Application and effect of tension-reducing suture in surgical treatment of hypertrophic scar.

PURPOSE: To investigate the application and effectiveness of tension-reducing suture in the repair of hypertrophic scars. METHODS: A retrospective analysis of clinical data was conducted on 82 patients with hypertrophic scars treated at the Department of Burns and Plastic Surgery of Nanjing Drum Tower Hospital from September 2021 to December 2022. Patients were operated with combination of heart-shaped tension-reducing suturing technique and looped, broad, and deep buried (LBD) suturing technique or conventional suture method. Outcomes of surgical treatment were assessed before and 6 months after surgery using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). RESULTS: Improvements were achieved on scar quality compared to that preoperatively, with a reduction in scar width (1.7 ± 0.6 cm vs. 0.7 ± 0.2 cm, P < 0.001). Assessment using the POSAS and VSS scales showed significant improvements in each single parameter and total score compared to preoperative values (P < 0.05). The Combination method group achieved better score in total score of VSS scale, in color, stiffness, thickness and overall opinion of PSAS scale, and in vascularity, thickness, pliability and overall opinion of OSAS scale. CONCLUSION: The amalgamation of the heart-shaped tension-reducing suturing technique and the LBD suturing technique has shown promising outcomes, garnering notably high levels of patient satisfaction in the context of hypertrophic scar repair. Patients have exhibited favorable postoperative recoveries, underscoring the clinical merit and the prospective broader applicability of this approach in the realm of hypertrophic scar management.

Effects of botulinum toxin type A in the prevention and treatment of facial hypertrophic scars: A meta-analysis.

A meta-analysis was conducted to comprehensively evaluate the prophylactic and therapeutic efficacy of botulinum toxin type A (BTX-A) in the treatment of facial hypertrophic scars. Computerised searches were performed in databases, from their inception to November 2023, including Embase, Google Scholar, Cochrane Library, Wanfang, PubMed and China National Knowledge Infrastructure databases, focusing on randomised controlled trials (RCTs) that investigated the use of BTX-A for treating facial hypertrophic scars. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Seventeen RCTs were ultimately included, involving 1605 patients who underwent facial cosmetic surgery. The analysis revealed that compared with conventional treatments, BTX-A significantly reduced visual analogue scale (VAS) scores (standardized mean difference [SMD]: -3.50, 95% confidence interval [CI]: -5.16 to -1.84, p < 0.001) and Vancouver scar scale (VSS) scores (SMD: -2.86, 95% CI: -4.03 to -1.68, p < 0.001), and narrowed scar width (SMD: -1.80, 95% CI: -2.48 to -1.13, p < 0.001), while also enhancing the overall effectiveness of the treatment. This study indicates that BTX-A is an effective modality in the prophylaxis and treatment of facial hypertrophic scars, significantly alleviating scar-related pain and preventing scar widening, and is thus worthy of broader clinical application.

Exogenous PRAS40 reduces KLF4 expression and alleviates hypertrophic scar fibrosis and collagen deposition through inhibiting mTORC1.

BACKGROUND: To identify the anti-fibrosis effect of PRAS40 in scar, and its potential mechanism. METHODS: We constructed a rat model of hypertrophic scarthat was locally injected the PRAS40 overexpression adenoviruses, mTORC1 inhibitor MHY1485 and activator rapamycin, and further observed the pathological changes of skin tissue and the severity of fibrosis by HE, Masson and sirius red staining, and analyzed the deposition of a-SMA and collagen I by western blot and immunofluorescence test. Meanwhile, the co-localization of KLF4 with a-SMA and type I collagen was analyzed, as well as the regulatory effect of PRAS40 on KLF4. In addition, we also verified whether the inhibition of scar fibrosis by PRAS40 is related to mTORC1, and whether the upregulation of KLF4 is related to mTORC1. RESULTS: The results showed that the expression of PRAS40 was low and p-PRAS40 was high in scar skin tissue. After local injection of PRAS40 overexpression adenovirus, the expression of PRAS40 in skin tissue was increased. The overexpression of PRAS40 can inhibit scar skin fibrosis and reduce the content of a-SMA and collagen I. Further mechanism analysis confirms that the inhibitory effect of PRAS40 on skin fibrosis is related to mTORC1, and PRAS40 inhibits the activation of mTORC1. The expression of KLF4 is relatively low in scar tissue. PRAS40 administration upregulated the expression of KLF4, which is related to mTORC1 CONCLUSIONS: PRAS40 significantly improves fibrosis of scar skin tissue and increases the expression of KLF4 in scars. The anti-fibrotic effect of PRAS40 depends on mTORC1.

