Scar Thickness Research Articles

Compression sutures combined with intracameral air injection versus thermokeratoplasty for acute corneal hydrops: a prospective-randomised trial

AimsTo compare the efficacy of compression sutures combined with intracameral air injection (CSAI) and thermokeratoplasty (TKP) for the management of acute corneal hydrops in keratoconus.MethodsIn this multi-centre randomised clinical trial,...

Preparation «Karipain Scar» in a pediatric combustion unit

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

Diagnostic Accuracy of Lower Uterine Segment Scar Thickness ≤1.6mm in Prediction of Scar Dehiscence in patients

Background: Cesarean section uterine scar dehiscence (CSD) is a rare but notable complication of Lower segment cesarean section (LSCS) surgery. The cause for a uterine scar dehiscence is based on the etiology behind the uterine scar defect or any event that would predispose the cesarean scar to dehisce. Globally accepted option for assessing the CS scar is transvaginal ultrasonography of the non-pregnant uterus. Objective: To determine the diagnostic accuracy of lower uterine segment scar thickness≤1.6mm in the prediction of scar dehiscence in patients with previous one LSCS who are undergoing repeat LSCS after trial of labour taking intraoperative findings as gold standard. Material and methods: This cross sectional study was conducted in Services Hospital, Lahore for 6 months. The Non probability consecutive sampling technique was used to include women with previous one LSCS at 36-38 weeks were asked to get their TVS done for scar thickness. Women with scar thickness≤1.6mm and scar thickness>1.6mm were identified. Their intraoperative findings of scar dehiscence were confirmed. All the data was entered and analyzed on SPSS version 20. Results: The mean age of patients was 29.87±6.07 years. The emergency LSCS was done in 599(49.1%) patients and elective LSCS was done in 621(50.9%) patients. The sensitivity, specificity & diagnostic accuracy of TVS was 98.31%, 99.05% & 98.69% respectively. Conclusion: According to our study results the TVS for uterine scar is a very useful and effective tool in the prediction of scar dehiscence in patients with previous one LSCS taking intraoperative findings as gold standard. Keywords: Transvaginal sonography, TVS, Uterine, Scar, dehiscence, LSCS, Intraoperative

A critical review on the potential role of adipose-derived stem cells for future treatment of hypertrophic scars.

Adipose-derived stem cells (ASCs) have recently gained researchers' interest as a solution to various diseases and conditions, including hypertrophic scar. This literature review aims to elucidate ASCs as a potential solution to alleviate hypertrophic scar in human subjects. Literature search was done in databases which includes PubMed, MEDLINE, and ProQuest using terms 'adipose derived stem cells', 'adipose cells', 'fat graft', 'fat grafting', 'autologous fat graft', 'fat injection', 'lipofilling', 'scar management', 'scar treatment', 'burn scar', and 'wound management'. The included articles which were published during year 2000-November 2020 must describe the use of ASCs or fat grafting or lipofilling as an attempt to alleviate hypertrophic scar. Clinically, ASCs improve hypertrophic scars in terms of scar color, elasticity, texture, thickness, and size. Histologically, ASCs promotes healthy tissue regeneration, reduction in fibroblasts, and reorganisation of collagen, resembling those of normal skin. In terms of molecular aspects, ASCs alleviates hypertrophic scars through direct differentiation and paracrine mechanisms. Adipose-derived stem cells, emerge to be a potential solution for alleviating hypertrophic scar, as demonstrated in various studies. However, there has been no studies conducted in human subjects to investigate the effect of ASCs on hypertrophic scar.

