Fibrous Tissue Overgrowth Research Articles

A Case study- Jalaukavacharan-Leech Therapyin management of Vranagranthi (Keloid)

Keloid is a type of scar that results from the overgrowth of dense fibrous tissue which is usually develops after healing of a skin injury. In other words, it represents an abnormal scar formation. The tissue extends beyond the borders of the original wound and does not usually regress spontaneously. It causes cosmetic deformity, itching, pain, and stress ultimately resulting in compromised quality of life and diminished functional performance. The treatment of Keloid is often difficult because there is an associated high risk of recurrence. Vrana represents a vast part of Shalyatantra and the pathogenesis of Keloid is similar to Vrana granthi which has been explained as a growth of mass at the site of Vrana following dietetic complications or any physical irritation in a Vrana patient. Jalaukavacharana (leech therapy) is a parasurgical type of Raktamokshana and is considered as the most unique and effective method of bloodletting. Leeches are widely used in most disorders ranging from skin disease with evidence of successful results. In the present paper, an effort has been made to case of keloid that have been conducted in Ayurveda as para surgical procedure.

Morphological structure of the levator muscle in congenital and acquired ptosis of the upper eyelid

AIM: To examine the relationship between the morphological structure of the levator in congenital and acquired ptosis based on dynamometric data and histological research.
 MATERIAL AND METHODS: Dynamometric and histological examination of the morphological structure of the levator in congenital and acquired ptosis of the upper eyelid was conducted. Twenty-seven fragments obtained during the operation to eliminate blepharoptosis were studied.
 RESULTS: With congenital ptosis of the upper eyelid, the average values of SS and fatigue were 1.060.39 g and 1.880.89 g, respectively; with acquired ptosis, the average values of SS and fatigue were 1.470.66 g and 2.310.91 g, respectively (p 0.05). All the biopsies were divided into two groups. Group 1 included biopsies of 16 patients with congenital ptosis (n=16), and group 2 included 11 levator fragments with acquired ptosis. Macroscopic examination revealed greater levator fragment lengths in the acquired ptosis group than in the congenital ptosis group: 2.331.32 mm and 1.220.34 mm, respectively (p 0.05). The levator fragments differed in color and had denser elastic consistency in the acquired ptosis group than in the congenital ptosis group. The histological picture in congenital ptosis (n=11) was an overgrowth of the fibrousadipose tissue, and five biopsies showed an overgrowth of fibrous tissue with signs of protein dystrophy. In levator biopsies with acquired ptosis, seven biopsies with aponeurotic ptosis of the upper eyelid were characterized by the overgrowth of fibrousadipose tissue. The first biopsy (myasthenic ptosis of the upper eyelid) demonstrated the predominance of adipose tissue, with scattered bundles of striated muscle fibers and areas of connective tissue with bundles of smooth muscle fibers. In the remaining three biopsies, fragments of adipose tissue with signs of edema and hyperplasia were identified.
 CONCLUSION: Congenital ptosis is characterized by relatively low strength and rapid fatigue of the upper eyelid levator, higher occurrence of fibrousadipose tissue, and fibrous tissue proliferation. Acquired ptosis is characterized by average strength and fatigue. In the acquired ptosis group, histological data indicate an equal ratio of fibrousadipose and adipose tissue growth. These results can be used in the diagnosis of various forms of ptosis and selection of an effective method for surgical correction for this pathology.

Keloid with intra-lesional steroid injection

Introduction: Keloids are the result of an overgrowth of dense fibrous tissue that usually develops after healing of a skin injury. The exact pathogenesis of Keloids is unknown and their occurrence is spontaneous. The uncontrolled overgrowth of dense fibrous tissue extends beyond the borders of original wound and does not regress. No single therapeutic modality has been proven to be most effective for treatment therefore this study is plan to use intralesional steroids injection in keloid and measure the efficacy and to see if it is a better and cost effective method and also to determine its utility for clinical practice in dermatology in future. Objective: To determine the efficacy of intralesional steroid injections in keloids with dental syringe. Settings: Dermatology department, Jinnah Medical College Hospital in outpatient department (OPD). Duration: 06 months from 14th April’2018 to 14th Oct’ 2018. Design: Cohort Study. Subject and Methods: A total of 79 patients with having keloid were included in this study. During each visit, the size of the keloid was recorded centimeter using the Vernier's calipers, in terms of length, breadth, and height Injection triamcinolone acetonide was used in strength of 40 mg/ml.

