bluuebunny/crossref_metadata_2025 huggingface dataset:
Minimally Invasive Technologies for the Treatment of Hypertrophic Scars and Keloids: Intralesional Cryosurgery
Authors: Har-Shai Yaron , Har-Shai Lior
Published: December 2020

A novel intralesional cryosurgical needle is inserted into the hypertrophic scars and keloid (HSK). It is connected to a canister of liquid nitrogen, which causes the cryoprobe to freeze, thereby freezing the HSK from inside out.

Following the cryo-treatment, the histomorphometric analysis demonstrated rejuvenation of the treated scar. The frozen tissue was devoid of proliferating cells and of mast cells whereas the number of blood vessels remained unaltered.

The surface thermal history showed slow cooling and thawing rates as well as less pronounced end temperature, which is “friendly” to the melanocytes, thus only minimal hypopigmentation was evident. A significant long hold time was documented. This allows time for solute effects, ice crystal formation, and recrystallization, which enhances and increases the rate of cell death. This long hold time is unique for the intralesional cryosurgery technology and might explain the superior clinical results.

More than 50% of scar volume reduction was achieved following a single cryotherapy. For ear HSK, 70% of volume reduction was achieved, and for the upper back and shoulders 60%. Significant alleviation of objective and subjective clinical symptoms was documented. During the follow-up period there was no worsening or infection of the HSK and only minimal hypopigmentation.

A pain control protocol was applied, which significantly reduced pain severity during and after the cryosurgery treatment to tolerable levels (VAS ≤ 3).

The intralesional cryosurgery treatment is an evidence-based, effective, and safe technology, simple to operate, can be applied as an office procedure, is cost-effective, and takes a short learning curve. The technique achieves remarkable clinical results usually by a single treatment.
Minimal-Invasive Technologies for Treatment of HTS and Keloids: Corticosteroids
Authors: Lee Juhee , Kim Jihee
Published: December 2020

Hypertrophic scars and keloids are common lesions caused by abnormal wound healing process. Especially in keloids, abnormal fibroblast activity and excessive synthesis of collagen is a histopathological hallmark in its pathogenesis. Due to heterogeneity of etiologies and clinical presentations, treatment of hypertrophic scars and keloids are often challenging. The response rate varies widely, depending on treatment modalities and the timing of therapeutic intervention. Corticosteroid is considered to be one of the best treatment options, yet paucity of information exists on its mechanism of action. It is mostly known to inhibit abnormal fibroblast proliferation leading to collagen synthesis and promote further degeneration of extracellular matrix. Intralesional injection of corticosteroid has been well advocated in the treatment of both hypertrophic scars and keloids. Locally delivered corticosteroid causes significant decrease in scar volume and ameliorates the symptoms of the scars such as pain and pruritus. However, the lesions are prone to localized adverse reactions upon repeated treatments. Therefore, appropriate use of steroids requires awareness of its mechanism of action in scar treatment.
Scar Formation: Cellular Mechanisms
Authors: Darby Ian A. , Desmoulière Alexis
Published: December 2020

Fibroblasts are key players in the maintenance of skin homeostasis and in orchestrating physiological tissue repair. Fibroblasts secrete and are embedded in a sophisticated extracellular matrix, and a complex and interactive dialogue exists between fibroblasts and their microenvironment. In addition to the secretion of the extracellular matrix, fibroblasts and myofibroblasts secrete extracellular matrix remodeling enzymes, matrix metalloproteinases and their inhibitors, and tissue inhibitors of metalloproteinases and are thus able to remodel the extracellular matrix. Myofibroblasts and their microenvironment form a network that evolves during tissue repair. This network has reciprocal actions affecting cell differentiation, cell proliferation, cell quiescence, or apoptosis and has actions on growth factor bioavailability by binding, sequestration, and activation. Mechanical forces also play a role in regulating the myofibroblast phenotype as cells are subjected to mechanical stress and mechanical signaling is activated. Innervation is also involved in both skin repair processes and differentiation of myofibroblasts. In pathological situations, for example, in excessive scarring, the dialogue between myofibroblasts and their microenvironment can be altered or disrupted, leading to defects in tissue repair or to pathological scarring, such as that seen in hypertrophic scars. Better understanding of the intimate dialogue between myofibroblasts and their local microenvironment is needed and will be important in aiding the identification of new therapeutic targets and discovery of new drugs to treat or prevent aberrant tissue repair and scarring.
Minimally Invasive Technologies for Treatment of HTS and Keloids: Low-Dose 5-Fluorouracil
Authors: Liu Wei , Wu Xiaoli , Gao Zheng , Xia Lingling
Published: December 2020

