Preparation of tanshinone IIA self-soluble microneedles and its inhibition on proliferation of human skin fibroblasts / 中草药·英文版

OBJECTIVE@#Hypertrophic scars (HS) are a variety of skin tissue fibrosis disease that occurs in human skin, the effective therapeutic method of which is still inaccessible up to now. As a bioactive constituent of a well-known medical plant, Salvia miltiorrhiza (Danshen in Chinese), tanshinone IIA (TSA) is reported to inhibit cell proliferation in HS. Therefore, the aim of this study was to prepare TSA self-soluble microneedles to strengthen its dermal retention and break through the difficulty of significantly thickening epidermal connective tissue and stratum corneum at the HS site. The possible mechanism of action in suppressing HS was studied using human skin fibroblasts (HSF).@*METHODS@#Tanshinone IIA self-dissolving microneedles (TSA-MN) was prepared using a negative mold casting method. The prescription process of microneedle was optimized by Box-Behnken effect surface method. Different media were selected to investigate the ability of transdermal absorption and in vitro release. Furthermore, according to Cell Counting Kit-8 (CCK8) method as well as the Western blot method, the effect of TSA-MN on the biological characteristics of HSF was investigated.@*RESULTS@#With remarkable slow release effect and dermal retention, the release and transdermal properties of TSA-MN in vitro were better than both TSA and ordinary dosage forms. Its effect of HSF confirmed the essential decrease in cell motility during cell proliferation and cell migration in vitro, which plays a significant role in down-regulating the secretion of transforming growth factor-β1 (TGF-β1) in HSF and increasing the expression level of Smad7.@*CONCLUSION@#The prepared TSA self-soluble microneedles is helpful in solving the problem of hypertrophic scars, with a stable dermal retention effect after process optimization.

Clinical study of modified photodynamic therapy combined with Taohong Siwu Decoction in treating hypertrophic scar after severe burn

Abstract Objective: The aim of this study was to study the curative effect and the relative mechanism of modified photodynamic therapy combined with Taohong Siwu Decoction in the treatment of hyperplastic scar after severe burn, in order to provide a stable, safe and satisfactory scheme for scar repair. Methods: Forty cases with hyperplastic scars after severe burns admitted to the plastic surgery department from May 2021 to May 2022 were divided into a control group and an observation group by means of the random number table method. The control group was treated with ordinary laser therapy combined with Taohong Siwu Decoction, while the observation group was treated with modified photodynamic therapy combined with Taohong Siwu Decoction. The Vancouver Scar Scale (VSS) was assessed in both groups, and the clinical effectiveness of both groups was compared. HE-staining was performed on the scar tissue of the same patient before and after treatment to observe the changes in the arrangement of fibroblasts. The Vascular Endothelial Growth Factor (VEGF), β-Transforming Growth Factor (TGF-β), and Platelet-Derived Growth Factor (PDGF) in the tissue samples of both groups were detected by quantitative real-time PCR. The patients were followed up for 6 months, and their satisfaction, side effects, and scar recurrence were observed. Results: Compared with the control group, the VSS score in the observation group was lower (p < 0.05). The therapeutic effect of the observation group was superior to the control group after 3 months (p < 0.05). After 3-months of therapy, the arrangement of fibroblasts in the scar became looser in two groups, and the observation group was more looser. The VEGF, TGF-β and PDGF levels in tissue samples of the observation group were lower than those in the control group after 3 months of treatment (p < 0.05). The satisfaction of the observation group was higher than that of the control group (p < 0.05). The adverse reactions between the two groups showed no difference (p > 0.05), while the recurrence rate was lower in the observation group (p < 0.05). Conclusion: Modified photodynamic therapy combined with Taohong Siwu Decoction shows remarkable efficacy in patients with hyperplastic scars after severe burns. It can improve the color, thickness, vascular distribution, and softness of the scar, and reduce the level of cytokines related to tissue repair. At the same time, it can improve patients' satisfaction with the aesthetic appearance and reduce the recurrence rate, providing a new comprehensive therapy that is safer and more effective, simple and quick, and easy to promote in the clinic.

A.S.A.P. - O primeiro algoritmo para tratar queloides e cicatrizes hipertróficas / A.S.A.P. - The first algorithm to treat keloids and hypertrophic scars

Queloides e cicatrizes hipertróficas são muito prevalentes, mas seu tratamento ainda é desafiador. Vários tratamentos se mostraram benéficos, mas ainda não há um protocolo ou algoritmo para abordar cicatrizes, que siga um passo-a-passo organizado e que justifique o uso de cada tipo de tratamento em uma fase da cicatriz. O objetivo deste estudo é apresentar uma proposta de algoritmo para tratar cicatrizes, usado em nosso serviço por alguns anos. Ele ajuda a organizar as diversas terapias empregadas no tratamento de cicatrizes. Combinadas, estas sequências de tratamentos levam a uma melhora progressiva em queloides e cicatrizes hipertróficas.