Efficacy and Safety of Pressure Therapy Alone and in Combination with Silicone in Prevention of Hypertrophic Scars: A Systematic Review with Meta-analysis of Randomized Controlled Trials.

BACKGROUND: At present, there are many kinds of hypertrophic scar treatment methods, among which pressure therapy and silicone therapy are very common and standard therapies, but whether they are used alone or in combination is still controversial. Therefore, the purpose of this systematic review was to compare the efficacy and safety of the combination of pressure therapy and silicone therapy (PTS) with pressure therapy alone (PT) in the treatment of hypertrophic scars to provide clinicians with information so that they can make better decisions. METHODS: Relevant randomized controlled trials (RCTs) were collected by searching PubMed, Ovid MEDLINE, Embase, ScienceDirect, Web of Science, The Cochrane Library, Scopus, and Google Scholar databases to assess scar scores (The Vancouver Scar Scale, VSS; Visual Analog Scale, VAS) and adverse effects. RESULTS: We screened 1270 articles and included 6 RCTs including 228 patients. We found that height (MD = 0.15, 95%CI 0.10-0.21, p < 0.01) and pliability (MD = 0.35, 95%CI 0.25-0.46, p <0.01) had a significant difference, these two measures showed that the PTS group was superior to the PT group. Results in other aspects, such as VSS, vascularity, pigmentation, VAS, and adverse effects were similar between the two groups. CONCLUSIONS: There was no significant difference between PTS and PT in the overall treatment efficacy of hypertrophic scars with similar VSS and adverse effects, but PTS might have potential benefits for height and pliability. Additional studies with larger sample size and sound methodological quality are needed to confirm our conclusions. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Comparison of LeniScar Silicone Stick (AnsCare) With Traditional Silicone Gel (Dermatix Ultra) in Wound Scar Prevention and Removal.

BACKGROUND: As we all know, the numbers of aesthetic surgery are increasing around the world. After the surgery, the scar would be a problematic issue for both the surgeons and the patients. Silicone has proven to be effective for keloids, hypertrophic scars, and prevention of scar formation in many literatures for a long time. In terms of scar prevention, silicone has been used in the form of silicone sheets in early times, which is later improved to be the form of silicone gel with the advantage of easier usage. Although silicone gel has improved greatly in the aspect of appearance and convenience of the silicone sheets, there are still some disadvantages of the gel form. Therefore, the LeniScar silicone stick (AnsCare) is invented. OBJECTIVE: This article aimed to compare the results of scar treatment and prevention of the AnsCare LeniScar Silicone Stick versus the traditional silicone gel (Dermatix Ultra). METHODS: This study was a prospective, nonblinded, randomized clinical study. There were a total of 68 patients from September 2018 to January 2020. Patients were divided into 2 groups with AnsCare (n = 43) and Dermatix (n = 25), who both were required to schedule regular outpatient clinic follow-up, and photographs were taken before use, 1, 2, and 3 months later after the usage for the record. The physician assessed the scar condition by the Vancouver Scar Scale (VSS). The scores of the VSS were further analyzed and compared. RESULTS: The overall P value of total score of VSS was 0.635, which indicates that there is no significant difference in using AnsCare LeniScar Silicone Stick versus Dermatix Ultra silicone gel in terms of scar prevention and treatment. Individual items of VSS such as pliability, height, vascularity, and pigmentation all show no significant statistical difference in the 2 treatment products, with P = 0.980, 0.778, 0.528, and 0.366, respectively. CONCLUSION: Traditional Dermatix Ultra silicone gel has been effective in the treatment of scar formation. AnsCare LeniScar Silicone Stick is statistically not different from the Dermatix Ultra silicone gel when comparing the treatment results of scar prevention. Furthermore, the AnsCare LeniScar Silicone Stick has the advantages of being time-saving with no need to wait for it to dry and application of precise amount to precise location, preventing waste or overuse.

Triangular Resection Epicanthoplasty: A Novel Method of Minimizing Hypertrophic Scar After Medial Epicanthoplasty.

Medial epicanthoplasty is a crucial component in Asian cosmetic eyelid surgery. Conventional surgical methods have mandated wide undermining for the purpose of sufficient release. However, excessive undermining may result in hypertrophic scar or webbing deformities. To minimize undesirable results, the authors are proposing a novel approach. From March 2010 to December 2017, a triangular resection epicanthoplasty was performed in 421 Asian patients. The authors' procedure consists of triangular skin resection, the release of orbicularis oculi muscle and upper half medial epicanthal tendon, and dog ear correction. No complication regarding scarring or webbing was reported. The revision was performed in 18 cases where the patients wanted additional correction. The triangular resection epicanthoplasty offers both optimal results and minimal scar with relative simplicity.

