The Characteristics of Blood Supply and Tissue Hypoxia in Pathological Scars

Blood supply is believed to be an important aspect in the development of pathological scars. However, there are controversies about vascular distribution, vascular structure and blood flow in pathological scars. Additionally, hypoxic microenvironment plays an important role in the vascularization of pathological scar tissues, and hypoxic conditions can be reflected by metabolic indexes and some cytokines. Furthermore, the correlation between blood supply and tissue hypoxia is controversial. The aim of this article is to review the literature on the characteristics of blood supply and tissue hypoxia in pathological scars, from which we can see pathological scars have unique characteristics of blood supply that are closely associated with tissue hypoxia. Moreover, development in the treatment of pathological scars is herein reviewed.

Using Zhang’s supertension-relieving suture technique with slowly-absorbable barbed sutures in the management of pathological scars:a multicenter retrospective study

Background:An ideal tension-relieving suture should be efficient for>3 months to retrieve normal tensile strength.Most preexisting suturing techniques provided tension elimination followed by relapse and scar proliferation due to absorption and cut-through of the sutures.This study introduces a simple but effective suture technique developed by a senior author(ZYX)to solve this problem.Methods:A total of 120 patients with pathological scar(PS)had intervention treatment with the proposed suturing strategy at three centers from January 2018 to January 2021.A slowly absorbable 2-0 barbed suturewas used for subcutaneous tension relieving with a set-back from the wound edge and a horizontal interval between proposed inserting points of 1 cm.The Patient and Observer Scar Assessment Scale(POSAS),scar width,perfusion and eversion of the wound edge were evaluated at 3-,6-and 12-month follow-up.The time needed to place the tension-relieving suture was recorded and relapse was monitored for 18 months postoperatively.Results:In total,76 trunks,32 extremities and 12 cervical PS were included,with an average subcutaneous tension-relieving suture time of 5 min.The Patient and Observer Scar Assessment Scale(POSAS)score decreased from 84.70±7.06 preoperatively to 28.83±3.09,26.14±1.92 and 24.71±2.00 at 3,6 and 12 months postoperatively,respectively(p<0.0001).The scar widths were 0.17±0.08,0.25±0.09 and 0.33±0.10 cm,respectively,with perfusion significantly decreased from 213.64±14.97 to 112.23±8.18 at 6 months(p<0.0001).The wound edge flattened out during the first 3 months in most cases with only two scar relapses.Conclusions:Zhang’s suture technique provides a rapid and long-lasting tension-relieving effect with ideal scar appearances and lower relapse rates in the surgical management of PS.

Discussion on the mechanism of Salvia miltiorrhiza in treating pathological scars based on network pharmacology

In the present study, we aimed to explore the mechanism of Salvia miltiorrhiza in the treatment of pathological scars(PS) by network pharmacology. The active ingredients and drug targets of Salvia miltiorrhiza were screened out through TCMSP database, the disease targets of PS in Gene Cards database were obtained, and Venn diagram analysis on drug targets and disease targets was performed, and the intersection was used as the target of Salvia miltiorrhiza for the treatment of PS. Cytoscape software was used to construct a drug-ingredient-target-disease network diagram. A protein-protein interaction network was constructed through String website, its key protein modules and hub genes were screened with Cytoscape software, and GO and KEGG enrichment analyses were performed in DAVID database. Fifty-nine active ingredients, 138 drug targets, and 90 targets of Salvia miltiorrhiza for the treatment of PS were screened out. Core ingredients, such as luteolin and tanshinone IIA, were obtained. The hub genes, such as VEGFA, TP53, JUN, STAT3, AKT1, MAPK1, and PTGS2, and signaling pathways, such as HIF-1, TNF, MAPK, PI3 K-Akt, and Jak-STAT, were screened out. Salvia miltiorrhiza might improve PS hypoxia, inflammation, and balance of proliferation and apoptosis of fibroblasts by regulating HIF-1, TNF, MAPK, PI3 K-Akt, and Jak-STAT signaling pathways. Moreover, it had the characteristics of multiple centers, multiple targets, and multiple pathways.

Implantation Instrument on the Expression of Collagen-I and Cell Proliferation Markers in Pathological Scar

Objective To explore the efficacyof Scar Infusion Instrument on expression of Type I Collagen and Cell Proliferation Markers in Pathological Scars.Methods 70 cases patients with pathologic scar admitted in our hospital from Augst 2016 to July 2017 were randomly divided into study group and control group.The control group was treated with scar ointment.The treatment group was treated with scar ointment combined with scar The expression of COL-I in scar tissue was determined by enzyme-linked immunosorbent assay(ELISA).The expression of ki-67 nuclear protein was determined by immunohistochemical staining(sp).Results The efficacy of the study group was significantly better than the control group,the total efficiency of the study group was significantly higher than the control group after 6 months treatment(P<0.05);The average COL-I and Ki67 nuclear protein expression in the single slice of the study group was significantly lower than that of the control group at the 3th months,6th months after treatment(P<0.001).Conclusions The scarring device is more effective in the treatment of pathological scar,and its mechanism may be related to the better inhibition of COL-I and ki-67 nucleoprotein expression.

