Effectiveness of various methods of manual scar therapy

Postoperative Physical Therapy Following Primary Cheiloplasty in Cleft Lip and Palate Patients: A Retrospective Analysis

ABSTRACT

Cleft lip and palate (CLP) are common congenital anomalies with significant functional and aesthetic implications. In Chile, the incidence of cleft lip is 14 per 10,000 live births. Primary cheiloplasty is the initial surgical intervention, typically followed by physical therapy for scar management. Despite inclusion in national guidelines, data on postoperative physical therapy after cheiloplasty are limited.This study aims to describe postoperative physical therapy management in CLP patients following primary cheiloplasty, focusing on initiation timing and number of sessions. A retrospective analysis of records from the Gantz Foundation included 91 patients who underwent primary cheiloplasty between 2022 and 2023. Data collected encompassed age at surgery, dates of surgery and therapy initiation, number of sessions, and the interval between surgery and therapy start.Seventy-one patients (78%) began postoperative physical therapy at the Gantz Foundation. Ages at surgery ranged from 2 to 24 months (mean: 4.8 mo), with 90.1% between 3.5 and 5 months old. Physical therapy commenced 8 to 136 days postsurgery (mean: 38 d); 47.8% started within the first month, while 10% began after 2 months. The number of sessions ranged from 1 to 11 (mean: 4.67, median: 4).

CONCLUSIONS

Significant variability exists in the timing and frequency of postoperative physical therapy following primary cheiloplasty in CLP patients. Delays and inconsistencies may result from geographical barriers and access issues. Enhancing referral protocols, improving communication with caregivers, and exploring strategies like telerehabilitation could improve access and adherence, potentially leading to better functional and aesthetic outcomes.

Immediate Changes in the Elasticity of Tissue and the Pain Pressure Threshold in Cesarean Scar Tissue After a Vacuum Intervention: An Open Clinical Trial

Background/Objectives: Cesarean section (C-section) scars are commonly linked to reduced tissue elasticity and increased pain due to adhesion formation. Addressing these concerns is essential to improving patient comfort and functional outcomes. This study aimed to assess the immediate effects of vacuum therapy on skin elasticity and pain sensitivity in C-section scar tissue. Methods: Thirty-one women with C-section scars older than six months and less than two years participated in an open clinical trial. The skin elasticity was assessed using the Adheremeter, and the pain sensitivity was measured through the Pressure Pain Threshold (PPT) using algometry. The intervention consisted of a 15 min vacuum therapy session using the AeroFlow® device that targeted the scar and surrounding areas. Results: The vacuum therapy intervention resulted in significant improvements in the skin elasticity at multiple assessment points, particularly in regions with fascial restrictions (p < 0.05). Concurrently, the PPT values decreased, indicating a reduction in pain sensitivity around the scar area (p < 0.05). These findings suggest that vacuum therapy may enhance tissue flexibility and alleviate pain in adherent C-section scars. Conclusions: This study demonstrated the potential of vacuum therapy as an effective intervention to improve skin elasticity and reduce pain sensitivity in C-section scars. The Adheremeter-based assessment provided valuable insights into the biomechanical properties of scar tissue and supported its use in scar management protocols. This approach offers a promising, non-invasive strategy for personalized scar treatment, ultimately aiming to enhance patient outcomes and quality of life.

The suture effect of butterfly suture combined with the looped, broad, and deep buried suture in patients with pigmented naevus receiving surgery excision

