Silicone Gel Sheeting Research Articles

Utilizing Magnetic Discs Combined with Thin Silicone Gel Sheets for Pressure Therapy in Earlobe Keloid Post-Excision

Utilizing Magnetic Discs Combined with Thin Silicone Gel Sheets for Pressure Therapy in Earlobe Keloid Post-Excision

Increased Patient Compliance with Silicone Gel Sheeting and Topical Silicone Gel for Hypertrophic Scar Improves Scar Outcomes

Background: Although silicone-based products are widely used for hypertrophic scar (HS) treatment, limited research exists on the correlation between patient compliance of silicone products and scar outcomes. This study aims to investigate whether continuous and consistent use of topical silicone gel (TSG) and silicone gel sheet (SGS) improves scar characteristics and whether patient compliance influences scar outcomes.Methods: A total of 79 patients with HS were randomized into either TSG (n=38) or SGS group (n=41) by an independent physician who had not seen the patients. Patient compliance was assessed based on application frequency and duration. Patients were divided into three subgroups according to compliance. Scar characteristics were evaluated using the Vancouver Scar Scale (VSS) and patient self-assessment via a visual analogue scale (VAS) for 6 months.Results: VSS pigmentation and scar height worsened in patients who applied silicone products for less than 3 days per week, especially in the TSG group. Patients who applied silicone products for more than 4 days per week showed significant improvements in all factors. Patients reported improvements in VAS scar height, pigmentation, and hardness as application time increased. Pain and itching improved regardless of application time.Conclusion: Continuous and consistent use of TSG and SGS improved HS outcomes. Applying silicone products more than 4 days in a week correlated with better scar characteristics, except pain and itching. Applying silicone products less than 3 days in a week is not recommended, as this may worsen scar height and pigmentation.

Comparative Evaluation of Postoperative Scarring with Nasolabial Flap Reconstruction Using Silicone Gel Versus Silicone Gel Sheet: Randomized Controlled Trial

Comparative Evaluation of Postoperative Scarring with Nasolabial Flap Reconstruction Using Silicone Gel Versus Silicone Gel Sheet: Randomized Controlled Trial

Compression Therapy for Keloid Scars: A Systematic Review and Meta-analysis.

Keloid scars have a multitude of treatments with varying success rates. The purpose of this systematic review and meta-analysis is to study the different types of compression therapies used following surgical excision and their recurrence rates. A literature search was conducted using the following databases: PubMed, Embase, and Cochrane Reviews. The following keywords were used in the search: "keloid" and "compression." The following inclusion criteria were used: (1) identifying lesion must be a keloid and (2) use of any type of compression therapy for keloid scar. A total of 27 articles were included in the final analysis, grouped into three treatment modalities for comparison. The three treatment modalities are (1) surgical excision and compression earring, (2) surgical excision and silicone gel sheeting, and (3) surgical excision, compression earring, and silicone gel sheeting. Based on our analysis, combination treatment with compression earring device and silicone gel sheeting had the lowest recurrence rate when compared with compression earring device or silicone gel alone, but the difference in recurrence rates between the three treatment modalities was not statistically significant. There were too few studies included in each treatment modality with even fewer sample sizes, and there is a need for a greater number of studies with increased sample size to evaluate which therapy is the most efficacious in preventing keloid recurrence following surgical excision.

Selective therapy (cryo or scalpel) combined with multimodal therapy for treating keloids.

Keloids are less responsive to any single treatment modality; hence, there is a need for combination therapy that can yield satisfactory outcomes. The present study assessed efficacy and safety of combination therapy-surgical excision or cryotherapy and intralesional corticosteroids along with 5-fluorouracil [IL (S + 5-FU)] injection, followed by silicone gel sheet (SGS) under compression therapy in the treatment of keloids. This was a retrospective, observational study comprising 21 clinically diagnosed keloid patients. All patients were treated with the stated combination therapy. Data about demographic, lesions, procedural characteristics, and treatment outcomes were reported. Of 21, 11 (52.4%) patients were treated with liquid nitrogen (LN2) cryotherapy, and 10 (47.6%) patients were treated with surgical excision. Mean age was 30.8 ± 7.6 (range: 14-44) years with slight male (52.4%) predominance. A mean surface area of keloid lesion was 96.8 ± 170.5 cm3. The most frequently involved site was auricle (8 [38.1%] patients). Patients received the following types of treatments: intralesional LN2 cryotherapy (6 [28.6%]), intralesional excisional surgery (6 [28.6%]), surface LN2 cryotherapy (5 [23.8%]), and extralesional excisional surgery (4 [19.0%]). Complications of recurrence (2 [9.5%]), secondary infections (2 [9.5%]), persistent postinflammatory hypopigmentation (1 [4.8%]), and atrophic scarring with postinflammatory hyperpigmentation (1 [4.8%]) were reported. After a study period of 2.5 years, 100% cure rate was achieved. Combination therapy of surgical excision or cryotherapy and IL (S + 5-FU), followed by SGS under compression, was safe and effective in treating keloids.

