Post-burn Scars Research Articles

Hair-Bearing Expanded Scalp Flap for Total Beard Reconstruction in Patients With Chin and Submental Postburn Scars.

Loss of beard in adult male caused by severe burn may cause cosmetic and psychological problems for these patients. Reconstruction of the beard with hair-bearing skin flaps in similar color and texture of the surrounding tissues remains a challenge. Eight male patients suffered from submental postburn scar and beard loss were treated by using the hair-bearing expanded scalp flap. A 1000mL nephroid tissue expander was first implanted under the frontal and mid scalp. After a 3 to 4-month tissue expansion, the expanded hair-bearing scalp flap based on bilateral superficial temporal vessels were raised and transferred for beard reconstruction, and the cutaneous pedicles were curled into tubes. Delay and division of the pedicles were performed 3 to 4 weeks after flap transfer. Eight male patients with postburn scar and beard loss were successfully treated with no major complication. One patient suffered from edge necrosis at distal end of the flap and healed after daily dressing change. Chin and submental areas were repaired by expanded scalp flap and total beard was reconstructed at the same time. All donor sites were closed directly without skin grafting. The modified expanded bipedicled scalp flap provides an easy and reliable way for total beard reconstruction and large-scale submental scars repairment.

Reconstruction of facial defects using a pre-expanded scalp flap: A description of the method used and outcomes of 43 patients.

BackgroundA technique for reconstructing facial units with matching colour, similar texture and sufficient contour is ideal for patients with various facial defects. The current report aimed to present the experience of the authors in facial reconstruction using pre-expanded scalp flaps combined with laser hair removal.MethodsFrom January 2014 to August 2021, 43 patients with different facial defects, such as post-burn scar and congenital nevus, were treated using this surgical technique that involved tissue expansion, scalp flap transfer and laser hair removal. Facial defects were artificially classified into three regions (forehead, n = 19; cheek, n = 15; and lips and chin, n = 9). Pedicle delaying and division were performed in patients who underwent reconstruction with pedicled flaps.ResultsOf the included patients, one presented with haematoma, one with infection and three had distal necrosis after expanded scalp flap transfer. The donor site was primarily closed in all patients. Further, all patients were successfully treated without major complications. The texture, colour and contour of the scalp flap after laser hair removal matched well with the surrounding skin tissues at 2–30-month follow-up.ConclusionReconstruction using pre-expanded scalp flaps combined with laser hair removal is an effective and reliable option for facial reconstruction with excellent colour and texture match.

The The Combination Effect of Co2 Laser and Topical Growth Factor Solution for Treatment of Atrophic Post-Burn Scar

Burn scars are among the most disfiguring scars seen in clinical practice, and patients may experience physical and psychological problems due to them. Combining Fractional CO2 Laser with Rejuvenating Complex solution (G.F.) provided an enhancement response for resurfacing therapy for post-burn scars. Treatment aimed to evaluate the response of post-burn scar for combination therapy. The sessions for each patient will be done monthly. The (G.F.) Rejuvenating Complex solution has been applied immediately after laser treatment. Thirty percent of the patients showed more than 75% improvement, 40% showed 51-75% improvement, 20% showed 25-50% improvement, and 10% showed less than 25% improvement. This line of treatment was safe and effective.

The Treatment of Chronic Postburn Scar and Contracture: A Case Report

The Treatment of Chronic Postburn Scar and Contracture: A Case Report

Застосування методів консервативної терапії в дітей з післяопіковими рубцевими деформаціями та їх вплив на метаболізм сполучної тканини

