Scar Therapy Research Articles

Assessing the effectiveness of massage therapy for bilateral cleft lip reconstruction scars.

Bilateral cleft lips occur when the bones that form the upper lip fail to fuse at birth. Surgical reconstruction creates scars, which may lead to the following impairments: adhesions, decreased oral range of motion, decreased strength of orbicularis oris muscle, and asymmetry of oral region leading to poor self-esteem. The purpose of this case study is to determine the effectiveness of massage therapy in its ability to improve these impairments. A five-week treatment plan consisting of fascial release, kneading, and intraoral techniques. Subjective information was assessed on two scales: restriction of scar and clients attitudes and acceptance of scar. Objective information was cataloged through photographs, a palpatory chart, and a self-created "Pen Test". Results included increase range of motion and strength, decrease restrictions (palpable and subjective), and increase of symmetry. Client's perceived confidence of scar and its appearance increased. The evidence suggests that massage therapy helped with the impairments associated with scars formed by bilateral cleft lip reconstruction.

Drug-eluting microneedles for self-administered treatment of keloids

Keloid is a long-term dermatological scarring disease characterized by disfiguring lesions resulting from overgrowth of dense fibrous tissue. Current therapeutics are ineffective, require clinical supervision and can be costly. This study investigated the use of microneedle technology in the self-management of keloid lesions. Specifically, a microneedle patch comprising of polyethylene glycol diacrylate (PEGDA) and encapsulating 5-fluorouracil (5-FU) has been developed for transdermal delivery. The microneedle patches showed requisite mechanical strength (hardness 45 ± 11 MPa, elastic modulus 0.66 ± 0.16 GPa) and were able to puncture porcine epidermis. The choice of PEGDA substrate enabled conformability to non-planar anatomical regions (e.g. elbow), with about 50% of the loaded 5-FU released during the first 12 hours. Thereafter, the microneedle efficacy was evaluated on in vitro keloid fibroblast culture models, where 5-FU loaded microneedles effectively abolished keloid fibroblast proliferation activity. In summary, we have developed a microneedle device with a good potential as an effective, economical and self-applied therapy for keloid scars.

The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: A randomized controlled trial

ObjectiveTo evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn. MethodOne hundred and forty-six burn patients with hypertrophic scar(s) were randomly divided into an experimental group and a control group. All patients received standard rehabilitation therapy for hypertrophic scars and 76 patients (massage group) additionally received burn scar rehabilitation massage therapy. Both before and after the treatment, we determined the scores of visual analog scale (VAS) and itching scale and assessed the scar characteristics of thickness, melanin, erythema, transepidermal water loss (TEWL), sebum, and elasticity by using ultrasonography, Mexameter®, Tewameter®, Sebumeter®, and Cutometer®, respectively. ResultsThe scores of both VAS and itching scale decreased significantly in both groups, indicating a significant intragroup difference. With regard to the scar characteristics, the massage group showed a significant decrease after treatment in scar thickness, melanin, erythema, TEWL and a significant intergroup difference. In terms of scar elasticity, a significant intergroup difference was noted in immediate distension and gross skin elasticity, while the massage group significant improvement in skin distensibility, immediate distension, immediate retraction, and delayed distension. ConclusionOur results suggest that burn rehabilitation massage therapy is effective in improving pain, pruritus, and scar characteristics in hypertrophic scars after burn.

Dystrophic Calcification and Accentuated Localized Argyria After Fractionated Carbon Dioxide Laser Therapy of Hypertrophic Scars

Fractionated, ultrapulsed carbon dioxide (CO2) laser therapy is a powerful tool for the treatment of scars. Common adverse effects of this therapeutic modality have been previously documented. We describe 2 unreported adverse effects of ultrapulsed CO2 laser treatment of mature scars in a patient previously treated with silver-impregnated dressings. A teenage survivor of toxic epidermal necrolysis presented with faint but diffuse dyschromia clinically and histologically consistent with localized argyria secondary to silver-impregnated dressings used years earlier. The patient was subsequently treated with fractionated CO2 for her scarring, but her hyperpigmentation worsened with each treatment. A subsequent biopsy specimen revealed a zone of dystrophic calcification with adjacent pseudo-ochronotic fibers that were not appreciated on biopsy specimens taken before CO2 laser treatment, suggesting unique complications not previously reported. We present 2 unique complications secondary to ultrapulsed, fractionated CO2 laser treatment in a patient previously treated with silver-impregnated dressings: (1) the appearance of pseudo-ochronotic fibers in areas of worsening pigmentation and (2) evidence of dystrophic calcification limited to columns of fractionated laser ablation. Therefore, a history of argyria or treatment with silver-impregnated dressings should be considered before treatment with fractionated CO2 lasers.