Both hypertrophic scar (HTS) and keloid are pathological scars that tend to overgrow and overproduce extracellular matrices, lead to large-sized scars along with severe pain and itching, and even result in functional disability. In particular, keloids are considered as benign skin tumors due to their nature of uncontrolled growth beyond the original wound boundary and invasion into normal skin; therefore, anticancer therapy has been employed in keloid therapy. 5-Fluorouraci (5-FU), a pyrimidine analog, is a commonly used chemotherapy agent and it has also been previously used in keloid treatment with intralesional injection at a concentration of 40–50 mg/ml. The authors propose the use of low dose 5-FU at the concentration of 1.5–5 mg/ml for establishing a sustainable chemotherapy without causing significant side effects in order to cure keloid by a possible long-term chemotherapy, which is essential for controlling keloid relapse. Since 2002, the authors have treated over 10,000 cases of keloids and demonstrated that this approach is effective and safe. In addition to intralesional injection treatment of keloids and HTS with combined use of 5-FU and steroids, it was also used for preventing keloid recurrence after surgical excision. In this chapter, the authors introduce the general background of keloid and HTS chemotherapy, the rational of using low-dose drugs, and the clinical protocol of low-dose 5-FU injection therapy and its applications along with typical case presentation.
Minimally Invasive Technologies for Treatment of HTS and Keloids: Pulsed-Dye Laser
Authors: Nischwitz Sebastian P. , Lumenta David B. , Spendel Stephan , Kamolz Lars-Peter
Published: December 2020

We present another minimally invasive technology for the treatment of hypertrophic scars and keloids: the pulsed-dye laser. Being first introduced by two groups around Schaefer (Germany) and Sorokin & Lankard (USA) in 1966, the pulsed dye laser is a rather new technology. The first clinical use of pulsed-dye lasers was reported in 1983 for the treatment of naevus flammeus, and was the first laser used for the treatment of keloids in the mid-1990s.

Its efficacy is based on the principle of selective photothermolysis, enabling a selective destruction of defined structures absorbing the respective wavelength used, as compared to other lasers working based on thermal coagulation or ablative tissue interaction. The preferred wavelengths being used are 585 or 595 nm, which makes small cutaneous vessels the main targets. Their destruction leads to a diminished blood supply of the irradiated area, thus reducing symptoms of hypertrophic scars like itching, vascularity, and redness, and secondary – probably by the induced hypoxemia – a reduction in scar height and pliability. This therapeutic approach also implies the use of pulsed-dye laser in the prevention of pathologic scars. While significant side effects are usually rare, slight signs of use like edema or scab formation can pertain for several days. Since the sensory impact of laser pulses are comparable to needle pricks, some form of analgesia during the application is highly recommended. The elusive data and still existing scarcity of high-quality studies on the use of pulsed-dye laser, however, make it hard to develop clear recommendations.
Long-Pulsed 1064 nm Nd:YAG Laser Treatment for Keloids and Hypertrophic Scars
Authors: Ogawa Rei
Published: December 2020

There are many therapeutic options for keloids and hypertrophic scars, including surgery, radiation, corticosteroids, 5-fluorouracil, cryotherapy, laser therapy, anti-allergy agents, anti-inflammatory agents, bleaching creams, and make-up therapies. In terms of laser therapy, we have used long-pulsed 1064 nm Nd:YAG laser to treat keloids and hypertrophic scars. This laser was developed for the treatment of vascular diseases, including inflammatory scars that exhibit neovascularization. The depth that is reached is determined by the spot size, the laser power, and the fluence: the larger the spot size, power, or fluence, the deeper the laser beam penetrates. The laser should generally be applied to the skin surface with the following standard treatment settings: a spot diameter of 5 mm, an energy density of 75 J/cm2, an exposure time per pulse of 25 ms, and a repetition rate of 2 Hz.
Minimally Invasive Technologies for Treatment of HTS and Keloids: Fractional Laser
Authors: Tretti Clementoni M. , Azzopardi E.
Published: December 2020

This chapter presents a state-of-the-art insight into the use of fractional laser for the management of this complex problem. In particular, we focus on the management of complex scars such as those occurring post-burn injury and split-thickness skin grafting.
Minimal Invasive Technologies for Treatment of HTS and Keloids: Medical Needling
Authors: Aliu Antigona , Aust Matthias
Published: December 2020

Medical needling or percutaneous collagen induction (PCI) is a nonablative and innovative method for the treatment of scars. The method of PCI displays a minimal invasive intervention that has developed in the last 25 years and gets significantly more integrated in the fields of plastic and reconstructive surgery. Medical needling is based on a simple therapy concept with a focus on sustainability and clinical data reveal new pathways for the treatment of especially HTS and keloids. In the context of modern medicine, medical needling overcomes deficits of conventional treatments by stimulating and modifying the endogenous potential of skin regeneration.
Usefulness of Local Flaps for Scar Contracture Release
Authors: Ogawa Rei
Published: December 2020

