Pressure Therapy for the Control of Hypertrophic Scar Formation after Burn Injury

1991 ◽  
Vol 12 (3) ◽  
pp. 257-262 ◽  
Author(s):  
R Scott Ward
1992 ◽  
Vol 59 (2) ◽  
pp. 78-86 ◽  
Author(s):  
Kathy Farquhar

Since 1982 a number of studies have investigated the use of silicone gel sheets in the prevention and reduction of hypertrophic scar formation. The statistical significance of several of these studies has been reduced by poor standardization of research methods, and the lack of a reliable and valid method of assessing hypertrophic scarring. When these studies are considered together, however, several clinically significant trends become apparent. The application of silicone gel appears to normalize the texture, colour, evaluation, and occurrence of subjective complaints (i.e., pain and pruritis) typically associated with hypertrophic scarring. These results are independent of the patient's age, method of attachment of the gel, or the location, age, or cause of the scar. The most appropriate treatment protocol for the application of silicone gel has yet to be determined. Current literature suggests that daily wearing tolerance be developed over the course of one to two weeks, the gel and scar be cleaned twice daily, and skin monitored regularly for signs of irritation. The optimal duration of treatment has not been established. Further research using standardized procedures and valid, reliable methods of measurement are required before this treatment can be ethically used to replace more established treatment techniques. However, the literature currently available would indicate that silicone gel may be an effective treatment technique for the prevention and reduction of hypertrophic scar formation following burn injury.


2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S27-S27
Author(s):  
Bonnie C Carney ◽  
Taryn E Travis ◽  
Romina Deldar ◽  
Lauren T Moffatt ◽  
Laura S Johnson ◽  
...  

Abstract Introduction Dyschromic hypertrophic scar (HTS) with areas of hyper- and hypo-pigmentation is a common sequelae of burn injury. The mechanism behind the development of dyschromia has not been elucidated. In this study, we provide a histological analysis of these scars with a focus on rete ridge presence. Rete ridges occur in epithelial tissues such as oral mucosa and skin and can be described as undulating “pegs” that are interdigitated with dermal papillae. Rete ridges enhance adhesion of the epidermis to the dermis. We hypothesize that rete ridge presence is important for normal skin physiology, and their absence or presence may hold mechanistic significance in post-burn HTS dyschromia. Methods Subjects with post-burn dyschromic HTS were consented and enrolled (n=27). Punch biopsies of hyper-, hypo-, and normally pigmented scar and skin were collected and stored in formalin. Biopsies were paraffin embedded, sectioned, stained with H&E, and imaged. The number of rete ridges were investigated by calculating a rete ridge ratio from the length of the basement membrane and the length of the epidermis. Results The patient population was predominantly female (55.5%), black (70.4%), and had Fitzpatrick skin Type V (51.9%). The injuries were primarily as a result of flame (37%) and scald (33.3%) and resulted in a median TBSA burn of 7%. The median age of the scar at the time of sample acquisition was 12.2 months. The rete ridge ratio of normally pigmented, un-injured skin was above 1 (1.31 ± 0.04), indicating that normal skin’s basement membrane is longer than its epidermal length due to the presence of rete ridges. HTSs resulting from burn wounds that healed without split thickness autografts were first investigated. The number of rete ridges was higher in normal skin compared to HTS that was either hypo- or hyperpigmented (1.31 ± 0.04 vs. 1.13 ± 0.05 and 1.14 ± 0.04 vs, p< 0.05). This difference was similar despite pigmentation phenotype. When hyper-pigmented scars resulting from wounds that were treated with split thickness autografts (Hyper(+)) were investigated, rete ridge number was significantly higher than in Hyper(-) (1.89 ± 0.23, p< 0.01). Patient age showed a weak correlation (R=-0.33) with rete ridge ratio where older patients had lower rete ridge ratios in normal, un-injured skin. Hyper(+) showed a weak correlation between rete ridge ratio and age of scar (R=-0.38). Conclusions Post-burn HTS that is dyschromic has fewer rete ridges than normal skin. This finding may explain the decreased epidermal barrier function that is associated with HTS.