Keloids (K) and hypertrophic scars (HS) are highly prevalent, but their treatment is still challenging. Several treatments are beneficial to treat K/HS, but there is still no protocol or algorithm to address scars following an organized step-by-step and justifying each type of treatment in the scar phases. This study aims to present an algorithm to treat keloids/scars. It has been used for several years in our clinic and helps organize several therapies to treat scars. Combined, these sequences of treatments lead to progressive improvement in K and HS.

Mechanical Model for Evaluating Curative Effect of Laser on Hypertrophic Scar / 医用生物力学

:Objective To establish a mechanical model with times of laser treatment as the independent variable in treatment process of rabbit ear hypertrophic scar (HPS) by combining experimental research and numerical simulation, so as to evaluate the curative effect of HPS. Methods Firstly, the HPS model of rabbit ear was established by CO2 laser instrument, and then the HPS was treated for continuous three times by pulsed dye laser (PDL) combined with CO2 lattice laser. After each treatment, the uniaxial compressive mechanical properties of HPS were tested to fit Ogden hyperelastic model to obtain mechanical parameters of HPS during the treatment. The functional relationship between mechanical parameters of HPS and times of laser treatment was established by LM optimization algorithm. Results Mechanical parameters of HPS increased with the increase of laser treatment times, and gradually became a constant, namely, mechanical parameters of normal skin. With the increase of laser treatment times, the growth ratio of HPS mechanical parameters gradually decreased. The initial growth ratio was 60% and decreased to 4.09% after three times of treatment. Conclusions The initial curative effect of laser therapy is the most obvious, and with the relief of symptoms, the effect of single laser therapy is no longer significant.

Clinical effects of photodynamic therapy combined with CO 2 fractional laser in treatment of hyperplastic acne scars / 中华医学美学美容杂志

Objective:To investigate the clinical effect of 5-aminolevulinic acid (ALA) photodynamic therapy (PDT) combined with CO 2 fractional laser on hypertrophic scars. Methods:From 2017 to 2019, 20 patients [17 males, 3 females, aged (24.4±4.24) years] with mandibular acne keloid in the Department of Dermatology of Air Force Medical Center, were treated with ALA-PDT combined with CO 2 fractional laser treatment, once a month, 3 times in total, and were followed up for 6 months. The efficacy, safety, and recurrence were evaluated by the Vancouver scar scale (VSS) score. Results:The effective rate was 100% after three treatments. The VSS score decreased significantly after the first treatment, and as the number of treatments increased, the VSS score further decreased. The first improvement after treatment was thickness and hardness. There was no recurrence during the 6-month follow-up. The main adverse reactions were pain, erythema and pigmentation.Conclusions:ALA-PDT combined with CO 2 fractional laser can be used as a new treatment for hypertrophic scars.

Aspirin inhibits the growth of hypertrophic scar in rabbit ears via regulating Wnt/β-catenin signal pathway / 中南大学学报(医学版)

OBJECTIVES@#Steroidal anti-inflammatory drugs have certain side effects in the treatment of hypertrophic scar, and the scar recurrence is easy after withdrawal of steroid anti-inflammatory drugs. Finding reliable alternative drugs is an effective means to improve this defect. Aspirin, a traditional non-steroidal anti-inflammatory drug, is safe for topical use and has anti-inflammatory effects similar to those of steroidal anti-inflammatory drugs, which may have similar effects on the treatment of hypertrophic scar. This study aims to investigate the inhibitory effect of aspirin on the proliferation of hypertrophic scar in rabbit ears and the underlying mechanism.@*METHODS@#The rabbit ear hypertrophic scar models were prepared. The rabbits were randomly divided into a normal skin group (group A), a blank control group (group B), a 0.9% NaCl group (group C), a 0.2% aspirin group (group D), a 0.5% aspirin group (group E), a 2% aspirin group (group F), and a triamcinolone acetonide group (group G). Macroscopic observation of hyperplasia was performed 8 weeks after local injection of the scar, followed by collecting the scar tissue samples for HE staining, Masson staining, and immunohistochemistry, respectively to assess the proliferation of fibroblasts and collagen fibers, and calculate the hypertrophic index, microvessel density, and immunohistochemical score.@*RESULTS@#All rabbit ear hypertrophic scar models were successfully constructed. In groups B and C, the hypertrophic scar edge was irregular, with reddish protruding epidermis, significant contracture and hard touch. In group D, E, and F, with the increase of aspirin administration concentration, the scar became thinner and gradually flat, the proliferation of fibrocytes and collagen fibers was weakened, and the hypertrophic index was gradually decreased (P<0.05). Immunohistochemistry showed that the expression of β-catenin was decreased in the group D, E and F in turn, and the immunohistochemical score was gradually decreased (P<0.05). There was no significant difference in hypertrophic index, microvessel density, and immunohistochemical score (all P>0.05).@*CONCLUSIONS@#Local injection of aspirin can reduce the generation of hypertrophic scar in a dose-dependent manner within a certain concentration range; aspirin inhibits the growth of hypertrophic scar in rabbit ears by inhibiting Wnt/β-catenin signal pathway; 2% aspirin and 40 mg/mL triamcinolone acetonide have similar curative efficacy on hypertrophic scar.

