Use of Adipose Stem Cells Against Hypertrophic Scarring or Keloid

Hypertrophic scars or keloid form as part of the wound healing reaction process, and its formation mechanism is complex and diverse, involving multi-stage synergistic action of multiple cells and factors. Adipose stem cells (ASCs) have become an emerging approach for the treatment of many diseases, including hypertrophic scarring or keloid, owing to their various advantages and potential. Herein, we analyzed the molecular mechanism of hypertrophic scar or keloid formation and explored the role and prospects of stem cell therapy, in the treatment of this condition.

Burn Care in the Era of Rapid Enzymatic Debridement: Challenging the Dogma that Healing Beyond 21 Days Results in Hypertrophic Scarring

Deep burns are characterized by the presence of a necrotic eschar that delays healing and results in a local and systemic inflammatory response and following healing by secondary intention: heavy scarring. Early surgical debridement followed by grafting was a major advance in deep burn care and is now the standard of care, reducing mortality and hypertrophic scarring. Eschars have alternatively been managed by non-surgical, autolytic debridement, which often results in infection-inflammation, slow epithelialization, granulation tissue formation and subsequent scarring. Studies based on these traditional approaches have demonstrated an association between delayed wound closure (beyond 21 days) and scarring. Early enzymatic debridement with NexoBrid (NXB) followed by appropriate wound care is a novel minimally invasive modality that challenges the well-accepted dictum of a high risk of hypertrophic scarring associated with wound closure that extends beyond 21 days. This is not surprising since early and selective removal of only the necrotic eschar often leaves enough viable dermis and skin appendages to allow healing by epithelialization over the dermis. In the absence of necrotic tissue, healing is similar to epithelialization of clean dermal wounds (like many donor sites) and not healing by the secondary intention that is based on granulation tissue formation and subsequent scarring. If and when granulation islands start to appear on the epithelializing dermis, they and the inflammatory response generally can be controlled by short courses (1-3 days) of topically applied low strength corticosteroid ointments minimizing the risk of hypertrophic scarring, albeit with wound closure delayed beyond the magic number of 21 days. Results from multiple studies and field experience confirm that while deep burns managed with early enzymatic debridement often require more than 21 days to reepithelialize, long-term cosmetic results are at least as good as with excision and grafting.

648 The Negative Impression Makes a Positive Impact

Introduction Providing timely and appropriate pressure to prevent/address hypertrophic scarring for burn survivors is an ongoing challenge. From time of measurement to obtaining a custom compression garment can be several weeks requiring creative solutions to providing interim pressure, particularly in the pediatric population and even more challenging for a facial burn scar. Historically, fabric custom garments were ordered, then with the advancement of silicone lined materials, clear facial masks could be fabricated. This process started with taking a plaster cast of the survivors’ face, frequently using sedation to allow for optimal fitting, but sedation can change the tone of the facial muscles adding to the challenge. With the advancements in technology, less invasive, more accurate, and more timely fabrication of face masks is possible. Methods A 3D picture was taken of a 14-month-old pediatric burn survivor with hypertrophic scarring on the face. This image was uploaded to a 3D printer and a positive print (facial surface down) was completed. The positive print was used to make an alginate mask and plaster was poured to create a casting of the positive printed face. A check mask was pulled from this positive plaster cast (+ mask). This check mask was too large for the patient’s face. To have a better fitting mask, another approach to the mask fabrication was completed. From the same 3D picture, a negative print (facial surface up) was completed. Plaster was poured directly into this negative print to create a casting of the negative printed face. A check mask was pulled from this negative plaster cast (- mask). Both check masks were fit to the patient to assess for accuracy of fit and estimation of required adjustments for optimal fit. Results There was a significant difference in the fit of the two masks created from the same 3D picture. The mask pulled on the positive casting was too large. The required adjustments to have the mask fit properly to provide appropriate compression to the hypertrophic scarring on the face would have been extremely difficult and time consuming to complete. The mask pulled on the negative casting fit well and only required small adjustments to ensure adequate pressure would be provided to the focused areas of hypertrophic scars on the face. Conclusions With advances in technology, 3D photography partnered with 3D printing allow for significant improvement in the accuracy of fitting facial masks, improve timeliness of compression, and improve the patient experience in the process of obtaining a facial mask.