Insights into How Plant-Derived Extracts and Compounds Can Help in the Prevention and Treatment of Keloid Disease: Established and Emerging Therapeutic Targets.

Keloid is a disease in which fibroblasts abnormally proliferate and synthesize excessive amounts of extracellular matrix, including collagen and fibronectin, during the healing process of skin wounds, causing larger scars that exceed the boundaries of the original wound. Currently, surgical excision, cryotherapy, radiation, laser treatment, photodynamic therapy, pressure therapy, silicone gel sheeting, and pharmacotherapy are used alone or in combinations to treat this disease, but the outcomes are usually unsatisfactory. The purpose of this review is to examine whether natural products can help treat keloid disease. I introduce well-established therapeutic targets for this disease and various other emerging therapeutic targets that have been proposed based on the phenotypic difference between keloid-derived fibroblasts (KFs) and normal epidermal fibroblasts (NFs). We then present recent studies on the biological effects of various plant-derived extracts and compounds on KFs and NFs. Associated ex vivo, in vivo, and clinical studies are also presented. Finally, we discuss the mechanisms of action of the plant-derived extracts and compounds, the pros and cons, and the future tasks for natural product-based therapy for keloid disease, as compared with existing other therapies. Extracts of Astragalus membranaceus, Salvia miltiorrhiza, Aneilema keisak, Galla Chinensis, Lycium chinense, Physalis angulate, Allium sepa, and Camellia sinensis appear to modulate cell proliferation, migration, and/or extracellular matrix (ECM) production in KFs, supporting their therapeutic potential. Various phenolic compounds, terpenoids, alkaloids, and other plant-derived compounds could modulate different cell signaling pathways associated with the pathogenesis of keloids. For now, many studies are limited to in vitro experiments; additional research and development are needed to proceed to clinical trials. Many emerging therapeutic targets could accelerate the discovery of plant-derived substances for the prevention and treatment of keloid disease. I hope that this review will bridge past, present, and future research on this subject and provide insight into new therapeutic targets and pharmaceuticals, aiming for effective keloid treatment.

Tuning the Tensile and Shear Properties of a Scar Healing Composite for Mechanotherapy

Conventional scar treatment options of single pressure garment therapy (PGT) or silicone gel sheeting (SGS, Cica-Care®, Smith and Nephew, London, UK) alone lack mechanical property tunability. This article discusses a scar healing composite (PGF-Biopor®AB, Dreve Otoplastik GmbH, Unna, Germany) and how its mechanical properties can be tuned for improved mechanotherapy. A balance between compression and tension was achieved by tuning the tensile and shear properties, facilitating tension shielding and pressure redistribution for scar therapeutics. Biopor®AB-wrapping on biaxial-tensioned pressure garment fabric (PGF) allowed compression therapy and internal pressure redistribution. The Biopor®AB surface, with a coefficient of friction close to 1, strategically localizes stress for effective tension shielding. A substantial five-fold reduction in silicone tension, amounting to 1.060 N, achieves tension shielding and pressure redistribution. Simultaneously, a dynamic internal pressure-sharing mechanism distributes 0.222 kPa from each SPK-filament bundle, effectively managing internal pressure. Alongside the principle compression-silicone dual therapy, this composite design with dynamic internal pressure sharing and mechanical property tunability provides an additional pressure-relieving strategy for multiple scar therapeutics.

Comprehensive Analysis of Current Treatment Approaches for Keloids in Pediatrics: A Systematic Review.