One of the factors of scarring is changes in the connective tissue (CT). Defeat of CT is accompanied by changes in the content of glycosaminoglycans (GAG), activity of lysosomal enzymes, levels of mineral metabolism. To eliminate the influence of inflammatory phenomena and disorders of CT metabolism on the formation of scar tissue, it is urgent to use conservative rehabilitation measures. Purpose - to determine the effectiveness of measures of conservative therapy of post-burn scars in children for the clinical course and metabolism of connective tissue. Material and methods. 27 children aged 5 to 18 were supervised. The group of healthy children without clinical manifestations of inflammatory reactions consisted of 17 people. Conservative treatment of children with scarring included local, drug, physiotherapy, balneological and efferent therapy methods. The impact of treatment measures was assessed on a modified scar score scale, which consisted of a patient (parent) scale and a researcher scale. Laboratory criteria of effectiveness were the amount of ceruloplasmin (CP), lactic (MC) and sialic (SC) acids, GAG content, lysosomal enzyme activity (bone and alkaline phosphatase), mineral metabolism (total calcium). Laboratory parameters in patients were studied in the period from 150 to 170 and 310 to 340 days after injury. SPSS v was used for statistical analysis. 17.0. Results. Improvements in clinical signs of scar tissue were 1.7-fold according to objective estimates and 1.6-fold according to patient estimates. Laboratory monitoring showed the effectiveness of conservative treatment of convalescents, which was manifested in a reduction in GAG levels 1.6 times after 6 months and 2.0 times after a year. There was a decrease in the activity of acid phosphatase in 1.6 times, alkaline phosphatase and its bone fraction in 1.4 times. In addition, after treatment, there was an increase in ceruloplasmin activity by 1.5 times at all times. A 1.5-fold increase in the number of MCs was determined at all observation times. After treatment, the amount of MC decreased by 1.2 times (P<0.05). Significant confirmation of an increase in the level of SC in 1.4 times (P<0.05) was observed only on the 160th day of the study. At other times, the increase in the IC was unreliable. Conclusions. Long-term studies have shown that in children after thermal trauma in the process of productive scarring there are deviations in the metabolism of CT in the direction of increasing its synthetic function, metabolic disorders and inflammation continue. The use of complex conservative therapy in children with post-burn scars during convalescence allowed to reduce the severity of inflammatory reactions, improve CT metabolism and reduce scarring. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: post-burn scarring in children, connective tissue, metabolism, inflammation, conservative therapy.

Expanded scalp flap combined with laser hair removal to reconstruct facial defects around the hairline

Congenital and acquired facial lesions around the hairline can bring huge physical and psychological trauma to patients. At present, reconstruction of this area remains a challenge. In this study, we present an alternative technique to reconstruct the aesthetic units using an expanded scalp flap combined with laser hair removal. We retrospectively reviewed 25 cases of facial lesions around the hairline reconstructed with this surgical technique between May 2014 and May 2020. Expander was implanted under the scalp as designed before the operation. After the expander was fully expanded, the lesion was removed and the scalp flap was transferred. Laser hair removal was performed on the transplanted skin flap 2 weeks after flap transfer. There were ten cases of postburn scar, nine cases of congenital nevus, four cases of traumatic scar, one case of haemangioma, and one case of nevus sebaceous. The median times of laser treatment was 3 (range, 1-8). The median follow-up time was 11 months, ranging from 1 to 27 months. The colour and texture of expanded flaps were similar to adjacent tissue in all cases. The direction of reserved hair in transferred flaps was consistent with the direction of hair in the recipient area or contralateral hair. There were no complications, such as infection, blistering, discolouration, and ulceration. All patients were satisfied with the appearance of the reconstructed hairline and the surgical outcomes. The expanded scalp flap combined with laser hair removal is a feasible and effective technique to reconstruct both sides of the hairline simultaneously from a single donor site with a good colour match and a similar texture and thickness.

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 .

Treatment of Postburn Scar Erythema and Dyschromia With Pulsed Dye and Q-Switched KTP Laser.

Treatment of Postburn Scar Erythema and Dyschromia With Pulsed Dye and Q-Switched KTP Laser.

Immunohistochemical Analysis of Postburn Scars following Treatment Using Dermal Substitutes.

Background Post-burn hypertrophic scars commonly occur after burns. Studies that compare dermal substitutes with other treatment methods are insufficient. The purpose was to analyze the histopathological differences in hypertrophic burn scars after Matriderm®+split-thickness skin graft (STSG) and compare with AlloDerm®+STSG, STSG, full-thickness skin graft (FTSG), and normal skin. Methods Samples of unburned, normal skin and deep 2nd or 3rd degree burns were obtained from patients who experienced a burn injury in the past to at least 6 months before biopsy, which was performed between 2011 and 2012. All subjects received >6 months of treatment before the biopsy. Intervention groups were normal (63), STSG (28), FTSG (6), Matriderm® (11), and AlloDerm® (18). Immunohistochemical analyses of elastin, collagen I, collagen III, cluster of differentiation 31 (CD31), smooth muscle actin (α-SMA), and laminin from scar and control tissues were performed and compared. Results α-SMA vascular quantity and vessel width, stromal CD31, and basement membrane laminin expression were not significantly different between normal and intervention groups. Matriderm® group showed no significant difference in elastin, collagen III, stromal CD31 and α-SMA, CD31 vessel width, stromal α-SMA, vessel quantity and width, and laminin length compared to the normal group, meaning they were not significantly different from the normal skin traits. Conclusion Dermal substitutes may be an optimal alternative to address the cosmetic and functional limitations posed by other treatment methods.

