Treatment Of Hypertrophic Scars Research Articles

Regenerative effect of combined laser and human stem cell-conditioned medium therapy on hypertrophic burn scar

PurposeThis study aimed to determine the effect of combined treatment with non-ablative laser and human stem cell-conditioned medium (HSCM) on tissue regeneration after burn-induced hypertrophic scar (HTS) formation. MethodsFourteen patients with HTSs on both sides of the same body part were subjected to three sessions of non-ablative laser treatment, with an interval of four weeks between each treatment. Following laser treatment, HSCM and normal saline were applied to the HTSs of the right (experimental) and left side (control), respectively. Over the next 6 days, HSCM and moisturizer were applied to experimental scars, while only moisturizer was applied to control scars. Skin characteristics were evaluated before laser treatment and on the seventh day after the third laser treatment. ResultsNo significant intergroup differences were noted in the initial evaluation (P > 0.05). We found significant differences between the pre- and post-treatment measurements of erythema (P < 0.001), trans-epidermal water loss (TEWL; P < 0.001), and Cutometer® parameters (all parameters; P <0.05) of experimental scars. Control scars also showed significant differences between pre- and post-treatment measurements of thickness (P = 0.01), erythema (P < 0.001), TEWL (P < 0.001), and Cutometer® parameters (all parameters; P < 0.05). Changes (pre- to post-treatment) in scar thickness between the experimental (−0.003 ± 0.09) and control scars (0.04 ± 0.12) were significant (P = 0.01). ConclusionThese results suggest that HSCM has a positive effect on short-term results when applied after laser treatment of hypertrophic scars.

In Vivo Models for Hypertrophic Scars-A Systematic Review.

Backgroundand Objectives: Hypertrophic scars following surgeries or burns present a serious concern for many patients because these scars not only lead to an aesthetical but also to a functional and psychological burden. Treatment of hypertrophic scars is challenging because despite various treatment options, a low level of evidence hinders preference of any specific treatment plan. To properly identify new therapeutic approaches, the use of in vivo models remains indispensable. A gold standard for hypertrophic scars has not been established to date. This review aims at giving a comprehensive overview of the available in vivo models. Materials and Methods: PubMed and CINAHL were queried for currently existing models. Results: Models with mice, rats, rabbits, pigs, guinea pigs and dogs are used in hypertrophic scar research. Rodent models provide the advantage of ready availability and low costs, but the number of scars per animal is limited due to their relatively small body surface, leading to a high number of test animals which should be avoided according to the 3Rs. Multiple scars per animal can be created in the guinea pig and rabbit ear model; but like other rodent models, these models exhibit low transferability to human conditions. Pig models show a good transferability, but are cost-intensive and require adequate housing facilities. Further, it is not clear if a currently available pig model can deliver clinical and histological features of human hypertrophic scars concurrently. Conclusions: None of the analyzed animal models can be clearly recommended as a standard model in hypertrophic scar research because the particular research question must be considered to elect a suitable model.

Knockdown of lncRNA-NEAT1 expression inhibits hypoxia-induced scar fibroblast proliferation through regulation of the miR-488-3p/COL3A1 axis.

Long non-coding (lnc)RNA nuclear-enriched transcripts 1 (NEAT1) has been demonstrated to be involved in the inhibition of hypoxia-induced scar fibroblast proliferation, but the specific mechanism remains undetermined. The present study found that with the decrease of oxygen concentration, lncRNA NEAT1 was upregulated in hypoxia-induced scar fibroblasts, which promoted the mRNA and protein expression levels of collagen (COL)-I, COL-III and α-smooth muscle actin, thereby suppressing hypoxia-induced scar fibroblasts proliferation. In addition, the microRNA (miR)-488-3p/COL3A1 axis was involved in lncRNA NEAT1's regulation of the proliferation of hypoxia-induced scar fibroblasts. In conclusion, the knockdown of lncRNA-NEAT1 expression can inhibit hypoxia-induced scar fibroblasts proliferation through regulation of the miR-488-3p/COL3A1 axis, which will provide a novel therapeutic target for the treatment of hypertrophic scars.