Reducing Risks of Facial Scarring.

Risk factors for the formation of facial scars include skin type, ethnicity, scar location, and certain medical conditions that contribute to poor or delayed healing. Risk of scar can be reduced with appropriate surgical planning, including proper placement and design of incisions, meticulous skin closure, aseptic technique, and wound care to improve healing. Common pathologic scars include hypertrophic scars and keloid scars, each of which has unique approaches to surgical revision and medical treatment due to their respective risks of recurrence. Topical scar therapies, medical therapies, and surgical revision techniques for improvement in final scar appearance are discussed.

Salvianolic Acid B Attenuates Hypertrophic Scar Formation In Vivo and In Vitro.

BACKGROUND: Hypertrophic scars (HTSs) are a fibroproliferative disorder that occur following skin injuries. Salvianolic acid B (Sal-B) is an extractant from Salvia miltiorrhiza that has been reported to ameliorate fibrosis in multiple organs. However, the antifibrotic effect on HTSs remains unclear. This study aimed to determine the antifibrotic effect of Sal-B in vitro and in vivo. METHODS: In vitro, hypertrophic scar-derived fibroblasts (HSFs) were isolated from human HTSs and cultured. HSFs were treated with (0, 10, 50, 100 µmol/L) Sal-B. Cell proliferation and migration were evaluated by EdU, wound healing, and transwell assays. The protein and mRNA levels of TGFßI, Smad2, Smad3, α-SMA, COL1, and COL3 were detected by Western blots and real-time PCR. In vivo, tension stretching devices were fixed on incisions for HTS formation. The induced scars were treated with 100 µL of Sal-B/PBS per day according to the concentration of the group and followed up for 7 or 14 days. The scar condition, collagen deposition, and α-SMA expression were analyzed by gross visual examination, H&E, Masson, picrosirius red staining, and immunofluorescence. RESULTS: In vitro, Sal-B inhibited HSF proliferation, migration, and downregulated the expression of TGFßI, Smad2, Smad3, α-SMA, COL1, and COL3 in HSFs. In vivo, 50 and 100 µmol/L Sal-B significantly reduced scar size in gross and cross-sectional observations, with decreased α-SMA expression and collagen deposition in the tension-induced HTS model. CONCLUSIONS: Our study demonstrated that Sal-B inhibits HSFs proliferation, migration, fibrotic marker expression and attenuates HTS formation in a tension-induced HTS model in vivo. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effects of mechanical forces on the formation of cutaneous wounds during skin expansion and emerging therapies for wound healing and scar prevention.

OBJECTIVES: To update a possible role of cosmeceutical topic treatment to obtain a better scar. METHODS: This is a preliminary supportive study. A total of 14 patients who went to the General Hospital of Mexico City, Mexico, between May and December 2020, for breast reconstruction were included in the current study. The biopsies were carried out to the scar area of the previous I° and II° surgery. The patients were thus divided into 2 groups: those who used Cicolea cream® as a treatment supplement and those who used only petrolatum. RESULTS: Collagen fibers arranged in a regular pattern in the group treated with Cicolea compared to dispersed collagen fibers in the group treated with pure petrolatum. Furthermore, the patients who presented hypertrophic or keloid scars secondary to mastectomy, developed after insertion of breast expanders an organized scarring process, with improvement of scar if treated with Cicolea. CONCLUSION: Based on our observations, it is possible to propose that the action of the polyphenols present in the different components of Cicolea® cream leads to a better evolution of the wound healing compared to the action of petrolatum composition.

Angiogenesis modulation-mediated inhibitory effects of tacrolimus on hypertrophic scar formation.

