Scar Height Research Articles

Enhanced wound closure in rabbit oral vestibule: a comparative analysis of suturing and laser tissue soldering

This study investigates the comparative effectiveness of laser soldering technique and conventional suturing methods for wound closure in rabbits. Over a 60-day post-operative period, scar formation and healing were monitored, with a particular focus on scar characteristics such as width, height, and overall appearance. Results indicate that the laser group exhibited improved scar characteristics, especially in the early stages (first and third days) of healing. By the seventh day, both groups demonstrated similar scar conditions, though the laser group showed a slightly faster recovery trajectory, with marginally lower scar height observed on the 21st and 60th days. While the laser technique showed some advantages in minimizing short-term complications, the long-term outcomes between the two methods were largely comparable. These findings suggest that the laser soldering method may offer some benefits over traditional suturing, particularly in the early stages of healing, but further research is needed to fully assess its clinical potential.

Losartan in Situ Forming Gel as a New Treatment for Hypertrophic Scars.

Hypertrophic scars are defined as visible lesions formed by excessive wound healing that cause cosmetic and, in some cases, functional challenges in patients. This study aimed to assess the efficacy of intralesional injections of losartan-loaded in situ forming gel and compare it with the common treatment (triamcinolone) in preventing scar formation. The formulation was prepared using a thermosensitive PLGA-PEG-PLGA triblock copolymer. Ear scar tissue in rabbits represented the hypertrophic scar, and the animals were treated with three treatments in three groups. Nine weeks following the single treatment, images of the scars were obtained and quantitatively analyzed using ImageJ and light microscopy was used to evaluate the fibroblast cell number, vascularization, inflammation and collagen deposition and fibrosis in H&E-stained sample tissue. According to the results based on the ImageJ and the Vancouver criteria, the losartan in situ forming gel (F-LG) indicated significantly higher improving effects on decreased vascularity and pigmentation in comparison with triamcinolone (F-TA) and placebo as a control (F-Ctl), although the effect F-LG was almost similar to F-TA on pliability and scar height, and they were better than the control. Histological findings showed F-LG and F-TA have less inflammatory and fibroblast cells compared to F-Ctl. Also, results indicated the dermal layers of the F-TA and F-LG groups' scar were thinner, and the deposition of collagens was reduced compared to the control. Consequently, F-LG was found to be an effective treatment in reducing scarring and promoting wound healing.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 .

Effects of Kinesio tape on vascularity, pliability and height of the hypertrophic scar in burns patients: a randomized pilot clinical trial.

Deep burns damage the reticular dermis and may lead to the formation of hypertrophic scars. Compression therapy reduces local vascularity and realigns collagen fibers, resulting in esthetic and functional improvements. This study evaluated the effect of Kinesio tape compression with maximum mechanical tension on vascularity, pliability and the height of hypertrophic scars following deep burns. A single blind, randomized pilot clinical trial was carried out. The elastic compression of Kinesio tape was applied at maximum stretch in the intervention group (n=11) and no stretch in the sham group (n=11). Vascularity, pliability and height (the primary outcomes) were evaluated at 0, 45 and 90 days using the Vancouver Scar Scale (VSS). The association between the VSS scores, the intervention and the evaluation moment were analyzed using linear mixed-effects regression models, while comparisons of means between the groups were performed using the t Student test was. Significance was set at 5%. The mean VSS scores were similar between the groups. Significant improvement occurred in both groups when post-treatment and baseline scores were compared. No further improvement was found in the vascularity, pliability or height of hypertrophic scars resulting from deep burns when an elastic compression of Kinesio tape was used at maximum tension compared to lesser mechanical tension.

