Scar Management Research Articles

734 A User-Centered Design Approach for a Burn Recovery Mobile Platform

Abstract Introduction People with burn injuries experience challenges in multiple domains including wound and scar management, pain/pruritus, psychosocial recovery, return-to-work, and community re-integration. Mobile software platforms can provide clear, concise, and consumable information across different stakeholder groups. These platforms require a user experience (UX) that values users’ expressed needs to maximize engagement with critical information. This study seeks to inform the UX for an outpatient mobile software platform to optimize recovery. Methods We performed semi-structured, in-depth interviews at a regional burn center with patients, clinicians, and carers to understand participant background, personal values, and requirements of a recovery platform. Interviews were transcribed and analyzed using grounded theory analysis and affinity mapping to surface major themes. Results Fourteen in-depth interviews (over 13.5 hours) were conducted with six patients, six clinicians, and two carers. Thematic analysis identified four principal themes and corresponding UX requirements: (1) Provide a clear path to recovery: need for easily understood temporal visualizations of recovery experiences in multiple domains. This includes outlining paths that list relatively individualized tasks critical for recovery. (2) Facilitate task habituation: UX to ease successful task performance such as daily schedules, reminders and integration of recovery tasks with activities of daily living. (3) Maintain motivation: recovery progress tracking, motivational messages and visualization of long-term recovery trends to maximize task adherence. Patients and clinicians identified goal-authoring and recovery progress as key motivators in performing recovery tasks. (4) Create a burn community: access to other people with burn injuries through integrated forums. Neither patients nor clinicians desired to directly communicate with each other through the platform, instead preferring existing electronic health record methods. Conclusions This study identified initial UX requirements for a person with burn injury-centered platform. There is strong support for temporal representations of recovery paths across multiple domains, UX design to facilitate and motivate users to stay engaged in performing critical recovery tasks, and access to the burn community. Applicability of Research to Practice Interviews of prospective users outlined four important features to include in the UX design of an online burn recovery platform.

754 A Longitudinal Study of Compression Therapy in Pediatric Burn Patients

Abstract Introduction Compression Therapy is crucial to managing and preventing hypertrophic scarring. The pediatric population can be especially at risk for hypertrophic scarring due to rapid growth periods and/or discomfort which interferes with compliance. Our previous practice was for pediatric patients to be scheduled every 6 -12 months like the adult burn population. To address this issue, we hypothesized pediatric patients would benefit from more frequent follow up visits. We arbitrarily determined to follow our pediatric patients every 3-4 months for garment remeasuring to improve proper garment fit, efficacy and compliance. Methods A longitudinal study was conducted to determine whether 3–4 month interval check-ups would improve compliance of garment wearing and presumably efficacy of overall management of hypertrophic scarring. Data was collected between June 2020 – December 2021 (1 ½ years). The data was manually retrieved from our Electronic Medical Record. Results Prior to June 2021, children were routinely scheduled in the Burn Clinic at intervals between six and twelve months for scar checks (same as adults). Children were not able to participate in long term compression therapy for the entire interval for several reasons including growth, size changes, garment failure, expired insurance authorization, and possibly lack of knowledge. We decided to schedule consistent follow-up of pediatric patients every 3-4 months, to ensure consistent remeasuring of garments was completed. Pre intervention results noted that only 35% of patients had a 2nd garment remeasured as compared to our post intervention results which showed that 88% of patients successfully had a 2nd garment remeasured. Conclusions Our data suggests that short interval follow up with pediatric burn patients for scar management has led to improved rates of compression therapy compliance and presumably efficacy. Applicability of Research to Practice We have continued the practice of short term follow up in pediatric burn patients for scar management and our data has also provided opportunities to reinforce education with patients and their families. We have found that with better understanding, our patients and families are motivated to seek out and comply with longitudinal care.

