Management Of Hypertrophic Scars Research Articles

Use of tape for the management of hypertrophic scar development: A comprehensive review.

Introduction:Tapes have been used to aid fresh wound closure. For hypertrophic scars, the use of tapes as a therapy to reduce the mechanical forces that stimulate excessive and long-term scarring is yet to be evaluated. The aim of this comprehensive review was to explore the current clinical application of tapes, as a minimally invasive option, as purposed specifically for the management of hypertrophic scarring, regardless of scar causation.Method:Databases were searched using MeSH terms including one identifier for hypertrophic scar and one for the intervention of taping. Studies included the following: patients who received tape for a minimum of 12 weeks as a method of wound closure specifically for the purpose of scar prevention; those who received tape as a method of scar management after scar formation; reported outcomes addressing subjective and/or objective scar appearance; and were available in English.Results:With respect to non-stretch tapes, their use for the prevention of linear surgical scarring is evident in reducing scar characteristics of height, colour and itch. Statistically significant results were found in median scar width, reduction in procedure times and overall scar rating. Tapes were predominately applied by participants themselves, and incidence of irritation was infrequently reported. After 12 months, significance with respect to scar pain, itch, thickness and overall scar elevation was reported in one study investigating paper tape. Two papers reported the use of high stretch tapes; however, subjective results limited formal analysis. Although the use of taping for abnormal hypertrophic scar management is in its infancy, emerging research indicates tapes with an element of stretch may have a positive impact.Conclusions:Non-stretch tapes, for the prevention of linear surgical scarring, are effective in reducing scar characteristics of height, colour and itch. Paper tapes have shown effectiveness when applied during wound remodelling or even on mature scarring, with reported subjective changes in scar colour, thickness and pliability. Preliminary evidence of the benefits of high-stretch, elasticised tapes for scar management in the remodelling phase of wound healing have also been reported.Lay SummaryPatients are often concerned about unsightly scars that form on their bodies after trauma, especially burn injuries. These scars can be thick, red and raised on the skin, and can impact on the patient’s quality of life. For some scars, the process of skin thickening continues for up to two years after an injury.Unfortunately, scar formation is a part of the body’s healing process, whereby there is a constant pull or tension under and along the skin’s surface. The use of simple tapes, such as microporetm, to help with wound closure are sometimes used as a therapy to reduce the tension on the skin’s surface when a wound is healing to minimise scar formation. However, the effectiveness of taping has not been proven. This paper looks at the available evidence to support the use of taping to reduce scar features of height, thickness and colour. Initial evidence of mixed levels, suggests some benefits of tapes for scar management and show preliminary efficacy for reduction of scar height, thickness and colour. More research is required to determine the direct impact, comparison to other treatments available and patient viewpoint for this therapy.

Microneedle-assisted steroid delivery therapy in the management of hypertrophic scars: A split-lesion study

Microneedle-assisted steroid delivery therapy in the management of hypertrophic scars: A split-lesion study

Experimental Study on Blue Light Interaction with Human Keloid-Derived Fibroblasts.

Keloids are an exuberant response to wound healing, characterized by an exaggerated synthesis of collagen, probably due to the increase of fibroblasts activity and to the reduction of their apoptosis rate: currently no standard treatments or pharmacological therapies are able to prevent keloid recurrence. To reach this goal, in recent years some physical treatments have been proposed, and among them the PhotoBioModulation therapy (PBM). This work analyses the effects of a blue LED light irradiation (410–430 nm, 0.69 W/cm2 power density) on human fibroblasts, isolated from both keloids and perilesional tissues. Different light doses (3.43–6.87–13.7–20.6–30.9 and 41.2 J/cm2) were tested. Biochemical assays and specific staining were used to assess cell metabolism, proliferation and viability. Micro-Raman spectroscopy was used to explore direct effects of the blue LED light on the Cytochrome C (Cyt C) oxidase. We also investigated the effects of the irradiation on ionic membrane currents by patch-clamp recordings. Our results showed that the blue LED light can modulate cell metabolism and proliferation, with a dose-dependent behavior and that these effects persist at least till 48 h after treatment. Furthermore, we demonstrated that the highest fluence value can reduce cell viability 24 h after irradiation in keloid-derived fibroblasts, while the same effect is observed 48 h after treatment in perilesional fibroblasts. Electrophysiological recordings showed that the medium dose (20.6 J/cm2) of blue LED light induces an enhancement of voltage-dependent outward currents elicited by a depolarizing ramp protocol. Overall, these data demonstrate the potentials that PBM shows as an innovative and minimally-invasive approach in the management of hypertrophic scars and keloids, in association with current treatments.

