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Surgical Science 2017年第6期8卷 240-255页

作者： Sharad P. Paul School of Medicine University of Queensland University of Auckland Auckland University of Technology Auckland New Zealand

Aim: The sternal region, cervico-mandibular region and the intra-mammary region have been the bane of many cutaneous surgeons, with a higher propensity for poor scarring and wound complications. In this article, the author undertakes a review of different methods of breaking up scars by utilizing zigs and zags, and conducts a pigskin study to measure the reduction in tension that can be achieved by using a simple zigzag technique while performing excisions. Methods: A pigskin study conducted into the use of the simple zigzag to reduce the tension (and thereby scarring) of surgical wounds is reported here, and comparison and review is undertaken of the biomechanics of elliptical excisions and traditional Z-plasties. Results: Using a simple zigzag reduces tension across the midpoint of the scar more effectively than a Z-plasty or a simple elliptical excision. Conclusion: The techniques of breaking up a scar or incision line by using zigs and zags, in a means to reduce scarring, are not new. However, each of these techniques has specific advantages and disadvantages that need consideration by the surgeon. In this paper, a pigskin study is conducted into the use of the simple zigzag to reduce the tension (and thereby reduce the risk of poor scarring) of surgical wounds.

关键词： Keloid Hypertrophic Scar scarring Wound Excision Ellipse Chest Sternum

Reduction of corneal scarring in rabbits by targeting the TGFB1 pathway with a triple siRNA combination

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Advances in Bioscience and Biotechnology 2013年第10期4卷 47-55页

作者： Sriniwas Sriram Daniel Gibson Paulette Robinson Sonal Tuli Alfred S. Lewin Gregory Schultz Department of Biomedical Engineering University of Florida Gainesville USA Department of Molecular Genetics and Microbiology University of Florida Gainesville USA Department of Ophthalmology University of Florida Gainesville USA Institute for Wound Research Department of Obstetrics and Gynecology University of Florida Gainesville USA

Purpose: The transforming growth factor beta1 (TGFB1) pathway has been linked to fibrosis in several tissues including skin, liver, kidney and the cornea. In this study, a RNA interference-based approach using siRNAs targeting three critical scarring genes, TGFB1, TGFB receptor 2 (TGFBR2) and connective tissue growth factor (CTGF), was tested for effects on reducing alpha smooth muscle actin (SMA) and corneal scarring (haze) in excimer laser ablated rabbit corneas. Methods: Levels of TGFB1 and CTGF mRNAs were measured using qRT-PCR in the epithelial and endothelial cell layers of normal and excimer ablated rabbit corneas at 30 minutes, 1 day and 2 days after ablation. Two different scarring models were utilized to assess the effects of the triple siRNA combination on corneal scarring. In the first model, rabbit corneas were unevenly ablated creating a mesh pattern then treated immediately with the triple siRNA combination. After 1 day the ablated areas of corneas were collected and levels of mRNAs for TGFB1, TGFBR2 and CTGF were measured. After 14 days, levels of mRNA for SMA were measured and SMA protein immunolocalized in frozen sections. In the second model, rabbit corneas were uniformly ablated to a depth of 155 microns followed by three daily doses of the triple combination of siRNA. After 14 days, corneas were photographed and images were analyzed using Image J software to assess corneal scarring. Corneas were also analyzed for levels of SMA mRNA. Results: In both unwounded and wounded corneas, levels of TGFB1 and CTGF mRNA were always significantly higher in endothelial cells than in epithelial cells (10 to 30 fold). Thirty minutes after injury, levels of both TGFB1 and CTGF mRNAs increased approximately 20-fold in both epithelial and endothelial cells, and further increased approximately 60-fold in 2 days. In the first therapeutic experiment with a single siRNA dose, two of three rabbits showed substantial reductions of all three target genes after 1 day with a maximum knock down of 80% of TGFb 1, 50% red

关键词： RNA Interference siRNA Combination Corneal scarring TGFB1 CTGF

Tackling Post-Operative Cutaneous scarring with Autologous Cell Therapy

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Open Journal of Regenerative Medicine 2017年第3期6卷 27-33页

作者： Denis E. Solomon 9B Somerville Road Wigan England (UK)

Regenerative medicine has brought about refreshing new thinking about age old problems. However, some problems remain mostly untouched and are not being addressed. A point in question is the track of scar tissue left behind post-operatively, which reveals the surgeon’s line of invasive incision. This confers on the patient an adverse psychological reminder and burden for the rest of his/her life. Most patients cannot afford corrective plastic surgery to ameliorate this skin defect. This paper seeks to ask whether biomedical scientists could play a role in arriving at a more pleasing cosmetic result, using a simple cell culture procedure of isolating un-manipulated autologous primary epidermal and dermal cells from a small skin tissue segment in close proximity to the surgeon’s incision line.

