Tissue healing

This chapter describes in detail the processes of acute and chronic wound healing, and how these can be influenced by the plastic surgeon. Wound healing as it is relevant to graft take is also described. The chapter also discusses hypertrophic and keloid scar formation.

Enhanced Drug Permeation into Human Keloid Tissues by Sonophoresis-Assisted Microneedling

Keloids are disfiguring pathological scars that could cause pain and pruritus. The conventional treatments, such as bolus injection of drugs or surgery, are invasive and require a personal visit to clinic. Microneedle (MN) technology has great potential to offer a self-administered and minimally invasive treatment of keloids. However, drugs delivered using MNs suffer from limited penetration in keloid tissue. This study demonstrates enhanced drug penetration in human keloid scar tissue by combining MN and sonophoresis.

Scar-Free Healing of Wounds Resulting Commonly from Domestic Accidents

Scalds and cuts are common causes of childhood injuries at home. Although the impairments are often non-fatal, timely and effective treatments for them may not only help prevent infections, but also facilitate faster recovery from the injuries and scarless wound healing. Skin growth factors including the 53-amino acid human epidermal growth factor (EGF) and the 146-amino acid human basic fibroblast growth factor (bFGF) have been shown to play important physiological functions in promoting the growth and regeneration of our skin cells. Moreover, they have been employed individually to enhance the healing process of various types of wound. The specific bioactivities exhibited by EGF and bFGF in the epidermal and dermal layers, respectively, strongly support the notion that they may function cooperatively in wound healing. In this communication, making use of our own recombinant EGF (rEGF) and bFGF (rbFGF) products, which share the same primary structures with their native counterparts, we present research findings to demonstrate that rEGF and rbFGF work collaboratively to promote healing of various types of wound, including scalds, punctures and lacerations. More importantly, despite the severity of the injuries, subsequent to their treatments with rEGF and rbFGF, the healed wounds were virtually scar-free and devoid of the formation of an outgrowth scar, a keloid scar.

Novel Chest Tube Anchoring and Closure Technique with an Aesthetic Scar

Technique: This chest tube anchoring technique differs from other techniques by introducing 2 layered closure to avoid wound healing complications such as hypertrophic or keloid scar and to achieve airtight closure. The first suture to be used is a monofilament synthetic absorbable 4/0 suture – Monocryl (Johnson & Johnson, New Jersey, USA) that is passed as a buried stitch in the dermal layer. The second suture to be used is a monofilament non-absorbable 3/0 suture – Prolene (Johnson & Johnson, New Jersey, USA) that is passed around the chest tube incision in a horizontal mattress manner taking the muscle/fascia and skin layers. The chest tube is then anchored with a 2/0 silk suture with a mesentery. The three suture ends are secured and wrapped around the chest tube with Steri-Strips™ (3M™, Minnesota, USA). Two long dressings are sandwiched together, partially on skin and partially on the tube as dressing anchors. Results: This technique has shown good results with no complications. Routine chest radiograph and physical examination showed no signs of pneumothorax or discharge from the wound nor any wound healing complications. Conclusion: This chest tube anchoring and closure technique is secure and produces an aesthetic pleasing scar that does not require any expensive sutures or special skills.

Successful treatment of extensive recurrent keloid scar

The treatment of scars and impact by them their deformations, as well as the formation of pathological scars, remain one of the most difficult and insufficiently explored problems of plastic and reconstructive surgery. The most severe type of pathological scars is keloid a tumor-like growth of immature connective tissue due to uncontrolled proliferative fibroblast activity. The simple removal of keloids even within healthy tissue was often accompanied by their recurrence. Here presented clinical observation of the patient with benign fibroma of 1 finger of the right foot, who had after excision of formation, keloid scar has developed. Repeated operations with keloid excision and the use of free skin plastic have proved ineffective. Only long-term therapy with diprospan injections for 1.5 years allowed to achieve cure of the patient.

Giant Protruding High-Grade Undifferentiated Pleomorphic Sarcoma Arising in a Keloid Scar on the Abdominal Wall

Undifferentiated pleomorphic sarcoma (UPS) is a high-grade, aggressive, soft tissue sarcoma that is often fatal. Although there are reports describing associations of sarcoma and skin lesions such as burns, radiation, and trauma, to our knowledge, UPS development in a keloid scar has not been reported. Herein, we present the case of a 76-year-old woman who had undergone surgery for endometrial cancer, 5 years before. She presented with a protruding lesion that was continuous to a keloid scar on the abdominal wall. The tumor appeared clinically malignant as it was protruding and doubled in size within three weeks, reaching approximately 6 × 6 × 2 cm. Since the tumor was diagnosed as UPS after pathological evaluation by needle biopsy, wide resection was performed. Intraoperatively, the tumor was apparently continuous to the keloid, protruding and pedunculated outside the body, and had not invaded the abdominal cavity. Histopathological examination of the resected tumor showed evidence of UPS and no suspicion of metastasis of endometrial cancer. No recurrence, metastases, or other complications were noted 6 months after surgery. The current case study reminds us that keloids may cause high-grade sarcoma such as UPS, and careful follow-up is required.