MiR-3613-3p inhibits hypertrophic scar formation by down-regulating arginine and glutamate-rich 1.

Hypertrophic scar (HS) is a severe skin disorder characterized by excessive extracellular matrix production and abnormal function of fibroblasts. Recent studies have demonstrated that microRNAs (miRNAs) play critical roles in HS formation. This study aims to investigate the role of miR-3613-3p in the formation of HS. The mRNA and miRNA levels were measured by quantitative RT-PCR analysis. The protein levels were examined by Western blot assay. Cell proliferation was determined by Cell Counting Kit-8 assay. The Caspase-3 and Caspase-9 activities were measured using flow cytometry assay. Dual-luciferase activity reporter assay and mRNA-miRNA pulldown assay were conducted to validate the target of miR-3613-3p. miR-3613-3p was downregulated, while arginine and glutamate-rich 1 (ARGLU1) was upregulated in HS fibroblasts (HSFs) and tissues. Overexpression of miR-3613-3p or knockdown of ARGLU1 markedly inhibited the expression of extracellular matrix (ECM) production-associated proteins and promoted Caspase-3 and Caspase-9 activations in HSFs. ARGLU1 was further identified as a direct target of miR-3613-3p. Restoration of ARGLU1 abrogated the suppressive effect of miR-3613-3p on cell proliferation and ECM protein expression of HSFs. Our results demonstrated that miR-3613-3p inhibited HS formation via targeting ARGLU1, which may provide potential therapeutic targets for the management of HS.

Ablative fractional laser treatment of hypertrophic burn and traumatic scars: a systematic review of the literature.

Hypertrophic scars (HTS) following burns and other trauma and are associated with significant functional and psychosocial impairment. Ablative fractional lasers (AFLs) are increasingly being applied in the treatment of HTS supported by a rapidly expanding multidisciplinary base of literature. The multidisciplinary authors sought to evaluate existing literature, provide context and identify gaps, and make recommendations for a path forward. A systematic review was conducted to identify literature pertinent literature through September 2019. Retrospective cohort, randomized controlled trials, quasi-randomized controlled trials, observational prospective cohort, or case series with five or more subjects with hypertrophic scars incurred from burns and related trauma were considered. Twenty-two of the 23 evaluated studies documented statistically significant and/or meaningful qualitative improvements in nearly all outcome measures. Adverse events were generally infrequent and minor. Significant heterogeneity was observed among the studies included in this systematic review, precluding metaanalysis of pooled data. There is abundant existing literature on the use of AFLs in the management of HTS but study heterogeneity limits generalizability. Future studies should prioritize standardized protocols including assessments of function and quality of life.

Nonsurgical Management of Hypertrophic Scars: Evidence-Based Therapies, Standard Practices, and Emerging Methods.

Hypertrophic scars, resulting from alterations in the normal processes of cutaneous wound healing, are characterized by proliferation of dermal tissue with excessive deposition of fibroblast-derived extracellular matrix proteins, especially collagen, over long periods, and by persistent inflammation and fibrosis. Hypertrophic scars are among the most common and frustrating problems after injury. As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. However, hypertrophic scars remain notoriously difficult to eradicate because of the high recurrence rates and the incidence of side effects associated with available treatment methods. This review explores the various treatment methods for hypertrophic scarring described in the literature including evidence-based therapies, standard practices, and emerging methods, attempting to distinguish those with clearly proven efficiency from anecdotal reports about therapies of doubtful benefits while trying to differentiate between prophylactic measures and actual treatment methods. Unfortunately, the distinction between hypertrophic scar treatments and keloid treatments is not obvious in most reports, making it difficult to assess the efficacy of hypertrophic scar treatment.

