• Archives of Plastic Surgery
• /
• v.49 no.4
• /
• pp.554-560
• /
• 2022

Background Hypertrophic scars cause aesthetic concerns and negatively affect the quality of life. A gold standard treatment for hypertrophic scars has not been established due to various responses of modalities. Extracorporeal shock wave therapy (ESWT) is a noninvasive and affects scar remodeling by fibroblast regulation. This study investigated the effectiveness of ESWT for hypertrophic scars. Methods Twenty-nine patients were enrolled. All patients underwent ESWT once a week for 6 consecutive weeks. Their scars were assessed using the Patient and Observer Scar Assessment Scale (POSAS), erythema index, melanin index, and scar pliability before treatment and again 4 weeks after treatment completion. Results Thirty-four hypertrophic scars in this study had persisted for between 6 months and 30 years. Most scars developed after surgical incision (55.88%). The chest and upper extremities were the predominant areas of occurrence (35.29% each). Most of the POSAS subscales and total scores were significantly improved 4 weeks after treatment (p < 0.05). Furthermore, the pain, itching, and pigmentation subscale were improved. The pliability, melanin index, and erythema index were also improved, but without significance. The patients were satisfied with the results and symptoms alleviation, although subjective score changes were insignificant. No serious adverse events were found. The patients reported pruritus in 62.5% and good pain tolerance in 37.5%. Subgroup analyses found no differences in scar etiologies or properties at different parts of the body. Conclusion The ESWT is a modality for hypertrophic scar treatment with promising results. Most of POSAS subscales were significantly improved.

• Archives of Plastic Surgery
• /
• v.37 no.4
• /
• pp.317-322
• /
• 2010

Purpose: There is no clear evidence of the original cause of hypertrophic scar, and the effective method of treatment is not yet established. Recently the steps of searching in gene and molecular level are proceeding. we are trying to recognize the difference between keratinocytes of hypertrophic scar and normal skin. Then we do support the comprehension of the scar formation mechanism and scar management. Methods: Total RNAs were extracted from cultured keratinocytes from 4 hypertrophic scars and normal skins. The cDNA chips were prepared. A total of 3063 cDNAs from human cDNA library were arrayed. And the scanning data were analyzed. Results: On microarray, heat shock protein, pyruvate kinase, tumor rejection antigen were more than 2 fold intensity genes. Among them, heat shock 70 kd protein showed the strongest intensity difference. Conclusion: In this study, it can be concluded that heat shock proteins play an important role in the process of wound healing and scar formation. This study provides basic biologic information for scar research. The new way of the prevention and treatment of scar formation would be introduced with further investigations.

• Archives of Plastic Surgery
• /
• v.43 no.6
• /
• pp.491-497
• /
• 2016

Background Hypertrophic scarring is a pathological condition that occurs after trauma or surgery. Angiogenesis occurs more often with hypertrophic scarring than with normotrophic scarring. The regulation of angiogenesis is one of the key factors in hypertrophic scar management. Vascular endothelial growth factor (VEGF) is an essential factor in the angiogenetic response. This study investigated whether decreasing the level of VEGF is effective for treating hypertrophic scarring. Methods Ten 8-week-old female New Zealand white rabbits were included. Four defects were created on each ear by using a 6-mm punch. Bevacizumab (Avastin, Roche Pharma, Basel, Switzerland) was administered in one ear and normal saline was administered in the other ear. Treatment was administered starting on day 2, every 2 days, until day 14. The levels of VEGF were measured using enzyme-linked immunosorbent assay on day 10 and histologic results were analyzed on day 40. Results Bevacizumab induced-defects showed less hypertrophic scarring when compared with the control group as measured by the scar elevation index (SEI) and loose collagen arrangement. The SEI in the experimental group was $1.89{\pm}0.13$, compared to $1.99{\pm}0.13$ in the control group (n=30, P=0.005). Additionally, the VEGF level was lower ($38.72{\pm}11.03pg$ vs. $82.50{\pm}21.64pg$, n=10, P=0.001) and fewer vessels existed ($8.58{\pm}0.76$ vs. $7.2{\pm}1.20$, n=10, P=0.007). Conclusions Preventing excessive angiogenesis is effective for preventing scar formation, especially with hypertrophic scarring. Although it is not an approach that is sufficient alone for the management of scarring, it may be one of several important strategies for scar treatment.