Associations and Outcomes of Patients with Submacular Hemorrhage Secondary to Age-related Macular Degeneration in the IVAN Trial

To compare demographics, visual acuity (VA) and retinal morphology between those with, and without baseline submacular hemorrhage (SMH) for patients enrolled in the Inhibit VEGF in Age-related Choroidal Neovascularization trial (IVAN). Secondary analyses of a randomized, controlled trial of image and clinical data. Setting; The IVAN trial collected data in 23 UK hospitals. Study population; IVAN study eyes (with untreated neovascular age-related macular degeneration at randomization) with at least 12 months of follow-up and adequate imaging. Intervention; Study eyes were randomly assigned between monthly ranibizumab, as-needed ranibizumab, monthly bevacizumab, or as-needed bevacizumab. Imaging at baseline was graded independently for the presence, type, position, and extent of SMH. Main outcome measures; The main outcome measures were VA (primary outcome), subretinal fibrosis, atrophic scarring, and retinal thickness outcomes at 12 and 24 months RESULTS: Of 605 IVAN trial participants, 535 were included in this analysis. Patients with SMH at baseline (286 [53%]) were older (P=.010) and affected eyes were more likely to have intraretinal fluid present (P=.038). The VA was significantly worse in those with baseline SMH at month 0 (P < .001; estimate of difference 6 letters; 95% CIs, 4-8 letters), but the difference decreased and was not significant at month 12 or 24. No significant association was found between baseline SMH and subretinal fibrosis, atrophic scarring, or central retinal thickness. The presence of SMH at baseline was associated with age, intraretinal fluid, and decreased baseline VA. By month 12, VA was no longer significantly different in those who presented with SMH at baseline.

ST-segment resolution as a marker for severe myocardial fibrosis in ST-segment elevation myocardial infarction

ObjectiveTo investigate the relationship between ST-segment resolution (STR) and myocardial scar thickness after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).MethodsForty-two STEMI patients with single-branch coronary artery stenosis or occlusion were enrolled. ST-segment elevations were measured at emergency admission and at 24 h after PCI. Late gadolinium-enhanced cardiac magnetic resonance imaging (CMR-LGE) was performed 7 days after PCI to evaluate myocardial scars. Statistical analyses were performed to assess the utility of STR to predict the development of transmural (> 75%) or non-transmural (< 75%) myocardial scars, according to previous study.ResultsThe sensitivity and specificity of STR for predicting transmural scars were 96% and 88%, respectively, at an STR cut-off value of 40.15%. The area under the curve was 0.925. Multivariate logistic proportional hazards regression analysis disclosed that patients with STR < 40.15% had a 170.90-fold higher probability of developing transmural scars compared with patients with STR ≥ 40.15%. Pearson correlation and linear regression analyses showed STR percentage was significantly associated with myocardial scar thickness and size.ConclusionSTR < 40.15% at 24 h after PCI may provide meaningful diagnostic information regarding the extent of myocardial scarification in STEMI patients.

Immediate Postoperative Treatment of Keloids with Intraoperative Radiation Therapy Technology: A Pilot Study.

Background:The combination of surgery and postoperative radiotherapy allows for the most effective results with keloids. In this trial, surgery and intraoperative radiation therapy (IORT) technology were used—the hypothesis being that the earlier the application of postoperative radiotherapy, the better the wound healing evolution.Methods:The study included 16 patients with 21 keloids. The keloids were radically excised and repaired with direct suture or local skin flaps. Collimated electron radiotherapy was applied within 45 minutes of surgery. The outcomes were assessed according to the modified Patient and Observer Scar Assessment Scale; the modified Vancouver Scar Scale; and the modified Common Terminology Criteria for Adverse Events v. 4.0 for skin and subcutaneous tissue disorders.Results:Recurrences were observed in one out of 16 patients, and in two out of 21 keloids (9.5%). The modified Patient and Observer Scar Assessment Scale demonstrated a statistically significant improvement in pain, itching, color, stiffness, thickness, and irregularity after the treatment. The modified Patient and Observer Scar Assessment Scale displayed a statistically significant improvement in the scar vascularity, pigmentation, thickness, and pliability after the treatment. The modified Vancouver Scar Scale demonstrated a statistically significant improvement in 90.48% of the scars after the treatment. The modified Common Terminology Criteria for Adverse Events v. 4.0 for skin and subcutaneous tissue disorders demonstrated an improvement in erythema multiforme and skin pain across the whole sample, with a temporary hyperpigmentation in 19% of the scars after the treatment.Conclusion:The combination of surgery and collimated electron radiotherapy with IORT technology demonstrated favorable results in 90.5% of the cases.

