Strategies to prevent hypertrophic scar formation:a review of therapeutic interventions based on molecular evidence

Once scar tissues mature,it is impossible for the surrounding tissue to regenerate normal dermal tissue.Therefore,it is essential to understand the fundamental mechanisms and establish effective strategies to inhibit aberrant scar formation.Hypertrophic scar formation is considered a result of the imbalance between extracellular matrix synthesis and degradation during wound healing.However,the underlying mechanisms of hypertrophic scar development are poorly understood.The purpose of this review was to outline the management in the early stage after wound healing to prevent hypertrophic scar formation,focusing on strategies excluding therapeutic agents of internal use.Treatment aimed at molecular targets,including cytokines,will be future options to prevent and treat hypertrophic scars.More basic studies and clinical trials,including combination therapy,are required to investigate the mechanisms and prevent hypertrophic scar formation.

Advances in surgical applications of growth factors for wound healing

Growth factors have recently gained clinical importance for wound management.Application of recombinant growth factors has been shown to mimic cellmigration,proliferation,and differentiation in vivo,allowing for external modulation of the healing process.Perioperative drug delivery systems can enhance the biological activity of these growth factors,which have a very short in vivo half-life after topical administration.Although the basic mechanisms of these growth factors are well understood,most have yet to demonstrate a significant impact in animal studies or small-sized clinical trials.In this review,we emphasized currently approved growth factor therapies,including a sustained release system for growth factors,emerging therapies,and future research possibilities combined with surgical procedures.Approaches seeking to understand wound healing at a systemic level are currently ongoing.However,further research and consideration in surgery will be needed to provide definitive confirmation of the efficacy of growth factor therapies for intractable wounds.

Topical odour management in burn patients

Preventing microbial colonization or infections that cause offensive smells may lead to odor reduction.As both anaerobic and aerobic bacteria cause the release of malodor from wounds,the most direct way of avoiding or eliminating wound odor is to prevent or eradicate the responsible infection through the debridement of necrotic tissues.However,some burn patients with malodorous wounds are unable to undergo debridement due to systemic conditions,especially in the acute stage.Moreover,the optimal drug doses and dressings to ensure the efficacy and cost-effectiveness of odorous burn wound management is unclear.The purpose of this commentary is to outline the odor management options available for burn patients,focusing on topical strategies.Numerous potential therapies for treating odorous wounds after burn injuries are suggested.

Dorsal hand reconstruction with radial artery perforator-based adipofascial flap

Reconstruction of dorsal hand soft tissue defects after severe injury is challenging for surgeons.Depending on the degree of defect,extensor tendon reconstruction may also be necessary.Various reconstruction methods are commonly performed to cover dorsal hand defects,such as skin grafting and distant,free,or local flaps.Among them,free vascularized flap transplantation is an ideal procedure because the major vessels that feed the local flap may have been damaged,and the affected limb can be reconstructed using a flow-through method.Although free flap surgery has advanced,few surgeons can choose this option due to its technical difficulty and uncertainty.On the other hand,distant flaps have been commonly used for the reconstruction of dorsal hand defects,and local flaps,such as reverse forearm flaps and retrograde posterior interosseous flaps,do not require microvascular anastomosis.However,they have some problems;distant flaps require at least two surgeries,reverse forearm flaps sacrifice major vessels and leave a scar at the donor site,and retrograde posterior interosseous flaps require meticulous dissection of the vascular pedicle.The radial artery perforator-based adipofascial flap is a versatile flap that is safe and easy to elevate without sacrificing the radial artery.In addition,elevating it as an adipofascial flap enables surgeons to avoid an unacceptable donor scar.We present two cases,demonstrating the usefulness of this pedicled perforator flap.