Preparation of Nanofat Concentrate and Its Use for Hypertrophic Scar Treatment

Objective: Nanofat grafting has been reported to improve tissue repair by the Stromal Vascular Fraction (SVF) of nanofat. However, the oil and liquid portions of fat tissues were released by mechanical emulsification during the nanofat procedure. Here, we reported a simple method to remove the oil and water for concentrating nanofat. Methods: The concentrate of nanofat was obtained by processing nanofat using negative pressure produced by syringer and two-step centrifugation. The volume of oil and fat tissue as well as morphological changes of nanofat concetrate obtained by different procedures was examined. Meanwhile, the SVF numbers, the proliferation and differentiation capacity of Adipose-Derived Stem Cells (ADSCs) were determined. The clinical outcome of nanofat concentrate in treatment hypertrophic scar was evaluated. Results: The centrifugation and negative pressure had no significant effect on the proliferation activity of the SVF in the concentrate of nanofat. The concentrated rate after 0, 15, 30 and 60 times of emulsification was 2.08±0.042, 2.63 ± 0.07, 3.8 ± 0.01 and 8.2 ± 0.12 times greater than the original, respectively. The SVF number per 10 ml of fat in the above-mentioned groups were increased by 1.80 ± 0.15, 2.68 ± 0.27, 4.64 ± 0.20 and 3.44 ± 0.27 times, respectively. The capacity of cell proliferation and differentiation decreased significantly after more than 30 times emulsification. The concentrates of nanofat effectively improve the appearence and hardness of hypertrophic scar. Conclusion: The nanofat concentrate prepared by our method include more SVF cells and less oil and might be more effective during clinical use.

Observation on the efficacy of 1565-nm non-ablative fractional laser combined with compound betamethasone topical application on the treatment of early scar in Chinese patients

The objective of the study was to evaluate the efficacy of combining 1565-nm non-ablative fractional laser with low-dose compound betamethasone topical application in the treatment of immature early red hypertrophic scar. We enrolled 38 cases of patients who had immature red hypertrophic scar due to surgery or trauma which are all less than 6months old. About 28 patients were assigned to the treatment group, and 10 patients were assigned to the control group. The patients in the treatment group were all treated with 1565-nm non-ablative fractional laser with the following parameters: spot size 10-16mm, round or square-shaped according to lesional morphology, fluence 20-35mJ/cm2, and density 150-200 microspot/cm2. The treated area was then applied immediately with low-dose compound betamethasone through topical application. Treatment cycles were repeated every month for a total 5months. Photos were taken before the start of the treatment, and then monthly after. Vancouver Scar Scale score was used to evaluate the scar changes; all the patients were followed up for 3 more months after the last treatment. All side effects were documented. The patients in the control group received no treatment at all. All the parameters were recorded as the same as the treatment group. The total VSS score after the combination therapy is 0.96 ± 1.53, which in comparison with prior treatment VSS score 8.86 ± 1.43, showed a significant reduction following the treatments (P < 0.001). The control group without any treatment shows VSS score 7.10 ± 0.99 at the end of the study vs VSS score 7.70 ± 0.82 at the start of the study (P > 0.05). The patient satisfaction rate reaches 89.2% after treatment, The major side effects reported include 3 patients with post-inflammatory hyperpigmentation (10.7% of patients in the treatment group), and other minor discomfort such as transient warmth, erythema, and swelling of treatment sites. The combination approach using 1565-nm non-ablative laser and low dose of local application of compound betamethasone can effectively improve the immature red hypertrophic scar with no significant side effects; this should provide our practitioners with a new weapon in fighting those hard-to-manage early scar formations.

Clinical features and the outcomes evaluation of hypertrophic scar treatment with triamcinolone injection at Can Tho University of Medicine and Pharmacy Hospital

Background: Excessive scarring has both cosmetic and psychological repercussions. Intra- scar injection, for example, makes a significant contribution to enhancing treatment efficiency.&#x0D; Objectives: To describe the morphological features, categorize, and assessing the effects of Triamcinolone injection therapy of hypertrophic scars. Materials and methods: A cross-sectional descriptive study of 80 patients with hypertrophic scars treated with triamcinolone intralesional injection at Can Tho University of Medicine and Pharmacy Hospital from 5/2018 to 5/2021. Results: There were 80 patients in all, with a male/female ratio of 1/1.05 and a median age of 15-35. There were 129 scars in all, with scar age &gt;1 year accounting for 83%, keloid scars accounting for 64%, and hypertrophic scars accounting for the remaining 36 percent. Scars are most commonly seen on the trunk, accounting for 53.5 percent of all scars, particularly on the anterior chest wall. When the source of scars was discovered, trauma and acne accounted for 24% and 23%, respectively, while the rest were predominantly spontaneous scars, accounting for 49%. Scarring and discomfort of mild to moderate severity were common clinical symptoms; scars larger than 5cm in size had more symptoms than scars smaller than 5cm. Prior to the therapy, the mean Vancouver Score Scale-VSS was 6.55±2.13. After 24 weeks of the therapy, 96.7% of patients had entirely improved itching symptoms, 75% had completely improved pain, and 25% still had minimal pain. After therapy, the mean Vancouver Score Scale-VSS was 2.55±1.81 (p&lt;0.05). At week 24, 3.75% of patients experienced skin shrinkage, 3.75% experienced depigmentation, and 13.75% experienced vasodilation. Conclusion: Triamcinolone intralesional injection should be utilized as a first-line therapy for hypertrophic scarring.

