Scar Index Research Articles

Investigating the Impact of Wound Edge Approximation with Skin Grafting on Hypertrophic Scar Reduction: A Randomized Controlled Clinical Trial.

In modern burn care, the focus extends beyond mere patient survival to encompass long-term functional and cosmetic outcomes. Research suggests that the technique and manner of suturing during skin grafting play a significant role in scar formation. This study aimed to explore the effectiveness of wound edge approximation with skin grafting compared to the conventional approach, where the graft edge exclusively interacts with the wound edge, in reducing hypertrophic scar development. Seventy-four burn unit patients eligible for grafting were randomly allocated into two groups: those receiving grafts with overlapping edges (Group A) and those receiving grafts with edges tailored to the burn wound (Group B). Evaluation of graft sites occurred immediately post-surgery and at 1 and 6 months post-operatively using the standardized Vancouver Scar Scale (VSS) administered by trained surgeons. The findings of this study revealed that there was no statistically significant difference between the two examined groups regarding the average duration of hospitalization and the mean thickness of wounds (P>0.05). Similarly, the mean scores for pain, vascular index, and pigmentation index immediately post-surgery, at 1 month, and 6 months later, as well as the scar height index and flexibility immediately and at 1 month post-surgery, and the Vancouver Scar Scale index at the study's conclusion, showed no significant variation between the two groups (P>0.05). However, at the 6-month follow-up, the mean scar height score (P=0.004) in the overlapping group and the mean flexibility score (P=0.017) in the non-overlapping group were significantly lower compared to the respective alternative group. This indicates a notable improvement in scar height and wound flexibility in the overlapping group over the non-overlapping group after 6 months.

Acceleration of wound healing using adipose mesenchymal stem cell secretome hydrogel on partial-thickness cutaneous thermal burn wounds: An in vivo study in rats.

The intricate healing process involves distinct sequential and overlapping phases in thermal injury. To maintain the zone of stasis in Jackson's burn wound model, proper wound intervention is essential. The extent of research on the histoarchitecture of thermal wound healing and the application of mesenchymal stem cell (MSC)-free-based therapy is limited. This study aimed to assess the efficacy of MSC-secretome-based hydrogel for treating partial-thickness cutaneous thermal burn wounds. Eighteen male Wistar rats were divided into three groups, namely the hydrogel base (10 mg), hydrogel secretome (10 mg) and Bioplacenton™ (10 mg) treatment groups. All groups were treated twice a day (morning and evening) for 7 days. Skin tissue samples from the animals were processed for histological evaluation using the formalin-fixed paraffin-embedded method on days 3 and 7. This study's findings showed that secretome hydrogel expedited thermal burn wound healing, decreasing residual burn area, boosting collagen deposition and angiogenesis, guiding scar formation, and influencing the inflammation response facilitated by polymorphonuclear leukocytes and macrophages. The secretome hydrogel significantly improves healing outcomes in partial-thickness cutaneous thermal burn wounds. The administration of secretome hydrogel accelerates the reduction of the residual burn area and promotes fibroblast proliferation and collagen density. The repairment of histo-architecture of the damaged tissue was also observed such as the reduction of burn depth, increased angiogenesis and epidermal scar index while the decreased dermal scar index. Furthermore, the secretome hydrogel can modulate the immunocompetent cells by decreasing the polymorphonuclear and increasing the mononuclear cells. Thus, it effectively and safely substitutes for thermal injury stem cell-free therapeutic approaches. The study focuses on the microscopical evaluation of secretome hydrogel; further research to investigate at the molecular level may be useful in predicting the beneficial effect of secretome hydrogel in accelerating wound healing.

Prospects for Use of Botulinum Toxin Type A for Prevention of Hypertrophic and Keloid Scars after Surgeries (Meta-analysis)

Abstract Objective To evaluate the possibility of improving and preventing the formation of postoperative hypertrophic and keloid scars using botulinum toxin type A (BTA). Materials and Methods Scientific articles published in English have been systematically screened in PubMed/MEDLINE database over the entire period. The following information about the studies was analyzed: first author surname; year of publication; number of patients; average age; scar location; dosage of the drug administered; follow-up duration; scar assessment methods; results, incidence of hypertrophic and keloid scars formation. The odds ratio and 95% confidence interval were calculated for each of the estimated parameters. The statistical heterogeneity of publications assessed using the criteria of chi-square test and I 2. The differences were considered significant at p < 0.05. Results A total of 18 prospective randomized studies were selected for evaluation, containing data on the use of BTA in 363 cases. Patients receiving botulinum toxin had a lower Vancouver scar scale index, higher visual analog scale index, and higher Stony Brook scar evaluation scale score. The use of BTA reduces the risk of perceptible scar formation, the incidence of hypertrophic and keloid scars. Conclusion The use of BTA to obtain imperceptible scar and prevent hypertrophic and keloid postoperative scars demonstrates good prospects. However, there is no consensus regarding the pathophysiological mechanisms underlying the positive effect of BTA on the prevention of hypertrophic and keloid scars.

