring. There is a need for a predictor tool that allows early implementation of treatment and addresses diagnosis, therapy, and prognosis. Future Directions: Validation of noninvasive objective scar assessment tools is essential as well as further development of technologies. There are currently more modalities that assess physical scar characteristics and only few that measure the physiological parameters. Therefore, the development of a technology that quantifies the metabolic and cellular activity in skin scars is necessary to allow for bespoke strategies for each patient.
Collapse
Affiliation(s)
- Sara Ud-Din
- Plastic and Reconstructive Surgery Research, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, England, United Kingdom
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, England, United Kingdom
- MRC-SA Wound Healing Unit, Division of Dermatology, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
12
|
Cox C, Bettiol P, Le A, MacKay BJ, Griswold J, McKee D. CO 2 laser resurfacing for burn and traumatic scars of the hand and upper extremity. Scars Burn Heal 2022; 8:20595131211047694. [PMID: 35003761 PMCID: PMC8738873 DOI: 10.1177/20595131211047694] [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] [Indexed: 11/17/2022] Open
Abstract
Background Scar formation is a normal part of the proliferative phase in wound healing where collagen is remodelled to better approximate normal skin. When collagen is not effectively redistributed, excessive scarring may occur. Recently, CO2 laser has emerged as an adjunct in improving scar quality via remodelling and redistribution of dermal collagen fibres. Due to the paucity of literature related to its use in the hands and upper extremities, we created a study to examine its effects on hypertrophic scars focused on the hands and upper extremities. Methods Patients treated with CO2 laser for hypertrophic scars of the hand and upper extremity were included. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) were used to assess the progression of scar quality. Unpaired t-tests were performed to determine statistical difference between pre- and post-treatment scores on each scale. Pearson correlation coefficients were used to understand the relationship between number of treatments and scar quality. Results Of the 90 patients enrolled, 54 patients completed serial scar assessment forms. All patient and observer-reported POSAS domains showed improvement (P < 0.05) apart from Itching. All VSS domains showed improvement (P < 0.05). There was moderate correlation between overall patient-reported opinion of scar quality and Discoloration, Stiffness and Thickness, and strong correlation between overall patient opinion and Irregularity (r = 0.715). All observer-reported domains were strongly correlated (r = 7.56–8.74) with overall observer opinion of scar quality. Conclusion The results of this study may further substantiate CO2 laser as a treatment modality for excessive scarring in a variety of surgical subspecialties. Lay Summary Complex trauma and burns that impact the skin sometimes result in abnormal healing of the skin called, “hypertrophic scarring”. In our study we assessed how using focused CO2 laser therapy impacts patients and health care provider assessment of wound progression. Our results were based upon patient reported and healthcare provider observations based upon two standardized forms the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). What we found is that after CO2 Laser Therapy, our 64 patients with 77 treated scars received on average almost 3 treatments and these treatments helped them with physical function and improved aesthetic appearance of their scars. The health care providers also found that the treatments improved functional and aesthetic end points. Overall, our study helps substantiate the body of evidence that using CO2 laser therapy improves aesthetics and function of hypertrophic scars in the upper extremity.
Collapse
Affiliation(s)
- Cameron Cox
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Patrick Bettiol
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Audrey Le
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Brendan J MacKay
- Texas Tech University Health Sciences Center, Lubbock, TX, USA.,University Medical Center, Lubbock, TX, USA
| | - John Griswold
- Texas Tech University Health Sciences Center, Lubbock, TX, USA.,University Medical Center, Lubbock, TX, USA
| | - Desirae McKee
- Texas Tech University Health Sciences Center, Lubbock, TX, USA.,University Medical Center, Lubbock, TX, USA
| |
Collapse
|
13
|
Wang P, Zhao Y, Wang J, Wu Z, Sui B, Mao X, Shi S, Kou X. Dephosphorylation of Caveolin-1 Controls C-X-C Motif Chemokine Ligand 10 Secretion in Mesenchymal Stem Cells to Regulate the Process of Wound Healing. Front Cell Dev Biol 2021; 9:725630. [PMID: 34790658 PMCID: PMC8592036 DOI: 10.3389/fcell.2021.725630] [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: 06/15/2021] [Accepted: 10/11/2021] [Indexed: 12/24/2022] Open
Abstract
Mesenchymal stem cells (MSCs) secrete cytokines in a paracrine or autocrine manner to regulate immune response and tissue regeneration. Our previous research revealed that MSCs use the complex of Fas/Fas-associated phosphatase-1 (Fap-1)/caveolin-1 (Cav-1) mediated exocytotic process to regulate cytokine and small extracellular vesicles (EVs) secretion, which contributes to accelerated wound healing. However, the detailed underlying mechanism of cytokine secretion controlled by Cav-1 remains to be explored. We show that Gingiva-derived MSCs (GMSCs) could secrete more C-X-C motif chemokine ligand 10 (CXCL10) but showed lower phospho-Cav-1 (p-Cav-1) expression than skin-derived MSCs (SMSCs). Moreover, dephosphorylation of Cav-1 by a Src kinase inhibitor PP2 significantly enhances CXCL10 secretion, while activating phosphorylation of Cav-1 by H2O2 restraints CXCL10 secretion in GMSCs. We also found that Fas and Fap-1 contribute to the dephosphorylation of Cav-1 to elevate CXCL10 secretion. Tumor necrosis factor-α serves as an activator to up-regulate Fas, Fap-1, and down-regulate p-Cav-1 expression to promote CXCL10 release. Furthermore, local applying p-Cav-1 inhibitor PP2 could accelerate wound healing, reduce the expression of α-smooth muscle actin and increase cleaved-caspase 3 expression. These results indicated that dephosphorylation of Cav-1 could inhibit fibrosis during wound healing. The present study establishes a previously unknown role of p-Cav-1 in controlling cytokine release of MSC and may present a potential therapeutic approach for promoting scarless wound healing.
Collapse
Affiliation(s)
- Panpan Wang
- South China Center of Craniofacial Stem Cell Research, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Yingji Zhao
- South China Center of Craniofacial Stem Cell Research, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Juan Wang
- South China Center of Craniofacial Stem Cell Research, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China
| | - Zhiying Wu
- Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministry of Education, Sun Yat-sen University, Guangzhou, China
| | - Bingdong Sui
- South China Center of Craniofacial Stem Cell Research, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.,Department of Microbiology, Zhongshan School of Medicine, Key Laboratory for Tropical Diseases Control of the Ministry of Education, Sun Yat-sen University, Guangzhou, China
| | - Xueli Mao
- South China Center of Craniofacial Stem Cell Research, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.,Key Laboratory for Stem Cells and Tissue Engineering, Sun Yat-sen University, Ministry of Education, Guangzhou, China
| | - Songtao Shi
- South China Center of Craniofacial Stem Cell Research, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.,Key Laboratory for Stem Cells and Tissue Engineering, Sun Yat-sen University, Ministry of Education, Guangzhou, China
| | - Xiaoxing Kou
- South China Center of Craniofacial Stem Cell Research, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, China.,Key Laboratory for Stem Cells and Tissue Engineering, Sun Yat-sen University, Ministry of Education, Guangzhou, China
| |
Collapse
|
14
|
Salameh F, Shehadeh W, Sprecher E, Artzi O. A stereoscopic optical system for objective quantification of the change in cumulative acne scar depth following various treatment interventions. J Cosmet Dermatol 2021; 21:2099-2105. [PMID: 34228895 DOI: 10.1111/jocd.14334] [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: 03/30/2021] [Accepted: 06/08/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current approaches for assessment of acne scars are subjective, including counting scar subtypes, subjective self-assessment, or scoring global acne scar severity. AIMS We aimed to validate accuracy and present initial data of a new, simple, non-contact, high-resolution 3D stereoscopic optical imaging system in the setting of acne scarring. PATIENTS/METHODS Ten patients treated for acne scars in the dermo-esthetic outpatient clinics in our institution from July to December 2019 were recruited from medical files and completed by telephone interview. Each patient was assessed by the 3D imaging system, the Qualitative Scarring Grading Score (QSGS), and the patient's questionnaire for Self-assessment of Clinical Acne-Related Scars (SCARS) before and 4 weeks after a single intervention. RESULTS Scar depth measured by the imaging system correlated significantly with the actual depth of printed surface depressions and the 3D optical imaging assessments. The changes in SCARS and 3D optical imaging assessments correlated significantly, but there were no correlations between changes in QSGS and 3D optical assessment measures, or between the QSGS and SCARS results. CONCLUSION The new stereoscopic optical system is a reliable and practical objective method for assessing the cumulative depth of atrophic acne scars and monitoring treatment response. It is more sensitive, accurate, and informative than subjective scales.