Laser Treatment of Traumatic Scars With an Emphasis on Ablative Fractional Laser Resurfacing

Despite expert wound care and assiduous management with traditional therapy, poor cosmetic outcomes, restricted motion, and symptoms such as pain and itch are a pervasive problem of disfiguring and debilitating scars. The advent of ablative fractional photothermolysis within the past decade and its application to the treatment of traumatic scars represents a breakthrough in the restoration of function and cosmetic appearance for injured patients, but the procedure is not widely used. To provide a synthesis of our current clinical experience and available literature regarding the laser treatment of traumatic scars with an emphasis on fractional resurfacing. Eight independent, self-selected academic and military dermatology and plastic surgery physicians with extensive experience in the use of lasers for scar treatment assembled for a 2-day ad hoc meeting on January 19 and 20, 2012. Consensus was based largely on expert opinion, but relevant literature was cited where it exists. After consensus was appraised, we drafted the manuscript in sections during the course of several months. The draft was then circulated among all panel members for final review and comment. Our consensus is that laser treatment, particularly ablative fractional resurfacing, deserves a prominent role in future scar treatment paradigms, with the possible inclusion of early intervention for contracture avoidance and assistance with wound healing. Laser scar therapy, particularly fractional ablative laser resurfacing, represents a promising and vastly underused tool in the multidisciplinary treatment of traumatic scars. Changes to existing scar treatment paradigms should include extensive integration of fractional resurfacing and other combination therapies guided by future research.

Ablative fractional photothermolysis for the treatment of hypertrophic burn scars in adult and pediatric patients: a single surgeon's experience.

Many patients develop hypertrophic scarring after a burn injury. Numerous treatment modalities have been described and are currently in practice. Photothermolysis or laser therapy has been recently described as an adjunct for management of hypertrophic burn scars. This study is a retrospective chart review of adult and pediatric patients undergoing fractional photothermolysis at a verified burn center examining treatment parameters as well as pre- and post-Vancouver Scar Scale scores. Forty-four patients underwent fractional photothermolysis during the study period of 8 months. Mean pretreatment score was 7.6, and mean posttreatment score was 5.4. The mean decrease in score was 2.2, which was found to be statistically significant. There were no complications. Fractional photothermolysis is a safe and efficacious adjunct therapy for hypertrophic burn scars. Prospective trials would be beneficial to determine optimal therapeutic strategies.

Hematopoietic Stem Cells: Do They Have a Role in Keloid Pathogenesis?

Keloids are slow growing neoplasms characterized by benign proliferation of fibroblasts that is due, at least in part, to altered cytokine profiles. Stem cells were claimed to play a role in skin tumor development. However, their role in keloid formation is unclear. The current study investigated the immunoreactivity of CD34 and c-KIT antibodies in 30 cases with keloid lesions together with normal skin biopsies of 30, sex and age-matched subjects representing the control group. Examined keloid sections showed positive dermal stromal immunoreactivity for CD34 in 76.7% of cases. CD34 expression intensity and H score were upregulated in keloid tissue relative to normal skin (p < 0.0001, p = 0.0002, respectively) and in perilesional relative to lesional tissue (p = 0.03, p < 0.001, respectively). c-KIT showed positive dermal stromal expression in all cases. Dermal c-KIT expression intensity and H score were upregulated in keloid tissue relative to normal skin (p < 0.008, p < 0.001, respectively) and in perilesional relative to lesional tissue (p < 0.0001, p < 0.001, respectively). Lesional skin showed more staining of basal keratinocytes when compared to perilesional tissue (p < 0.0001). Hematopoietic stem cells may share in keloid pathogenesis. Further studies are warranted to gain firmer conclusion about the exact role played by these cells and the significance of their perilesional accumulation. The future therapy of keloid scars may have to target this stem cell population in order to deprive these tumors of their regenerative cell pools.

