Prevention Of Scars Research Articles

The control of conjunctival fibrosis as a paradigm for the prevention of ocular fibrosis-related blindness. "Fibrosis has many friends".

The processes involved in ocular fibrosis after disease or ocular tissue injury, including surgery play an important part in the development or failure of treatment of most blinding diseases. Ocular fibrosis is one of the biggest areas of unmet need in ophthalmology. Effective anti-scarring therapies could potentially revolutionise the management of many diseases like glaucoma worldwide. The response of a quiescent or activated conjunctiva to glaucoma surgery and aqueous flow with different stimulatory components and the response to different interventions and future therapeutics is a paradigm for scarring prevention in other parts of the eye and orbit. Evolution in our understanding of molecular and cellular mechanisms in ocular fibrosis is leading to the introduction of new and re-purposed therapeutic agents, targeting a wide range of key processes. This review provides current and futures perspectives on different approaches to conjunctival fibrosis following glaucoma surgery and highlights the challenges faced in implementing these therapies with maximal effect and minimal side effects.

Personalising surgical treatments for glaucoma patients.

Surgical treatments for glaucoma have relied for decades on traditional filtering surgery such as trabeculectomy and, in more challenging cases, tubes. Antifibrotics were introduced to improve surgical success in patients at increased risk of failure but have been shown to be linked to a greater incidence of complications, some being potentially vision-threatening. As our understanding of glaucoma and its early diagnosis have improved, a more individualised management has been suggested. Recently the term "precision medicine" has emerged as a new concept of an individualised approach to disease management incorporating a wide range of individual data in the choice of therapeutic modalities. For glaucoma surgery, this involves evaluation of the right timing, individual risk factors, targeting the correct anatomical and functional outflow pathways and appropriate prevention of scarring. As a consequence, there is an obvious need for better knowledge of anatomical and functional pathways and for more individualised surgical approaches with new, less invasive and safer techniques allowing for earlier intervention. With the recent advent of minimally invasive glaucoma surgery (MIGS) a large number of novel devices have been introduced targeting potential new sites of the outflow pathway for lowering intraocular pressure (IOP). Their popularity is growing in view of the relative surgical simplicity and apparent lack of serious side effects. However, these new surgical techniques are still in an era of early experiences, short follow-up and lack of evidence of their superiority in safety and cost-effectiveness over the traditional methods. Each year several new devices are introduced while others are withdrawn from the market. Glaucoma continues to be the primary cause of irreversible blindness worldwide and access to safe and efficacious treatment is a serious problem, particularly in the emerging world where the burden of glaucoma-related blindness is important and concerning. Early diagnosis, individualised treatment and, very importantly, safe surgical management should be the hallmarks of glaucoma treatment. However, there is still need for a better understanding of the disease, its onset and progression, the functional and structural elements of the outflow pathways in relation to the new devices as well as their long-term IOP-lowering efficacy and safety. This review discusses current knowledge and the future need for personalised glaucoma surgery.

Effects of Botulinum Toxin Type A on Microvessels in Hypertrophic Scar Models on Rabbit Ears.

Background Although Botulinum Toxin Type A (BTXA) has been applied to scar prevention and treatment, the mechanisms still require further exploration. Objective To investigate the effects of BTXA on microvessels in the hypertrophic scar models on rabbit ears. Methods Eight big-eared New Zealand rabbits (males or females) were selected to establish scar models. One ear of each rabbit (4 models in each ear) was selected randomly to be injected with BTXA immediately after modeling and included in the treated group, while the opposite ear was untreated and included in the control group. The growth of scars in each group was observed and recorded, and 4 rabbits were sacrificed on days 30 and 45 after modeling. Then, scar height was measured by hematoxylin-eosin (HE) staining, vascular endothelial growth factor (VEGF) expression was detected by immunohistochemical (IHC) testing, and microvessel density (MVD) was calculated based on CD34 (human hematopoietic progenitor cell antigen). Results The wounds in each group were well healed and free from infection or necrosis. On days 30 and 45, the scar height, MVD value, and VEGF expression in the treated group were lower than those in the control group (P < 0.05). For the treated group, the above indicators on day 45 were lower than on day 30 (P > 0.05). Besides, there was a positive correlation between the MVD value and the VEGF expression in the treated group (P < 0.05). Conclusion The injection of BTXA immediately after modeling inhibits VEGF expression and reduces angiogenesis, thereby inhibiting hypertrophic scar formation.