Physically Consistent Scar Tissue Dynamics from Scattered Set of Data: A Novel Computational Approach to Avoid the Onset of the Runge Phenomenon

The foreign body reaction is a complex biological process leading to the insulation of implanted artificial materials through a capsule of scar tissue. In particular, in chronic implantations of neural electrodes, the prediction of the scar tissue evolution is crucial to assess the implant reliability over time. Indeed, the capsule behaves like an increasing insulating barrier between electrodes and nerve fibers. However, no explicit and physically based rules are available to computationally reproduce the capsule evolution. In addition, standard approaches to this problem (i.e., Vandermonde-based and Lagrange interpolation) fail for the onset of the Runge phenomenon. More specifically, numerical oscillations arise, thus standard procedures are only able to reproduce experimental detections while they result in non physical values for inter-interval times (i.e., times before and after experimental detections). As a consequence, in this work, a novel framework is described to model the evolution of the scar tissue thickness, avoiding the onset of the Runge phenomenon. This approach is able to provide novel approximating functions correctly reproducing experimental data (R2≃0.92) and effectively predicting inter-interval detections. In this way, the overall performances of previous approaches, based on phenomenological fitting polynomials of low degree, are improved.

Effect of Autologous Platelet–Rich Plasma on Cesarean Section Scar; A Randomized, Double-Blinded Pilot Study

Background: One of the complications of cesarean section (C/S) is related to the incision site. Considering the effectiveness of platelet–rich plasma (PRP) on healing of wounds and management of scars, the present study aimed to inquire the effect of PRP on the thickness and completeness of the uterine scar. Methods: In a randomized double-blinded, placebo-controlled clinical trial, the women who underwent C/S from November 2019 to 2020 were included and randomized into two studied groups, including the control (n = 15) and intervention (n = 15) groups. In the intervention group, PRP, extracted from patients’ blood samples, was injected to the incision site (between decidua and myometrium), while the control group did not receive this treatment. The scar thickness of C/S as the primary outcome and postpartum hemorrhage as the secondary outcome were compared between the groups. Both groups were followed for 12 weeks. Results: The two groups (intervention and control) were not significantly different in terms of weight, height, BMI, age, parity, gravidity, duration of surgery, and blood hemoglobin (HB) level (P &gt; 0.05). Comparison of scar characteristics showed the creation of a niche in the PRP group, which was almost one-fourth of that of the control group; a difference that was statistically significant (P = 0.002). The thickness of adjoining myometrium was comparable between the two groups. Mean uterine niche height in the intervention group was lower than in the control group, which was statistically significant (P = 0.048). The mean of residual myometrium thickness (RMT) in the intervention and control groups were 7.62 ± 0.95 and 5.6 ± 3.5 mm, respectively, a difference that was statistically significant (P &lt; 0.001). Conclusions: Local injection of PRP is an effective and viable measure for reducing the uterine niche; therefore, it is suggested to be included in the routine wound care of CS. Future studies are needed to confirm PRP efficacy in different settings.

PILOT STUDY OF LOWER UTERINE SEGMENT CESAREAN SCAR THICKNESS PREOPERATIVELY BY TRANSVAGINAL SONOGRAPHY AND ITS CORRELATION WITH INTRA-OPERATIVE FINDINGS