Study on the effect of combined action of topical silicone gel and pressure therapy in hypertrophic scar management

Background: Widespread hypertrophic scars usually resulting from burn injuries or extensive soft tissue trauma is a common problem presented to plastic OPD. Non-invasive treatment like Pressure/compression therapy and siliconee sheets and gels are well-accepted, evidence-based recommendations for a long time. Very few studies are there for their combined effect on hypertrophic widespread scars. Aims and objectives of the study was to see the outcome of hypertrophic scar management following application of combined therapy of silicone gel and pressure garment.Methods: In the present study we have taken patients, who were randomly allotted in two groups. In one group only silicone gel was used for scar management while other group we applied silicone gel along with customized pressure garment locally for 6 months. Patients are seen in OPD monthly and after 6 months final results were analyzed, to see the effect of combined therapy.Results: Although silicone gel is alone is effective in widespread post burn scar, pressure garment provides a synergistic effects when used together. There is no significant change in colour and vascularity, but changes in scar thickness and pliability are most significant in combined therapy group.Conclusions: For small linear scar silicone gel treatment is alone sufficient, but for widespread hypertrophic scar this should always be used along with pressure garment therapy.

635 Compression Garments with Silicone Improve Hypertrophic Scars Compared to Compression Garments Alone: A Retrospective Study

Abstract Introduction The management of hypertrophic scars is one of the major challenges facing healthcare providers in the treatment of burn patients. Two of the mainstay noninvasive clinical practices for hypertrophic scars is the utilization of pressure garments and garments with Silicone gel sheeting. Here, we present a comparison of the effectiveness of compression garments alone and garments with silicone in the treatment of a large pediatric patient population with hypertrophic scars. Methods A retrospective study was performed to compare the effectiveness of compression garments with silicone versus compression garments without silicone in the treatment of pediatric hypertrophic scars. Included in this study were patients who received at least 12 months of follow-up treatment with silicone or non-silicone compression garments between 2013 and 2018. Modified Vancouver Scar Scale (VSS) scores were analyzed 1, 3, 6, 9, and 12 months post-injury/surgery for each scar. Descriptive statistics and t tests were used to summarize and compare the total VSS scores between the two groups. In addition, descriptive and ANOVA statistics were performed to compare the effectiveness of silicone compression treatment for scars located on different regions of the body. Results In total, the compression garment with silicone group included 99 scars of 70 different patients and the non-silicone group included 28 scars of 19 different patients. Before-after total VSS scores for silicone group decreased from 4.11 (SD, 1.522) to 1.47 (SD, 1.268) compared to a decrease from 3.27 (SD, 1.117) to 1.80 (SD, 1.380) for compression group after 12 months of treatment (P< 0.05). ANOVA analysis revealed no statistically significant difference between silicone’s effectiveness on scars located in different regions of the body based on total VSS score after 12 months of treatment (F(4, 99)=1.47, p< 0.05). Conclusions Compression garments with silicone are more effective in treating hypertrophic scars than garments without silicone. The effectiveness of silicone is independent of the scar location assuming sufficient contact and coverage. Applicability of Research to Practice This retrospective study supports the use Silicone compression garments for hypertrophic scars in pediatric patients and is completely applicable to medical practice.