Hypertrophic scar (HS) is a fibroproliferative disorder that causes cosmetic as well as functional problems; however, to our knowledge, there is no satisfactory treatment for HS to date. Previous studies have indicated that angiogenesis plays a crucial role in HS formation; therefore, anti-angiogenetic therapies are considered effective in improving HS. Although tacrolimus (TAC) has been proven effective in preventing HS formation in vivo and in vitro, its underlying mechanism remains controversial and ambiguous. Because of its anti-angiogenic effects in other diseases, we aimed to determine whether TAC reduces HS by suppressing angiogenesis. Using a rabbit ear HS model that we developed, HS was treated once a week with normal saline, dimethyl sulfoxide, or TAC for 3 weeks. Histological evaluation indicated that TAC significantly reduced collagen deposition and microvessel density in scar tissues. Moreover, immunofluorescence staining for CD31 and vascular endothelial growth factor (VEGF)-A revealed that TAC significantly inhibited HS angiogenesis. In vitro analysis showed that TAC inhibited endothelial cell migration and tubulogenesis as well as the viability and proliferation of human umbilical vascular endothelial cells (HUVECs) and HS fibroblasts (HSFBs). Furthermore, TAC significantly downregulated the expression of the human angiogenetic factors VEGF-A, FGF-2, PDGF-ß, and TGF-ß1 in HUVECs and HSFBs. Additionally, TAC-mediated inhibition of angiogenesis decreased the gene expression of crucial fibrotic markers, including α- smooth muscle actin and collagens 1 and 3, in HSFBs. This is the first study to demonstrate the inhibitory effects of TAC on HS formation mediated by a mechanism involving the suppression of scar angiogenesis.

Early Postoperative Injections of Polydeoxyribonucleotide Prevent Hypertrophic Scarring After Thyroidectomy: A Randomized Controlled Trial.

Objective: Polydeoxyribonucleotide (PDRN) is known to enhance wound healing, but there has been no clinical trial investigating the effect of PDRN on scar prevention in surgical wounds. This study aimed to evaluate the efficacy of PDRN administration in preventing postoperative scars. Approach: In this randomized controlled trial (NCT05149118), 44 patients who underwent open thyroidectomy were randomly assigned to the PDRN treatment or untreated control group. Only patients in the treatment group received two consecutive injections of PDRN 1 and 2 days after surgery. The modified Vancouver Scar Scale (mVSS), patients' subjective symptoms, erythema index (EI), melanin index (MI), and scar height were assessed 3 months after surgery. Results: Patients in the treatment group had lower mVSS scores (1.619 ± 1.244 vs. 2.500 ± 1.540, respectively; p = 0.059) and a significantly lower vascularity subscore (0.476 ± 0.512 vs. 0.900 ± 0.447, respectively; p = 0.010) than those in the control group at the 3-month follow-up. Compared with the control group, the level of subjective symptoms, EI, and scar height were all significantly lowered in the PDRN injection group. No specific side effects related to PDRN injection were observed. Innovation: This is the first clinical study that demonstrated that PDRN injections rapidly decreased postsurgical wound erythema and as a result, significantly reduced both excessive scar formation and accompanying symptoms. Conclusion: Early postoperative injection of PDRN is an effective and safe treatment to prevent hypertrophic scars and improve scar outcomes.

The Molecular Mechanisms Involved in the Hypertrophic Scars Post-Burn Injury.

Scar formation is a normal response to skin injuries. During the scar-remodeling phase, scar tissue is usually replaced with normal, functional tissue. However, after deep burn injuries, the scar tissue may persist and lead to contractures around joints, a condition known as hypertrophic scar tissue. Unfortunately, current treatment options for hypertrophic scars, such as surgery and pressure garments, often fail to prevent their reappearance. One of the primary challenges in treating hypertrophic scars is a lack of knowledge about the molecular mechanisms underlying their formation. In this review, we critically analyze studies that have attempted to uncover the molecular mechanisms behind hypertrophic scar formation after severe burn injuries, as well as clinical trials conducted to treat post-burn hypertrophic scars. We found that most clinical trials used pressure garments, laser treatments, steroids, and proliferative inhibitors for hypertrophic scars, with outcomes measured using subjective scar scales. However, fundamental research using human burn injury biopsies has shown that pathways such as Transforming Growth factor ß (TGFß), Phosphatase and tensin homolog (PTEN), and Toll-like receptors (TLRs) could be potentially regulated to reduce scarring. Therefore, we conclude that more testing is necessary to determine the efficacy of these molecular targets in reducing hypertrophic scarring. Specifically, double-blinded clinical trials are needed, where the outcomes can be measured with more robust quantitative molecular parameters.

Prevention and management of hypertrophic scars after laparoscopic surgery using silicone gel sheets: a pilot study.