Objectives: Cesarean section rates are increasing with a decrease in the rate of trial of labor after first cesarean section. Proper assessment of uterus especially scar of the previous lower segment cesarean sections (LSCS) in pregnant females is the key stone for the successful vaginal birth after cesarean section. The objective of this pilot study was to evaluate LSCS scar thickness using transvaginal sonography (TVS) and to determine the correlation between TVS and intraoperatively measured lower uterine segment cesarean scar thickness. Methods: This prospective observational analytic pilot study was carried out jointly by the Departments of Obstetrics and Gynaecology and Radiodiagnosis, Government Medical College and Rajindra Hospital, Patiala after due ethical and research committee approval. 100 women at term with history of previous LSCS and who were scheduled for elective LSCS were recruited for the study after taking the informed consent. Pre-operative scar measurement as on TVS was compared with and analyzed with intraoperative (I/o) scar measurements taken by Calipers. Results: The cutoff value for TVS readings was found to be ≤2.5 mm using receiver operating characteristic analysis. It has significant correlation with I/o scar measurements. It also has a significant relationship with age, pre-pregnancy overweight, number of the previous LSCS, and gestational age. Conclusion: Assessment of the scar integrity and quality by TVS will be helpful in selecting candidates for trial of labor with an optimally informed decision but still a number of studies have to be done to develop a robust scoring system.

Ultrasonographic Comparison of Previous Caesarean Scar Thickness in Second and Third Trimester of Current Pregnancy

Background: The rate of caesarean section is increasing in the world. With which there is an increase in complications of pregnancy. There is risk of the uterine rupture if there is trial of the normal delivery. The aim of study is to determine and compare previous caesarean scar thickness in second and third trimester of pregnancy. Objective(s): To determine previous caesarean scar thickness in second and third trimester of current pregnancy. Methodology: An analytical study was conducted in the Saima medical center Shalimar link road Lahore. Sixty-two patients were enrolled in this study with convenient sampling. Toshiba nemio 10 ultrasound machines with convex transducer frequency range 3.5 MHz.patients with placenta previa and twin gestation were excluded from this study. Transabdominal technique was used in this study. Data were collected through data collection sheets and was tabulated and analyzed using statistical package for the social sciences (SPSS)version 24(SPSS, IBM, Armonk, NY, United States of America) Microsoft excel. Results: A total of 62 patient were examined in the study. The age incidence of the cases in this study varied between 22 years to 36 years. The mean age of the patients in the study was 27. 2903.The mean gestational age was 27.47. The mean scar thickness at 24-28 weeks was3.3925. parity varied patient to patient.16(25.8%) females had para 2.23(37.1%) had para 3 and 16(25.8%) had para 4.3(4.8%) females had para 5 and 4(6.5%) had para 6. In the current study out of sixty-two patients 13(21%) were gravida1,24(38.7%) was gravid 2,17(27.4) were gravid 3,4(6.5%) gravid 4 and (6.5) gravid. A statistical significance difference found in mean scar thickness at 24-28 weeks of gestation and at 32-36 weeks of gestation-value = 0.000 &lt; α = 0.05. Conclusion(s): ultrasound is the useful modality for determining scar thickness. The scar thickness of previous c section in the current pregnancy. Keywords: Analytical study, cesarean scar thickness DOI: 10.7176/JHMN/93-02 Publication date: September 30 th 2021

Preoperative Prediction of Difficult Laparoscopic Cholecystectomy: A Scoring Method