Focused versus radial extracorporeal shock wave therapy in post burn hypertrophic scar: A single blinded randomized controlled trial

Purpose. Hypertrophic scar (HTS) is one of the common post-burn complications that lead to functional and cosmetic impairments, so we pursued to examine efficacy of extracorporeal shock wave therapy (ESWT) on HTS in expression of improving scar thickness and appearance. Materials and Methods. 60 patients with post burn HTS were recruited in this trial and divided randomly into 3 equal groups. Group A: received focus ESWT (100 shock waves per cm2, 0.037 mJ/mm2, 4 Hz, 2 times/week for six weeks) plus traditional topical medication (MEBO Scaro cream). Group B: received radial ESWT (500 shock waves per cm2, 0.13 mJ/mm2, 6 Hz, 2 times/week for six weeks) plus MEBO Scaro cream. Group: received only MEBO Scaro cream. Ultrasonography was utilized for scar thickness measurement and scar characteristics assessment was done by Modified Vancouver Scar Scale (MVSS). All measures were gathered before the start of the study, and after termination of the trial (after 6 weeks). Results. Both focus and radial ESWT showed significant advance in scar thickness and MVSS post treatment (p > 0.001), without statistical differences between them (p > 0.05), while group C showed only a significant diminution in MVSS post treatment (p > 0.001), without any change in scar thickness. Conclusion. Higher statistical results were achieved with both focus and radial ESWT without any side effects, confirming the safety and efficiency of ESWT in HTS management.

ALTERATION IN GENE EXPRESSION OF TRANSFORMING GROWTH FACTOR- Β FOLLOWING TREATMENT OF HYPERTROPHIC BURN SCARS WITH THREE DIFFERENT THERAPEUTIC MODALITIES

Background: Hypertrophic scar (HTS) is a dermal form of fibro-proliferative disorder often caused by thermal injury to the deep dermis. Transforming growth factor β1 & 2 are well known pro-fibrotic cytokines promoting ECM production and tissue fibrosis. The present study was designed to evaluate the different therapeutic modalities for management of hypertrophic scar and correlate it with altered expression of TGF beta gene at the molecular level.
 Materials and Methods: One hundred and twenty patients with hypertrophic post burn scar were randomly distributed into three different treatment groups of Pressure Garments, Silicone Gel Sheet and Triamcinolone Injection. Total RNA was isolated from the scar tissue in cases before and 6 months after the therapy and from normal skin in controls to evaluate the expression of TGF beta (1, 2 & 3) by real time PCR.
 Results: Following treatment, the expression of TGF β-1 & 2 was down regulated while that of β-3 up regulated. The overall positive response (combining all the groups) was 94% out of which, 16.6% were cured, 47.5% showed major improvement and minor changes were observed in 30.8% of patients.
 Discussion: All the three modalities of treatment were effective in bringing down the level of TGF β-1&2 and in up-regulating antifibrotic β3 and this correlated well with the clinical improvement in the scar thickness, pliability etc. Conclusion: Out of all, intralesional Triamcinolone Injection achieved the best result.
 Keywords: Hypertrophic Scar, Transforming Growth Factor β, Pressure Garments, Silicone Gel Sheet, Triamcinolone Injection

The experience of wearing compression garments after burn injury: “On the inside it is still me”

BackgroundCompression garments are widely used for the management of hypertrophic scars, however, the patient experience of wearing compression garments remains minimally explored. ObjectiveTo gain an understanding of the patient experience of wearing compression garments post burn injury, including why patients remove their garments. MethodInterpretive description was the methodological approach used in this study. Semi-structured interviews and a focus group were used to gain in-depth insights into the lived experience of wearing compression garments. Thematic analysis revealed key themes across the data and member checking confirmed data interpretation. ResultsThree main themes related to wearing compression garments were identified: what it feels like to wear compression garments, what it is like to be a patient within a burns service and the impact of garments on patients’ lives and recovery. ConclusionsThe results highlighted a variety of influences that affected the individual experience of garment wear, highlighting the need for a patient centred approach by burn service providers.