Local flaps are useful for reconstructing scar contractures on mobile areas such as joints, the neck, the axilla, the digital web, and the mouth commissure. They are superior to skin grafts because the latter can contract, thereby leading to secondary contractures. Moreover, the color and texture match of local flaps is better than that of grafted skin. Consequently, local flaps generally provide superior aesthetic outcomes. Thus, if there is healthy skin adjacent to the scar contracture, local flaps should be the first choice. In terms of local flap selection, it is necessary to choose between a skin-pedicled flap and an island flap. We showed recently that 6 months after surgery, skin-pedicled flaps associate with greater scar extension rates than island flaps. Thus, local flaps, especially skin-pedicled flaps, elongate the scar as effectively as z-plasty. It should be noted that if the scar is large, it is effective only by dividing the scar with the local flap. However, the flap size can be slightly smaller than the deformity size (although how much smaller depends somewhat on how extensible the flap type is): it is not necessary that the flap is as big as the open wound after scar division or scar removal.
Scar Resurfacing
Authors: Wood Fiona M.
Published: December 2020

Scar resurfacing is focused on the improvement in the quality of a scar by disruption of the skin surface and reducing the bulk of the scar by control of the secondary healing process. The prerequisite is knowledge of the wound healing and scarring process such that the intervention can be designed to reduce the risk of increasing the scarring.

The clinical examination and assessment of the scar will guide the selection of the technique addressing the specific aspects of the scar, such as the pigment restoration and volume reduction, with the aim of blending the scar with the surrounding uninjured skin.

Understanding the natural history of the scar, the impact it has on the patient, and the techniques available for improvement provides the clinical decision-making matrix to drive an improved scar outcome. Resurfacing is one opportunity for scar modulation which needs to be taken into context relative to the range of conservative and surgical therapeutic opportunities explored within the chapters of the book.
Facial Scars Reconstruction
Authors: Téot Luc
Published: December 2020

Facial postburns scars have always generated a large interest in the general population and stimulated many movie stories, but they remain a source of social exclusion in most of the countries in the world and are a challenge for advanced surgical solutions. Several strategic options have been proposed in the last two decades for patients suffering severe facial scars with a high psychological impact. The tissues of each subunit of the face are specific (eyebrows, front, cheeks, chin, etc.), which makes it difficult for a conventional flap to reproduce this specificity, the different subunits presenting different characteristics in terms of depth, dermal component, softness, and gliding possibilities.

The choice between the different advanced techniques will be limited to a thin partial thickness skin graft, plus a dermal substitute (Integra or Matriderm), a pre-expanded flap coming from the surrounding areas (shoulder, back), or an allogeneic transplantation, which imposes a permanent immunosuppression and whose number is regulated at national levels.
Invasive Techniques in Scar Management: Fat Injections
Authors: Bassetto F. , Scarpa C. , Vindigni V.
Published: December 2020

Since the end of the nineteenth century, fat grafting has become one of the most promising treatments for posttraumatic deformities and more in general for scars. Its easy application and collection have made it as the ideal therapy to restore volume and pliability, and contour and to prevent symptoms as pain. In these years the application method, the indications and the guidelines have been changed many times. In this chapter, we analyze why fat grafting is becoming so popular in the twentieth century and what is the scientific rational to use autologous adipose tissue. We will also discuss the current guidelines and the possible applications. At the end, we will also present some new fields such as the application of autologous fat grafting in the treatment of the hypertrophic scars and how we can try to improve its engraftment using external mechanical forces (the external negative pressure therapy) and/or the plasma-rich platelet (PRP).
The Epidemiology of Keloids
Authors: Huang Chenyu , Wu Zhaozhao , Du Yanan , Ogawa Rei
Published: December 2020

Keloids are pathological scars that are characterized histologically by an overwhelming aggregation of fibroblasts and collagen type I within the inflammatory reticular dermis. Their clinical characteristics include continuous growth and invasion into the neighboring healthy skin beyond the original wound boundary via an erythematous and pruritic leading edge. They also show a strong tendency to recur when they are surgically excised in the absence of adjuvant therapies. Despite the fact that keloids are common throughout the world, their epidemiology has not been adequately investigated. In this chapter, we will summarize the limited epidemiological data on keloids that exists to date in terms of: (1) the demographic distribution of keloids, mainly on the geographical regions and ethnic racies; (2) the internal genetic factors that shape keloid rates; and (3) the external environmental factors that influence keloid epidemiology. The aim of the chapter is to facilitate a greater understanding of the complexity and diversity of keloids from an epidemiological perspective, thereby potentiating further and deeper explorations into individualized strategies that prevent and treat keloids.
Specific Attention Areas in Scar Management: Management of Atrophic Scars
Authors: Clementoni Matteo Tretti , Azzopardi Ernest
Published: December 2020

This chapter is intended for the experienced laser practitioner tackling three clinical conditions presenting to the reconstructive specialties, often as a last resort after exhaustive traditional management: acne, striae albae, and burns. It explores common principles, followed by state-of-the-art management and evaluation of the senior author’s experience.
Scar and Scarring in the Elderly
Authors: Colboc Hester , Meaume Sylvie
Published: December 2020