2021 ◽  
Vol 7 ◽  
pp. 205951312110292 ◽  
Author(s):  
Sarah O’Reilly ◽  
Erin Crofton ◽  
Jason Brown ◽  
Jennifer Strong ◽  
Jenny Ziviani

Introduction: Tapes have been used to aid fresh wound closure. For hypertrophic scars, the use of tapes as a therapy to reduce the mechanical forces that stimulate excessive and long-term scarring is yet to be evaluated. The aim of this comprehensive review was to explore the current clinical application of tapes, as a minimally invasive option, as purposed specifically for the management of hypertrophic scarring, regardless of scar causation. Method: Databases were searched using MeSH terms including one identifier for hypertrophic scar and one for the intervention of taping. Studies included the following: patients who received tape for a minimum of 12 weeks as a method of wound closure specifically for the purpose of scar prevention; those who received tape as a method of scar management after scar formation; reported outcomes addressing subjective and/or objective scar appearance; and were available in English. Results: With respect to non-stretch tapes, their use for the prevention of linear surgical scarring is evident in reducing scar characteristics of height, colour and itch. Statistically significant results were found in median scar width, reduction in procedure times and overall scar rating. Tapes were predominately applied by participants themselves, and incidence of irritation was infrequently reported. After 12 months, significance with respect to scar pain, itch, thickness and overall scar elevation was reported in one study investigating paper tape. Two papers reported the use of high stretch tapes; however, subjective results limited formal analysis. Although the use of taping for abnormal hypertrophic scar management is in its infancy, emerging research indicates tapes with an element of stretch may have a positive impact. Conclusions: Non-stretch tapes, for the prevention of linear surgical scarring, are effective in reducing scar characteristics of height, colour and itch. Paper tapes have shown effectiveness when applied during wound remodelling or even on mature scarring, with reported subjective changes in scar colour, thickness and pliability. Preliminary evidence of the benefits of high-stretch, elasticised tapes for scar management in the remodelling phase of wound healing have also been reported. Lay Summary Patients are often concerned about unsightly scars that form on their bodies after trauma, especially burn injuries. These scars can be thick, red and raised on the skin, and can impact on the patient’s quality of life. For some scars, the process of skin thickening continues for up to two years after an injury. Unfortunately, scar formation is a part of the body’s healing process, whereby there is a constant pull or tension under and along the skin’s surface. The use of simple tapes, such as microporetm, to help with wound closure are sometimes used as a therapy to reduce the tension on the skin’s surface when a wound is healing to minimise scar formation. However, the effectiveness of taping has not been proven. This paper looks at the available evidence to support the use of taping to reduce scar features of height, thickness and colour. Initial evidence of mixed levels, suggests some benefits of tapes for scar management and show preliminary efficacy for reduction of scar height, thickness and colour. More research is required to determine the direct impact, comparison to other treatments available and patient viewpoint for this therapy.


Author(s):  
Jia Huang ◽  
Xiaobo Zhou ◽  
Lingling Xia ◽  
Weiwei Liu ◽  
Fei Guo ◽  
...  

2015 ◽  
Vol 37 (2) ◽  
pp. 666-676 ◽  
Author(s):  
Ting He ◽  
Xiaozhi Bai ◽  
Longlong Yang ◽  
Lei Fan ◽  
Yan Li ◽  
...  

Background/Aims: Our previous study confirmed that Loureirin B (LB) can inhibit hypertrophic scar formation. However, the mechanism of LB-mediated inhibition of scar formation is still unknown. Methods: Immunohistochemistry was used to detect expression of Col1, FN and TGF-β1 in skin and scar tissue. Fibroblasts were stimulated with TGF-β1 to mimic scar formation. LB or MAPK inhibitors were used to study the pathways involved in the process. Western blotting was used to evaluate the expression of p-JNK, p-ERK, p-p38, Col1 and FN. The contractile capacity of fibroblasts was evaluated using a gel contraction assay. Tissues were cultured ex vivo with LB to further investigate the participation of ERK and JNK in the LB-mediated inhibition of scar formation. Results: FN and Col1 were up regulated in hypertrophic scars. LB down regulated p-ERK and p-JNK in TGF-β1-stimulated fibroblasts, while levels of phosphorylated p38 did not change. The down regulation of p-ERK and p-JNK was associated with a reduction of Col1 and FN. Similarly, inhibition of ERK and JNK down regulated the expression of Col1 and FN in TGF-β1-stimulated fibroblasts. LB down regulated protein levels of p-ERK and p-JNK in cultured hypertrophic scar tissue ex vivo. Conclusions: This study suggests that LB can inhibit scar formation through the ERK/JNK pathway.


2011 ◽  
Vol 19 (3) ◽  
pp. 292-301 ◽  
Author(s):  
Willem M. van der Veer ◽  
Frank B. Niessen ◽  
José A. Ferreira ◽  
Peter J. Zwiers ◽  
Etty H. de Jong ◽  
...  

2018 ◽  
Vol 50 (6) ◽  
pp. 661-668 ◽  
Author(s):  
Myeongjin Kim ◽  
Hyejin Kim ◽  
Hyun Wook Kang

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