Post-burn Scars Research Articles

Изучение влияния соединений церия на послеожоговый рубец в эксперименте in vivo методом трансмиссионной электронной микроскопии

The effect of nanosized cerium dioxide and a solution of cerium (III) chloride on the state of a post-burn scar was studied in an in vivo experiment via transmission electron microscopy. The intracellular accumulation of cerium compounds with their agglomeration with cytoplasmic and/ or lysosomal localization was observed after 4 injections of nanodispersed cerium dioxide or cerium (III) chloride solution at concentrations of 0.5% and 0.05% in the formed scar area. The application of the cerium preparations both in nanodisperse form (sol) and in solution did not cause inflammatory reactions or cell destruction and had a positive effect on a regenerative process; it contributed to the full-fledged tissue regeneration in a shorter time and changed the scar characteristics for the better. sol, nanodispersed cerium dioxide, cerium (III) chloride solution, electron microscopy, post-burn scar, functional activity of cells

Pre-expanded bipedicled visor flap: an ideal option for the reconstruction of upper and lower lip defects postburn in Asian males.

BackgroundReconstruction of upper and lower lip subunits is a complicated and elusive challenge. For patients affected by defects involving upper and lower lip subunits, a technique able to reconstruct both aesthetic units with matched colour, sufficient contours and similar texture would be ideal. In this study, we present our experience with upper and lower lip reconstruction using the pre-expanded bipedicled visor flap.MethodsFrom January 2014 to January 2017, 12 male patients presenting with defects of the upper and lower lip subunits were treated using this surgical technique. After a period of expansion of the scalp flap of over 6 months, the bipedicled visor flap was raised from both the parietal regions and rotated to resurface the defect. Delay and section of the pedicle were then performed.ResultsTwelve male patients with postburn scars aged 22 to 48 years (mean: 34 years) were successfully treated with no major complications. The donor site was closed primarily in all cases. Subsequent flap debulking and minor revisions were performed under local anaesthesia between 6 and 12 months postoperatively.ConclusionsThe pre-expanded bipedicled visor flap provides an effective and reliable option for upper and lower lip reconstruction with excellent colour and texture. It is feasible to achieve these results simultaneously from a single donor site by using a pre-expanded bipedicled visor flap.

P53(Cp44), an Endogenous Human p53 Fragment Generated via M-Calpain-Mediated Cleavage Beyond Degradation

Endogenous fragments of p53 identified recently in human cytomegalovirus (HCMV)-infected human lung fibroblasts, specifically a ~44-kDa N- terminal fragment referred to as p53(Cp44), have been shown to be generated via m-calpain cleavage. p53(Cp44) appeared to be tightly associated with a chromatin-rich fraction, and was stabilized by the proteasome inhibitor MG132, particularly in mock-infected cells. The N- terminal p53 fragments were also present in three human dermal fibroblast cell lines tested, including fibroblasts isolated from post-burn hypertrophic scar. Understanding the biological functions of these fragments in the regulation of physiological and pathological processes, and the mechanisms regulating their generation and degradation, may shed light on currently unrecognized aspects of p53 regulation and function, and may provide a pathway for drug discovery.

Using Freestyle Skin Flap in Closure of Defects in Upper Limb

Background: Defects in upper limb may result from primary open trauma, postoperative wound infection, raw area after burns or post burn scar excision, tumor excision, radiation injury. Some defects require skin flap for proper coverage and restoration of function. One of the methods recently used for reconstruction of defects in upper limb is local freestyle skin flap. This flap is based on a perforator which provides blood supply for flap and acts as pivot point when the flap is rotated. Objectives: To evaluate using freestyle flap for reconstruction of defects in upper limb and assess the post-operative results for restoring function and cosmoses. Patients and Methods: This is a prospective study carried out in Plastic & Reconstructive Surgery Department & Emergency Unit, Zagazig University Hospitals in the period from January to July 2018 including 12 patients with soft tissue loss in upper limb managed by freestyle skin flap. Results: 50% of the cases had soft tissue defect after contracture scar release, while 25% were due to traumatic cause and the remaining 25% were post malignancy resection. flap dimensions ranged from 6 - 96 cm². we had no complications in 58.3% of our cases, while minor complications like flap congestion and distal partial necrosis occurred in 33.4% which were resolved within 1 week. Unfortunately, we experienced 1 flap loss (8.3%) which managed later by debridement of necrotic tissue and skin grafting the remaining soft tissue. Conclusion: Freestyle skin flaps are a reliable option for coverage of small to moderate sized defects

