Hypertrophic scar therapy : pressure-induced remodelling and its determinents

Hypertrophic scars are cosmetically unattractive products of abnormal wound healing and, if they occur over flexor aspects of joints, considerable functional impairment often results. Pressure, as a therapy for hypertrophic- scarring has considerable attraction since it is effective and nonsurgical. Previous reports of this therapy have not quantified magnitudes or durations of pressure required to induce remodelling. Correlation of these parameters is necessary to define guidelines to optimise pressure therapy. Measurement of pressure applied to hypertrophic scars by garments with elastic properties was achieved using a monitoring system based on a thin (0.2mm) flat (1cm²) capacitive transducer. Pressures of 15 - 40mnmHg produced, in general, accelerated scar remodelling with superior cosmesis resulting from higher pressures. Clinical studies suggested that 6-9 months pressure is sufficient to induce permanent remodelling, although studies of rates of collagen biosynthesis in pressure-treated and untreated scars indicated 9- 12 months pressure was necessary. Two types of pressure applying garments, Tubigrip and Lycra, were studied and compared. Tubigrip garments demonstrated superior elastic properties for maintaining pressure with-time. Investigations of two hypotheses for pressure-induced remodelling were performed. A first hypothesis that pressure induces ischaemia in scars, implying remodelling by autolysis, was investigated with vital microscopy using a hamster cheek pouch model. Pressure magnitudes which induced scar remodelling did not disturb the microcirculation sufficiently to cause permanent damage, therefore this hypothesis was thought unlikely to be correct. A second hypothesis that pressure-induced vascular changes produce scar resorption via a collagen-based mechanism was investigated using a radioactive isotope assay of the rate of collagen biosynthesis. The time for which the rate of collagen biosynthesis approached normal scar levels was reduced by half in pressure-treated compared to untreated scars. A two-phase scar remodelling theory was introduced comprising a pressure-magnitude dependent phase followed by a time-dependent phase. The second hypothesis was thought to be partially correct and the complexity of the pressure-induced remodelling mechanism is discussed.Hypertrophic scars are cosmetically unattractive products of abnormal wound healing and, if they occur over flexor aspects of joints, considerable functional impairment often results. Pressure, as a therapy for hypertrophic- scarring has considerable attraction since it is effective and nonsurgical. Previous reports of this therapy have not quantified magnitudes or durations of pressure required to induce remodelling. Correlation of these parameters is necessary to define guidelines to optimise pressure therapy. Measurement of pressure applied to hypertrophic scars by garments with elastic properties was achieved using a monitoring system based on a thin (0.2mm) flat (1cm²) capacitive transducer. Pressures of 15 - 40mnmHg produced, in general, accelerated scar remodelling with superior cosmesis resulting from higher pressures. Clinical studies suggested that 6-9 months pressure is sufficient to induce permanent remodelling, although studies of rates of collagen biosynthesis in pressure-treated and untreated scars indicated 9- 12 months pressure was necessary. Two types of pressure applying garments, Tubigrip and Lycra, were studied and compared. Tubigrip garments demonstrated superior elastic properties for maintaining pressure with-time. Investigations of two hypotheses for pressure-induced remodelling were performed. A first hypothesis that pressure induces ischaemia in scars, implying remodelling by autolysis, was investigated with vital microscopy using a hamster cheek pouch model. Pressure magnitudes which induced scar remodelling did not disturb the microcirculation sufficiently to cause permanent damage, therefore this hypothesis was thought unlikely to be correct. A second hypothesis that pressure-induced vascular changes produce scar resorption via a collagen-based mechanism was investigated using a radioactive isotope assay of the rate of collagen biosynthesis. The time for which the rate of collagen biosynthesis approached normal scar levels was reduced by half in pressure-treated compared to untreated scars. A two-phase scar remodelling theory was introduced comprising a pressure-magnitude dependent phase followed by a time-dependent phase. The second hypothesis was thought to be partially correct and the complexity of the pressure-induced remodelling mechanism is discussed

Anagen hair follicles transplanted into mature human scars remodel fibrotic tissue

Despite the substantial impact of skin scarring on patients and the healthcare system, there is a lack of strategies to prevent scar formation, let alone methods to remodel mature scars. Here, we took a unique approach inspired by how healthy hairbearing skin undergoes physiological remodelling during the regular cycling of hair follicles. In this pilot clinical study, we tested if hair follicles transplanted into human scars can facilitate tissue regeneration and actively remodel fibrotic tissue, similar to how they remodel the healthy skin. We collected full-thickness skin biopsies and compared the morphology and transcriptional signature of fibrotic tissue before and after transplantation. We found that hair follicle tranplantation induced an increase in the epidermal thickness, interdigitation of the epidermal-dermal junction, dermal cell density, and blood vessel density. Remodelling of collagen type I fibres reduced the total collagen fraction, the proportion of thick fibres, and their alignment. Consistent with these morphological changes, we found a shift in the cytokine milieu of scars with a long-lasting inhibition of pro-fibrotic factors TGFβ1, IL13, and IL-6. Our results show that anagen hair follicles can attenuate the fibrotic phenotype, providing new insights for developing regenerative approaches to remodel mature scars