557 Adverse Events Associated with Fractional CO2 Laser Therapy for Hypertrophic Burn Scars

Abstract Introduction Laser therapy is a growing intervention in hypertrophic scar treatment. This therapy is associated with minimal risks, however these are poorly studied in the burn population. Anecdotal reports of adverse effects such as pain and dyspigmentation exist. As patients, stakeholders, and insurance companies decide on reimbursement for this therapy, a better studied safety profile is necessary. This study is a retrospective review of all laser therapies for adverse events. Methods A retrospective review of patients who underwent laser therapy at two centers between May 2019 and June 2022. Patient demographics, details of laser treatments, adverse events, and scar characteristics before and after laser therapy were collected. Results A total of 167 patients underwent 533 laser treatments. There were 75 (44.9%) males and 92 (55.1%) females, with an average age of 26 (SD: 20.6) years. In total, 94 patients (56.3%) were Hispanic or Latino, 24 (14.4%) Caucasian, and 49 (29.3%) identified as "Other". All patients were treated for hypertrophic scars after burn injuries. For all patients, average number of laser treatments was 3 (SD: 2.2), with a range of 1 to 17 sessions. There were 9 (1.68%) instances of adverse events out of the total laser encounters. There were 5 (0.93%) reports of increased pain, 1 (0.18%) of an open wound, 2 (0.37%) of increased scar discoloration, and 1 (0.18%) of decreased scar pliability. Of the 5 (2.98%) total patients who encountered adverse events, 3 continued with laser therapy. There was no correlation between number of laser treatments and adverse events. Conclusions Patients undergoing laser treatment for burn scar management rarely face adverse events, of which the most common were increased scar pain and dyspigmentation. Even so, most patients experiencing adverse events chose to continue treatments. Laser therapy remains effective in burn scar treatment with minimal risks regarding safety profile. Applicability of Research to Practice This review will assist patients in making more informed decisions when considering laser therapy for burn scar management.

A Self-Pumping Composite Dressing Improved Hypertrophic Scar Healing with Dual Therapy and Active-Fluid Transport

Silicone gel sheeting (SGS) and pressure garment therapy (PGT) are the International Clinical Recommendations on Scar Management’s (ICRSM) two principal non-invasive scar-healing procedures. This study created a new PGT-SGS composite (PGF-Biopor®AB-based) via pre-strained screen printing. The Biopor®AB hydrophobicity and nylon-hydrophilicity enabled self-pumping for PGT-SGS dual therapy and pressure-driven “warp insertions” mobility facilitates active-fluid transportation. Integrating both therapies in a single PGT-SGS composite achieved efficacy optimization, and the 3D channel structure allowed trauma-free active-fluid transport. The 3D channel topology enables smooth diffusional transport in active-fluid transport environments—and active “nylon absorbency” improved water uptake and enhanced permeability capabilities with sustainability achieved dynamic hydration. The sole use of PGF-Biopor®AB composite in empirical trials verified dual therapy with trauma-free active-fluid transport with one-month efficacy, providing a new route for dual treatment and active scar management.

Concept of Vaikritapaham for the Management of Scar in Ayurveda – A Critical Review

A wound has six root causes, and eight primary locations, characterized by signs of five, prescribed with sixty therapeutic measures and management by four limbs of treatment. The aesthetic management of wounds and scars has been an extensive concept from ancient days to the current surgical practice. Ayurveda is elemental in boundless cosmetic measures for people spanning centuries, with the idea of vaikritapaham commending wound management in the branch of Shalya Tantra. This study aimed to explore the concept of vaikritapaham, managing scar and granulation issues in Ayurveda. The method followed for this review was a thorough analysis of brihatrayees and their commentaries and reference from various research articles on scar management in Ayurveda. It was found that in Sushruta Samhita, the concept of vaikritapaham as the anti-scar measure is mentioned in sapta upakrama of vrana-sopha and various concepts like Utsadana and avasadana for stimulating and depressing granulation, mrdukarma and darunakarma for hardening and softening the woundksarakarma for improper granulation, krsnakarma, pandukarma and pratisarana for discolouration of the skin, romasanjanana and lomapaharana for repilatory and depilatory measures respectively have been mentioned in shasti upakrama of Vrana. Charaka and Vagbatta have described lepas for discolouration issues in managing Vrana. The research thoroughly reviewed the concept of vaikritapaham, scar management and measures for granulation issues in Ayurveda.