Application effects of enhanced computed tomography and three-dimensional reconstruction technology in reconstruction of pediatric post-burn scars with expanded flaps

Objective: To explore the application effects of enhanced computed tomography (CT) and three-dimensional reconstruction technology in the reconstruction of pediatric post-burn scars with expanded flaps. Methods: From May 2016 to March 2019, 19 children with hypertrophic scars after thermal injuries were admitted to our unit, including 10 boys and 9 girls, aged from 4 years and 5 months to 15 years and 11 months. The area of scars ranged from 5 cm×4 cm to 23 cm×9 cm. One or more skin and soft tissue expanders with suitable volume and shape were implanted into the normal skin area around scar of children. Three to six months later, enhanced CT and three-dimensional reconstruction were performed before the second stage operation to obtain three-dimensional images of the vascular branches in the donor site for expanded flaps to be cut, so as to determine the course and distribution of the vascular branches and guide the design of expanded flaps. According to the design scheme, the resection of scar, removal of expanders, and excision and transfer of flaps were performed to repair the wounds after scar resection. The area of flaps ranged from 6 cm×4 cm to 25 cm×10 cm. The donor site was closed directly. The number of flaps was counted. The anatomical structure, vascular distribution, and adverse reactions during enhanced CT and three-dimensional reconstruction of site for expanded flaps to be cut, the survival of expanded flaps and the follow-up after the second-stage operation were observed. Results: A total of 48 expanded flaps were designed and excised in 19 children. The anatomical structure of the site for expanded flaps to be cut and the adjacent spatial position relationship were visually observed through the three-dimensional reconstruction after enhanced CT, and no adverse reactions were observed. Arterial branch blood supply or venous return was observed in 29 sites for expanded flaps to be cut. All the expanded flaps survived well without blood supply disorder after the second stage operation. The children were followed up for 6 months to 1 year and 6 months after the second stage operation. The appearance of the flaps was natural, and the color and thickness of the flaps were similar to those of the surrounding normal skin, except for one child with obvious linear scar. Conclusions: Enhanced CT and three-dimensional reconstruction can assist the vascular assessment of the expended flaps, which is helpful for rational design of the flap excision and transfer protocol to improve the survival rate of flaps. Thus, it has certain clinical application value in the reconstruction of post-burn scar in children with expanded flaps.

Use of Tissue Expansion and Serial Z-plasty for Release of Neck Postburn Scar Contracture.

Z-plasty is widely employed in plastic surgery and its mainly functions include elongation along the axis of the scar, dispersal, and realigning the scar within the lines of minimal tension. It is especially useful to release linear-scar contracture, yet difficult for wide scars. Here, we described a technique of tissue expansion followed by serial Z-plasty for several cases of severe postburn scar contracture. In this procedure, first, full expansion should be achieved in the tissues adjacent to the contracture by tissue expansion. Then, the serial Z-plasty technique with precise trimming and adjustment is performed with adequate tension-free skin to release the contracture. Over a period of 2 years from 2015 to 2017, this technique was employed in moderate or severe postburn scar contracture in four patients (1 male and 3 females) aged 14 to 40 years old. The size of contracture ranged from 5 to 27 cm in diameter. Improved appearance and excellent skin match was observed in our four patients. All patients healed uneventfully without any complications and no patient required revision surgery. The range of motion, short form-36 health survey and Vancouver Scar Scale indicated that this technique offered a durable skin coverage with satisfying appearance in these patients. Through the outcomes of our patients, tissue expansion followed by serial Z-plasty has a great potential to be a useful alternative for the treatment of scar contracture especially for contracture adjacent to cervical joints.

