Scar Management Research Articles

Assessment of intralesional injection of botulinum toxin type A in hypertrophic scars and keloids: Clinical and pathological study.

Keloids and hypertrophic scars are cosmetic problems with significant morbidity. Many clinical modalities were tried in order to modulate the disfigurement related to these pathologic scars. To evaluate the clinical and histopathological effects of Botulinum toxin type A (BTX-A) injection on keloids and hypertrophic scars. Twelve patients with keloids and 8 with hypertrophic scars were enrolled in this study. Botulinum toxin type A was injected intralesional (1 session/month) for three sessions. Clinical outcome was assessed via Vancouver Scar Scale (VSS), Observer Scar Assessment Scale (OSAS), and the Patient Scar Assessment Scale (PSAS). Histologic grading scores were used to assess the changes in the quality of collagen and elastic tissues and image analysis was used to detect their quantitative morphometric changes. This study showed a high statistically significant difference between baseline and the result after each of the three sessions of injection and 3, 6months after the last session regarding VSS, OSAS, and PSAS with p value ≤0.001 for each. The study also showed that there was a statistically significant difference between the histopathologic findings before injection of BTX and 1month after the third session regarding all parameters used. Botulinum toxin type A can be a good therapeutic maneuver for management of keloid and hypertrophic scars with significant clinical and histologic improvement.

Prevention and management of hypertrophic scars after laparoscopic surgery using silicone gel sheets: a pilot study.

ObjectiveTo assess the effectiveness and safety of modified silicone gel sheets applied to hypertrophic scars and keloids following laparoscopic surgery.MethodsPatients who had undergone laparoscopic surgery and who had either conventional or modified silicone gel sheets affixed to their surgical lesions for 6 months postoperatively (treatment groups), and control patients who had not received postsurgical treatment involving silicone gel sheets, were enrolled. The surgical wounds were assessed visually and using the Japan Scar Workshop (JSW) Scar Scale. Patients were interviewed before, 3 months after, and 6 months after sheet affixation.ResultsA total of 45 patients were included, comprising 15 patients per group. Both silicone gel-sheet groups had significantly lower JSW Scar Scale scores at 3 and 6 months after affixation compared with controls. The scores were not significantly different between the conventional and modified treatment groups and no adverse events were observed in the latter.ConclusionsModified silicone gel sheets were more effective than controls and comparable to conventional gel sheets, and there were no adverse events related to laparoscopic surgical wounds in the improved silicone gel sheet group, demonstrating the safety and effectiveness of the modified silicone gel sheets.

Needling, lasers, and Meso-Botox for hypertrophic and keloidal scars: A comprehensive review study on promising procedural treatments.

Scars are among the most prevalent referral cases of dermatology clinics, including atrophic, hypertrophic, or keloidal scars. Approach to scar usually needs a holistic trend, attention to individualized characteristics, and combination therapy. Scars usually need multiple sessions of therapy and the use of combination therapeutic approaches to reach the most acceptable outcomes by safe modalities. Studies on scars are always one of the most important fields of research in medicine, especially in dermatology. For writing this review study, we searched all the databases to find the most relevant and the newest studies related to our topic, because based on expert opinion, this topic may be really practical and interesting for dermatologists and all physicians of various specialties or subspecialties who manage and treat various kinds of scars, including hypertrophic scars and keloids. Based on our results, we concluded that different procedures, which basically use needling, lasers, especially pulsed dye laser (PDL) and carbon dioxide (CO2) laser, and MesoBotox (micro-injection of botulinum toxin), are really promising therapeutic options for hypertrophic and keloidal scars and a combination of these therapies results in more efficacy and lesser side effects in the field of scar management.

Human SMILE-Derived Stromal Lenticule Scaffold for Regenerative Therapy: Review and Perspectives.

A transparent cornea is paramount for vision. Corneal opacity is one of the leading causes of blindness. Although conventional corneal transplantation has been successful in recovering patients’ vision, the outcomes are challenged by a global lack of donor tissue availability. Bioengineered corneal tissues are gaining momentum as a new source for corneal wound healing and scar management. Extracellular matrix (ECM)-scaffold-based engineering offers a new perspective on corneal regenerative medicine. Ultrathin stromal laminar tissues obtained from lenticule-based refractive correction procedures, such as SMall Incision Lenticule Extraction (SMILE), are an accessible and novel source of collagen-rich ECM scaffolds with high mechanical strength, biocompatibility, and transparency. After customization (including decellularization), these lenticules can serve as an acellular scaffold niche to repopulate cells, including stromal keratocytes and stem cells, with functional phenotypes. The intrastromal transplantation of these cell/tissue composites can regenerate native-like corneal stromal tissue and restore corneal transparency. This review highlights the current status of ECM-scaffold-based engineering with cells, along with the development of drug and growth factor delivery systems, and elucidates the potential uses of stromal lenticule scaffolds in regenerative therapeutics.