Judicious management of pinna keloids: our experience with combination therapy

<p class="abstract"><strong>Background:</strong> Keloids occur as a result of overgrowth of fibrous tissue following healing of a cutaneous injury and they cause aesthetic issues when they appear on the exposed parts of the body, especially the face. Keloids are difficult to treat, with a high recurrence rate. There are several treatment modalities for management of keloids, though no single modality is completely effective. Most commonly used treatment modalities are intra-lesional steroids, surgical excision, pressure application, silicone gel sheets, 5-fluorouracil (5-FU), cryotherapy, radiation therapy, laser therapy or a combination of these modalities. The aim of the study was to analyse the causes of development of keloids on the pinna and evaluated the outcomes of various treatment modalities applied. It focused on assessing the clinical efficacy of combined surgical excision of pinna keloids with serial steroid injections to prevent recurrence, in comparison to monotherapy with intra-lesional steroid injections alone.</p><p class="abstract"><strong>Methods:</strong> A retrospective review based on medical records was done for 18 patients with keloid of pinna, who were treated with either monotherapy or combination therapy. </p><p class="abstract"><strong>Results:</strong> Satisfactory low recurrence rates were observed with meticulous surgical excision followed by serial steroid injections (18.2%), as compared to monotherapy with serial steroid injections alone (71.4%), and these comparative results were statistically significant at p<0.05 in the cohort.</p><p class="abstract"><strong>Conclusions:</strong> A judicious plan for management for pinna keloids is necessary in order to achieve the best functional and cosmetic outcomes, while reducing the recurrence rates to a minimum. Following a combination of interventions has proved safe and effective for managing this challenging entity.</p>

The experience of interdisciplinary interaction in elimination of midface deformation (clinical observation)

Fibrous dysplasia is a hamartoma appearing as a benign pathologic process in which normal bone tissue formation is replaced by overgrowth of fibrous connective tissue. The problem of diagnosis and treatment of patients with fibrous dysplasia remains unsolved in the absence of a uniform understanding of its etiology and pathogenesis. Treatment and rehabilitation of patients with midface fibrous dysplasia is a complicated medico-social problem, which requires interaction of specialists of different fields to resolve it. The disease presents a practical interest for doctors of more than 20 specialties, as it can lead to disability. The present article describes a clinical case of interdisciplinary interaction of specialists in the fields of maxillofacial surgery, ophthalmology, otorhinolaryngology, plastic surgery and radiology involved in complex treatment of a patient with midface fibrous dysplasia accompanied by eyeball dislocation, decreased vision, as well as progressive impairment of nasal breathing function. The performed treatment resulted in favorable functional and aesthetic outcomes including elimination of exophthalmos, vertical strabismus, lacrimation disorders, nasal breathing disorders, increase of visual acuity and improvement of external appearance.

Reductive Otoplasty and Facial Debulking in a Pediatric Patient With PIK3CA-Related Overgrowth

Overgrowth syndromes encompass a number of rare genetic diseases with heterogeneous clinical phenotypes. Accordingly, there is a strong imperative to collect data and classify these disorders to aid in diagnosis and management. Recent advances in the genetics of overgrowth syndromes have identified mutations in the PIK3CA gene. These somatic mutations manifest in progressive segmental overgrowth of fibrous and adipose tissue and bone, vascular malformations, and in some cases, increased risk for malignancy. Targeted medical therapy is under investigation for the management of PROS, but treatment of overgrowth relies on surgical debulking. Macrotia in PIK3CA-related overgrowth spectrum (PROS) has not been reported in the literature. In this case, we discuss a novel approach to reductive otoplasty and facial soft tissue debulking in a pediatric patient with PROS.