An Experimental Model of Myocardial Infarction for Studying Cardiac Repair and Remodeling in Knockout Mice.

Cardiovascular disease is the most prevalent cause of death in Western countries, with acute myocardial infarction (MI) being the most prevalent form. This paper describes a protocol for studying the role of galectin 3 (Gal-3) in the temporal evolution of cardiac healing and remodeling in an experimental animal model of MI. The procedures described include an experimental model of MI with a permanent coronary ligature in male C57BL/6J (control) and Gal-3 knockout (KO) mice, an echocardiography procedure to study cardiac remodeling and systolic function in vivo, a histological evaluation of interstitial myocardial fibrosis with picrosirius red-stained and rhodamine-conjugated lectin-stained sections for studying myocyte hypertrophy by the cross-sectional area (MCSA), and the quantification of infarct size and cardiac remodeling (scar thinning, septum thickness, and expansion index) by planimetry in slices stained with Masson's trichrome and triphenyl tetrazolium chloride. Gal-3 KO mice with MI showed disrupted cardiac remodeling and an increase in the scar thinning ratio and the expansion index. At the onset of MI, myocardial function and cardiac remodeling were also severely affected. At 4 weeks post MI, the natural evolution of fibrosis in infarcted Gal-3 KO mice was also affected. In summary, the experimental model of MI is a suitable model for studying the temporal evolution of cardiac repair and remodeling in mice with the genetic deletion of Gal-3 and other animal models. The lack of Gal-3 affects the dynamics of cardiac repair and disrupts the evolution of cardiac remodeling and function after MI.

Allogeneic biomaterial: a fibrosis inhibitor in ischemic myocardial damage

Injectable allogeneic decellularized biomaterials are being developed both as scaffolds for delivery of cellular products and as independent pharmacological agents that affect the cascade of tissue reactions during the period of post-ischemic myocardial remodeling. Biomaterial degradation products can affect cellular processes and modulate cytokine effects, thus determining the healing strategy of damaged tissue. In this work, the influence of biomaterial on the expression of key fibrogenic factors by the cells of tissue bed was demonstrated, and the degree of damage to the myocardium during its ischemic damage was experimentally determined. The aim of our study was to determine the area of myocardial scar degeneration and detection of key fibrogenic factors (bFGF-1, TGFb1, MMP-9), as well as TIMP-2 (MMP-9 antagonist) at the acute and subacute stages of myocardial infarction after implantation of allogeneic powder-like biomaterial in an experimental model.In the course of experiments, the left ventricular coronary artery was ligated in male Wistar rats (experimental group). All animals were divided into 3 groups: experimental group I (n = 50), experimental group II (n = 50), and controls (n = 50). In experimental group I, the artery ligation was simultaneously accompanied by intramyocardial administration of powder-like biomaterial suspension (2 mg). In experimental group II, the allogeneic powder-like biomaterial was administered 5 days after coronary occlusion, and only physiological saline was administered in the control group. The animals were withdrawn from experiment on days +3, +7, +14, +30, and +45. Standard histological assessment (hematoxylin and eosin staining, according to Mallory) and immunohistochemical examination (MMP-9, TGFb1, bFGF-1, TIMP-2) were made, and statistical evaluation was performed. The cells with positive staining were counted, and the scar area index was calculated.We have found that administration of dispersed allogeneic biomaterial was followed by a five-fold decrease in the degree of scar degeneration in both experimental groups at the acute and subacute stages of ischemic myocardial damage as compared to the control group. A significantly decreased expression of fibrogenic factors (MMP-9, TGFb1, bFGF-1) by the local cells was found, along with increased activity of metalloproteinase inhibitor (TIMP-2) in connective tissue cells.Decellularized allogeneic powder-like biomaterial serves as a fibrosis inhibitor and promotes cardioprotection during myocardial remodeling at the initial stages after ischemic injury.

