Scar Thickness Research Articles

CO2 fractional laser combined with triamcinolone acetonide injection for the hypertrophic scars: which is first?

The aim of this study is to investigate and analyze the effect of different application sequences of CO2 fractional laser and triamcinolone acetonide injection on the application effect of hypertrophic scar in one operation. Patients with hypertrophic scars who received CO2 lattice laser combined with triamcinolone acetonide injection from January 2021 to December 2022 were retrospectively analyzed. According to the different initial operations, they were divided into CO2 FL-TA group and TA-CO2 FL group. The Vancouver Scar Scale score and scar thickness of the two groups before and after treatment were analyzed. The complications occurred in the two groups during the treatment period. The clinical efficacy of the two groups before and after the treatment was calculated. Before treatment, there was no difference in scar thickness and VSS score between the two groups (P > 0.05). After treatment, the above indexes in CO2 FL-TA group were significantly better than those in TA-CO2 FL group (P < 0.05);the incidence of adverse reactions in CO2 FL-TA group was 9.38%,which was significantly lower than that in TA-CO2 FL group (18.75%) (P < 0.05);the total effective rate of CO2 FL-TA group was 90.63%, which was significantly higher than that in TA-CO2 FL group (65.63%) (P < 0.05).In the process of combined CO2 fractional laser and triamcinolone acetonide injection in the treatment of hypertrophic scars, CO2 fractional laser treatment first, and then triamcinolone acetonide injection can reduce the number of treatments, reduce the incidence of adverse reactions, and achieve more satisfactory treatment effect.

Clinical Utility of the Portable Pressure-Measuring Device for Compression Garment Pressure Measurement on Hypertrophic Scars by Burn Injury during Compression Therapy.

Compression therapy for burn scars can accelerate scar maturation and improve clinical symptoms (pruritus and pain). This study objectively verified the effect of pressure garment therapy in maintaining a therapeutic pressure range for hypertrophic scars. Sixty-five participants (aged 20~70 years) with partial- or full-thickness burns, Vancouver scar scale score of ≥4, and a hypertrophic scar of ≥4 cm × 4 cm were enrolled. Compression pressure was measured weekly using a portable pressure-monitoring device to regulate this pressure at 15~25 mmHg for 2 months. In the control group, the compression garment use duration and all other burn rehabilitation measures were identical except for compression monitoring. No significant difference was noted in the initial evaluations between the two groups (p &gt; 0.05). The improvements in the amount of change in scar thickness (p = 0.03), erythema (p = 0.03), and sebum (p = 0.02) were significantly more in the pressure monitoring group than in the control group. No significant differences were noted in melanin levels, trans-epidermal water loss, or changes measured using the Cutometer® between the two groups. The efficacy of compression garment therapy for burn-related hypertrophic scars can be improved using a pressure-monitoring device to maintain the therapeutic range.

8861 Enhancing Laparoscopic Metroplasty Results in Patients with Scar Defects after Caesarean Section

<h3>Study Objective</h3> Enhancing the results of laparoscopic metroplasty (LM) in patients with the c-section scar defects. <h3>Design</h3> Level I, Canadian Task Force. A 4-year randomized prospective study evaluating two methods of LM. <h3>Setting</h3> National Center for Obstetrics, Gynecology, and Perinatology, named after V.I. Kulakov, Moscow, Russia. <h3>Patients</h3> The study includes 83 patients of reproductive age (18 – 45 years) with c-section scar defects/niches, who are interested in pregnancy. The first group – 49 patients: LM. The second group – 34 patients: LM with plication of round ligaments and injection of platelet-riched autoplasma (PRP). <h3>Interventions</h3> Standard for both groups laparoscopic metroplasty included hysteroscopic niche exploration and cervical dilation. Laparoscopic exploration of the scar zone; excision of fibrotic tissue using a monopolar hook; myometrial approximation in two layers. The second group also included 5 ml of PRP injection into the myometrial repair zone and plication of the round ligaments. The ultrasound measurement of the scar was carried out before the operation and 6 months following it. <h3>Measurements and Main Results</h3> The original scar thickness in Group 1 was 2.1 (±0.9) mm, and after surgery – 5.0 (±2.4) mm, p = 0.00001; three patients had an unsatisfactory outcome with scar thickness of less than 2.5 mm, which required a repeated operation. In Group 2 the thickness of the scar was originally 2.1 (±0.6) mm before surgery, and 5.6 (±1.3) mm after surgery, p = 0.00001, no unsatisfactory results were noted. When comparing the two methods, a significant difference was found in the increase in the newly formed scar thickness in the second group compared to the first – by 3.9 mm and 2.9 mm, respectively, p = 0.029. <h3>Conclusion</h3> Tissue tension reduction in the area of a newly formed suture on the uterus as well as use of PRP provides for the most favorable conditions for tissue repair after LM.