Transition of autophagy and apoptosis in fibroblasts depends on dominant expression of HIF-1α or p53 / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

It has been revealed that hypoxia is dynamic in hypertrophic scars; therefore, we considered that it may have different effects on hypoxia-inducible factor-1α (HIF-1α) and p53 expression. Herein, we aimed to confirm the presence of a teeterboard-like conversion between HIF-1α and p53, which is correlated with scar formation and regression. Thus, we obtained samples of normal skin and hypertrophic scars to identify the differences in HIF-1α and autophagy using immunohistochemistry and transmission electron microscopy. In addition, we used moderate hypoxia in vitro to simulate the proliferative scar, and silenced HIF-1α or p53 gene expression or triggered overexpression to investigate the changes of HIF-1α and p53 expression, autophagy, apoptosis, and cell proliferation under this condition. HIF-1α, p53, and autophagy-related proteins were assayed using western blotting and immunofluorescence, whereas apoptosis was detected using flow cytometry analysis, and cell proliferation was detected using cell counting kit-8 (CCK-8) and 5-bromo-2'-deoxyuridine (BrdU) staining. Furthermore, immunoprecipitation was performed to verify the binding of HIF-1α and p53 to transcription cofactor p300. Our results demonstrated that, in scar tissue, HIF-1α expression increased in parallel with autophagosome formation. Under hypoxia, HIF-1α expression and autophagy were upregulated, whereas p53 expression and apoptosis were downregulated in vitro. HIF-1α knockdown downregulated autophagy, proliferation, and p300-bound HIF-1α, and upregulated p53 expression, apoptosis, and p300-bound p53. Meanwhile, p53 knockdown induced the opposite effects and enhanced HIF-1α, whereas p53 overexpression resulted in the same effects and reduced HIF-1α. Our results suggest a teeterboard-like conversion between HIF-1α and p53, which is linked with scar hyperplasia and regression.

Algoritmos para manejo de cicatrizes: a importância da sistematização de condutas / Algorithms for the management of scars: the importance of systematizing behaviors

■ RESUMO Introdução: As cicatrizes patológicas ocorrem a partir de hiperproliferaçãoo de fibroblastos, podendo ser classificadas em cicatrizes hipertróficas e queloides, basicamente as cicatrizes hipertróficas não crescem além dos limites da ferida original, enquanto os queloides crescem horizontalmente de forma nodular. Apesar da diversidade de instrumentos utilizados para orientar a prevenção, tratamento e seguimento de cicatrizes patológicas, existe a necessidade de instrumentos que contemplem realidades locais. O objetivo é realizar uma revisão narrativa de literatura sobre algoritmos para manejo de cicatrizes e criar um algoritmo atualizado. Métodos: Estudo descritivo de revisão narrativa de literatura, sendo realizado uma pesquisa nas bases de dados PubMed, SciELO, LILACS, MEDLINE e Cochrane, no período de novembro de 2010 até novembro de 2020, publicados nos idiomas inglês, português e espanhol. Os descritores utilizados foram: "cicatrix", "keloid", "algorithms" e "wound healing". A seleção da amostra consistiu da identificação dos artigos, leitura dos títulos e resumos e seleção de estudos relacionados ao tema e, posteriormente, foi realizada a leitura na íntegra dos estudos selecionados e classificação segundo os critérios de elegibilidade. Resultados: Foram encontrados 209 artigos sendo eliminados 116 devido duplicidade resultando em 45 artigos. Foram identificados um total de 8 artigos que preencheram os critérios de inclusão e após análise e reunião de consenso foram excluídos quatro artigos devido à ausência de algoritmos com rigor científico sendo este estudo composto de quatro artigos. Conclusão: Foram encontrados quatro algoritmos na revisão de literatura que resultaram na elaboração de um algoritmo atualizado para cicatrizes.

