Non-Invasive and Surgical Modalities for Scar Management: A Clinical Algorithm

Scars can lead to aesthetic and functional impairments. The treatment of scars requires meticulous planning and an individually adapted therapeutic strategy. A conceptual algorithm for scar treatment makes everyday clinical work easier for the practitioner and offers more safety for the patient. Based on a retrospective analysis of 1427 patients who presented for treatment of a variety of scars, we developed an algorithm for scar management and treatment. The treatments are presented using case descriptions. Additionally, an electronic search of MEDLINE, EMBASE, and ClinicalTrials.gov databases was performed utilizing combinations of relevant medical subject headings for “scar treatment”, “hypertrophic scar treatment” and “keloid treatment”. Reference lists of relevant articles and reviews were hand-searched for additional reports. Observed outcomes included: conservative scar therapy, minimally invasive scar therapy, and surgical scar therapy using local, regional and free flaps. With this work, we provide an algorithm for safe scar treatment. For better understanding, we have described a clinical case for each algorithm modality.

Manual scar therapy on the example of a caesarean section scar

Surgical procedures (including cesarean section) or accidental cuts, may leave marks on the skin in the form of scars and accompanying ailments. There are many methods of scar treatment, including physiotherapeutic techniques. The aim of the study was to present the issues of manual work with a scar on the example of a scar after a caesarean section. Soft tissue manipulation techniques allow physiotherapists to be effective in removing the negative effects of poor wound healing, including restoring the aesthetics of visible tissues.

C-sections impact on maternal and fetal health. Positive outcomes with Micro Point Stimulation of C-section scars

This review clearly demonstrates the dramatic impact of a C-section on the morbidity for both mother (pyhsical and emotional) and child (especially related to adverse microbiom development in the growing infant). In addition millions of women who suffer symptoms both locally around the surgical site and more importantly distant effects related to sympathetic up-regulation, mainly through fascial/ fibrotic nerve stimulation. Our experience of the application of Micro Point Stimulation Scar Release therapy to C- section scars resulted in markedly improved pain in these patients who had long-standing symptoms The preliminary but impressive ultrasound findings showing the dramatic reduction in the fibrous/fascial mass after just one session of Micro Point Stimulation Scar therapy of 35 secs adds credence to the efficacy of this procedure in relieving pain symptoms from a simple inexpensive method of treatment. Micro Point Stimulation scar release therapy impacts on distant locations of pain; this challenges the traditionally held concepts of diseases and its pathophysiology. Abdominal and C-section scars may now be viewed as significant systemic contributors to pain and dysfunction throughout the entire body. The overuse of C-sections cannot be justified and it is imperative that the entire practice be reviewed to stem the rising use of this procedure. Where ever possible a delivery should happen in home friendly environment, which is conducive to good health for mother and child.

Mitigation of traumatic blepharoptosis with “central levator tuck”: A novel approach in upper eyelid repair

Purpose: Complex upper eyelid lacerations can present to the emergency department after a myriad of trauma. The goal of the surgical repair is anatomical and functional recovery along with symmetrical cosmesis. Despite meticulous surgery, post traumatic blepharoptosis may develop. We describe an additional step during upper eyelid laceration repair to help mitigate the development of traumatic blepharoptosis. Methods: Patients with traumatic eyelid laceration without head injury, globe injury or associated orbital fractures, who were planned for a primary upper eyelid repair were included. Intraoperatively, wound margins and tissues were identified to establish anatomical continuity. After the LPS muscle was reinserted onto the tarsus, a single, central suture LPS plication – the “ central levator tuck” was performed. This helped in improving the muscle action as well as strengthening its reattachment onto tarsus. Results: Four cases underwent laceration repair with this modified technique. The nature of eyelid injury, surgical technique, and the outcome at 6 months is described. Three patients had a successful outcome, whereas one patient developed early scarring which reduced with scar therapy over time. Conclusion: We describe a simple and effective “central levator tuck” technique for traumatic eyelid laceration repair with optimal functional and cosmetic outcome while reducing the development of blepharoptosis in four patients.

Mechanosensitive Aspects of Cell Biology in Manual Scar Therapy for Deep Dermal Defects

Deep dermal defects can result from burns, necrotizing fasciitis and severe soft tissue trauma. Physiological scar restriction during wound healing becomes increasingly relevant in proportion to the affected area. This massively restricts the general mobility of patients. External mechanical influences (activity or immobilization in everyday life) can lead to the formation of marked scar strands and adhesions. Overloading results in a renewed inflammatory reaction and thus in further restriction. Appropriate mechanical stimuli can have a positive influence on the scar tissue. “Use determines function,” and even minimal external forces are sufficient to cause functional alignment (mechanotransduction). The first and second remarkable increases in connective tissue resistance (R1 and R2) seem to be relevant clinical indications of adequate dosage in the proliferation and remodulation phase, making it possible to counteract potential overdosage in deep dermal defects. The current state of research does not allow a direct transfer to the clinical treatment of large scars. However, the continuous clinical implementation of study results with regard to the mechanosensitivity of isolated fibroblasts, and the constant adaptation of manual techniques, has nevertheless created an evidence-base for manual scar therapy. The manual dosages are adapted to tissue physiology and to respective wound healing phases. Clinical observations show improved mobility of the affected regions and fewer relapses into the inflammatory phase due to mechanical overload.

A facile and efficient approach for hypertrophic scar therapy via DNA-based transdermal drug delivery

DNA-Fe NPs, a novel and efficient nanocarrier, improve DOX penetration and enhance scar-inhibiting effects for HS therapy.