The pathology of early failure in Mitroflow pericardial valve bioprosthesis (12A/LX)

BackgroundLimited mid-term durability of 12A/LX Mitroflow bioprosthesis has been reported. Aim of the study was to ascertain the pathologic substrates and possible mechanisms of structural valve deterioration in explants from animals and humans. MethodsNine aortic 12A/LX Mitroflow bioprostheses preserved in hypotonic solution and three aortic 12A/LX bioprostheses, preserved in isotonic solution, were explanted from juvenile sheep, mean time from implant 95.66 ± 36.04 days and 132.33 ± 28.88 days from implant respectively. One stented unimplanted 12A/LX Mitroflow preserved in isotonic colution before glutaraldeyde fixation served as control. Ten aortic 12A/LX Mitroflow bioprostheses were explanted from humans because of severe dysfunction: five children, (3 females and 2 males, mean age 14.19 ± 4.77 years, range 11-21), 26 ± 8.24 months from implant and 5 adults (4 females and 1 male, mean age 57.4 ± 19.85 years, range 31-72), 64.4 ± 26.94 months from implant. X-ray, histology, and transmission electron microscopy were carried out as well as spectroscopy for calcium (Ca++) and phosphorus (P) content in human explants. ResultsExplants, from both animals and humans, showed cusp folding and stiffness, with coarse calcific deposits at gross examination and X-ray. Severe collagen denaturation, plasma insudation and massive calcification, involving both collagen and cell debris, were observed microscopically. Mean Ca++ content of 183.27 ± 62.48 and P content of 94.35 ±33.76 mg/g dry weight was found in children and Ca++ content of 205.49 ± 2.23 and P content of 99.75 ± 0.11 mg/g dry weight in adults. Obstructive fibrous tissue overgrowth was detected in 6 human cases. ConclusionsCollagen denaturation was observed in pericardial Mitroflow 12A/LX bioprosthesis with premature structural valve deterioration. Optimal collagen fixation and preservation as well as phospholipids reduction by removing cell debris, as employed in the novel CROWN PRT Mitroflow bioprosthesis, are expected to solve the flaw and achieve long-term durability.

Morphologic investigation on Perceval S, a sutureless pericardial valve prosthesis: collagen integrity after collapsing-ballooning and structural valve deterioration at distance

Perceval S is a self-expandable, stent-mounted bioprosthetic valve (BPV), with glutaraldehyde treated bovine pericardium, processed with homocysteic acid as an anti-calcification treatment.The stent is crimpable but the valve insertion is done surgically via a shorter procedure which does not require sutures. Objectives1)Effects of in vitro crimping and ballooning on collagen integrity.2)Pathology of Perceval S explants, with special reference to structural valve deterioration. Material and methods1)Twelve unimplanted Perceval S BPVs, time collapse 15, 60 and 180 min (4 devices per time interval), were studied. Four uncollapsed BPVs served as control. Gross examination, histology and scanning electron microscopy were performed. Collagen periodicity (μm) was measured in each group.2)Twenty-four Perceval S explants, available from failure during clinical trials, were submitted to gross, X-Ray and histological study. Results•There was no difference in cusp collagen integrity after crimping and ballooning, when compared to controls.•Calcification with stenosis occurred in 4 cases (time of explant 58.2 ± 4.1 months) and isolated stenotic fibrous tissue overgrowth in other 4 (time to explant 24.2 ± 12 mos). ConclusionsCollapsing and ballooning do not alter cusp collagen periodicity. Structural valve deterioration with stenosis, due to dystrophic calcification and fibrous tissue overgrowth, seldom occurred in the mid-term. Glutaraldehyde fixed pericardium has the potential to undergo structural valve deterioration with time, similar to well-known BPV failure. This supports the recommendation to pursue improvement of tissue valve treatment with enhanced durability.