■ ABSTRACT Introduction: Pathological scars occur from the hyperproliferation of fibroblasts and can be classified into hypertrophic scars and keloids. Basically, hypertrophic scars do not grow beyond the limits of the original wound, while keloids grow horizontally in a nodular form. Despite the diversity of instruments used to guide the prevention, treatment and follow-up of pathological scars, there is a need for instruments that address local realities. The objective is to carry out a narrative review of the literature on scar management algorithms and create an updated algorithm. Methods: Descriptive study of narrative literature review, with a search in PubMed, SciELO, LILACS, MEDLINE and Cochrane databases, from November 2010 to November 2020, published in English, Portuguese and Spanish. The descriptors used were: "cicatrix," "keloid," "algorithms," and "wound healing." The sample selection consisted of identifying the articles, reading the titles and abstracts, and selecting studies related to the topic. Subsequently, the full reading of the selected studies and classification according to the eligibility criteria were carried out. Results: 209 articles were found, and 116 were eliminated due to duplicity, resulting in 45 articles. A total of 8 articles that met the inclusion criteria were identified. Four articles were excluded after analysis and consensus meeting due to the absence of algorithms with scientific rigor; this study is composed of four articles. Conclusion: Four algorithms were found in the literature review that resulted in the development of an updated algorithm for scars.

Tacrolimus action pathways in an ointment base for hypertrophic scar prevention in a rabbit ear model

Abstract Background: Tacrolimus is used to prevent unaesthetic scars due to its action on fibroblast activity and collagen production modulation. Objectives: To evaluate the action pathways, from the histopathological point of view and in cytokine control, of tacrolimus ointment in the prevention of hypertrophic scars. Methods: Twenty-two rabbits were submitted to the excision of two 1-cm fragments in each ear, including the perichondrium. The right ear received 0.1% and 0.03% tacrolimus in ointment base twice a day in the upper wound and in the lower wound respectively. The left ear, used as the control, was treated with petrolatum. After 30 days, collagen fibers were evaluated using special staining, and immunohistochemistry analyses for smooth muscle actin, TGF-β and VEGF were performed. Results: The wounds treated with 0.1% tacrolimus showed weak labeling and a lower percentage of labeling for smooth muscle actin, a higher proportion of mucin absence, weak staining, fine and organized fibers for Gomori's Trichrome, strong staining and organized fibers for Verhoeff when compared to controls. The wounds treated with 0.03% tacrolimus showed weak labeling for smooth muscle actin, a higher proportion of mucin absence, strong staining for Verhoeff when compared to the controls. There was absence of TGF-β and low VEGF expression. Study limitations: The analysis was performed by a single pathologist. Second-harmonic imaging microscopy was performed in 2 sample areas of the scar. Conclusions: Both drug concentrations were effective in suppressing TGF-β and smooth muscle actin, reducing mucin, improving the quality of collagen fibers, and the density of elastic fibers, but only the higher concentration influenced elastic fiber organization.

The effect of proliferative hypertrophic scars on determining treatment options for preventing recurrence of vesicourethral anastomotic stenosis after radical prostatectomy: a single-center cross-sectional study

ABSTRACT BACKGROUND: Vesicourethral anastomotic stenosis (VUAS) following retropubic radical prostatectomy (RRP) significantly worsens quality of life. OBJECTIVES: To investigate the relationship between proliferative hypertrophic scar formation and VUAS, and predict more appropriate surgical intervention for preventing recurrent VUAS. DESIGN AND SETTING: Retrospective cross-sectional single-center study on data covering January 2009 to December 2019. METHODS: Among 573 male patients who underwent RRP due to prostate cancer, 80 with VUAS were included. They were divided into two groups according to VUAS treatment method: dilatation using Amplatz renal dilators (39 patients); or endoscopic bladder neck incision/resection (41 patients). The Vancouver scar scale (VSS) was used to evaluate the characteristics of scars that occurred for any reason before development of VUAS. RESULTS: Over a median follow-up of 72 months (range 12-105) after RRP, 17 patients (21.3%) had recurrence of VUAS. Although the treatment success rates were similar (79.5% versus 78.0%; P = 0.875), receiver operating characteristic (ROC) curve analysis indicated that dilatation using Amplatz dilators rather than endoscopic bladder neck incision/resection in patients with VSS scores 4, 5 and 6 may significantly reduce VUAS recurrence. A strong positive relationship was observed between VSS and total number of VUAS occurrences (r: 0.689; P < 0.001). VSS score (odds ratio, OR: 5.380; P < 0.001) and time until occurrence of VUAS (OR: 1.628; P = 0.008) were the most significant predictors for VUAS recurrence. CONCLUSIONS: VSS score can be used as a prediction tool for choosing more appropriate surgical intervention, for preventing recurrent VUAS.