Accuracy of Cesarean Scar Indicators for Predicting Intra-abdominal Adhesions

Background: The cesarean section rate has increased in the last decade, a significant risk factor for intra-abdominal adhesion. This study investigated the diagnostic accuracy of cesarean scar indicators for intra-abdominal adhesions in pregnant women. Methods: This cross-sectional study was conducted on pregnant women with a previous cesarean section who were candidates for elective repeated cesarean section. We gathered demographic information, including age, number of prior cesarean sections, past medical and surgical history, the time since the last operation, and the inspection of the cesarean incision. The evidence of pelvic adhesion was calculated in the operating room by the Manchester scar scale, and intra-abdominal adhesions were graded using a modified Nair's classification. The data were analyzed by proper tests. Results: One hundred pregnant women were included in the study and divided into two groups with high and low incision indices. In the low incision index group, 82.1% had a history of one cesarean section, and 1.3% had three or more, and in the group with a high incision index, 54.5% had a history of one cesarean section, and 13.6% had three times or more (P < 0.05). Women with a high incision index had a higher adhesion rate than the other group (P < 0.001). The sensitivity and specificity of the scar index in the diagnosis of adhesions were 57.48% and 92.30%, respectively. Conclusions: It is challenging to accurately predict the severity of adhesions resulting from cesarean section, but it is urged to prevent an unnecessary cesarean section.

Role of enkephalin derivative in promoting wound healing and scar remodeling via increased epidermal growth factor in a mouse model

Background Enkephalin, an endogenous neuropeptide, binds to the delta (δ) opioid receptor and exerts an antinociceptive effect. Recent studies have suggested that neuropeptides might effectuate cutaneous wound healing. Therefore, we investigated the effects of an enkephalin derivative on wound healing and scar formation in vivo.Methods Enkephalin derivatives (leucine-enkephalin) were synthesized using the alanine scan method, and the most promising derivative (E10) was selected for further testing. In 15 C57BL/6N mice, two full-thickness skin defects (10 mm in diameter) were made on both sides of the back (left side, enkephalin group; right side, control group). The enkephalin group was administered 100 μL of E10 (AGGFL, 200 μg/mL), and the control group received phosphate-buffered saline. The wound size was digitally analyzed on days 2, 4, 7, and 10. After 21 days, the scar tissues were histologically evaluated for the scar depression index (SDI), and the epidermal growth factor (EGF) concentration was assessed using an enzyme-linked immunosorbent assay.Results The skin defect percentages were 98.4%±17.9% (day 2), 83.2%±24.0% (day 4), 39.7%±17.4% (day 7), and 16.2%±10.0% (day 10) in the control group and 86.1%±15.0% (day 2), 61.4%±11.6% (day 4), 26.6%±8.8% (day 7), and 16.4%±8.8% (day 10) in the enkephalin group. The SDI values were significantly lower in the enkephalin group (0.06±0.19) than in the control group (0.22±0.13, P<0.001). The EGF level was significantly higher in the enkephalin group (102.2±22.6 pg/mL) than in the control group (42.1±20.5 pg/mL, P<0.001).Conclusions An enkephalin derivative promoted wound healing and reduced depressed scar formation in a mouse model.

Ellipsoidal porous patch with anisotropic cell inducing ability for inhibiting skin scar formation

• An ellipsoidal porous patch is fabricated for inhibiting skin scar formation. • The anisotropic surface microstructure of patch showed dramatic capability in guiding cell growth and arrangement by reconstructing cell morphology. • The proliferation of fibroblasts growing on the stretched inverse opal patch was significantly suppressed without cell cytotoxicity. • The patch effectively reduce the scar formation by inhibiting excessive fibroblast proliferation of and type-I collagen deposition. Scar formation has always been a difficult point to overcome in the field of clinical wound care. Here, we present an ellipsoidal porous patch with cell inducing ability for inhibiting scar formation. The patch was prepared by stretching a poly (lactic-co-glycolic acid) (PLGA) inverse opal film at the glass transition temperature to form a neatly arranged three-dimensional ellipsoidal porous structure. Such anisotropic structure showed dramatic capability in directing cell growth and arrangement by reconstructing cell morphology. Besides, the proliferation of cells growing on the stretched patch was significantly suppressed without cell cytotoxicity. In addition, benefitting from the abundant and connected nanopores, the patch could be imparted with a potent ability to promote cell migration by encapsulating fibroblast growth factor 2 (FGF2) via the second filling of functional gelatin methacryloyl (GelMA) hydrogel into its scaffold. In a typical scar model, we have demonstrated that the resultant patch performed well in inhibiting scar formation characterized by inhibiting the excessive proliferation of fibroblasts, decreasing the deposition of type I collagen, reducing the scar index and achieved complete tissue reconstruction. These results indicate the anisotropic inverse opal patch has an excellent application prospect in inhibiting scar formation during wound repair.