Ultrasound Assessment of Cesarean Section Scar and its Correlation to Intraoperative Scar Status

Background and Aim: In the past decades the rate of cesarean sections has increased enormously, there are many indications for cesarean section like placenta previa, labor dystocia, presumed fetal distress, fetal malpresentation, multiple gestation, and suspected fetal macrosomia, but the commonest reason for performing a cesarean is a previous cesarean birth .The present study aimed to compare the sonographically measured lower uterine scar with actual status of scar at the time of operation. Methodology: The descriptive cross-sectional study was conducted on 150 female patients who presented to Obstetrics department of Creek general hospital, affiliated with UMDC from August 2021 to January 2022. The Inclusion Criteria was: females with singleton pregnancy with history of previous single caesarian section, vertex presentation and gestational age 36-40 weeks. While women with multiple gestations, placenta previa, polyhydramnios or any uterine abnormality were excluded. Results: The overall mean of age, gestational age, parity and fetal weight were 28.22±4.59 years, 37.60±0.78 weeks, 1.73±0.94 and 2.75± 0.47 kg respectively. Significant association was observed between lower uterine segment measurements by Sonographic scar thickness during pregnancy and intra-operative scar findings at the time of delivery (p-value&lt; 0.05). Conclusion: The present study found that sonographically measured lower uterine scar thickness is a solid predictor for scar defect in women with previous cesarean section. As a result, we can conclude that sonographic measurement of lower uterine segment thickness is a reliable tool for assessing scar status and deciding which women should be given a vaginal delivery trial. Keywords: Previous Caesarean Section, Lower uterine scar, Sonography

Patients’ satisfaction with the effects of microporous tape on surgical scars: a randomized controlled study

Background Following surgery or other types of trauma, scar formation occurs with wound healing because of the replacement of normal skin with fibrous tissue. The conversion of a normal scar to an abnormal scar usually occurs 6 to 8 weeks after surgery. Abnormal scars can be a source of patient dissatisfaction, especially following cosmetic surgical procedures. Therefore, supporting scars with tape after surgery is critical for reducing scar tension. The aim of this study was to determine the extent of patients’ satisfaction with their scar outcomes following microporous taping and to identify the determinants of scar satisfaction.Methods A prospective randomized controlled study was conducted to compare the scar satisfaction of postsurgical patients who underwent scar taping with microporous tape to those who did not. The scars were assessed at 6 weeks, 3 months, and 6 months after surgery using the Patient Scar Assessment Scale (PSAS). The test group had microporous tape applied to their scars and the tape was worn 24 hours a day for a period of 6 months. The data were analyzed using SPSS version 22.0. Categorical variables and mean PSAS scores were compared using the chi-square test and repeated-measures analysis of variance, respectively.Results At 6 weeks, 3 months, and 6 months the taped group had significantly lower PSAS scores and higher satisfaction scores than the control group. Scar thickness and pruritus were statistically significant determinants of patient satisfaction.Conclusions Microporous tape is an effective modality for improving scar satisfaction in postsurgical patients.

The Preparation and Biological Testing of Novel Wound Dressings with an Encapsulated Antibacterial and Antioxidant Substance.