How to improve compression garment wear after burns: Patient and therapist perspectives

BackgroundCompression garments are a widely used intervention for the management of hypertrophic scar and recent research demonstrates the varied experiences of patients wearing compression garments. However, the patient and therapist perspective on how to improve the experience of wearing compression garments remains unexplored. ObjectiveTo gain an understanding of the patient and therapist perspective of potential improvements to the provision of compression garments after burns. MethodA qualitative research design with an interpretive description approach was utilised in this study. Data was collected from patients through semi-structured interviews and a focus group and therapists by a focus group. Thematic analysis was completed to reveal the key themes across the data. ResultsTwo main themes were identified: “what patients want” and “access to professional development”. The first theme “what patients want” described three suggested improvements including education, peer support, and increased participation in garment prescription. ConclusionsThe reported patient and therapist perspectives highlight the need for further research into service improvement to enhance the patient experience of wearing compression garments after burns.

Epithelial-mesenchymal transition in the formation of hypertrophic scars and keloids.

Abnormal wound healing is likely to induce the formation of hypertrophic scars and keloids, which leads to dysfunction, deformity, and mental problem in the patients. Despite the advances in prevention and management of hypertrophic scar and keloids, the mechanism underlying scar and keloid formation has not been fully elucidated. Recent insights into the role of the epithelial-mesenchymal transition (EMT) in development, wound healing, stem cell regulation, fibrosis, and tumorigenesis have increased our understanding of the pathophysiology of hypertrophic scarring and keloids and suggested new therapeutic targets. This review summarizes recent progress in the elucidation of the role of EMT in physiologic wound healing and pathologic scar formation. This knowledge will facilitate an understanding of EMT roles in scar formation and shed new light on the modulation and potential treatment of hypertrophic scars and keloids.

MicroRNA‑486‑5p inhibits the growth of human hypertrophic scar fibroblasts by regulating Smad2 expression.

The aim of the current study was to investigate the expression and role of microRNA-486-5p (miR-486-5p) in hypertrophic scar (HS) formation, and to examine the associated mechanisms. First, miR-486-5p expression was detected in HS tissues and human hypertrophic scar fibroblasts (hHSFs) by reverse transcription-quantitative polymerase chain reaction. Target genes of miR-486-5p were predicted using TargetScan and verified by dual-luciferase reporter assays. To investigate the role of miR-486-5p in HS formation, miR-486-5p was overexpressed in hHSFs through transfection with miR-486-5p mimics. MTT, cell apoptosis and cell cycle assays were preformed to investigate the proliferation, cell apoptosis and cell cycle distribution of hHSFs, respectively. Additionally, protein expression was measured by western blot analysis. The results demonstrated that miR-486-5p expression was significantly decreased in HS tissues and cells. Mothers against decapentaplegic homolog (Smad)2 was a target gene of miR-486-5p, and it was negatively regulated by miR-486-5p. It was also found that Smad2 expression was significantly increased in HS tissues and cells. Further analysis indicated that miR-486-5p mimic transfection inhibited the proliferation, induced cell apoptosis and increased G1/S phase arrest in hHSFs. Furthermore, the expression of cyclin-dependent kinase (CDK)2, CDK4 and apoptosis regulator Bcl-2 was repressed, while apoptosis regulator BAX expression was enhanced by miR-486-5p mimic transfection. Notably, the effects of miR-486-5p mimic on hHSFs were significantly eliminated by Smad2 plasmid transfection. Taken together, these results demonstrated that miR-486-5p inhibited the proliferation, induced apoptosis and increased G1/S phase arrest of hHSFs by targeting Smad2. miR-486-5p may be a promising therapeutic target for HS management.

Efficacy and safety of botulinum toxin for management of hypertrophic scars: a systematic review and meta-analysis

Efficacy and safety of botulinum toxin for management of hypertrophic scars: a systematic review and meta-analysis

Lower energy radial shock wave therapy improves characteristics of hypertrophic scar in a rabbit ear model.