Therapy of pathological scars

The various clinical manifestations of scarring are an important topic for physicians in many disciplines. The prevention of excessive scarring is more successful than the treatment afterwards. Multiple options exist for prevention, wound repair modulation, and treatment of scars. This publication includes an overview of the pathogenesis, clinical classification, documentation, prevention, and invasive and non-invasive therapy options.

Development and Assessment of a Cutaneous Tissue Stretch Device as Scar Therapy

INTRODUCTION: Mechanical force plays an important yet incompletely understood role in scar formation.1–2 Tension during the wound healing process may affect collagen deposition and TGF-β1 production.1 The purpose of the present study was to develop and test a device that produces parallel stretch on new scars and to analyze its potential to reduce scarring. METHODS: Thirty-six mice with identical scars were randomized into three treatment groups (0.5X, 1X, or 2X device strength). Animals were treated for 10 days and their scars were scored using the Vancouver Scar Scale. Scar tissue samples were compared between treatment groups by histological analysis and TGF-β1 between control and treatment groups was measured by ELISA. RESULTS: Scar morphology scores from 0.5X and 1X stretch groups were significantly lower than the control scar group (p<0.05). Scar scores from the 1X treatment group were also significantly lower when compared to the 0.5 X group (p<0.05). Histological analysis demonstrated that sham, control scar and 2X groups showed more collagen deposition and a thicker dermal scar than the 0.5x and 1x treatment groups. The dermis in unstretched scars had fewer fibroblasts with more collagen between cells when compared with the 0.5x fibroblasts and 2x group. TGF-β1 levels were significantly lower in the stretch treatment groups 0.5x (342.1±9) and 1x (254.1 ±3) when compared to the control scar group (p<0.05). TGF-β1 levels in the 1X treatment group were also significantly lower than the 0.5X treatment group (p<0.05). CONCLUSION: Intermittent cutaneous tissue stretch parallel to the scar during the proliferative phase of wound healing can decrease scar formation on a macroscopic, microscopic and biochemical level.

Pressure therapy upregulates matrix metalloproteinase expression and downregulates collagen expression in hypertrophic scar tissue

Background Pressure therapy improves hypertrophic scar healing, but the mechanisms for this process are not well understood. We sought to investigate the differential expression of matrix metalloproteinases (Mmps) and collagen in post-traumatic hypertrophic scar tissue with mechanical pressure and delineate the molecular mechanisms of pressure therapy for hypertrophic scars. Methods Fibroblast lines of normal skin and scar tissue were established and a mechanical pressure system was devised to simulate pressure therapy. Reverse transcription-polymerase chain reaction (RT-PCR) and Western blotting assays were used to compare differences in the mRNA and protein expression of Mmps and collagen in scar fibroblasts before and after pressure therapy. Results The expression differed between the hypertrophic scar cell line and the normal cell line. RT-PCR assays showed that Collagen I, highly expressed in the hypertrophic scar cell line, decreased significantly after pressure therapy. Mmp2, Mmp9, and Mmp12 expression in the hypertrophic scar tissue increased significantly after pressure therapy (P &lt;0.05). Western blotting assays further revealed that Mmp9 and Mmp12 expression increased significantly in the hypertrophic scar tissue after pressure therapy (P &lt;0.05) but not Mmp2 expression (P &gt;0.05). Conclusion Mechanical pressure induces degradation of Collagen I in hypertrophic scar tissue by affecting the expression of Mmp9 and Mmp12.

The efficacy of autologous platelet-rich plasma combined with erbium fractional laser therapy for facial acne scars or acne

The aim of this study was to evaluate the efficacy of autologous platelet-rich plasma (PRP) combined with erbium fractional laser therapy for facial acne or acne scars. PRP combined with erbium fractional laser therapy was used for the treatment of 22patients, including 16 patients who suffered from facial acne scars and 6 patients who suffered from acne scars concomitant with acne. Whole blood (40ml) was collected from each patient, and following differential centrifugation, PRP was harvested. After using an erbium fractional laser, we applied PRP to the entire face of every patient. Digital photos were taken before and after the treatment for evaluation by dermatologists and the patients rated the efficacy on a 5-point scale. The erythema was moderate or mild, while its total duration was <3days; after receiving the treatment three times, 90.9% of the patients showed an improvement of >50%, and 91% of the patients were satisfied; no acne inflammation was observed after treatment. PRP combined with erbium fractional laser therapy is an effective and safe approach for treating acne scars or acne, with minimal side-effects, and it simultaneously enhanced the recovery of laser-damaged skin.

