bluuebunny/crossref_metadata_2025_split huggingface dataset:
Objective Assessment Technologies: General Guidelines for Scar Assessment
Authors: Poetschke Julian , Gauglitz Gerd G. 
Published: December 2020

AbstractScar assessment has long relied on a variety of instruments, most of them questionnaires or scales that are susceptible to bias and limit the level of evidence in research. Throughout recent years, a variety of objective assessment tools have been developed. They allow for the exact quantification of different scar parameters such as texture, pliability, color, and size, thus facilitating detailed progress analysis throughout treatment.The advent of new technology, however, has its pitfalls, too. The number of different technologies available is hard to review, and oftentimes, clinical validation is lacking, making it hard for researchers to gauge whether a certain instrument is adequate for their individual projects.The use of each individual instruments has different requirements regarding patient preparation and calibration, and the measurements themselves can often be adjusted through a variety of parameters. This requires intensive familiarization with the respective instruments. Additionally, interpretation of the data can be complicated, and distinguishing statistically significant differences from clinically important differences remains difficult.Modern technology, however, allows researchers to measure treatment effects that otherwise would have eluded them through the use of subjective evaluation only.Through objective scar assessment technology and its detailed abilities to document changes throughout treatment, the evidence in scar-related research can be greatly improved, and current as well as new treatment options can finally be adequately gauged for their efficacy.
Objective Assessment Tools: Physical Parameters in Scar Assessment
Authors: Jaspers M. E. H. , Moortgat P. 
Published: December 2020

AbstractObjective assessment tools can be used to evaluate whether (new) scar treatment is effective and to monitor the scar’s response to interventions in clinical practice. It is important to take the clinimetric properties of each tool into account, especially when used for the follow-up of an individual patient. An overview is provided for three important physical scar parameters that can be assessed by noninvasive objective tools: color, elasticity, and perfusion. To assess the color of a scar, an array of tools is available, all using reflectance spectroscopy and determining color by measuring the intensity of reflected light of specific wavelengths. The handheld DSM III ColorMeter offers read-out of erythema and melanin index values as well as CIEL∗a∗b values. The interrater reliability is best for the parameter a∗ of the DSM III ColorMeter. To assess scar elasticity, the Cutometer is the most widely used tool. Scar deformation is measured using negative pressure and reflected in relative and absolute elasticity parameters. On the contrary, firmness or hardness of scar tissue can be quantified by tonometry, a technique that works by exerting pressure on the skin. Lastly, it is of interest to measure scar blood flow (i.e., perfusion) as several treatment regimens work by destructing the microvasculature and/or reducing the blood flow to enhance shrinkage of hypertrophic scar tissue. Laser Doppler imaging and laser speckle imaging can be used to quantify and visualize scar blood flow, but a thorough clinimetric evaluation of these tools in scars is not performed yet.
Objective Assessment Techniques: Physiological Parameters in Scar Assessment
Authors: Moortgat Peter , Anthonissen Mieke , Van Daele Ulrike , Meirte Jill , Vanhullebusch Tine , Maertens Koen 
Published: December 2020

AbstractIn order to assess new and often costly treatments, the need for objective scar measurement tools has become increasingly important. A combination of subjective and objective measures should be the aim of every researcher. Quantitative assessment of scars requires devices to measure their physical and physiological properties. Physiological scar parameters are scar characteristics relevant to pathological scarring which cannot be seen with the bare eye. This also means that they can only be assessed with objective assessment tools.Skin hydration is defined as the water content of the epidermis and the dermis, and the ability of the skin to retain water is important to avoid dry appearance of the skin and prolonged inflammation in scarring. Many approaches exist to measure skin water content. One single method is often not enough to capture all the relevant information. Trans-epidermal water loss, stratum corneum water content, and dermal water content are equally important and related to each other.Scar maturation has been related to transcutaneous oxygen tension, and it is hypothesized that low levels of transcutaneous oxygen pressure in evolving scars result from low oxygen diffusibility through scar tissue.Tactile sensitivity of the skin can be measured by esthesiometers. The Semmes-Weinstein monofilament test is found to be a feasible and reliable outcome measure to evaluate touch perception threshold in older upper extremities burn scars.
Structural Assessment of Scars Using Optical Techniques
Authors: van Haasterecht L. , van Zuijlen Paul P. M. , Groot ML. 
Published: December 2020

AbstractThe evaluation of scar treatment benefits from exact structural measurements. Accurate assessment of thickness, surface area, and relief is crucial in routine clinical follow-up. From an experimental perspective, precise visualization of the microstructural organization is necessary for a better understanding of the mechanisms underlying pathological scarring. Structural proteins in scars differ from healthy skin in terms of amount, type, and importantly, organization. The precise quantification of this extracellular matrix (ECM) organization was, until recently, limited to two-dimensional images from fixated and stained tissue. Advances in optical techniques now allow high-resolution imaging of these structures, in some cases in vivo. The enormous potential of these techniques as objective assessment tools is illustrated by a substantial increase in available devices. This chapter describes currently used devices and techniques used in the clinical follow-up of scar progression from a volumetric standpoint. Furthermore, some of the most powerful techniques for microstructural research are described including optical coherence tomography, nonlinear optical techniques such as second harmonic generation microscopy, and confocal microscopy.
Mechanobiology of Cutaneous Scarring
Authors: Ogawa Rei 
Published: December 2020

