Risk Of Hypertrophic Scarring Research Articles

Various Applications of Purse-String Suture and Its Cosmetic Outcome in Cutaneous Surgical Defects.

Purse-string suture is a simple technique to reduce wound size and to achieve complete or partial closure of skin defects. To classify situations in which purse-string sutures can be utilized and to assess the long-term size reduction and cosmetic outcome of the final scar. Patients (93 from Severance hospital and 12 from Gangnam Severance hospital) in whom purse-string sutures were used between January 2015 and December 2019 were retrospectively reviewed. Wound site, final reconstruction method, repair duration, final wound size, and Vancouver scar scale were assessed. A total of 105 patients were reviewed. Lesions were located on the trunk (48 [45.7%]), limbs (32 [30.5%]), and face (25 [23.8%]). Mean ratio of wound length/primary defect length was 0.79±0.30. Multilayered purse-string suture showed the shortest duration from excision to final repair (p<0.001) and most effectively minimized the scar size (scar to defect size ratio 0.67±0.23, p=0.002). The average Vancouver scar scale measured at the latest follow-up visit at least 6 months postoperatively was 1.62, and the risk of hypertrophic scarring was 8.6%. There was no significant difference in the Vancouver scar scale and the risk of hypertrophic scarring between the different surgical method groups. Purse-string sutures can be utilized in many stages of reconstruction to effectively reduce scar size without compromising the final cosmetic outcome.

Burn Care in the Era of Rapid Enzymatic Debridement: Challenging the Dogma that Healing Beyond 21 Days Results in Hypertrophic Scarring

Deep burns are characterized by the presence of a necrotic eschar that delays healing and results in a local and systemic inflammatory response and following healing by secondary intention: heavy scarring. Early surgical debridement followed by grafting was a major advance in deep burn care and is now the standard of care, reducing mortality and hypertrophic scarring. Eschars have alternatively been managed by non-surgical, autolytic debridement, which often results in infection-inflammation, slow epithelialization, granulation tissue formation and subsequent scarring. Studies based on these traditional approaches have demonstrated an association between delayed wound closure (beyond 21 days) and scarring. Early enzymatic debridement with NexoBrid (NXB) followed by appropriate wound care is a novel minimally invasive modality that challenges the well-accepted dictum of a high risk of hypertrophic scarring associated with wound closure that extends beyond 21 days. This is not surprising since early and selective removal of only the necrotic eschar often leaves enough viable dermis and skin appendages to allow healing by epithelialization over the dermis. In the absence of necrotic tissue, healing is similar to epithelialization of clean dermal wounds (like many donor sites) and not healing by the secondary intention that is based on granulation tissue formation and subsequent scarring. If and when granulation islands start to appear on the epithelializing dermis, they and the inflammatory response generally can be controlled by short courses (1-3 days) of topically applied low strength corticosteroid ointments minimizing the risk of hypertrophic scarring, albeit with wound closure delayed beyond the magic number of 21 days. Results from multiple studies and field experience confirm that while deep burns managed with early enzymatic debridement often require more than 21 days to reepithelialize, long-term cosmetic results are at least as good as with excision and grafting.

618 Clinical and Humanistic Burdens of Pediatric Burns: A Systematic Literature Review

Abstract Introduction Children face long-term clinical and psychological sequelae from burn injuries. This review summarizes the scientific literature on the clinical and humanistic burdens of pediatric burns. Methods A systematic review of literature published between Jan 2015 and Jun 2020 was conducted based on PRISMA guidelines in Embase, Biosis, and MEDLINE to identify publications examining the clinical, humanistic, economic, and/or epidemiologic burdens of illness associated with pediatric burns in the US. Results Of 2,286 unique articles identified, 28 met eligibility criteria. This analysis focused on studies relating to the clinical (n=8) and humanistic (n=9) burdens of pediatric burns. Across all studies, flame and scald were the most common burn etiologies. Among the 8 clinical studies, several evaluated outcomes (n=2) or treatments (n=3) in predominantly graft recipients. One study found that 64% of pediatric split-thickness autograft recipients exhibited hypertrophic scarring (HTS) at the donor site. Other variables (time to re-epithelialization, donor-site harvest depth, harvest in an acute burn care setting, thigh donor-site location) were associated with increased risk of HTS. An increase in percentage total body surface area (%TBSA) burned corresponded to increased number of autograft procedures, risk for HTS, and viral infection risk. Other reported outcomes included infections (eg, healthcare-associated, wound, viral), pain, inhalation injury, and sepsis. One study found that while the frequency and intensity of pruritis decreased over time, 63% of children continued to report symptoms at 2 years after injury. Among the 9 humanistic studies, 4 reported larger %TBSA corresponded to worse health-related quality of life assessed by various instruments. In a study of patients under age 5 with burns, Burns Outcomes Questionnaire (0–4) scores improved over time in multiple domains. In youth with a history of burn injuries, patient-reported pain interference with daily living was significantly associated with decreased physical functioning, depression, and impaired peer relationships. Two studies assessed caregiver burden, with one study finding that 19% of caregivers self-reported clinical or at-risk levels of distress following the child’s burn injury. Conclusions Pediatric burns place a substantial clinical and humanistic burden on patients and their caregivers. While outcomes appeared to improve over time, clinical and humanistic consequences of pediatric burns endured. More research on novel treatment products and procedures is needed to reduce the burden of burns for this population.