Effect of TGF-β1 on expression of β-catenin in fibroblasts of pathological scar and its significance

Objective To explore interaction and interrelationship between TGF - β/Smad signal pathway and Wnt/β - catenin signal pathway in pathogenesis of pathological scar. Methods Three cases of keloid ( K group) ,3 of hyperplastic scar ( H group) and 3 of normal skin ( N group) were selected randomly, and then

Clinical efficacy of Salvia miltiorrhiza in pathological scar treatment:A systematic review and meta-analysis

To systematically assess the clinical efficacy of Salvia miltiorrhiza(SM)in treating pathological scars and provide a reference basis for scar pharmacotherapy,we conducted a comprehensive literature search in both English and Chinese databases from database inception to December 2022.Key search terms included Salvia miltiorhiza,cryptotanshinone,tanshinone IIA,sodium-tanshinol,compound Salvia miltiorrhiza dripping pills,cicatrix,cicatrices,and scar.The inclusion criteria encompassed all clinical randomized controlled studies on the treatment of pathological scars with SM,without regard to blinding or allocation concealment,as well as irrespective of patient nationality,race,or age.Data from the selected literature were subjected to analysis using Rev Man 5.4 software,employing the standard mean difference or weighted mean difference for numerical variables and odds ratios(ORs)for dichotomous variables.Statistical significance was set at P<0.05.Six eligible studies involving a total of 778 patients met the inclusion criteria.The analysis revealed a significant therapeutic efficacy with an OR of 3.83(95%CI:2.65–5.54),indicating a substantially higher therapeutic efficacy rate in SM group compared to the control group.Furthermore,the total effective rate of treatment exhibited an OR of 6.94(95%CI:2.53–19.06),signifying a significantly superior treatment outcome in SM group.Regarding scar scores,no significant improvement was observed in SM group compared to the control group after 3 months of treatment(mean difference[MD]=–0.96,95%CI:–2.29–0.36).However,after 6 months of treatment,the scar score demonstrated a noteworthy improvement in SM group(MD=–1.37,95%CI:–2.44 to–0.30)compared to the control group.In summary,this study affirmed that SM treatment markedly enhanced the therapeutic efficacy and overall treatment efficiency for clinical scar patients,underscoring its positive clinical therapeutic impact on scar patients.

The application of corticosteroids for pathological scar prevention and treatment:current review and update

The prevention and treatment of pathological scars remain challenging.Corticosteroids are the mainstay drugs in clinical scar prevention and treatment as they effectively induce scar regression and improve scar pruritus and pain.Currently,intralesional injections of corticosteroids are widely used in clinical practice.These require professional medical manipulation;however,the significant accompanying injection pain,repetition of injections and adverse effects,such as skin atrophy,skin pigmentation and telangiectasia,make this treatment modality an unpleasant experience for patients.Transdermal administration is,therefore,a promising non-invasive and easy-to-use method for corticosteroid administration for scar treatment.In this review,we first summarize the mechanisms of action of corticosteroids in scar prevention and treatment;then,we discuss current developments in intralesional injections and the progress of transdermal delivery systems of corticosteroids,as well as their corresponding advantages and disadvantages.

Diagnosis and Treatment of Keloids and Hypertrophic Scars—Japan Scar Workshop Consensus Document 2018

There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases.This is particularly true for clinicians who deal with Asian and African patients because these ethnicities are highly prone to these diseases.By contrast,Caucasians are less likely to develop keloids and hypertrophic scars,and if they do,the scars tend not to be severe.This ethnic disparity also means that countries vary in terms of their differential diagnostic algorithms.The lack of clear treatment guidelines also means that primary care physicians are currently applying a hotchpotch of treatments,with uneven outcomes.To overcome these issues,the Japan Scar Workshop(JSW)has created a tool that allows clinicians to objectively diagnose and distinguish between keloids,hypertrophic scars,and mature scars.This tool is called the JSW Scar Scale(JSS)and it involves scoring the risk factors of the individual patients and the affected areas.The tool is simple and easy to use.As a result,even physicians who are not accustomed to keloids and hypertrophic scars can easily diagnose them and judge their severity.The JSW has also established a committee that,in cooperation with outside experts in various fields,has prepared a Consensus Document on keloid and hypertrophic scar treatment guidelines.These guidelines are simple and will allow even inexperienced clinicians to choose the most appropriate treatment strategy.The Consensus Document is provided in this article.It describes(1)the diagnostic algorithm for pathological scars and how to differentiate them from clinically similar benign and malignant tumors,(2)the general treatment algorithms for keloids and hypertrophic scars at different medical facilities,(3)the rationale behind each treatment for keloids and hypertrophic scars,and(4)the body site-specific treatment protocols for these scars.We believe that this Consensus Document will be helpful for physicians from all over the world who treat keloids and hypertrophic scars.

Macrophage Polarization in Skin Wound Healing:Progress in Biology and Therapeutics

The morphological and functional barriers caused by pathological scars are extremely painful for patients.Up to now,pathological scar poses a big unmet medical challenge for plastic surgeons and dermatologists worldwide.Macrophage polarization has shown a non-negligible effect on wound healing and scar formation.However,the role of macrophages in wound healing and pathological scar formation is still controversial.To summarize the latest data on probing biological functions of macrophage polarization in wound healing and scar formation and target macrophages in wound healing,we particularly paid attention to studies on different groups of macrophages,the transition among those groups,and modulators regulating the transition process.A comprehensive understanding of macrophage polarization in wound healing is certain to facilitate the development of new and efficient therapeutic modalities for pathological scar.