AbstractThe last phase of cutaneous wound healing produces the scar. Under normal circumstances, the immature scar then undergoes the scar maturation process over several months. This process involves tissue remodeling, which associates with a natural decrease in the inflammation and the numbers of blood vessels, collagen fibers, and fibroblasts. However, sometimes the scar maturation process is not properly engaged because inflammation continues in the scar. Consequently, the immature scar stage is prolonged. This results in the pathological scars called hypertrophic scars and keloids. Many factors that prolong the inflammatory stage have been identified. However, multiple lines of evidence acquired in recent years suggest that mechanical force can be an important cause of pathological scar development.
Ethical Considerations: Scar Management
Authors: Ganier Clarisse , Gaucher Sonia 
Published: December 2020

AbstractThe purpose of this chapter was to provide an overview and potential answers to the ethical considerations of the clinical scar management. Here, we focused on two main aspects. The first aspect was to discuss the need to invoke ethics when the clinician is faced to a patient’s scar. The second aspect was to discuss the clinicians dilemmas in their daily practice when they are managing a patient’s scar.
Ideal Wound Closure Methods for Minimizing Scarring After Surgery
Authors: Ogawa Rei 
Published: December 2020

AbstractWound-healing phenomena are the result of a cascade of complex biochemical events that can be categorized into four general overlapping phases: coagulation, inflammation, proliferation, and remodeling. Significantly, all four phases of wound healing are influenced by both intrinsic and extrinsic mechanical forces. These mechanical forces provoke chronic inflammation of the dermis, namely, the unceasing influx and activation of inflammatory cells, the persistent generation of blood vessels and nerve fibers, and the constant production of collagen by the activated fibroblasts. This chronic inflammation blocks the conversion of the granulation tissue into dermis-like tissue by the remodeling process and results in an immature hypertrophic scar that is red, elevated, hard, and painful. These observations suggest that, to prevent pathological scarring after surgery, it is necessary to ensure that the sutures cause the wound edges to adhere to each other without any tension, even when strong extrinsic forces are placed on the wound. This will allow the granulation tissue to convert smoothly into dermis-like tissue, thereby yielding minimal scarring. Another way to prevent pathological scar formation in high-tension areas is to use zigzag suturing techniques such as the Z-plasty.
Treatment of Immature Scars: Evidence-Based Techniques and Treatments
Authors: Poetschke Julian , Gauglitz Gerd G. 
Published: December 2020

AbstractSevere scarring is known for causing severe functional, aesthetic, and psychosocial impairments. During the last years, treatment of mature scars has evolved significantly; however, researchers and clinicians are more and more focused on preventing excessive scarring altogether, thus avoiding long and strenuous treatment. While some forms of scar prevention have been known and used for decades, others are relatively new and have yet to prove themselves. Pressure garments have long been successfully used in widespread burn scar prevention. However, reduced compliance, large treatment costs, and little hard evidence are points that should be taken into consideration regarding this well-established form of treatment. Silicone gel sheeting has also been used for a long time, and it is well regarded for its efficacy in reducing scar height and improving pliability while boasting little side effects. Its mode of action, however, remains unclear. Recently, lasers have become a new focus in the effort to prevent pathological scarring. Here, the older pulsed dye laser, as well as newer, fractional ablative and nonablative lasers, is increasingly employed for the treatment of fresh scars, where initial research is showing significant promise.This chapter explores the currently available methods for scar prevention and examines their application and the evidence regarding their efficacy.
Onion Extract
Authors: Poetschke Julian , Gauglitz Gerd G. 
Published: December 2020

AbstractMultiple studies on hypertrophic scar and keloid formation have led to a plethora of therapeutic strategies in order to prevent or attenuate keloid and hypertrophic scar formation. To date, preventing pathologic scarring remains undoubtedly more effective than treating it. Next to specific surgical techniques and an appropriate general aftercare of fresh wounds, a multitude of scar gels, creams, patches, and ointments are available and are being promoted for scarless wound healing. Next to silicone-based products, onion extract or cepalin has been highlighted as one potential anti-scarring agent over recent years. Based on several studies, onion extract alone or in combination with allantoin and heparin seems to alleviate the wound-healing process and appears beneficial for preventional application in fresh scars. The study data available, however, remains overall relatively poor and clearly objective data regarding this approach is widely missing.
Treatment of Immature Scars with Botulinum Toxin
Authors: Chambers Alexandra 
Published: December 2020

AbstractUsing Botulinum neurotoxin type A (BoNTA) has yielded promising results in the treatment of immature scars. The biological effects of the toxin on tissue healing appear to be complex and multidimensional and still require additional research. Nevertheless, it is clear that not only does BoNTA reduce muscle tension at the edges of wounds, but it also provides anti-inflammatory effects, promotes angiogenesis and healing, and exerts mediatory or inhibitory effects on a variety of cells. In clinical practice, this pluripotency of BoNTA has been recognized as a therapeutic choice for both prophylaxis and treatment of excessive scarring.
Compression Therapy and Conservative Strategies in Scar Management After Burn Injury
Authors: Van den Kerckhove Eric , Anthonissen Mieke 
Published: December 2020

AbstractThis chapter gives an overview of the different conservative therapeutic strategies that are mostly used in the rehabilitation of patients with severe scars after burn injury. These strategies include pressure therapy, the use of silicones, massage, the use of moisturizers, splinting and positioning, exercise, and mobilizations. Pressure and silicone therapy are the two most evidence-supported conservative treatments of (burn) scars, with compression therapy considered an evidence-based conservative intervention to treat the thickness of the scars. The other noninvasive treatment modalities have less supporting evidence. The relevance of these conservative therapeutic strategies will be situated within the field of the available scientific literature or guidelines.
Minimally Invasive Technologies for the Treatment of Hypertrophic Scars and Keloids: Intralesional Cryosurgery
Authors: Har-Shai Yaron , Har-Shai Lior 
Published: December 2020

AbstractA 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

AbstractHypertrophic 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

AbstractFibroblasts 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

AbstractBoth 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

AbstractWe 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

AbstractThere 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

AbstractThis 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.