The Japanese Experience with Basic Fibroblast Growth Factor in Cutaneous Wound Management and Scar Prevention: A Systematic Review of Clinical and Biological Aspects.

IntroductionBasic fibroblast growth factor (bFGF) plays several key roles in wound healing. Over the last 2 decades, clinical and basic research on bFGF has been actively conducted in Japan with reports on its potent efficacy in accelerating the healing of chronic ulcers and burn wounds by stimulating key cellular players in the skin. However, its efficacy remains unrecognized internationally. Thus, this study reviews current knowledge about the therapeutic value of bFGF in wound management and scar prevention accumulated in Japan over the last 2 decades.MethodsWe review the Japanese literature that demonstrates the anti-scarring effects of bFGF and exhaustively assess how these effects are exerted. Using the search terms “bFGF OR growth factors AND wound healing in Japan” and “bFGF AND scar prevention in Japan,” we conducted a search of the PubMed database for publications on the role of bFGF in wound and scar management in Japan. All eligible papers published between 1988 and December 2019 were retrieved and reviewed.ResultsOur search yielded 208 articles; 82 were related to the application of bFGF for dermal wound healing in Japan. Of these, 27 fulfilled all inclusion criteria; 11 were laboratory studies, 7 were case reports, 4 were clinical studies, and 5 were randomized controlled trials.ConclusionFurther research, with recognition of the therapeutic value of bFGF in wound and scar management and its clinical applications, is needed to provide additional clinical advantages while improving wound healing and reducing the risk of post-surgical scar formation.

Electrospun Biomaterials in the Treatment and Prevention of Scars in Skin Wound Healing.

Electrospinning is a promising method for the rapid and cost-effective production of nanofibers from a wide variety of polymers given the high surface area morphology of these nanofibers, they make excellent wound dressings, and so have significant potential in the prevention and treatment of scars. Wound healing and the resulting scar formation are exceptionally well-characterized on a molecular and cellular level. Despite this, novel effective anti-scarring treatments which exploit this knowledge are still clinically absent. As the process of electrospinning can produce fibers from a variety of polymers, the treatment avenues for scars are vast, with therapeutic potential in choice of polymers, drug incorporation, and cell-seeded scaffolds. It is essential to show the new advances in this field; thus, this review will investigate the molecular processes of wound healing and scar tissue formation, the process of electrospinning, and examine how electrospun biomaterials can be utilized and adapted to wound repair in the hope of reducing scar tissue formation and conferring an enhanced tensile strength of the skin. Future directions of the research will explore potential novel electrospun treatments, such as gene therapies, as targets for enhanced tissue repair applications. With this class of biomaterial gaining such momentum and having such promise, it is necessary to refine our understanding of its process to be able to combine this technology with cutting-edge therapies to relieve the burden scars place on world healthcare systems.

Comparison of Silicone Sheets and Paper Tape for the Management of Postoperative Scars: A Randomized Comparative Study.

To compare the effectiveness of silicone sheets and paper tape in the prevention of postoperative cesarean section scars. Patients undergoing horizontal cesarean section were included in this randomized controlled trial. Surgical wounds were divided into two halves. Patients randomly applied silicone sheets or paper tape to each side of their wound as assigned for 3 months. Wounds were assessed at 1, 3, 6, and 12 months after surgery. Researchers used the objective Vancouver Scar Scale (VSS) to evaluate the scars and the subjective visual analog scale (VAS) to evaluate itch, pain, and scar appearance. No significant differences between the silicone sheet and paper tape groups were noted at postoperative follow-ups with respect to VSS scores. The silicone sheet group had significantly better VAS scores for scar appearance than the paper tape group at 6 (6.81 ± 1.47 vs 6.19 ± 1.62, P = .03) and 12 (6.88 ± 2.01 vs 6.2 ± 2.08, P = .04) months' follow-up, respectively. The silicone sheet group showed statistically significant differences in comparison with the paper tape group in terms of scar appearance as determined by the VAS. However, the differences were too small to be clinically meaningful.