Morphological aspects of orbital defect reconstruction in rats with elastin-based biomaterial

The objective of the study was to identify morphological aspects of replacement of xenogeneic decellularized elastin matrix (ХDEM) transplanted into a bone defect of the upper orbital wall in rats. Materials and methods. The experiment was performed on 60 Wistar rats with artificially created 7×4 mm defect in the upper edge of their orbit. In the experimental group (n=30), DХEM was placed in the defect area. Its size matched the size of the defect, and it was attached with a suture material (50 μm silk). Soft tissues were sutured layer by layer in the control group (n=30). Tissue excision was performed after 1, 3 and 12 months. Histological, immunohistochemical and electron microscopic methods were employed. Results. We were gradually replacing DХEM with bone tissue against the background of a pronounced reaction of CD68+/MMP-9+ macrophages, which implied its resorption and lysis. Osteogenesis occurred via intramembranous ossification and endochondral ossification, which was preceded by centripetal migration of endothelial kidneys with subsequent differentiation into capillaries and overgrowth of loose fibrous connective tissue containing progenitor cells. The microenvironment, represented by reticulin fibers, TGF-β1, and sulfated glycosaminoglycans, could contribute to the differentiation of progenitor cells in the osteogenic direction and to osteogenesis per se. In the control group, the defect remained open throughout the experiment. Conclusion. Decellularized biomaterial, based on elastin matrix, has osteoconductive and osteoinductive properties and can serve an adequate biomimetic for reconstruction of the bone defects.

Investigating global gene expression changes in a murine model of cherubism

Cherubism is a rare genetic disorder caused primarily by mutations in SH3BP2 resulting in excessive bone resorption and fibrous tissue overgrowth in the lower portions of the face. Bone marrow derived cell cultures derived from a murine model of cherubism display poor osteogenesis and spontaneous osteoclast formation. To develop a deeper understanding for the potential underlying mechanisms contributing to these phenotypes in mice, we compared global gene expression changes in hematopoietic and mesenchymal cell populations between cherubism and wild type mice. In the hematopoietic population, not surprisingly, upregulated genes were significantly enriched for functions related to osteoclastogenesis. However, these upregulated genes were also significantly enriched for functions associated with inflammation including arachidonic acid/prostaglandin signaling, regulators of coagulation and autoinflammation, extracellular matrix remodeling, and chemokine expression. In the mesenchymal population, we observed down regulation of osteoblast and adventitial reticular cell marker genes. Regulators of BMP and Wnt pathway associated genes showed numerous changes in gene expression, likely implicating the down regulation of BMP signaling and possibly the activation of certain Wnt pathways. Analyses of the cherubism derived mesenchymal population also revealed interesting changes in gene expression related to inflammation including the expression of distinct granzymes, chemokines, and sulfotransferases. These studies reveal complex changes in gene expression elicited from a cherubic mutation in Sh3bp2 that are informative to the mechanisms responding to inflammatory stimuli and repressing osteogenesis. The outcomes of this work are likely to have relevance not only to cherubism, but other inflammatory conditions impacting the skeleton.

Benefits of Gotu Kola Leaf in Responding to Prevent The Form of Keloid in The Wound

Keloids are a type of scar, which is the result of overgrowth of dense fibrous tissue that usually develops after healing a skin injury. Keloids occur due to prolonged inflammatory phases in the wound, resulting in increased fibroblast activity and continuous extracellular matrix formation. Gotu kola (Centella asiatica) leaves are effective in the treatment of wounds because they contain Triterpene components such as asiatic acid, madecassic acid, asiaticoside and madecassoside. The purpose of this literature review is to report the latest scientific findings on the role of gotu kola leaf content in preventing keloid formation by increasing fibroblast proliferation, increasing collagen synthesis and mucopolysaccharide acids, increasing intracellular fibronectin which then significantly increases the tensile strength of newly formed skin, inhibiting the phases of the formation of skin, inflammation of the keloid scar tissue. The method used in this article is article search through the NCBI database and Google Scholar. The year of publication of library resources is from 1999 to 2018 with 20 sources of literature. The theme collected was related to the Centella asiatica leaf content towards the wound phase to prevent keloid formation. The results of the synthesis of articles that have been found are gotu kola leaves can inhibit the formation of keloids in wounds.
 Keywords: gotu kola leaf, keloid, wound