Collapse
Affiliation(s)
- Fares Salameh
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Waseem Shehadeh
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Sprecher
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Human Molecular Genetics & Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Artzi
- Division of Dermatology, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
15
|
Ruccia F, Zoccali G, Cooper L, Rosten C, Nduka C. A three-dimensional scar assessment tool for keloid scars: Volume, erythema and melanin quantified. Skin Res Technol 2021; 27:1007-1016. [PMID: 33974724 DOI: 10.1111/srt.13050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND There is no non-invasive objective assessment tool to measure keloid scar characteristics over time. This study aimed to ascertain the ability of the Antera 3D® camera to detect differences in keloid features pre- and post-steroid injection. In order to identify whether those variation could be considered as treatment response predicting factors. METHODS Enrolled patients received three intra-lesional steroid injections at four-weekly intervals. Images were taken with the Antera 3D camera 12 and 24 weeks after treatment. Keloids' colour, volume, and area as well as haemoglobin and melanin average levels and variation have been analysed pre- and post-steroid injection. t Tests and relative risk have been used to analyse the significance and association strength of our finding. RESULTS Forty patients have been enrolled in the study. Significant changes as been recorded in keloids' volume and colour after steroid injection (P < 0.05). 53% have recorded a Hb reduction showing no recurrence of pathology, patient who had increase in Hb showed an early recurrence. Melanin variation was significant after steroid injection (P < 0.05) but no correlation has been found with treatment response. CONCLUSIONS The Antera 3D camera is able to detect differences in the investigated keloid's features helping in two ways: by providing an objective, longitudinal method to monitor and document changes in scar morphology, and through monitoring haemoglobin change, which strongly correlates to both response to treatment and likelihood of recurrence. Allowing clinicians to identify which patients will respond early, in order to change treatment if necessary, limiting morbidity and costs.
Collapse
Affiliation(s)
- Francesca Ruccia
- Department of Plastic and Reconstructive Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Giovanni Zoccali
- Department of Plastic and Reconstructive Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Lilli Cooper
- Department of Plastic and Reconstructive Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | - Claire Rosten
- School of Health, University of Brighton, Brighton, UK
| | - Charles Nduka
- Department of Plastic and Reconstructive Surgery, Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| |
Collapse
|
16
|
Microencapsulated rhEGF to facilitate epithelial healing and prevent scar formation of cesarean wound: A randomized controlled trial. Taiwan J Obstet Gynecol 2021; 60:468-473. [PMID: 33966730 DOI: 10.1016/j.tjog.2021.03.014] [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] [Accepted: 10/15/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Cesarean section (CS) is a major surgical intervention that affects women at childbearing age. Scarring from CS potentially causes discomfort and psychological distress. Emerging evidence indicates that epidermal growth factor (EGF) plays crucial roles in wound healing with the potential of minimizing scar formation. This study aims to investigate the effect of microencapsulated recombinant human EGF (Me-EGF) in scar prevention. Silicone gel was incorporated as part of the routine scar treatment. MATERIALS AND METHODS Healthy women scheduled for cesarean delivery were enrolled and randomized to three groups: (1) no scar treatment, (2) silicone gel only, or (3) silicone gel plus Me-EGF. Vancouver Scar Scale (VSS: vascularity, pigmentation, elasticity, and height) was used for scar assessment at the 6th month and 9th month after CS. RESULTS A total of 60 women were enrolled, but one patient withdrew due to noncompliance with the follow-up visit requirement. Me-EGF-containing treatment group consistently scored the lowest on every parameter in the VSS scale, followed by silicone gel group, and the group with no scar treatment. Kruskal-Wallis tests indicated significant differences (p < 0.05) between Me-EGF-containing treatment group and the other two groups in vascularity, pigmentation, elasticity, and the VSS total score, at either 6th month, 9th month, or both time points. The only parameter not showing any significant between-group difference was scar height, but the pattern still remained the same, in which Me-EGF group scored better in both month 6 and 9. CONCLUSION Surgical incisions in lower abdomen posed challenge in scar management. Our findings suggest that Me-EGF is a potential therapeutic option for better wound healing and scar prevention.
Collapse
|
17
|
Daily Quality-of-life Impact of Scars: An Interview-based Foundational Study of Patient-reported Themes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3522. [PMID: 33868874 PMCID: PMC8049395 DOI: 10.1097/gox.0000000000003522] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 01/07/2021] [Indexed: 11/26/2022]
Abstract
Background: Scars negatively impact mental health. Prior patient interview studies on cutaneous scars have elicited opinions pertaining to psychosocial effects, appearance, and symptoms. There remains a need for patient-reported opinions in broader contexts, including career and sexual well-being, to better understand patients’ experiences with their cutaneous scars. Methods: In this qualitative study, patients with cutaneous scars participated in semi-structured interviews. Transcripts were analyzed using a constant comparative approach using the data software QDAMiner, to generate a thematic framework encompassing patients’ experience with cutaneous scars. Results: In total, 37 patients aged 25–79 years (mean 45, SD 17.9) were interviewed. Patients presented with keloid (2/37, 5%), hypertrophic (5/37, 14%), atrophic (4/37, 11%), and linear surgical (18/37, 49%) scars. Opinions fell under 8 overarching themes. Patients spoke commonly about psychological and social well-being (references to the frequency of thinking about a scar and talking about scars with others were mentioned 56 times by 26 patients and 103 times by 29 patients, respectively, for example). Discussions of sexual well-being and career were elicited but rarer (references to feeling uncomfortable when naked and negative impacts on professional networking were mentioned 17 times by 7 patients and 5 times by 3 patients, respectively, for example). Conclusions: The relationship between determinants of patients’ opinions of their scars and their impact on quality-of-life is complex. These results expand upon the existing knowledge of the effects scars have on quality-of-life and can contribute to the development and validation of future scar outcome measures.