Abstract Background: Laparoscopic cholecystectomy is the most frequent operation nowadays for gallbladder stones. It is associated with faster recovery and shorter hospital stay. On the wide use of laparoscopic cholecystectomy, various com-plications appeared. This made researches work on studies to predict the difficulty of laparoscopic cholecystectomy through different scoring system. This study validates the usage of a scoring system for preoperative prediction of intraoperative difficulties of lapar-oscopic cholecystectomy that may help the patient as well as surgeon in being better prepared for intraoperative challenges. Gallbladder-related disease is one of the common surgical elective and emergency indications. Laparoscopic cholecys-tectomy (LC) is the gold standard nowadays for gallbladder removal. The frequency of complications associated with laparo-scopic cholecystectomy varies from 0.5-6%. Complications of cholecystectomy include iatrogenic perforation of gallblad-der with spilt gallstones that is considered the most common, bile duct injury, bile leaks, bleeding and bowel injury. Con-version rate was about 5% of all laparoscopic cholecystecto-mies. Many risk factors have been found to be associated with difficult laparoscopic cholecytectomy. These result in part from patient selection, surgical inexperience, and the technical constraints that are inherent to the minimally invasive approach. Scoring proposed by Randhawa and Pujahari in 2008 is the most used currently. They found its statistically and clinically good test for predicting outcome in LC. This score had positive predictive value of 88.8% and 92.2% for easy and difficult. One of the unique features in this score is the inclusion of palpable Gallbladder that was not reported earlier. But there was no correlation of score and conversion in this study as all cases of conversion were due to anomalous ducts that could have been predicted by MRCP. It included various clinical and ultrasonographic parameters. Aim of Study: To validate a risk score based on the patient's history, physical examination and abdominal ultrasonography parameters for preoperative prediction of difficult laparoscopic cholecystectomy. Patients and Methods: Our study included 30 patients underwent laparoscopic cholecystectomy in Ain Shams Hos-pital and Alamria Hospital. Results: In our study, males were more predominant than females (73.3% vs 26.7%) with mean age of (40.23±13.64) years. Our patients had mean BMI of (28.43±4.03) kg/m2 with most of them were obese (63.3%). Intra operative diffi-culty showed significant relation with sex and BMI. 13.3% of patients had leukocytosis and all our patients had normal alkaline phosphatase. 56.7% of the study patients were presented with previous acute attacks, 20% presented with fever, 6.7% had palpable GB and 33.3% had abdominal scar. Intra operative difficulty showed significant relation with previous acute attack, abdominal scar and GB wall thickness. We found that preoperative scoring had a sensitivity of 89.5%, specificity of 100%, positive predictive value of 100%, negative predictive value of 84.6%, diagnostic accuracy of 93.3%, and Kappa agreement of 0.862 compared to the intraoperative scoring system. Conclusion: We strongly recommend using the preoper-ative scoring system for predicting the degree of difficulty for laparoscopic cholecystectomy.

Effects of multiple modes of UltraPulse fractional CO2 laser treatment on extensive scarring: a retrospective study

The main therapeutic options for extensive scarring (e.g., > 20% of the total body surface area, or TBSA) after burns and trauma have focused on conservative treatments, such as compression, moisturization, and topical agent application. However, these treatments may not achieve optimal effects due to the large size and complexity of the scars. UltraPulse fractional CO2 laser treatment is a novel approach that is currently a subject of intense interest; this treatment is most widely used to improve texture, pliability, and pigmentation in all types of scars. However, no studies on the independent use of UltraPulse fractional CO2 laser treatment for extensive scars have been reported. This retrospective study evaluated a total of 21 patients, whose scars covered 20 to 65% TBSA. Scar thickness was measured by ultrasonography before treatment. Personalized treatment modalities and parameters were set according to the scar type and thickness. Scar formation and treatment effects were evaluated by photography, the Patient and Observer Scar Assessment Scale (POSAS), and patients’ judgment of effectiveness. Where the scars covered joints, joint function was assessed by measuring the maximum range of motion (ROM). With laser therapy, scars became flatter and lighter; furthermore, pruritus, pain, and discomfort decreased significantly. POSAS scores significantly decreased after laser therapy, including the item scores for pain and pruritus. There were no instances of joint contracture, ROM reduction, apparent functional impairment, serious adverse events, or comorbidities. This study demonstrates the safety and efficiency of UltraPulse fractional CO2 laser treatment for extensive scarring.

