Background: Fetal wounds can heal without any histological evidence of scarring. Fetal wounds lack the inflammatory infiltrate characteristic of adult wounds, and the fetal environment is not necessary for scarless healing to occur. Recent evidence suggests that fibroblasts are the main effector of scarless healing in fetal tissue. What has not been shown is what profile of growth factors the fibroblast uses to influence wound repair.

Keloids are an abnormal response to wound healing distinguished by an overproduction of collagen. Thickened bundles of collagen in the reticular dermis oriented haphazardly in relation to the overlying epithelium are found in keloids, in contrast to thinner collagen fibers in a more orderly arrangement that are found in normal scars. Previous clinical trials of intralesional interferon-gamma (IFN-G) injections by Larrabee et al. and Granstein et al. showed a decrease in lesion size. These findings led to a conclusion that IFN-G would be a useful adjunct to surgical excision of keloids to aid in preventing recurrence. We performed a double-blind, placebo-controlled trial in patients with two or more keloids treated with excision and subsequent local injections of IFN-G or placebo.

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Upper airway diseases have been characterized in the literature as limited to the pediatric population. From Chevalier Jackson's original description of laryngotracheobronchitis (LTB) in 19361 to the present, this disease entity has remained a pediatric illness. LTB, or croup, is characterized by a barking cough, hoarseness, fever, and varying degrees of stridor. A literature review of adult upper airway disease revealed a small series of adult patients with LTB 2 and several cases of adult tracheitis. 3 Epiglottitis has also been reported almost exclusively in the pediatric population. Most recently, several case reports of adult epiglottitis have suggested that adult upper airway disease is increasing either by actual numbers or by improved reporting. 4,5The changes that occur during pregnancy affect every region of the body. There are several laryngologic manifestations of pregnancy. A condition known as laryngopathia gravidarum can affect changes of the laryngeal mucosa, including edema, mucosal drying, and occasional crusting. 6-8 These changes are most pronounced during the third trimester. 8 Sixty percent to 75% of pregnant women report hoarseness and or dyspnea. 6,8,9 High levels of estrogen in the pregnant woman have been implicated in increasing tissue hydration, edema, capillary congestion, and hyperplastic and hypersecretory mucous glands. 8 Obstetric complications caused by laryngeal edema are well documented in the literature and will be discussed below.

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Wound healing research has produced some startling discoveries during the past decade. Foremost among these is the observation that cutaneous wounds created and healed in utero are histologically indistinguishable from intact, unwounded tissue. Observers have documented that the acute inflammatory response and endogenous immunoglobulins that characterize healing in human beings after birth are absent in the fetal wound. Determination of the cellular and biochemical differences between fetal and postdelivery wound healing offers the promise of improved control over the process of tissue repair. Another promise of fetal wound healing research is the option of in utero repair of defects such as cleft lip and palate. We review what is known at present about fetal wound healing.

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