Collapse
|
18
|
Deflorin C, Hohenauer E, Stoop R, van Daele U, Clijsen R, Taeymans J. Response to Vercelli et al. re: "Physical Management of Scar Tissue: A Systematic Review and Meta-Analysis". J Altern Complement Med 2021; 27:374-376. [PMID: 33826859 DOI: 10.1089/acm.2020.29089.cde] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlina Deflorin
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
| | - Erich Hohenauer
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland.,School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom.,International University of Applied Sciences THIM, Landquart, Switzerland
| | - Rahel Stoop
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
| | - Ulrike van Daele
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.,Oscare, Organization for Burns, Scar After-Care and Research, Antwerp, Belgium
| | - Ron Clijsen
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland.,School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom.,International University of Applied Sciences THIM, Landquart, Switzerland.,Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Health, Bern University of Applied Sciences, Berne, Switzerland
| | - Jan Taeymans
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Health, Bern University of Applied Sciences, Berne, Switzerland
| |
Collapse
|
19
|
Li Y, Zhang J, Shi J, Liu K, Wang X, Jia Y, He T, Shen K, Wang Y, Liu J, Zhang W, Wang H, Zheng Z, Hu D. Exosomes derived from human adipose mesenchymal stem cells attenuate hypertrophic scar fibrosis by miR-192-5p/IL-17RA/Smad axis. Stem Cell Res Ther 2021; 12:221. [PMID: 33789737 PMCID: PMC8010995 DOI: 10.1186/s13287-021-02290-0] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hypertrophic scar (HS) is a fibro-proliferative disorder of dermis after burn or trauma and usually leads to esthetic disfiguration and functionary impairment for patients. Emerging evidences demonstrated ADSC-Exo could alleviate the visceral fibrosis, but little attention had been paid to its role in skin fibrosis. In the study, we would explore the effect of ADSC-Exo on HS and investigated the exact mechanism underlying the properties. METHODS ADSC-Exo were isolated, identified, and internalized by HS-derived fibroblasts (HSFs). The effect of ADSC-Exo on the proliferation and migration of HSFs were detected by flow cytometry and Ki67 immunofluorescence staining, or scratch and trans-wells assays, respectively. RT-PCR, immunoblotting, immunofluorescence, and immunohistochemistry staining were used to evaluate the expression of IL-17RA, Col1, Col3, α-SMA, SIP1, and p-Smad2/p-Smad3 in HSFs stimulated with ADSC-Exo, miR-192-5p mimics, or inhibitors, IL-17RA siRNA and their negative controls. Digital morphology, H&E, Masson's trichrome staining, and immunohistochemistry staining were performed to measure the effect of ADSC-Exo and Lv-IL-17RA shRNA on excisional wound of BALB/c mice. RESULTS The verified ADSC-Exo effectively inhibited the proliferation and migration of HSFs, decreased the expression of Col1, Col3, α-SMA, IL-17RA, and p-Smad2/p-Smad3 and increased the levels of SIP1 in HSFs. Besides, the mice in ADSC-Exo-treated group demonstrated faster wound healing and less collagen deposition. Furthermore, miR-192-5p was highly expressed in ADSC-Exo and ADSC-Exosomal miR-192-5p ameliorated hypertrophic scar fibrosis. Meanwhile, miR-192-5p targeted the expression of IL-17RA to decrease the pro-fibrotic proteins levels. Moreover, IL-17RA was overexpressed in HS and HSFs, and knockdown IL-17RA alleviated the expression of Col1, Col3, α-SMA, and p-Smad2/p-Smad3 and increased the expression of SIP1 in HSFs. Most importantly, IL-17RA silence also facilitated wound healing, attenuated collagen production, and modulated Smad pathway in HSFs. CONCLUSIONS This study illustrated ADSC-Exo attenuated the deposition of collagen, the trans-differentiation of fibroblasts-to-myofibroblasts, and the formation of hypertrophic scar by in vitro and in vivo experiments. ADSC-Exosomal miR-192-5p targeted IL-17RA to regulate Smad pathway in hypertrophic scar fibrosis. ADSC-Exo could be a promising therapeutic strategy for clinical treatment of hypertrophic scar and the anti-fibrotic properties could be achieved by miR-192-5p/IL-17RA/Smad axis.
Collapse
Affiliation(s)
- Yan Li
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Chang-le Road, Xi'an, 710032, Shaanxi, China
| | - Jian Zhang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Chang-le Road, Xi'an, 710032, Shaanxi, China
| | - Jihong Shi
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Chang-le Road, Xi'an, 710032, Shaanxi, China
| | - Kaituo Liu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Chang-le Road, Xi'an, 710032, Shaanxi, China
| | - Xujie Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Chang-le Road, Xi'an, 710032, Shaanxi, China
| | - Yanhui Jia
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Chang-le Road, Xi'an, 710032, Shaanxi, China
| | - Ting He
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Chang-le Road, Xi'an, 710032, Shaanxi, China
| | - Kuo Shen
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Chang-le Road, Xi'an, 710032, Shaanxi, China
| | - Yunchuan Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Chang-le Road, Xi'an, 710032, Shaanxi, China
| | - Jiaqi Liu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Chang-le Road, Xi'an, 710032, Shaanxi, China
| | - Wei Zhang
- Department of Plastics and Aesthetic Surgery, The First Affiliated Hospital of Xi'an Medical University, No.48 West Fenghao Road, Xi'an, 710077, Shaanxi, China
| | - Hongtao Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Chang-le Road, Xi'an, 710032, Shaanxi, China.
| | - Zhao Zheng
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Chang-le Road, Xi'an, 710032, Shaanxi, China.
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, 127 West Chang-le Road, Xi'an, 710032, Shaanxi, China.
| |
Collapse
|
20
|
Kemp Bohan PM, Cooper LE, Lu KN, Raper DM, Batchinsky M, Carlsson AH, Cancio LC, Chan RK. Fractionated Ablative Carbon Dioxide Laser Therapy Decreases Ultrasound Thickness of Hypertrophic Burn Scar: A Prospective Process Improvement Initiative. Ann Plast Surg 2021; 86:273-278. [PMID: 32826444 DOI: 10.1097/sap.0000000000002517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Carbon dioxide (CO2) laser treatment is routinely used to treat hypertrophic burn scars (HBS). Although prior research has documented subjective improvement in HBS after treatment, there is little data evaluating objective changes in scar characteristics after therapy. The aim of our process improvement project was to evaluate changes to scar thickness (ST) using high-frequency ultrasound in patients with HBS undergoing CO2 laser therapy. METHODS Ultrasound measurements of ST were obtained from patients with HBS before initial and at each subsequent treatment. ST, reduction in ST per treatment, and percentage reduction in ST from baseline were tabulated. Post hoc analyses examining the effect of initial ST and scar maturity on outcome were performed. First, patients were grouped by baseline ST into thicker (group 1, initial ST ≥ median value) and thinner (group 2, initial ST < median value) scar groups. Second, patients were divided into quartiles based on time from injury to treatment. Outcomes at each time point were compared with either Mann-Whitney U or Kruskal-Wallis tests, with Bonferonni corrections performed for post hoc subgroup analyses. Significance was set at P < 0.05. RESULTS Twenty-one consecutive patients with HBS treated with CO2 laser were included. All patients completed 1 or more treatment, 48% completed 2 or more treatments, and 28% completed 3 treatments. Median initial ST was 0.71 cm (0.44-0.98 cm), and median scar maturity was 7.5 months (4.9-9.8 months). Overall, ST decreased over the treatment course (P < 0.001), with post hoc analysis demonstrating that 2 treatments were required to achieve a significant ST reduction (P < 0.01). On subgroup analysis comparing initial ST, ST decreased significantly in group 1 (thicker scars) overall (P < 0.001) but not in group 2 (P = 0.109). ST reduction was greatest after 1 treatment in group 1 (P = 0.022) and group 2 (P = 0.061). Percent reduction was greater in group 1 relative to group 2 after 1 treatment (P = 0.016). On subgroup analysis of scar maturity, there were no significant differences in either baseline ST or ST at any subsequent visit. CONCLUSIONS Fractionated ablative CO2 laser treatment improved ST after 1 to 2 treatments. Patients with thicker scars demonstrated greater ST reduction than those with thinner scars. Ultrasound adequately assessed treatment response.