• Archives of Craniofacial Surgery
• /
• v.19 no.2
• /
• pp.120-126
• /
• 2018

Background: Minimizing scarring has long been a challenge in plastic surgery. Factors affecting scar formation are well known, but the effect of some patient-specific factors such as dermal thickness remains unverified. Management of factors predictive of scarring can improve postoperative patient satisfaction and scar treatment. Methods: For 3 years, we used ultrasonography to measure dermal thickness in female patients who had undergone thyroidectomy for cancer at our hospital. We confirmed the influence of dermal thickness on hypertrophic scar formation and the Patient and Observer Scar Assessment Scale scar score 6 months after surgery. Results: There was a positive correlation between dermal thickness and scar score (p<0.05), and dermal thickness appears to be a cause of hypertrophic scar formation (p<0.05). Conclusion: Thick dermis was found to cause poor scar formation and hypertrophic scarring. Prediction of factors that can influence scar formation can be used to educate patients before surgery and can help in scar management and improvement in patient satisfaction.

• Archives of Plastic Surgery
• /
• v.33 no.6
• /
• pp.700-705
• /
• 2006

Purpose: For hypertrophic scars and keloids no universally effective treatment modality exists. Surgical revision, intralesional steroid injection, silicone gel sheeting, pressure, laser, and others have been used with variable success, but many treatments are associated with high recurrence rates. Although optimal treatment remains undefined, successful treatment can be obtained through a combined therapeutic approach. Methods: We used three therapeutic modalities in combination, which are intralesional injection of triamcinolone acetonide, silicone gel sheeting, and 585 nm flashlamp-pumped pulsed dye laser. Fifty-eight cases of hypertrophic or keloid scar were treated by combined therapeutic regimen for mean period of 18 months. The changes of thickness, color, and pliability of scars were evaluated with clinical photographs by grading scale. Results: As summing the grades and categorizing the result into three group, we obtained 28% good, 67% fair, and 5% poor results. There was a desirable improvement of scars with insignificant adverse effects. Conclusion: Combination of intralesional steroid injection, silicone gel sheeting, and pulsed dye laser can lead to successful treatment of hypertrophic scar and keloid.

• Medical Lasers
• /
• v.8 no.2
• /
• pp.90-93
• /
• 2019

The treatment of keloid and hypertrophic scars (HTSs) remains one of the most difficult challenges, with a high recurrence rate regardless of the method of treatment. The latest trend in scar management is a combined approach using multiple modalities that are individualized to the patient and that would provide successful results for keloid and HTSs. There are previous reports that stromal vascular fraction (SVF) is effective for scar remodeling. Based on these reports, we introduced the concept of a combination treatment using SVF injection and fractional ablative CO₂ laser. In this report, we present a 21-year-old woman who was involved in a car accident. A defect on her foot was covered with a skin graft, but the scars became elevated, which turned out to be HTSs. She was treated with a fractional ablative CO₂ laser for five sessions. A month later, SVF injection and fractional ablative CO₂ laser were conducted simultaneously. The result of a year's follow-up showed a flattened scar with resolution of pigment deposition. In conclusion, the combination treatment for HTSs with SVF injection and ablative fractional CO₂ laser is one of the modalities to achieve an excellent outcome for treating HTS.

• Applied Microscopy
• /
• v.3 no.1
• /
• pp.29-38
• /
• 1973

Introduction. The human cutaneous scars manifest themselves many ways in different types according to the factors such as the age, sex, race of the patient as well as the location,. kind and heal ing process of the wound. Among the scars it is quiet difficult to verify the clinical course of the hypertrophic or keloidal scars from the true keloids. However, clinical observations indicate that stress, either mechanical or in the forms of chronic infections, can induce a functional change in the fibroblasts causing an excessive production of collagenous matrix. In this study, we preliminary attempt to justify any difference of the cellular structure between keloids and hypertrophic scars by using electron microscope. Material and Methods. A total of 23 cases: 2 scars, 2 hypertrophic scars and 19 keloids are examined. Immediately, the biopsy tissue was fixed in 10% neutral formalin and 4% glutaraldehyde solution in phosphate buffer for 4 hours, post fixed in 1 % osmium tetraoxide for two hours, dehydrated with graded alcohol, and embedded in Epon 812. Thick sections were stained with hematoxylin eosin, periodic acid-Schiff(PAS) and Van Gieson stain. Thin sections were cut and uranyle acetate, lead citratestain and examined with the electron microscope. Result. The morphologic features of keloid showed thick, homogenously eosinophilic bands of collagen and numberous large active fibroblasts. The hypertrophic scar and soft scar are more cellular than keloid and composed thinner collagenous fiber. For this paper in the etiology of keloids can not as be defined, but and interesting keloidal tissue fibroblast showed irregular nucleus with irregular shape dense bodies and fibril materials contained in to the cytoplasm.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.21 no.1
• /
• pp.23-28
• /
• 1999