Protomyofibroblast Pathway in Early Thermal Burn Healing

Wound healing following partial thickness thermal burns is commonly hampered by the risk of hypertrophic scarring. Skin myofibroblast (MF) density is commonly increased in postburn healing. The transition between fibroblast-like cells and α-smooth muscle actin (SMA)+ MF possibly begins with CD14+ monocytes, evolving to CD14+ CD34+ fibrocytes, followed by β-SMA+ protomyofibroblast (PMF) maturation. Skin biopsies from 25 burn patients were collected about 1 and 4 weeks after injury. Immunohistochemistry was performed using monoclonal antibodies to α-SMA, β-SMA, factor XIIIa, lysozyme, Mac 387, CD14, CD117 and Ulex europaeus agglutinin-1 (UEA-1). The set of Mac 387+ and CD14+ monocytes was accompanied by both CD34+ fibrocytes and factor XIIIa+ dendrocytes. By contrast, β-SMA+ PMF were rare. Of note, α-SMA+ MF were more abundant at week 4 than at week 1 (p < 0.01). The UEA-1+ endothelial cells showed marked variations in their dermal distribution, irrespective of the densities in the other scrutinized cells. In conclusion, healing of partial thickness thermal burns involves a diversity of cell types including PMF. In the present samples, the PMF density remained low.

Quick and effective treatment of small neurofibromas

Discussion The technique described here with a combination of Erbium:YAG laser Introduction Type I neurofibromatosis (von Reckling hausen disease) is a genetic disorder that is characterized by the presence of numerous neurofibromas. Lesions may be cutaneous, subcutaneous, or plexiform. Disfiguring cutaneous and subcutaneous neurofibromas on visible parts of the body are particularly distressing for the patient. The standard treatment for these small tumors is excision. This is associated with scarring and, if several excisions are necessary, is very timeconsuming [1]. Thus in recent years carbon dioxide laser has increasingly been used for quick removal of neurofibromas [2, 3]. Yet Ostertag and colleagues have shown that CO2 laser therapy involves a significantly greater risk of hypertrophic scarring [4]. To help prevent scarring, we use a combination of Erbium:YAG and CO2 laser.

The dermal overlap subareolar mastopexy: A preliminary report

Background: The major disadvantage of the circumareolar mastopexy is the risk of hypertrophic scarring and relapse or widening of the areola. Objective: The author describes a new technique that gives added support to the scar by means of a dermal overlap flap that is buried under the areola. Methods: A doughnut incision is made, with the size of the outer circle dependent on the amount of ptosis to be corrected. The areolar flap is elevated close to the nipple pedicle, a circumferential incision is made through the dermis between the pedicle and the outer incision, and the dermal edge is elevated. After the mastopexy, closure is performed with nonabsorbable purse-string sutures. Results: Initial results in a series of 34 cases have been encouraging, with no loss of nipple sensation and with less scarring and more natural nipple projection than occurs in conventional doughnut mastopexy procedures. Conclusions: This technique can be used to reduce scarring in procedures such as mastopexy, breast reduction, and tubular breast correction. (Aesthetic Surg J 2001;21:423-427.)

395 TREATMENT OF PORT-WINE STAINS

Treatment of port-wine stains (PWS) has developed from doing nothing, surgery, cryosurgery, tattoo, dermabrasia. X-ray irradiation, treatment with argon, CO2, Nd-Yag laser to treatment with pulsed dye laser. With the last one it is for the first time possible to treat children without risk of hypertrophic scarring. Since 1992 patients with PWS in the face, who haven't had any therapy before, are treated with the tunable dye laser. Four age groups (0-5, 6-11, 12-17, 18-31) each consist of 25 patients. Now, 1,5 years later, average treatment of the whole group is 4.6, which averages 9 sessions. No complete clearance is reached yet. At least a double number of treatments seem to be necessary. Revision of literature shows that 4.6 treatments are mentioned for complete clearance. Final results in treatment are poorly circumscribed.