A comprehensive study on Twak Shareera and an experimental study to evaluate histological changes observed by application of Jathyadi Taila

Background: Twak is the outermost protective layer as well as largest sensory organ of body. Acharya Susrutha and Acharya Charaka described its layers according to their functions and diseases, which are related to those layers. It is the location of sweat channels, hairs and hair pits. It is the largest organ constituting 15 -20% of total body mass. Objectives: To do the literary study of Twak Shareera as explained in Samhitha, Comparative study of Twak Shareera with contemporary science and to study the wound healing process on the effect of Jathyadi Taila in experimental Wistar albino rats with control, standard and test group with the help of histological observation. Methodology: Literary study was done by collecting references from different Samhitas, contemporary science, journals and web sites. Experimental study was carried out on albino rats, wound is made under aseptic conditions and the skin is taken for histopathological study. Jathyadi Taila is applied at the site of wound in test group, Povidone- iodine is applied in Standard group and control group is left for natural healing. The skin is taken for histopathological studies on the 24th day in all the three groups. Results: The event in the wound healing like inflammatory phase, the granulation tissue, fibroblast etc are seen in histopathological studies. Application of Jathyadi Taila has shown significant results in wound healing and scar remodelling. The data shows there was Increase in percentage wound contraction of healing in standard and test group, when compared to the normal control group. The observed increase was found to be statistically significant. Conclusion: Jathyadi Taila does Shodhana and Ropana of Vrana by the virtue of its ingredients and its properties. Jathyadi Taila has shown significant results in wound healing and scar remodelling

Prospective Evaluation of the Ultrasound Signs Proposed for the Description of Uterine Niche in Nonpregnant Women

OBJECTIVES: To evaluate the new ultrasound-based signs for the diagnosis of post-cesarean section uterine niche in nonpregnant women. METHODS: We investigated prospectively a cohort of 160 consecutive women with one previous term cesarean delivery (CD) between December 2019 and 2020. All women were separated into two subgroups according to different stages of labor at the time of their CD: subgroup A (n = 109; 68.1%) for elective CD and CD performed in latent labor at a cervical dilatation (≤4 cm) and subgroup B (n = 51; 31.9%); for CD performed during the active stage of labor (>4 cm). RESULTS: Overall, the incidence of a uterine niche was significantly (P  3 mm in subgroup A than in subgroup B and a significant negative relationship was found between the RMT and the cervical dilatation at CD (r = -0.22; P = .008). CONCLUSIONS: Sonographic cesarean section scar assessment indicates that the type of CD and the stage of labor at which the hysterotomy is performed have an impact on the location of the scar and the scarification process including the niche formation and RMT

A dose-ranging, parallel group, split-face, single-blind phase II study of light emitting diode-red light (LED-RL) for skin scarring prevention: study protocol for a randomized controlled trial.

BackgroundSkin fibrosis is a significant global health problem that affects over 100 million people annually and has a profoundly negative impact on quality of life. Characterized by excessive fibroblast proliferation and collagen deposition, skin fibrosis underlies a wide spectrum of dermatologic conditions ranging from pathologic scars secondary to injury (e.g., burns, surgery, trauma) to immune-mediated diseases. Effective anti-scarring therapeutics remain an unmet need, underscoring the importance of developing novel approaches to treat and prevent skin fibrosis. Our in vitro data show that light emitting diode-red light (LED-RL) can modulate key cellular and molecular processes involved in skin fibrosis. In two phase I clinical trials (STARS 1 and STARS 2), we demonstrated the safety and tolerability of LED-RL at fluences of 160 J/cm2 up to 480 J/cm2 on normal human skin.Methods/designCURES (Cutaneous Understanding of Red-light Efficacy on Scarring) is a dose-ranging, randomized, parallel group, split-face, single-blind, mock-controlled phase II study to evaluate the efficacy of LED-RL to limit post-surgical skin fibrosis in subjects undergoing elective mini-facelift surgery. Thirty subjects will be randomly allocated to three treatment groups to receive LED-RL phototherapy or temperature-matched mock irradiation (control) to either periauricular incision site at fluences of 160 J/cm2, 320 J/cm2, or 480 J/cm2. Starting one week post-surgery (postoperative days 4-8), treatments will be administered three times weekly for three consecutive weeks, followed by efficacy assessments at 30 days, 3 months, and 6 months. The primary endpoint is the difference in scar pliability between LED-RL-treated and control sites as determined by skin elasticity and induration measurements. Secondary outcomes include clinical and photographic evaluations of scars, 3D skin imaging analysis, histological and molecular analyses, and adverse events.DiscussionLED-RL is a therapeutic modality of increasing importance in dermatology, and has the potential to limit skin fibrosis clinically by decreasing dermal fibroblast activity and collagen production. The administration of LED-RL phototherapy in the early postoperative period may optimize wound healing and prevent excessive scarring. The results from this study may change the current treatment paradigm for fibrotic skin diseases and help to pioneer LED-RL as a safe, non-invasive, cost-effective, portable, at-home therapy for scars.Trial registrationClinicalTrials.gov, NCT03795116 . Registered on 20 December 2018

