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A simple and rapid method that is not based on race and ethnicity for classifying people with skin of color is of paramount importance in dermatology. The currently used Fitzpatrick classification of sun-reactive skin types is inadequate. Newer scales that have been used in immigration surveys and sociology studies are not applicable in the office setting. A new, non-racial and non-ethnic, colorimetric scale for skin of color has recently been proposed that is simple to perform. The scale has five colors: very light beige (skin color type 1), light brown (skin color type 2), medium brown (skin color type 3), dark brown (skin color type 4) and very dark brown (skin color type 5); an individual with white skin, such as in albinism, would have a skin color type 0 in this classification. In conclusion, the colorimetric scale enables the rapid classification of individuals with skin of color and allows for accurate assessment of skin cancer risk, more appropriate management of cosmetic dermatologic procedures and aesthetic devices, and enhanced ability for focused counseling regarding hair products, skin care interventions, and color-targeted makeup based on the person's skin tone.

Looking back at the various advancements in the field of laser and aesthetics in 2023, it can be observed that an increasing number of clinical studies from China are emerging. These changes and developments have been a significant driving force for clinical research in international laser and aesthetics, especially in terms of clinical data and conclusions among Asians, who make up more than 60% of the global population. They also provide opportunities for the development of domestic laser equipment. Laser therapy has shown certain advantages in the treatment of superficial skin diseases and aesthetics, facial rejuvenation and hair removal, pigmentary diseases and tattoos, vascular diseases, superficial tumors, and skin tags. The author has conducted a basic screening and evaluation of the progress in various aspects of the laser field, aiming to provide clinical evidence for current treatment methods. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusion Monkeypox (MPOX) caused a public health emergency of international concern (PHEIC) outbreak between 2022 and 2023, with a recent rise in cases that prompted the World Health Organization (WHO) to declare the disease a PHEIC once again. There is little information on its long‐term scarring sequelae.The objective of this study was to assess the risk and characteristics of scarring in patients with MPOX in a tertiary hospital.This is a prospective cohort study including patients diagnosed using polymerase chain reaction (PCR) tests. Clinical data were collected and followed up at 12–15 months to assess scarring and its impact on quality of life.Of the 40 patients, 19 (47.5%) developed scars, which were more common in those with initial cutaneous manifestations. Scars significantly affected the quality of life, especially in the genital and mucosal areas. The limited sample and loss to follow‐up may affect the validity of the results.Scarring is a frequent and disfiguring sequela of MPOX, particularly in patients with early skin symptoms. Prevention and close follow‐up are crucial in mitigating these complications. [ABSTRACT FROM AUTHOR]

Background: Scar formation after neck surgery is a frequent concern, impacting patients both physically and psychologically. Cosmetic appearance plays a crucial role in assessing surgical success. At present, the evolving medical technologies introduces innovations like Geometric Electron Modulation (GEM) electrocautery. GEM technology offers potential benefits such as reduced thermal injury and consistent heat emission during surgery compared to conventional electrocautery. Objectives: To compare the difference between postoperative neck scars from the surgical blade as the gold standard and geometric electron modulation electrocautery. Material and methods: A randomized controlled study was performed on the patients who were diagnosed with surgical conditions requiring neck surgery at the Department of Otolaryngology Head and Neck Surgery, King Chulalongkorn Memorial Hospital, from 2023 to 2024. The Patient and Observer Scar Assessment Scale was utilized to assess scar appearance at 1 and 3 months following the surgery, and the amount of blood loss during incision was recorded. Results: 22 patients were enrolled to this study. At 1-month follow-up, we saw significant difference between GEM (20.32 ± 4.11) and the surgical blade (23.27 ± 4.59) (P = 0.008) from POSAS, patient scale but no significant difference in doctor scale, (GEM 21.55 ± 7.34, surgical blade 24.27 ± 7.88, P = 0.155). At 3-month follow-up, there were no significant difference between the groups both doctor (GEM 16.45 ± 4.62, surgical blade 17.65 ± 4.50, P = 0.411) and patient scale (GEM 13.15 ± 2.96, surgical blade 14.05 ± 3.33, P = 0.328). Conclusion: GEM electrocautery had a superior scar outcome to a surgical blade at 1 month from the patient perspective. There was also significantly less blood loss in GEM compared with the surgical blade. [ABSTRACT FROM AUTHOR]