Use of Lidocaine Analgesia Prior To Steroid Injection in Reducing Post-Traumatic Hypertrophic Scars

Background and Aim: Hypertrophic scars are painful and can develop after surgery or trauma, with symptoms varying from an intractable allodynia to minor itch. Extraneural and intraneutral structures could be involved in painful scars issue. The standard treatment for hypertrophic scars is intralesional steroid injections. The present study aimed to investigate the lidocaine analgesia for pain relief in post-traumatic hypertrophic scars. Place and Duration: Burn Centre Dr Ruth K.M. Pfao Civil Hospital, Karachi and the department of Plastics and Burn Surgery, Bolan Medical Complex Hospital, Quetta during the period from October 2020 to September 2021. Methodology: Thirty-five patients with post-traumatic hypertrophic scars were enrolled in this study. Steroids were injected through scars with or without Lidocaine (-10°C) applications for 15 seconds. Ethical approval was taken from the institutional ethical committee. In this experimental protocol, two arms were used. In the first arm, two scars on the same patient's body were randomly assigned as control or experimental scars. Patients were used as their own controls because everyone experiences pain differently. Scars were injected into patients once a month, and pain intensity scores were recorded after each injection. A visual analog score (VAS) was used for the evaluation of pain severity or degree in each individual. Results: Of the total 35 hypertrophic scars patients, about 23 (65.7%) and 12 (34.3%) were females and male respectively. The overall mean age was 32.67±5.83 years. All the hypertrophic scars patients with age ranges from 20 to 65 years were enrolled. Of the total lesions, the presence of hypertrophic scars on the arms, shoulder, back, and chest were 7 (20%), 3 (8.6%), 9 (25.7%), and 16 (45.7%) respectively. The visual analogue score for control and pretreated was 2.8±1.42 and 7.91±1.29 respectively. The VAS pain score was significantly associated (p&lt;0.1) with difference in VAS score of control and pretreated scars. Conclusion: The present study found that lidocaine analgesia provides significant pain relief in post-traumatic hypertrophic scars prior to steroid injection. It also provides a safe and effective way for enhancing the management of disease and patient compliance. Keywords: Hypertrophic scars, Lidocaine Analgesia, Pain relief, Steroid Injection.

β-Elemene induces apoptosis by activating the P53 pathway in human hypertrophic scar fibroblasts.

Hypertrophic scar (HS) is a condition characterized by excessive synthesis and deposition of collagen. There are many clinical methods to alleviate HS, but most of them are accompanied by many complications. To investigate the effects of β-Elemene, extracted from the ginger family plant Wenyujin, on human hypertrophic scar fibroblast (hHSFs). Cultured hHSFs and human normal fibroblasts, observed the effect of β-Elemene on apoptosis, extracellular matrix, and endoplasmic reticulum stress (ERS) by western blot, Real Time-Polymerase Chain Reaction (RT-PCR), and flow cytometry. Based on our findings, it is clear that β-Elemene could inhibit the expression of α-smooth muscle actin (α-SMA), collagen I, and fibronectin, reduced collagen deposition. Further studies had found that β-Elemene could increase the expression of ERS-related proteins CHOP and Calnexin in a dose-dependent manner, thereby promoting the aggregation of cleaved-caspase-3 and inducing hHSFs to undergo poptosis. This process may depend on the regulation of P53. The results of our study indicates that β-Elemene induced hHSFs to undergo apoptosis though ERS pathway in a P53-dependent manner, which means that our research provided a new strategy for the development of drugs for the treatment of HS.