Autologous Fat Transfer for Scar Prevention and Remodeling: A Randomized, Blinded, Placebo-controlled Trial.

Background:Autologous fat transfer—also referred to as fat grafting—has been reported to provide beneficial effects to overlying scar and skin. Despite procedural frequency, there is a paucity of high-level evidence guiding the surgeon in technique, patient selection, and efficacy.Methods:A multicenter, double-blinded, randomized, internally placebo-controlled trial was performed with an aim to qualitatively and quantitatively evaluate the impact of autologous fat transfer on the quality of overlying scar tissue. Fat-grafted scars were evaluated and compared with paired, saline-injected “control” scars. Subjective and objective metrics were evaluated in treated sites for 12 months after treatment.Results:Blinded qualitative results demonstrated a statistically significant improvement in scar quality over time in fat-grafted scars. However, these improvements were not found to be statistically different from changes noted in scars treated with saline. In addition, objective metrics did not statistically differ between saline-injected and autologous fat-grafted scars.Conclusions:Our results demonstrate that autologous fat grafting can improve the qualitative profile of a scar from both the patient and observer perspectives. However, there was no difference in improvement when compared with scars that were treated with saline in a randomized and blinded fashion. These results demonstrate that any improvements in scar quality related to fat grafting are also achieved using saline and suggest that mechanisms other than cell activity may be at play. Additional randomized, blinded, placebo-controlled trials are required to either corroborate or contest the putative beneficial effect(s) of adipose tissue on scar remodeling.

Keloid and Hypertrophic Scar Formation, Prevention, and Management: Standard Review of Abnormal Scarring in Orthopaedic Surgery.

Keloid and hypertrophic scar formation after orthopaedic surgical closure is a complex issue. The nature and location of procedures maximize wound tension, leave foreign bodies, and diminish dermal supply, all potentiating keloid formation. There is little discussion regarding the pathophysiology and management of this recurrent problem in orthopaedic literature. Keloid formation is a fibroproliferative disorder resulting in extensive production of extracellular matrix and collagen, but prevention and treatment is poorly understood. Patient and surgical factors contributing to the development of this condition are discussed. The treatments include both medical and surgical therapies that work at a biologic level and attempt to produce a cosmetic and complication-free management strategy. Medical options that have been investigated include combinations of intralesional steroid therapy, laser therapy, and biologics. Preventive surgical closure and excision remain mainstays of treatment. Radiation therapy has also been used in refractory cases with mixed results. Despite medical therapies and surgical excision aimed at treating the resulting scar, recurrence rate is very high for all modalities that have been studied to this point. Future work is being done to better understand the pathophysiology leading to keloid and hypertrophic scar formation in an effort to find preventive methods as compared to treatment strategies.

A Prospective Randomized Double-blind study of silicone gel plus Herbal Extracts Versus Placebo in Pre-sternal hypertrophic scar prevention and amelioration

