Legislative Documents

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Scar roughness (Rz) as a function of time and treatment.

<p>Groups which received PGT were significantly smoother than controls at week 17. Cessation of PGT resulting in an increase in surface roughness versus the continuous pressure group. Photographs of scar replicas at week 29 (<i>Right)</i> illustrating the differences in surface texture. Scars treated with continuous PGT were comprised of very fine wrinkles whereas the released and control groups had much larger scale roughness. All images at the same magnification. Scale bar = 1 cm. N = 8 per group.</p

Early cessation of pressure garment therapy results in scar contraction and thickening - Fig 7

<p><b>Representative images from trichrome stained histological sections prior to pressure release (left) and at the final time point (right).</b> Pressure garment therapy resulted in less dense matrix deposition, indicated by a lighter blue stain. Over time, collagen deposition increased in all groups, but the density was greater in the pressure released and control groups at week 29. Scale bar = 750 μm.</p

Scar area as a function of time and treatment.

<p>Scar area was normalized to the area of each individual scar at week 0 to obtain a percent of the original area. Pressure garment therapy was stopped at week 17 in the pressure released group, indicated by the red arrow. Cessation of PGT resulted in rapid contraction of the skin with scars in the pressure released group exhibiting similar scar areas as untreated controls by week 29 post injury. N = 8 per group.</p

Histological sections of scars cut <i>en face</i> showing extracellular matrix organization as a function of treatment and time.

<p>Collagen fibers in the groups receiving pressure garment therapy (PGT) were oriented in two primary directions whereas controls were oriented parallel to the circumference of the pig (the vertical axis in each image). After cessation of PGT, collagen fibers within the pressure released group became more uniformly oriented in one direction. This increase in alignment continued until the end of the experiment (Week 29).</p

Scar height with respect to the levels of the surrounding normal skin.

<p>Negative values represent scars that were depressed with respect to the surrounding tissue and positive values indicate raised scars. Cessation of pressure garment at week 17 resulted in significant scar thickening to raise the scar close to the level of the surrounding tissue. N = 8 per group except N = 7 for Continuous Pressure at week 17.</p

Representative images of scars.

<p>Scars were either treated continuously with pressure garment therapy (continuous pressure), or pressure garment therapy was halted at week 17 (pressure released). Control scars did not receive any treatment. Pressure garment therapy (PGT) resulted in smoother, less contracted scars; however, when pressure was removed at 17 weeks scars became visibly contracted within 4 weeks post therapy cessation. Scale bar = 2 cm.</p

Early cessation of pressure garment therapy results in scar contraction and thickening

<div><p>Pressure garment therapy is often prescribed to improve scar properties following full-thickness burn injuries. Pressure garment therapy is generally recommended for long periods of time following injury (1–2 years), though it is plagued by extremely low patient compliance. The goal of this study was to examine the effects of early cessation of pressure garment therapy on scar properties. Full-thickness burn injuries were created along the dorsum of red Duroc pigs. The burn eschar was excised and wound sites autografted with split-thickness skin. Scars were treated with pressure garments within 1 week of injury and pressure was maintained for either 29 weeks (continuous pressure) or for 17 weeks followed by cessation of pressure for an additional 12 weeks (pressure released); scars receiving no treatment served as controls. Scars that underwent pressure garment therapy were significantly smoother and less contracted with decreased scar height compared to control scars at 17 weeks. These benefits were maintained in the continuous pressure group until week 29. In the pressure released group, grafts significantly contracted and became more raised, harder and rougher after the therapy was discontinued. Pressure cessation also resulted in large changes in collagen fiber orientation and increases in collagen fiber thickness. The results suggest that pressure garment therapy effectively improves scar properties following severe burn injury; however, early cessation of the therapy results in substantial loss of these improvements.</p></div

Schematic of the scar biopsy processing methodology.

<p>At each time point, at least one 6-mm biopsy punch was collected. Scars were marked to identify tissue orientation with respect to anatomy. The biopsy was cut in half with one half snap frozen and the other half processed for histology. The biopsy was first sectioned in cross-section. Subsequently, the biopsy was sectioned <i>en face</i> following removal of the epidermis with coarse sectioning.</p