A stented bovine pericardial prosthesis in the pulmonary position

BackgroundPulmonary valve replacement is very common among patients with congenital heart disease. The Carpentier Edwards Perimount valve (Edwards Lifesciences, Irvine, Calif), which was originally designed for the aortic position is among the most implanted valves. We aim to describe the follow-up of this valve in the pulmonary position. MethodsPatients with a Perimount valve implanted between 2003 and 2013 in the University Medical Center Groningen were followed for the primary end point reintervention, defined as surgical or transcatheter valve replacement. Secondary end point was the occurrence of valve failure, defined as significant valvular regurgitation or stenosis. Explanted valves were histologically examined. ResultsForty-five patients (median age at operation 27.8 years, 55.6% women) had a mean follow-up duration of 5.8 ± 3.3 years. There were 7 reinterventions (5 surgical and 2 transcatheter). Freedom from reintervention was respectively 95% ± 4% and 83% ± 8% at 5- and 10- years of follow-up. Freedom from valve failure was 75% ± 4% at 2 years, 65% ± 8% at 5 years of follow-up and 57% ± 10% at 10 years of follow-up. Morphology evaluation (n = 4) showed stiffened valves in the open position, with extensive fibrous tissue overgrowth on the leaflets and a variable proliferation of myofibroblasts. ConclusionsThe Perimount valve has adequate function in the pulmonary valve position at 5 years of follow-up, although after 10 years of follow-up valve failure and reinterventions are common. Explanted valves show retraction and stiffening of the leaflets due to a fibrotic layer on both sides of the leaflet.

Evaluation of the efficacy and safety of intralesional 5- fluorouracil in keloid

Background: Keloid is an area of overgrowth of fibrous tissue that usually develops after healing of skin injury and extends beyond the original defect. The existing treatment modalities include intralesional steroids, cryotherapy, silicone gel sheets, verapamil and 5- fluorouracil (5-FU).
 Methods: An open label study on 48 keloids in 35 subjects attending the Department of Dermatology in Dhaka Medical College Hospital during June 2017 and November 2017. Patients with keloids of 10cm and less along the longest diameter in the age group 18-75 years, Keloids with signs of infection, History of hypersensitivity and/or intolerance to 5- FU were included in the study.
 Results: Majority 21(60.0%) patients had single site keloid and 14(40.0%) had multiple site keloid. Majority 54.3% patients had keloids size 2-5 cm. All patients had pain and hyperpigmentation, 5(14.3%) had pustules, 3(8.6%) had necrosis and 1(2.9%) had ulceration. The median keloid area before the treatment was 4 with an inter quartile range of 1.5 to7.8 and this is compared with post treatment area, median 1.5 and inter quartile range 0.6 to 4. Wilcoxon signed rank test was used to assess the reduction in the size of keloid before and after treatment which was significant (P<.001).
 Conclusion: Majority patients had single site keloid. All patients had pain and hyperpigmentation. low dose intralesional 5-FU is safe and effective modality in the treatment of keloids.
 Journal of Paediatric Surgeons of Bangladesh (2016) Vol. 7 (2): 46-49

Reinforced Electrospun Polycaprolactone Nanofibers for Tracheal Repair in an In Vivo Ovine Model.