Society for Maternal-Fetal Medicine Consult Series #63: Cesarean scar ectopic pregnancy

Cesarean scar ectopic pregnancy is a complication in which an early pregnancy implants in the scar from a previous cesarean delivery. This condition presents a substantial risk for severe maternal morbidity and mortality because of challenges in securing a prompt diagnosis. Ultrasound is the primary imaging modality for cesarean scar ectopic pregnancy diagnosis, although a correct and timely determination can be difficult. Surgical, medical, and minimally invasive therapies have been described for cesarean scar ectopic pregnancy management, but the optimal treatment is unknown. Patients who decline treatment of a cesarean scar ectopic pregnancy should be counseled regarding the risk for severe morbidity. The following are the Society for Maternal-Fetal Medicine recommendations: we recommend against expectant management of cesarean scar ectopic pregnancy (GRADE 1B); we suggest that operative resection (with transvaginal or laparoscopic approaches when possible) or ultrasound-guided uterine aspiration be considered for the surgical management of cesarean scar ectopic pregnancy and that sharp curettage alone be avoided (GRADE 2C); we suggest intragestational methotrexate for the medical treatment of cesarean scar ectopic pregnancy, with or without other treatment modalities (GRADE 2C); we recommend that systemic methotrexate alone not be used to treat cesarean scar ectopic pregnancy (GRADE 1C); in patients who choose expectant management and continuation of a cesarean scar ectopic pregnancy, we recommend repeated cesarean delivery between 34 0/7 and 35 6/7 weeks of gestation (GRADE 1C); we recommend that patients with a cesarean scar ectopic pregnancy be advised on the risks of another pregnancy and counseled regarding effective contraceptive methods, including long-acting reversible contraception and permanent contraception (GRADE 1C).

Traumatic Facial Injury Treated by Botulinum Toxin A

Introduction: Botulinum toxin type A (BTA) is used in the treatment of various medical and aesthetic conditions. The mechanism of action of the drug includes action on fibroblast stimulation, decrease of wound tension and production of collagen. Objective: This study aimed to demonstrate the use of botulinum toxin as a possible treatment for reducing facial scarring. Methods:It was a retrospective study involving patients who were treated with BTA for the management of facial scars. Conclusion: Botulinumtoxin A is efficient for the treatment and reduction of facial scars resulting from trauma or surgical interventions.

The Role of Fractional Co2(Carbon Dioxide)Laser in Management of Acne Scars' as Monotherapy

The Role of Fractional Co2(Carbon Dioxide)Laser in Management of Acne Scars' as Monotherapy

BC02: A systematic review of skin resurfacing techniques used to enhance transepidermal delivery of topical biostimulants in the management of atrophic acne scarring

BC02: A systematic review of skin resurfacing techniques used to enhance transepidermal delivery of topical biostimulants in the management of atrophic acne scarring

The Efficacy of Low Energy Fractional Carbon Dioxide Laser Therapy in Management of Post-Surgical Hypertrophic Scars

The Efficacy of Low Energy Fractional Carbon Dioxide Laser Therapy in Management of Post-Surgical Hypertrophic Scars

A comparative study of radiofrequency micro-needling with platelet rich plasma and fractional LASER in acne scar management

<p class="abstract"><strong>Background:</strong> Acne scars (AS) results in permanent scarring causes facial disfigurement to the patients. The aim of the study was to assess the comparative effectiveness and outcomes of radiofrequency micro needling and fractional carbon dioxide laser methods in treating acne scars.</p><p class="abstract"><strong>Methods:</strong> This comparative observational study was conducted in the Ibn Sina diagnostic and consultancy center, Dhaka, Bangladesh during the period from January 2019 to December 2020. In total 30 patients with acne scar were selected as the study population. Among total participants, 15 patients who underwent radiofrequency micro needling treatment method were denoted as group-1 and the rest 15 patients who underwent carbon dioxide laser treatment method were denoted as group-2 patients. All data were processed, analyzed and disseminated by Microsoft (MS) office and statistical package for the social sciences (SPSS) version 26.<strong></strong></p><p class="abstract"><strong>Results:</strong> In this study, in group A as per Goodman and Baron scale at the baseline 40% had grade-3 and 60% had grade-4 status. In the same group, after treatment 23.33, 30.00%, 20.00% and 13.33% patients improved up to grade 1, grade 2, grade 3 and grade 4 status respectively. On the other hand, in group-2, after treatment 26.67%, 50.00%, 20.00% and 13.33% patients improved up to grade 1, grade 2, grade 3 and grade 4 status respectively. Finally, according to the mean Goodman and Baron scale scores in both the groups, we found extremely significant correlations between both the baseline and after treatment status where <0001.</p><p><strong>Conclusions:</strong> Both radiofrequency micro needling and fractional CO<sub>2</sub> laser treatment methods are effective for the treatment of acne scars. </p>

