bluuebunny/crossref_metadata_2025_split huggingface dataset:
Minimal Invasive Technologies for Treatment of HTS and Keloids: Medical Needling
Authors: Aliu Antigona , Aust Matthias 
Published: December 2020

AbstractMedical 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

AbstractLocal 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

AbstractScar 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

AbstractFacial 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

AbstractSince 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

AbstractKeloids 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

AbstractThis 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

AbstractDespite 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

AbstractPatients 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.
Genital Scars
Authors: Mirastschijski Ursula 
Published: December 2020

AbstractGenital 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

AbstractTopical 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

AbstractCutaneous 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

AbstractLinear 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

AbstractVacuum 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

AbstractShock 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

AbstractIn 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

AbstractMechanotherapy 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

AbstractMultiple 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

AbstractIn 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

AbstractEarlobe 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

AbstractBreast 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.