Evaluation of the diagnosis and treatment of cesarean scar pregnancy induced in the second trimester: a national multicenter retrospective study

Objective: To study the risk factors of adverse pregnancy outcomes for induced abortion of cesarean scar pregnancy in midtrimester. Methods: A national multicenter retrospective study was conducted. A total of 154 singletons pregnant women with cesarean scar pregnancy during the second trimester induced abortion by various reasons in 12 tertiary A hospitals were selected, their pregnant outcomes were observed and the risk factors of serious adverse outcomes were analyzed with univariate and multivariate logstic regression; the role of ultrasound and MRI in predicting placenta accreta and severe adverse outcomes was evaluated, the effectiveness of uterine artery embolization (UAE) in preventing hemorrhage in pregnant women with and without placenta accreta was compared. Results: Among 154 subjects, the rate of placenta accreta was 42.2% (65/154), the rate of postpartum hemorrhage≥1 000 ml was 39.0% (60/154), the rate of hysterectomy was 14.9% (23/154), the rate of uterine rupture was 0.6% (1/154). The risk factor of postpartum hemorrhage≥1 000 ml and hysterectomy was placenta accreta (P<0.01). For each increase in the number of parity, the risk of placenta accreta increased 2.385 times (95%CI: 1.046-5.439; P=0.039); and the risk of placenta accreta decreased with increasing ultrasound measurement of scar myometrium thickness (OR=0.033, 95%CI: 0.001-0.762; P=0.033). The amount of postpartum hemorrhage and hysterectomy rate in the group with placenta accreta diagnosed by ultrasound combined with MRI were not significantly different from those in the group with placenta accreta diagnosed by ultrasound only or MRI only (all P>0.05). For pregnant women with placenta accreta, there were no significant difference in the amount of bleeding and hysterectomy rate between the UAE group [median: 1 300 ml; 34% (16/47)] and the non-embolization group (all P>0.05); in pregnant women without placenta accreta, the amount of bleeding in the UAE group was lower than that in the non-embolization group (median: 100 vs 600 ml; P<0.01), but there was no significant difference in hysterectomy rate [2% (1/56) vs 9% (3/33); P>0.05]. Conclusions: (1) Placenta accreta is the only risk factor of postpartum hemorrhage≥1 000 ml with hysterectomy for induced abortion of cesarean scar pregnancy in midtrimester; multi-parity and ultrasound measurement of scar myometrium thickness are risk factors for placenta accreta. (2) The technique of using ultrasound and MRI in predicting placenta accreta of cesarean scar pregnancy needs to be improved. (3) It is necessary to discuss of UAE in preventing postpartum hemorrhage for induced abortion of cesarean scar pregnancy in midtrimester.

Topical Emulsion Containing Lavandula stoechas Essential Oil as a Therapeutic Agent for Cutaneous Wound Healing

Background and objectives: The present research was designed to evaluate the chemical composition of Lavandula stoechas essential oil (EOLS) as well as the in vivo wound-healing property. The chemical composition of EOLS was identified by gas chromatography mass spectrometry. Nineteen compounds of EOLS were reported. Linalool was identified as the major chemical compound (24.87%), followed by linalyl acetate (19.10%). EOLS showed a high content of oxygenated compounds (63.54%). In vivo wound healing activity of the topical cream prepared from EOLS (0.5% w/w) was assessed using a circular excision wound model. The wound area (mm2) in all animal groups was estimated and measured on day 0, 4, 8, 11, and 16. Results: The EOLS formulation cream (0.5% v/w) showed the highest effect on wound models when compared to reference Madecassol® (Asiaticoside). On days 4, 11, and 16, wound contractions were 26.4%, 78%, and 96.3% for the EOLS-treated group, and 8.5%, 64.1%, and 86.1% for the vehicle cream-treated group. Animals treated with EOLS cream showed a significant decrease in the epithelization period, wound area, and scar thickness, whereas the rate of wound contraction significantly increased. This is the first such report to be published. Histological analyses were also consistent with the results of the excision experimental method. Treatment with EOLS cream formulation resulted in decreased inflammation and an increased rate of tissue perfusion and proliferation as well as remodeling, along with re-epithelization. Conclusions: Our results support the use of EOLS in the development of pharmaceuticals for the management of wounds, and/or inflammatory-related diseases. Additional studies are needed to elucidate and explain the exact mechanism of its pharmacological activity.