Comparison of long-term abdominal scarring after DIEP flap reconstruction: conventional dermal sutures versus INSORB dermal staples

Background The importance of adequate wound closure in plastic surgery cannot be overstated. With the goals of shortening the operative time and improving outcomes, various methods and devices have been introduced to enhance the speed and quality of wound closure. To simplify dermal closure with favorable outcomes, several studies have compared results between the INSORB dermal stapler and conventional dermal sutures. We hypothesized that the dermal stapler would yield satisfactory scar formation without increasing complication rates over the long term.Methods This retrospective study included patients who had undergone breast reconstruction with a deep inferior epigastric perforator (DIEP) free flap between October 2019 and May 2020 at a single center. Postoperative photographs of the patients’ abdominal scars were assessed at a minimum of 248 days by three blinded attending plastic surgeons using the Vancouver Scar Scale.Results A total of 108 patients who underwent DIEP-free flap reconstruction after mastectomy were included in this study. Among them, 68 patients (group 1) underwent dermal closure with the INSORB dermal stapler, while 40 patients (group 2) underwent conventional dermal sutures. No significant differences were observed between the two groups in terms of vascularity, pigmentation, pliability, scar height, or overall scar assessment. Additionally, there was no significant difference in complication rates between the two groups.Conclusions The INSORB dermal stapler is a valuable tool that can reduce operative time while delivering satisfactory outcomes. When used appropriately with proper training, it can mitigate perioperative complications and alleviate the surgical burden for the surgeon.

Investigating the Impact of Wound Edge Approximation with Skin Grafting on Hypertrophic Scar Reduction: A Randomized Controlled Clinical Trial.

In modern burn care, the focus extends beyond mere patient survival to encompass long-term functional and cosmetic outcomes. Research suggests that the technique and manner of suturing during skin grafting play a significant role in scar formation. This study aimed to explore the effectiveness of wound edge approximation with skin grafting compared to the conventional approach, where the graft edge exclusively interacts with the wound edge, in reducing hypertrophic scar development. Seventy-four burn unit patients eligible for grafting were randomly allocated into two groups: those receiving grafts with overlapping edges (Group A) and those receiving grafts with edges tailored to the burn wound (Group B). Evaluation of graft sites occurred immediately post-surgery and at 1 and 6 months post-operatively using the standardized Vancouver Scar Scale (VSS) administered by trained surgeons. The findings of this study revealed that there was no statistically significant difference between the two examined groups regarding the average duration of hospitalization and the mean thickness of wounds (P>0.05). Similarly, the mean scores for pain, vascular index, and pigmentation index immediately post-surgery, at 1 month, and 6 months later, as well as the scar height index and flexibility immediately and at 1 month post-surgery, and the Vancouver Scar Scale index at the study's conclusion, showed no significant variation between the two groups (P>0.05). However, at the 6-month follow-up, the mean scar height score (P=0.004) in the overlapping group and the mean flexibility score (P=0.017) in the non-overlapping group were significantly lower compared to the respective alternative group. This indicates a notable improvement in scar height and wound flexibility in the overlapping group over the non-overlapping group after 6 months.

Comparison of the wound healing and complications of zipper type closure adhesive tape and stapler for surgical wound suture: A randomized control, single-centre, open-label trial.

Xkin closure is a newly developed medical suture device for lacerations and surgical wounds that can reduce scarring, pain and the risk of infection compared with conventional sutures or staplers. A randomized controlled study was performed to compare the wound healing effects and complications of Xkin closure with stapler closure. Fifty patients who underwent robot-assisted radical prostatectomy for prostate cancer were randomly assigned. Only the wound above the navel, which was extended to take out the prostate was targeted. The wound was examined at 2, 6 and 12 weeks after surgery, and the modified Vancouver Scar Scale (mVSS), scar height and side effects were assessed with a 3D skin analyser. Forty-six patients (23 Xkin, 23 Stapler) were analysed. The mVSS scores, vascularity and pliability were significantly lower in the Xkin group compared with the stapler group at the 12-week follow-up. No significant differences in the maximum peak and depth of the scars were detected between the two groups using 3D photographs at 12 weeks. Xkin is an effective wound closure method for improving scar outcomes. This method is expected to be widely used for surgical wounds and lacerations caused by trauma in daily life.

Role of Triamcinolone Acetonide in the Maturation of Scars.

