Scarring Occurs at a Critical Depth of Skin Injury: Precise Measurement in a Graduated Dermal Scratch in Human Volunteers

Dunkin, Christopher; Pleat, Jonathon; Gillespie, Paddy; Tyler, Michael; Roberts, A.H.N.; McGrouther, Duncan Angus

doi:10.1097/01.prs.0000258829.07399.f0

Cited by 136 publications

(94 citation statements)

References 22 publications

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“…23 In addition, the shallower the wound depth, the better the prognosis for healing. 4,24,25 Because commercially available miniscrews are less than 2 mm in diameter, the current removal schemes do not necessarily recommend primary closure using sutures after miniscrew removal. 26 Even though the regions used for miniscrew insertion (such as the attached gingiva and the palate) are known as the safe zone for scar formation, [4][5][6] there are several conditions that are unfavorable for scarless healing of miniscrew removal sites regardless of stability.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional evaluation of the prevalence and factors associated with soft tissue scarring after the removal of miniscrews

Jung

Choi

Lee

et al. 2014

The Angle Orthodontist

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Objective: To investigate the prevalence of distinguishable soft tissue scarring after the removal of temporary anchorage devices (TADs) such as orthodontic miniscrews and to analyze the factors associated with scar formation. Materials and Methods: The prevalence of soft tissue scarring in 66 patients (202 miniscrew removal sites) was clinically investigated at least 1 year after miniscrew removal. To determine the clinical factors associated with soft tissue scar formation, miniscrew stability; host factors including age, gender, and gingival biotype; and miniscrew-related factors such as insertion site, vertical position, and insertion period were evaluated. Results: The prevalence of a distinguishable scar remaining at least 1 year after miniscrew removal was 44.6%. Patients with flat gingiva showed a significantly higher prevalence of soft tissue scar formation than did those with pronounced scalloped gingiva (P , .05). Maxillary buccal removal sites showed a significantly higher prevalence of soft tissue scar formation than did those in the mandible or palatal slope (P , .05). Miniscrew sites at the alveolar mucosa showed a significantly lower prevalence of soft tissue scar formation than did those in the mucogingival junction or the attached gingiva (P , .01). Conclusion: The prevalence of distinguishable scarring after miniscrew removal was fairly high. On the basis of our results, patients with flat gingiva and buccal interdental gingival insertion sites are more susceptible to scar formation. (Angle Orthod. 2015;85:420-426.)

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Section: Discussionmentioning

confidence: 99%

Cross-sectional evaluation of the prevalence and factors associated with soft tissue scarring after the removal of miniscrews

Jung

Choi

Lee

et al. 2014

The Angle Orthodontist

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“…These factors alter wound healing properly and effect to produce scar. Large size and deep partial thickness burn wound always tend to form hypertrophic scar (Dunkin et al, 2007). Combination with other treatments such as steroid injection and biophysical therapy should be appropriate for these scars (Juckett and Hartman-Adams, 2009).…”

Section: Discussionmentioning

confidence: 99%

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

Muangman¹,

Aramwit

Palapinyo³

et al. 2011

Afr. J. Pharm. Pharmacol.

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The development of hypertrophic scars is an unsolved problem in the process of wound healing. The objective of this research was to study the efficacy of the combination of herbal extracts and a silicone derivative in a gel preparation (Cybele ® Scagel) on the treatment of deep second degree burns after complete epithelialization. Sixty-three patients were enrolled in this study. One wound area larger than 10 × 10 cm was selected from each patient to receive treatment with Cybele ® Scagel. Patients were observed for pigmentation, pliability, pain and itching for 0, 2, 4, 8, 12, 16, 20 and 24 weeks after treatment. Their data and wound characteristics were collected during each visit using the Vancouver scar scale. After 24 weeks, all scales (pigmentation, pliability, pain and itching) were significantly lower in the sites treated with Cybele ® Scagel compared with the previous time points (p< 0.05). However, vascularity and height scale were not significantly different (p> 0.05). One patient was excluded at week 2 because of moderate itching at the wound site, which could have interfered with the evaluation. The application of Cybele ® Scagel might have some beneficial effects for prevention of hypertrophic scar formation after partial thickness burn injuries.