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

Long-term effects of vacuum massage on postburn hypertrophic scar thickness: a single blind randomised controlled study

Background. Burn victims develop hypertrophic scar as a progression to burn wound healing. Physical therapy intervention may help, as adjuvant therapy, in solving this problem. Objective. The aim was to study the effectiveness of vacuum therapy on the post burn scar in addition to conventional physical therapy. Design, Setting, and Participants. Randomized, single-blind, superiority, parallel, controlled, clinical trial in patients with hypertrophic scar post-burn in the lower limb, age between 20 and 40 years, selected form Out-Patient Clinic of burn and surgery in the South Valley University Hospitals between October 2017 and May 2018. 48 patients were randomized into either study or control group, using block randomization (study group n=24 and control group n=24). Interventions: conventional physical therapy in form of friction massage and lower limb muscles stretching was conducted for the control group and vacuum treatment in addition to conventional physical therapy was conducted for the study group. Treatment frequency was 3 sessions per week for 4 weeks. Outcomes: assessment of scar thickness using ultrasonography and assessment of scar severity by modified Vancouver Scar Scale (mVSS) were the main outcomes. Results. 42 patients were analysed (study group n = 22 and control group n = 20) with follow up measure after 4 weeks showed significant improvement in scar sickness with 22% and 34% percentage of improvement and 56% and 62% improvement in mVSS within groups control and study groups respectively, with no significant difference between both groups in before or after treatment measures. Conclusion. Adding vacuum therapy to conventional physical therapy treatment program is effective but not superior to the conventional physical therapy intervention alone, in the form of friction massage and stretching, in the treatment of lower limb hyper trophic scar

The experience of application of antiscar combined agent with boswellic and hyaluronic acids and cepalin in patients with scars at early stages of their development

The article describes the experience of application of the combined antiscar agent containing boswellic acid, cepalin, hyaluronic acid and allantoin with the subsequent application of the prolonged action pressing patch with the matrix of active release of cepalin and allantoin at the early stages of formation and maturation of scars in the patients with postoperative, post-burn scars and traces after cosmetic manipulations in the form of persistent skin redness. A comparison of the efficacy of two therapy schemes for 43 patients aged 18 to 45 in two groups was shown. When evaluating the effectiveness of the therapy by analyzing the data of evaluation scales, ultrasound, dermatoscopy, a greater effectiveness of the combined antiscar agent and pressure patch in comparison with the use of hydrating agents and silicone patches was noted.

Loco-Regional Perforator Flaps for Reconstruction of Post Burn Contracted Elbow

Context: the post-burn scar is inevitable problem even with the best treatment as it depends on the depth of the burn injury, so only superficial dermal burns, heal with no scarring, but the contracture is preventable problem especially with the best treatment. The post-burn elbow flexion contracture may be associated with heterotropic calcification of the elbow joint which needs orthopedic team consultation. The elbow reconstruction represents a demanding procedure for the plastic surgeon. Objective: aim of this study was to evaluate the validity and application of local arm forearm and regional chest perforator flaps for coverage after release of post burn elbow contractures. Patients and Methods: this prospective randomized study was done on 20 patients aged from 6 to 54 years old. All of them were asking for elective release of postburn flexion contracture of the elbow at outpatient clinics of Al Azhar University and Al-Ahrar Teaching Hospitals. It was done from March 2018 to March 2019. Results: we have performed in our study the local and regional perforator flaps as lateral arm flap, medial arm flap, PBUF flap, PBRF flap, thoracoabdominal pedicle flap. Skin grafting is an easy procedure, however, success is limited with the technique because there is always the risk of incomplete graft take and prolonged splinting and physiotherapy is imperative in the postoperative period. Conclusion: flaps are better for resurfacing the defects after post-burn contractures release. Flaps do not need vigorous post-operative physiotherapy or splint age and grow with age especially in children.