The aim of the present study was to investigate the effects of radial extracorporeal shock wave therapy (rESWT) on scar characteristics and transforming growth factor (TGF)-β1/Smad signaling in order to explore a potential modality for the treatment of hypertrophic scars (HS). The HS model was generated in rabbit ears, then rabbits were randomly divided into 3 groups: Lower (L)-ESWT [treated with rESWT with lower energy flux density (EFD) of 0.1 mJ/mm2], higher (H)-ESWT (treated with a higher EFD of 0.18 mJ/mm2) and the sham ESWT group (S-ESWT; no ESWT treatment). Scar characteristics (wrinkles, texture, diameter, area, volume of elevation, hemoglobin and melanin) were assessed using the Antera 3D® system. The protein and mRNA expression of TGF-β1, Smad2, Smad3 and Smad7 was assessed by enzyme-linked immunosorbent assay and reverse transcription-quantitative polymerase chain reaction, respectively. The Antera 3D® results indicated that wrinkles and hemoglobin of the HS were significantly improved in both of the rESWT groups when compared with the S-ESWT group. However, these changes appeared much earlier in the L-ESWT group than the H-ESWT. Scar texture was also improved in the L-ESWT group. However, rESWT did not influence HS diameter, area, volume of elevation or melanin levels. rESWT had no effect on TGF-β1 or Smad7 expression in either of rESWT groups. Although no difference was observed in Smad2 mRNA expression in the L-ESWT group, the Smad3 mRNA and protein expression significantly decreased when compared with the H-ESWT and S-ESWT groups. By contrast, Smad2 and Smad3 mRNA expression were upregulated in the H-ESWT group. These results demonstrated that rESWT with 0.1 mJ/mm2 EFD improved some characteristics of the HS tissue. Downregulation of Smad3 expression may underlie this inhibitory effect. Inhibition of the TGF-β1/Smad signal transduction pathway may be a potential therapeutic target for the management of HS.

The application of 3D-printed transparent facemask for facial scar management and its biomechanical rationale

IntroductionDeep facial burns leave conspicuous scar to the patients and affect their quality of life. Transparent facemask has been adopted for the prevention and treatment of facial hypertrophic scars for decades. Recently, with the advancement of 3D printing, the transparent facemask could facilitate the fitting of the facial contour. However, the effectiveness of the device and its biomechanical characteristics on pressure management of hypertrophic scar would need more objective evaluation. MethodA biomechanical model of the transparent 3D-printed facemask was established through finite element analysis. Ten patients with extensive deep facial burns within 6 months were recruited for clinical study using 3D-printed facemask designed according to biomechanical model, and the interface pressure was measured on each patient. The patients in the treatment group (n=5) was provided with the 3D-printed transparent face mask soon after initial scar assessment, while the delayed treatment group (n=5) began the treatment one month after the initial scar assessment. The scar assessment was performed one month post intervention for both groups. ResultsThe biomechanical modeling showed that the 3D, computer-generated facemask resulted in unbalanced pressure if design modifications were not incorporated to address these issues. The interface pressure between the facemask and patient’s face was optimized through individualized design adjustments and the addition of silicone lining. After optimization of pressure through additional lining, the mean thickness and hardness of the scars of all 10 patients were decreased significantly after 1-month of intervention. In the delayed treatment group, the mean thickness of the scars was increased within the month without intervention, but it was also decreased after intervention. ConclusionFacemask design and the silicone lining are important to ensure adequate compression pressure of 3D-printed transparent facemask. The intervention using the 3D-printed facemask appeared to show its efficacy to control the thickness and hardness of the facial hypertrophic scars.