Purpose: Identifying outcome measurements instruments (OMIs) to evaluate treatment efficacy in patients with vocal fold atrophy and/or sulcus. Methods: Systematic review of records published before March 2021 by searching Pubmed and EMBASE. Included studies reported on adults (> 18 year) with dysphonia caused by glottic insufficiency due to vocal fold atrophy with or without sulcus, who were enrolled into a randomized controlled trial, a non-randomized controlled trial, a case-controlled study or a cohort study. All included studies described an intervention with at least one outcome measurement. Results: A total of 5456 studies were identified. After removing duplicates, screening title and abstract and full text screening of selected records, 34 publications were included in final analysis. From these 50 separate OMIs were recorded and categorized according to the ELS protocol by DeJonckere et al. (Eur Arch Otorhinolaryngol 258: 77–82, 2001). With most OMIs being used in multiple studies the total number of OMIs reported was 265. Nineteen (19) individual OMIs accounted for 80% of reports. The most frequently used OMIs according to category were: VHI and VHI-10 (subjective evaluation); G of GRBAS (perceptual evaluation); F0, Jitter and Shimmer (acoustic evaluation); MPT and MFR (aerodynamic evaluation) and glottic closure and mucosal wave (endoscopic evaluation). Of these OMIs VHI had a high percentage of significance of 90%. Conclusion: This systematic review identifies the most used OMIs in patients with glottic incompetency due to vocal fold atrophy and/or sulcus as a step toward defining a Core Outcome Set (COS) for this population. PROSPERO registration: 238274. [ABSTRACT FROM AUTHOR]

Macrophages (MΦ) play pivotal roles in tissue homeostasis and repair. Their mechanical environment has been identified as a key modulator of various cell functions, and MΦ mechanosensitivity is likely to be critical – in particular in a rhythmically contracting organ such as the heart. Cultured MΦ, differentiated in vitro from bone marrow (MΦBM), form a popular research model. This study explores the activity of mechanosensitive ion channels (MSC) in murine MΦBM and compares it to MSC activity in MΦ enzymatically isolated from cardiac tissue (tissue‐resident MΦ; MΦTR). We show that MΦBM and MΦTR have stretch‐induced currents, indicating the presence of functional MSC in their plasma membrane. The current profiles in MΦBM and in MΦTR show characteristics of cation non‐selective MSC such as Piezo1 or transient receptor potential channels. While Piezo1 ion channel activity is detectable in the plasma membrane of MΦBM using the patch‐clamp technique, or by measuring cytosolic calcium concentration upon perfusion with the Piezo1 channel agonist Yoda1, no Piezo1 channel activity was observed in MΦTR. The selective transient receptor potential vanilloid 4 (TRPV4) channel agonist GSK1016790A induces calcium entry in MΦTR and in MΦBM. In MΦ isolated from left‐ventricular scar tissue 28 days after cryoablation, stretch‐induced current characteristics are not significantly different compared to non‐injured control tissue, even though scarred ventricular tissue is expected to be mechanically remodelled and to contain an altered composition of pre‐existing cardiac and circulation‐recruited MΦ. Our data suggest that the in vitro differentiation protocols used to obtain MΦBM generate cells that differ from MΦ recruited from the circulation during tissue repair in vivo. Further investigations are needed to explore MSC identity in lineage‐traced MΦ in scar tissue, and to compare mechanosensitivity of circulating monocytes with that of MΦBM. Key points: Bone marrow‐derived (MΦBM) and tissue resident (MΦTR) macrophages have stretch‐induced currents, indicating expression of functional mechanosensitive channels (MSC) in their plasma membrane.Stretch‐activated current profiles show characteristics of cation non‐selective MSC; and mRNA coding for MSC, including Piezo1 and TRPV4, is expressed in murine MΦBM and in MΦTR.Calcium entry upon pharmacological activation of TRPV4 confirms functionality of the channel in MΦTR and in MΦBM.Piezo1 ion channel activity is detected in the plasma membrane of MΦBM but not in MΦTR, suggesting that MΦBM may not be a good model to study the mechanotransduction of MΦTR.Stretch‐induced currents, Piezo1 mRNA expression and response to pharmacological activation are not significantly changed in cardiac MΦ 28 days after cryoinjury compared to sham operated mice. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods Results Discussion Conclusion The physical and emotional burden that scars impose on people's lives has been the concern of dermatological research for quite some time. Usually, the available literature on the topic draws a grim image containing solely dry medical facts. The present study deviates from this approach by reflecting a solution‐centered study which has also touched on the quotidian life of an average person. The overall intention of the present experiment was to inspect how a holistic approach to scars in dermatology can be crucial for the patient's quality of life.This pilot study compiles data collected through the Patient and Observer Scar Assessment Scale (POSAS) and the Dermatology Life Quality Index (DLQI) from the same set of patients within the span of a year. Sixty patients with diverse scar profiles were asked to rate POSAS and DLQI in every session. A combination of EBDs was used based on the scar examination. Student's t‐test was run to validate the data.The evaluations by POSAS and DLQI indicate significant improvement in the physical aspect of the scar as well as the patient quality of life a year after the first treatment. According to mean values collected from POSAS, there is a direct correlation between average patient evaluations and physician assessments. Thus, EBDs prove to be efficient in improving the QoL of scar patient. The 20 patients who had reported mild side effects after treatments recovered fully within a few days after the sessions. No patient reported severe side effects.Apart from the physical indications that scars bring about into patients' lives, the psychological repercussions caused by scars have a major effect on the QoL of the patients. These repercussions can be divided into individual and social. At the individual level, scars have a profoundly negative effect on the image of the self which leads to several different psychological complications by time. At the social level, scars affect the radius of physical movement besides the quality of the patient's activities. Therefore, EBDs as effective treatment methods can improve itchiness, pain, and so forth, of the patient, and can also improve the psychological aspect.All in all, the present study aims to produce a more panoramic perspective on the concern of scars in the field of dermatology, centering around EBDs as a solution for improving scar patient QoL. With a focus on the efficacy of EBDs in the scar treatment, and with reference to studies on the topic, it is safe to assume that the earlier the scar treatment initiates, the better the outcomes. Departing from this point, in the future of cosmetic dermatology, prepping the skin by EBD treatments before surgery is imaginable. [ABSTRACT FROM AUTHOR]