Chronic wounds represent a significant socio-economic problem, and the improvement of their healing is therefore an essential issue. This paper describes the preparation and biological properties of a novel functionalized nanofiber wound dressing consisting of a polycaprolactone nanofiber carrier modified by a drug delivery system, based on the lipid particles formed by 1-tetradecanol and encapsulated gentamicin and tocopherol acetate. The cytotoxicity of extracts was tested using a metabolic activity assay, and the antibacterial properties of the extracts were tested in vitro on the bacterial strains Staphylococcus aureus and Pseudomonas aeruginosa. The effect of the wound dressing on chronic wound healing was subsequently tested using a mouse model. Fourteen days after surgery, the groups treated by the examined wound cover showed a lower granulation, reepithelization, and inflammation score compared to both the uninfected groups, a lower dermis organization compared to the control, a higher scar thickness compared to the other groups, and a higher thickness of hypodermis and bacteria score compared to both the uninfected groups. This work demonstrates the basic parameters of the safety (biocompatibility) and performance (effect on healing) of the dressing as a medical device and indicates the feasibility of the concept of its preparation in outpatient conditions using a suitable functionalization device.

Rehabilitation of hand through leap motion control on burn injury patients

Burn injuries, especially severe burns, triggers immune and inflammation response, disturbances of metabolism and distributive type of shock, all of this can be said as hard to treat and may lead to cause multiple organ failure. The fact that the injury not only effects physical health but also mental health his mental health and quality of life is critical. As a result, people with burn injuries cannot be deemed recovered if wounds have healed; rather, burn injuries cause long-term fundamental changes that must be focused in order to improve quality of life. As a result, burn care providers encounter a variety of issues, including managing acute and critical care, long-term care, and rehabilitation. Hand is the most commonly injured body part out of all accidents that are work related , ranks third of all workplace injuries and necessitating surgical and lengthy recovery. Hand burns make it difficult to function. The rehabilitation process has benefited from the usage of virtual reality (VR). LMC is a form of virtual reality game that uses new technology to provide biofeedback and training for fine motor function and functional skills. According to this review paper, leap motion training will enable hand burns patient to enhance finger mobility, reduce scar thickness, and improve hand function along with enhancing quality of life of patient. Although improvement in condition depends on severity of burn but this gadget proved to be a boon for hand rehab. on burn population. . Finally in conclusion of review it can be said that leap motion training may aid patients with hand burns in increasing finger range of motion, reducing scar thickness, and improving hand function.

Adipocytes the Forgotten Culprit in Skin Fibrosis: Exploring the Mechanism of Fat Driven Skin Fibrosis

INTRODUCTION: Adipocytes have previously been implicated in skin wound healing in both metabolic and nonmetabolic roles. We hypothesized that mature adipocytes directly participate in wound repair via conversion into fibroblasts and that adipocyte-derived fibroblasts contribute to skin scarring. METHODS: AdipoqCre transgenic driver mice were crossed to R26mTmG reporter mice to generate AdipoqCreERT;ROSA26mTmG mice to perform lineage tracing of mature adipocytes. To achieve local adipocyte ablation AdipoqCre;ROSA26mTmG;R26tm1 (HBEGF) Awai mice were generated and wounded, and diphtheria toxin (DT) was injected into the wound base. DT- and vehicle control-treated wounds underwent histologic analysis. Last, we performed scRNAseq on wounded and unwounded tissue to identify fibrotic fibroblast subpopulations. RESULTS: Using our AdipoqCre;ROSA26mTmG adipocyte lineage-tracing model (Fig. A), we identified significantly greater number of adiponectin lineage-positive cells (GFP+) within wounds at postoperative day 14 (POD-14) compared with unwounded skin (*p < 0.05, n = 6; Fig. B). FACS further confirmed that the GFP+ cells were fibroblasts and increased to 10% at POD-14 (Fig. C). Compared with typical subcutaneous adipocytes, the GFP+ cells exhibited upregulation of fibroblast markers and downregulation of adipocyte markers (Fig. D). DT-induced ablation of Adipoq lineage-positive cells (Fig. E) exhibited reduced scar thickness (Fig. F) and collagen deposition at POD-14 compared with control wounds (*p < 0.05, n = 6; Fig. G). scRNAseq analysis revealed novel markers for distinct mechanosensitive fibroblast subpopulations responsible for scar formation (Fig. H).FigureCONCLUSION: Our findings strongly suggest that mature adipocytes in the skin undergo conversion to profibrotic fibroblasts in response to injury. Local adipocyte ablation resulted in reduced scarring, suggesting that adipocyte-derived fibroblasts are important contributors to wound fibrosis. These findings together suggest that adipocyte mechanosensitive fibroblast subpopulations drive dermal scar formation.