Scar formation from the perspective of complexity science: a new look at the biological system as a whole.

A burn wound is a complex systemic disease at multiple levels. Current knowledge of scar formation after burn injury has come from traditional biological and clinical studies. These are normally focused on just a small part of the entire process, which has limited our ability to sufficiently understand the underlying mechanisms and to predict systems behaviour. Scar formation after burn injury is a result of a complex biological system-wound healing. It is a part of a larger whole. In this self-organising system, many components form networks of interactions with each other. These networks of interactions are typically non-linear and change their states dynamically, responding to the environment and showing emergent long-term behaviour. How molecular and cellular data relate to clinical phenomena, especially regarding effective therapies of burn wounds to achieve minimal scarring, is difficult to unravel and comprehend. Complexity science can help bridge this gap by integrating small parts into a larger whole, such that relevant biological mechanisms and data are combined in a computational model to better understand the complexity of the entire biological system. A better understanding of the complex biological system of post-burn scar formation could bring research and treatment regimens to the next level. The aim of this review/position paper is to create more awareness of complexity in scar formation after burn injury by describing the basic principles of complexity science and its potential for burn care professionals.

Factors affecting the outcome of fractional carbon dioxide laser resurfacing of various types of scars in skin of color.

Fractional laser resurfacing has been used widely in management of scars. However, data for post-traumatic and post-burn scar are limited in skin of color. This retrospective study assessed the efficacy of fractional ablative carbon dioxide laser in treatment of various types of scars other than acne scars. We also tried to find out the effect of different factors like skin type, duration, shape, location, and color of the scars on the outcome. Forty-two patients with 67scars including post-traumatic (43), post-burn (15), post-surgical (5), and post-folliculitis (5) scars treated during 2019-2020 were analyzed. The improvement was graded according to investigator and patient global assessment (IGA & PGA) through percentage improvement and quartile scale. Overall, there was 45.4% and 32.7% of improvement according to PGA and IGA, respectively. Scars with >50% improvement were recorded in 13.43% of the scars with IGA and 41.78% with PGA. Early scars, scars without hyperpigmentation, lighter skin type, post-traumatic scars had better results. There was no significant difference for other parameters like atrophic versus hypertrophic, facial versus extra facial, linear versus non-linear, or the number of sessions. Fractional carbon dioxide laser efficacious for non-acne facial and extra facial scars in the skin of color. Early intervention could yield more satisfactory results.

Study of the effectiveness of post-burn scars correction using Er:YAG laser

The purpose of this study was to investigate the effectiveness of post-burn scars laser correction using an Er:YAG laser (2936 nm) with an SMA module (6mm). 112 women aged 16–50 years were monitored on an outpatient basis. All patients were diagnosed with post-burn scars of the face and body. The main inclusion criteria were post-burn scars; non-inclusion criteria were other types of scars, previously performed procedures for the correction of scars by physiotherapy, general contraindications to laser therapy. During the study, high efficacy and safety of this method was demonstrated in 112 patients. The dynamics of changes were evaluated according to the Dermatology Life Quality Index (DLQI), Dermatological Symptom Scale Index and special research methods (ultrasound scanning, photographing). The follow-up period ranged from 3 to 7 months. Patients underwent from 2 to 6 laser procedures on the face and body with an interval of 1 month. The study is prospective and is planned to be continued. At the moment, a cross-section of the results is presented. During the course of laser procedures, 13 patients dropped out, 99 continue treatment.