Keloids, benign fibrous growths resulting from atypical skin responses to injuries, present a complex challenge in dermatology. These lesions, characterized by excessive collagen production, often lead to physical discomfort and psychological distress. While various treatment methods exist, the lack of a universally effective modality underscores the need for a systematic evaluation of current approaches. This systematic review aims to comprehensively analyze the current available treatment modalities used for the management of keloids in the pediatric population in terms of their effectiveness, safety, and quality of life outcomes. The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted on PubMed and Google Scholar databases to identify relevant studies published in English. The review specifically focused on randomized controlled trials involving patients under 18 diagnosed with keloids, assessing different treatment modalities, and reporting validated measures of treatment efficacy, safety outcomes, and quality of life. The risk of bias was assessed using Cochrane's Risk of Bias Tool for randomized studies to ensure the methodological quality of the included trials. Four studies met the inclusion criteria, collectively involving 196 pediatric patients. Treatment interventions included glucocorticosteroid and fusidic acid cream with silicone gel patches, botulinum toxin type A injections, and Scarban silicone gel sheets. Patient-reported outcomes exhibited varying degrees of improvement in scar size, vascularity, and pliability. Complications, such as rash and wound infection, were reported in some cases. Based on our review of the selected studies and due to the incompletely understood pathogenesis of keloids, there is an ongoing lack of universally effective treatment modality for the management of keloids resulting in their persistently high recurrence rate.

A therapeutic evaluation of various modalities of treatment of keloid-A randomized open label study

Keloid and hypertrophic scar are the result of abnormal growth of fibrous tissue following healing of a cutaneous injury in predisposed individuals. Some treatment options are pressure garments, radiation therapy, excision, intralesional injections, cryotherapy, silicone gel dressing and lasers though no single modality is completely effective.To study the efficacy, to compare and to study the adverse effects of 4 different modalities of treatment of keloid namely, Intralesional triamcinolone acetonide (TAC), Intralesional triamcinolone acetonide and 5-fluoro uracil (5-FU), Intralesional triamcinolone acetonide and silicone gel sheet (SGS) and Intralesional Radiofrequency (RF). Arandomized open label study was conducted in the dermatology department of a tertiary care hospital in Gujarat from Nov 2020 to December 2022. 108 patients were allocated to 4 groups, Group 1(TAC), Group 2( + 5FU), Group 3( + SGS) and Group 4(RF). Group 1 received Intralesional injections of Triamcinolone acetonide (alone), Group 2 received Intralesional injections of Triamcinolone acetonide and 5- fluorouracil, Group 3 was given Intralesional injections of Triamcinolone acetonide and topical silicone gel sheet and Group 4 was treated with intralesional radiofrequency.A total of 108 patients of age group 18-52 years were enrolled and was divided into 4 groups consisting of 27 patients each Improvement of pliability, vascularity, pigmentation and height of keloid was maximum in TAC + 5FU group and least was in TAC + SGS group. At the end of 4 weeks, excellent improvement was found highest in 29.6% of TAC+5FU group, 22.2% in TAC alone, 18.5% in RF group and 11.1% in TAC+SGS group. At the end of 8 weeks, excellent improvement was found highest in 51.8% of TAC+5FU group, 44.4% in TAC alone, 40.7% RF group and 25.9% in TAC+SGS group. The difference was statistically significant.Skin atrophy, telangiectasia, hypopigmentation and recurrence were observed more TAC group therapies whereas, ulceration and infection were more frequent with RF treatment, however few cases were also seen TAC+5FU group.In this study in terms of pliability and overall improvement maximum response was seen in group TAC + 5 FU and TAC + SGS was least effective.

A Self-Pumping Composite Dressing Improved Hypertrophic Scar Healing with Dual Therapy and Active-Fluid Transport

Silicone gel sheeting (SGS) and pressure garment therapy (PGT) are the International Clinical Recommendations on Scar Management’s (ICRSM) two principal non-invasive scar-healing procedures. This study created a new PGT-SGS composite (PGF-Biopor®AB-based) via pre-strained screen printing. The Biopor®AB hydrophobicity and nylon-hydrophilicity enabled self-pumping for PGT-SGS dual therapy and pressure-driven “warp insertions” mobility facilitates active-fluid transportation. Integrating both therapies in a single PGT-SGS composite achieved efficacy optimization, and the 3D channel structure allowed trauma-free active-fluid transport. The 3D channel topology enables smooth diffusional transport in active-fluid transport environments—and active “nylon absorbency” improved water uptake and enhanced permeability capabilities with sustainability achieved dynamic hydration. The sole use of PGF-Biopor®AB composite in empirical trials verified dual therapy with trauma-free active-fluid transport with one-month efficacy, providing a new route for dual treatment and active scar management.