Transumbilical single-site laparoscopic parallel mattress suturing prevents bleeding and chronic pelvic pain in myomectomy: a retrospective cohort study of 124 cases with intramural fibroids

BackgroundThe most common complications of myomectomy are intraoperative hemorrhage and postoperative adhesion. The key point to overcome this problem is to improve suture quality. However, to date, there is still no consensus on the optimal method of uterine repair. In this study, we explored the effectiveness and feasibility of single-site laparoscopic parallel mattress sutures to reduce intraoperative bleeding and postoperative adhesion.MethodsA retrospective cohort analysis was performed, according to the STROBE guidelines, on 124 patients with intramural fibroids admitted between May 2020 and April 2021. The cases were divided into two groups based on the description of the uterine incision suture in the surgical records, including 68 cases in the parallel mattress suture (PMS) group and 56 cases in the simple continuous suture (SCS) group. Operation-related indicators, bleeding indicators, surgical complications, scar reduction index 1 month after surgery, and the incidence of chronic pelvic pain 6 months after the surgery were observed. Independent sample t-tests and Mann–Whitney U tests were performed for the measurement data, and Pearson Chi-square tests were performed for count data. Statistical significance was set at P < 0.05.ResultsThere was no significant difference in the baseline characteristics between the two groups. All operations were performed under transumbilical single-site laparoscopy without conversion. Compared to the SCS group, the PMS group had earlier postoperative anal exhaust (14.3 ± 6.7 h vs. 19.2 ± 9.6 h, P = 0.002), fewer postoperative hemoglobin drops (7.6 ± 3.7 g/L vs. 11.6 ± 4.3 g/L, P = 0.000), smaller uterine scars (3.7 ± 1.9 cm vs. 5.2 ± 1.8 cm, P = 0.000), and a larger uterine scar reduction index (50.2% vs. 31.0%, P = 0.000) one month after surgery and less chronic pelvic pain 6 months after surgery (2.9% vs. 12.5%, P = 0.016). No difference was found in auxiliary trocar usage, transfusion rate, operation time, hospital stay, or perioperative complications between the two groups.ConclusionSeromuscular parallel mattress sutures during myomectomy can prevent pinhole errhysis of the uterine incision, achieve complete serosal and aesthetic incisions, and reduce postoperative chronic pelvic pain. It is effective and feasible to complete a parallel mattress suture during myomectomy via single-site laparoscopy. Further prospective studies are required to determine its efficacy as well as pregnancy outcomes.

Analysis of the Effect of Wound-Edge Microgranular Skin Grafting in the Treatment of Various Small Wounds

ObjectiveTo explore the clinical effect of wound edge microgranular skin grafting in the treatment of various small wounds.MethodsFrom September 2018 to September 2021, Yueqing people’s Hospital of Wenzhou City, Zhejiang Province collected and recorded the data of 12 patients with chronic wounds and third degree burns. The method of skin grafting with particles at the edge of the wound was used to graft skin on the wound. Scar evaluation scale was used to evaluate the wound. The patients were followed up for 12 months. The preoperative and postoperative data, scar index and patient satisfaction after healing were recorded and statistically analyzed.ResultsAll patients in this group were followed up for 3–12 months, and the results showed that SCAR Scale score decreased gradually over time, with patient satisfaction ranging from 80% to 96%. The patient gradually healed, scar hyperplasia gradually improved, functional activities gradually returned to normal, clinical effect is satisfactory.ConclusionMicroparticle skin grafting at the edge of wound avoids skin grafting at different skin donor sites. It has the characteristics of simple anesthesia, small trauma and convenient operation. This method can be considered when treating patients with chronic wounds and burns who need skin grafting.

Intraoperative Intradermal Application of Stromal Vascular Fraction into the Abdominal Suture Line: Histological Analysis of Abdominal Scar Tissue.