关键词： Cutaneous scarring Post-Operative Epidermal Rosettes Dermal Fibro-blasts Autologous Cell Therapy Wound Healing

Patient experience of scar assessment and the use of scar assessment tools during burns rehabilitation:a qualitative study

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Burns & Trauma 2021年第1期9卷 441-453页

作者： Kate Price Naiem Moiemen Laura Nice Jonathan Mathers College of Medical and Dental Sciences University of BirminghamBirminghamUK Scar Free Foundation Centre for Conflict Wound Research Queen Elizabeth HospitalUniversity Hospitals Birmingham NHS Foundation TrustBirminghamUK NIHR Surgical Reconstruction and Microbiology Research Centre Queen Elizabeth HospitalBirminghamUK Institute of Applied Health Research University of BirminghamBirminghamUK

Background:Scar assessment plays a key role during burns aftercare,to monitor scar remodelling and patients’psychosocial well-being.To aid assessment,subjective scar assessment scales are available that use health-care professionals’and patients’opinions to score scar characteristics.The subjective scales are more widely used in clinical practice over objective scar measures.To date,there is no research that considers patients’views on scar assessment and the role of subjective and objective assessment tools.Therefore,the aim of this qualitative study was to explore patients’perspectives on scar assessment and the utility of scar assessment tools during burns rehabilitation.Methods:Semi-structured interviews were conducted with 10 adult burn patients who were being reviewed in clinic for scarring.Participants were recruited via their clinical care team and research nurses at the Queen Elizabeth Hospital,Birmingham,UK.Topics covered during interview included patient experience of scar assessment,the use of scar assessment tools and discussion surrounding important factors to be addressed when assessing scars.A thematic analysis using the Framework Method was conducted.Results:Participants identified key subthemes that contribute towards the overarching theme of patient-centred scar assessment.These are:patient-led care;continuity in care;learning how to self-manage scarring;and psychological assessment.Links were demonstrated between these subthemes and the remaining themes that describe scar assessment strategies,indicating their potential patient-centred contributions.The subjective opinions of clinicians were found to be valued above the use of subjective or objective scar assessment tools.Scar assessment scales were perceived to be a beneficial method for self-reflection in relation to psychosocial function-ing.However,minimal feedback and review of completed assessment scales led to uncertainty regarding their purpose.Patients perceived objective tools to be of primary use for health-care professionals,though

关键词： Burns scarring Scar assessment Scar assessment scales Qualitative research Interviews Objective scar assessment

Wound healing during hibernation by black bears (Ursus americanus) in the wild: elicitation of reduced scar formation

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Integrative Zoology 2012年第1期7卷 48-60页

作者： Paul A.IAIZZO Timothy G.LASKE Henry J.HARLOW Carolyn B.McCLAY David L.GARSHELIS Department of Surgery University of Minnesota Medtronic Inc Department of Zoology and Physiology University of WyomingLaramie Minnesota Department of Natural Resources USA