This study aims to explore the suture effectiveness of butterfly suture combined the looped, broad, and deep buried suture (butterfly tension-reducing suture) in patients with pigmented naevus. A retrospective analysis of patients with pigmented naevus from January 2021 to December 2022 were performed. Patients were divided into: (1) control group that received routine suture; (2) observation group receiving butterfly tension-reducing suture. The ratio of scar area to the naevus area, the scar width and the incision complication were investigated. Vancouver Scar Scale scores of patients (VSS), Patient Scar Assessment Scale (PSAS) and the Observer Scar Assessment Scale (OSAS) at pre-operation and 6 months after surgery were compared. Logistic regression analysis was used for the risk factor analysis of post-operative scars. The study included 34 in control group and 41 in observation group. Observation group showed a lower incidence of incision complication and smaller scar width. At 6 months after surgery, VSS items showed statistical changes between the control and observation group, including pigmentation, vascularity, pliability, height, and total opinion. Using PSAS, observation group showed lower scores in color, stiffness, thickness, irregularity, pain, itch, and overall opinion as compared to control group. There were significant decreases in OSAS items of the observation group compared to the control group, including vascularity, thickness, pigmentation, pliability, relief, and overall opinion. Suture method and incision complication were the risk factors of post-operative scars. Butterfly tension-reducing suture improves aesthetics and prognosis in pigmented naevus patients by inhibiting extension excessive tension.

The Impact of Vegan and Vegetarian Diets on Wound Healing: A Scoping Review

BACKGROUND

Globally, vegan and vegetarian diets have grown in popularity. At the same time, it is well-known that nutrition plays a critical role in postoperative outcomes, including wound healing. The present investigation undertakes a systematic scoping review of the current literature that explores the impact of vegan or vegetarian diets on wound healing.

METHODS

The protocol followed PRISMA-ScR guidelines. PubMed, Web of Science, and Cochrane Library were used to identify articles published until 2024. Studies comparing any wound healing outcome between vegan or vegetarian patients and omnivorous patients were considered eligible. A two-stage screening process was conducted for study selection. Data extraction focused on the primary outcome-any wound healing outcome-and secondary outcomes, which included study general information, laboratory values, limitations, and future perspectives.

RESULTS

Eight studies were included in this review. The majority of publications (87.5%) were prospective studies. Papers reported diverse wound healing outcomes after the following interventions: fractional microneedle radiofrequency, laser surgery, microfocused ultrasound, narrow-band ultraviolet B phototherapy, ultrapulsed CO2 resurfacing, excisional biopsy, skin graft, and photodynamic therapy. In almost all studies (87.5%) wound healing outcomes were statistically inferior in vegan or vegetarian patients compared to omnivorous patients.

CONCLUSION

Our results suggest that wound healing outcomes may be suboptimal in patients adhering to vegan or vegetarian diets, indicating that these dietary patterns might contribute adversely to the wound healing process. Future research is needed to understand better the underlying mechanisms and the potential implications in the preoperative assessment and postoperative course of these patients.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266.

The role of apoptosis, immunogenic cell death, and macrophage polarization in carbon ion radiotherapy for keloids: Targeting the TGF-β1/SMADs signaling pathway

Keloids, characterized by excessive extracellular matrix (ECM) deposition and aberrant fibrous tissue proliferation, present significant therapeutic challenges due to their recalcitrant and recurrent nature. This study explores the efficacy of Carbon Ion Radiotherapy (CIRT) as a novel therapeutic approach for keloids, focusing on its impact on fibroblast proliferation, apoptosis induction, immunogenic cell death (ICD), macrophage polarization, and the TGF-β/SMAD signaling pathway. Utilizing a murine model of keloid formed by subcutaneous injection of zeocin in C57BL/6 mice, we demonstrated that CIRT effectively reduces collagenous fiber synthesis and collagen production in keloid tissues. Further, CIRT was shown to inhibit keloid fibroblast proliferation and to induce apoptosis, as evidenced by increased expression of apoptosis-related proteins and confirmed through flow cytometry and TUNEL assay. Notably, CIRT induced mitochondrial stress, leading to enhanced immunogenicity of cell death, characterized by increased expression of ICD markers and secretion of interferon-γ. Additionally, CIRT promoted a shift from M2 to M1 macrophage polarization, potentially reducing TGF-β release and mitigating ECM deposition. Our findings suggest that CIRT mediates its therapeutic effects through the inhibition of the TGF-β/SMAD signaling pathway, thereby attenuating ECM formation and offering a promising avenue for keloid treatment. This study underscores the potential of CIRT as an innovative strategy for managing keloids, highlighting its multifaceted impact on key cellular processes involved in keloid pathogenesis.