Collapse
Affiliation(s)
| | | | | | - David M Raper
- Department of Oral and Maxillofacial Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX
| | | | | | | | | |
Collapse
|
21
|
Nast A, Gauglitz G, Lorenz K, Metelmann HR, Paasch U, Strnad V, Weidmann M, Werner RN, Bauerschmitz J. S2k‐Leitlinie Therapie pathologischer Narben (hypertrophe Narben und Keloide) –
Update
2020. J Dtsch Dermatol Ges 2021; 19:312-327. [PMID: 33586893 DOI: 10.1111/ddg.14279_g] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Alexander Nast
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM)
| | - Gerd Gauglitz
- Praxis Dermatologie München-Neuhausen, München.,Klinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität München
| | - Kerstin Lorenz
- Klinik für Viszerale, Gefäß- und Endokrine Chirurgie, Universitätsklinikum Halle, Halle/Saale
| | - Hans-Robert Metelmann
- Klinik und Poliklinik für Mund-Kiefer-Gesichtschirurgie und Plastische Operationen, Universitätsmedizin Greifswald
| | - Uwe Paasch
- Hautärzte Paasch, Praxis Gotha, Jesewitz OT Gotha
| | | | | | - Ricardo Niklas Werner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Dermatologie, Venerologie und Allergologie, Division of Evidence-Based Medicine (dEBM)
| | | |
Collapse
|
22
|
Modeling of Old Scars: Histopathological, Biochemical and Thermal Analysis of the Scar Tissue Maturation. BIOLOGY 2021; 10:biology10020136. [PMID: 33572335 PMCID: PMC7916157 DOI: 10.3390/biology10020136] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 01/31/2021] [Accepted: 02/04/2021] [Indexed: 12/26/2022]
Abstract
Simple Summary Severe skin scars (i.e., hypertrophic and keloid) induce physical and emotional discomfort and functional disorders such as contractures and body part deformations. Scar’s response to treatment depends on “maturity”, which increases with time but is not merely proportional to it. When “fresh”, scars are relatively more treatable by conservative methods, while the treatment is only partially efficient. In contrast, surgery is a preferred approach for the older scars, but it is associated with a risk of the scar regrowth and worsening after excision if unrecognized immature scar tissue remains in the operated lesion. Therefore, to develop better treatment and diagnostics of scars, understanding of the scar maturation is essential. This requires biologically accurate experimental models of skin scarring. The current models only mimic the early stages of skin scar development. They are useful for testing new scar-preventing approaches while not addressing the problem of the older scars that exist for years. In our study, we demonstrate a new rabbit model of “old” scars and explore what happens to the scar tissue during maturation. We define measurable signs to delineate the scar development stages and discuss how this knowledge can improve scar diagnostics and treatment. Abstract Mature hypertrophic scars (HSs) remain a challenging clinical problem, particularly due to the absence of biologically relevant experimental models as a standard rabbit ear HS model only reflects an early stage of scarring. The current study aims to adapt this animal model for simulation of mature HS by validating the time of the scar stabilization using qualitative and quantitative criteria. The full-thickness skin and perichondrium excision wounds were created on the ventral side of the rabbit ears. The tissue samples were studied on post-operation days (PODs) 30, 60, 90 and 120. The histopathological examination and morphometry were applied in parallel with biochemical analysis of protein and glycosaminoglycans (GAGs) content and amino acid composition. The supramolecular organization of collagen was explored by differential scanning calorimetry. Four stages of the rabbit ear HS maturation were delineated and attributed with the histolomorphometrical and physicochemical parameters of the tissue. The experimental scars formed in 30 days but stabilized structurally and biochemically only on POD 90–120. This evidence-based model can be used for the studies and testing of new treatments of the mature HSs.
Collapse
|
23
|
An Angled Mirror Device Facilitates Measurement of Skin Lesion Height. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3233. [PMID: 33299701 PMCID: PMC7722576 DOI: 10.1097/gox.0000000000003233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022]
|
24
|
Nast A, Gauglitz G, Lorenz K, Metelmann HR, Paasch U, Strnad V, Weidmann M, Werner RN, Bauerschmitz J. S2k guidelines for the therapy of pathological scars (hypertrophic scars and keloids) - Update 2020. J Dtsch Dermatol Ges 2020; 19:312-327. [PMID: 33015930 DOI: 10.1111/ddg.14279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Alexander Nast
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM)
| | - Gerd Gauglitz
- Dermatological Practice München-Neuhausen, Munich.,Department of Dermatology and Allergology, Ludwig-Maximilian University, Munich
| | - Kerstin Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, University Hospital Halle, Halle/Saale
| | - Hans-Robert Metelmann
- Department and Clinic for Oral and Maxillofacial Surgery and Plastic Surgery, University Hospital Greifswald
| | - Uwe Paasch
- Dermatological Practice Paasch, Gotha, Jesewitz OT Gotha
| | | | | | - Ricardo Niklas Werner
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Dermatology, Venereology and Allergology, Division of Evidence-Based Medicine (dEBM)
| | | |
Collapse
|
25
|
Baumann ME, DeBruler DM, Blackstone BN, Coffey RA, Boyce ST, Supp DM, Bailey JK, Powell HM. Direct comparison of reproducibility and reliability in quantitative assessments of burn scar properties. Burns 2020; 47:466-478. [PMID: 32839037 DOI: 10.1016/j.burns.2020.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/03/2020] [Accepted: 07/22/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Determining the efficacy of anti-scar technologies can be difficult as qualitative, subjective assessments are often utilized instead of systematic, objective measures. Perceptions regarding the reliability of instruments for quantitative measurements along with their high cost and increased data collection time may discourage their use, leading to use of scar scales which are relatively quick and low-cost. To directly evaluate the reliability of instruments for quantitative measurements of scar properties, instruments and two qualitative scales were compared by assessing a variety of cutaneous scars. METHODS Scar height and surface texture were evaluated using a 3D scanner and a mold/cast technique. Scar color was evaluated by using a spectroscopy-based tool, the Mexameter®, and digital photography with image analysis. Scar biomechanics were evaluated using the BTC-2000™, Dermal Torque Meter (DTM®), and ballistometer®. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) were used to qualitatively evaluate the same scar properties. Intraclass correlation coefficients (ICC) were used to determine inter- and intra-user reliability (poor, moderate, good, excellent) with all instruments and the kappa reliability statistic was used to asses inter-user reliability (poor, fair, moderate, good, very good) for VSS and POSAS. Time for measurement collection and after collection analysis was also recorded. RESULTS The Mexameter® was the most reliable method for evaluating erythema and pigmentation compared to digital photography and image processing, POSAS and VSS. Digital photography and analysis was more reliable than POSAS and VSS. Assessment of scar height was significantly more reliable when using a 3D scanner versus VSS and POSAS. The 3D scanner and mold-cast techniques also offered an additional benefit of providing an absolute value of scar height relative to the surrounding tissue. Intra-user reliability for all mechanical tests was moderate to good. Inter-user reliability was greater when using the BTC-2000™ and ballistometer® versus the DTM®. All quantitative measurements took less than 90 s for collection, with the exception of the mold/cast technique. CONCLUSION Non-invasive instruments allow scar properties to be quantitatively assessed with high sensitivity and as a function of time and/or treatment without the need for biopsy collection. Overall, the reliability of scar assessments was significantly improved when quantitative instruments were utilized versus scar scales. Quantitative assessment of color and biomechanics were swift, requiring less than 90 s per measurement while assessments of texture and height required additional analysis time after collection. With proper training of clinical staff and well-defined protocols for measurement collection, reliable, quantitative assessments of scar properties can be collected with little disruption to the clinical workflow.
Collapse
Affiliation(s)
- Molly E Baumann
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Danielle M DeBruler
- Department of Materials Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Britani N Blackstone
- Department of Materials Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Rebecca A Coffey
- Department of Surgery and Division of Critical Care, Trauma and Burns, The Ohio State University, Columbus, OH, United States
| | - Steven T Boyce
- Research Department, Shriners Hospitals for Children, Cincinnati, OH, United States; Department of Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - Dorothy M Supp
- Research Department, Shriners Hospitals for Children, Cincinnati, OH, United States; Department of Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - J Kevin Bailey
- Department of Surgery and Division of Critical Care, Trauma and Burns, The Ohio State University, Columbus, OH, United States; Department of Surgery, Wake Forest University College of Medicine, Winston-Salem, NC, United States
| | - Heather M Powell
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States; Department of Materials Science and Engineering, The Ohio State University, Columbus, OH, United States; Research Department, Shriners Hospitals for Children, Cincinnati, OH, United States.
| |
Collapse
|
26
|
Viktoriya A, Irina R, Anastasiia G, Alexey G, Mikhail MR, Eleonora B, Yuliya C, Maksim B, Dmitry R, Aleksandr S, Dmitry K. Laser fluorescence spectroscopy in predicting the formation of a keloid scar: preliminary results and the role of lipopigments. BIOMEDICAL OPTICS EXPRESS 2020; 11:1742-1751. [PMID: 32341844 PMCID: PMC7173908 DOI: 10.1364/boe.386029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/25/2020] [Accepted: 02/20/2020] [Indexed: 06/11/2023]
Abstract
Keloid scars, in contrast to other scar types, significantly reduce the patient's quality of life. To develop a nondestructive optical diagnostic technique predicting the keloid scars formation in vivo, laser-induced fluorescence spectroscopy (LFS) was used to study the autofluorescence in skin of patients with various types of head and neck cicatricial deformities. The unexpected results were obtained for the endogenous fluorescence of lipofuscin. Significantly reduced autofluorescence of lipofuscin was registered both in the intact and in the keloid scar tissues in comparison with the intact and scar tissues in patients with hypertrophic and normotrophic scars. Sensitivity and specificity achieved by LFS in keloid diagnosis are 81.8% and 93.9% respectively. It could take place due to the changes in the reductive-oxidative balance in cells, as well as due to the proteolysis processes violation. Therefore, we suppose that the evaluation of the lipofuscin autofluorescence in skin before any surgical intervention could predict the probability of the subsequent keloid scars formation.