Translated article] Laser Treatment of Burn Scars

Burn scars cause high morbidity in the form of contractures, body disfigurement, and itching, as well as a high emotional impact that adversely affects patient quality of life. Laser therapy has proven effective in this setting. It is superior to topical treatments and can be used in conjunction with surgery, helping to reduce morbidity. The use of lasers in hospital dermatology departments, however, is still limited. Carbon dioxide laser is the most widely used device for reducing scar thickness, improving textural abnormalities, and treating associated contractures, which may restore the mobility of these patients when it is altered. Pulsed dye laser treatments are particularly useful for reducing erythema in recent burn scars and preventing subsequent hypertrophy. Pigment laser treatments with short pulse durations (nanoseconds or picoseconds) can improve hyperpigmentation. In this article, we review the evidence for the use of laser therapy for burn scars and propose a treatment algorithm.

Effectiveness of four topical treatment methods in a rat model of superficial partial-thickness burn injury: the advantages of combining zinc-hyaluronan gel with silver foam dressing

BackgroundThere are several options available for conservative treatment of partial-thickness burns, however, reliable, affordable, and easily obtainable animal testing models are hard to find for the comparison of the different treatment methods. We aimed at developing a preclinical testing model and at comparing four treatment methods for superficial partial-thickness burns. MethodsBurn injury was induced in 90 adult male Wistar rats by placing the 130°C hot tip of a commercially obtainable soldering device for 30 s on the clipped skin of the interscapular region at a steady pressure. Skin histology was studied on days 5, 10, and 22 after the induction of the burn injury, on which days, respectively, the ratio of the not epithelialized wound (%), the extent of re-epithelialization (score), and the scar thickness (µm) were assessed. We compared 4 groups: silver-sulfadiazine cream, zinc-hyaluronan gel, silver foam dressing, and the combination of zinc-hyaluronan gel with a silver foam dressing. ResultsOn day 5, the induction of superficial partial-thickness burn injury was confirmed histologically in the rats. The zinc-hyaluronan gel and the combination treatment resulted in a markedly smaller ratio of the non-epithelialized area (29 ± 10% and 28 ± 13%, respectively) than silver-sulfadiazine cream (69 ± 4%; p < 0.01). On day 10, the extent of re-epithelialization was the lowest (∼0.2) in the silver-sulfadiazine cream group, while the other 3 treatments performed significantly better. The combination treatment lead to the maximal score of 2 in all rats, which was higher than in the other 3 treatment groups. On day 22, the scar thickness was the smallest in the combination treatment group (560 ± 42 µm), which was significantly less than in the silver-sulfadiazine cream group (712 ± 38 µm; p < 0.05). ConclusionsWe designed and histologically confirmed a reproducible method for induction of superficial partial-thickness burns in rats for preclinical testing. In our model, the combination of zinc-hyaluronan gel with silver foam dressing was more effective than either of its components alone or than silver-sulfadiazine cream.

Oct4 cooperates with c-Myc to improve mesenchymal-to-endothelial transition and myocardial repair of cardiac-resident mesenchymal stem cells