Aesthetic Rehabilitation Medicine: Enhancing Wellbeing beyond Functional Recovery

Although rehabilitation medicine emphasizes a holistic health approach, there is still a large gap of knowledge about potential interventions aimed at improving overall wellbeing through cosmetic interventions. Therefore, this narrative review investigates the role of different rehabilitative techniques in enhancing aesthetics, quality of life, and psychosocial wellbeing for patients with disabilities. The study follows the SANRA framework quality criteria for a narrative review. Literature searches across PubMed/Medline, Web of Science, and Scopus identified articles focusing on rehabilitation strategies within the aesthetic rehabilitation domain. The review identified evidence supporting injection procedures, such as Botulinum Toxin, Platelet-Rich Plasma, Hyaluronic Acid, Ozone, and Carboxytherapy, and assessing their applications in several disabling disorders. Additionally, physical therapies like Extracorporeal Shock Wave Therapy, Laser Therapy, Microcurrent Therapy, Tecar Therapy, and physical exercises were explored for their impact on cutaneous microcirculation, cellulite treatment, wound healing, and scar appearance improvement. Lastly, the manuscript underlines the role of manual therapy techniques in addressing both physical discomfort and aesthetic concerns, discussing their effectiveness in adipose tissue therapy, scar tissue mobilization, and regional fat thickness reduction. Taken together, this review emphasizes the role of a multidisciplinary approach, aiming to provide valuable insights into potential benefits for both functional and aesthetic outcomes.

Stretching of the anterior fascial tape in women after a caesarean section

Introduction. The cesarean section rate in the 21st century has significantly increased compared to the previous century. Consequences related to the existence of a scar after a cesarean section may contribute to various discomforts in the abdominal, back, or pelvic regions. Aim of the study. The research hypothesis posited that the application of stretching therapy of the anterior fascial band has an impact on and is associated with the scar texture after a cesarean section. Study materials and methodology. Eight women, 3-4 months postpartum, with an average age of 27.5 ± 4.17 years, participated in the study. The MyotonPro device was utilized to assess the biomechanical properties of the tissue around the scar. The women performed stretching exercises for 2 months, twice a week. One session per week was supervised by the researcher, and during the other session, participants performed the assigned exercises independently. Measurements with the MyotonPro device were repeated after 8 weeks. Results. A strong and positive correlation was observed between: cs_2 and cs_1 r = 0.88, cs_2 and ls_1 r = 0.96, cs_2 and rs_1 r = 0.82, ls_2 and ls_1 r = 0.97, rs_2 and rs_1 r = 0.96. Conclusions. Engaging in stretching exercises has a positive impact on improving the texture of scar tissue.

The skin-brain connection and pleasant touch as supportive care for psychocutaneous disorders

Psychodermatology is a subdiscipline of dermatology at the intersection of dermatology, psychiatry, and psychology. In dermatology clinical practice, patients may present with skin disease that affects their mental health, or skin disorders induced or worsened by psychological/psychiatric problems so there is a need for specialised education of dermatologists, as well as multidisciplinary teams, to achieve better management of these patients. Understanding the interaction between the central nervous system and the skin underlying psychocutaneous disorders could help identify alternative therapies that may improve patient well-being. The concept of pleasurable touch has received increasing attention following the discovery of C-tactile (CT) fibres. While afferent C-fibre stimulation is usually associated with pain, temperature, or itch, CT-fibres are stimulated optimally by a stimulus not in the nociceptor range but by a gentle, low-force stroking. As this affective touch may counteract unpleasurable sensations, such as pain and itch, and elicit positive feelings, the potential benefits of gentle touch and massage are interesting for dermatological, especially psychocutaneous, disorders. Here we provide an overview of the skin-brain connection to help understand the benefits of touch and massage, as illustrated with studies on atopic dermatitis and burns, as an adjunct to dermatological treatment for improving patient well-being and optimising treatment outcomes.

Postoperative Scar Management Protocol for Asian Patients

BACKGROUND

Postoperative scar formation remains a morbidity for patients even with the advent of minimally invasive techniques. Furthermore, the significant difference between the Asian and Caucasian skin results in poorer postoperative scar outcomes in Asians, supporting the need for an evidence-based scar management protocol.