A six-herb Chinese medicine composition ointment as a promising candidate for treatment of hypertrophic scars / 中草药·英文版

Objective: To study the anti-hypertrophic scar effect of the six-herb Chinese medicine composition (SCMC) ointment on the rabbit ear hypertrophic scar models. Methods: The optimal formulation of SCMC ointment matrix was screened by the orthogonal designs and a series of evaluation tests. The SCMC ointment was prepared through emulsifying method. The rabbit ear hypertrophic scar models were established and used to investigate the anti-hypertrophic scar effect of SCMC ointment. Results: Our results demonstrated that all the quality control indications of the SCMC ointment met the requirements. Anti-hypertrophic scar activity results showed that all the rabbit ear scar tissues appeared different degrees of shrink and fading, and took an unobvious but palpable shift from hard to soft texture with the low, middle and high concentration SCMC ointments treatments in vivo. Additionally, on 21st day the scar area and thickness in different concentrations of SCMC ointment groups were significantly reduced than control group, in a concentration-dependent manner. The immunohistochemical results also indicated that the SCMC ointment had good anti-hypertrophic scar properties and could inhibit hypertrophic scar formation. Conclusion: The SCMC ointment could improve the blood circulation condition of hypertrophic scar tissues. Our research has demonstrated the Chinese medicine composition ointment with good anti-hypertrophic scar properties that could be used to treat hypertrophic scars. Meanwhile, it provides a theoretical basis for further clinical application.

Emodin alleviates hypertrophic scar formation by suppressing macrophage polarization and inhibiting the Notch and TGF-β pathways in macrophages

Hypertrophic scar (HS) formation is a common complication that develops after skin injury; however, there are few effective and specific therapeutic approaches for HS. Emodin has previously been reported to inhibit mechanical stress-induced HS inflammation. Here, we investigated the molecular mechanisms underlying the inhibitory effects of emodin on HS formation. First, we conducted in vitro assays that revealed that emodin inhibited M1 and M2 polarization in rat macrophages. We subsequently established a combined rat model of tail HS and dorsal subcutaneous polyvinyl alcohol (PVA) sponge-induced wounds. Rats were treated with emodin or vehicle (DMEM). Tail scar specimens were harvested at 14, 28, and 42 days post-incision and subjected to H&E staining and Masson's trichrome staining. Histopathological analyses confirmed that emodin attenuated HS formation and fibrosis. Macrophages were separated from wound cells collected from the PVA sponge at 3 and 7 days after implantation. Flow cytometry analysis demonstrated that emodin suppressed in vivo macrophage recruitment and polarization at the wound site. Finally, we explored the molecular mechanisms of emodin in modulating macrophage polarization by evaluating the expression levels of selected effectors of the Notch and TGF-β pathways in macrophages isolated from PVA sponges. Western blot and qPCR assays showed that Notch1, Notch4, Hes1, TGF-β, and Smad3 were downregulated in response to emodin treatment. Taken together, our findings suggested that emodin attenuated HS formation and fibrosis by suppressing macrophage polarization, which is associated with the inhibition of the Notch and TGF-β pathways in macrophages.

Inhibition of Notch signaling pathway reduces angiogenesis in hypertrophic scar / 中南大学学报(医学版)

OBJECTIVES@#Hypertrophic scar (HS) is the most common pathological scar in clinical practice. During its formation, angiogenesis-related factors show dynamic expression. Modern studies have found that Notch signaling pathway has an extremely important role in maintaining the construction and remodeling of vascular endothelial cells and vascular network. The correlation between Notch signaling pathway and angiogenesis in hypertrophic scar has been rarely reported. This study aims to investigate correlation between Notch signaling pathway and the expression of angiogenic factors in a proliferative scar model.@*METHODS@#A total of 81 Sprague Dawley rats (SPF grade) were randomly assigned into a blank control group, a model group, and a blocker group. In the blocker group, a 2 cm diameter circular scald head was placed on the back of the rats for 10 s at 75 ℃ by using a constant temperature and pressure electrothermal scalding apparatus to form a rat deep II° burn model, and a hyperplastic scar model rat was obtained after natural healing of the wound skin (21 to 23 day epithelialization). A syringe was used to inject a needle from the normal skin around the scar at the 1st, 3rd, 5th, 7th, and 14th days after modeling. The γ-secretase inhibitor was injected locally at 2 mg/kg in a dilution of 0.1 mL at the base of the scar. The rats in the model group was injected with the same amount of saline after modeling; the rats in the blank control group was injected with the same amount of saline. Nine rats in each group was randomly killed by air embolization at the 21st, 28th, and 35th days, respectively. The protein expressions of collagen type I (COL-I) and collagen type III (COL-III) were detected by immunohistochemistry. The protein expressions of vascular endothelial growth factor (VEGF), angiopoietin 1 (Ang1), transforming growth factor-β1 (TGF-β1), and matrix metalloproteinase-2 (MMP-2) were detected by Western blotting.@*RESULTS@#Immunohistochemical results showed that, at the 21st,28th, and 35th days, the protein expressions of COL-I and COL-III in the model group were up-regulated compared with the blank control group (all @*CONCLUSIONS@#In the Sprague Dawley rat proliferative scar model, inhibition of Notch signaling pathway could attenuate the expressions of COL-I and COL-III, reduce traumatic scar proliferation, down-regulate the expressions of VEGF, Ang1, TGF-β1, and MMP-2, and inhibit angiogenesis. The expressions of angiogenesis-related factors appeare to be up-regulated during the formation of proliferative scar. When the Notch signaling pathway is inhibited, the up-regulated angiogenic factors show a decreasing trend and the proliferative scar is alleviated, which suggests that Notch signaling pathway may affect the formation of hyperplastic scar by regulating the expression of angiogenic factors.

