Role of Topical Putrescine (Fibrostat) for Prevention of Hypertrophic Scars in Mammoplasty Patients

Study Overview
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Brief Summary
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Linked to previous Clinical Trial E92:069 in which biochemical effect of 1,4 diaminobutane was studied in human scar harvested at revision surgery after a 12 week application. Analytical data was collected in this phase of the work completed in 1999. This was then followed by clinical correlation in a scar prevention model with topical application of 1,4 diaminobutane for 12 weeks and measuring duredness , as well photographic and POSAS score data for quality of scar formation.

Detailed Description
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In this study, patients were randomized into one of 2 study groups described below. They agreed to being treated on the right side or the left with active agent, while the other side was to receive inactive cream. The active molecule is called Fibrostat or 1,4 diaminobutane and is a naturally occurring inhibitor of scar formation. The inactive jar contains the vehicle alone without Fibrostat. The patients received both cream types to be applied to the appropriate side assigned by the randomization process, one numbered jar each per breast in the order and amount as explained in detail by the patient educator. The cream was applied daily and in the same order, one jar for the right and the other jar for the left consistently. The randomization was performed at the factory with an assigned number recorded on each jar and the jar contents listed and recorded with its assigned number. Each jar of active cream is randomly assigned with another jar of inactive cream to form a pair which were both given to the patient. The cream in both jars looks and smells the same. Neither the patient nor the study doctor knew which breast as receiving the active agent. In an emergency, this information was to be made available. Participation in the study was for 12 weeks. the patients were seen for photos and scar testing using a painless surface testing device called a Rex® durometer at 1, 3, 6, and 12 weeks post op. The researcher could decide to take patients off this study if a patient were to develop a rash during the run-in period of 1 week from the cream on either side. The patients could stop participating at any time. However, this was usually accompanied by a valid reason such as lack of transportation to regular follow up appointments. No serious effects were seen and the only patients to stop participation in the study except 1 which was lost to follow-up could be accounted for. The results were revealed to patients at the completion of the 12 week trial.

Official Title
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Role of Topical Putrescine (Fibrostat) in 10%Urea (TFU) for Prevention of Hypertrophic Scars in Mammoplasty Patients

Conditions
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Hypertrophic Scar

Intervention / Treatment
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* Drug: 1,4-Diaminobutane
* Drug: 10% Urea cream


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Undergoing breast reduction surgery - Exclusion Criteria: Not pregnant or lactating -

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Interventional Model Description: Double-Blind Randomized Controlled Trial; Patient as their own control
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Sham Comparator: 10% Urea cream<br>Opposite breast scars treated OD at hs simultaneously using sham 10% Urea cream | Drug: 10% Urea cream<br>* Daily application to surgical breast scars of 10% Urea cream on the sham side<br>|
| Active Comparator: Active cream with 1,4 diaminobutane<br>Other breast scar treated daily with active cream with 1,4 diaminobutane topically OD at hs | Drug: 1,4-Diaminobutane<br>* Daily application to surgical breast scars of 1,4 diaminobutane on the active side<br>* Other names: Fibrostat;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Duredness of scar at post treatment time frame for active versus control breast | Surface deformational force in grams of scar tissue in each of the treated breasts | 12 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Observer Objective Scar Assessment Scale ratings | Validated scale of scar outcome based on seven parameters graded on a scale of 1-10 ranked lowest to highest in severity. Patient was the observer in this study making subjective parameters listed such as pain and itch a direct patient correlate rather than one recorded by a second-person observation. | at least one year post operatively | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Prevention of hypertrophic scar