Stem cell therapy is a promising new approach to wound healing. Stromal vascular fraction is a heterogeneous collection of cells, including adipose-derived stem cells, which are traditionally isolated using a manual collagenase-based technique. To our knowledge, this is the first human study that histologically assesses the potential of intraoperative intradermal injection of stromal vascular fraction on skin regeneration. In this controlled study, 20 patients undergoing deep inferior epigastric perforator flap breast reconstruction and bilateral flank liposuction were included. Stromal vascular fraction was injected intradermally into one side of the abdominal suture line, while the other side served as a control. Outcome measures included analysis of stromal vascular fraction by flow cytometry, histological analysis of scar tissue, and scar photography. Cell yield for application and cell viability were 55.9 ± 28.5 × 106 and 75.1% ± 14.5%, respectively. Age and body mass index were positively correlated with the number of cells for application and adipose-derived stem cells. Mean vascular density, elastic fiber content, collagen maturity (scar index), epidermal thickness, and number of rete ridges all showed higher values on the treated side. Furthermore, the injected number of adipose-derived stem cells and pericytes positively correlated with vascular density. It is safe to speculate that intradermal stromal vascular fraction injection at the beginning of the healing process increases vascular density, collagen maturity and organization, elastic fiber content, epidermal thickness, epidermal-dermal anchoring of the scarring skin and is therefore responsible for improved skin regeneration. It is a viable and safe method that can be used as an adjunctive treatment in plastic surgery procedures where suboptimal wound healing is anticipated. 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 .

"Never Trust the Skin": A Rationale for Using Polydioxanone Internal Support Matrix to Minimize Scarring in Primary Mastopexy-Augmentation-An Observational Study.

BackgroundThe process of scar formation is complex and multi-factorial. Basic plastic surgery tenets focus on tension-free techniques to optimize aesthetic outcomes and minimize scarring.ObjectivesProphylactic use of a polydioxanone (PDO) internal support matrix in cosmetic mastopexy-augmentation to decrease scar burden has never before been described.MethodsA high volume (n = 41) single-surgeon mastopexy-augmentation experience (S.S.K.) followed scar quality in consecutive cases from June 2020 to July 2021. A minimum of 6 months of postoperative evaluation was required to assess scar quality. Fitzpatrick scores were also evaluated and compared. All surgeries in this study were performed in the dual plane using silicone gel implants, a superior or superomedial dermal pedicle blood supply, and a wise-pattern or vertical scar. Scar quality was evaluated by photography and scored according to an internally developed scar quality scale.ResultsThere have been no cases of hypertrophic or keloid scarring. All patients receiving mastopexy-augmentation with prophylactic PDO mesh have a favorable appearance with fine line scars, and the mean scar quality scale score across the cohort was 4.341/5. The mean Fitzpatrick scale score across the cohort was 2.97, and, of the patients who scored a 5 on the scar quality index, the mean Fitzpatrick scale score was 3.545.ConclusionsProphylactic use of PDO internal support matrix in silicone gel mastopexy-augmentation offers further protection against poor scarring in patients across the Fitzpatrick scale, with varying degrees of skin quality, and across medium to high-volume implant augmentations. Patients who received PDO prophylaxis demonstrated a better-than-average scar appearance.Level of Evidence: 4

Study of the effectiveness of fractional laser ablation in patients with atrophic postacne scars using the quantitative scar index

Introduction. Atrophic scars are common in acne patients. Regardless of their number and size, they are persistent defects and reduce patients' quality of life. With a variety of treatment options, effective scar correction remains a challenge. Laser technology continues to evolve and is considered promising for the treatment of scars.The aim of the study was to investigate the effectiveness of the fractional laser ablation method in patients with atrophic postacne scars using the quantitative postacne scar index.Materials and methods. The study involved 60 patients with ARP of II-IV severity, 35 women and 25 men. The patients underwent fractional ablation of scars with an Erbium laser (2940 nm). To assess the scars before and after treatment, we used the post-acne scar severity index according to the quantitative assessment scale according to G.J. Goodman et al. Goodman et al. (2006). The international scales Patient's Satisfaction Score, Physician's Satisfaction Score, and Definitive Graduated Score were used to assess physician and patient satisfaction with the results of the procedures.Results. The quantitative index of postacne scars before treatment ranged from 4.0 to 16.0 points and averaged 10.9±3.56 points; median was 12.0 points (8.0±13.0 points). After fractional laser ablation procedures, improvement of quantitative indexes scores (p&lt;0.05), positive dynamics of the doctor's and patients' evaluation of procedure results were noted; no gender differences were noted.Discussion. Quantitative indices of scar expression reflect the severity of the affected skin areas in patients with postacne. This study confirms the effectiveness of fractional ablation with the Erbium laser in patients with ARP, which is confirmed by a decrease in quantitative scar severity indices. Dynamic growth of PSS, PhSS, DGS indices testifies to high satisfaction of the physician and the patient with the results of treatment and correlates with regression of clinical manifestations in these patients.Conclusion. Despite the limitations and laboriousness of counting quantitative indices of postacne scars, this approach allowed to establish and objectify the clinical efficacy of treatment of patients with ARP by fractionated ablation.