Wireless pressure sensors for pressure garments treated with chitosan

PurposeThe purpose of this paper is to analyze the effects of chitosan treatments on exerted pressures of nylon 6.6/elastane pressure garments in three different knit structures using wireless pressure sensors for an accurate and a precise scar management for future designs.Design/methodology/approachPressure garments designed in different structures consist of 70/30 and 75/25 nylon 6.6/elastane were treated with chitosan and the exerted pressures were analyzed using wireless pressure sensors including ultra-thin and flexible printed circuit sensors in comparison with untreated control samples. Antimicrobial activities and washing tests were also evaluated.FindingsIt is found that chitosan treatments have a significant effect on final pressures. Exerted pressures increased significantly for all samples after chitosan treatments. Higher pressures were measured for weft knit structured designs while lower pressures were recorded for powernet structured garments. It is found that the elasticity showed a small significant decrease and it has attributed due to a small significant shrinkage during processes. The mean scores of pressures were found in the acceptable medical range which will continue to help hypertrophic scar management for future designs. The exerted pressures of the fabrics remained constant after five washes and showed a small significant decrease after 10 and 50 washes which will provide a long period of compression. Permanent antimicrobial effectiveness has gained at around 90 percent after five washes and 50 percent after 50 washes. A small significant increase was observed for stiffness (CD, MD) after ten washes.Originality/valueChitosan treatments impact exerted pressures of pressure garments significantly. It is a reference to evaluate pressure functions of pressure garments using wireless pressure sensors while imparting antimicrobial activity.

Current and Emerging Treatments for Postsurgical Cleft Lip Scarring: Effectiveness and Mechanisms

Cleft lip with or without cleft palate is the most common congenital malformation of the head and the third-most common birth defect. Surgical repair of the lip is the only treatment and is usually performed during the first year of life. Hypertrophic scar (HTS) formation is a frequent postoperative complication that impairs soft tissue form, function, or movement. Multiple lip revision operations are often required throughout childhood, attempting to optimize aesthetics and function. The mechanisms guiding HTS formation are multifactorial and complex. HTS is the result of dysregulated wound healing, where excessive collagen and extracellular matrix proteins are deposited within the wound area, resulting in persistent inflammation and resultant fibrosis. Many studies support the contribution of dysregulated, exaggerated inflammation in scar formation. Fibrosis and scarring result from chronic inflammation that interrupts tissue remodeling in normal wound healing. Failure of active resolution of inflammation pathways has been implicated. The management of HTS has been challenging for clinicians, since current therapies are minimally effective. Emerging evidence that specialized proresolving mediators of inflammation accelerate wound healing by preventing chronic inflammation and allowing natural uninterrupted tissue remodeling suggests new therapeutic opportunities in the prevention and management of HTS.

Anti-Vascular Endothelial Growth Factor (Bevacizumab) Therapy Reduces Hypertrophic Scar Formation in a Rabbit Ear Wounding Model.

BackgroundHypertrophic scarring is a pathological condition that occurs after trauma or surgery. Angiogenesis occurs more often with hypertrophic scarring than with normotrophic scarring. The regulation of angiogenesis is one of the key factors in hypertrophic scar management. Vascular endothelial growth factor (VEGF) is an essential factor in the angiogenetic response. This study investigated whether decreasing the level of VEGF is effective for treating hypertrophic scarring.MethodsTen 8-week-old female New Zealand white rabbits were included. Four defects were created on each ear by using a 6-mm punch. Bevacizumab (Avastin, Roche Pharma, Basel, Switzerland) was administered in one ear and normal saline was administered in the other ear. Treatment was administered starting on day 2, every 2 days, until day 14. The levels of VEGF were measured using enzyme-linked immunosorbent assay on day 10 and histologic results were analyzed on day 40.ResultsBevacizumab induced-defects showed less hypertrophic scarring when compared with the control group as measured by the scar elevation index (SEI) and loose collagen arrangement. The SEI in the experimental group was 1.89±0.13, compared to 1.99±0.13 in the control group (n=30, P=0.005). Additionally, the VEGF level was lower (38.72±11.03 pg vs. 82.50±21.64 pg, n=10, P=0.001) and fewer vessels existed (8.58±0.76 vs. 7.2±1.20, n=10, P=0.007).ConclusionsPreventing excessive angiogenesis is effective for preventing scar formation, especially with hypertrophic scarring. Although it is not an approach that is sufficient alone for the management of scarring, it may be one of several important strategies for scar treatment.