OBJECTIVE: To assess the effectiveness and safety of modified silicone gel sheets applied to hypertrophic scars and keloids following laparoscopic surgery. METHODS: Patients who had undergone laparoscopic surgery and who had either conventional or modified silicone gel sheets affixed to their surgical lesions for 6 months postoperatively (treatment groups), and control patients who had not received postsurgical treatment involving silicone gel sheets, were enrolled. The surgical wounds were assessed visually and using the Japan Scar Workshop (JSW) Scar Scale. Patients were interviewed before, 3 months after, and 6 months after sheet affixation. RESULTS: A total of 45 patients were included, comprising 15 patients per group. Both silicone gel-sheet groups had significantly lower JSW Scar Scale scores at 3 and 6 months after affixation compared with controls. The scores were not significantly different between the conventional and modified treatment groups and no adverse events were observed in the latter. CONCLUSIONS: Modified silicone gel sheets were more effective than controls and comparable to conventional gel sheets, and there were no adverse events related to laparoscopic surgical wounds in the improved silicone gel sheet group, demonstrating the safety and effectiveness of the modified silicone gel sheets.

Interleukin-10-Modified Adipose-Derived Mesenchymal Stem Cells Prevent Hypertrophic Scar Formation via Regulating the Biological Characteristics of Fibroblasts and Inflammation.

Hypertrophic scar causes serious functional and cosmetic problem, but no treatment method is known to achieve a satisfactory therapeutic effect. However, mesenchymal stem cells show a possible cure prospect. Here, we investigated the effect of interleukin-10-modified adipose-derived mesenchymal stem cells (IL-10-ADMSC) on the formation of hypertrophic scar. In vitro, IL-10-ADMSC could highly express IL-10 and exhibited stronger inhibition of hypertrophic scar fibroblasts (HSFs) proliferation, migration, and extracellular matrix synthesis (the expression of collagen I, collagen III, FN, and α-SMA protein) than ADMSC. In vivo, we found that IL-10-ADMSC speeded up wound healing time and reduced scar area and scar outstanding height. Same as in vitro, IL-10-ADMSC also exhibited stronger inhibition of extracellular matrix synthesis (the expression of collagen I, collagen III protein) in wound than ADMSC. In addition, we also found that IL-10-ADMSC is also a stronger inhibitory effect on inflammation in wound than ADMSC, and IL-10-ADMSC inhibited TGF-ß/Smads and NF-κB pathway. In conclusion, IL-10-ADMSC demonstrated the ability to prevent hypertrophic scar formation. And its possible molecular mechanism might be related to IL-10-ADMSC inhibiting the proliferation and migration of the synthesis of extracellular matrix of HSFs, and IL-10-ADMSC inhibited the inflammation during the wound healing.

Concentration-Dependent Inhibition of Hypertrophic Scar Formation by Botulinum Toxin Type A in a Rabbit Ear Model.

BACKGROUND: Hypertrophic scar (HS), as a disappointing result of wound healing, adversely affects the patient, both physically and psychologically. Botulinum toxin type A (BTXA) has been revealed to prevent and improve HS. We conducted this study to assess the effect of different BTXA concentrations on inhibiting HS in a rabbit ear model. METHODS: Eight healthy New Zealand long-eared rabbits were included in the experiment for modeling. Four wounds of 1 cm in diameter were created on both ears, which separately received an injection of a given BTXA concentration immediately after surgery. On postoperative days 40, scar tissue was obtained and subjected to hematoxylin and eosin (HE) staining for the hypertrophic index (HI) and immunohistochemical staining for CD31, Ki67, and transforming growth factor-beta 1 (TGF-ß1) expression. The HI was assessed for scar proliferation, and CD31 and Ki67 expression were used to assess the effect of BTXA on angiogenesis and fibroblast proliferation, respectively. RESULTS: All rabbits healed well without infection or mortality. From the HE staining, the HI showed a significant decrease with increasing BTXA concentration (p < 0.05). BTXA also inhibited angiogenesis and TGF-ß1 expression in a concentration-dependent manner, with significant differences between the groups (p < 0.05). BTXA inhibited fibroblast proliferation with increasing BTXA concentration. However, there was no significant difference between the 0.5 U/0.1 ml and 0 U/0.1 ml groups (p > 0.05). CONCLUSION: Immediate postoperative BTXA injection inhibited angiogenesis, fibroblast proliferation, and TGF-ß1 expression in a concentration-dependent manner, thus suppressing HS formation in rabbit ears. NO LEVEL ASSIGNED: This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/journal/00266 .

A prospective study to evaluate the treatment effect of pulsed dye laser on thyroidectomy hypertrophic scars using 3D imaging analysis.

