New Innovations in Scar Management

Abstract

As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. With this in mind, a scar management program has been adopted based on the modalities of wound support, hydration, and hastened maturity, all factors gleaned from scientific evidence published over the past 25 years. Tension on a scar in one axis will result in a stretched scar, probably initiated by neutrophils and their neutral proteases [18,26]. Tension on a scar from many directions or intermittently will result in a hypertrophic scar, possibly initiated by lymphocytes but definitely related to a prolongation of the inflammatory process, with increased fibroblast activity and overabundant extracellular matrix secretion [24,26]. The common initiating factor is the tension on the scar, and the critical element needed to counteract this tension is scar support. Clinical experience has shown us that the most reliable way to support a scar is by using microporous tape. Hydration is a second beneficial influence on scar control and is the basis of the use of silicone sheeting and gel [7,29,36]. Alpha Centella cream has two main components. The first is an extract from the plant Bulbine frutescens. This increases hydration under the tape by leaving a layer of fatty vesicles of glycoprotein on the skin surface. This also has antibacterial properties. The second component is the principal terpenoids extracted from the Centella asiatica plant. These include asiatic acid, madecassic acid, and asiaticoside. Centella asiatica has been documented to aid wound healing in a large number of scientific reports [5,12,21,22,33,34,40]. The most beneficial effect appears to be the stimulation of maturation of the scar by the production of type I collagen [4,19] and the resulting decrease in the inflammatory reaction and myofibroblast production. Thus these components have been incorporated into the formulation of a scar management program. This publication reviews much of the available literature relating to scar management and describes the formulation and use of a scar management program based on this information.

Centella asiatica extract selectively decreases amyloid β levels in hippocampus of Alzheimer's disease animal model

“…While the effects of CaE on the neurovasculature have yet to be studied in detail, an alteration of extracellular matrix composition may play a role in regulating the clearance of amyloid β or the deposition as visible plaques. Centella asiatica has also shown to regulate dermal fibroblast associated genes that contribute to wound healing, including genes involved in extracellular matrix synthesis (Shukla et al, 1999;Maquart et al, 1999;Widgerow et al, 2000;Cataldi et al, 2001;Coldren et al, 2003;Lu et al, 2004). Deposition of fibrillar amyloid β can be promoted by the extracellular matrix molecule, perlecan or fibril formation inhibited by another extracellular matrix molecule, laminin (Holcomb et al, 2000;Castillo et al, 2000).…”

Efficacy of the combination of herbal extracts and a silicone derivative in the treatment of hypertrophic scar formation after burn injury

“…Previous research has reported that some herbal extracts have demonstrated beneficial effects on scar treatment (Bombaro et al, 2003;Hosnuter et al, 2007;Lawrence, 1967;Widgerow et al, 2000). Quercetin, a bioflavonoid from Allium cepa, has shown antiproliferative effects on both normal and malignant cells and also exhibited antihistamine release effects.…”

“…Quercetin, a bioflavonoid from Allium cepa, has shown antiproliferative effects on both normal and malignant cells and also exhibited antihistamine release effects. These properties could theoretically prove beneficial in reversing the inflammatory and proliferative responses (Bombaro et al, 2003;Widgerow et al, 2000). Willital and Heine (1994) reported using onion extracts to treat fresh scars after thoracic surgery in 45 cases of children and adolescents.…”

Comparison of the effectiveness of topical silicone gel and corticosteroid cream on the pfannenstiel scar prevention — a randomized controlled trial

“…The injection causes reductions in the scar volume and results in an improvement in the scar pliability, height, and symptoms. Owing to poor tissue absorption, intralesional injections are preferred in mature scars [21]. Intralesional corticosteroid injection is recommended at the end of 6 months for patients with postoperative linear scars who fail to respond to prophylactic treatments in the first 6 months postoperatively and having ongoing HS [5,6,[22][23][24].…”