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“…Dunkin et al 1 found that skin cuts to a depth of 0.5-0.6 mm close by electrical cell stimulation without any trace of scar tissue. Zhao et al 2 reported similar effects of electrical currents on cell motility and healing.…”

mentioning

confidence: 99%

Skin Cell Proliferation Stimulated by Microneedles

Liebl¹,

Kloth

2012

Journal of the American College of Clinical Wound Specialists

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A classical wound may be defined as a disruption of tissue integrity. Wounds, caused by trauma from accidents or surgery, that close via secondary intention rely on the biological phases of healing, i.e., hemostasis, inflammation, proliferation, and remodeling (HIPR). Depending on the wound type and severity, the inflammation phase begins immediately after injury and may last for an average of 7-14 days. Concurrent with the inflammation phase or slightly delayed, cell proliferation is stimulated followed by the activation of the remodeling (maturation) phase. The latter phase can last as long as 1 year or more, and the final healed state is represented by a scar tissue, a cross-linked collagen formation that usually aligns collagen fibers in a single direction. One may assume that skin microneedling that involves the use of dozens or as many as 200 needles that limit penetration to 1.5 mm over 1 cm 2 of skin would cause trauma and bleeding followed by the classical HIPR. However, this is not the case or at least the HIPR phases are significantly curtailed and healing never ends in a scar formation. Conversely dermabrasion used in aesthetic medicine for improving skin quality is based on ''ablation'' (destruction or wounding of superficial skin layers), which requires several weeks for healing that involves formation of new skin layers. Such procedures provoke an acute inflammatory response. We believe that a less intense inflammatory response occurs following microneedle perforation of the skin. However, the mechanism of action of microneedling appears to be different. Here we review the potential mechanisms by which microneedling of the skin facilitates skin repair without scarring after the treatment of superficial burns, acne, hyperpigmentation, and the non-advancing periwound skin surrounding the chronic ulcerations of the integument. Ó 2013 Elsevier Inc. All rights reserved. Potential Mechanism of Microneedle Treatment of Normal SkinSome explanations can be found with a closer look at enhanced cell communication and motility by endogenous electrical signals (electro-taxis). Dunkin et al 1 found that skin cuts to a depth of 0.5-0.6 mm close by electrical cell stimulation without any trace of scar tissue. Zhao et al 2 reported similar effects of electrical currents on cell motility and healing. Deeper skin cuts close by ''skin repair'' that ultimately results in scar formation Figure 1.In 2010 Liebl proposed that microneedling could be used in treating chronic wounds. In reviewing the literature related to wound healing by electric field stimulation, he theorized that the mechanisms for the main action of microneedling may include trans-epithelial potentials (TEPs) and the skin battery. 3 Foulds and Barker 4 placed electrodes on the stratum corneum (SC) and inside the dermis, and measured a negative potential difference of the SC ranging from 10 to 60 mV, and averaging 223.4 mV (Figure 2).

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Scarring Occurs at a Critical Depth of Skin Injury: Precise Measurement in a Graduated Dermal Scratch in Human Volunteers

Abstract: The dermal scratch provides a well-tolerated, standardized, and reproducible wound model for investigating the healing response to dermal injury of different depths. There is a threshold depth of dermal injury at which scarring develops.

Cited by 136 publications

References 22 publications

Cross-sectional evaluation of the prevalence and factors associated with soft tissue scarring after the removal of miniscrews

Cross-sectional evaluation of the prevalence and factors associated with soft tissue scarring after the removal of miniscrews

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

Skin Cell Proliferation Stimulated by Microneedles

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