Surgeons have tried various measures to achieve a minimum and aesthetically appealing scars after wound healing at surgical sites. Various regimens have been recommended to minimize scars both intraoperatively and postoperatively. Our study aims to assess the outcome of the injection of triamcinolone acetonide used intraoperatively on a normal surgical suture line. This is a prospective, observational study of 21 patients (divided into test and control groups with a single scar at the same site) treated with or without injection of triamcinolone acetonide, and outcomes were assessed using Vancouver Scar Scale and Stony Brook Scar Evaluation Scale. We found a significant difference (P > 0.05) between the median of vascularity, pigmentation, and total score on the Vancouver Scar Scale, whereas there was significant difference between height, color, and overall appearance according to the Stony Brook Scar Evaluation Scale between the test and the control group. We could not find a significant difference in outcome with varying, increasing doses of triamcinolone acetonide. A low dose of triamcinolone acetonide is an effective drug that tends to improve the outcome of a scar in terms of vascularity, pigmentation, height, and overall appearance of the postoperative surgical scar and helps in the maturation of a normal scar.

Increased Patient Compliance with Silicone Gel Sheeting and Topical Silicone Gel for Hypertrophic Scar Improves Scar Outcomes

Background: Although silicone-based products are widely used for hypertrophic scar (HS) treatment, limited research exists on the correlation between patient compliance of silicone products and scar outcomes. This study aims to investigate whether continuous and consistent use of topical silicone gel (TSG) and silicone gel sheet (SGS) improves scar characteristics and whether patient compliance influences scar outcomes.Methods: A total of 79 patients with HS were randomized into either TSG (n=38) or SGS group (n=41) by an independent physician who had not seen the patients. Patient compliance was assessed based on application frequency and duration. Patients were divided into three subgroups according to compliance. Scar characteristics were evaluated using the Vancouver Scar Scale (VSS) and patient self-assessment via a visual analogue scale (VAS) for 6 months.Results: VSS pigmentation and scar height worsened in patients who applied silicone products for less than 3 days per week, especially in the TSG group. Patients who applied silicone products for more than 4 days per week showed significant improvements in all factors. Patients reported improvements in VAS scar height, pigmentation, and hardness as application time increased. Pain and itching improved regardless of application time.Conclusion: Continuous and consistent use of TSG and SGS improved HS outcomes. Applying silicone products more than 4 days in a week correlated with better scar characteristics, except pain and itching. Applying silicone products less than 3 days in a week is not recommended, as this may worsen scar height and pigmentation.

Unveiling the language of scars: A patient-centric themed framework for comprehensive scar morphology

BackgroundScarring, a pervasive issue spanning across medical disciplines, lacks a comprehensive terminology for effective communication, patient engagement, and outcome assessment. Existing scar classification systems are constrained by specific pathologies, physician-centric features, and inadequately account for emerging technologies. This study refrains from proposing yet another classification system and instead revisits the foundational language of scar morphology through a theme analysis of primary patient complaints. MethodData encompassing five years of a high-volume scar practice was analysed. Primary complaints were aggregated into collective descriptors and further organized into theme domains. The resulting hierarchical map of presenting complaints revealed five key domains: Loss of Function, Contour, Texture, Vector, and Colour Presenting complaints were codified into 42 items, which were then categorised into 14 collective descriptor terms. The latter were in turn organised into five overarching themes. ResultLoss of Function, accounting for 10% of primary concerns, signifies reduced function attributed solely to the scar. Contour, encompassing 41% of concerns, pertains to scar height, shape, and depth. Texture, representing 12% of concerns, denotes tactile variations such as hardness, roughness, and moisture. Vector, comprising 13% of concerns, refers to scar tissue tension and associated distortions. Colour, the concern in 24% of cases, encompasses variations in pigmentation, vascularity, and exogenous pigments. DiscussionStandardized terminology enhances patient care, communication, and research. This study underscores the fundamental question of "what bothers the patient," reviving a patient-centred approach to scar management. By prioritizing themes based on patient complaints, this study innovatively integrates function, aesthetics, and patient experience. In conclusion, this study pioneers a paradigm shift in scar management by presenting a patient-driven theme framework that offers a common language for healthcare professionals and patients. Embracing this language harmonizes scar treatment, fosters innovation, and transforms scars from silent reminders into stories of resilience and healing.