Reconstruction of Postburn Scar Contracture of the Sole Using the Medialis Pedis Free Flap

Reconstruction of Postburn Scar Contracture of the Sole Using the Medialis Pedis Free Flap

Preparation «Karipain Scar» in a pediatric combustion unit

Introduction. The existing problem of post-burn scar treatment is associated with diffculties in delivering enzyme preparations through the cicatricial tissue; so, it is stimulating searches for the preparations with proteolytic and anti-inflammatory effects which could penetrate deep into scar thickness. Such a preparation is the gel "Karipain Scar" (manufacturer LLC "Scientifc and production company "AS-COM", Moscow, Russian Federation), containing proteolytic enzymes and a transcutaneous conductor – titanium glycerosolvate aquacomplex in the form of a gel (trade name Tizol®, LLC "Society for Laboratory Research of Medicines", Ekaterinburg, Russian Federation). The article describes administration of this preparation in a pediatric combustion unit to treat post-burn pathological scars, including old scars , by applying the drug on scars and by electrodragging.Material and methods. The described technique is used one month after the wound healing. At the frst stage of the study, Karipain Scar was applied on the scar area twice a day to the patients of experimental group (20 children aged 4-16 years with scars on limbs, torso, and large joints). At the second stage, Karipain Scar gel was applied to 18 patients aged 4-16 with scars on limbs, torso, and joints using electrodragging. The scars were photographed once a week and assessed by the Vancouver Scar Scale (VSS).Results. At the frst stage , all participants of the experimental group reported less itching until its complete disappearance by the end of the second week and the decrease of scar height at the beginning of the second month of treatment. The scars turned pale by the end of the 2nd month. At the second stage, 100% of patients from the experimental group reported the improvement in scars since the 5th procedure. There was no signifcant difference between fresh and old scars. Karipain Scar gel was well-tolerated. There were no allergic reactions and complications.Conclusion. The conducted studies has confrmed the effectiveness of Karipain Scar gel for treating children with post-burn scars

Resurfacing in Facial Burn Sequelae Using Parascapular Free Flap: A Long-Term Experience.

It is difficult to treat large postburn sequelae (scars and defects) over the face. Available methods include skin grafts, local flaps, tissue expansion, and free flaps. These surgical options should be chosen wisely, depending on individual patient requirements and the area involved. In patients with large postburn scars and defects in which the surrounding tissue is also involved, use of free tissue transfer is extremely useful. A retrospective analysis was done between 2011 and 2019 of 52 cases with extensive facial burn deformities in whom secondary reconstruction was done with free parascapular flap cover in our department. Outcome was assessed by a direct questionnaire. There was no complete flap loss in the series. Two cases were re-explored for venous insufficiency and suffered partial marginal necrosis. Twenty patients had to undergo further debulking procedure. Forty-seven patients were satisfied by the final outcome. Postburn facial deformities are difficult to treat; in many cases, there are no local options, and tissue from different regions is to be used for reconstruction. Free parascapular flaps can be used as an effective method in such cases with a high level of patient satisfaction.

Lower Pole Breast Reconstruction Using Muscle-sparing Latissimus Dorsi Flap in Postburn Breast Deformity.

Background:Full-thickness burns of the anterior chest wall during childhood are a devastating problem that results in significant distortion of the developing breast. This deformed burnt breast represents a serious aesthetic problem, and can lead to functional impairment as well as severe emotional trauma for patients.Methods:Patients with postburn scarring affecting the lower pole of the breast were included. Only patients with small to medium-sized breasts were targeted. The lower breast pole was reconstructed using muscle-sparing latissimus dorsi flap. All patients had been subjectively assessed, including overall patient satisfaction regarding breast aesthetics, donor site morbidity, and functional deficits of latissimus dorsi muscle, 3 months postoperatively.Results:Six patients (seven breasts) were included in this study. Muscle-sparing latissimus dorsi flap was used to reconstruct lower breast pole in all patients. A horizontally-oriented skin paddle was used in five patients, whereas a vertically oriented skin paddle was used in one patient. Average patient satisfaction was 9.1 (SD 0.6) for the reconstructed lower breast pole. For the donor site, average overall satisfaction was 9.1 (SD 0.8). Latissimus dorsi muscle function was objectively confirmed in 90% of cases after 3 months postoperatively. Patients had an average score of 3.9 (SD 0.4) for the activity score as well.Conclusions:The muscle-sparing latissimus dorsi flap is a good reconstructive tool for lower breast pole in postburn breast reconstruction. It has a reliable versatile skin paddle that can resurface the whole lower breast pole, while avoiding many of the latissimus flap morbidities.