Even mildly hypothermic body or limb temperatures can retard healing processes in mammals.Despite this,we observed that hibernating American black bears(Ursus americanus Pallas,1780)elicit profound abilities in mounting inflammatory responses to infection and/or foreign bodies.In addition,they resolve injuries during hibernation while maintaining mildly hypothermic states(30–35°C)and without eating,drinking,urinating or defecating.We describe experimental studies on free-ranging bears that document their abilities to completely resolve cutaneous cuts and punctures incurred during or prior to hibernation.We induced small,full-thickness cutaneous wounds(biopsies or incisions)during early denning,and re-biopsied sites 2–3 months later(near the end of denning).Routine histological methods were used to characterize these skin samples.All biopsied sites with respect to secondary intention(open circular biopsies)and primary intention(sutured sites)healed,with evidence of initial eschar(scab)formation,completeness of healed epidermis and dermal layers,dyskeratosis(inclusion cysts),and abilities to produce hair follicles.These healing abilities of hibernating black bears are a clear survival advantage to animals injured before or during denning.Bears are known to have elevated levels of hibernation induction trigger(delta-opioid receptor agonist)and ursodeoxycholic acid(major bile acid within plasma,mostly conjugated with taurine)during hibernation,which may relate to these wound-healing abilities.Further research as to the underlying mechanisms of wound healing during hibernation could have applications in human medicine.Unique approaches may be found to improve healing for malnourished,hypothermic,diabetic and elderly patients or to reduce scarring associated with burns and traumatic injuries.

关键词： black bear denning hair growth healing hibernation histology scarring

Decorin treatment of spinal cord injury

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Neural Regeneration Research 2014年第18期9卷 1653-1656页

作者： Maryam Esmaeili Martin Berry Ann Logan Zubair Ahmed Neurotrauma Research Group Neurobiology SectionSchool of Clinical and Experimental MedicineUniversity of Birmingham

The scarring response after a penetrant central nervous system injury results from the interaction between invading leptominingeal/pericyte-derived fibroblasts and endogenous reactive astrocytes about the wound margin. Extracellular matrix and scar-derived axon growth inhibitory mole- cules fill the lesion site providing both a physical and chemical barrier to regenerating axons. Dec orin, a small leucine-rich chondroitin-dermatan sulphate proteoglycan expressed by neurons and astrocytes in the central nervous system, is both anti-fibrotic and anti-inflammatory and attenu- ates the formation and partial dissolution of established and chronic scars. Here, we discuss the potential of using Decorin to antagonise scarring in the central nervous system.

关键词： spinal cord injury Decorin transforming growth factor-beta scarring chondroiti^sulphate proteoglycan matrix metalloproteases

Hypertrophic Scar Formation and Wound Healing Modulation Fatty Acids as Modulators of Severe Scars

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Modern Plastic Surgery 2023年第1期13卷 41-51页

作者： Bárbara Díaz Valerie Nuñ ez Department of General Surgery Burn Unit Care Dr. Ricardo Gutiérrez Children’s Hospital Buenos Aires Argentina

Scar tissue usually generates severe discomfort in the short and long term. Common symptoms include anesthetics sequelae, pruritus, joint malfunction, new wounds on the scar surface, and pain. There are several treatments for scars, like compression, topical or intralesional steroid infiltration, 5-fluorouracil, dermabrasion, and surgeries with new scar tissue. For adult patients, it is easier to choose the treatment. However, compression is commonly applied in children to prevent treatments that have adverse effects. This study reports the outcomes of 15 patients submitted to abdominoplasty, traumatic wounds and post-burn scar treatments, which showed significant changes after the continuous use of an ointment composed of petrolatum, cod liver oil, BHT, Chamomilla recutita (chamomile) oil, Helianthus annuus (sunflower) oil, and Prunus amygdalus dulcis (sweet almond) oil. As components of the stratum corneum, unsaturated fatty acids influence the cutaneous structural and immune status and permeability. They also interfere with the maturation and differentiation of the stratum corneum and inhibit the production of proinflammatory eicosanoids, reactive species (ROS and RNS), and cytokines, thereby influencing the inflammatory response and possibly wound healing. This article aims to share our experience with the regular use of an ointment in adult and pediatric patients for three months. The increase in proinflammatory cytokine production at wound sites, resulting in a noninvasive, therapeutical, and effective cutaneous wound healing and scarring modulation, may provide a physiopathological explanation for the fast improvement of scars.