Treatment of post burn scar by Laser

Treatment of post burn scar by Laser

Tratamentul cicatricilor postcombustionale de la nivelul sânului

Tratamentul cicatricilor postcombustionale de la nivelul sânului

55 The Advantages of Fasciocutaneous Free Tissue Transfers for the Management of Post-Burn Scar Contractures

55 The Advantages of Fasciocutaneous Free Tissue Transfers for the Management of Post-Burn Scar Contractures

The Presence of Scarring and Associated Morbidity in the Burn Model System National Database.

Postburn scarring is common, but the risk factors, natural history, and consequences of such scars are still poorly understood. This study aims to describe the frequency of scar-related morbidity for up to 2 years after injury and to analyze the impact of burn scars on long-term functional, psychosocial, and reintegration outcomes. Analysis was conducted on data collected between January 2006 and May 2014 from 960 patients (2440 anatomic burn sites) using the Burn Model System (BMS) database. Study population demographics were analyzed and odds ratios for the development of raised or thick scarring were determined. Regression analyses were used to evaluate the impact of hypertrophic scarring (HTS) on psychosocial outcomes, including the Community Integration Questionnaire, Satisfaction with Life Scale, Distress, and the Short Form 12. Symptoms associated with scarring were analyzed at discharge and 6, 12, and 24 months after burn using a set of questions on scarring developed by the BMS. Mixed-effect modeling was used to determine linear change over time and the significance of symptoms. The study population was primarily white (65.0%) and male (71.8%), with a mean (SD) age of 44.0 (15.2) years and mean total body surface area burned of 19.6% (17.9%). The incidence of raised or thick scars increased from 65% to 80% (P < 0.0001) for the 2-year follow-up period. The presence of scarring was not associated with Community Integration Questionnaire, Satisfaction with Life Scale, or Short Form 12 scores. Most patients reported symptoms associated with scarring at 2 years after burn, including dry or fragile skin, scars that restrict range of motion at a joint, issues with hand function, and scar pain and itch. In this large, longitudinal, multicenter cohort of burn survivors, nearly all patients noted the presence of scarring, and a majority noted additional symptoms and morbidity related to their scars even at 2 years after injury. This study demonstrates a need for the continued support of burn survivors to address scar-related morbidity. Furthermore, future studies examining the impact of novel treatments for scarring should use similar scar problem questionnaires and distress scores.

Role of Early Application of Pressure Garments following Burn Injury and Autografting.

Pressure garment therapy, used for reduction of postburn scarring, is commonly initiated after complete healing of the wound or autograft. Although some clinicians have suggested that earlier treatment may improve outcomes, the effect of early initiation of therapy has not been studied in a controlled environment. Full-thickness burns were created on red Duroc pigs, burn eschar was excised, and the wound bed was grafted with split-thickness autografts. Grafts were treated with pressure garments immediately, 1 week (early), or 5 weeks (delayed) after grafting with nontreated grafts as controls. Scar morphology, biomechanics, and gene expression were measured at multiple time points up to 17 weeks after grafting. Grafts that received pressure within 1 week after grafting exhibited no reduction in engraftment rates. Immediate and early application of pressure resulted in scars with decreased contraction, reduced scar thickness, and improved biomechanics compared with controls. Pressure garment therapy did not alter expression of collagen I, collagen III, or transforming growth factor β1 at the time points investigated; however, expression of matrix metalloproteinase 1 was significantly elevated in the immediate pressure garment therapy group at week 3, whereas the delayed pressure garment therapy and control groups approached baseline levels at this time point. Early application of pressure garments is safe and effective for reducing scar thickness and contraction and improving biomechanics. This preclinical study suggests that garments should be applied as soon as possible after grafting to achieve greatest benefit, although clinical studies are needed to validate the findings in humans.