Silicone gel sheeting for treating keloid scars.

Silicone gel sheeting for treating keloid scars.

Laser therapy for treating hypertrophic and keloid scars.

Laser therapy for treating hypertrophic and keloid scars.

34238 Laser revision of periareolar scarring following masculinizing chest surgery: A case report

Background: Masculinizing chest surgery (top surgery) involves the removal of breast tissue and nipple repositioning/reshaping to achieve a masculine chest appearance in transmasculine and transgender men. Keyhole mastectomy (KM) involves breast tissue removal via periareolar incision, which avoids the linear scarring seen with double-incision mastectomies (DM). Patients prefer the KM to the DM for this cosmetic advantage. However, outcomes are consistently poorer for the KM and literature regarding revision of post-KM scarring is limited to invasive surgical approaches. No studies examining laser revision have been published. Herein, we describe a case of laser revision for periareolar scarring following KM. Case: A 15-year-old transgender male presented 10 months following KM with hypertrophic, erythematous, and hyperpigmented periareolar scars bilaterally. Postsurgical complications included abscess formation requiring surgical revision. He had been using chest compression (ACE wrap) and silicone gel sheets to minimize scarring, but desired improved skin texture and decreased erythema to facilitate tattoo camouflage. The left areola was treated with 5 pulsed dye laser (PDL) (595 nm) and 5 CO2 laser (10,600 nm) sessions while the right was treated with 3 PDL sessions and a single CO2 session. Treatments were spaced 6-8 weeks apart. The patient reported improvement in skin texture and decreased erythema after 3 treatments with continued benefit after subsequent treatments without adverse events. Discussion: Laser therapy has been successfully used in the revision of postsurgical and burn scars. Our novel case highlights that laser therapy may be an effective option for treating periareolar scarring and dyspigmentation following KM.

Judicious management of pinna keloids: our experience with combination therapy

<p class="abstract"><strong>Background:</strong> Keloids occur as a result of overgrowth of fibrous tissue following healing of a cutaneous injury and they cause aesthetic issues when they appear on the exposed parts of the body, especially the face. Keloids are difficult to treat, with a high recurrence rate. There are several treatment modalities for management of keloids, though no single modality is completely effective. Most commonly used treatment modalities are intra-lesional steroids, surgical excision, pressure application, silicone gel sheets, 5-fluorouracil (5-FU), cryotherapy, radiation therapy, laser therapy or a combination of these modalities. The aim of the study was to analyse the causes of development of keloids on the pinna and evaluated the outcomes of various treatment modalities applied. It focused on assessing the clinical efficacy of combined surgical excision of pinna keloids with serial steroid injections to prevent recurrence, in comparison to monotherapy with intra-lesional steroid injections alone.</p><p class="abstract"><strong>Methods:</strong> A retrospective review based on medical records was done for 18 patients with keloid of pinna, who were treated with either monotherapy or combination therapy. </p><p class="abstract"><strong>Results:</strong> Satisfactory low recurrence rates were observed with meticulous surgical excision followed by serial steroid injections (18.2%), as compared to monotherapy with serial steroid injections alone (71.4%), and these comparative results were statistically significant at p<0.05 in the cohort.</p><p class="abstract"><strong>Conclusions:</strong> A judicious plan for management for pinna keloids is necessary in order to achieve the best functional and cosmetic outcomes, while reducing the recurrence rates to a minimum. Following a combination of interventions has proved safe and effective for managing this challenging entity.</p>

Glucocorticosteroid and Silicone Gel During Patch Application Without Clinical Scar Improvement After Central Venous Catheter Removal: A Randomized Trial.