Fractional ablative laser therapy for the treatment of severe burn scars: A pilot study of the underlying mechanisms.

Ablative fractional resurfacing is clinically an efficient treatment for burn scar management. The aim of this pilot study was to investigate the poorly understood mechanisms underlying ablative fractional CO2 laser (AFL-CO2) therapy in relation to biomarkers S100 and 11β-hydroxysteroid dehydrogenase type 1 (11β-HSD1). S100 stains for Langerhans cells and neuronal cells, potentially representing the pruritus experienced. 11β-HSD1 catalyses the interconversion of cortisol and cortisone in cells, promoting tissue remodelling. Immunohistochemical analysis of S100 and 11β-HSD1 protein expression in the dermis and epidermis of the skin was performed on normal skin, before and after AFL-CO2 therapy. Data assessing outcome parameters was collected concurrently with the skin biopsies. 13 patients were treated with AFL-CO2 therapy. Langerhans cells decreased by 39% after 2nd treatment. Neuronal cells were overexpressed before treatment in the scar tissue by 91% but levels returned to that resembling normal skin. 11β-HSD1 expression in keratinocytes was significantly higher after laser treatment compared to before in scar tissue (p<0.01). No clear correlation was found in dermal fibroblast numbers throughout the treatment course. Whilst the role of the explored mechanisms and their association with clinical outcomes cannot conclusively be stated, this pilot study demonstrates promising trends that encourages investigation into this relationship.

Clinical profile of duplex kidneys in children and its association with vesicoureteric reflux

BackgroundDuplex kidney is a relatively common renal anomaly with a wide array of associations. With routine antenatal screening it is increasingly diagnosed these days. With this study, we aim to assess the clinical profile, prevalence of vesicoureteric reflux and highlighting the need for aggressive workup and management in selected cases to prevent further renal damage.ResultsFifty-three children with duplex kidneys who attended the department of pediatric surgery at our institution from December 2016 to December 2021 were included in the study. The most common mode of presentation was urinary tract infection (58%). Fifty-three percent had an antenatally detected renal anomaly (out of these 46% were asymptomatic, 33% had UTI and 11% had other symptoms like straining, incontinence and abdominal mass). Sixty-one percent of patients were conservatively managed and 19 patients needed surgical intervention. Ureterocele was the most common condition necessitating surgery. Prevalence of vesicoureteric reflux was 60% and was comparable with other studies. Thirty-six percent of patients had renal scarring. Among the patients with scarring, 84% had VUR and 63% had febrile UTI.ConclusionDuplex kidney though a common congenital anomaly, requires a systematic evaluation to detect its various associations and a structured management protocol according to the associations. It has a high incidence of VUR which is a potentially hazardous condition which can affect the renal function if not evaluated and managed appropriately. Duplex can also be associated with obstructive conditions like PUJO, ureterocele, and ectopic megaureter which can cause rapid deterioration of renal function if not managed early enough. Though majority of the patients need only follow-up and antibiotic prophylaxis, there may be a certain sub group of patients who develop early scarring and need aggressive management. Our study aims to highlight the need to detect such patients early enough to reduce the morbidity.

Congress Report on the Second World Congress of Global Scar Society with Scar Academy and Japan Scar Workshop

Pathological scars (including keloids, hypertrophic scars, and scar contractures) are present with high severity among certain populations, particularly in Asians and Africans who are highly prone to develop scars. Understanding the patho-mechanism that underlies scarring, such as mechanosignaling, systemic, and genetic factors, as well as optimal surgical techniques and integrated noninvasive therapeutic methods can guide clinicians to develop treatment protocols that can overcome these issues. This report summarizes a congress at Pacifico Yokohama (Conference Center) on December 19, 2021 involving researchers and clinicians from diverse disciplines who convened to discuss current clinical, preclinical, and most recent research advances in understanding pathological scarring, keloid and hypertrophic scar management, and research progress in wound healing. Presenters described the advances in scar therapies, understanding scarring mechanisms, and scar prevention and assessments tools. Moreover, presenters addressed the challenges during the COVID-19 pandemic and using telemedicine in management of scar patients.

