Update on Scar Management

Kim, Sukwha; Choi, Tae Hyun; Liu, Wei; Ogawa, Rei; Suh, Jeong Seok; Mustoe, Thomas A.

doi:10.1097/prs.0b013e3182a8070c

Cited by 118 publications

(62 citation statements)

References 52 publications

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“…To be effective, pressure garment should be worn for at least 23 hours a day and the treatment should be continued for a period of 6–12 months or until the scar matures922394041. However, the exact optimal pressure required for effective treatment has never been scientifically established15.…”

Section: Discussionmentioning

confidence: 99%

“…The exact mechanisms of how pressure positively influences the scar outcome following burns are not fully understood789. However, it is widely believed that the pressure can control collagen synthesis, facilitate scar maturation and reduce scar redness by limiting the supply of blood, oxygen and nutrients to the scar tissue2829.…”

Section: Discussionmentioning

confidence: 99%

“…Hypertrophic scar (HS) is a very common cutaneous complication following dermal wound, especially after severe burns78. Currently, there are a variety of therapeutic options for treatment of HS including pressure therapy (PT), silicone-based products, intralesional corticosteroids, laser therapy, bleomycin, fluorouracil, topical imiquimod and surgical excision2910. However, no ideal or all-purpose method of scar control exists and HS management remains a problematic challenge for both patients and health care providers511.…”

mentioning

confidence: 99%

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The effectiveness of pressure therapy (15–25 mmHg) for hypertrophic burn scars: A systematic review and meta-analysis

Liu

Pei

et al. 2017

Sci Rep

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Although pressure therapy (PT) represents the standard care for prevention and treatment of hypertrophic scar (HS) from burns, its practice is largely based on empirical evidence and its effectiveness remains controversial. To clarify the effect of PT (15–25 mmHg) for HS, we performed the systematic review and meta-analysis. Several electronic databases were screened to identify related randomized controlled trials (RCTs). 12 RCTs involving 710 patients with 761 HS resulting from burn injuries were included. Compared with non/low-PT, cases treated with PT (15–25 mmHg) showed significant differences in Vancouver Scar Scale score (MD = −0.58, 95% CI = −0.78–−0.37), thickness (SMD = −0.25, 95% CI = −0.40–−0.11), brightness (MD = 2.00, 95% CI = 0.59–3.42), redness (MD = −0.79, 95% CI = −1.52–−0.07), pigmentation (MD = −0.16, 95% CI = −0.32–−0.00) and hardness (SMD = −0.65, 95% CI = −1.07–−0.23). However, there was no difference in vascularity (MD = 0.03, 95% CI = −0.43–0.48). Our analysis indicated that patients with HS who were managed with PT (15–25 mmHg) showed significant improvements. Due to limitations, more large and well-designed studies are needed to confirm our findings and the side-effects of the PT may also need to be evaluated.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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The effectiveness of pressure therapy (15–25 mmHg) for hypertrophic burn scars: A systematic review and meta-analysis

Liu

Pei

et al. 2017

Sci Rep

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“…Hypertrophic scar is caused by excessive deposition of fibroblast-derived extracellular matrix proteins and collagen, which results from exaggerated wound-healing response with persistent inflammation and fibrosis [24]. The incidence of hypertropic scar was found to be higher amongst Chinese when compared with Caucasians, which may be related to skin pigmentation [25][26][27]. Since most of the subjects from previous studies on scar evaluation after external DCR were from fair-skinned populations, we undertook this study to assess external DCR scar cosmetic results in Asians.…”

Section: Discussionmentioning

confidence: 98%

Aesthetic assessment in periciliary “v-incision” versus conventional external dacryocystorhinostomy in Asians

Chan

Yu³

et al. 2015

Graefes Arch Clin Exp Ophthalmol

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“…Scar is a general term of changes in histopathology and appearance of skin tissues caused by various wounds, and the clinical incidence rate of scar can be as high as 40–70%, especially in the skin burn, postoperative period and trauma (1). Scar generation not only brings the physical and mental pain for patients, but also causes the appearance damage or even dysfunction to relevant tissues.…”

Section: Introductionmentioning

confidence: 99%

Effects of transplanted adipose derived stem cells on the expressions of α‑SMA and DCN in fibroblasts of hypertrophic scar tissues in rabbit ears

Chu

Wang

et al. 2018

Exp Ther Med

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To study the effects of transplanted adipose derived stem cells (ADSCs) on the expressions of α-smooth muscle actin (α-SMA) and decorin (DCN) in fibroblasts of hypertrophic scar tissues in rabbit ears. Twelve New Zealand white rabbits were selected; the normal subcutaneous adipose tissues in inguinal region were removed, ADSCs were extracted via enzyme digestion, cultured in Dulbecco's modified Eagle's medium (DMEM) and inoculated into the culture dish (3–5×104 cells/ml). After the rabbit ear hypertrophic scar model was established successfully, the fibroblasts of hypertrophic scar tissues in rabbit ears were separated and cultured using the mechanical method combined with enzyme digestion, and the ADSCs and scar fibroblasts were cultured in non-contact Transwell co-culture system for 21 days (experimental group); the corresponding scar fibroblasts were cultured in an ordinary 6-well plate without any treatment for 21 days (control group). The content of collagen I in fibroblasts was detected using the enzyme-linked immunosorbent assay (ELISA) kit, the mRNA expressions of α-SMA and DCN were detected via reverse transcription-polymerase chain reaction (RT-PCR), the protein expressions of α-SMA and DCN were detected via western blot analysis, and the expressions and distribution of α-SMA and DCN were detected via immunofluorescence assay. The results of ELISA showed that the content of collagen I in experimental group was decreased significantly (p<0.01). The results of RT-PCR and western blot analysis revealed that the mRNA and protein expression levels of α-SMA were significantly decreased (P<0.01, but those of DCN were significantly increased (p<0.01). Moreover, the results of immunofluorescence assay showed that the expression of α-SMA in experimental group was significantly decreased, while the expression of DCN was significantly increased. ADSCs can inhibit the mRNA and protein expressions of α-SMA and promote the mRNA and protein expressions of DCN in in vitro culture system, and they are expected to be used in the prevention and treatment of pathological scars.

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Update on Scar Management

Abstract: Updated scar management recommendations will benefit practitioners making decisions regarding optimal, evidence-based treatment strategies for their patients.

Cited by 118 publications

References 52 publications

The effectiveness of pressure therapy (15–25 mmHg) for hypertrophic burn scars: A systematic review and meta-analysis

The effectiveness of pressure therapy (15–25 mmHg) for hypertrophic burn scars: A systematic review and meta-analysis

Aesthetic assessment in periciliary “v-incision” versus conventional external dacryocystorhinostomy in Asians

Effects of transplanted adipose derived stem cells on the expressions of α‑SMA and DCN in fibroblasts of hypertrophic scar tissues in rabbit ears

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