Collapse
|
27
|
Guo R, Xiang X, Wang L, Zhu B, Cheng S, Qiu L. Quantitative Assessment of Keloids Using Ultrasound Shear Wave Elastography. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1169-1178. [PMID: 32063394 DOI: 10.1016/j.ultrasmedbio.2020.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 02/08/2023]
Abstract
This study was aimed at investigating the value of shear wave elastography (SWE) in quantitative evaluation of keloids. A total of 87 patients with 139 keloids were enrolled. Vancouver scar scale (VSS) scores were recorded. Thickness and blood flow grade were evaluated using high-frequency ultrasound. Skin stiffness (mean speed of shear wave, Cmean) was evaluated using SWE in both transverse and longitudinal sections. All measurements were performed in both keloids and site-matched unaffected skin (normal controls). The reliability of measurements was evaluated using intra- and inter-class correlation coefficients by two observers. Inter- and intra-observer repeatability was excellent (correlation coefficient > 0.99, p < 0.01). The SWE results revealed a significant increase in Cmean in keloids (p < 0.001) compared with the normal controls. Cmean in the longitudinal section was greater than that in the transverse section for keloids (p < 0.001). Cmean was highly positively correlated with VSS score (r = 0.904, p < 0.001), moderately positively correlated with thickness (r = 0.490, p < 0.001) and less positively correlated with blood flow (r = 0.231, p < 0.01). This non-invasive, tolerable and convenient imaging technique could be an effective tool for objectively evaluating keloid stiffness in the future, thus laying a foundation for the treatment and evaluation of keloids.
Collapse
Affiliation(s)
- Ruiqian Guo
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xi Xiang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Liyun Wang
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Bihui Zhu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shan Cheng
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Li Qiu
- Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
28
|
Shao T, Tang W, Li Y, Gao D, Lv K, He P, Song Y, Gao S, Liu M, Chen Y, Yi Z. Research on function and mechanisms of a novel small moleculeWG449E for hypertrophic scar. J Eur Acad Dermatol Venereol 2019; 34:608-618. [PMID: 31650631 DOI: 10.1111/jdv.16028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/04/2019] [Indexed: 11/29/2022]
Affiliation(s)
- T. Shao
- East China Normal University and Shanghai Fengxian District Central Hospital Joint Center for Translational Medicine Shanghai Key Laboratory of Regulatory Biology Institute of Biomedical Sciences and School of Life Sciences East China Normal University Shanghai China
| | - W. Tang
- East China Normal University and Shanghai Fengxian District Central Hospital Joint Center for Translational Medicine Shanghai Key Laboratory of Regulatory Biology Institute of Biomedical Sciences and School of Life Sciences East China Normal University Shanghai China
- School of Biomedical Sciences The Chinese University of Hong Kong Hong Kong China
| | - Y. Li
- East China Normal University and Shanghai Fengxian District Central Hospital Joint Center for Translational Medicine Shanghai Key Laboratory of Regulatory Biology Institute of Biomedical Sciences and School of Life Sciences East China Normal University Shanghai China
| | - D. Gao
- East China Normal University and Shanghai Fengxian District Central Hospital Joint Center for Translational Medicine Shanghai Key Laboratory of Regulatory Biology Institute of Biomedical Sciences and School of Life Sciences East China Normal University Shanghai China
| | - K. Lv
- Department of Burn Changhai Hospital Second Military Medical University Shanghai China
| | - P. He
- East China Normal University and Shanghai Fengxian District Central Hospital Joint Center for Translational Medicine Shanghai Key Laboratory of Regulatory Biology Institute of Biomedical Sciences and School of Life Sciences East China Normal University Shanghai China
| | - Y. Song
- Department of Plastic and Reconstructive Surgery Xijing Hospital Fourth Military Medical University Shaanxi China
| | - S. Gao
- East China Normal University and Shanghai Fengxian District Central Hospital Joint Center for Translational Medicine Shanghai Key Laboratory of Regulatory Biology Institute of Biomedical Sciences and School of Life Sciences East China Normal University Shanghai China
| | - M. Liu
- East China Normal University and Shanghai Fengxian District Central Hospital Joint Center for Translational Medicine Shanghai Key Laboratory of Regulatory Biology Institute of Biomedical Sciences and School of Life Sciences East China Normal University Shanghai China
| | - Y. Chen
- East China Normal University and Shanghai Fengxian District Central Hospital Joint Center for Translational Medicine Shanghai Key Laboratory of Regulatory Biology Institute of Biomedical Sciences and School of Life Sciences East China Normal University Shanghai China
| | - Z. Yi
- East China Normal University and Shanghai Fengxian District Central Hospital Joint Center for Translational Medicine Shanghai Key Laboratory of Regulatory Biology Institute of Biomedical Sciences and School of Life Sciences East China Normal University Shanghai China
| |
Collapse
|
29
|
Ren ZH, Fan TF, Zhang S, Wu HJ. Nonvascularized Iliac Bone Reconstruction for the Mandible Without Maxillofacial Skin Scarring. J Oral Maxillofac Surg 2019; 78:288-294. [PMID: 31622571 DOI: 10.1016/j.joms.2019.09.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/11/2019] [Accepted: 09/11/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE There are many methods to reconstruct the mandible, but they are often accompanied by trauma, which can lead to scarring of the maxillofacial skin. The purpose of this study was to show the utility of a minimally invasive method for reconstruction of the mandible with nonvascularized iliac bone grafts without a skin scar, as well as to evaluate the success rate and complications. PATIENTS AND METHODS This was a retrospective case series. We retrospectively analyzed patients who underwent transoral resection of benign mandibular pathologies, followed by nonvascularized iliac bone graft reconstruction. The primary outcome variable was the success rate of the bone grafts. Secondary outcome variables were postoperative complications at the grafted bone recipient and donor sites, the long-term absorptivity of grafted bone, and the type of mandibular defect. We computed descriptive statistics or performed the χ2 test for each variable. RESULTS Overall, 54 patients were included in the study, including 21 male and 33 female patients, with an age range of 10 to 65 years. The complete survival rate was 87.0% (47 of 54 patients), and the partial survival rate was 98.1% (53 of 54). The average bone absorption rate 3 years after surgery was 1.8 to 30.7%. We propose a new classification method for mandibular defects based on the extent of the tumor, location of the osteotomy, and degree of surgical difficulty. CONCLUSIONS Intraoral nonvascularized iliac bone grafting is a highly successful minimally invasive method for mandibular reconstruction. It is also one of the best methods for mandibular reconstruction in patients with benign mandibular tumors without soft tissue involvement.
Collapse
Affiliation(s)
- Zhen-Hu Ren
- Visiting Staff, Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, China; and Attending Doctor, Department of Oral and Maxillofacial & Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Teng-Fei Fan
- Resident, Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Sheng Zhang
- Associate Professor, Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Han-Jiang Wu
- Department Head, Department of Oral and Maxillofacial Surgery, The Second Xiangya Hospital of Central South University, Changsha, China.
| |
Collapse
|
30
|
The use of 3D stereophotographic systems as an objective tool in scar assessment. Burns 2019; 45:1734-1735. [PMID: 31445713 DOI: 10.1016/j.burns.2019.07.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 07/31/2019] [Indexed: 11/20/2022]
|
31
|
High-resolution ultrasound for keloids and hypertrophic scar assessment. Lasers Med Sci 2019; 35:379-385. [DOI: 10.1007/s10103-019-02830-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/11/2019] [Indexed: 11/26/2022]
|
32
|
Coentro JQ, Pugliese E, Hanley G, Raghunath M, Zeugolis DI. Current and upcoming therapies to modulate skin scarring and fibrosis. Adv Drug Deliv Rev 2019; 146:37-59. [PMID: 30172924 DOI: 10.1016/j.addr.2018.08.009] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/08/2018] [Accepted: 08/26/2018] [Indexed: 12/12/2022]
Abstract
Skin is the largest organ of the human body. Being the interface between the body and the outer environment, makes it susceptible to physical injury. To maintain life, nature has endowed skin with a fast healing response that invariably ends in the formation of scar at the wounded dermal area. In many cases, skin remodelling may be impaired, leading to local hypertrophic scars or keloids. One should also consider that the scarring process is part of the wound healing response, which always starts with inflammation. Thus, scarring can also be induced in the dermis, in the absence of an actual wound, during chronic inflammatory processes. Considering the significant portion of the population that is subject to abnormal scarring, this review critically discusses the state-of-the-art and upcoming therapies in skin scarring and fibrosis.