Follicular Unit Extraction (FUE) Hair Transplantation in Combination with Platelet Rich Plasma for the Treatment of Scarring Alopecia: A Case Series

Objective: To study the effect of addition of platelet rich plasma (PRP) to the hair transplantation for scarring alopecia. Methods: An evaluation of the patients with detailed history, clinical examination and laboratory investigations was done. Routine baseline investigations and skin biopsy were done in order to rule out any activity of the underlying disease process. Freshly prepared Platelet rich plasma (PRP) using YCELL BIO kit was injected in freshly done slits over recipient area. Results: A total of 4 cases were studied- A 26 years old male with cleft lip surgical scar with absent hair growth on the middle third of the upper lip, a 22 year old male with a 5 year old post traumatic depressed scar over the junction of medial and lateral third of the right eyebrow, a 17 year old boy with a post burn scar over his left upper lip and adjoining lower cheek area and a 55 years old post menopausal female, an already diagnosed and treated case of frontal fibrosing alopecia (FFA). Hair transplantation was performed with follicular unit extraction (FUE). Freshly prepared PRP was injected intradermally after creating the slits. In all the cases, there was a good survival rate of the healthy hair follicles, accompanied by improvement in the texture of the surrounding skin. Conclusions: Platelet rich plasma, being a cocktail of growth factors, can bring vitality to the tissue and improve its vascularity, thus making it more receptive to the transplant. Additionally, with the improved vascularity of the recipient bed and activated fibroblasts, there is accelerated hair growth and better cosmetic outcomes of the scar.

Double V-Y Flaps for Post Burn Contracted Neck

Background: Several techniques have been defined to beused in surgical treatment of post burn contracted neck. But,there were many problems with those techniques, like failureof graft take and postoperative contracture of the graft. Thecommonest problem in those techniques was distal flap necrosiswhich is frequently seen. As most of these techniques werebased on random-pattern flaps and there is usually a poorblood supply to the scar tissue. But, here in this study, we canbenefit from expansion in the distal part of the upper chestand lower neck caused by continuous traction of the contractedband which leads to expansion of the surrounding tissue withexcess skin.Aim of the Study: In this study, we aim to shift the excesstissue resulted from tissue expansion caused by traction ofthe contracture band from the base of the neck and upperchest to the upper neck by “double V-Y flaps” with directclosure of the donor site.Patients and Methods: 17 patients with post burn scarringof the neck were included in this study. 11 females and 6males with average age 20 (9-32) years old. 9 patients withdouble linear contracture and 8 patients with band contracture.Release of post burn scarring of the neck by “double V-Yflaps” was done, the excess tissue of the flap was used anddirect closure of the donor site was done.Results: The postoperative results represent the successof this technique in the surgical treatment of post burn scarcontractures of the neck. All patients had an uneventfulpostoperative period with no distal flap necrosis. There waspostoperative wound disruption in one patient that was managedby secondary sutures. The post burn scarring was successfullymanaged with this surgical technique “double V-Yflaps”, with no major postoperative complications. One yearfollow-up period revealed no recurrence of the contractedbands.Conclusion: “Double V-Y flaps” is a good technique insurgical treatment of post burn contracted neck with doublelinear or band contracture lines. This technique offers thepatient a good chance for release of post burn contracted neckwith no need to use graft or to wear postoperative neck collar.