Despite the aging of the population, little attention is paid to the development of specific care protocols appropriate to the skin and even less to the scars in the elderly. The purpose of this chapter is to highlight common clinical problems with scar and scarring in older adults and provide appropriate advices on protocols for managing them. The literature review was carried out to look for the evidence-based elements, but, if the subject of scars is sometimes found, the elements relating specifically to scars in old age are nonexistent. Unsurprisingly, practices vary widely and are carried out according to habit rather than science. Based on our clinical experience of dermatologist and geriatrician and some literature data, some pathways for future research on scars in elderly are proposed.
Management of Scarring Following Aesthetic Surgery
Authors: Chambers Alexandra
Published: December 2020

Patients undergo cosmetic surgery to improve their appearance and so, even though surgical scars cannot be avoided, they must be minimized as part of the aesthetic care process. The challenge is to make scars as inconspicuous as possible, and there are many techniques to be considered, including proper patient selection, preoperative preparation, the choice of surgical techniques, and postoperative care. The proactive management of tissue healing with prophylaxis of pathological scarring is particularly important. As the scarring process passes through multiple phases over a 6-week to 6-month period, cosmetic surgeons should not only plan to prepare patients well in advance of surgery but also be prepared to provide support to patients well after.
Scars in Pediatric Patients
Authors: Le Touze Anne
Published: December 2020

Physiological healing process is not much different in children, but the resulting scar is very rich in collagen and very dense. Therefore, when dealing with children, it is necessary to be aware of these particularities and to “guide” the scaring process to avoid disgracious and disabling scars.
Genital Scars
Authors: Mirastschijski Ursula
Published: December 2020

Genital scarring is a topic rarely addressed and discussed in public. Scarring can occur after trauma, female genital mutilation/cutting, circumcision, tumor surgery, burns, infections, or local skin diseases, for example, lichen sclerosus et atrophicus. Genital skin anatomy and wound healing differ from other regions of the body. This chapter focuses on genital skin anatomy, the physiology of normal genital wound healing, the pathophysiology of genital scarring, and the current state-of-the-art for plastic surgical treatment of genital tissue defects and scars.
Emerging Technologies in Scar Management: Laser-Assisted Delivery of Therapeutic Agents
Authors: Lee Juhee , Kim Jihee
Published: December 2020

Topical application of medications is difficult through intact skin due to physiological barrier of stratum corneum. Effective transdermal drug delivery system can offer distinct advantages over the topical application and oral administration of drugs. Laser systems have showed clinical benefits for patients in various types of scars for decades. In particular, the advent of fractional resurfacing advanced laser has enhanced the scar treatments dramatically. A fractional laser irradiates cells with high precision by controlling the area and degree of ablation through laser settings. In addition to local thermal destruction and stimulation, fractionated devices may also play an important role in drug delivery through the skin. Preclinical studies substantiate enhanced drug accumulation for a variety of topically applied drugs after ablative fractional laser therapy. Laser-assisted drug delivery is an evolving technology with potentially broad clinical applications. Multiple studies demonstrate that laser pretreatment of the skin can increase the permeability and depth of penetration of topically applied drug molecules. We discuss the mechanisms of laser-assisted drug delivery for scar treatment to enhance our understanding of this evolving technology and suggest optimal protocols of treatment.
New Drugs for Scar Treatment
Authors: Kwon Sun Hyung , Padmanabhan Jagannath , Henn Dominic , Chen Kellen , Gurtner Geoffrey C.
Published: December 2020

Cutaneous scar formation following injury is an exuberant fibro-proliferative event and causes aesthetic distress associated with functional problems for those afflicted. Traditionally, surgical revision of excessive hypertrophic scars is commonly performed. However, scar recurrence rate is high and surgical treatments are often combined with radiation therapy, corticosteroid injections, or with other noninvasive therapies. Pharmacological intervention of scar-promoting cellular activities has recently gained traction based on the emerging scientific evidence proving efficacy and safety of new therapeutics in preclinical studies. Ideal new drug therapies would be noninvasive, inexpensive, safe-to-use, and effective in prevention of scar formation. Recently, cytokine-based therapies and modulators of mechanotransduction are being evaluated for their anti-fibrotic properties in the reduction and prevention of scarring. Therapeutic potential of evidence-based new scar therapeutics holds promise toward improving the current wound and scar management practice.
Emerging Technologies in Scar Management: Remodeling of Post-surgical Linear Scar Using Microplasma Radiofrequency
Authors: Liu Wei
Published: December 2020

Linear scar is a common problem in all fields of surgery as it leads to unpleasant appearance that is not socially acceptable. In particular, linear scars in the exposed areas such as face, neck, and upper extremities cause significant psychological disturbance to patients who need proper medical assistance to release their suffering. The author proposed tissue remodeling strategy on an existed linear scar using FMRT (fractional microplasma radiofrequency technology) to render gross view of a linear scar less visible or non-visible by changing the scar tissue architecture. Similar concept is also applied to the intervention of an early-stage wound to significantly alter the natural process of wound healing via FMRT-mediated change of the histological architecture of a wound, and thus to prevent the formation of a grossly visible linear scar. This chapter introduces the general background information, FMRT concept, and its application on linear scar treatment and prevention with the presentation of several typical cases.
Vacuum Massage in the Treatment of Scars
Authors: Moortgat Peter , Meirte Jill , Van Daele Ulrike , Anthonissen Mieke , Vanhullebusch Tine , Maertens Koen
Published: December 2020

Vacuum massage is a noninvasive mechanical massage technique performed with a mechanical device that lifts the skin by means of suction to create and mobilize a skin fold. It was invented by a French engineer suffering from burn scars after a car accident and has since then been frequently used for the treatment of burn scars.