Mechanomodulation of Burn Scarring Via Pressure Therapy.

Significance: The physical and psychological sequalae of burn injuries account for 10 million disability-adjusted life years lost annually. Hypertrophic scarring (HSc) after burn injury results in reduced mobility, contracture, pain, itching, and aesthetic changes for burn survivors. Despite the prevalence of scarring and the number of scar therapies available, none are highly effective at preventing HSc after burn injury. Recent Advances: Recent studies modulating the mechanical environment surrounding incisional and excisional wounds have shown off-loading of tension to be a powerful strategy to prevent scar formation. Preclinical studies applying force perpendicular to the surface of the skin or using a combination of pressure both circumferentially and perpendicularly have shown substantial reductions in scar thickness and contraction after burn injury. Critical Issues: Though pressure therapy is highly effective in preclinical studies, outcomes in clinical studies have been variable and may be a result of differing therapy protocols and garment material fatigue. A recent adult clinical study reported a significant reduction in pressure after 1 month of use and significant reduction between 1 and 2 months of use, resulting in below therapeutic doses of pressure applied after only 1 month of use. Future Directions: To enhance efficacy of pressure garments, new low-fatigue materials must be developed for use in standard garments or garments must be redesigned to allow for adjustment to compensate for the loss of pressure with time. Additionally, measurements of applied pressure should be performed routinely during clinic visits to ensure that therapeutic doses of pressure are being delivered.

Evaluation of Efficacy of Corticosteroid and Corticosteroid Combined with Botulinum Toxin Type A in the Treatment of Keloid and Hypertrophic Scars: A Meta-Analysis.

Both keloid and hypertrophic scars are common benign skin lesions manifested by hyperplasia of fibroblasts. Clinically, this will not only have physiological effects on patients, but also cause psychological damage. However, there is no unified standard treatment method at present. Intralesional corticosteroid injection alone and corticosteroid combined with botulinum toxin type A has been gradually found to be useful for the treatment of keloid and hypertrophic scars, but the difference in efficacy between the two is controversial. A systematic search was made of the relevant experiments from Web of Science, PubMed, Scopus, Google Scholar, Cochrane Library, and China National Knowledge Infrastructure (CNKI). The scores of Visual Analog Scale (VAS), Vancouver Scar Score sheet (VSS), scar thickness, itching degree and patient satisfaction after the combination of corticosteroid and botulinum toxin type A were superior than those after corticosteroid (P<0.05). Compared with corticosteroid alone, corticosteroid combined with botulinum toxin type A is more effective in the treatment of keloid and hypertrophic scar. Although clinical case studies for the treatment of keloid or hypertrophic scars are limited, it is necessary and helpful to understand the effectiveness of corticosteroid combined with botulinum toxin type A in the treatment of keloid or hypertrophic scars. 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 .

Babu and Magon uterine closure technique during cesarean section: A randomized double-blind trial.

We compared the effectiveness of the Babu and Magon uterine closure technique and unlocked double-layer uterine closure on the integrity and thickness of the uterine scar. A randomized double-blind trial was performed at Hazrat-e Rasoul -e-Akram Hospital, Tehran, Iran, from March 2018 to December 2019, in 72 pregnant women who were candidates for cesarean section for the first time. Women were randomly assigned to the Babu and Magon uterine closure technique (intervention group, n=34) or double-layer closure of the uterine incision (control group, n=38). The primary outcome of the study was the frequency of myometrial defects at the site of the scar (niche), and a large niche. Secondary outcomes, including the time taken for uterine closure and postpartum hemorrhage (early and late), were compared between groups. Adjacent myometrium thickness (AMT) between the two groups was not statistically significant. A niche was reported in 23.5% (8/34) and 50% (19/38) of women in the intervention and controls, respectively (p=0.02). A large niche was reported in 2.9% (1/34) and 23.7% (9/38) of women in the intervention and controls, respectively (p < 0.01). The duration of uterine closure was not statistically significant between the two groups. Hemoglobin levels did not differ significantly between groups during the first 24 h post-surgery. The results of the study showed that the technique of uterine closure is one of the main potential determinants of myometrial healing. The Babu and Magon uterine closure technique seems to lead to tissue alignment during suturing and consequently cause better myometrial healing, although this issue calls for well-founded longer studies of appropriate design.