ALP (alkaline phosphatase) is a membrane-bound metalloenzyme that is expressed in osteoblasts, hepatocytes, lung, kidney, endothelial cells, leukocytes and other cells. Normal soft tissue and skin show little tissue nonspecific ALP (TN-AP), However, scar tissue contains high levels of TN-AP activity, and in fact, TN-AP is expressed intensely in regenerating connective tissue after the wounding. The purpose of this study was to evaluate the change of ALP expression in hypertrophic scar model in rabbits and the effect of triamcinonolone on ALP expression. Adult male New Zealand white rabbits, weighing about 2.5 kg, were used. After full-thickeness wounding over the ventral surface of each ear, either saline (control ear) or triamcinolone (contralateral ear) was injected on day 16. Rabbits were sacrificed on day 3, 7, 15, 17, 19, 23, and the specimens were retrieved en bloc. Histologic and immunohistochemical examinations of tissue samples were done. The results obtained were as follows: On day 3, ALP reaction was observed on fibroblasts and inflammatory cells in wound margin. On day 7, ALP reaction was more intense than day p in capillaries, inflammtory cells, and fibroblasts behind newly formed epithelium. On day 15, ALP reaction was lessened in both groups and appeared mainly in subepidermal capillary network, Since day 17, ALP reaction was lessened in both groups and weaker in triamcinolone-injected group than in saline-injected group. These results suggest that ALP reaction isn't increased in triamcinolone-injected scar and triamcinolone reduces scar not by increasing TN-AP expression but other mechanism.

• Maxillofacial Plastic and Reconstructive Surgery
• /
• v.34 no.6
• /
• pp.494-497
• /
• 2012

Traumatic lacerations are common in the orofacial region as a result of accidents. Due to the frequent movement of the skin around the mandible, scars in that area are more likely to widen or become hypertrophic. Treatment of facial laceration was performed on three patients and followed by regular check-up. It was discovered that the scars have become hypertrophic, so steroid injections were used. The results were satisfactory with the decrease in sizes and hardnes of the scar. Facial scarring is a particularly distressing phenomenon and has always been a challenge to treat as the scars are more likely to widen or become hyphertrophied due to the frequent movement of the muscle in the facial area. We confirmed that the positive effect of steroid on hypertrophic scars. So, we suggest that proper treatment and periodic follow-up, adjuvant treatments especially steroid injection is necessary in patients with lacerations.

• Archives of Plastic Surgery
• /
• v.48 no.6
• /
• pp.678-684
• /
• 2021

Background A car-tire friction injury on the dorsum of a child's foot often results in hypertrophic scarring of the wound margins. This study describes the clinical appearance of the injured areas and surgical complications that occurred during the follow-up period in a series of children with car-tire friction injuries who were treated with split-thickness skin grafts (STSGs). We describe the clinical features that we believe need to be highlighted when initially treating car-tire injuries in children. Methods From May 2003 to June 2016, our retrospective study included 15 patients with car-tire injuries on the dorsum of the foot who were treated with surgical excision and STSG to cover the wound. Results A total of 15 patients with car-tire injuries were treated. The average age was 6.26 years old. The average injury grade was 3.26. Two patients were treated using delayed repair, and 13 patients received STSG for initial management. Four patients experienced no complications, while 11 patients had hypertrophic scars and/or scar contracture after surgery. Conclusions A car-tire friction injury on the dorsum of a child's foot often results in hypertrophic scar formation or scar contracture even if proper management is undertaken. Since the occurrence of these complications in childhood can lead to a secondary deformity, it is important to properly treat car-tire friction wounds, inform patients and caregivers about potential complications, and ensure regular follow-up evaluations over a 12-month period following the initial surgery.