关键词： scarring Burn Scar Inflammatory Modulation Cytokine Sequelae Fatty Acids Eicosanoids Non-Adverse Effects Aesthetics Hypertrophic

瘢痕灸对失眠模型大鼠血清褪黑素及神经肽Y含量表达影响的研究

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World Journal of Acupuncture-Moxibustion 2020年第1期30卷 57-60页

作者：陈新旺史智君温婧王栋斌张明明高希言河南中医药大学郑州450046 河南省人民医院郑州450008 深圳平乐骨伤科医院广东深圳518122 河南中医药大学针灸研究所郑州450000

Objective:To explore the influence of scarring moxibustion on the changes of serum melatonin(MT)and neuropeptide Y(NPY)expressions in the insomnia model rats.Methods:A total of 40 SD rats were randomly divided into a blank group,a model group,a scarring moxibustion group,an embedding needling group and a mild moxibustion group,8 rats in each group.The intraperitoneal injection of p-chlorophenylalanine(PCPA)was adopted to establish the insomnia model rats and the corresponding interventions were given,consecutively for 6 days.Separately,before modeling and the first intervention as well as before sample collection,the body weight was measured and the serum was collected in the insomnia model rats.The enzyme linked immunosorbent assay(ELISA)was used to detect the levels of serum MT and NPY.Results:Compared with the blank group,the body weight of rat in the model group was lower(Pscarring moxibustion group,the embedding needling group and the mild moxibustion group,the body weight and the levels of MT and NPY of the insomnia model rats were all higher(all Pscarring moxibustion group(all P0.05).Conclusion:The regulation mechanism of sleep-wake circadian rhythm may be related to the levels of serum MT and NPY in the insomnia model rats.scarring moxibustion increases the levels of MT and NPY more effectively and displays the effect in the intervention as compared with embedding needling and mild moxibustion in the insomnia model rats.

关键词： Insomnia scarring moxibustion Mild moxibustion Embedding needling Serum melatonin(MT) Neuropeptide Y(NPY) Back-shu point

Frontal fibrosing alopecia update

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World Journal of Dermatology 2015年第1期4卷 33-43页

作者： Anna Lyakhovitsky Aviv Barzilai Boaz Amichai Department of Dermatology Chaim Sheba Medical Center Tel-Aviv University Sackler School of Medicine Tel Hashomer 52621 Israel Department of Dermatology Meir Medical Center Kfar-Saba Tel-Aviv University Sackler School of Medicine Tel Hashomer 52621 Israel

Frontal fibrosing alopecia(FFA) is a recently described form of primary cicatricial alopecia, characterized by progressive recession of the frontotemporal hairline and eyebrow loss, occurring predominantly in postmenopausal women. The incidence of FFA has increased significantly during the last decade and we may be facing an epidemic of the disease. Because this condition causes permanent hair loss, prompt diagnosis and treatment are essential for obtaining optimal outcome. This article reviews existing knowledge on epidemiology, etiopathogenesis, clinico-histological features, diagnosis,and treatment modalities of FFA.

关键词： Cicatricial alopecia scarring alopecia Frontal fibrosing alopecia Lichen planopilaris Hair loss

Ablative laser assisted topical delivery of antifibrotics in the management of cicatricial ectropion

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World Journal of Ophthalmology 2014年第2期4卷 7-13页

作者： Audrey C Ko Benjamin P Erickson Marcus J Ko Mohamed S Sayed Wendy W Lee Bascom Palmer Eye Institute University of Miami Miller School of MedicineMiami FL 33136 United States

A variety of surgical techniques have traditionally been used to manage cicatricial ectropion. These techniques primarily aim at vertical lengthening of the anterior lamella and include a variety of skin flaps and grafts. Alternative techniques such as dermal filler injection to support the eyelid margin may also be used in the management of select patients with cicatricial ectropion. The application of different types of laser for scar revision throughout the body has rapidly evolved; similar mechanisms, principles and treatment rationale can be applied to the use of lasers in the management of cicatricial ectropion. Additionally, ablative lasers, such as Carbon Dioxide and Erbium:yttrium-aluminumgarnet lasers, may be used in the transdermal delivery of antifibrotic agents, such as interferon gamma, interferon alpha, vitamin D, triamcinolone and 5-fluorouracil, resulting in efficient target tissue penetration, limitation of systemic drug toxicity and decreased degradation. Although the combination of ablative fractional resurfacing and topical antifibrotic agents is a new treatment modality, there is a great potential for its efficient utilityin the management of periocular scarring and cicatricial ectropion. The introduction of these innovative therapeutic modalities offers ophthalmologists a greater range of possible effective treatments to address periocular scar tissue and the resultant cicatricial ectropion.

关键词： Laser Antifibrotic agents Cicatricial ectro-pion Periocular scarring Ablative fractional resurfacing