The two most reported physical effects of vacuum massage were improvement of the tissue hardness and the elasticity of the skin. Besides physical effects, a variety of physiological effects are reported in the literature, for example, an increased number of fibroblasts and collagen fibers accompanied by an alteration of fibroblast phenotype and collagen orientation. Little information was found on the decrease of pain and itch due to vacuum massage.

Although vacuum massage initially had been developed for the treatment of burn scars, a literature review found little evidence for the efficacy of this treatment. Variations in duration, amplitude, or frequency of the treatment have a substantial influence on collagen restructuring and reorientation, thus implying possible beneficial influences on the healing potential by mechanotransduction pathways. Vacuum massage may release the mechanical tension associated with scar retraction and thus induce apoptosis of myofibroblasts. Suggestions for future research include upscaling the study design, investigating the molecular pathways and dose dependency, comparing effects in different stages of repair, including evolutive parameters and the use of more objective assessment tools.
Shock Wave Therapy for Wound Healing and Scar Treatment
Authors: Moortgat Peter , Anthonissen Mieke , Van Daele Ulrike , Meirte Jill , Vanhullebusch Tine , Maertens Koen
Published: December 2020

Shock Wave Therapy (SWT) meets all the requirements for the ideal non-invasive scar treatment. It is safe, well tolerated by patients, cost-effective, easy to apply, has low complication rates, and can be used in an outpatient setting. The overall effect of SWT is an improvement of tissue homeostasis, accompanied by an improvement of the tissue self-healing abilities, and it seems to focus on inducing tissue regeneration and matrix remodelingin vivoby means of mechanotransduction.

SWT has a beneficial effect on wound healing and is characterized by an upregulation of the angio-active factors as nitric oxide (NO) and vascular endothelial growth factor (VEGF) leading to induced angiogenesis. A downregulation of alpha-SMA expression, myofibroblast phenotype, TGF-β1 expression, fibronectin, and collagen type I are measured after SWT on scars, leading to improvement of several relevant scar parameters like height, pliability, vascularity, and pigmentation, and thus ameliorating function.

For a full treatment outline, the energy flux density (EFD), the number of pulses, the pulse frequency, and the number and interval of treatments are the most relevant parameters. The EFD for soft tissue indications is typically in the range of 0.08–0.25 mJ/mm2, while scars and fibrosis are treated with an EFD ranging between 0.15 and 0.33 mJ/mm2. These settings seem to be ideal to induce the optimal cell responses for each indication.

All the presented findings are fundamental knowledge for further investigation of SWT to reduce the fibrous component in regenerating and remodeling tissues. However, the full potential of SWT in wound healing and scar treatment needs further unraveling.
Effectiveness of Corticosteroid Tapes and Plasters for Keloids and Hypertrophic Scars
Authors: Ogawa Rei
Published: December 2020

In Japan, corticosteroid tapes and plasters have long served as a first-line therapy for keloids and hypertrophic scars. Pediatric patients are particularly responsive to this type of treatment. This may reflect the fact children have thinner skin than adults and the steroids are therefore more easily absorbed. The postoperative application of corticosteroid tapes/plasters also significantly prevents the development of keloids and hypertrophic scars after surgery. Steroid tape is available in the following three countries in different preparations. In the UK, the commercially available formulation comprises a fludroxycortide-impregnated tape (4 μg/cm2). Fludroxycortide tape is a Group III preparation. The USA has a steroid tape preparation that contains 4 μg/cm2 flurandrenolide, which is also a Group III preparation. In Japan, two steroid tape formulations are available, namely, the Group III preparation found in the UK (4 μg/cm2 fludroxycortide tape) and a 20 μg/cm2 deprodone propionate tape. Deprodone propionate tape is considered to be a Group I or II preparation. In our experience, deprodone propionate tape (Eclar® plaster) is the most effective tape for the treatment and prevention of keloids.
Suture Edge Tension Control Technologies for Scar Improvement
Authors: Téot Luc , Fluieraru Sergiu , Herlin Christian
Published: December 2020

Mechanotherapy of postoperative scarring is considered an effective measure to prevent pathological scars. Tension increases suture line enlargement, opening the way to infection. Several options have been proposed since decades and are currently used in practice, from adhesive sutures to adhesive dressings, reapproximation devices, and postoperative negative pressure. Closed incision negative pressure therapy (ciNPT) was recently proposed in at-risk patients, showing a significant difference in prevention of infection. These technologies offer a double effect of mechanical stabilization and aspiration of exudates and have recently been extended to different clinical indications. This chapter describes the recently developed technologies to diminish scar enlargement on a suture line and to prevent infection after extensive surgical procedures in thoracic, abdominal, plastic and orthopedic surgery.
Hyperpigmented Scar
Authors: Poetschke Julian , Gauglitz Gerd G.
Published: December 2020