BackgroundCardiac-resident mesenchymal stem cells (cMSCs) can exhibit fibrotic, proinflammatory, and proangiogenic phenotype in response to myocardial ischemia (Isch). How their phenotypic fate decisions are determined remains poorly understood. Here, we demonstrate that the cooperation of Oct4 and c-Myc in cMSCs creates a preferable mesenchymal-to-endothelial transition (MEndoT) to promote angiogenesis and consequent myocardial repair.MethodsWe collected MSCs from cardiac and peripheral blood of rat with left ventricular Isch (LV Isch) 30 days after myocardial infarction (MI) or sham operation. After a comparison of characterization between cMSCs and peripheral blood MSCs (pbMSCs), we conducted transcriptome analysis and RNA sequencing of cMSCs. Using loss/gain-of-function approaches to understand the cooperation of c-Myc and Oct4 on MEndoT of cMSCs under hypoxic condition, we explored the mechanisms through transcriptome and functional experiment, and chromatin immunoprecipitation. Next, we transplanted male cMSCs with overexpression or inhibition of c-Myc/Oct4 into the infarcted myocardium of female rats and evaluated infarct size, cell retention, inflammation, remodeling, and function after 30 days.ResultsLV Isch switched cMSCs toward both inflammatory and proangiogenic phenotypes, with increased secretion of inflammatory cytokines as well as decreased expression of proangiogenic factors. The effect of LV Isch on pbMSCs was less remarkable. Gene expression heatmap showed imbalance in expression of Oct4 and c-Myc regulating genes associated with remodeling of cMSCs. We provided evidence that cMSCs-specific c-Myc- versus Oct4-overexpression showed divergent genomic signatures, and their corresponding target genes play an important role in regulating cMSCs phenotypic changes. In particular, Oct4 accelerated angiogenesis induced by c-Myc overexpression in cMSCs and inhibited their phenotypic transition into inflammatory cells and fibroblast. Mechanistically, exogenous Oct4 caused c-Myc to translocate from the nucleus to the cytoplasm and activated some of its target signalings including VEGF signaling. Although transplantation of cMSCs alone did not improve LV remodeling and function, cMSCs co-transfected with c-Myc and Oct4 promoted a more positive effect in their survival and reparative properties, increased animal survival, reduced infarct size, decreased scar thickness, inhibited LV remodeling, and improved heart function 30 days after MI. Significantly, Oct4 promoted MEndoT (“Rescue me” signal) of cMSCs after both c-Myc stimulation in vitro and transplantation into the infarcted heart.ConclusionsMyocardial Isch drives resident cMSCs toward multiple phenotypes. Oct4 interacts with c-Myc to promote MEndoT capacity of cMSCs and improve their survival and reparative effects through upregulation of angiogenesis-related signaling pathways. These findings may identify novel targets for stem cell therapy.

Tourniquet Does Not Affect Long-term Outcomes in Minor Hand Surgery: A Randomized Controlled Trial.

Background:Surgeons often prefer to use a tourniquet during minor procedures, such as carpal tunnel release (CTR) or trigger finger release (TFR). Besides the possible discomfort for the patient, the effect of tourniquet use on long-term results and complications is unknown. Our primary aim was to compare the patient-reported outcomes 1 year after CTR or TFR under local anesthesia with or without tourniquet. Secondary outcomes included satisfaction, sonographically estimated scar tissue thickness after CTR‚ and postoperative complications.Methods:Between May 2019 and May 2020, 163 patients planned for open CTR or TFR under local anesthesia were included. Before surgery, and at 3, 6, and 12 months postoperatively, Quick Disabilities of the Arm, Shoulder and Hand and Boston Carpal Tunnel questionnaires were administered, and complications were noted. At 6 months postoperatively, an ultrasound was conducted to determine the thickness of scar tissue in the region of median nerve.Results:A total of 142 patients (51 men [38%]) were included. The Quick Disabilities of the Arm, Shoulder and Hand questionnaire and Boston Carpal Tunnel Questionnaire scores improved significantly in both groups during follow-up, wherein most improvements were seen in the first 3 months. No difference in clinical outcome and scar tissue formation was found between the two groups after 12 months. The complication rate was comparable between both groups. Thirty-two (24%) patients had at least one complication, none needed surgical interventions, and no recurrent symptoms were seen.Conclusions:Our study shows similar long-term clinical outcomes, formation of scar tissue, and complication rates for patients undergoing CTR or TFR with or without a tourniquet. Tourniquet usage should be based on shared decision-making.