Comparison of Clinical Estimation and Stereophotogrammic Instrumented Imaging of Burn Scar Height and Volume

Descriptive clinical tools for characterizing burn scars are limited by between-user variability and unknown sensitivity to change over time. We previously described preclinical assessment of stereophotogrammetry as a valid measure of burn-related scars. Here, we compared the estimated vs. instrumented measurements of maximum height and total positive volume of 26 burn scars. The burn scars were imaged with the QuantifiCare LifeViz Micro 3D camera. Three experienced wound care therapists first estimated, then measured using 3D Track software, the imaged scars’ height and volume. Two-factor analysis without replication was performed to calculate intraclass correlation coefficients (ICCs) between assessors’ estimated scar height and volume, and measured height and volume. Two-sided Wilcoxon tests were performed comparing the mean estimated height and volume with the estimated and measured outputs. The estimated scar height’s ICC was 0.595, and for volume, it was 0.531. The measured scar height’s ICC was 0.933 and for volume, it was 0.890. The estimated and measured volume were significantly different (z = −2.87, p = 0.041), while the estimated and measured height were not (z = −1.39, p = 0.161). Stereophotogrammic measurement of scar height and volume is more reliable than clinical photograph assessment. Stereophotogrammetry should be utilized when assessing burn scar height and volume, rather than subjective estimates from clinical scar tools.

Application of fractional carbon dioxide laser monotherapy in keloids: A meta-analysis.

There is no evidence-based guidance on the use of fractional CO2 laser in the excision of scars. To explore the effectiveness and safety of fractional CO2 laser in the treatment of keloids. In this meta-analysis, we searched the PubMed, Embase, and Cochrane databases from inception to April 2023. We only included studies reporting fractional CO2 laser treatment of keloids. We excluded duplicate published studies, incomplete studies, those with incomplete data, animal experiments, literature reviews, and systematic studies. The pooled results showed that the Vancouver Scar Scale (VSS) parameters of height weighted mean difference (WMD) = -1.10, 95% confidence interval (CI): -1.46 to -0.74), pigmentation (WMD = -0.61, 95% CI: -1.00 to -0.21), and pliability (WMD = -0.90, 95% CI: -1.17 to -0.63) were significantly improved after fractional CO2 laser treatment of keloids. However, vascularity did not significantly change. Additionally, the total VSS was significantly improved after treatment (WMD = -4.01, 95% CI: -6.22 to -1.79). The Patient Scars Assessment Scale was significantly improved after treatment (WMD = -15.31, 95% CI: -18.31 to -12.31). Regarding safety, the incidences of hyperpigmentation, hypopigmentation, pain, telangiectasia, and atrophy were 5%, 0%, 11%, 2% (95% CI: 0%-6%), and 0% (95% CI: 0%-4%), respectively. Fractional CO2 laser is effective in the treatment of keloids and can effectively improve the height, pigmentation, and pliability of scars, and patients are satisfied with this treatment. Further studies should explore the role of combination therapy.

Influence of scar age, laser type and laser treatment intervals on paediatric burn scars: a systematic review and meta-analysis.