We studied whether glucocorticosteroid during patch occlusion has a beneficial effect on scar outcome in children and adolescents treated for cancer. A double-blinded placebo-controlled randomized clinical trial was performed. The main outcome was the Vancouver Scar Scale. Secondary outcomes were scar width and scar quality measured using the Patient and Observer Scar Assessment Scale. The patients were divided into an intervention groups and a control group. The intervention group was randomized into active and placebo group. The active treatment consisted of cream with glucocorticosteroid and fusidic acid. The placebo treatment consisted of cream with fusidic acid. Both groups received silicone gel patch after central venous catheter removal. The control group received no specific skin care. Assessment at 12 months showed that the intervention group had a significantly lower Vancouver Scar Scale and a smaller scar (0,1cm) compared with the control group ( P =0.00, P =0.02) but no benefit of glucocorticosteroid. The Patient and Observer Scar Assessment Scale showed no significant difference between the intervention and control groups ( P =0.84, P =0.36). Silicone gel sheet alone or in combination with application of glucocorticosteroid during sheet occlusion does not clinically improve scar outcome after removal of central venous catheter in children treated for neoplastic diseases.

Prevention and management of hypertrophic scars after laparoscopic surgery using silicone gel sheets: a pilot study.

ObjectiveTo assess the effectiveness and safety of modified silicone gel sheets applied to hypertrophic scars and keloids following laparoscopic surgery.MethodsPatients who had undergone laparoscopic surgery and who had either conventional or modified silicone gel sheets affixed to their surgical lesions for 6 months postoperatively (treatment groups), and control patients who had not received postsurgical treatment involving silicone gel sheets, were enrolled. The surgical wounds were assessed visually and using the Japan Scar Workshop (JSW) Scar Scale. Patients were interviewed before, 3 months after, and 6 months after sheet affixation.ResultsA total of 45 patients were included, comprising 15 patients per group. Both silicone gel-sheet groups had significantly lower JSW Scar Scale scores at 3 and 6 months after affixation compared with controls. The scores were not significantly different between the conventional and modified treatment groups and no adverse events were observed in the latter.ConclusionsModified silicone gel sheets were more effective than controls and comparable to conventional gel sheets, and there were no adverse events related to laparoscopic surgical wounds in the improved silicone gel sheet group, demonstrating the safety and effectiveness of the modified silicone gel sheets.

Therapeutic evaluation of various modalities in keloid

Keloid is deregulated fibroproliferative growth in response to tissue injury. Keloids are known for their stubborn nature and present as therapeutic challenges in practice. Aim of our study is to evaluate various treatment modalities for search of treatment which stand out with maximum efficacy and least side effect. 120 patients with presternal keloid (female and male, aged 18-60 years) were recruited to receive one of the five treatment methods which were(1) Cryotherapy,(2) Cryotherapy and intralesional Triamcinolone acetonide,(3) Cryotherapy and intralesional 5- Fluorouracil(4) Cryotherapy and combination of Intralesional Triamcinolone acetonide with 5- Fluorouracil(5) Cryotherapy and Intralesional Triamcinolone acetonide combined with Silicone gel sheet application in each group respectively. Evaluation done by the Patient and Observer Scar Assessment Scale (POSAS) score at every 3 week till 6 months. Patients with significant improvement (> 50% reduction in POSAS) were 42%, 75%, 75%, 85%, and 90% in each 5 group respectively. Side effects like Hypopigmentation and Skin atrophy were significantly much frequent in group 2 while skin ulceration and pain were common with group 3. Group 1 showed maximum recurrence of lesion while no recurrence was seen in group-2 and 5 even after 3 month of post treatment. Among nonsurgical treatment modalities, Cryotherapy along with intralesional medication like triamcinolone acetonide and 5 fluorouracil and adjuvant therapy like silicone gel sheet are promising, inexpensive and an effective OPD based treatment that provide good alternative for keloid treatment in comparison to surgical procedures.