ObjectivePost-surgical hypertrophic scar is more frequently reported in Asians. Many modalities can treat scars but there have not been any publications to define the efficacy of silicone gel plus herbal extracts for scar prevention or amelioration. Design48 patients, who underwent median sternotomy were randomized and double-blinded to 2 groups to use topical silicone gel plus herbal extract gel or placebo for 6 months. Patients were treated either with topical silicone gel plus herbal extract gel or control using only placebo for 6 months. The scars were observed by experienced plastic surgeons using the Vancouver scar scale. SettingA single tertiary care center at Khon Kaen University. Paticipants48 patients who underwent median sternotomy were enrolled in this study. All patients were aged over 18 years. All the wounds were sutured with polyglycolic 4/0 subcuticular suture material and did not receive other scar management before participating in this study. InterventionThe silicone gel plus herbal extract gel (Bangkok Botanica, Bangkok, Thailand) in semi-liquid form was formulated from 15% Herbal extract (Allium Cepa extract, Centella Asiatica extract, Aloe Vera extract and Paper Mulberry extract), 50% polydemethysiloxane, 30% cyclopentasiloxane and 5% silica. The placebo gel was a composite of water, acrylate, C10-30 alkyl acrylate cross-polymer, polysorbate 20 and fragrance that was similar in color and consistency as that of the active gel and packed in the similar sealed packages. Main outcome measuresThe scar was assessed using the Vancouver scar scale to determine pigmentation, vascularity, pliability and height. Resultsthe study showed the silicone gel plus herbal extract gel could improve scar amelioration in height (p = 0.005) and pliability (p < 0.001) when compared to the placebo. The vascularity and pigmentation showed improvement using silicone gel plus herbal extracts but the improvement was not statistically significant. ConclusionThe silicone gel plus herbal extracts gel was effective for scar improvement in median sternotomy wounds.

Free tissue transfer for burns reconstruction: A single-site experience

This study reviews free tissue transfer (FTT) surgery for both acute wound and reconstructive scar management of burn injuries at a UK burns unit over a 10-year period. Thirty eight patients underwent 46 FTTs, or free flaps, as part of their burn injury pathway. For the cohort of patients, there was one flap failure, which occurred for a secondary scar reconstruction. It is noted that FTT was successful for all seven acute or primary interventions. Anterolateral thigh flap was the most frequently performed (57%); followed by parascapular flaps (22%) of which 43% were pre-expanded. A method of pre-expansion for neck contractures and a novel technique of anchoring this flap to the pre-tracheal fascia are described here. This can provide the patient with good neck contouring by using the capsule to hitch the flap into a good position. It is clear that further work is required to study the prevention of hypertrophic scarring that can occur at the interface between flap and adjacent skin, where occurrence rate in this cohort was 17%. It is proposed that FTT now provides a viable solution both to the coverage of complex burn wounds and to the revision of scar contractures. Consensus over an FTT protocol for the primary management of open burn wounds is seen as the logical next step for this surgical intervention.

Inhibition of post-trabeculectomy fibrosis via topically instilled antisense oligonucleotide complexes co-loaded with fluorouracil

Trabeculectomy is the mainstay of surgical glaucoma treatment, while the success rate was unsatisfying due to postoperative scarring of the filtering blebs. Clinical countermeasures for scar prevention are intraoperative intervention or repeated subconjunctival injections. Herein, we designed a co-delivery system capable of transporting fluorouracil and anti-TGF-β2 oligonucleotide to synergistically inhibit fibroblast proliferation via topical instillation. This co-delivery system was built based on a cationic dendrimer core (PAMAM), which encapsulated fluorouracil within hydrophobic cavity and condensed oligonucleotide with surface amino groups, and was further modified with hyaluronic acid and cell-penetrating peptide penetratin. The co-delivery system was self-assembled into nanoscale complexes with increased cellular uptake and enabled efficient inhibition on proliferation of fibroblast cells. In vivo studies on rabbit trabeculectomy models further confirmed the anti-fibrosis efficiency of the complexes, which prolonged survival time of filtering blebs and maintained their height and extent during wound healing process, exhibiting an equivalent effect on scar prevention compared to intraoperative infiltration with fluorouracil. Qualitative observation by immunohistochemistry staining and quantitative analysis by Western blotting both suggested that TGF-β2 expression was inhibited by the co-delivery complexes. Our study provided a potential approach promising to guarantee success rate of trabeculectomy and prolong survival time of filtering blebs.

When Testosterone Needs to be Contrasted: A Preliminary Study of Scar Prevention in Transmen Top Surgery with an Innovative Galenic Preparation.