Use of Microneedling with Platelet Rich Plasma for Management of Atrophic Post-Acne Scars: Review Article

Use of Microneedling with Platelet Rich Plasma for Management of Atrophic Post-Acne Scars: Review Article

Topical Insulin and Fractional Laser in Management of Acne Scars: Review Article

Topical Insulin and Fractional Laser in Management of Acne Scars: Review Article

Maternal Morbidity After Double Balloon Catheter Management of Cesarean Scar and Cervical Pregnancies

Department of Gynecology, Guangdong Second Provincial General Hospital, Guangzhou, China Guidelines for Letters. Letters posing a question or challenge to an article appearing in Obstetrics & Gynecology should be submitted within 8 weeks of the article’s publication online. Letters received after 8 weeks will rarely be considered. Letters should not exceed 350 words, including signatures and 5 references. Letters will be published at the discretion of the Editor. The Editor may send the letter to the authors of the original paper so their comments may be published simultaneously. The Editor reserves the right to edit and shorten letters. Letters should be submitted using the Obstetrics & Gynecology online submission and review system, Editorial Manager (http://ong.edmgr.com). Financial Disclosure The authors did not report any potential conflicts of interest. This work was supported by a grant from the Medical Science and Technology Research Fund of Guangdong (NO. A2020244).

The versatility of biodegradable temporising matrix – A 63 paediatric case series with complex wounds

IntroTreating complex paediatric wounds is a challenge for many clinicians. Biodegradable Temporising Matrix (BTM) is a completely synthetic product that has shown promise in adults with acute burns, complex wounds, and reconstructive procedures. Currently, there is little documentation regarding the use of BTM in the paediatric population. MethodA retrospective chart review was conducted of all children who required application of BTM for wound treatment. Children were grouped into categories according to the type of injury or condition including thermal, friction, and electrical injuries, scar reconstruction, and various wound defects. Outcomes of interest included infection rates, time to application of BTM and split-thickness skin graft (SSG), dressings used, and overall functional and cosmetic outcomes. Results63 children were identified. Thermal (19/63) and friction (10/63) injuries represented the largest groups. Males accounted for 68 % of total children with lower limbs and feet most often affected. The median time for application of BTM was 7.5 days and 27 days from time of application of BTM to SSG. BTM provided satisfactory options for early wound closure and the ability to convert complex wounds, however it still does not negate the need for scar management. ConclusionFrom our review, BTM is a versatile product that has shown positive results for the treatment of complex wounds in the paediatric population. It represents the largest consecutive BTM case series in either adult or paediatric populations to date.

Surgical Subcision for Acne Scars: A Review of Instrumentation.

Subcision is a surgical technique for managing atrophic acne scars. Over time, new instruments have emerged to increase the efficiency, efficacy, and safety of the subcision procedure, including sharp, blunt, and energy-assisted devices. To review the instrumentation used for the subcision of acne scars and to provide clinicians with practical information regarding the selection of instrumentation, with a focus on advantages and disadvantages. A search of PubMed, MEDLINE, and Google Scholar was conducted for articles from January 2000 to June 2022 describing the use of subcision alone for the management of acne scarring. Demographic and clinical data were collected from the included articles. A total of 417 patients from 17 articles were included; 155 patients underwent sharp subcision, 235 patients underwent blunt subcision, and 27 patients underwent energy-assisted subcision. The main indication for subcision was atrophic facial acne scars. Subcision using sharp, blunt, and energy-assisted instruments were all effective in treating atrophic acne scars. Adverse effects common to all subcision methods included erythema and edema. Subcision is a safe and effective modality for the revision of selected acne scars and is a valuable skill set for dermatologists who perform scar revision to master.

Ultrapulse Fractional CO2 Laser With Different Fluences and Densities in the Prevention of Periorbital Laceration Scars: A Split-Scar, Evaluator-Blinded Study.