95 Incidence of Hypertrophic Scar Diagnosis in Burn Patients Prescribed Glucocorticoids

IntroductionDespite advancements in burn care, the optimal treatment to prevent or treat hypertrophic scars is still elusive. Therefore, the objective of this study is to compare the efficacy of five glucocorticoid medications commonly used in the treatment of hypertrophic scarring in burned patients using a large patient database.MethodsPatients diagnosed with hypertrophic scarring, hypertrophic disorders of the skin, or scar conditions and fibrosis of skin at least one day after burn injury were identified in the TriNetX database. Hydrocortisone, methylprednisolone, dexamethasone, triamcinolone, and prednisone were the glucocorticoids investigated. Those who received a glucocorticoid on the same day or any time after the incidence of burn injury were compared to those who did not take glucocorticoids in the previous five years. Patients were stratified into four groups based on percent total body surface area (TBSA) burned: 0-9%, 10-19%, 20-39%, and 40-100%. A total of 165,041 burned patients were found who did not receive glucocorticoids, and 66,652 burn patients who received glucocorticoids after injury. Statistical analysis for comparison included a risk ratio with a significance defined as a p-value < 0.05.ResultsIn all burn patients identified, the risk of hypertrophic scarring diagnosis was reduced with methylprednisolone (RR=0.60, p< 0.001) and prednisone (RR=0.37, p< 0.001), while it was increased with dexamethasone (RR=2.48, p< 0.001). Stratification based on %TBSA burned showed that diagnosis of hypertrophic scarring was reduced in the < 10% TBSA group with methylprednisolone (RR=0.49, p< 0.001) and prednisone (RR=0.33, p< 0.001), while it was increased with dexamethasone (RR=3.6, p< 0.001). Similarly, in the 10-19% TBSA group, the risk was reduced with prednisone (RR=0.57, p=0.024) while increased with dexamethasone (RR=2.2, p< 0.001). No significant effect was observed with hydrocortisone or triamcinolone with any of the %TBSA groups examined. Patients treated with dexamethasone continued to show increased risk for hypertrophic scar diagnosis with 20-39% TBSA (RR=1.69, p< 0.001) and 40-100% TBSA (RR=1.87, p< 0.001).ConclusionsWhile methylprednisolone and prednisone decreased the risk of hypertrophic scarring diagnosis among all burn patients identified, dexamethasone showed an increased risk of hypertrophic scarring diagnosis in all burn patients and in each %TBSA stratified group.

595 Hypochlorous Acid for Skin Preparation in Fractional Ablative CO2 Laser Treatment of Burn Scars

IntroductionWhile complications from fractional ablative CO2 laser treatment for burn hypertrophic scar (HTS) are relatively rare, the risk of surgical site infection (SSI) after laser treatment exists. When infection occurs, it has been linked to further morbidity, such as scar development in previously unaffected skin. Hypochlorous acid is a non-flammable and colorless antiseptic solution that has been used to treat wounds and is believed to be a less cytotoxic alternative to other agents such as betadine and chlorhexidine. This study aims to investigate the use of hypochlorous acid solution as a skin prep for patients undergoing laser scar revision for HTS and determine its efficacy in preventing SSI.MethodsAll patients undergoing fractional ablative CO2 laser revision of HTS at a single center from September 2016 through September 2021 were retrospectively reviewed. Data pertaining to patient demographics, skin characteristics, treatment sessions, and post-treatment complications were recorded. All patients underwent topical skin preparation with hypochlorous acid-soaked laparotomy pads for 10 minutes before laser treatment. No perioperative oral or topical antibiotics were given to any included patient. Patients were excluded from analysis if they were not treated with a fractional ablative CO2 laser, were treated for a scar etiology outside of burn injury, or if insufficient follow-up was documented.ResultsA total of 208 patients undergoing a total of 758 laser treatments were identified. Average patient age was 45 years (SD 16), with 112 (53.8%) patients being female and 96 (46.2%) being male. Median number of laser treatments was 3 (IQR: 1-5). Patients from all Fitzpatrick skin types were treated, with the most common type being type 5 (n=54, 26.0%). None (n=0, 0.0%) of the 208 patients experienced a surgical site infection after any of the laser treatments received.ConclusionsHypochlorous acid is a safe and effective skin preparation for patients undergoing laser burn-scar revision to prevent SSI. Moreover it is non-flammable, colorless and does not need to dry prior to procedure.