Máscara termoplástica recubierta de silicona para el manejo de la cicatriz hipertrófica facial / Silicone coated thermoplastic mask for management of hypertrophic facial scars

Resumen Las quemaduras secundarias a agresión física con intención de desfigurar, torturar o incluso asesinar, se han convertido en un motivo de consulta común en el siglo XXI, siendo Bangladesh el país con la más alta incidencia en el mundo. Colombia es uno de los países con mayor incidencia a nivel de Latinoamérica. La mayoría de las lesiones ocurre en áreas expuestas como el rostro y se acompaña de graves secuelas físicas, estéticas y funcionales. Se realiza la presentación de caso de una paciente de 35 años con quemaduras de tercer grado en región frontal, periocular, malar bilateral, nasal, labial superior y pabellón auricular derecho, manejada con injertos de piel, quien posteriormente desarrolla cicatriz hipertrófica. Se describe el tratamiento con máscara termoplástica elaborada por los profesionales tratantes, con cubierta interna de silicona, fabricada sobre molde a medida y ajustada con bandas elásticas; integrando en un único dispositivo removible, cómodo y de bajo costo, diferentes alternativas terapéuticas que logran modular efectivamente el proceso de cicatrización y por su simplicidad favorecen la adherencia al tratamiento, la cual es indispensable para obtener resultados satisfactorios. MED.UIS.2020;33(3): 49-58

Abstract Burns secondary to physical aggression with the intention of disfiguring, torturing or even murdering, have become a common reason for consultation in the 21st century, with Bangladesh being the country with the highest incidence in the world. Colombia is one of the countries with the highest incidence in Latin America. Most injuries occur in exposed areas such as the face and are accompanied by serious physical, aesthetic and functional sequelae. We present the case of a 35-year-old patient with third degree burns in the frontal, periocular, bilateral malar, nasal, upper labial and right ear region, managed with skin grafts, who later developed a hypertrophic scar. The treatment with a thermoplastic mask made by the treating professionals is described, with an internal silicone cover, made on a custom mold and adjusted with elastic bands; integrating in a single removable, comfortable and low-cost device, different therapeutic alternatives that manage to effectively modulate the healing process and, due to their simplicity, favor adherence to treatment, which is essential to obtain satisfactory results. MED.UIS.2020;33(3): 49-58

Avalição da eficácia de dispositivo protetor de lipoaspiração modificado: estudo experimental em suínos / Evaluation of the effectiveness of a modified liposuction protective device: an experimental study in swine

A lipoaspiração é um dos procedimentos mais comuns na especialidade de cirurgia plástica. No levantamento da ISAPS de 2018 foi a segunda cirurgia mais realizada em todo o mundo. Devido aos movimentos repetitivos próprios da cirurgia, fricção importante é gerada no local e as consequências são queimaduras cutâneas que podem deixar cicatrizes inestéticas e discromias. O objetivo deste estudo é criar um protótipo de um dispositivo protetor da pele, a partir de um modelo antigo, que sirva a esse propósito, e observar sua funcionalidade e os efeitos da sua utilização na pele de suínos. Os testes foram realizados em animais mortos sem sofrimento disponibilizados pelo setor de Medicina Veterinária da Universidade Positivo. Foram feitas três incisões no abdome do animal para passagem da cânula de lipoaspiração e outras três para a inserção e utilização do protótipo, bem como para comparação com o dispositivo modelo. O tempo estabelecido de movimentos de lipoaspiração foi de vinte minutos, realizados com a cânula de 5mm diretamente em contato com a pele e dentro do protótipo. Foi avaliada a ergonomia do protótipo, facilidade de inserção e travamento adequado na pele com diferentes trações. Observação e avaliação da pele após os procedimentos e medição (cm) das incisões foram realizadas. O protótipo do dispositivo protetor cutâneo de lipoaspiração criado apresentou fácil manuseio e mecanismo de travamento na pele mais eficiente quando comparado ao modelo utilizado. A incisão cutânea para uso do protótipo foi ligeiramente maior e a pele não apresentou sinais de queimadura.