53. Wound Edge Inversion Delays Healing and Contributes to Dystrophic Scar Formation in a Mouse Model

Purpose: Management of dystrophic scars often requires surgical excision in the delayed periods as there are few reliable options to prophylax against the formation off dystrophic scars during physiologic or pathologic wound healing. This is in part because of limitations in the availability of genetically tractable small-animal models which can reliably generate the desired dystrophic tissue architecture. While using small animal models of wound healing is desired, the nature of murine dermal healing through contracture makes it poorly suited to the study of later wound sequalae such as dystrophic scars. We have previously demonstrated that tissue-edge inward folding mimicking the architecture of epibole mitigates contracture, restricts epithelialization, and prolongs wound opening. Here we demonstrate that murine epibolous wounds generate an environment of sustained inflammatory infiltration and proliferative granulation and ultimately generate consistent and reliable dystrophic scars in mice. Methods: Male C57BL/6J control (wt/wt) and diabetic (db/db) mice received bilateral 6mm excisional wounds. Each wound was stratified as either untreated control or chronic model. Chronic wounds were generated by incising skin flaps, which were sutured to the dermis side to create a folded skin edge. A first (acute) cohort was s were maintained for 14-days until all control wounds had closed and/or epithelialized and were harvested for flow cytometry for neutrophils and/or macrophages and/or histology for pan-keratin (epithelium) and alpha-smooth-muscle actin (myofibroblasts). A second (delayed) cohort was maintained until closure up to 63 days. Photographs were taken at time of sacrifice and samples were collected for H&E and Masson’s Trichrome Stain. Results: The epibolous wound environment maintained prolonged neutrophil-dominant inflammatory infiltrate up to 2-weeks with simultaneous enrichment of macrophage/monocyte populations (p<0.05). Epibolous wounds demonstrated reduced frequency of epithelialization as defined by pan-keratin signaling. In epibolous wounds without epithelialization, strong alpha-smooth-muscle actin signal was noted. When allowed to proceed to maturation, scars from epibole injuries remained significantly larger (p<0.05). This was true in both control and diabetic models. All wound-edge inversion injuries demonstrated gross and histologic evidence of dystrophic healing and collagen deposition compared to controls. Conclusion: Previously we demonstrated that wound-edge inversion to mimic epibole prolongs wound opening. Here we demonstrate that this translates to prolongs inflammation and a transition of murine healing to a more human-relevant granulation pattern. Furthermore, the delay of closure results in a consistent dystrophic scar without need for thermal, radiological, chemical or biological interference. Consequently, this simple surgical maneuver enhances our ability to study and intervene in the process of acute and chronic wound development and dystrophic scar formation in a histologically humanized model while retaining access to the genetic tractability of murine stock.

Insight about Different Physical Therapy Techniques for Management of Hypertrophic Scars

The most common complication of burn injuries is scar formation, which causes structural and cosmetic impairment. Between 1 and 3 months after an injury, hypertrophic scarring develops. Hypertrophic scarring caused by surgical operations, trauma, and particularly burns is a source of worry for patients and a difficult problem for practitioners. Burn scars can cause aesthetic and functional problems, resulting in limitations in activities of daily living. They can substantially impact one's quality of life, both functionally and cosmetically. Despite using many therapeutic techniques, scar control remains a significant concern. Pharmacological and physical therapy, as well as surgical procedures, are used with varying degrees of success and efficacy. New treatments for scar prevention are currently making their way into normal practice, due to the implementation of novel procedures for treating hypertrophic scars and keloids, as are new insights into the pathophysiology of excessive scarring. The purpose of this study was to review different physical therapy modalities that might be effective for the management of hypertrophic scars.