723 Carbon Dioxide Laser Treatment Practices for Hypertrophic Burn Scars Amongst American Burn Association Burn Centers

IntroductionScarring is a major outcome of severe burn wound healing. Severe scars often persist and diminish quality of life by disfigurement, pain, and pruritis. In the last decade, utilization of ablative fractional carbon dioxide (CO2) laser therapy has become a popular treatment modality for severe burn scars. Although the efficacy of CO2 lasers for the treatment of hypertrophic burn scars has been established via systematic reviews, there have been no attempts to query the 63 American Burn Association (ABA) centers across the United States regarding specific treatment parameters involving serious, sometimes high, total body surface area (TBSA) burns.MethodsThroughout October and November of 2020, a Qualtrics survey consisting of 14 questions was administered to burn surgeons practicing at all 63 ABA burn centers across the United States. Topics assessed were specific laser parameters utilized (5), treatment preferences (2), peri-operative follow-up (5), scar assessment practices (1), and TBSA treatment tolerance (1).ResultsExploratory, descriptive data was analyzed. Surgeons practicing at 27 of the 63 total ABA burn centers responded to the survey (43% response rate). Data elucidates the level of variance regarding current initial management of hypertrophic burn scars via CO2 laser treatment. Surgeons demonstrated variation in the level of TBSA treatment tolerance and pulse energy settings, respectively.ConclusionsOur findings show a substantial amount of variation in several aspects of CO2 laser hypertrophic scar revision between ABA centers across the country, including preoperative evaluation, laser settings, treatment regimen, and postoperative recommendations . Standardization of care when utilizing ablative fractional CO2 lasers should be further explored.

537 Laser-Assisted Drug Delivery in the Treatment of Hypertrophic and Keloid Scars: A Systematic Review

IntroductionHypertrophic scars (HTS) and keloids (K) cause significant morbidity and disfigurement. Care of HTS and keloids range from less invasive treatments, such as pressure garments and silicone products, to more invasive treatments, such as intralesional injections (ISI) of medication, and surgical excision. Laser-Assisted Drug Delivery (LADD) is becoming a more popular treatment for HTS and K. The ablative fractional laser creates microchannels in the skins which allows the delivery of drugs into deeper skin layers. We have conducted a systematic review of the literature to assess the effectiveness of LADD in the treatment of HTS and K.MethodsA search was performed on PubMed between January 1998-August 2021 using the following keywords: Laser Assisted Drug Delivery, Laser Combined Drug Delivery, Laser Drug Delivery, Laser Drug, Hypertrophic, Burn, Keloid, Scar. Inclusion criteria was the use of LADD in HTS or K. Exclusion criteria were studies in animal models, case reports, reviews, and non-english articles. One article was excluded due to concerns of plagiarism.ResultsA total of 11 articles were included in the final review. One study found no difference in HTS outcomes between LADD of corticosteroids (CTS) and laser with topical petrolatum used as a control. Two prospective studies found that LADD of CTS led to improved HTS outcomes. Two split-scar studies found no difference in K outcomes between LADD of CTS and ISI of CTS. One prospective study assessed LADD of CTS in K and found statistically significant improvements in scar outcomes. A retrospective study looking at K outcomes found a 50% mean improvement when treated with LADD of CTS. A split-scar study found statistically significant better HTS outcomes with LADD of 5-FU compared to topical 5-FU alone. One study found no difference in HTS outcomes between LADD of CTS and 5-Fluorouracil (5-FU). Two studies assessed both HTS and K. The first study found that both LADD of 5-FU and LADD of CTS led to significantly better scar outcomes when compared to laser monotherapy. The other reported that HTS outcomes were significantly better with LADD of Botulinum toxin A and K outcomes were better with ISI of Botulinum Toxin A.ConclusionsThe use of LADD is effective in the setting of HTS. There is evidence that LADD of scar modulating agents to HTS lesions is more effective than topical delivery or ISI of the same agent. LADD shows promise as an alternative treatment for K as it displays similar efficacy as ISI.