Liposuction is one of the most common procedures in the plastic surgery specialty. In the 2018 ISAPS survey, it was the second most performed surgery worldwide. Due to the repetitive movements typical of the surgery, significant friction is generated at the site, and the consequences are skin burns that can leave unsightly scars and dyschromias. This study aims to create a skin protective device prototype from an old model, which serves this purpose, and to observe its functionality and its effects on the pigskin. The tests were carried out on dead animals without suffering provided by the Veterinary Medicine sector at Universidade Positivo. Three incisions were made in the animal's abdomen to pass the liposuction cannula and another three for the insertion and use of the prototype to compare it with the model device. The established time for liposuction movements was twenty minutes, performed with the 5mm cannula directly in contact with the skin and inside the prototype. The prototype's ergonomics, ease of insertion, and good locking on the skin with different tractions were evaluated. Observation and evaluation of the skin were performed after procedures and incisions' measurements (cm). The cutaneous liposuction protective device prototype presented easy handling and a more efficient skin locking mechanism than the model used. The skin incision for using the prototype was slightly larger, and the skin showed no burning signs.

Study on the effect of combined action of topical silicone gel and pressure therapy in hypertrophic scar management

Background: Widespread hypertrophic scars usually resulting from burn injuries or extensive soft tissue trauma is a common problem presented to plastic OPD. Non-invasive treatment like Pressure/compression therapy and siliconee sheets and gels are well-accepted, evidence-based recommendations for a long time. Very few studies are there for their combined effect on hypertrophic widespread scars. Aims and objectives of the study was to see the outcome of hypertrophic scar management following application of combined therapy of silicone gel and pressure garment.Methods: In the present study we have taken patients, who were randomly allotted in two groups. In one group only silicone gel was used for scar management while other group we applied silicone gel along with customized pressure garment locally for 6 months. Patients are seen in OPD monthly and after 6 months final results were analyzed, to see the effect of combined therapy.Results: Although silicone gel is alone is effective in widespread post burn scar, pressure garment provides a synergistic effects when used together. There is no significant change in colour and vascularity, but changes in scar thickness and pliability are most significant in combined therapy group.Conclusions: For small linear scar silicone gel treatment is alone sufficient, but for widespread hypertrophic scar this should always be used along with pressure garment therapy.

Cicatriz queloide gigante / Giant keloid scar

Introducción: La cicatriz queloide forma parte de las cicatrices patológicas por exceso; es una afección que se caracteriza por el depósito excesivo de colágeno en la dermis y tejido celular subcutáneo. El proceso por el cual se desarrolla no es del todo conocido, es más frecuente en la raza negra y afecta en igual proporción a hombres que mujeres. Objetivo: Informar a la comunidad médica sobre experiencia en el manejo y tratamiento con dos pacientes portadores de lesiones queloides de gran tamaño. Caso clínico: Se presentan dos pacientes con cicatriz queloide gigante a partir de ambos lóbulos auriculares y cuello anterior; se expone la conducta terapéutica basada en la combinación de tres modalidades de tratamiento: cirugía; infiltración con acetónido de triamcinolona, 1 ml (40 mg) desde el día del acto quirúrgico, se repitió cada 15 días; junto a presoterapia con crema esteroidea. Conclusiones: Aunque no existe un tratamiento ideal, se debe tener en cuenta al tratar esta enfermedad si se está ante una lesión recidivante, el tiempo de aparición de la tumoración, sus características clínicas; de seleccionarse el tratamiento quirúrgico como opción terapéutica, debe acompañarse de otras modalidades de tratamiento(AU)

Introduction: The keloid scar is part of the pathological scars by excess, is a condition characterized by the excessive deposit of collagen in the dermis and subcutaneous cell tissue, the process by which it develops is not entirely known, it is more frequent in the black race, affects in equal proportion men than women. Objective: To inform the medical community of the experience in handling and treating two patients with large keloid lesions. Clinical case: Two patients with giant keloid scars are presented from both earlobes and anterior neck where therapeutic behavior based on the combination of three treatment modalities is exposed: surgery, triamcinolone acetonide 1 ml (40mg) infiltration beginning on the first day after surgery, repeated every 15 days and pressotherapy with steroid cream. Conclusions: Although there is no ideal treatment, it should be taken into account when treating this disease if we are facing a recurrent injury, the time of onset of the tumor, its clinical characteristics, surgical treatment should be selected as a therapeutic option, accompanied by other forms of treatment(AU)

Effects of lipopolysaccharide on expression of fibrosis-related factors in dermal fibroblast and hypertrophic scar formation / 解放军医学杂志