Laser therapy has emerged to play a valuable role in the treatment of paediatric burn scars; however, there is heterogeneity in the literature, particularly concerning optimal timing for initiation of laser therapy. This study aims to investigate the effect of factors such as scar age, type of laser and laser treatment interval on burn scar outcomes in children by meta-analysis of previous studies. A literature search was conducted across seven databases in May 2022 to understand the effects of laser therapy on burn scar outcomes in paediatric patients by metanalysis of standardized mean difference (SMD) between pre- and post-laser intervention. Meta-analyses were performed using the Comprehensive Meta-Analysis software version 4.0. Fixed models were selected when there was no significant heterogeneity, and the random effects model was selected for analysis when significant heterogeneity was identified. For all analyses, a p-value < 0.05 was considered significant. Seven studies were included in the meta-analysis with a total of 467 patients. Laser therapy significantly improved Vancouver Scar Scale (VSS)/Total Patient and Observer Scar Assessment Scale (Total POSAS), vascularity, pliability, pigmentation and scar height of burn scars. Significant heterogeneity was found between the studies and thus subgroup analyses were performed. Early laser therapy (<12months post-injury) significantly improved VSS/POSAS scores compared to latent therapy (>12months post-injury) {SMD -1.97 [95% confidence interval (CI) = -3.08; -0.87], p < 0.001 vs -0.59 [95%CI = -1.10; -0.07], p = 0.03} as well as vascularity {SMD -3.95 [95%CI = -4.38; -3.53], p < 0.001 vs -0.48 [95%CI = -0.66; -0.30], p < 0.001}. Non-ablative laser was most effective, significantly reducing VSS/POSAS, vascularity, pliability and scar height outcomes compared to ablative, pulse dye laser and a combination of ablative and pulse dye laser. Shorter treatment intervals of <4 weeks significantly reduced VSS/POSAS and scar height outcomes compared to intervals of 4 to 6 weeks. Efficacy of laser therapy in the paediatric population is influenced by scar age, type of laser and interval between laser therapy application. The result of this study particularly challenges the currently accepted initiation time for laser treatment. Significant heterogeneity was observed within the studies, which suggests the need to explore other confounding factors influencing burn scar outcomes after laser therapy.

The efficacy of single treatment of fractionated CO2 laser to improve scars in rhinoplasty

Background: The formation of scars is fairly inevitable after open rhinoplasty and alar base procedures. Oftentimes, patients exhibit insecurities or discomfort at the appearance of these scars. CO2 laser resurfacing has been proposed as an effective treatment to minimize the appearance of surgical scars. Objective: To demonstrate the effectiveness of fractionated CO2 laser in the minimization of the appearance of surgical scars. Methods: Retrospective analysis of a rhinoplasty surgeon’s database as well as blinded grading of 54 consecutive alar wedge scars using Vancouver Scar Scales. Results: No complications were seen with the use of fractionated CO2 lasers as a treatment on rhinoplasty scars. No difference was seen in scar appearance, including scar height, vascularity, pliability, and scar height after one treatment of CO2 laser. Conclusion: A single treatment of fractionated CO2 laser does not improve scars. Multiple sessions of fractionated CO2 laser could be a more effective treatment for the appearance of surgical scars.

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

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. 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). 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). 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.

Carrier-free 5-Fu nanoparticle-mediated domestication therapy for scar treatment: A preclinical and first-in-human study

Pathological scars, including hypertrophic scars (HTSs) and keloids, are abnormal wound healing responses, and current treatments are often unsatisfactory. Intralesional multi-injection of 5-fluorouracil (5-Fu), a commonly used approach, has raised great concerns due to its short retention time and adverse effects for anti-scar treatments. To address this, we developed a novel formulation of 5-Fu for scar management, carrier-free pure 5-Fu nanoparticles (nano 5-Fu), prepared by a super-stable pure-nanomedicine formulation technology. In vitro tests on keloid fibroblasts and human umbilical vein endothelial cells (HUVECs) showed that nano 5-Fu possessed superior ability to inactivate these cells compared to free 5-Fu. In vivo retention tests on rabbit HTSs and rat normal skin demonstrated that nano 5-Fu could coexist in soft tissues for a longer time, resulting in a more effective dosage in scar lesions. In vivo results on rabbit scars indicated that nano 5-Fu can lead to a significant reduction in scar elevation index (SEI), collagen fiber deposition and microvessels for skin remodeling. Importantly, the results of the first-in-human trial demonstrated that nano 5-Fu could decrease scar height and vascularity with excellent and stable efficacy as well as less topical side effects. Peripheral blood analyses demonstrated the high systemic safety of nano 5-Fu intralesional injection in HTSs. The carrier-free 5-Fu nanoparticle-mediated “domestication” therapy, featuring low dosage, outstanding efficacy and safety, represents a promising strategy for pathological scar treatment.