Laterale Supramalleolarlappenplastiken zur Defektdeckung im Sprunggelenks- und Fußbereich

Defect reconstruction by transposition of well-vascularized thin and pliable skin. Defect coverage involving the antero- and dorsolateral distal one third of the lower leg, the dorsolateral and dorsomedial hindfoot and dorsal midfoot. Severe peripheral arterial occlusive disease (PAOD), previous trauma at the anterolateral aspect of the lower leg and foot. Lateral fasciocutaneous supramalleolar flap with orthograde blood flow, fasciocutaneous lateral supramalleolar perforator flap with orthograde blood flow, adipofascial lateral supramalleolar flap with orthograde blood flow, lateral fasciocutaneous supramalleolar flap based on the lateral tarsal artery with retrograde blood flow, lateral fasciocutaneous supramalleolar flap based on the anterolateral malleolar artery with retrograde blood flow according to Oberlin. "Tie over" dressing for grafting site for 5 days (healing of split/full-thickness skin graft), complete immobilization of the lower leg for 7 days in a dorsal plaster splint (ensure that there is no pressure on the flap), progressive increase of range of motion after 1 week, postoperative standardized compression therapy, combined with scar therapy (silicone sheet). Reliable, excellent functional and aesthetic results with thin skin in small to midsize defects. Increasing morbidity of grafting site in larger flaps and risk of neuroma when the superficial peroneal nerve was exposed.

Die Musculus-peroneus-brevis-Lappenplastiken

Soft tissue defect reconstruction by transposition of well-vascularized muscle tissue with a muscle flap and as an osteomuscular flap together with a fibular bone segment for combined skeletal and soft tissue defects. Small- and medium-sized defects of the hindfoot, around the ankle and the distal and middle third of the lower leg, skeletal reconstruction of underlying small- and medium-sized bone defects. Lesions of the proximal anterior tibial artery (proximal pedicled flap), combined lesions of the distal peroneal artery including the communicating branch with the posterior tibial artery (distal pedicled flap); lesion or paralysis of the peroneus longus muscle in an intact ankle joint. Distally pedicled flap: blunt separation between the peroneus longus and brevis muscle, subperiosteal release with isolation on a distal septocutaneous branch of the peroneal artery. To increase perfusion, the proximally released branch of the anterior tibial artery may be re-anastomosed in the recipient site. Proximally pedicled flap: dissection of distal peroneus brevis muscle tendon and subperiosteal release in a proximal direction with ligation of the segmental peroneal artery branches until the flap is isolated on its proximal anterior tibial artery branch. For an osteomuscular flap, simultaneous harvest of a fibula segment underneath the muscle origin with preservation of the intimate periosteal relationship between muscle and bone. Complete immobilization and elevated leg position for 5 days, followed by successive orthostatic training for 10 days. Postoperative standardized compression garments for 6 months, eventually combined with silicone sheet scar therapy. Reliable, excellent functional and aesthetic results with very low donor site morbidity.

Gefäßgestielte Arteria-peronea-Perforatorlappenplastik

Defect reconstruction at the distal lower extremity by transposition of a vascularised fasciocutaneous flap. Reconstruction of defects at the lateral aspect of the middle and distal third of the lower leg, the lateral ankle and achilles tendon region. Lesions or occlusion of the peroneal artery, traumatized skin and soft tissues at the donor site of the flap, deep vein thrombosis of the ipsilateral leg. Preoperative localisation of the dominant perforator using Duplex or Doppler ultrasound or CT-angiography. Initially limited skin incision and identification and microsurgical dissection of the dominant perforator up to its origin from the peroneal artery. Completion of skin incision and mobilisation of the flap while the secondary perforans vessels are still preserved. Evaluation of flap perfusion and transfer of the flap into the defect by advancement or 180° rotation as a propeller flap. Closure of the donor site defect by direct suture or skin grafts. Elevation of the extremity for 5 days. Elastocompressive garments and orthostatic training with increasing intensity. Standardised postoperative compression therapy and scar therapy if necessary. Minimal functional donor site defect and optimal functional and aesthetic results.