Effects of Apremilast on Induced Hypertrophic Scar of Rabbits.

The present study aimed to assess the effect of Apremilast on experimentally inducedhypertrophic scarsin rabbits. A total of 40 healthy male New Zealand White rabbits between 6 and 12 months of age were assigned to four groups (n=10). Group I consists of apparently healthy control rabbits, in group II, the rabbits with an induced hypertrophic scar received no treatment, except for base gel. In group III, the rabbits with induced hypertrophic scar were treated with triamcinolone acetonide (TAC) 0.1% as standard medication. In group IV, rabbits with induced hypertrophic scars were treated with Apremilast 5%. On the first day,four surgical incisions were madeusing an 8-mm biopsy punch on the ventral surface of the rabbit eardownto cartilage. The TAC and Apremilast were topically administered to thedeveloped scars on day 31. The results included an examination of skin histopathology, thelevel oftransforming growth factorbeta-1 (TGF-β1), andcollagen III in skin tissue. In the treatments, the inflammatory score, scar index, as well as immunological scores of TGFβ1 and collagen III, significantly decreased, compared to the hypertrophic induced scar group(P≤0.001). Moreover, there was a significant reductionin fibroblast count, compared to thegroup of inducedhypertrophic scars (P<0.05). Apremilast was efficacious in the treatment of hypertrophic scars due to its ability to reduce inflammations and fibroblast counts and scar index. Nonetheless, the reduction of immunological scoreswas almost comparableto that of topical TAC.

Cardiac Magnetic Resonance Imaging and Ventricular Tachycardias Involving the Sinuses of Valsalva in Patients With Nonischemic Cardiomyopathy

The goal of this study was to investigate the relationship between cardiac scar on late gadolinium enhancement cardiac resonance imaging (LGE-CMR) and the presence of ventricular tachycardia (VT) ablation target sites within the sinuses of Valsalva (SV). Patients with idiopathic dilated cardiomyopathy (IDCM) often have scarring involving the basal myocardium, including the SV, allowing targeting of VTs from within the SV. Forty-three consecutive patients with IDCM underwent a VT ablation procedure with pre-procedure LGE-CMR. Retrospectively, scar characteristics were compared between patients with and without VT target sites in the SV. The ratio between SV-related scarring and the total cardiac scarring was defined as the SV scar index: SV-related scarring/total cardiac scarring. VT target sites were identified in the SV in 22 (51%) of 43 patients. LGE-CMR identified peri-aortic scarring involving the SV in 34 patients (79%). Scarring extended to the septum in 26 patients, involved the lateral basal wall in 4, and both areas in 13 patients. Scar volume within the SV was larger in patients with SV-VT targets (1.7 ± 0.9cm3 vs. 0.7 ± 0.6cm3; p<0.0001) compared with other patients. A cutoff scar volume identifying SV-VT targets was 1.23cm3 in the short-axis view (area under the curve 0.82; sensitivity 0.64; specificity 0.91). The SV scar index was significantly greater in patients who had SV-VT target sites (0.33 ± 0.2 vs. 0.09 ± 0.09; p<0.0001). Patients with IDCM undergoing ablation of VT often have peri-aortic scarring visualized on LGE-CMR. Both the presence and the extent of scarring adjacent to the aortic annulus are associated with the presence of VT target sites within the SV.