596 Implementation of a Burn Laser Program at a Children’s Hospital

IntroductionCarbon dioxide ablative fractional laser (CO2-AFL) therapy has become standard of care for adult burn hypertrophic scars (HTS). This therapy option has not been widely adopted in pediatric burn care and no established guidelines for treatment protocols have been published. We sought to modify our American Burn Associated Adult Verified Burn Centers laser protocol at our Children’s Hospital with hopes to provide optimal care to our pediatric burn population. We present our protocol and early experience of CO2-AFL therapy for pediatric burn HTS.MethodsWe conducted a retrospective chart review of pediatric burn patients undergoing CO2-AFL treatment of HTS during the study period of Jan 2021-Oct 2021. Pediatric burn patients were offered laser treatment if their scars were symptomatic with patient complaints of HTS, pruritis, neuropathic pain, and scar contractures. 37 pediatric patients ≤13 years of age were included in our review.ResultsWe treated 13 pediatric patients for a total of 40 laser sessions with each patient averaging 3 sessions. Of the 13 patients that were treated with laser, 62% (8 of the 13 patients) had split-thickness skin grafting with 38% (3 of the 8 patients) of those having a staged grafting procedure with dermal substitute. 15% (2 of the 13 patients) healed primarily and 15% (2 of the 13 patients) required excision and closure. Only 1 patient treated with ASCS alone required laser therapy. Our protocol requires patients to receive pre-operative Tylenol, Benadryl, Pepcid, and Oxycodone. The patients then received MAC anesthesia with Toradol, Dexamethasone, Ketamine or Propofol, and Zofran. Patients with extensive HTS on the face or neck were intubated for the procedures. Oxycodone and/or Dilaudid were provided if needed in the post-operative phase. All patients were discharged with Tylenol or Motrin and Triamcinolone 0.1% ointment to be applied daily for 48 hours and then 3-4x/day until the follow-up clinic appointment at one week. Patients were able to resume normal activities the day following the procedure.ConclusionsPatients and their parents have reported improvements in pigment, pliability, thickness, and pruritis following laser treatments. We created a protocol that allows on average 8 pediatric patients per day to receive laser treatment without it over burdening the pre-operative and post-operative recovery room nursing staff. We are currently tracking outliers of patients requiring increased post-operative analgesia and/or greater than 1 hour in the recovery phase. With the implementation of a laser protocol, we have successfully introduced laser therapy as a viable option for our pediatric burn survivors.

LINC01605 knockdown induces apoptosis in human Tenon's capsule fibroblasts by inhibiting autophagy.

Glaucoma is an irreversible disease that causes blindness. Formation of a hypertrophic scar (HS) is the main cause of failure of glaucoma surgery. The long non-coding RNA LINC01605 is closely associated with the formation of HS; however, the function of LINC01605 in the formation and development of HS remains unclear. For this study, firstly, human Tenon's capsule fibroblasts (HTFs) and corneal epithelial cells (control cells) were collected from patients (n=5) with POAG who underwent glaucoma filtration surgery at Fuyang People's Hospital. Immunofluorescence analysis was performed to detect the expression levels of vimentin (one of the main components of medium fiber and plays an important role in the cytoskeleton and motility), keratin (the main component of cytoskeletal proteins) and LC3 (an autophagy marker). In addition, reverse transcription-quantitative PCR analysis was performed to detect LINC01605 expression. Besides, the Cell Counting Kit-8 assay was performed to assess the viability of human Tenon's capsule fibroblasts (HTFs). Next, flow cytometry was performed to detect HTF apoptosis. Furthermore, western blot analysis was performed for Bax, Bcl-2, Pro-caspase-3, cleaved caspase-3, phosphorylated (p-)Smad2, Smad2, α-SMA, MMP9, ATG7, p62, beclin 1, p-AMPK and AMPK in HTFs to determine the mechanism by which LINC01605 regulates the formation and development of HS. Moreover, a Transwell assay was performed to detect the migratory ability of HTFs. The results demonstrated that LINC01605 was significantly upregulated in HS tissues compared with that in normal (control/healthy) tissues. In addition, vimentin was highly expressed in HTFs, whereas keratin was expressed at a low level. Also, in HTFs, LINC01605 knockdown inhibited cell viability by inducing apoptosis, decreasing Smad2 activation and inhibiting autophagy. Furthermore, LINC01605 knockdown significantly inhibited the migratory ability of HTFs. Transfection with LINC01605 small interference RNAs significantly downregulated the expression levels of p-Smad2, α-SMA and MMP9 in HTFs. Furthermore, LINC01605 knockdown notably inhibited the viability and migration, and induced the apoptosis of HTFs, the effects of which were reversed following treatment with TGF-β. Taken together, the results of the present study suggested that LINC01605 knockdown may inhibit the viability of HTFs by inducing the apoptotic pathway. These findings may provide novel directions for the treatment of HS.