Tracheal stenosis caused by congenital anomalies, tumors, trauma, or intubation-related damage can cause severe breathing issues, diminishing the quality of life, and potentially becoming fatal. Current treatment methods include laryngotracheal reconstruction or slide tracheoplasty. Laryngotracheal reconstruction utilizes rib cartilage harvested from the patient, requiring a second surgical site. Slide tracheoplasty involves a complex surgical procedure to splay open the trachea and reconnect both segments to widen the lumen. A clear need exists for new and innovative approaches that can be easily adopted by surgeons, and to avoid harvesting autologous tissue from the patient. This study evaluated the use of an electrospun patch, consisting of randomly layered polycaprolactone (PCL) nanofibers enveloping 3D-printed PCL rings, to create a mechanically robust, suturable, air-tight, and bioresorbable graft for the treatment of tracheal defects. The study design incorporated two distinct uses of PCL: electrospun fibers to promote tissue integration, while remaining air-tight when wet, and 3D-printed rings to hold the airway open and provide external support and protection during the healing process. Electrospun, reinforced tracheal patches were evaluated in an ovine model, in which all sheep survived for 10 weeks, although an overgrowth of fibrous tissue surrounding the patch was observed to significantly narrow the airway. Minimal tissue integration of the surrounding tissue and the electrospun fibers suggested the need for further improvement. Potential areas for further improvement include a faster degradation rate, agents to increase cellular adhesion, and/or an antibacterial coating to reduce the initial bacterial load.

Morphological changes in the distal segments of the aorta
 femoral reconstructions as predictors of late thrombosis

Results of studying the effect of histological type of atherosclerotic plaques in the area of vascular anastomoses after reconstructive operations on the main arteries of the lower extremities on the risk of developing late thrombotic complications are presented. It was found that atherosclerotic plaques in patients with no evidence of a hemodynamically significant restenosis in the distal anastomosis identified thickening and overgrowth of fibrous connective tissue, the amount of lipids is minimal or absent, stored elastic fibers and the layers of smooth muscle cells. The extracellular lipids in extensive, but well-defined area in the intima. Macrophages are single and located mainly along the periphery of the lipid core, form clusters of 2–3 cells, there are no lipid inclusions in the cytoplasm. In atherosclerotic plaques of patients with late thrombosis in the distal anastomosis area, a significant uneven thickening and proliferation of fibrous connective tissue was revealed, lipid inclusions are represented by a large nucleus or a group of nuclei. Elastic fibers are replaced by collagen fibers and inclusion of lipids, several sites of calcification are noted. Macrophages form association of 4-5 cells at the periphery of the lipid core and in the coating, where their number is significantly higher; in their cytoplasm the inclusion of lipids are noted. Generally, it was revealed that the histological characteristic of atherosclerotic plaques of VI, VII type (AHA 5 classification [6]) correlated with the high risk of late thrombotic complications in patients operated with peripheral artery disease.

Hiperplasia estromal seudoangiomatosa. Una lesión de la mama infrecuente y de presentación variable

Pseudoangiomatous stromal hyperplasia is a rare benign mammary lesion. It is characterised by an overgrowth of fibrous connective tissue that produces numerous spaces resembling vascular structures. This lesion usually affects women of reproductive age but has been described in patients aged between 12 and 75 years. It may appear as an incidental finding in histological analysis after surgery for benign or malignant disease, either as a painless breast tumour, simulating a fibroadenoma, or as a gigantomastia or deformity that becomes more evident on comparison with the contralateral breast. Percutaneous ultrasound-guided biopsy allows definitive identification of the type of lesion and exclusion of malignant disease, such as low-grade angiosarcoma. Treatment is surgical and includes both surgical removal of the lesion and mastectomy with prosthetic reconstruction. We describe a series of three cases with different clinical presentations and treatment. The first case was a radiological and histopathological finding related to a breast deformity and asymmetry, while the remaining two cases presented as a palpable, single and painless breast tumour.

A New Approach in the Treatment of Keloids: UVA-1 Laser

Keloids are scars that grow beyond the boundaries of a cutaneous injury, inflammation, surgical incision, or burn. They are the result of an overgrowth of dense fibrous tissue that usually develops after healing of a skin injury, and do not usually regress spontaneously. In addition to symptomatic relief, cosmetic concern is the primary reason patients seek medical intervention. Therapeutic options such as occlusion dressings, intralesional corticosteroids or interferon injections, silicone gel application, cryotherapy, irradiation, and ablative lasers have been used in various combinations. We present the results from two patients who underwent UVA1 laser therapy.