Topical Isoxsuprine in experimentally induced hypertrophic scar in rabbits

Hypertrophic scars are pathological scars which result from exaggerated skin proliferation following a wound and injury. Although many theories have been implicated for keloidogenesis, the precise pathophysiological cause is still masked. Different treatment strategies have been tried in their management,but there is no satisfactory option for treating hypertrophic scar currently; moreover the standard steroid therapy is associated with numerous local side effects, and there is a need for researches in new treatment options. The aim of this study is to evaluate the role of topical isoxsuprine in experimentally induced hypertrophic scar in rabbits. In the current experimental study, 40 healthy male albino rabbits between 12 and 14 months of age were studied. These rabbits were categorized into five groups: healthy animal group (n = 8), hypertrophic scar without treatment (n = 8), hypertrophic scar treated with triamcinolone acetonide gel (n = 8), and hypertrophic scar treated with isoxsuprine gel (n = 8). Histological assessment of skin biopsy, including the conventional hematoxylin and eosin stain, and immunohistochemistry for transforming the growth factor beta 1 level (TGF-?1) and collagen 3 alpha1 (COLIII?I) in skin tissue was done. The immunohistochemical score of TGF-? and collagen III was highest in group 2 (hypertrophic scar without treatment), followed by group 3 (hypertrophic scar treated with triamcinolone acetonide gel) and group 4 (hypertrophic scar treated with isoxsuprine gel) – no significant difference between them since p > 0.05, and then by group 1 (healthy control group). Regarding histopathological scores of inflammation, the scar height, and scar index, the scores were highest in was highest in group 2 (hypertrophic scar without treatment), followed by group 3 (hypertrophic scar treated with triamcinolone acetonide gel) and group 4 (hypertrophic scar treated with isoxsuprine gel) – no significant difference between them since p > 0.05,with the exception of index of scar, and then by group 1 (healthy control group). It was concluded that isouxoprine in a topical formulation greatly reduced inflammation and scar formation in deep wounds in a manner comparable to that seen with triamcinolone.

Effect of herbal extracts on peripheral nerve regeneration after microsurgery of the sciatic nerve in rats

BackgroundRecent experimental studies using herbal extracts have shown the possibility of peripheral nerve regeneration. This study aimed to investigate the effects of herbal extracts on peripheral nerve regeneration in a rat sciatic nerve injury model.MethodsA total of 53 rats were randomly assigned to a control group or one of four experimental groups. In all rats, the sciatic nerve was completely severed and microscopic epineural end-to-end neurorrhaphy was performed. Normal saline (2 mL) was topically applied to the site of nerve repair in the control group, whereas four different herbal extracts – 2 mL each of Astragalus mongholicus Bunge, Coptis japonica (Thunb.) Makino, Aconitum carmichaelii Debeaux, or Paeonia lactiflora Pall. – were topically applied to the site of nerve repair in each experimental group. Nerve conduction studies were performed at an average of 11.9 weeks after the operation, and conduction velocity and proximal and distal amplitudes were measured. Biopsies were performed at an average of 13.2 weeks after the initial neurorrhaphy. The quality of nerve anastomosis and perineural adhesion to the surrounding soft tissues was macroscopically evaluated. The neuroma size at the site of the neurorrhaphy was microscopically measured, whereas the size of the scar tissue was evaluated relative to the diameter of the repaired nerve.ResultsThe nerve conduction study results showed the highest nerve conduction velocity in the experimental group that used the Coptis japonica (Thunb.) Makino extract and the highest proximal and distal amplitudes in the experimental group that used the Aconitum carmichaelii Debeaux extract. Macroscopic evaluations after the second operation showed that grade 2 perineural adhesion was found in 70.8% of rats. The mean neuroma size in the Coptis japonica (Thunb.) Makino, Aconitum carmichaelii Debeaux, and Paeonia lactiflora Pall. groups showed statistically significant decreases relative to the control group. The mean scar tissue formation index in the Paeonia lactiflora Pall. group showed a statistically significant decrease relative to the control group.ConclusionsThe peripheral nerve regeneration effect of the herbal extracts was confirmed through decreased neuroma and scar tissue formation.

A comparison on the scar development when done through overlapping versus approximating seams techniques — A clinical trial