Multiple studies on the use of different wave lengths for the improvement of hypertrophic scars and keloids have been published over recent years. To date, most data and experience exist regarding the use of vascular lasers (pulsed-dye-laser, PDL; Neodym-YAG, Nd:YAG), intense pulsed light (IPL), and fractional (ablative) lasers. However, with growing awareness in this area, an increasing number of patients are seeking help for the amelioration of pigmentary changes associated with existing scars or for postinflammatory hyperpigmentation resulting from previous therapies. Here, we present a female patient in her early 20s, who suffered from a deep dermal burn with a resulting hypertrophic scar on her left lower leg, which showed distinct hypertrophy as well as significant hyperpigmentation.
Scar Epidemiology and Consequences
Authors: El Kinani M. , Duteille F.
Published: December 2020

In this chapter, after a short reminder of the different scars types, epidemiological factors and risk factors are described. The consequences for the patient of an impairment of healing are multiple: aesthetic discomfort, itching, pain, or even functional impairment, especially in the periarticular area, can lead not only to physical but also to psychological and social repercussions.

This chapter focuses on the epidemiology of scars, including hypertrophic and keloid scars. The role of mechanobiology looks major as the pathology may start in specific anatomical locations submitted to excessive tension, and the influence of genetic factors, even if not completely confirmed with evidence-based medicine, is highly suspected.
Clinical Case: Earlobe Keloid
Authors: Téot Luc
Published: December 2020

Earlobe keloid is encountered in young adults with different etiologies, with some of them occurring spontaneously and others being secondary to earlobe piercing. In both sexes, the lesions may be limited to the fold or the external canthus or embed the posterior part of the ear. The rate of recurrence is higher than 80% when surgical excision is realized alone and associations of procedures are proposed. They may vary between authors, with some of them proposing excision and radiotherapy and others preferring excision supplemented by postoperative injections of corticosteroids, cryotherapy being also proposed as well as YAG lasers. In this clinical case, 5-FU 50 mg/mL injections were administered every 3 weeks before surgical excision. The patient was followed every month till the 14th month postoperation. The result was good with no recurrence.
Scars After Breast Reconstruction
Authors: van der Sluis Wouter B.
Published: December 2020

Breast cancer develops in the lifetime of 12% of women. Breast reconstruction increases the quality of life in these women. There are different surgical options for breast reconstruction: immediate or delayed prosthesis-based reconstruction, oncoplastic reconstruction, fat grafting, and free or pedicled flap reconstructions. Different techniques leave different scars on the breast. Here, we present a woman with a breast scar after breast reconstruction using a deep inferior epigastric perforator (DIEP) flap.
Atrophic Scars: Reinforcing the Flap Mattress Using Adipocyte Transfer in Paraplegic Patients at Risk of Pressure Ulcer Recurrence
Authors: Téot Luc
Published: December 2020

Atrophic scars may be defined as depressive areas on the skin, due to a defect of fatty tissue under the skin. This situation may lead to adherence to the depth (fascia, bone, tendon) to be a source of functional impairment. Most of the atrophic scars are secondary to acne localized over the face. Multiple techniques were proposed to restore the volume and uniformize the surface, like laser, injection of fat, microneedling, microdermabrasion, dermal fillers, and surgical techniques such as subcision and platlet rich plasma (PRP). On the basis of level 1 evidence currently available, it appears that PRP can improve the quality of atrophic acne scars treated with ablative fractional CO2 laser and decrease the duration of laser-related side effects including edema and erythema (Goutos). Regenerative surgery, including fat harvesting, centrifugation, and isolation of adipocyte stem cells, has been promoted since years and should be repeated when injected fat progressive crush is observed. The clinical case presented here is a paraplegic patient presenting a pressure sore in the left ischiatic area. The flap was successful but the depth of the transplanted fatty tissue was decreasing after some years. A first fat injection was programmed.
Secondary Lip Correction in a Cleft Lip Patient
Authors: van der Sluis Wouter B. , Don Griot Johan P. W.
Published: December 2020

In unilateral cleft lip and palate, the orbicularis muscle, the alveolar bone, the floor of the nose, and the hard and soft palate are interrupted, creating an open communication between nasopharynx and oropharynx. Patients with a cleft lip and palate are treated in specialized cleft centers by a multidisciplinary team. Having cleft lip and/or palate has a noteworthy impact on quality of life and psychosocial functioning. Surgical scars are in the center of the face and can be quite noteworthy. Postoperative scarring is a common cause of patient dissatisfaction.