782 Mohs Micrographic Surgery and Patient Satisfaction in Skin Cancer; a Systematic Review

Abstract Aim Mohs micrographic surgery (MMS) has revolutionised the treatment of skin cancer. It is commonly considered as gold standard, with good cosmesis effect for patients. Patient perception plays an important outcome in skin cancers. This systematic review aims to explore evidence of post-operative patient reported satisfaction after MMS. Method We conducted a systematic search using 10 databases including OVID Medline(R), Pubmed, Cochrane (CENTRAL) of all study types between 2000–2021. Studies were appraised for bias and data was tabulated with a narrative synthesis. Results The literature search generated 1068 studies. After removing duplicates, 728 were screened and 37 underwent full-text review. Thirteen relevant studies comprising 3046 patients undergoing MMS were included. Patients undergoing MMS expressed higher anxiety pre-operatively compared to conventional excision surgery but post-operatively Mohs was associated with a significantly higher skin cancer index (SCI) score. This was both in the short- and long-term follow up. Patients showed overall very high satisfaction with the technical quality, irrespective of reconstructive complexity or the surgeon's expertise. Patients’ main concerns post-operatively included scar skin thickness, colour, and irregularity. Higher satisfaction was observed in those with better pre-operative quality of life (QOL) including skin quality, co-morbidities, mental health, and age. Conclusion Overall patient satisfaction after MMS is high and supports transition to this surgical technique within skin cancer surgery. Higher satisfaction rates are observed in patients with better pre-operative QOL. Post-operatively patients are most concerned of scar thickness, colour, and irregularity. These factors should guide surgeons’ decision-making when aiming to maximise patient satisfaction.

Tratamiento láser de cicatrices por quemaduras

Burn scars cause high morbidity in the form of contractures, body disfigurement, and itching, and they also have a high emotional impact that adversely affects patient quality of life. Laser therapy has proven effective in this setting. It is superior to topical treatments and can be used in conjunction with surgery, helping to reduce morbidity. The use of lasers in hospital dermatology departments, however, is still limited. Carbon dioxide laser resurfacing is the most widely used modality for reducing scar thickness, improving textural abnormalities, and treating contractures. Treatments improve mobility for patients with constrictions. Pulsed dye laser treatments are particularly useful for reducing erythema in recent burn scars and preventing subsequent hypertrophy. Pigment laser treatments with short pulse durations (nanoseconds or picoseconds) can improve hyperpigmentation. In this article, we review the evidence for the use of laser therapy for burn scars and propose a treatment algorithm.

Ultrasound evaluation of uterine scar thickness after open fetal surgery for myelomeningocele.

This study aimed to analyse the evolution of uterine scar thickness after open fetal surgery for myelomeningocele (MMC) by ultrasonography, and to establish a cut-off point for uterine scar thickness associated with high-risk of uterine rupture. A prospective longitudinal study was conducted with 77 pregnant women who underwent open fetal surgery for MMC between 24 and 27weeks of gestation. After fetal surgery, ultrasound follow-up was performed once a week, and the scar on the uterine wall was evaluated and its thickness was measured by transabdominal ultrasound. At least five measurements of the uterine scar thickness were performed during pregnancy. A receiver operating characteristics (ROC) curve was constructed to obtain a cut-off point for the thickness of the scar capable of detecting the absence of thinning. Kaplan-Meier curves were constructed to evaluate the probability of thinning during pregnancy follow-up. The mean ± standard deviation of maternal age (years), gestational age at surgery (weeks), gestational age at delivery (weeks), and birth weight (g) were 30.6 ± 4.5, 26.1 ± 0.8, 34.3 ± 1.2 and 2287.4 ± 334.4, respectively. Thinning was observed in 23 patients (29.9%). Pregnant women with no thinning had an average of 17.1 ± 5.2min longer surgery time than pregnant women with thinning. A decrease of 1.0mm in the thickness of the uterine scar was associated with an increased likelihood of thinning by 1.81-fold (95% confidence interval [CI]: 1.32-2.47; p < 0.001). The area below the ROC curve was 0.899 (95% CI: 0.806-0.954; p < 0.001), and the cut-off point was ≤ 3.0mm, which simultaneously presented greater sensitivity and specificity. After 63days of surgery, the probability of uterine scarring was 50% (95% CI: 58-69). A cut-off point of ≤ 3.0mm in the thickness of the uterine scar after open fetal surgery for MMC may be used during ultrasonography monitoring for decision-making regarding the risk of uterine rupture and indication of caesarean section.

Combination of chemically modified SDF-1α mRNA and small skin improves wound healing in diabetic rats with full-thickness skin defects.