Periorbital laceration can result in complex, permanent scars, and even lead to serious complications such as cicatricial ectropion. Early intervention with laser devices has been suggested as a novel modality to reduce scar formation. However, no consensus exists regarding the optimal treatment parameters for scar management. This study evaluated the efficacy and safety of ultrapulse fractional CO2 laser (UFCL) with different fluences and densities in preventing periorbital surgical scars. To assess the efficacy and safety of UFCL with different fluences and densities in the prevention of periorbital laceration scars. A prospective, randomized, blinded study was conducted on 90 patients with periorbital laceration scars of 2 weeks old. Four treatment sessions of UFCL were administered to each half of the scar at 4-week intervals, with halves treated with high fluences with low density versus low fluences with low-density treatment. Vancouver Scar Scale was used to assess the 2 portions of each individual scar at baseline, final treatment, and 6 months. The patient's 4-point satisfaction scale was used to evaluate the patient's satisfaction at baseline and 6 months. Safety was evaluated by registration of adverse events. Eighty-two of 90 patients completed the clinical trial and follow-up. There was no significant difference in Vancouver Scar Scale and satisfaction score between different laser settings between the two groups (P > 0.05). Adverse events were minor and no long-term side effects were noted. Early application of UFCL is a safe, strategy to significantly improve the final traumatic periorbital scar appearance. Objective evaluation of scars did not identify differences in scar appearance between high fluences with low density versus low fluences with low density of UFCL treatment. Level III.

Healing Pathology: Keloid Scar

Skin conditions known as keloid scars can afflict people of all ages and ethnicities. The description, features, and potential risk factors for this ailment are covered in the introduction. I provide a thorough analysis of the etiology, administration, mitigation, and therapy of keloid scars. The distinctions between keloid scars and hypertrophic scars, the causes of keloid scar development, and the surgical and non-surgical therapies that are available are all discussed. The discussion focuses on the main issues and factors in the management of keloid scars. The necessity of prevention and the need for a customized and interdisciplinary approach are explored, along with the current therapy techniques and their individual limitations. The conclusion reviews the material covered in the earlier parts and highlights the value of prevention, selecting a therapy that is tailored to the patient's particular needs, and the necessity for more study into the pathophysiology of keloid scars.

Use of Hyaluronic Acid Filler in Patients with Secondary Cleft Lip Deformity.

Retrospective case note review was undertaken of all patients treated in the clinic over a two-year period. 20 patients underwent HA filler injections to the upper lip 26 times. Most were female (F:M = 3:1) and patients were aged 18-58 years. Most patients had a unilateral cleft lip +/- palate (n = 13, 65%). The most common indication was to address upper lip volume (n = 13, 65%). Other indications included vermillion notch (n = 5, 25%), cupid bow peak height asymmetry (n = 4, 20%), scar asymmetry (n = 1, 5%) and nasal sill flattening (n = 1, 5%). Small volumes of filler were used with an average of 0.34 ml (range 0.05-1.2 ml). There were no complications and one patient reported pruritis post procedure. HA filler is a safe and reliable treatment for certain aspects of asymmetry following cleft lip repair. It can be used to address volume deficiency and asymmetry, cupid bow peak height discrepancies and a vermillion notch for patients who do not want surgery. Injection of HA to the lips can be performed easily, with appropriate training, in the outpatient setting.

Microtoxin for Improving Pore Size, Skin Laxity, Sebum Control, and Scars: A Roundtable on Integrating Intradermal Botulinum Toxin Type A Microdoses Into Clinical Practice.

In aesthetic clinical practice, botulinum toxin type A (BoNT-A) is best known for its use as a neuromodulator for the treatment of dynamic facial lines; however, when injected intradermally as microdroplets, BoNT-A can improve skin quality and overall skin appearance. To discuss key aspects of microtoxin use in clinical practice and provide expert guidance on utilization. As part of a continuing medical education lecture series and roundtable, the authors discussed key aspects of microtoxin patient selection, injection technique, and safety. The experiences of expert faculty are shared here. Clinical experience is consistent with reported data. Microtoxin can be used to reduce pore size, sebum production, rosacea, acne, and fine lines, and to improve jawline and neck definition. Intradermal injection can also be employed for the improvement of transverse neck lines as well as for the safe prevention and management of scars and keloids. Expanding the use of BoNT-A, a predictable, minimally invasive, and affordable treatment to address commonly encountered complaints is appealing. The authors have found that making patients aware of microtoxin as a treatment option results in an increased interest in and utilization of BoNT-A, and high satisfaction among appropriately selected patients.