OBJECTIVES: The pulsed dye laser (PDL) is an effective modality for preventing and improving hypertrophic scars (HSs). However, the heterogeneity of the parameter settings of the laser and subjective scar assessment methods used in most studies resulting in uncertainty with treatment plans. Therefore, we investigated the treatment effect of the PDL (V-beam; Candela Laser Corporation) on HSs in post-thyroidectomy patients using three-dimensional imaging analysis and intended to provide a systemic and optimal treatment protocol. METHODS: Nineteen patients with HS after thyroidectomy underwent eight treatment sessions with the 595 nm PDL (with the dose gradually increased by 0.5 J/cm2 ) at 4- to 6-week intervals. Patients with an elevated lesion also received intralesional corticosteroid (ICS) treatment. After every two treatment sessions, we assessed the patients' HS using the Vancouver Scar Scale (VSS), a patient satisfaction questionnaire, and with a three-dimensional (3D) skin imaging device (Antera 3D™; Miravex Limited). RESULTS: In repeated-measures analysis of variance, the mean VSS and patient satisfaction significantly improved (p < 0.001), with significant differences in these values observed until the sixth and eighth treatment sessions, respectively. In the quantitative analysis using Antera 3D™, the mean height, pigmentation, and vascularity scores were observed to be significantly improved (p < 0.001). Significant differences in these values were observed until the fourth, second, and eighth treatment sessions, respectively. Subgroup analysis according to ICS treatment showed no significant differences in scar characteristics between those with and without ICS treatment. CONCLUSIONS: In this study, we found that the PDL was effective in reducing scar height, vascularity, and pigmentation in patients with thyroidectomy HS using 3D imaging analysis. Furthermore, we have suggested a cost-effective treatment plan with the 595 nm PDL.

Efficacy Of Microporous Tape In The Prevention Of Abnormal Post-Surgical Scars Among A Black Population.

BACKGROUND: A scar can be defined as a mark or a blemish resulting from a healed wound. All surgical incisions give rise to scars and approximately 15% have excessive scars. Some scars are thin lines which are almost unnoticeable, whereas others become abnormal when the amount of fibrosis is excessive or suboptimal or when it causes functional disability or aesthetic distress to the patient. The conversion of normal scarring to hypertrophic scarring occurs six to eight weeks after surgery as a result of increasing scar tension. Thus, scar support especially with the use of microporous tape is critical during this period. Objectives were to determine the efficacy of microporous tape in the prevention of abnormal post-surgical scars. METHODS: A randomized control study which compared the limb scar outcome between post-surgical patients who underwent scar taping with microporous tape and those who did not. The scars were assessed at six weeks, three months and six months after surgery using the Patient and Observer Scar Assessment Scale. The test group had microporous tape applied to their scars over a period of six months and worn twenty-four hours daily. The tapes were changed every fortnight or whenever they fell off. The data was analyzed using SPSS-22. The categorical variables, the relative scar height, the scar width and the OSAS score were compared using the Chi-square test and the independent t-test respectively. RESULTS: At six weeks, 48.8% of non-taped scars and 97.6% of taped scars were normal; at three months 75.6% of non-taped scars and 2.4% of taped scars were abnormal while at 6 months 80.5% of non-taped scars and none of the taped scars were abnormal. CONCLUSIONS: Microporous tape is an effective modality for preventing abnormal scarring in postsurgical patients.

Safety and efficacy of botulinum toxin type A in preventing and treating scars in animal models: A systematic review and meta-analysis.

Previous studies have used botulinum toxin type A (BTXA) to improve postoperative and hypertrophic scars; however, there is lack of detailed verification on the safety and effectiveness of this approach. This study aimed to evaluate the therapeutic effect of BTXA on postoperative hypertrophic scars and its influence on cytokine expression in animal models. A computerised search of different databases was performed, including PubMed, Web of Science, Scopus, Cochrane, Embase, CNKI, and Wanfang, up to 10 March 2021. A meta-analysis was performed using R 4.0.0 based on hypertrophic index, epithelialisation time, wound area, and vascular endothelial growth factor (VEGF) expression. Eleven studies were included. The meta-analysis showed a significant difference in hypertrophic index (standardised mean difference [SMD] = -2.63, 95% confidence interval [CI]: -3.50 to -1.76, P < .01), wound area (SMD = -0.54, 95% CI: -1.24 to 0.16, P < .01), and VEGF expression (SMD = -2.56, 95% CI: -3.50 to -1.62, P < .01). This study shows that BTXA is safe and effective in preventing and treating scar hypertrophy in animal models, but excessive doses of BTXA and BTXA to treat large areas should be avoided.