Assessment and management of immature facial scars by non-surgical methods

BackgroundScar quality is affected by patients’ wound healing conditions, trauma type, and skin features that differ due to ethnicity. Despite tremendous improvements in scar remodeling techniques, conspicuous scars can still remain postoperatively. Non-surgical methods used for handling scars include the use of topical corticosteroids, pressure therapy, lasers, and platelet-rich plasma (PRP). This study aimed to assess and evaluate different non-surgical modalities for treating immature facial scars. MethodsFifteen patients with scars were included for non-surgical management. They received one or more of 5 treatments: corticosteroid injection, topical silicone gel application with or without bandage, pressure therapy, lasers, or PRP injection. Scars were assessed using the Patient and Observer Scar Assessment Scale (POSAS) and serial photographs. ResultsThere were no significant differences in the results obtained using POSAS. None of the patients required a secondary intervention or sought a second opinion. The rate of complications associated with the treatments were very minor. ConclusionGood assessment of patient characteristics, proper planning, and appropriate treatment lead to favorable outcomes.

Botulinum toxin A in dentistry and orofacial surgery: an evidence-based review - part 1: therapeutic applications.

Objective An evidence-based review on the safety and efficacy of botulinum toxin type-A (BoNTA) in orofacial conditions, focusing on the therapeutic applications and role of BoNTA as an adjuvant treatment.Data source and selection Data was collected using PubMed (Medline), Cochrane Library of Systematic Reviews and Cochrane Central Register of Controlled Trials electronic databases. Having satisfied the search parameters, 32 studies for therapeutic applications and 26 for BoNTA as an adjunctive treatment were included. The quality of relevant studies was assessed using the Best Evidence Topics (BETs) Critical Appraisal Tool.Data extraction The highest level of evidence (LOE) behind BoNTA safety and efficacy was for wound healing and scar management in the orofacial surgery context, where BoNTA was presented as an adjunctive modality. Level-I evidence was controversial for temporomandibular disorders and bruxism. However, it showed promising results for painful temporomandibular disorders of myogenic origin refractory to conservative therapies, and to decrease muscle contraction intensity in sleeping bruxism. There was only one level-II study for persistent recurrent aphthous stomatitis. Data showed limited level-III evidence for orofacial pain conditions (temporomandibular joint recurrent dislocation and pain, burning mouth syndrome or atypical odontalgia), oral cancer complications, or as an adjuvant to maxillofacial and orthognathic surgeries. Benefits of BoNTA in prosthodontics had weak level-IV evidence. No evidence was found among the periodontology field.Conclusion There is growing evidence to support the safety and efficacy of BoNTA in the investigated orofacial pathological conditions, with high levels of satisfaction from the patient and clinician perspective. However, there are some inconsistencies and limited high-quality evidence available. Well-designed controlled clinical trials are necessary to evaluate long-term safety, efficacy and cost-effectiveness before BoNTA is widely adopted with irrefutable evidence-based clinical guidelines.

Skin Fractional Scar Treatment with a New Carbon Dioxide Scanner: Histological and Clinical Evaluation.

Background: The mechanism of action of fractional carbon dioxide (CO2) laser in the management of skin scarring is stimulation of collagen and fibroblasts in the dermis, resulting in remodeling and shrinking of the skin. Objective: The purpose of this research is to assess the safety and performance of a new CO2 laser scanner for treatment of acne scars. Methods: The study was carried out on 20 patients of both sexes, with a mean age of 25.7 ± 6.7 years. To assess the performance and safety of this new CO2 scanner, a preclinical histological evaluation was done. A clinical evaluation of acne scars was performed using Goodman and Baron's quantitative global acne scarring grading system (GBQGASGS) and a crusting scale where crusting scores ranged from 1 = none to 4 = severe. Digital photographs were taken to obtain esthetic results. Results: GBQGASGS showed a significant improvement in patients' scars and the treatment was well tolerated, with no lasting side effects. Conclusions: The new scanner seems to be an effective and safe device for skin scarring treatment, speeding up the healing time of scars.

Role of guidelines in scar management

Scar can be defined as a fault or blemish resulting from wound, sore or burn. Hypertrophic scars and keloids are caused by chronic inflammation in the reticular dermis. Here we described our experience by using algorithms for treatment of scar.