Keloid-derived keratinocytes acquire a fibroblast-like appearance and an enhanced invasive capacity in a hypoxic microenvironment in vitro.

A keloid scar is an overgrowth of dense fibrous tissue that develops around a wound. These scars are raised scars that spread beyong the margins of the orinigal wound to normal skin by invasion. Keloid tissue consists of both an epithelium and dermal fibroblasts. Recent studies have primarily focused on keloid fibroblasts; however, the precise role of keratinocytes in the invasion process of keloids remains to be identified. Hypoxia is a typical characteristic of keloid scars, as well as other solid tumors. The expression of the transcription factor, hypoxia-inducible factor-1α (HIF-1α), is mainly induced by hypoxia and is known for its ability to induce proliferative and transformative changes in cells; its expression has been shown to correlate with tumor invasion and metastasis. In the present study, we used immunohistochemistry, fluorescence staining and western blot analysis and demonstrated that HIF-1α was highly expressed in both the epithelial layer of keloid tissue specimens and in hypoxia-exposed keratinocytes, which suggested that the keloid keratinocytes underwent epithelial-to-mesenchymal transition (EMT) in vitro. The high expression of mesenchymal markers, such as as vimentin and fibronectin was confirmed, as well as the reduced expression of E-cadherin and zonula occludens-1 (ZO-1) during this process by detection at the protein and mRNA level. Moreover, siRNA targeting HIF-1α reversed the changes which had occurred in the morphology of the keratinocytes (cells had acquired a fibroblast-like appearance) and suppressed the invasive ability of the keratinocytes. In conclusion, the present findings demonstrate that the hypoxia/HIF-1α microenvironment provides a favorable environment for keloid-derived keratinocytes to adopt a fibroblast-like appearance through EMT. This transition may be responsible for the enhanced capacity of keloid keratinocytes to invade, allowing the keloids to extend beyond the wound margin.

Drug-eluting microneedles for self-administered treatment of keloids

Keloid is a long-term dermatological scarring disease characterized by disfiguring lesions resulting from overgrowth of dense fibrous tissue. Current therapeutics are ineffective, require clinical supervision and can be costly. This study investigated the use of microneedle technology in the self-management of keloid lesions. Specifically, a microneedle patch comprising of polyethylene glycol diacrylate (PEGDA) and encapsulating 5-fluorouracil (5-FU) has been developed for transdermal delivery. The microneedle patches showed requisite mechanical strength (hardness 45 ± 11 MPa, elastic modulus 0.66 ± 0.16 GPa) and were able to puncture porcine epidermis. The choice of PEGDA substrate enabled conformability to non-planar anatomical regions (e.g. elbow), with about 50% of the loaded 5-FU released during the first 12 hours. Thereafter, the microneedle efficacy was evaluated on in vitro keloid fibroblast culture models, where 5-FU loaded microneedles effectively abolished keloid fibroblast proliferation activity. In summary, we have developed a microneedle device with a good potential as an effective, economical and self-applied therapy for keloid scars.

Application of diode laser for excision of non-inflammatory vascular epulis fissuratum

Introduction: Epulis fissuratum is essentially one of overgrowth of fibrous tissue from vestibular mucosa, that most commonly develops when a full denture or partial denture flange begins to impinge/irritate on the tissues in this area. It must be surgically removed with scalpel, electrosurgery or lasers. As a component of the treatment, the denture must usually be re­made or substantially adjusted to prevent recurrence. Case Report: A fold of fibrous tissue in the anterior left segment of maxillary alveolar ridge with its base in vestibule, in a 65­year­old male patient, was excised using a diode laser. Follow­up was done after 15 days and 1 month and a new complete denture was fabricated for the patient. Conclusion: Based on the results obtained, it can be concluded that, diode laser is an excellent tool for surgical excision of fibrous overgrowths. It also helps in clean field with good vision, less postoperative bleeding or discomfort. Early recovery is an added advantage, since the patient can be delivered denture early and they can resume their regular activities in lesser time.