Here, we describe a patient with an unpleasing esthetic result after surgical correction of unilateral cleft lip and palate in China. After careful surgical planning, scar excision and a single Z-plasty were performed to achieve scar lengthening. Pre- and postoperative images are shown.
Other Scar Types: Optimal Functional and Aesthetic Outcome of Scarring in Cleft Patients
Authors: van der Sluis Wouter B. , Kornmann Nirvana S. S. , Tan Robin A. , Don Griot Johan P. W.
Published: December 2020

Cleft lip and palate are facial and oral malformation due to failures in the embryologic craniofacial development during early pregnancy. A unilateral cleft lip and palate is the most common type, whereby the upper lip, the orbicularis muscle, the alveolar bone, the floor of the nose, and the hard and soft palate are interrupted, creating an open communication between nasopharynx and oropharynx. Patients with a cleft lip and palate are treated in specialized cleft centers by a multidisciplinary team. Having cleft lip and/or palate has a noteworthy impact on quality of life and psychosocial functioning. Postoperative scarring is a common cause of patient dissatisfaction. The goal of cleft lip surgery is to close the lip, provide optimal function in terms of speech, mastication, dental protection, breathing and feeding, and provide an aesthetically pleasing facial scar. Precise surgical technique and adequate aligning of anatomical structures is important for the postoperative aesthetic result and scar formation. Different surgical techniques are available for this purpose. Optimal scar management can be divided in surgical (precise surgical technique, planning, and adequate aligning of anatomical structures) and nonsurgical methods (botulinum toxin, silicone application, carbon dioxide fractional laser).
Genetics of Keloid Scarring
Authors: Sadiq Alia , Khumalo Nonhlanhla P. , Bayat Ardeshir
Published: December 2020

Keloid disease is a benign fibro-proliferative reticular dermal tumor that develops in response to dysregulated cutaneous wound-healing process. The key alterations result in keloid formation have not been fully understood yet.

Extensive literature review suggests that there is a strong genetic predisposition for keloid formation as keloid cases have appeared in twins, families, Asian and African descendant ethnic groups predominantly. Thus, there have been several attempts to investigate the genetic variations that may act as contributing factors in keloid pathogenesis, but no single genetic cause has been identified so far. Gene expression studies have shown highly variable results in linkage analysis of keloid families and in keloid fibroblasts. These findings provide clues that keloids arise from heterogeneous genetic events in coordination with immune-related components for example, the Major Histocompatibility Complex genes, consequently that may contributing towards dermal fibrosis. In addition, it is likely that multiple genetic and epigenetic factors are responsible for the development of the disease pathology. In summary, keloid disease is a disorder in which the exact genetic contribution to pathogenesis is yet to be elucidated. Understanding the genetic basis of keloid disease would help to identify targeted therapies as well as accurately assess individual genetic susceptibility to keloids, in order to provide a more personalized approach to their management.
International Scar Classification in 2019
Authors: Mustoe Thomas A.
Published: December 2020

Scars can be classified into immature scars and mature scars. Mature scars can be “normal,” atrophic, or hypertrophic. Keloids occur in patients with a genetic predisposition and behave differently than hypertrophic scars, although there can be a continuum in terms of appearance. The molecular mechanisms of scarring, hypertrophic scar and keloids, have been the subject of intensive research. There are still many unanswered questions.
The Use of Internal Crowdsourcing for Qualification and Competence Development in Organizations
Authors: Uhl André , Göll Edgar
Published: December 2020

This article deals with the question of how internal crowdsourcing can be used as a tool to support employee qualification measures and help develop their competencies in organizations. The first chapter examines the current state of the competence research. A paradigm shift from ‘qualification and professional development’ towards ‘competencies’ and the implications for the concept are described. Chapter “An Introduction to Internal Crowdsourcing” deals with the analyses and work on the subject of competence acquisition and development, including considering the results of two interview series and two workshops. In chapter “Managing the Crowd: A Literature Review of Empirical Studies on Internal Crowdsourcing”, the authors present a combined and practical approach to support competence development through internal crowdsourcing in organizations. Finally, the last chapter sums up main results and perspectives for competence development through a combination of virtual and face-to-face working processes.
Power to the Network: The Concept of Social Business and Its Relevance for IC
Authors: Zinke-Wehlmann Christian , Friedrich Julia , Römer Vanita
Published: December 2020

The concept of IC puts the employee, in its potential role as crowdsource, Campaign Owner or initiator into focus. This reflects the emancipatory and participatory principle that goes hand in hand with the concept of Social Business. The basic idea of Social Business is not to link the business success of a company exclusively to its management capabilities or the business plan, but to understand and value the individual stakeholder as part of a successful enterprise network. For Social Business, value is not exclusively understood as business value; rather, the perspective is expanded to include social added value, in the sense that the value of the work for the employee, society or the environment is considered as an indirect corporate goal. Thus, Social Business is defined as a framework or strategy that uses digital social networks (enterprise social networks) with the primary goal of generating social, ecological and economic benefits. This article introduces the Social Business reference model, which supports the adoption and implementation of the outlined strategy and contrasts it to the ICU Model in order to identify the strengths as well as weaknesses of both models.
An Introduction to Internal Crowdsourcing
Authors: Pohlisch Jakob
Published: December 2020