METHODS

Following a literature review of the PubMed and the Cochrane databases over the past 10 years, we constructed a novel postoperative scar management protocol for the Asian skin, utilized in a Singaporean tertiary healthcare institution.

RESULTS

We describe a timeline-based scar protocol from the point of skin closure to a minimum of 1 year of follow-up. We support the use of intraoperative botulinum toxin for selected high-risk individuals upon skin closure with a follow-up regimen in the postoperative setting. For recalcitrant keloids, we have described a multimodal therapy comprising elements of intralesional steroids, botulinum toxin, lasers, surgery, and radiotherapy.

CONCLUSIONS

A consolidated postoperative scar management protocol provides the necessary guidance for improved scar outcomes in the Asian skin. There is inherent potential in expanding the protocol to include post-traumatic and burn wounds or support other skin types including the Caucasian skin.

NO LEVEL ASSIGNED

This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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 .

Acupuncture and dry needling for physical therapy of scar: a systematic review

BACKGROUND

There is a continuing interest in finding effective methods for scar treatment. Dry needling is gaining popularity in physiotherapy and is defined by Western medicine as a type of acupuncture. The terms acupuncture and dry needling have been used interchangeably so we have focused on the efficacy of dry needling or acupuncture in scar treatment.

OBJECTIVE

The aim of this systematic review was to determine the usefulness of dry needling or local acupuncture for scar treatment. In our search process, we used the terms 'acupuncture,' 'needling,' or 'dry needling' to identify all relevant scientific papers. We have focused on the practical aspects of local management of different scar types with dry needling or acupuncture.

SEARCH STRATEGY

The search strategy included different combinations of the following keywords: 'scar', 'keloid', 'dry needling', 'needling', 'acupuncture', 'treatment', 'physical therapy'. This systematic review was conducted in accordance with PRISMA guidelines. MEDLINE (PubMed, EBSCOHost and Ovid), EMBASE (Elsevier), and Web of Science databases were searched for relevant publications from inception through October 2023.

INCLUSION CRITERIA

The studies that investigated the effectiveness of dry needling or acupuncture for scar treatment were included.

DATA EXTRACTION AND ANALYSIS

The main extraction data items were: the needling technique; needle: diameter, length; needling locations; manual needling manipulation; number of sessions; settings; outcomes and results.

RESULTS

As a result of a comprehensive search, 11 manuscripts were included in the systematic review, of which eight were case reports, two were randomized trials and one study concerned case series. Two case reports scored 2-4 out of 8 points on the JBI checklist, five studies scored 5-7, and one study scored 8 points. The methodological quality of the two clinical trials was rated as good or fair on the PEDro scale. The case series study scored 7 of 10 points on the JBI checklist. A meta-analysis was not possible as only two randomized trials, eight case reports, and one case series were eligible for review; also, scar assessment scales and pain severity scales were highly heterogeneous.

CONCLUSIONS

The studies differed regarding the delivery of dry needling or local acupuncture for scar treatment. Differences included treatment frequency, duration, number of treatments, selection of needle insertion sites, number of needles used, angle of needle placement, and use of manual needling manipulation.

SYSTEMATIC REVIEW REGISTRATION

INPLASY no. 202310058.

Influence of scar age, laser type and laser treatment intervals on adult burn scars: A systematic review and meta-analysis

AIM

The study aims to identify whether factors such as time to initiation of laser therapy following scar formation, type of laser used, laser treatment interval and presence of complications influence burn scar outcomes in adults, by meta-analysis of previous studies.

METHODS

A literature search was conducted in May 2022 in seven databases to select studies on the effects of laser therapy in adult hypertrophic burn scars. The study protocol was registered with PROSPERO (CRD42022347836).