TREATMENT OF KELOIDS AND HYPERTROPHIC SCARS BY COMBINED CRYOTHERAPY AND INTRALESIONAL TRIAMCINOLONE

Objectives: To evaluate the outcomes of combining cryotherapy and intralesional triamcinolone in the treatment of keloids and hypertrophic scars. Methods: 60 patients (31 males and 29 females) with 266 keloids and 34 hypertrophic scars were enrolled and divided equally into 2 groups. Group 1 were treated with cryotherapy in combination with intralesional triamcinolone 20 mg/ml (treated group) and group 2 (control group) were treated with intralesional triamcinolone alone 20mg/ml. The duration of treatment for both groups was 12 weeks with 4 sessions. The assessment of therapeutic responses was made at baseline, after 4, 8, 12 and 16 weeks. Results: After treatment, in terms of thickness, the keloids and hypertrophic scars responded significantly better to combined cryotherapy and triamcinolone than triamcinolone alone (p &lt; 0.05): 1.3% had excellent improvement, 46.4% had good improvement and 41.2% had moderate improvement and 11.1% had little improvement. Meanwhile, in control group, the percentage for each degree of improvement were 1.4%, 16.7%, 55.6% and 26.4%, respectively. Ultrasound revealed an average reduction of scar height in treated group (2.4 ± 1.3 mm), which was higher than the result in control group (1.8 ± 0.4 mm) (p &lt; 0.05). Side effects in treated group including pain, blister, hypopigmentation, longer healing time, acne, and troublesome with menstrual cycles were sometimes were reported. No significant side effects were reported in both groups. Conclusion: Combining cryotherapy with injection of intralesional steroids appeared to be superior in comparision with intralesional steroids alone in treatment of keloids and hypertrophic scars without severe side effects.

571 Effectiveness of Compression Garments with Silicone versus Compression Garments Alone on Hypertrophic Scar

Abstract Introduction Only a few studies have looked at the effects of custom compression garments with silicone sheeting sewn into the garments versus garments alone on scar management. This retrospective study hypothesizes that garments with silicone will improve the Modified Vancouver Scar Scale (mVSS) total scores and sub-scores of pliability, vascularity and height of hypertrophic scars(HTS) when compared to garments alone. Methods This is a retrospective study of patients that were autografted or required &amp;gt;21 days to heal and placed in compression garments with or without silicone between 2013 and 2020. Charts were reviewed and mVSS scores from 91 patients with 191 scar locations (134 silicone/57 non-silicone) were collected at 1,3,6,9,12 months. Descriptive statistics were used to describe the sample characteristics. The mean mVSS score and mean sub-scores for pliability, height and vascularity were computed at 1,3,6,9,12 months and reported for the silicone and non-silicone groups. Results When comparing the two groups at 9-months (with 45% of initial scars scored), the silicone group had a greater decrease in numerical value and overall % change from 1 to 9-months as compared to the non-silicone group in all areas. The results at 12-months (with 30% of initial scars scored) demonstrated the non-silicone group had a greater decrease in numerical value and % change in height and overall score. Pliability had a 25% improvement in silicone group compared to 16% change in non-silicone group. Vascularity % change was similar with a 47% change in non-silicone group and 46% change in silicone group. The scars in silicone group that were analyzed at 12-months were consistently scored higher across prior months. Conclusions Silicone group demonstrated improved %change in all categories at 9-months and in pliability %change at 12-months despite the decreased sample size. Pliability is improved with the use of silicone garments. Although the 12-month %change in mean for height, vascularity and total score did not show improvement over non-silicone, this reflects the return patients having significant scarring throughout treatment and needing continued interventions. These returning patients had scars in the non-silicone group as well that were also rated resulting in the disparity in the groups. The patients in the silicone group with improved scars did not continue follow-up at 12-months. Further research with focus on 9-18 month follow-up mVSS scores is warranted. Applicability of Research to Practice Effectiveness of adding silicone to garments in scar treatment.