Clinical effects of in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage in the treatment of hypertrophic scar in non-functional sites after burns

Objective: To investigate the clinical effects of in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage in the treatment of hypertrophic scar in non-functional sites after burns. Methods: A retrospective observational study was used. From June 2017 to June 2019, 33 patients (24 males and 9 females, aged 8-50 years) who met the inclusion criteria with hypertrophic scars in non-functional sites outside the face after burns were treated in General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University). All patients underwent scalp transplantation after perforation of retained split scar matrix in situ (with scar thinning area of 90-500 cm2), and then the vacuum sealing drainage was performed. The hematoma and infection of wounds were observed on the 7th day after operation. At the same time, the survival rate of skin grafting was observed and calculated. The flatness and thickness of the scar in the operative area were observed in 12 months after operation, and the itching and pain of the patients were recorded. Vancouver Scar Scale was used to score the scar of patients before operation and at 3, 6 and 12 months after operation. The healing time and hair growth of donor site were observed. Data were statistically analyzed with repeated analysis of variance, paired sample t test and bonferroni correction. Results: On the 7th day after operation, local subcutaneous hematoma appeared in the wound of 2 patients, which healed after dressing change; no infection occurred. On the 7th day after operation, the survival rate of skin grafting of patients was 94.6%-99.0%(96.8±1.2)%. Scar flatness was well, the thickness of scar was not significantly higher than that of normal skin in 12 months after operation, and the symptoms of itching pain of patients disappeared or significantly relieved. Vancouver Scar Scale scores of patients before operation and at 3, 6, and 12 months after operation were 12.1±2.8, 8.5±1.5, 7.6±1.6, 6.7±1.3, respectively, and the scores of 3, 6, and 12 months after operation were all significantly lower than that before operation (with t values of 4.48, 4.06, and 3.97, respectively, P<0.01). All the donor sites of the head healed well in 4-7 days after operation. By 3-6 months after operation, all patients had good hair growth in the donor site and achieved no scar healing. Conclusions: The treatment of hypertrophic scar in non-functional sites outside the face after burns by in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage can effectively improve the appearance of hypertrophic scar in non-functional areas after burn and reduce its degree of hyperplasia, with scar-free donor site healing.

A one-time pneumatic jet-injection of 5-fluorouracil and triamcinolone acetonide for treatment of hypertrophic scars-A blinded randomized controlled trial.

Patients with hypertrophic scars (HTS) risk reduced quality of life due to itching, pain, poor cosmesis, and restriction of movement. Despite good clinical efficacy, patients are often reluctant to undergo repeated needle injections due to pain or needle phobia. To evaluatethe applicability of needle-free pneumatic jet injection (PJI) and assesschanges in hypertrophic scars following a single PJI treatment with 5-fluorouracil (5-FU) and triamcinolone acetonide (TAC). Twenty patients completed this blinded, randomized, controlled, split-scar trial. The intervention side of the HTS received a one-time treatment with PJIs containing a mixture of TAC + 5-FU injected at 5 mm intervals (mean 7 PJI per HTS); the control side received no treatment. Assessments were made at baseline and 4 weeks posttreatment. Outcome measures included change in (1) Vancouver Scar Scale (VSS) total score and subscores, (2) scar volume and surface area assessed by three-dimensional imaging, (3) skin microarchitecture measured by optical-coherence tomography (OCT), (4) photo-assessed scar cosmesis (0-100), (5) patient-reported pain and satisfaction (0-10), and (6) depiction of drug biodistribution after PJI. PJI with TAC + 5-FU significantly decreased both HTS height (-1 VSS; p = 0.01) and pliability (-1 VSS; p < 0.01) with a nonstatistically significant reduction of -1 in total VSS score (0 in control; p = 0.09). On 3D imaging, a 33% decrease in scar volume (p = 0.016) and a 37% decrease in surface area (p = 0.008) was observed. OCT indicated trends towards smoother scar surface (Ra 11.1-10.3; p = 0.61), normalized dermal microarchitecture (attenuation coefficient: 1.52-1.68; p = 0.44), and a reduction in blood flow between 9% and 17% (p = 0.50-0.79). Despite advances in VSS subscores and OCT, no improved photo-assessed cosmesis was found (-3.2 treatment vs. -1.4 control; p = 0.265). Patient-reported pain was low (2/10) and 90% of the patients that had previously received needle injections preferred PJI to needle injection. Depositions of TAC + FU were imaged reaching deep into the scar at levels corresponding to the reticular dermis. A single PJI injection containing 5-FU and TAC can significantly improve the height and pliability of HTS. PJI is favored by the patients and may serve as a complement to conventional needle injections, especially for patients with needle phobia.