Collapse
Affiliation(s)
- João Q Coentro
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland; Science Foundation Ireland (SFI), Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland
| | - Eugenia Pugliese
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland; Science Foundation Ireland (SFI), Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland
| | - Geoffrey Hanley
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland; Science Foundation Ireland (SFI), Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland
| | - Michael Raghunath
- Center for Cell Biology and Tissue Engineering, Institute for Chemistry and Biotechnology (ICBT), Zurich University of Applied Sciences (ZHAW), Wädenswil, Switzerland
| | - Dimitrios I Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland; Science Foundation Ireland (SFI), Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland.
| |
Collapse
|
33
|
Nedelec B, Couture MA, Calva V, Poulin C, Chouinard A, Shashoua D, Gauthier N, Correa JA, de Oliveira A, Mazer B, LaSalle L. Randomized controlled trial of the immediate and long-term effect of massage on adult postburn scar. Burns 2019; 45:128-139. [DOI: 10.1016/j.burns.2018.08.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/22/2018] [Accepted: 08/07/2018] [Indexed: 11/24/2022]
|
34
|
Jin J, Li H, Chen Z, Sheng J, Liu T, Ma B, Zhu S, Xia Z. 3-D wound scanner: A novel, effective, reliable, and convenient tool for measuring scar area. Burns 2018; 44:1930-1939. [PMID: 30509366 DOI: 10.1016/j.burns.2018.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/12/2018] [Accepted: 05/17/2018] [Indexed: 10/28/2022]
Abstract
This study aimed to investigate whether a three-dimensional (3-D) wound scanner could be used to measure the area of scars. Scar models were constructed using flesh-colored, brown-colored (simulating hyperpigmented scars), orange-colored (simulating scars with obvious vascularization), and white-colored (simulating hypopigmented scars) plastic. Each colored plastic was used to construct scar models with regular and irregular base surfaces (four each). Two human models were selected to simulate patients with scars, and the scar models were placed on the right cheek, right lower jaw-neck, right ulnar forearm, anterior tibial region of the right calf, and at the back of these human models for scar area measurement. Two experimenters separately measured the scar area vertically using the profile method, pixel method, and 3-D wound scanner. Each experimenter measured the scar area thrice. Regarding accuracy, we found significant differences between the data and standard value of various measurement methods (P<0.05); however, the ratio of the data and standard value using the 3-D wound scanner was 0.982, which was the closest to 1, and showed the lowest coefficient of variation. Regarding correlation, Spearman's coefficient using the 3-D wound scanner was 0.992, showing the strongest correlation. With respect to inter-experimenter reliability and stability of retesting, each Cronbach's coefficient of the 3-D wound scanner between the two experimenters was >0.90, showing high reliability; thus, fulfilling the requirements for clinical measurement. The 3-D wound scanner took an average time of 38.87±3.45s for measurement, which was significantly shorter compared that for other methods The 3-D wound scanner showed greater accuracy and correlation, and a shorter measurement time, compared with other measurement methods The inter-experimenter reliability and retesting stability of the 3-D wound scanner also fulfilled the requirements for clinical measurement.
Collapse
Affiliation(s)
- Jian Jin
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Haihang Li
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Zhengli Chen
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Jiajuan Sheng
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Tong Liu
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Bing Ma
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China
| | - Shihui Zhu
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China.
| | - Zhaofan Xia
- Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, China.
| |
Collapse
|
35
|
Teplyi V, Grebchenko K. Evaluation of the scars' vascularization using computer processing of the digital images. Skin Res Technol 2018; 25:194-199. [PMID: 30328632 DOI: 10.1111/srt.12634] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 09/24/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND The application of new techniques of the scars' correction requires the objective evaluation of their vascularization. OBJECTIVE To evaluate the effectiveness of digital program ImageJ in assessing neovascularization of pathologic scars. MATERIAL AND METHODS In this cross-sectional study, a total of 25 patients with pathologic scars were enrolled. Vessel selection in the first set of digital images of their scars was performed by computer processing started from thresholding with subsequent manual correction. In the second set of the same pictures, Vessel Analysis plugin was used. Comparison of both approaches was performed by three independent investigators. The time required for images processing was measured. RESULTS The average time that image processing and calculation have taken in the first group (753.3 ± 88.02 seconds) was statistically longer (P < 0.0001) than in the second one (358.1 ± 105.91 seconds). Independent investigators scored the precision of vessel selection in the first group as 80.4 ± 9.82, in the second group as 72.6 ± 10.53 (P < 0.0001). Kolmogorov-Smirnov test demonstrated higher precision of vessel selection by method that involves manual correction (P < 0.001). The results of Vascular Density measurements were obviously overestimated in the second group. More expedient looks calculation of the Vascular Length Density: ratio of skeletonized vasculature area to total area. Skeletonization avoids overestimation of Vascular Density, but the density of the vessel mesh can be determined. CONCLUSIONS Computer processing of the scars' digital photographs using ImageJ software gives cheap, technically easy and not cumbersome way of superficial scars' vascularization objectifying. Vessel selection with subsequent manual correction has advantage of higher precision.
Collapse
Affiliation(s)
- Valerii Teplyi
- Department of Surgery #2, O.O. Bogomolets National Medical University, Kyiv, Ukraine
| | - Kateryna Grebchenko
- Department of Surgery #2, O.O. Bogomolets National Medical University, Kyiv, Ukraine
| |
Collapse
|
36
|
Prabhu V, Acharya A, Satish Rao BS, Rathnakar B, Kumar P, Guddattu V, Mahato KK. Probing endogenous collagen by laser-induced autofluorescence in burn wound biopsies: A pilot study. JOURNAL OF BIOPHOTONICS 2018; 11:e201700394. [PMID: 29675982 DOI: 10.1002/jbio.201700394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 04/18/2018] [Indexed: 06/08/2023]
Abstract
The focus of the current study was to interrogate the predictive potential of laser-induced autofluorescence (LIAF) by objectively assessing collagen synthesis in burn wound granulation tissues ex vivo. Prior grafting, granulation tissues (20 samples) following burn injury were collected from 17 subjects of age range 18 to 60 years with patient/donor consent and the corresponding autofluorescence spectra were recorded at 325 nm He-Cd laser (≈2 mW) excitations. The resulting endogenous collagen intensity from the above tissue samples was computed by normalizing the nicotinamide adenine dinucleotide levels. In addition, the hydroxyproline content was also estimated biochemically from the same granulation tissues. A comparative assessment of both LIAF and biochemical estimations for endogenous collagen by hydroxyproline resulted in strong positive correlation among them. The above relevant observations suggest that LIAF is equally informative as that of biochemical estimations, in evaluating endogenous collagen content in wound granulation tissues. Thus, it can be concluded that LIAF has the predictive potential, as a noninvasive objective tool to measure the endogenous collagen levels in wound biopsy tissues and provide complementary data conducive for making clinical decisions.