IntroductionSkin autografting is performed widely for deep burn wounds as an ideal coverage. Scaring at the site of grafting has been always a challenge for surgeons. Many methods have been proposed to lessen the probability of scaring, but conflicting results have been obtained. It is said that the suture type is important in the development of scaring. Seams technique has also been introduced to decrease scar after autografting. ObjectiveWe sought to compare two approximating (AP) and overlapping (OV) Seams technique to compare the development of scars. Methods and materialsPatients with deep burns of 10% to 50% TBSA who were candidates for grafting entered this double-blind randomized trial. One side of the graft was fixed with a stapler using the “approximating” technique and the other side was fixed by the “overlapping” technique with a 1–2 mm margin overlap. The Vancouver Scar Scale (VSS) standard was used to evaluate scar formation at the graft edges at six months. Data entered SPSS 16 and analyzed. A P-value below 0.05 was considered as statistically significant. ResultsThirty-six patients entered. Two (5.6%) were females and 34 (94.4%) males. The mean age of patients was 39.14 ± 8.53 years. The mean burn surface area percentage was 15.2 ± 2.84. Vascularity Scar index had no statistically significant difference between the overlapping and approximating techniques (P = 0.564). However, pigmentation (P = 0.014), pliability (P = 0.008) and the height indices (P < 0.001) were statistically significantly better in the approximating technique. The mean of total score of Vancouver was better in the approximating technique as well (P < 0.001). ConclusionWe compared two techniques of Seams between the normal skin and the graft edge for the first time. We showed that the AP method had a better Vancouver score compared to the OV regarding pigmentation, height, and pliability indices.

Comparison of Clinical Outcomes of Upper Eyelid Blepharoplasty Using Two Different Suture Techniques.

Objectives:To compare upper eyelid blepharoplasty patients’ suture techniques with interrupted cutaneous in one eye and running cutaneous in the other in terms of edema, ecchymosis, and scar index.Methods:Among patients whose suture techniques with interrupted cutaneous in one eye and running cutaneous in the other, 34 patients in the vicryl group and 46 patients in the polypropylene group were included in the study. The patients’ edema and ecchymosis levels on postoperative days 1, 7, and 30 days and 3 months were selected. The Manchester Scar Scale was used to evaluate the scar index at 30 days and 3 months after surgery. Suture material (either 6-0 polypropylene sutures or 6-0 vicryl sutures) were evaluated independently.Results:In vicryl group, there was significantly less ecchymosis and edema first week postoperatively in interrupted sutured eyelid than running sutured eyelid (p=0.001, p=0.011, respectively). In polypropylene group, there was significantly less ecchymosis at the first day and first week postoperatively in interrupted sutured eyelid than running sutured eyelid (p=0.025, p=0.001, respectively). The total scar index scores in both groups at first month and third month were significantly better at the interrupted sutured eyelid than running sutured eyelid (p<0.05, for all).Conclusion:In upper eyelid blepharoplasty, an interrupted suture technique yielded the lowest rates of edema, ecchymosis, and scar formation compared with a running suture technique.

Extracellular matrix-based biomaterials as adipose-derived stem cell delivery vehicles in wound healing: a comparative study between a collagen scaffold and two xenografts

BackgroundStem cell therapies represent a promising tool in regenerative medicine. Considering the drawbacks of direct stem cell injections (e.g. poor cell localisation), extracellular matrix-based biomaterials (e.g. scaffolds and tissue grafts), due to their compositional biofunctionality and cytocompatibility, are under investigation as potential stem cell carriers.MethodsThe present study assessed the potential of three commercially available extracellular matrix-based biomaterials [a collagen/glycosaminoglycan scaffold (Integra™ Matrix Wound Dressing), a decellularised porcine peritoneum (XenoMEM™) and a porcine urinary bladder (MatriStem™)] as human adipose-derived stem cell delivery vehicles.ResultsBoth tissue grafts induced significantly (p < 0.01) higher human adipose-derived stem cell proliferation in vitro over the collagen scaffold, especially when the cells were seeded on the basement membrane side. Human adipose-derived stem cell phenotype and trilineage differentiation potential was preserved in all biomaterials. In a splinted wound healing nude mouse model, in comparison to sham, biomaterials alone and cells alone groups, all biomaterials seeded with human adipose-derived stem cells showed a moderate improvement of wound closure, a significantly (p < 0.05) lower wound gap and scar index and a significantly (p < 0.05) higher proportion of mature collagen deposition and angiogenesis (the highest, p < 0.01, was observed for the cell loaded at the basement membrane XenoMEM™ group). All cell-loaded biomaterial groups retained more cells at the implantation side than the direct injection group, even though they were loaded with half of the cells than the cell injection group.ConclusionsThis study further advocates the use of extracellular matrix-based biomaterials (in particular porcine peritoneum) as human adipose-derived stem cell delivery vehicles.Graphical abstractComparative analysis of a collagen scaffold (Integra™ Matrix Wound Dressing) and two tissue grafts [decellularised porcine peritoneum (XenoMEM™) and porcine urinary bladder (MatriStem™)] as human adipose-derived stem cells carriers