Digital workflow for fabrication of bespoke facemask in burn rehabilitation with smartphone 3D scanner and desktop 3D printing: clinical case study

We present a digital workflow for the production of custom facial orthosis used for burn scar management using smartphone three-dimensional (3D) scanner and desktop 3D printing. 3D facial scan of a 48-year-old lady with facial burn scars was obtained. 3D modeling with open-source programs were used to create facemask then 3D printed using rigid polylactic acid (PLA) filament and semi-rigid thermoplastic polyurethane (TPU). Conventional facemask was used as a control. Each mask was worn for 7 days. Primary outcomes were level of comfort, and adherence to treatment. The conventional facemask was the most convenient followed by the TPU-facemask (mean comfort score of 9/10 and 8.7/10, respectively). Patient’s compliance was high for both TPU and conventional masks, each was worn for at least 21 hours/day for 7 days. On the contrary, PLA-facemask was not well tolerated. The proposed digital workflow is simple, patient-friendly and can be adopted for resource-intensive healthcare.

Occlusion and hydration of scars: moisturizers versus silicone gels

BackgroundThe mainstay of non-invasive scar management, consists of pressure therapy with customized pressure garments often combined with inlays, hydration by means of silicones and/or moisturizers as well as UV protection. It is generally accepted that scar dehydration resulting from impaired barrier function of the stratum corneum and expressed by raised trans epidermal water loss (TEWL) values, can lead to increased fibroblast activity and thereby hypertrophic scar formation. However, we have reached no consensus on exactly what optimal scar hydration is nor on barrier function repair: by means of silicone sheets, liquid silicone gels or moisturizers. Occlusive silicone sheets almost completely prevent TEWL and have been shown to be effective. Nevertheless, many important disadvantages due to excessive occlusion such as difficulties in applying the sheets exceeding 10–12 h, pruritus, irritation, and maceration of the skin are limiting factors for its use. To avoid these complications and to facilitate the application, liquid silicone gels were developed. Despite a reduced occlusion, various studies have shown that the effects are comparable to these of the silicone sheets. However, major limiting factors for general use are the long drying time, the shiny aspect after application, and the high cost especially when used for larger scars. Based on excellent clinical results after using three specific moisturizers for scar treatment in our patients, we wanted to investigate whether these moisturizers induce comparable occlusion and hydration compared to both each other and the widely recognized liquid silicone gels. We wanted to provide a more scientific basis for the kind of moisturizers that can be used as a full-fledged and cost-effective alternative to silicone gel. MethodsA total of 36 healthy volunteers participated in this study. Increased TEWL was created by inducing superficial abrasions by rigorous (20x) skin stripping with Corneofix® adhesive tape in squares of 4 cm². Three moisturizers and a fluid silicone gel were tested: DermaCress, Alhydran, Lipikar and BAP Scar Care silicone gel respectively. TEWL reducing capacities and both absolute (AAH) and cumulative (CAAH) absolute added hydration were assessed using a Tewameter® TM300 and a Corneometer® CM825 at different time points for up to 4 h after application. ResultsWe found an immediate TEWL increase in all the zones that underwent superficial abrasions by stripping. Controls remained stable over time, relative to the ambient condition. The mean percentage reduction (MPR) in TEWL kept increasing over time with Alhydran and DermaCress, reaching a maximum effect 4 h after application. Silicone gel reached maximal MPR almost immediately after application and only declined thereafter. The silicone gel never reached the minimal MPR of Alhydran or DermaCress. Hydration capacity assessed through CAAH as measured by the Corneometer was significantly less with silicone gel compared to the moisturizers. Compared to silicone gel Lipikar provided similar occlusion and the improvement in hydration was highly significant 4 h after application. ConclusionBased on the results of both our previous research and this study it is clearly demonstrated that the occlusive and hydrative effect of fluid silicone gel is inferior to the moisturizers used in our center. Lipikar hydrates well but is less suitable for scar treatment due to the lack of occlusion. A well-balanced occlusion and hydration, in this study only provided by Alhydran and DermaCress, suggests that moisturizers can be used as a scar hydration therapy that replaces silicone products, is more cost-effective and has a more patient-friendly application.

A comparative study between autologous nanofat graft and fractional CO2 laser in the management of post burn scars .

A comparative study between autologous nanofat graft and fractional CO2 laser in the management of post burn scars .

Diagnosis, Treatment, and Management of Painful Scar: A Narrative Review.

Painful scars can develop after surgery or trauma, with symptoms ranging from a minor itch to intractable allodynia. The problem of the painful scar may involve both intraneural and extraneural structures, requiring a systematic approach to diagnosis and treatment of this neuropathic pain condition that can impact quality of life and function profoundly. In this review, we outline the algorithm for the diagnosis, management, medical and surgical treatment of painful scars.