Phyto-Extracts and Silicone Gel (JUMI) in Reduction of Surgical Scar Post-joint Arthroplasty. A Randomized Control Trial

Background and Objective: To assess the clinical potency of JUMI Anti-Scar Cream (JASC) in the prevention of excessive scar formation post total hip replacement (THR) and total knee replacement (TKR). Patients and Methods: Our study was an open-label, prospective, randomized control to test the efficacy of JASC. After surgery, the same material was used in both groups to close the skin. After 14 days, once the staples were removed, JASC was applied twice a day for 60 days. Patients were seen at 6 and 12 weeks. At 3-month follow-ups, the scars were assessed using the Visual Analogue Scale (VAS) and Vancouver Scar Scale (VSS). Results: Forty patients were part of this trial; two patients in the control group were lost during follow-up. The average age-matched in both groups. There were no adverse or untoward effects due to the use of JASC. At 3 months, there were significant differences between the parameters assessed; VAS scores were P&lt;0.0001. VSS parameters such as vascularity, pigmentation, pliability, and scar height were much lower compared to patients who had standard treatment (P&lt;0.0001). Conclusion: Our study demonstrated that JASC was effective and successful in suppressing excessive scar formation. We believe that JASC has the potential as a prime anti-scar therapy, and we recommend more multicentric studies. Clinical Trial Rg. No: This trial was registered with the Sri Lankan Trial Registry vide #2022/021.

PROBABILITY OF MORTALITY IN CASUARINA TWO YEARS AFTER THE FIRE AT THE PIEDMONT OF THE TLALOC VOLCANO, STATE OF MEXICO, 2017

In 2017, at the foot of the Tlaloc volcano, occurred the largest forest fire in the State of Mexico (2500 ha), with surface and crown (canopy) phases, on plantations of various species and various types of vegetation. Studies on the effects of fires on trees serve to define mortality and whether or not restoration will be required in an affected area. The hypothesis was: the greater the intensity and severity of the fire and the smaller the size of the trees, the greater the probability of mortality. The objective of the study was to establish the fire severity and dasometric variables that influence the probability of both mortality and resprouting in Casuarina equisetifolia L. plantations affected by fire. The study was conducted at the Experimental Forestry Station “Las Cruces” (Universidad Autónoma Chapingo, State of Mexico). In 2019, 442 trees (15 sites of 100 m2) were sampled in 50 ha of plantations affected by the fire. Records were made on whether the trees were alive or dead, normal diameter, bark thickness, height, height at the base of the original crown, height of the fire scar on the trunk, height of crown scorch and presence of resprouting. The statistical analysis consisted of logistic regressions, using the Proc Logistic procedure of the SAS program. The average tree mortality was 63 %. The variable that was directly related (p ≤ 0.05) to the probability of mortality was the height of the scar above the trunk. The dasometric variables inversely related (p ≤ 0.05) with the probability of mortality were: height, normal diameter and bark thickness. For resprouting probability, there was an inverse relationship (p ≤ 0.05) with normal diameter, bark thickness and height of scar on the trunk. It is concluded that casuarina is a fire sensitive species.

EGCG inhibits hypertrophic scar formation in a rabbit ear model.

Hypertrophic scarring is a common skin fibro-proliferative disease, but currently there has no satisfactory drugs for anti-scar treatments. Previous study showed that epigallocatechin gallate (EGCG), the main catechin in green tea, improved wound healing and tissue fibrosis in both rats and mice. In the present study, the therapeutic effects of EGCG on hypertrophic scar were analyzed using a rabbit ear hypertrophic scar model. A rabbit ear model of hypertrophic scarring was used. DMSO, 0.5mg EGCG/wound, 1.0mg EGCG/wound or triamcinolone were injected subcutaneously once a week for 4 weeks. The scar elevation index (SEI) was measured using HE staining images, the collagen fibers were examined by Masson' trichrome staining images, and the number of capillaries in hypertrophic scar were calculated by CD31 staining images. The mRNA levels in the scar tissues were detected by quantitative real-time polymerase chain reaction (qRT-PCR). Gross observation and histological evaluation showed the inhibitory effects of EGCG on hypertrophic scar formation at both doses, and decreased scar height and SEI were detected. EGCG also attenuated the mean collagen area fraction and decreased the number of capillaries in scar tissues. qRT-PCR revealed that EGCG significantly inhibited the mRNA expression of TGF-β1, Col I, Col III, α-SMA, and eNOS. EGCG may serve as a useful candidate therapeutic drug for hypertrophic scar via inhibiting fibrotic gene expression and suppressing angiogenesis.