Comparison of the effect of silicone gel sheets by thickness on excisional scars in pediatric and adolescent patients

Background Selecting effective products among the various types of silicone gel sheets can be challenging for surgeons. Therefore, we assessed the effect of silicone gel sheet thickness on surgical scars in pediatric and adolescent patients.Methods From December 2017 to May 2018, we identified patients aged 1–19 years who underwent excision. Among these patients, those who were prescribed 0.3-mm or 1.0-mm-thick silicone sheets were selected. Scars were subjectively evaluated using a questionnaire consisting of seven items. Objective evaluation was performed by two plastic surgeons using the Vancouver Scar Scale (VSS).Results The mean age of the 49 selected patients was 9.78 years. The patients were divided into two groups according to the thickness of the silicone gel sheet used (0.3 mm vs. 1.0 mm). Objective evaluation of the patients’ scars revealed more favorable results in the 0.3 mm group than in the 1.0 mm group (P=0.010). Multivariate analysis of VSS scores indicated that the resulting scars in cases involving the trunk were of poorer quality than those involving facial areas (P=0.015). Additionally, favorable (i.e., below-average) VSS scores were significantly less likely in patients with longer scars (odds ratio, 0.896; 95% confidence interval, 0.834–0.963; P=0.003) or thicker silicone sheets (odds ratio, 0.085; 95% confidence interval, 0.011–0.699; P=0.019).Conclusions The use of thinner silicone gel sheets in children and adolescents resulted in better scars according to subjective evaluations, underscoring the importance of compliance in pediatric patients. The type of operation and surgical lesion should also be considered when planning the management of surgical scars.

Pulse dye laser therapy and superficial cryotherapy as a novel combination treatment for hypertrophic scars and keloids

Background: Hypertrophic scars are benign and fibrotic skin lesions caused by defects in the regulation of cellularity during the wound-healingprocess, in which there is higher collagen production and less degradation. Genetic predisposing factors and different skin injuries may play a role in developing these types of lesions. On the other hand, keloids are overgrowths of fibrous tissue outside the original boundaries of trauma, yet these may also occur spontaneously. There are numerous treatment options for both conditions, including silicone gel sheeting, pressure therapy, intralesional triamcinolone acetonide, radiation, laser therapy, cryosurgery, interferon, 5-fluorouracil, and surgical excision as well as a multitude of extracts and topical agents. Objective: The objective was to evaluate the effectiveness of pulse dye laser (PDL) therapy and superficial cryotherapy as a combination treatment for hypertrophic scars and keloids. Method: Four Arabic female patients were seen at the outpatient clinic of the Department of Dermatology at the King Fahd Hospital of the University in Khobar, Saudi Arabia. The patients had keloids and hypertrophic scars. Treatment with cryotherapy every week for three weeks followed by one session of pulsed dye laser was administered rotationally for three to six months until the lesions displayed remarkable physical improvement or complete resolution. Results: All patients experienced significant improvement, showing a reduction in the size, erythema, pliability, and pruritus. None of the hypertrophic scars or keloids deteriorated during the one year of treatment. No complications were noted during the treatment period. Conclusion: Sequential PDL therapy combined with superficial cryotherapy may be an option for treating hypertrophic scars and keloids.

Effect of Polarized Light on Post Burn Hypertrophic Scars

Background. Hypertrophic scar (HTS) formation after burn remains a major issue for burned patients and is considered a huge problem for clinicians because the hypertrophic scar is painful, reddish, elevated, pruritic, and aesthetically unacceptable. Purpose. To study the effect of polarized light therapy (PLT) on post burn HTS. Materials and Methods. Thirty patients complaining of HTS formation after thermal burn with ages ranged from 20 to 40 years shared in this study and were randomly distributed into two matching groups in number (15 patients for each group). Group A (Study group): received 10 min. PLT 3 sessions/week plus silicone gel sheet (SGS) kept for 12 hours/day, medical treatment such as (hydration creams and antihistamine drugs), and routine physical therapy (splinting, massage therapy, stretching exercises, and strengthening exercises) for 2 months. Group B (Control group): received SGS kept for 12 hours/day, medical treatment such as (hydration creams and antihistamine drugs), and routine physical therapy (splinting, massage therapy, stretching exercises, and strengthening exercises) for 2 months. Methods of evaluation included Vancouver scar scale (VSS) to measure four parameters of hypertrophic scar (height, vascularity, pigmentation, and pliability) and photographic method to allow for visual assessment of the scars. Results. Comparison between post-treatment and pre-treatment in the study group showed a significant decrease in height, vascularity, pigmentation, and pliability scores (p > 0.01). There was a significant decrease in height and pliability scores of the study group in comparison with that of the control group (p < 0.01), while there was no significant difference in vascularity and pigmentation between groups (p > 0.05). Conclusion. PLT is an effective, easy to apply, and non-invasive treatment modality in post burn HTS.