Low-cost alternative approaches for pressure garments for keloid treatment

Pressure garment therapy has been used in both the prevention and treatment of keloids and hypertrophic scars.1 Pressure garment therapy is highly dependent on its correct use to exert its effects; it should be in close contact with the whole scar, it should be used for several hours per day, and it should promote scar blanching.2 However, garments can be costly for the lower-income population or unavailable in remote areas of a few countries. Another difficulty found with pressure garment therapy is that garments sometimes do not properly adapt in close contact with the whole scar, on certain anatomical areas, such as the medial chest area, slightly depressed compared with the breasts, or the ears, where earrings might not properly fit larger keloids.

A scoping review of the treatment of hypertrophic scars and keloids

AbstractHypertrophic scars and keloids are both conditions that represent an abnormal healing response by skin in response to some form of trauma. They are a cause of significant morbidity and psychological distress to patients. The costs associated with treating these conditions are considerable and had already reached 12 billion US dollars per annum by 2009. The lack of a well‐established treatment to reliably and effectively treat these conditions is demonstrated by the multitude of different treatments available. This scoping review aimed to review the treatment landscape available for hypertrophic scars and keloids to provide an overview of this varied field. A total of 113 studies representing 5211 participants were located. We identified over 40 different treatments utilised in the treatment of established scars and prophylactically to prevent scarring of wounds and burns. The heterogeneity of study design in terms of control arms, comparators, and outcome measures means that direct comparison of studies across the identified studies is difficult. While a large number of interventions were shown to have a beneficial effect compared with no treatment, there was no clear treatment that was both sufficiently effective and useable to have achieved widespread usage. This study highlights the wide variety of treatments available for hypertrophic scars and keloids. Future work will concentrate on more specific questions which will lend themselves to more detailed investigation using techniques such as network meta‐analysis. Future studies of treatments for hypertrophic scars and keloids should also ensure they are designed to allow for easy comparison with other studies.

Co-delivery of triamcinolone acetonide and verapamil for synergistic treatment of hypertrophic scars via carboxymethyl chitosan and Bletilla striata polysaccharide-based microneedles

Hypertrophic scar (HS) is a frequently diagnosed skin disease that is difficult to treat. HS is usually associated with itching and pain and causes both physical and psychological issues. In this study, a safe, convenient, and efficient therapy for HS is developed. Carboxymethyl chitosan (CMCH) and Bletilla striata polysaccharide (BSP) are used to prepare microneedles (MN) via a micro-molding method. Hydroxypropyl β-cyclodextrin (HP-β-CD) is used to encapsulate triamcinolone acetonide (TA) and the obtained inclusion is co-loaded with verapamil (VRP) to MN. The MN is then attached to an Ethyl cellulose (EC) base layer to obtain a MN patch. The MN patch has uniform needles, sufficient mechanical strength, good penetration and dissolution in skin, and low cytotoxicity. It also significantly decreases the thickness of HS, and hydroxyproline (HYP) and transforming growth factor-beta 1 (TGF-β1) expression in HS, improves collagen fiber arrangement, and reduces dermis congestion and hyperplasia.

Management of hypertrophic scars in adults: A systematic review and meta-analysis.

Hypertrophic scars (HTS) are elevated scars which occur due to abnormalities in wound healing after injury and may be associated with pain, pruritus and functional impairment. Despite multiple available treatment options, there is no universal approach to treating HTS. We searched the Web of Science (Core Collection), MEDLINE and EMBASE databases. Title, abstract and full-text screening, along with data extraction, were performed in duplicate. Risk of bias was assessed using the Cochrane risk-of-bias tool. The Vancouver Scar Scale (VSS) scores and mean differences were used for meta-analysis. We screened 3800 abstracts and included 34 randomised controlled trials evaluating treatments for HTS in adults. Silicone and laser modalities improved VSS scores by 5.06 (95% CI: 6.78, 3.34) and 3.56 (95% CI: 5.58, 1.54), respectively. Intralesional triamcinolone combined with silicone or 5-fluorouracil was superior to intralesional triamcinolone monotherapy. Limitations of this study include exclusion of studies which did not utilise VSS, and pooling of studies based on common modalities. Further studies are needed to examine the efficacy of existing and emerging treatment modalities for HTS. Our study supports the treatment of HTS in adults with silicone gel or sheets, injected triamcinolone (preferably combined with 5-fluorouracil or silicone products), pulsed dye laser and fractionated CO2 laser.