Trzy różne nowotwory złośliwe skóry na podłożu blizny pooparzeniowej

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Burdach R, Sławińska M, Biernat W, et al. Three distinct cutaneous malignancies arising in a post-burn scar. Dermatology Review/Przegląd Dermatologiczny. 2019;106(4):417-423. doi:10.5114/dr.2019.88260. APA Burdach, R., Sławińska, M., Biernat, W., Nowicki, T. K., Jankau, J., & Kołacz, S. et al. (2019). Three distinct cutaneous malignancies arising in a post-burn scar. Dermatology Review/Przegląd Dermatologiczny, 106(4), 417-423. https://doi.org/10.5114/dr.2019.88260 Chicago Burdach, Robert, Martyna Sławińska, Wojciech Biernat, Tomasz K Nowicki, Jerzy Jankau, Szymon Kołacz, and Barbara Chrzanowska et al. 2019. "Three distinct cutaneous malignancies arising in a post-burn scar". Dermatology Review/Przegląd Dermatologiczny 106 (4): 417-423. doi:10.5114/dr.2019.88260. Harvard Burdach, R., Sławińska, M., Biernat, W., Nowicki, T., Jankau, J., Kołacz, S., Chrzanowska, B., Sobjanek, M., and Starzyńska, A. (2019). Three distinct cutaneous malignancies arising in a post-burn scar. Dermatology Review/Przegląd Dermatologiczny, 106(4), pp.417-423. https://doi.org/10.5114/dr.2019.88260 MLA Burdach, Robert et al. "Three distinct cutaneous malignancies arising in a post-burn scar." Dermatology Review/Przegląd Dermatologiczny, vol. 106, no. 4, 2019, pp. 417-423. doi:10.5114/dr.2019.88260. Vancouver Burdach R, Sławińska M, Biernat W, Nowicki T, Jankau J, Kołacz S et al. Three distinct cutaneous malignancies arising in a post-burn scar. Dermatology Review/Przegląd Dermatologiczny. 2019;106(4):417-423. doi:10.5114/dr.2019.88260.

Second-generation self-inflating tissue expanders: a new dimension in tissue expansion

Objective To study the different uses of second-generation self-inflating tissue expanders regarding the advantages, disadvantages, and the rate of complications. Background Tissue expansion is a valuable technique in soft-tissue reconstruction. Osmotic expanders are self-inflating and obviate the need for repeated injections. They eliminate port-site problems and reduce the potential to introduce infection. The use of such expanders has become more common in recent years. Patients and methods The study included two parts: retrospective part from January to June 2017 and prospective part from August 2017 till January 2019. The study included 40 patients, admitted to the Plastic Surgery at El-Menoufyia University Hospital and Prince Mohammad Bin Abdulaziz National Guard Hospital – Madinah in Saudi Arabia. The patients had post-burn scars, alopecia, and large nevi. A total of 69 second-generation self-inflating tissue expanders were implanted from January 2017 till January 2019, with a follow-up period of 12 months. Results Of the patients, 30 patients were females and 10 were males. The indication was large scar in 30 cases, alopecia in five cases, and giant nevus in five cases. Extrusion occurred in 10 (14.4%) expanders, which occurred in six (15%) patients. The highest percentage of extrusion occurred in the scalp, in which six of 10 expanders extruded. Conclusion The study indicates that self-inflating expanders can be safely and effectively used for various plastic and reconstructive procedures especially in children. The fact that numerous painful and distressing filling sessions are obviated with these expanders is particularly beneficial for those children too young to understand and cooperate. Moreover, this approach minimizes the risk of infection and lowers costs.

Microneedling versus fractional CO2 laser in the treatment of atrophic postburn scars

Background Microneedling is an evolving approach in the treatment of postburn scars based on the principle of collagen induction and neovascularization. Objective To evaluate and compare the clinical and histopathological outcome of microneedling versus ablative fractional CO2 laser targeting atrophic postburn scars. Patients and methods Twenty-five patients with atrophic postburn scars were included in this study. Each patient received four treatment sessions of both microneedling and fractional CO2 laser with 4-week interval. Histopathological and histochemical evaluations of collagen and elastic fibers were done. Quantitative morphometric studies were also performed. Results A significant increase in collagen deposition was detected after fractional CO2 laser therapy. A significant increase in elastic fiber deposition was detected after both laser therapy and microneedling with fractional CO2 laser showing more significant results than microneedling. Conclusion Ablative fractional CO2 laser is more effective than microneedling in the treatment of atrophic postburn scars; however, microneedling did show a significant increase in elastic fiber deposition and thus can be a promising therapeutic approach when combined with other treatment modalities.