Objective: To study the effect of lipopolysaccharide (LPS) on normal skin tissues (NS)-derived fibroblasts (NSFs) and the formation of hypertrophic scar (HS). Methods: HSs and the corresponding NS tissues were sampled from the patients who underwent surgical excision at Xijing Hospital from November 2017 to November 2018. The characteristics of HSs and HSFs were identified by HE and Masson staining, immunohistochemistry/immunocytochemistry, real time quantitative PCR (RTqPCR), Western blotting and electron microscopy in scar formation cell models and mouse wound healing models. Results: The staining results showed that the number of fibroblasts, level of extracullar matrix (ECM) proteins (Col I, Col III, and α-SMA) in HS were significantly higher than those in NS (P<0.05). The mRNA and protein expression levels of Col I, Col III and α-SMA in HS/HSFs were significantly higher than those in NS/NSFs (P<0.05). LPS could significantly increase the expression of Col I, Col III and α-SMA in NSFs, and the result was similar to those in HSFs (P<0.05). The endoplasmic reticulum was normal and regulated in NSFs, but it was swollen and unregulated in LPS-stimulated NSFs and HSFs. After injection of LPS, the mice showed delayed wound healing and obvious scarring. Conclusions: LPS can change the ultrastructure of endoplasmic reticulum, increase the expression of fibrotic proteins (e.g. Col I, Col III and α-SMA), lead to the accumulation of ECM proteins and the transformation of fibroblasts, and finally form HS.

Botulinum toxin a injection in the prevention of facial trauma or postoperative hypertrophic scar: A systemic review of effectiveness and safety / 中国组织工程研究

BACKGROUND: Facial scars are mainly caused by trauma or surgery, which greatly affect the appearance. Dermatologists and plastic surgeons have tried many ways to change the appearance of scars. Botulinum toxin A injection is widely used in clinical practice for prevention of scars, but the efficacy and safety are not proved. OBJECTIVE: To evaluate the effectiveness and safety of botulinum toxin A injection in the prevention of facial trauma or postoperative hypertrophic scar. METHODS: PubMed, EMbase, the Cochrane library, CNKI, CBM, WanFang, and VIP were searched for randomized controlled trials regarding botulinum toxin A injection in the prevention of facial scars. Manual retrieval was done for supplement of incomplete data. Two doctors were responsible for literature screen and evaluation. Finally, 11 randomized controlled clinical trials were included. The experimental group was injected with botulinum toxin A, and the control group was given saline or nothing. Part of the data was analyzed using Revman 5.3 software for meta-analysis, and the data that could not be analyzed using software were subjected to a descriptive analysis. RESULTS AND CONCLUSION: Eleven randomized controlled trials were included, involving 436 patients with 518 wounds. Meta-analyses showed that Vancouver scar scale score, visual analogue scale score and width of scars in the botulinum toxin A group were significantly better than those in the control group (weighted mean difference (WMD)=-1.61, 95% confidence interval (CI)=-2.06 to -0.26, P = 0.02; WMD=1.7, 95%CI=0.38 to 3.02, P = 0.01; WMD=-0.17, 95%CI=-0.22 to -0.12, P < 0.000 1). Incidence of adverse reactions of botulinum toxin A group was higher than that in the control group (χ2 =8.335, P=0.004), but they were all slight and easy to release. There were no serious adverse events in both groups. It seems that botulinum toxin A injection can reduce the width of scars, improve Vancouver scale and visual analogue scale scores. However, it is suggested to make clear communication before and after the operation and take measures to deal with various adverse reactions in advance.

Effect and mechanism of tanshinone IIA on TGF-β1 induced human skin fibroblast proliferation / 中草药

Objective: To study the effect and mechanism of tanshinone IIA on human skin fibroblasts cell (HSF). Methods: CCK- 8 method was used to determine the effect of different concentrations of TSA on the proliferation of HSF induced by TGF-β1. The plate cloning ability of HSF treated with different concentrations of TSA (2.5, 5, 10 and 20 μmol/L) for 48 h were analyzed by plate clonogenesis assay. The protein expression of TGF-β1/Smad signaling pathway proteins and α-SMA, VEGFA and COL I were further measured by Western blotting. Results: CCK-8 and plate clonognesis assay results showed that TSA significantly inhibited the proliferation and colony forming efficiency of HSF (P < 0.01). Western blotting results revealed that each concentration group of TSA significantly inhibited the protein levels of p-Smad2 and p-Smad3, and down-regulated the ratio of p-Smad2/Smad2 (P < 0.01). The ratio of p-Smad3/Smad3 was significantly decreased in 5, 10 and 20 μmol/L TSA groups. Additionally, the expression levels of α-SMA, VEGFA and COL I in HSF decreased significantly with the increase of TSA concentration (P < 0.01). Conclusion: TSA exhibits the inhibitory effect on proliferation of HSF, and its mechanism may be related to TGF-β1/Smads signaling pathway.