The Role of Fractional CO2 and Pulsed Dye Laser in Scar Management

Introduction: An estimated 100 million patients acquire scars of any type every year, a few of which will lead to hypertrophic, contracting scars or keloids. Management remains challenging and encompasses surgical and non-surgical treatment options. The introduction of fractional photothermolysis (FP) in 2004,marked a major advancement in treatment. Unlike classic non-fractional ablative lasers, FP uses well focused laser beams to create small columns of ablation called microscopic treatment zones (MTZ).FP has since been discovered to be particularly useful in relieving scar contractures with efficacy on improving functionality and cosmetic outcomes. We aim to present a case of a contracting scald burn over the buttocks improving exceptionally following pulsed dye (595 nm) laser and fractional resurfacing using an ablative CO2 (10600 nm) laser associated with transepidermal triamcinolone delivery. Materials and Methods: Case presentation of the management of a hypertrophic scar following a scald burn. Results: A 12 year old boy suffered a third degree scald burn on the right buttock requiring a split thickness skin graft. The follow-up was complicated by a contracting, hypertrophic scar with a negative impact on his soccer playing due to diminished running ability. we started treatment with pulsed dye laser (595 nm, handpiece of 12 mm, pulse duration of 6 ms, fluence of 5 à 6 J/cm2),fractional resurfacing treatments using an ablative fractional CO2 laser(10600 nm, Deep-Fx, 30 to 50 mJ/MTZ, 5% coverage)followed by topical triamcinolone application by the principle of fractional laser-assisted drug delivery. We applied a hydrocolloid dressing 24/7,wearing compression shorts and to massage the scar regularly. After a total of 19 treatments, we observed a smooth scar without any signs of contraction and a normal range of motion of the hip joint. The patient was highly satisfied with the functional and aesthetic result. Conclusion: Lasers are a safe and effective treatment option for traumatic scars. Choosing the appropriate laser with the appropriate dosimetry is one of the cornerstones to a good scar-management.

WEO Newsletter.

WEO Newsletter.

Study of platelet-rich plasma application for skin and plastic surgery in recent 20 years: A bibliometric analysis.

In recent years, platelet-rich plasma (PRP) has been used in plastic surgery, dermatology, and other treatment procedures worldwide. Since the number of scientific writings has been significantly increasing, it is challenging to generate a manual compilation and systematic review of PRP's therapeutic applications in dermatology and plastic surgeries. This study aimed to make a bibliometric analysis of the literature in the field and evaluate research hotspots and frontiers in this field in the past 20 years. Using the Academic Search Premier and ScienceDirect defined search terms, we searched the Web of Science Core Collection (WoSCC) and Scopus databases. All data were analyzed using CiteSpace 5.8.R3 and VOSviewer, including countries, institutions, authors, keywords, cited authors, cited journals, cited references, discovered research hotspots, and frontiers. A total of 1931 studies were retrieved. The number of publications on PRP application in dermatology and plastic surgeries showed a yearly increase. The United States was the most significant contributor to this field, while Italy's contribution was noteworthy. The journal with the highest number of relevant articles in dermatology and plastic surgery included the Journal of Cosmetic Dermatology. However, the Wound Repair and Regeneration and International Journal of Molecular Sciences were the leading journals that should be paid attention to in the future. Author Anitua E from the Tor Vergata University of Rome published the most publications in this field. In the keyword co-occurrence analysis, all keywords were divided into six clusters, and the most common one in recent years was "PRP for facial beauty." Facial rejuvenation, scar, and alopecia were the main hotspots and research trends in this field. Based on the current global trends, the use of PRP in cosmetics and skin care is receiving increasing attention from researchers and clinicians. Recently, an increasing number of articles on PRP's application in skin tissue repair have been published in the United States and Italy. The number of studies on hair loss, facial rejuvenation, and scar management is increasing, suggesting that these subjects may become research hotspots for PRP in dermatology and cosmetic surgeries in recent years.