Collapse
Affiliation(s)
- Vijendra Prabhu
- Department of Biophysics, School of Life Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Anusha Acharya
- Department of Biophysics, School of Life Sciences, Manipal Academy of Higher Education, Manipal, India
- Department of Biotechnology, School of Life Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Bola S Satish Rao
- Department of Radiation Biology and Toxicology, School of Life Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Bharath Rathnakar
- Department of Biophysics, School of Life Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Pramod Kumar
- Department of Plastic Surgery and Burns, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Vasudeva Guddattu
- Department of Statistics, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Krishna K Mahato
- Department of Biophysics, School of Life Sciences, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
37
|
Fractional Carbon Dioxide Laser in Patients with Skin Phototypes III to VI and Facial Burn Sequelae. Plast Reconstr Surg 2018; 142:342e-350e. [DOI: 10.1097/prs.0000000000004688] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Novel Stereoscopic Optical System for Objectively Measuring Above-Surface Scar Volume-First-Time Quantification of Responses to Various Treatment Modalities. Dermatol Surg 2018; 44:848-854. [PMID: 29799828 DOI: 10.1097/dss.0000000000001434] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Current approaches use subjective semiquantitative or cumbersome objective methodologies to assess physical characteristics of hypertrophic and keloid scars. OBJECTIVE This pilot study aimed to evaluate the accuracy and feasibility of a new stereoscopic optical and high-resolution 3-dimensional imaging system, for objectively measuring changes in above-surface scar volume after various interventions. METHODS Feasibility and accuracy were assessed by monitoring the above-surface scar volume of 5 scars in 2 patients for 5 successive months. Above-surface scar volume and Vancouver Scar Scale scores and the investigator and patient volume improvement assessment scores were assessed before and 12 weeks after last intervention. RESULTS Scar volume measured by the imaging system correlated significantly with the gold standard (actual weight). The greatest volume reduction followed a combination of cryotherapy and intralesional triamcinolone acetonide and 5-fluorouracil injections in Patient 1 and a combination of pulse dye laser and intralesional triamcinolone acetonide injections in Patient 2. CONCLUSION The new stereoscopic optical system is a valid, accurate, and practical objective method for assessing scar volume and for monitoring treatment response. It is more sensitive and accurate than semiquantitative objective scales. Further studies with a higher number of patients and scars are required to increase the measurement validity of the system.
Collapse
|
39
|
Kim HI, Kwak CY, Kim HY, Yi HS, Park EJ, Kim JH, Park JH. Correlation between dermal thickness and scar formation in female patients after thyroidectomy. Arch Craniofac Surg 2018; 19:120-126. [PMID: 29996640 PMCID: PMC6057126 DOI: 10.7181/acfs.2018.01907] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 06/20/2018] [Indexed: 11/11/2022] Open
Abstract
Background Minimizing scarring has long been a challenge in plastic surgery. Factors affecting scar formation are well known, but the effect of some patient-specific factors such as dermal thickness remains unverified. Management of factors predictive of scarring can improve postoperative patient satisfaction and scar treatment. Methods For 3 years, we used ultrasonography to measure dermal thickness in female patients who had undergone thyroidectomy for cancer at our hospital. We confirmed the influence of dermal thickness on hypertrophic scar formation and the Patient and Observer Scar Assessment Scale scar score 6 months after surgery. Results There was a positive correlation between dermal thickness and scar score (p<0.05), and dermal thickness appears to be a cause of hypertrophic scar formation (p<0.05). Conclusion Thick dermis was found to cause poor scar formation and hypertrophic scarring. Prediction of factors that can influence scar formation can be used to educate patients before surgery and can help in scar management and improvement in patient satisfaction.
Collapse
Affiliation(s)
- Hong Il Kim
- Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Chan Yee Kwak
- Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Hyo Young Kim
- Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Hyung Suk Yi
- Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Eun Ju Park
- Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Jeong Hoon Kim
- Department of Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| | - Jin Hyung Park
- Department of Plastic and Reconstructive Surgery, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea
| |
Collapse
|
40
|
Evaluating the Therapeutic Success of Keloids Treated With Cryotherapy and Intralesional Corticosteroids Using Noninvasive Objective Measures. Dermatol Surg 2018; 44:635-644. [DOI: 10.1097/dss.0000000000001427] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
41
|
Petit L, Zugaj D, Bettoli V, Dreno B, Kang S, Tan J, Torres V, Layton AM, Martel P. Validation of 3D skin imaging for objective repeatable quantification of severity of atrophic acne scarring. Skin Res Technol 2018; 24:542-550. [DOI: 10.1111/srt.12464] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2018] [Indexed: 11/30/2022]
Affiliation(s)
- L. Petit
- Galderma R&D; Sophia Antipolis France
| | - D. Zugaj
- Galderma R&D; Sophia Antipolis France
| | - V. Bettoli
- Department of Dermatology; University of Ferrara; Ferrara Italy
| | - B. Dreno
- Dermatology Department; CHU Nantes; CIC 1413; CRCINA; University Nantes; Nantes France
| | - S. Kang
- Department of Dermatology; Johns Hopkins Medicine; Baltimore USA
| | - J. Tan
- Windsor Clinical Research Inc.; Western University; Windsor Ontario Canada
| | - V. Torres
- Private Practice; Mexico City Mexico
| | - A. M. Layton
- Harrogate and District NHS Foundation Trust; Harrogate UK
| | - P. Martel
- Galderma R&D; Sophia Antipolis France
| |
Collapse
|
42
|
Wei Y, Wang Y, Zhang M, Yan G, Wu S, Liu W, Ji G, Li-Tsang CW. The application of 3D-printed transparent facemask for facial scar management and its biomechanical rationale. Burns 2018; 44:453-461. [DOI: 10.1016/j.burns.2017.08.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 07/17/2017] [Accepted: 08/09/2017] [Indexed: 11/30/2022]
|
43
|
Gauglitz G, Steckmeier S, Pötschke J, Schwaiger H. Cohesive Polydensified Matrix ® hyaluronic acid volumizer injected for cheek augmentation has additional positive effect on nasolabial folds. Clin Cosmet Investig Dermatol 2017; 10:507-513. [PMID: 29276401 PMCID: PMC5733916 DOI: 10.2147/ccid.s141906] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Purpose Cohesive Polydensified Matrix® hyaluronic acid (CPM-HA) volumizer has been used successfully for several years to reverse biometric volume loss during facial aging. This observational study explored the additive effect on nasolabial folds when CPM-HA volumizer is injected into the neighboring cheek area. Patients and methods In this open-label, prospective, postmarketing noninterventional study, 18 adult patients seeking esthetic enhancement of the lateral cheek hollows and cheekbone area were injected with CPM-HA volumizer integrated with lidocaine (CPM-HA-VL) in the upper or lower cheek area. Safety and performance of CPM-HA-VL up to 12 months after injection with follow-up visits at week 4 and month 3, 6, and 12 were assessed. The primary endpoint was improvement of cheek fullness on the validated Merz Aesthetics Scales. Additionally, changes in nasolabial folds were quantified using a phaseshift rapid in vivo measurement of skin optical three-dimensional (3D) in vivo measurement device. Results Patients (94.4% female, median age 52 years, age range 39–69 years) were injected with a mean volume of 2.5±1.1 mL CPM-HA-VL per side. Immediately after injection, mean severity for upper and lower cheek fullness assessed on the validated MAS improved from 2.5±0.6 and 2.8±0.5, respectively, to 1.0±0.0, and remained unchanged through month 12. Improvement in relation to baseline was attested on the Global Aesthetics Improvement Scale for all assessments. Compared with baseline, the following assessments offered a statistical significance in the reduction of wrinkle depth of nasolabial folds (maximum depth reduction by 30.4% at 3 months) according to optical 3D in vivo measurements. Pain during injection was minimal and abated within 30 minutes. Treatment was well tolerated and led to great patient satisfaction. Conclusion CPM-HA-VL injected into the upper and lower cheeks led to long-lasting satisfactory cosmetic results in cheek augmentation as well as in reducing depth of nasolabial folds adjacent to the injection site.