Endostatin inhibits hypertrophic scarring in a rabbit ear model

The present study was designed to use an in vivo rabbit ear scar model to investigate the efficacy of systemic administration of endostatin in inhibiting scar formation. Eight male New Zealand white rabbits were randomly assigned to two groups. Scar model was established by making six full skin defect wounds in each ear. For the intervention group, intraperitoneal injection of endostatin was performed each day after the wound healed (about 15 d post wounding). For the control group, equal volume of saline was injected. Thickness of scars in each group was measured by sliding caliper and the scar microcirculatory perfusion was assessed by laser Doppler flowmetry on Days 15, 21, 28, and 35 post wounding. Rabbits were euthanatized and their scars were harvested for histological and proteomic analyses on Day 35 post wounding. Macroscopically, scars of the control group were thicker than those of the intervention group. Significant differences between the two groups were observed on Days 21 and 35 (p<0.05). Scar thickness, measured by scar elevation index (SEI) at Day 35 post wounding, was significantly reduced in the intervention group (1.09±0.19) compared with the controls (1.36±0.28). Microvessel density (MVD) observed in the intervention group (1.73±0.94) was significantly lower than that of the control group (5.63±1.78) on Day 35. The distribution of collagen fibers in scars treated with endostatin was relatively regular, while collagen fibers in untreated controls were thicker and showed disordered alignment. Western blot analysis showed that the expressions of type I collagen and Bcl-2 were depressed by injection of endostatin. Our results from the rabbit ear hypertrophic scar model indicate that systemic application of endostatin could inhibit local hypertrophic scar formation, possibly through reducing scar vascularization and angiogenesis. Our results indicated that endostatin may promote the apoptosis of endothelial cells and block their release of platelet-derived growth factor (PDGF) and fibroblast growth factor (FGF), thereby controlling collagen production by fibroblasts. Blood vessel-targeted treatment may be a promising strategy for scar therapy.

Collagen Induction Therapy With Dermaroller

Dermaroller is relatively a new modality for the treatment of acne scars, stretch marks, wrinkles, facial rejuvenation inducing collagen induction by the use of microneedling. Two versions are available: (1) the standard dermaroller version and (2) miniature versions. The principle of using dermaroller modality is to provide collagen induction therapy. Dermaroller is more effective in rolling and boxcar type of scars. It has been shown that rolling with a dermaroller (192 needles, 200 urn length and 70 urn diameter) over an area for 15 times will result in approximately 250 holes/ cm 2 . Microneedling leads to the release of growth factors form new collagen and elastin in the papillary dermis. In addition, new capillaries are formed. The neovascularisation and neocollagenesis lead to reduction of scars. The procedure is aptly called "percutaneous collagen induction therapy" and is also used in the treatment of photoageing. Dermaroller is an extremely effective therapy for post acne scars, even trauma scars. Best results are seen in rolling and box type scars, and even papular scars respond to it. DOI: http://dx.doi.org/10.3329/cbmj.v1i1.13854 Community Based Medical Journal Vol.1(1) 2012 35-37

Treatment of Active Acne Vulgaris by Chemical Peeling Using TCA 35%

Background: The pathogenesis of acne vulgaris is multifactorial, and therapy can be directed at many of these factors, singly or in combination. There are different modalities of treatment of active acne vulgaris but they are often long lasting which could not be accepted by many patients. Objective: To evaluate the effectiveness, long term efficacy and safety of chemical peeling using 35% TCA solution in the treatment of active acne vulgaris. Patients and Methods:This clinical, interventional, therapeutic study was done at the Department of Dermatology—Baghdad Teaching Hospital during the period from January 2012 to March 2013. Eighteen patients with active acne vulgaris were included in this study, 10 (55.6%) females and 8 (44.4%) males. Their ages ranged from 15 to 35 (21.56 ± 5.501) years. Twelve patients were associated with acne scars. History and dermatological examination were performed for all patients regarding all demographic points related to the disease. Chemical peeling with 35% TCA used one session regarding active acne vulgaris and three sessions in patients with associated scarring. Scoring for active acne vulgaris and acne scar was done for each case before and after peeling to evaluate the severity of acne lesions and scarring. All patients were with Fitzpatrick’s skin types III and IV. Patients were followed up every two weeks for 12 weeks after starting therapy and every 4 weeks for 12 weeks after stopping the treatment to watch improvement, side effects and relapse. Results: Scoring for active acne vulgaris including papules and pustules showed highly statistically significant reduction after 2 weeks of therapy (p Conclusions: Chemical peeling by TCA 35% is a cost-effective mode of therapy for active acne vulgaris and acne scar with low down time in patients with dark complexion.