Effectiveness of topical silicone gel and pressure garment therapy for burn scar prevention and management in children 12-months postburn: A parallel group randomised controlled trial

Objective: The longer-term effectiveness of silicone and pressure burn scar interventions was evaluated at 12-months postburn. Design: Parallel group, randomised trial. Setting: Hospital outpatient clinics, research centre. Participants: Children referred for burn scar management following grafted or spontaneously healed acute burn injuries or scar reconstruction surgery. Interventions: Participants were randomised to: (1) topical silicone gel only, (2) pressure garment only, or (3) combined topical silicone gel and pressure garment. Main measures: Primary outcomes were scar thickness (blinded ultrasound measurement) and itch intensity (caregiver proxy-report, numeric rating scale). Results: Of 153 participants randomised who received the interventions (silicone n = 51, pressure garment n = 49, combined n = 53), 86 were followed-up at 12-months postburn (n = 34, n = 28, n = 24). No differences were identified for the primary outcomes using intention-to-treat analysis. Scar thickness mean difference (95% confidence interval) = 0.00 cm (−0.04, 0.05); −0.03 cm (−0.07, 0.02); 0.03 cm (−0.02, 0.08) and scar itch = 0.09 (−0.88, 1.06); −0.21 (−1.21, 0.79); 0.30 (−0.73, 1.32) for silicone vs pressure; silicone vs combined and combined vs pressure respectively. No serious adverse effects occurred. Conclusion: Similar to short-term results, the combined intervention offered no statistically or clinically significant benefit for improving the primary outcomes compared to each intervention alone. No differences in the primary outcomes were identified between the silicone and pressure alone groups.

S100A8 and S100A9, both transcriptionally regulated by PU.1, promote epithelial-mesenchymal transformation (EMT) and invasive growth of dermal keratinocytes during scar formation post burn.

S100 calcium-binding protein A8 (S100A8) and S100A9 are small molecular weight calcium-binding regulatory proteins that have been involved in multiple chronic inflammatory diseases. However, the role of S100A8 and S100A9 in keratinocytes in wounded skin and how they are regulated during this process are still unclear. Here, we found that S100A8 and S100A9 were both upregulated in burn-wounded skins in vivo and thermal-stimulated epidermal keratinocytes in vitro, accompanied by increased levels of epithelial-mesenchymal transition (EMT). Then, we demonstrated that upregulation of S100A8 and S100A9 alone or together enhanced characteristics of EMT in normal keratinocytes, manifested by excessive proliferation rate, abnormal ability of cell invasion, and high expression levels of EMT marker proteins. The transcription factor PU box-binding protein (PU.1) bound to the promoter regions and transcriptionally promoted the expression of S100A8 and S100A9 both in the human and mice, and it had strong positive correlations with both S100A8 and S100A9 protein levels in burned skin in vivo. Moreover, PU.1 positively regulated expression of S100A8 and S100A9 in a dose-dependent manner, and enhanced EMT of keratinocytes in vitro. Finally, through the burn mouse model, we found that PU.1-/- mice displayed a lower ability of scar formation, manifested by smaller scar volume, thickness, and collagen content, which could be enhanced by S100A8 and S100A9. In conclusion, PU.1 transcriptionally promotes expression of S100A8 and S100A9, thus positively regulating epithelial-mesenchymal transformation (EMT) and invasive growth of dermal keratinocytes during scar formation post burn.