Relationship between the distribution of myofibroblasts, and stellar and circular scar formation due to the contraction of square and circular wound healing

金沢大学大学院医学系研究科臨床実践看護学Square skin wounds can heal to form a stellar scar with four protrusions at the four angles, whereas circular wounds can heal to form an ellipsoid scar. It is not clear why these differences occur and the aim of the present study was to clarify this phenomenon. Two square or circular full-thickness skin wounds were made on the dorsum of mice, and covered with hydrocolloid dressing. They were observed from day 0 to 15 after wounding, and used to prepare paraffin sections stained with anti-α-smooth muscle actin antibody to detect myofibroblasts. The square wound was transiently enlarged by edema and skin tension on day 3, at which time the angles became round, and thus the square form became more circular. Thereafter, the wound contracted rapidly and the circular form was maintained until day 11. On day 11 distinct angles appeared where the scar formation had progressed further, and there were fewer myofibroblasts than in any other section. A stellar scar with protrusions from the four angles was formed on day 15, when myofibroblasts almost disappeared in the protrusions. This indicates that due to the earlier disappearance of myofibroblasts and earlier scarring in the angles of the square wound, the scar angle cannot be pulled into the center of the wound but residual myofibroblasts on the side can pull the side into the center due to myofibroblastic contraction and consequently a stellar scar is formed. Thus, the earlier disappearance of myofibroblasts in the angles is very important for the formation of stellar scars. © 2007 The AuthorsJournal compilation © 2007 Japanese Association of Anatomists.全文公開20080

Nighttime Bandaging to Reduce Lymphedema Swelling

Multilayer compression bandaging (MLB) for breast cancer-related lymphedema (BCRL) patients may be easier to apply during nighttime sleep. Little is known about the specific effects of nighttime multilayer bandaging (NMLB) alone. In the present study, we examined whether NMLB alone significantly improved the negative symptoms of BCRL such as excessive swelling and an unpleasant feeling. A pre–post study was conducted as a basis for the development of efficient self-care treatment. Eight middle-aged female patients with unilateral upper extremity BCRL voluntarily participated in this study. During the first 2 weeks, the participants were educated and trained in the self-bandaging technique. The participants then wore MLB on the affected extremity for the following seven nights at home from bedtime to the next morning (hereafter referred to as the intervention ). We measured the segmental total body water (STBW) volume on the affected upper extremity using bioimpedance spectroscopy and subjective symptoms using a visual analog scale. Each parameter was measured at the beginning and end of the intervention periods. It was found that the STBW volume on the affected upper extremity decreased significantly during intervention. The mean STBW volume reduction was 0.088 L ( p  = .047, 95% CI [0.001, 0.175] L]). Subjective symptoms related to swelling (i.e., tightness, heaviness, and fullness) decreased significantly during intervention ( p  < .05). In conclusion, decrease in the STBW volume and subjective symptoms on the affected upper extremity were observed at the end of the intervention. These results suggest that NMLB reduces both swelling and swelling-related symptoms of BCRL

ポケットを有する褥瘡のポケット被蓋部の組織学的研究

金沢大学医薬保健研究域保健学系ポケットを有する褥瘡が治癒しがたいことを被蓋部の組織像から検討した. 外科治療の目的で切除されたポケットを有する褥瘡のポケット被蓋部13組織を, 肉眼的, 組織学的方法で研究した. 肉眼的所見：皮膚はポケット開口部で白く浸軟し, 表皮が開口部より内表面の一部を覆い停止していた. 断面では, 線維化した白い結合組織がみられた. 組織学的所見：表皮は基部から開口部に向かって厚さを増し, 表皮索または突起と真皮乳頭は互いに咬み合い, 伸展が停止した表皮は棍棒状または舌状形態を呈していた. 表皮下では, 正常な膠原線維束はみられず, 線維性瘢痕を呈し, 炎症細胞が少数みられた. 内表面は炎症細胞を含むさまざまな厚さのフィブリン様膜に覆われていた. 3組織の開口部にのみ炎症性肉芽組織が観察された. これらの結果は, ポケット被蓋部内表面を覆うフィブリン様膜と瘢痕組織が表皮の再生と肉芽組織の増殖を阻害し, 被蓋部と創底部の接着を妨げている可能性を示唆している.This study macroscopically and microscopically examined the wound roof from thirteen pressure ulcers that were surgically excised. Based on these findings, we discussed the cause of intractability of pressure ulcers with undermining. The skin covering the wound roof was white and macerated at the wound orifice area. The epidermis covered part of the inner surface of the wound roof. White fibrosis was observed under the epidermis at the cutting plane of the roof. The epidermis became increasingly thicker from the base area of the roof to the wound orifice area, and interdigitated with the dermis. The edge of the extending epidermis showed a club-like or tongue-like shape. Under the epidermis, there was no normal collagen bundle, but there was collagenous scar tissue. Moreover, a few inflammatory cells and blood vessels were present in the scar. The inner surface of the wound roof was lined with various thicknesses of fibrinoid tissue including inflammatory cells. Inflammatory granulation tissue was observed in the wound orifice area in only 3 of 13 tissue specimens, indicaing that fibrinoid tissue over the inner surface of the roof and scar of the roof could impede the development of granulation tissue and extension of the epidermis.日本褥瘡学会の許可を得て登録_2021.9.2