Immunolocolization of CD29 in keloid

ObjectiveTo shed light on the role of mesenchymal stem cells (MSCs) in keloid pathogenesis.BackgroundKeloids are fibroproliferative scars that show a benign yet quasineoplastic behavior and morphology, as evidenced by high recurrence and aggressive invasion into the surrounding skin. MSC populations originate from bone marrow (BM) stroma, which can give rise to stromal mature mesenchymal cells and aid regeneration of the BM microenvironment. Human BM-derived MSCs may contribute toward keloid pathogenesis.Patients and methodsA total of 30 skin biopsy specimens from keloid lesions were used and 15 healthy volunteers were used as a control. Histopathological examination of hematoxylin and eosin-stained sections of keloid was carried out for the evaluation of histopathological parameters. The expression of CD29 was examined immunohistochemically.ResultsThere were statistically significant differences between CD29 immunostaining in normal skin and lesional area of keloid in favor of keloid. There were no significant differences between different epidermal intensities of CD29 expression in keloid.ConclusionMSCs may share in keloid pathogenesis. The future therapy of keloid scars may have to target MSC differentially in order to deprive these tumors of their regenerative cell pools. This may represent an innovative method for keloid treatment.

Topical Cepae Extract-Heparin Sodium-Allantoin Gel versus Placebo on Hypertrophic Thyroidectomy Scars: A Randomized, Double- Blinded, Split-Scar Controlled Trial

Objective: Topical cepae extract-heparin sodium-allantoin gel is one of the many non-invasive scar treatments available to improve the appearance and physical attributes of scars. This paper aims to compare the effectiveness of topical cepae extract-heparin sodium-allantoin gel versus placebo based on appearance and physical attributes of hypertrophic thyroidectomy scars.&#x0D; Methods: &#x0D; Design: Randomized, double-blinded, split-scar controlled trial&#x0D; Setting: Out-Patient Department of a Tertiary Government Hospital&#x0D; Participants: 20 patients with hypertrophic thyroidectomy scars had each side of the scar randomly assigned treatment with topical extract.-cepae-heparin sodium-allantoin gel or placebo (glycerine gel). Each product was applied two times daily for 6 weeks, and scars were evaluated prior to initiation of treatment and after 6 weeks by patients and one observer. Pre- and post-treatment photo documentation and scar evaluation using a local language translation of the Patient and Observer Scar Assessment Scale (POSAS) were completed for each side of the scar. &#x0D; Results: There was no significant difference in effectiveness of topical cepae extract-heparin sodium-allantoin gel versus placebo for both the patient scale (p = 0.91) and observer scale (p = 0.87) in appearance and physical attributes of a thyroidectomy scar.&#x0D; Conclusions: Topical cepae extract-heparin sodium-allantoin gel was not proven to be superior to the placebo as scar therapy in all parameters assessed by the Filipino translation of POSAS. The small sample size, duration of hypertrophic scar, duration of treatment, and validity and reliability of the Filipino translation of POSAS may have affected our results; and periodic subjective and objective assessments with multi-observer evaluation of scars and pre- and post- treatment photographs may be considered for further studies.&#x0D; Keywords: Topical Cepae Extract-Heparin Sodium-Allantoin Gel, Glycerine, Patient and Observer Scar Assessment Scale, thyroidectomy scar, scar

Skin Wound Healing and Scarring: Fetal Wounds and Regenerative Restitution

The adverse physiological and psychological effects of scars formation after healing of wounds are broad and a major medical problem for patients. In utero, fetal wounds heal in a regenerative manner, though the mechanisms are unknown. Differences in fetal scarless regeneration and adult repair can provide key insight into reduction of scarring therapy. Understanding the cellular and extracellular matrix alterations in excessive adult scarring in comparison to fetal scarless healing may have important implications. Herein, we propose that matrix can be controlled via cellular therapy to resemble a fetal-like matrix that will result in reduced scarring.