RESULTS

Eleven studies were included in the meta-analysis, with a total of 491 patients. Laser therapy significantly improved overall VSS/POSAS, vascularity, pliability, pigmentation and scar height of burn scars. Vascularity improvement was greater when laser therapy was performed >12 months (-1.50 [95%CI = -2.58;-0.42], p = 0.01) compared to <12 months after injury (-0.39 [95%CI = -0.68; -0.10], p = 0.01), the same was true for scar height ((-1.36 [95%CI = -2.07; -0.66], p<0.001) vs (-0.56 [95%CI = -0.70; -0.42], p<0.001)). Pulse dye laser (-4.35 [95%CI = -6.83; -1.86], p<0.001) gave a greater reduction in VSS/POSAS scores compared to non-ablative (-1.52 [95%CI = -2.24; -0.83], p<0.001) and ablative lasers (-0.95 [95%CI = -1.31; -0.59], p<0.001).

CONCLUSION

Efficacy of laser therapy is influenced by the time lapse after injury, the type of laser used and the interval between laser treatments. Significant heterogeneity was observed among studies, suggesting the need to explore other factors that may affect scar outcomes.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Gaps Between the Indication and the Home Execution of Massage Therapy in Children in the Postsurgical Stage of Primary Cheiloplasty or Rhinocheiloplasty

PURPOSE

This study describes the compliance rate with home massage therapy in children in the postsurgical stage of primary cheiloplasty or rhinocheiloplasty and the factors that facilitate or hinder its execution.

METHODS

The parents of 15 children treated at the Gantz Foundation - Children's hospital for cleft lip and palate in Santiago, Chile were recruited. Parents received instructions to perform massages at home 5 times daily and were followed up for 3 months by recording in a log. Qualitative information on facilitators and barriers was collected in a focus group session.

RESULTS

Compliance rate was close to 75%, and the factors that facilitated the execution were performing the massage with some distracting activity and noticing the positive changes in the appearance of the scars. The most important factors that hindered the execution were the infant's crying and changes in the routine.

CONCLUSION

The authors conclude that the compliance rate is high and suggest that parents and guardians identify and implement a routine with a distracting activity that allows the massage to be carried out effectively.

Osteopathic Approach for Keloids and Hypertrophic Scars

The skin is a complex organ, a system that influences and is influenced by the body system, with different skin layers always mechano-biologically active. In the presence of a lesion that damages the dermis, the skin undergoes sensory, morphological, and functional alterations. The subsequent adaptation is the formation of scar tissue, following distinct and overlapping biological phases. For reasons not yet fully elucidated, some healing processes lead to pathological scars, from which symptoms such as pain, itching, and functional limitations are derived. Currently, there is no gold standard treatment that fully meets the needs of different scars and can eliminate any symptoms that the patient suffers. One such treatment is manual medicine, which involves direct manual approaches to the site of injury. Reviewing the phases that allow the skin to be remodeled following an injury, this article reflects on the usefulness of resorting to these procedures, highlighting erroneous concepts on which the manual approach is based, compared to what the current literature highlights the cicatricial processes. Considering pathological scar adaptations, it would be better to follow a gentle manual approach.

Soluble Polymer Microneedles Loaded with Interferon Alpha 1b for Treatment of Hyperplastic Scar

To achieve the painless administration of interferon alpha 1b (rhIFNα-1b), a double-layered soluble polymer microneedle (MN) patch loaded with rhIFNα-1b was used to deliver rhIFNα-1b transdermally. The solution containing rhIFNα-1b was concentrated in the MN tips under negative pressure. The MNs punctured the skin and delivered rhIFNα-1b to the epidermis and dermis. The MN tips implanted in the skin dissolved within 30 min and gradually released rhIFNα-1b. The rhIFNα-1b had a significant inhibitory effect on the abnormal proliferation of fibroblasts and excessive deposition of collagen fibers in the scar tissue. The color and thickness of the scar tissue treated using the MN patches loaded with rhIFNα-1b were effectively reduced. The relative expressions of type I collagen (Collagen I), type III collagen (Collagen III), transforming growth factor beta 1 (TGF-β1), and α-smooth muscle actin (α-SMA) were significantly downregulated in scar tissues. In summary, the MN patch loaded with rhIFNα-1b provided an effective method for the transdermal delivery of rhIFNα-1b.