This chapter aims to provide the reader with an introduction to crowdsourcing in general and internal crowdsourcing in particular. First, the elementary principles of crowdsourcing will be introduced, completed by a definition that will constitute the basis for this book. Second, different crowdsourcing typologies will be described to inform the reader about classifications of the phenomenon in scientific literature. Third, the crowdsourcing process is outlined to clarify the general procedure of this new kind of work organization. Lastly, the concept will be transferred to the intraorganizational context, describing and defining the concept of internal crowdsourcing which represents the main topic of this book.
Managing the Crowd: A Literature Review of Empirical Studies on Internal Crowdsourcing
Authors: Pohlisch Jakob
Published: December 2020

The phenomenon of crowdsourcing is increasingly being addressed in academic literature. Companies utilize crowdsourcing to search for solutions to internal problems outside of the companies’ boundaries, accessing the vast and diverse knowledge and creativity of people all over the world. More recently, a growing interest has emerged that concentrates on the intra-organizational application of this phenomenon—internal crowdsourcing. While conventional internal innovation activities are mostly concentrated within a few dedicated departments, this new approach helps companies to open up their innovation process to all employees. Internal crowdsourcing can help companies bridge geographical distances, integrate new employees, predict the market success of products, and create ideas for new businesses.

This chapter aims to provide a comprehensive overview of the existing empirical findings regarding the management of internal crowdsourcing. In this review, 27 papers, covering more than 100 companies, are analysed. They are based on more than 800 interviews, participant observations, action design research, surveys, and datasets of internal innovation contests. The results of this review will help practitioners to design the management of internal crowdsourcing based on existing implementations and lessons learned, helping them to unleash the full innovation potential of their employees, creating a valuable competitive advantage.
Systematization Approach for the Development and Description of an Internal Crowdsourcing System
Authors: Wedel Marco , Ulbrich Hannah
Published: December 2020

There is a need for a scientific and theoretical foundation in the description of internal crowdsourcing systems with binding, consensus-based terminologies and descriptions. (How) Can the already described subcategories and aspects of an IC System be meaningfully described and placed in an orderly overall relationship? What needs to be added to existing system descriptions, if at all? The present article concentrates on identifying existing descriptions and definitions in connection with approaches to systematize the development of an internal crowdsourcing system (Some aspects of this article will also be published in German. Please be referred to: Daum, M.; Wedel, M.; Zinke-Wehlmann, C.; Ulbrich, H. (ed.) (2020): Gestaltung vernetzt-flexibler Arbeit. Beiträge aus Theorie und Praxis für die digitale Arbeitswelt. Berlin: Springer Vieweg). Since the phenomenon itself eludes allocation to an exclusively dedicated academic discipline, it seems appropriate to choose interdisciplinary approaches and to build on existing theoretical and terminological approaches from related sciences.
Proposals for the Future of Internal Crowdsourcing: A Trade Union-Based Approach
Authors: Schröter Welf
Published: December 2020

The “FST” personnel network “Forum Soziale Technikgestaltung” (Forum for Social Forms of Technology) from the German Trade Union Confederation (DGB) of Baden-Württemberg has been examining the subjects informatization of work and digitization since 1991. More than 4600 women and men from works councils and staff councils, union representative bodies and the workforce, large companies, small- and medium-sized enterprises, the manual trades, as well as self-employed people have been involved in an exchange about their experiences in production and services and in administrations. Against this background, and drawing on the accumulated knowledge gained from experience, the following proposals for the future of internal crowdsourcing have been derived. The proposals represent a trade union-based approach.
Good Practice at GASAG Group: Recommendations for the Application of Internal Crowdsourcing from a Business Perspective
Authors: Porth Florian
Published: December 2020

Developing innovative and marketable products and services and maintaining innovation capacity are basic prerequisites for a company’s economic success and present implicit challenges in the adaptation to twenty-first-century needs. These success factors are put at risk by silo mentalities and by insufficiently pronounced cross-departmental knowledge transfers. The GASAG Group as a typical organizational layout of medium-sized enterprises in Germany has been and still is confronted with these challenges as well. In order to face them, the GASAG Group decided to work on company culture as well as to develop an open and innovative mindset, prompting it to join the ICU (ICU stands for ‘Internal Crowdsourcing in Enterprises’ and is a joint project funded by the Federal Ministry of Research and Education (BMBF) and the European Social Fund (ESF) for a period of 3 years, from June 2017 to May 2020, under the funding measure ‘Work in the Digitalised World’ and supervised by the project management organization Karlsruhe. The project goal was the development of an employee-friendly cross-industry reference model for Internal Crowdsourcing.). Research Project in 2017. The aim of this chapter is to describe the ICU approach from the practical, company perspective of the GASAG Group and to map out identified success factors as well as provide general recommendations for the implementation of Internal Crowdsourcing in a business environment.