Collapse
Affiliation(s)
- Gerd Gauglitz
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - Stephanie Steckmeier
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - Julian Pötschke
- Department of Plastic and Hand Surgery, Klinikum St Georg gGmbH, Leipzig, Germany
| | - Hannah Schwaiger
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| |
Collapse
|
44
|
Scar satisfaction and body image in thyroidectomy patients: prospective study in a tertiary referral centre. The Journal of Laryngology & Otology 2017; 132:60-67. [DOI: 10.1017/s0022215117002158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:This study is the first to evaluate scar satisfaction and body image in thyroidectomy patients using validated assessment tools.Methods:A total of 123 thyroidectomy patients were recruited over 8 months. Both patients and clinicians completed assessment tools that included: the Manchester Scar Scale (to measure scar perception), Dysmorphic Concern Questionnaire (to assess body image), Body Dysmorphic Concern Questionnaire (to screen for body dysmorphic disorder) and EQ-5D (to measure life quality). A separate image panel comprising experts and non-experts assessed 15 scar photographs. The results were analysed using non-parametric descriptive statistics.Results:Poor body image was associated with poor scar perception (ρ = 0.178,p= 0.05). Poor life quality correlated with poor scar perception (ρ = −0.292,p= 0.001). Scar length did not affect scar perception. Prevalence of body dysmorphic disorder among patients was found to be 8.94 per cent, which is higher than general population rates.Conclusion:Negative body image and life quality impact negatively upon scar perception.
Collapse
|
45
|
Hypertrophic Burn Scar Research: From Quantitative Assessment to Designing Clinical Sequential Multiple Assignment Randomized Trials. Clin Plast Surg 2017; 44:917-924. [PMID: 28888317 DOI: 10.1016/j.cps.2017.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article explores the current options for the quantitative assessment of hypertrophic burn scars. It also introduces a novel type of randomized, controlled trial, which relies on heterogeneity of the subject population to improve the predictive value of personalized treatment strategies.
Collapse
|
46
|
Jaspers M, Stekelenburg C, Simons J, Brouwer K, Vlig M, van den Kerckhove E, Middelkoop E, van Zuijlen P. Assessing blood flow, microvasculature, erythema and redness in hypertrophic scars: A cross sectional study showing different features that require precise definitions. Burns 2017; 43:1044-1050. [DOI: 10.1016/j.burns.2017.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 11/11/2016] [Accepted: 01/07/2017] [Indexed: 11/28/2022]
|
47
|
Agabalyan NA, Su S, Sinha S, Gabriel V. Comparison between high-frequency ultrasonography and histological assessment reveals weak correlation for measurements of scar tissue thickness. Burns 2017; 43:531-538. [DOI: 10.1016/j.burns.2016.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/09/2016] [Accepted: 09/11/2016] [Indexed: 10/20/2022]
|
48
|
Current and Emerging Options for Documenting Scars and Evaluating Therapeutic Progress. Dermatol Surg 2017; 43 Suppl 1:S25-S36. [DOI: 10.1097/dss.0000000000000698] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
|
49
|
Meirte J, Moortgat P, Anthonissen M, Maertens K, Lafaire C, De Cuyper L, Hubens G, Van Daele U. Short-term effects of vacuum massage on epidermal and dermal thickness and density in burn scars: an experimental study. BURNS & TRAUMA 2016; 4:27. [PMID: 27574695 PMCID: PMC4964043 DOI: 10.1186/s41038-016-0052-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Accepted: 06/17/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND Vacuum massage is a non-invasive mechanical massage technique invented to treat burns and scars. To date, no effects of vacuum massage on thickness and density of human scar tissue have been reported. The process in which external stimuli are converted into biochemical responses in the cell is known as mechanotransduction. In the skin endothelial cells, fibroblasts and myofibroblasts embedded in the extracellular matrix (ECM) sense mechanical stimuli (created by vacuum massage) and may promote intracellular processes leading to matrix remodelling. Since mechanotransduction could be a plausible working mechanism for vacuum massage as an anti-scarring therapy, this study aims to investigate the short-term effects of vacuum massage on thickness and density of epidermis and dermis in burn scars in order to find proof of ECM remodelling. METHODS A one group experimental study was performed. Patients with burn scars on upper extremities, lower extremities, and trunk were recruited for participation in this study. The DUB®cutis 22 MHz ultrasound scanner was used to assess thickness and density of the epidermal and dermal skin layers. After baseline measurements, vacuum massage was performed according to a pre-defined protocol. Measurements were carried out at 5 min, 30 min, 1 h, and 2 h post-intervention. RESULTS Thirteen scar sites from 9 different patients were investigated. In 8 out of the 13 scar sites, a disruption of the epidermis was noticed after the vacuum massage. Five minutes after the intervention, epidermal density decreased statistically significantly (p = .022) and dermal thickness increased (p = .018). Both changes lasted for more than 1 h, but after 2 h, the changes were no longer statistically significant. Dermal density decreased significantly (p = .048) immediately after the intervention, and this decrease was still present after 2 h (p = .011). CONCLUSIONS Preliminary results show that the disruption of the epidermis may indicate that vacuum massage could be able to actually breach the skin barrier. The statistically significant changes in the dermal layers could suggest an increased ECM production after vacuum massage.
Collapse
Affiliation(s)
- Jill Meirte
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
- Rehabilitation Sciences and Physiotherapy, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
| | - Peter Moortgat
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
| | - Mieke Anthonissen
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
- KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium
| | - Koen Maertens
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
- Department of Clinical and Lifespan Psychology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Cynthia Lafaire
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
- ZNA Stuivenberg, Burn Center, Antwerp, Belgium
| | - Lieve De Cuyper
- OSCARE, Organisation for Burns, Scar After-care and Research, Van Roiestraat 18, 2170 Antwerp, Belgium
- ZNA Stuivenberg, Burn Center, Antwerp, Belgium
| | - Guy Hubens
- Department of Antwerp Surgical Training Anatomy and Research Centre, University of Antwerp, Antwerp, Belgium
| | - Ulrike Van Daele
- Rehabilitation Sciences and Physiotherapy, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium
| |
Collapse
|
50
|
Lee KC, Dretzke J, Grover L, Logan A, Moiemen N. A systematic review of objective burn scar measurements. BURNS & TRAUMA 2016; 4:14. [PMID: 27574684 PMCID: PMC4964074 DOI: 10.1186/s41038-016-0036-x] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/29/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Problematic scarring remains a challenging aspect to address in the treatment of burns and can significantly affect the quality of life of the burn survivor. At present, there are few treatments available in the clinic to control adverse scarring, but experimental pharmacological anti-scarring strategies are now beginning to emerge. Their comparative success must be based on objective measurements of scarring, yet currently the clinical assessment of scars is not carried out systematically and is mostly based on subjective review of patients. However, several techniques and devices are being introduced that allow objective analysis of the burn scar. The aim of this article is to evaluate various objective measurement tools currently available and recommend a useful panel that is suitable for use in clinical trials of anti-scarring therapies. METHODS A systematic literature search was done using the Web of Science, PubMed and Cochrane databases. The identified devices were then classified and grouped according to the parameters they measured. The tools were then compared and assessed in terms of inter- and intra-rater reproducibility, ease of use and cost. RESULTS After duplicates were removed, 5062 articles were obtained in the search. After further screening, 157 articles which utilised objective burn scar measurement systems or tools were obtained. The scar measurement devices can be broadly classified into those measuring colour, metric variables, texture, biomechanical properties and pathophysiological disturbances. CONCLUSIONS Objective scar measurement tools allow the accurate and reproducible evaluation of scars, which is important for both clinical and scientific use. However, studies to evaluate their relative performance and merits of these tools are scarce, and there remain factors, such as itch and pain, which cannot be measured objectively. On reviewing the available evidence, a panel of devices for objective scar measurement is recommended consisting of the 3D cameras (Eykona/Lifeviz/Vectra H1) for surface area and volume, DSM II colorimeter for colour, Dermascan high-frequency ultrasound for scar thickness and Cutometer for skin elasticity and pliability.
Collapse
Affiliation(s)
- Kwang Chear Lee
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, B15 2TH UK
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Janine Dretzke
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Liam Grover
- School of Chemical Engineering, University of Birmingham, Birmingham, B15 2TT UK
| | - Ann Logan
- School of Clinical and Experimental Medicine, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT UK
| | - Naiem Moiemen
- The Healing Foundation Burn Research Centre, University Hospital Birmingham Foundation Trust, Birmingham, B15 2TH UK
| |
Collapse
|