Transmen are individuals who live a marked incongruence between the assigned gender and the experienced gender. Crucial and life-changing steps in their transition are testosterone treatment and mastectomy to remove the stigma of feminine identity. After surgery, patients' attention turns to the scars, often not aesthetically pleasant. We thus created an innovative galenic preparation for scar treatment after surgery composed by spironolactone, alfa bisabolol and silicone gel. Functional outcomes, side effects and satisfaction were assessed. For the present prospective randomized controlled study, 30 patients with similar demographic characteristics who underwent double incision mastectomy with NA grafts between February 2014 and June 2019 were selected. The treatment Group A (n = 15) was treated for 12 months with "Top Surgery Scar go," the control Group B (n = 15) with silicon gel. Statistical analysis including Wilcoxon test and Kruskal-Wallis test per variable was performed. To assess satisfaction, a second Wilcoxon test was applied. The differences between Group A and Group B were statistically significant, especially at T12 with very low p values. Satisfaction was greater in Group A (p value = 3e-4). No major side effects were noticed in Group A. TSSgo scar innovative treatment showed long-term efficacy in comparison with silicon gel in terms of improved scar tissue texture, pigmentation, pliability and height. It is easy to set up, cost-effective and safe. Further studies are necessary to better assess efficacy and validity of TSSgo, but it appears to be promising as the new treatment of reference for scar management after top surgery in transmen. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Efficacy of topical silicone gel in scar management: A systematic review and meta-analysis of randomised controlled trials.

To assess the efficacy of topical silicone gel in the management of scars, we conducted this meta-analysis. The systematic search was performed on PubMed, Web of Science and Embase, and six randomised controlled trials with a total of 375 patients were involved. The outcome data of Vancouver Scar Scale were extracted from the studies and their effect sizes were calculated using Review Manager 5.3. As a result, topical silicone gel significantly reduced pigmentation, height, and pliability scores postoperatively compared with placebos or no treatment (Pigmentation: standard mean difference [SMD] = -0.55 [-0.83 to -0.26], P = .0002; Height: SMD = -0.73 [-1.02 to -0.44], P < .00001; Pliability: SMD = -0.49 [-0.95 to -0.03], P = .04). Topical silicone gel and silicone gel sheet were comparably effective (P > .05). The performance of topical silicone gel and other non-silicone topical treatment was also similar (P > .05). In summary, topical silicone gel was effective in post-operative scar prevention.

Local Injection of Botulinum Toxin Type A to Prevent Postoperative Scar.

Physical scars, especially those in the head and neck area, can cause emotional and psychological distress. Recent studies, have suggested that botulinum toxin type A (BTX-A), also known as Botox, may improve surgical scars by speeding up the wound healing process. Injection of BTX-A is generally considered a less invasive approach. The purpose of this meta-analysis was to assess the efficacy and safety of BTX-A in the prevention of postoperative scars compared to placebo or no treatment. Following databases were searched from inception to March 2019: Cochrane Library, EMBASE, Web of Science, PubMed, and Open grey. Five trials registers were searched for potentially related trials. The authors also searched reference lists of relevant articles and contacted the investigators to identify additional published and unpublished studies. Two authors independently evaluated all potential studies that met the selection criteria. Two authors independently extracted and analyzed the data. Analysis was conducted on 267 patients who were enrolled in trials and randomly assigned to receive local injection of BTX-A (184 patients) and placebo (182 patients). Improved Vancouver scar scale scores were noted among patients treated with BTX-A injections compared with the control group (P = .000). The visual analogue scale scores revealed a significant improvement in appearance for the BTX-A-treated scars (P = .000). In addition, lower increase in width of the wound was observed in the experimental group compared to the control group (P = .000). This systematic review provided preliminary evidence that supports the efficacy and safety of BTX-A for the prevention of postoperative scar.