Diabetes mellitus is associated with refractory wound healing, yet current therapies are insufficient to accelerate the process of healing. Recent studies have indicated chemically modified mRNA (modRNA) as a promising therapeutic intervention. The present study aimed to explore the efficacy of small skin engineered to express modified mRNAs encoding the stromal cell-derived factor-1α (SDF-1α) facilitating wound healing in a full-thickness skin defect rat model. This study, devised therapeutic strategies for diabetic wounds by pre-treating small skin with SDF-1α modRNA. The in vitro transfection efficiency was evaluated using fluorescence microscopy and the content of SDF-1α in the medium was determined using ELISA after the transfection of SDF-1α into the small skin. To evaluate the effect of SDF-1α modRNA and transplantation of the small skin cells on wound healing, an in vivo full-thickness skin defect rat model was assessed. The results revealed that a modRNA carrying SDF-1α provided potent wound healing in the small skin lesions reducing reduced scar thickness and greater angiogenesis (CD31) in the subcutaneous layer. The SDF-1α cytokines were significantly secreted by the small skin after transfection in vitro. This study demonstrated the benefits of employing small skin combined with SDF-1α modRNA in enhancing wound healing in diabetic rats having full-thickness skin defects.

5-Aminolevulinic Acid-Hyaluronic Acid Complexes Enhance Skin Retention of 5-Aminolevulinic Acid and Therapeutic Efficacy in the Treatment of Hypertrophic Scar.

Hypertrophic scar is a serious skin disorder, which reduces the patient's quality of life. 5-aminolevulinic acid (5-ALA)-mediated photodynamic therapy has been used to treat patients with hypertrophic scar. However, the poor skin retention of 5-ALA limited the therapeutic effect. In this study, we constructed the 5-ALA-hyaluronic acid (HA) complex to potentially prolong the skin retention of 5-ALA for improving the therapeutic efficacy. HA is a polysaccharide with viscoelasticity and the carboxyl groups could conjugate with amino groups of 5-ALA via electrostatic interaction. The protoporphyrin IX (PpIX) assay revealed that 5-ALA-HA complexes markedly enhanced the skin retention, resulting in increased generation and accumulation of endogenous photosensitizer PpIX. Furthermore, 5-ALA-HA complexes allowed PpIX to be maintained at a high level for 12h, much longer than the 3h of 5-ALA alone. And then, the accumulative PpIX induced by 5-ALA-HA in human hypertrophic scar fibroblasts (HSF) was triggered by laser irradiation to produce sufficient reactive oxygen species, leading to efficient necrosis and apoptosis of HSF. In vivo therapeutic efficacy study indicated that 5-ALA-HA effectivelyreducedthe appearance and scar thickness, and the scar elevation index with 5-ALA-HA treatment was significantly lower than other groups, suggesting that the 5-ALA-HA-treated scar became flattened and was closely matched to the unwounded tissues. Moreover, 5-ALA-HA treatment markedly downregulated the gene expression levels of α-SMA and TGF-β1, demonstrating attenuated the scar formation and growth. Therefore, the 5-ALA-HA complex enhancing skin retention and PpIX accumulation at the lesion site provide a promising therapeutic strategy for hypertrophic scar.

Analysis of the Utility of CO2 and Pulse-Dye Lasers Together and Separately in the Treatment of Hypertrophic Burn Scars.