Composite Cerium Oxide Nanoparticles - Containing Polysaccharide Hydrogel as Effective Agent for Burn Wound Healing

A high risk of complications in burn injuries is associated with the development of systemic inflammatory response syndrome. Thermal injury (burn) causes the release of cytokines and prostaglandia, resulting in increased interaction between leukocytes, platelets and endothelial cells. Activation of leukocytes leads to an increase in the formation of reactive oxygen species (ROS) and nitrogen, which is normally compensated by the activation of protective antioxidant enzymes. An imbalance between the activity of the radical-producing and antioxidant systems leads to an excess of free radicals and the development of oxidative stress. Oxidative stress limits the repair of damaged tissue and also leads to localized chronic inflammation. Thus, the removal of inflammation and a decrease in the ROS level, which exceeds the physiological level in the burn zone, seems to be expedient for accelerating the healing process of burn injuries of the skin. In this study, we used a polysaccharide hydrogel modified with cerium dioxide (CeO2) nanoparticles, which have unique anti-inflammatory and antioxidant properties, as an effective agent for the treatment of thermal burns. It has been shown that modification of the hydrogel with CeO2 nanoparticles provides accelerated healing of a model burn wound in rats. Already on the 5th day after the treatment of damage to the skin with the modified hydrogel, a decrease in the area of ​​the burn wound that is different from the control is observed. The use of a hydrogel accelerates the healing process of a burn wound on the 25th day by 25.42% (p <0.05) and ensures complete healing of burn wounds on average 5 days earlier in comparison with the control group with Levomekol ointment. Treatment of burn wounds using a hydrogel leads to the formation of a small post-burn scar. Thus, a polysaccharide hydrogel modified with CeO2 nanoparticles can be considered as an effective wound healing agent in the treatment of thermal burns and skin lesions of various etiologies.

Application of Auriculotherapy for Post-Burn Scar Syndrome in Young Adults with Major Burns.

A burn scar is a type of hypertrophic scar that can cause significant clinical symptoms, discomfort, and post-burn scar (PBS) syndrome in up to 77% of patients with burn injuries. Medication and rehabilitation are rarely effective at managing patient discomfort, and both laser and surgical interventions are postponed until the scar stabilizes and discomfort is tolerable. Objectives: The present study was conducted to investigate the effectiveness of auricular acupuncture among burn victims from the Formosa Color Dust Explosion in Taiwan. We enrolled 31 victims of the 2016 Formosa Color Dust Explosion who met the study inclusion criteria. The intervention involved placement of magnetic beads over the auricular Shenmen and Subcortex acupoints on one ear. Patients performed selfmassage five times per day, and both magnet beads were removed between the fifth and seventh days during the sessions. Several evaluation tools were used to assess clinical symptoms: the visual analogue scale for pain assessment, Burn Man Itch Scale for perceived patient itchiness, 5-D Pruritus Scale for sleep quality, and heart rate variability (HRV) for effects on the autonomic nervous system. The clinical symptoms were significantly decreased following the intervention, but the effect did not endure. The normal-to-normal heart rate interval, heart rate analysis abnormalities, and very low frequency heart rate were significantly decreased among patients with abnormal HRV (SD < 40) following treatment. Stimulation of the auricular Shenmen and Subcortex acupoints may effectively reduce pain, itchiness, and sleep disturbances among patients with PBS syndrome.

Letter on Hair Transplantation in Burn Scar Alopecia After Combined Non-Ablative Fractional Laser and Microfat Graft Treatment.

Letter on Hair Transplantation in Burn Scar Alopecia After Combined Non-Ablative Fractional Laser and Microfat Graft Treatment.

"Hurricane-like" Presentation of a Recurrent Marjolin's Ulcer in a Young Female.

Marjolin's ulcer (MU) with rapid progression and multiple distant metastases is rare. We report a case of an MU of the thigh developing in a postburn scar, which after successful R0 resection developed multiple bony and visceral metastasis to femur, vertebra, skull, lung, and liver within 3 months of excision. We highlight the "hurricane-like" recurrence in an MU, which is unusual for the metachronous disease. We stress that MUs, unlike conventional wisdom, need a thorough metastatic workup at presentation, and prognostication of a possible rapidly progressive course after surgery which may lead to grave prognosis and mortality.