Role of Insulin in Prevention of Hypertrophic Scars

Role of Insulin in Prevention of Hypertrophic Scars

Viability of silicone gel use in the prevention of hypertrophic scars in rats Wistar

Viability of silicone gel use in the prevention of hypertrophic scars in rats Wistar

Medicated prevention of scarring after glaucoma surgery

Modulation of wound healing is one of the main challenges in glaucoma surgery. Modern antiproliferative agents used to reduce postoperative scarring are either insufficiently effective or inadequate in terms of safety. In the search for novel agents devoid of such drawbacks, specialists directed their attention to selective inhibitors of proinflammatory cytokines and growth factors. The article reviews pathophysiologic basis of wound healing, characteristics of inflammatory mediators affecting fibroblast proliferation and scarring, and provides description of the currently used and new, potentially promising antiproliferative agents.

Pustular rash after dermal filler injection should not be interpreted as Herpes Simplex infection

Filler-induced arterial obstruction can mimic other dermatological conditions. In this case series, the authors describe four patients with filler-induced arterial obstruction presenting with pustular rash that was misdiagnosed as a herpetic infection. Since correct and timely diagnosis is crucial for scar prevention, pustular rash has to be recognized by injectors as a clinical expression of vascular obstruction induced by dermal filler injection

Current status of long-term antibiotic prophylaxis for urinary tract infections in children: An antibiotic stewardship challenge.

Recurrent urinary tract infections (UTIs) in children are associated with development of pyelonephritis and renal scarring. Traditionally, continuous antibiotic prophylaxis (CAP) has been used to prevent recurrent UTI. Recent studies have challenged the efficacy of CAP for preventing renal scarring and have raised concerns about inducing bacterial resistance. This review focuses on studies published between January 2000 and April 2019 and evaluates the use of CAP in children for avoiding recurrent UTIs and renal scarring. A systematic literature search was carried out using the following search terms and related medical subject headings in the MEDLINE electronic database: ‘urinary tract infection’, ‘antimicrobial/antibiotic prophylaxis’, and ‘children/pediatrics’. Randomized clinical trials (RCTs), original research articles, guidelines, systematic reviews, and meta-analyses describing antibiotic prophylaxis for UTIs were included. A total of 34 RCTs, 9 systematic reviews, and 3 guidelines describing antibiotic prophylaxis were included in this review. The efficacy of CAP for preventing recurrent UTI remains unclear due to non-generalizability of results obtained from suboptimally designed clinical trials. CAP has not been proven as beneficial for preventing new renal scarring in children. Additionally, CAP is associated with increased risk of multidrug resistant infections in children. No conclusive evidence can be drawn from the available clinical data to support routine use of CAP for prevention of renal scarring. Accumulation of evidence from additional well designed studies may result in different conclusions in the future. It is important to identify specific risks for recurrent UTI and ensuing renal injury to ensure more judicious use of CAP.

Refinements of the application of paramedian forehead flap in nasal defects repair in Asian patients.

Due to the relatively higher tendency of postsurgery scars, insufficient cartilage support, and low surgical acceptability, nasal defect repair with forehead flap in Asian patients needs further study. We aim to determine the necessity of tissue expansion, timing of pedicle division, and the importance of cartilage scaffold reinforcement and scar prevention at the donor site during nasal reconstruction in Asian patients with paramedian forehead flap. A retrospective analysis was performed on patients who underwent nasal reconstruction with forehead flap at our hospital from January 2013 to January 2018. The demographical information, surgery details, and postoperative complications of all patients were recorded. The reconstructed nose, scars, and eyebrow deformities were evaluated by digital photographs, and the overall satisfaction of the patients was documented. The study included 15 patients (7 males and 8 females). All nasal defects involved at least two aesthetic units and included seven full-thickness defects. Only one patient underwent two revision operations. Complications like hematoma, infection, and necrosis were not detected, except in one patient with partial necrosis of the flap. All patients were satisfied with the reconstructed nose and did not report any respiratory dysfunction. No obvious scars or eyebrow deformities were observed. Three-stage full-thickness forehead flap should be used to repair nasal defects in Asian patients, with immediate cartilage scaffold reconstruction at stage one and reinforcement at stage two. Botox injection into the forehead can refine the scar.