Hypertrophic burn scars (HTBSs) remain a significant source of morbidity. Contemporary treatment has evolved to use CO2 lasers and/or pulse-dye lasers (PDLs) to reduce scar thickness (ST) and erythema. This study seeks to compare treatment efficacy with CO2 or PDL individually and in combination. Patients undergoing laser treatments for HTBSs were enrolled. Three 3 × 3 cm squares of HTBSs were randomized to receive treatment with CO2 laser, PDL or CO2 + PDL. Patients underwent 3 treatments, 4 to 6 weeks apart and were followed up over 3 to 6 months. Scar assessments occurred at each visit before treatment and consisted of photographs, ultrasound, colorimetry, and the Patient and Observer Scar Assessment Score. Twenty-five patients were enrolled. Twenty completed 2 treatments (80%) and 11 completed all 3 treatments (44%). Median initial ST was 0.3 cm. Median time since injury was 8 months. Hypertrophic burn scars treated with CO2 or PDL showed a significant decrease in Patient and Observer Scar Assessment Scale score from visit 1 to 3 (P = 0.01 and 0.01, respectively). When separated by ST, thick scars (≥0.3 cm) showed a significant decrease in thickness between visit 1 and 2 using all laser modalities (CO2 + PDL, P = 0.01; CO2, P = 0.02; PDL, P = 0.03). Thin scars (<0.3 cm) showed a reduction in thickness by visit 3 after CO2 + PDL or PDL alone (P = 0.01 and 0.04, respectively). Separating scars by age, younger scars (<9 months) showed a significant reduction in thickness between visit 1 and 2 for CO2 treatment (P = 0.04), and between visit 2 and 3 for CO2 + PDL treatment (P = 0.04). Hypertrophic burn scars treated with PDL did not demonstrate a significant reduction in thickness until visit 3 (P = 0.002). Older scars (≥9 months) showed a significant reduction in thickness between visit 1 and 2 only after CO2 + PDL (P = 0.01). Hypertrophic burn scars of varying ages, etiologies, and thicknesses were examined in this study with greater degree of early reduction seen in thicker scars using all laser modalities of CO2, PDL or in combination. However, there was no clinically meaningful benefit found with combination as compared with individual treatment. These data support the use of laser to improve HTBS but does not support one modality or combination of modalities over another.

Clinical efficacy of laparoscopic surgery used for the excision of villus tissue and the repair of uterine scar in patients with cesarean scar pregnancy-II.

The present study described the clinical presentation of patients with cesarean scar pregnancy type II (CSP)-II diagnosed by ultrasound or magnetic resonance imaging, who underwent laparoscopic surgery resection or hysteroscopic treatment. The aim of the present study was to evaluate the outcomes of different treatments for CSP. The patients with CSP-II were assigned to the laparoscopy and hysteroscopy groups according to the type of surgery performed. The general indicators and post-operative outcomes were compared between the two groups. Statistically significant differences (P<0.05) were noted in the treatment efficacy indices between the two groups. The laparoscopic group exhibited a lower value of β-human chorionic gonadotropin (β-HCG) following surgery (P=0.017), a shorter time required for β-HCG to return to normal levels (P=0.001), a reduced post-operative thickness of the uterine scar (P<0.001) and a reduced menstruation recovery time (P<0.001). However, no significant differences were noted in blood loss during operation (P>0.05). On the whole, the data indicated that the laparoscopic resection of the scar with gestational tissue and wound repair may be used to preserve the uterus and may thus be an effective method for CSP-II. The appropriate treatment needs to be selected according to the condition of each patient. Based on the latter and on the available technology, priority may perhaps be given to laparoscopic surgery.

Inhibition of p38 mitogen-activated protein kinases may attenuate scar proliferation after cleft lip surgery in rabbits via Smads signaling pathway

BackgroundCleft lip repair surgery always results in visible scarring. It has been proved that scar formation can be reduced by inhibiting the p38 mitogen-activated protein kinases (p38MAPKs) signaling pathway. However, the interaction between p38MAPK and Smads in scar formation is still controversial.MethodsThis study was designed to investigate whether inhibition of p38MAPK reduces postoperative scar formation of cleft lips on rabbits via the Smads signaling pathway. Scar models in rabbits after cleft lip surgery were created and their fibroblasts were extracted. Then the expression of p38MAPK was disturbed by adenovirus in vitro and Vivo. The scar thickness was measured and scar tissues were excised for Sirius red staining and immunohistochemistry to detect the expression of type I collagen (col I), type III collagen (col III), and α-smooth muscle actin (α-SMA). The underlying mechanisms of p38MAPK knockdown on the extracellular matrix and Smad signaling pathway were invested in vitro using the EdU assay, Western blot, RT PCR, and immunofluorescence.Resultsp38MAPK knockdown suppresses the expression of p-smad3 and p-smad2 in fibroblasts, modulating the expression of its target genes, such as α-SMA, col I, and col III. When Ad-P38MAPK-1 was injected into lip scar, it reduced the expression of scar-related genes and scar thickness when compared to the negative control groups.ConclusionsIn rabbits, inhibiting p38MAPK expression prevents scar proliferation through inhibiting the Smad signaling pathway after cleft lip surgery.