Potential oral wound healing of topical application of dental gel prepared from baccaurea angulata fruit in diabetic rats

Objective: This study investigates the effect of Baccaurea angulata fruit extract towards wound healing activity at tooth extractions sites. Significance: High antioxidant content in underutilised Baccaurea angulata were expected to open up new possibilities for tooth extraction procedure among diabetic patients. Methods: Sprague dawley rats were divided into 6 groups, and l their left mandibular first molar tooth were extracted. The alveolar socket were treated accordingly where group 1, 2, 3, 4, and 5 were diabetic rats (induced using Streptozotocin) applied with plain gel, alveolex, 3%, 5%, and 10% Baccaurea angulata extract respectively. Group 6 were non diabetic rats applied with plain gel. On day 4, 7 and 18, rats were euthanized, and the tissue samples were processed for histomorphological analysis. Results: It was found that Baccaurea angulata does significantly promotes tooth extraction wound healing in diabetic rats comparable to diabetic group treated with alveolex and non-diabetic rats at early phase of the wound. However the positive effect were not obvious at day 7, while at day 18, groups treated with Baccaurea angulata treated group had higher mean scores in most categories although may not statistically significant different. BADG concentration of 4% was found to give the best effects on wound healing. Conclusion: To a certain extent, Baccaurea angulata extract does promotes tooth extraction wound healing in diabetic rats

Scar Revision: Surgical and Nonsurgical Options

Facial scarring represents a challenging issue for the facial plastic surgeon owing to the unpredictable and variable nature of scar formation. The psychologic, cosmetic, and functional implications of facial scars oftentimes necessitate revision. It is important for the facial plastic surgeon to be aware of the invasive and noninvasive options to best educate patients in terms of treatment modalities. As there are multiple options available with no single option touted as superior, management of expectations and patient motivation will allow for realistic treatment planning with the greatest change of success

Trends in the availability and usage of electrophysical agents in physiotherapy practices from 1990 to 2010: A review

This is the Pre-print version of the Article. The official published version can be accessed from the link below - Copyright @ 2012 Maney PublishingBackground: The use of electrophysical agents has a historically important role in physiotherapy practice. There are anecdotal reports that the availability and usage of electrotherapy modalities are declining, which may have implications for physiotherapy practice. The aim of this literature review was to provide scientific evidence on electrotherapy usage in the last 20 years by identifying trends in availability, use, and non-use of nine electrotherapeutic modalities in physiotherapy practices during 1990s and 2000s. Methods: Review of empirical studies published in the English language from 1990 to 2010 and identified through searching online bibliographic databases, which included: Medline/OvidSP, PubMed Central, CINAHL/EBSCOhost, ScienceDirect, Scopus, ISI Web of Science, and Google Scholar. Findings: In the last 20 years, ultrasound availability and usage show increasing trends in several countries. The availability and use of pulsed shortwave diathermy and laser have shown steady trends. Transcutaneous electrical nerve stimulation, interferential, and biofeedback availability and usage have shown increasing trends in the UK and decreasing trends in Australia and the Republic of Ireland. Trends of continuous shortwave diathermy availability and use are declining irrespective of the country of the study. The availability and usage of microwave diathermy and H-wave show steeply declining trends, while there is a sharp rise in their non-availability over the last several years. Conclusions: The availability and use of electrophysical agents have greatly changed in the last 20 years. Declining trends in the availability and usage along with increasing trend of non-availability of electrotherapy modalities may have implications for electrotherapy education, training, and practice in the coming years.This study was funded by Health & Safety Executive, UK (grant no. 4371/R47.022)