Objective: To compare residual myometrial thickness (RMT) and cesarean scar defect (CSD) development after cesarean section using double-layer locked and unlocked closure techniques. Materials and methods: We conducted a randomized double-blinded trial comparing double-layer locked and unlocked uterine closure techniques following cesarean section in primiparous women. The locked technique involved continuous suturing of the full myometrial thickness in the first layer, followed by back-and-forth needle maneuvering on both sides of the incision for the second layer. The unlocked method included running suturing of two-thirds of the myometrial thickness in the first layer, followed by suturing the upper half of the myometrial thickness in the second layer. Transvaginal ultrasonography was performed one year post-cesarean section, with RMT as the primary outcome and scar depth and width as secondary outcomes. Independent t-test and Chi-square test were utilized for statistical analysis. Results: All 30 patients from the locked and 26 from the unlocked group in the follow-up were diagnosed with CSD (scar depth>2mm). The mean RMT for the unlocked and locked groups were 4.44±1.07mm and 4.12±0.48mm, respectively, showing no significant difference (p =0.14). There was also no significant difference in mean scar width between the locked and unlocked groups (3.68±1.44mm vs. 3.95±1.00mm, p =0.42). However, the mean scar depth was higher in the unlocked group (3.77±1.11 mm vs. 3.16±1.1mm, p =0.04). Conclusion: We have found no significant differences in the RMT and CSD prevalence between two-layered locked and unlocked uterine closure techniques, while the scar depth was greater in the unlocked group. Nonetheless, future randomized trials implementing larger sample sizes are required to precisely compare the outcomes of the double-layer locked and unlocked uterine suturing techniques. [ABSTRACT FROM AUTHOR]

To compare paediatric oncologic vascular access ports located on the anterior thoracic wall to ports on the lower lateral thoracic wall, in terms of perceived port-related hindrance and scar-quality. A cross-sectional survey study including paediatric oncology patients (≥8-<19 yrs), caregivers (in patients <8 yrs), survivors (>22 yrs with only anterior ports) and nurses of the Princess Máxima Center, the Netherlands, was performed. The survey consisted of questions regarding satisfaction, hindrance during daily life, and port position preference. For survivors, scar-quality was assessed using the validated Patient and Observer Scar Assessment Scale (POSAS 2.0); a high score (i.e., a displeasing scar) was defined as a score higher than the third quartile of the median for that question. In total, 147 participants were included; 83 patients/caregivers, 31 survivors, and 33 nurses. Overall, 81 % was satisfied with the position of their port. Satisfaction, hindrance and complications did not differ between anterior and lower lateral ports. For the anterior position, minimal pressure on the port during daily life was a mentioned reason to prefer this position. For the lower lateral position, less visibility of the scar and easiest access were mentioned. Of all survivors with an anterior port scar, one in five had a displeasing scar and all scars observed were widened. Female patients preferred a lower lateral port, and scar-quality was better for left-sided port scars. The port position should be chosen together with patients/caregivers based on the (dis-)advantages of each position, as identified by this study. II. • Satisfaction, hindrance and complications did not differ between anterior and lower lateral ports. • The most ideal port position should therefore be chosen together with patients/caregivers based on the (dis-)advantages of each position. [ABSTRACT FROM AUTHOR]

This prospective study aimed to evaluate the outcomes of the use of dermal templates for lengthy volar soft tissue defects (1.5–4 cm) in the fingers. The volar soft tissue defects of 15 patients (19 fingers) were treated with Lando dermal template coverage between June 2022 and November 2022. We evaluated sensory recovery, scar formation, and overall appearance of the repair site at an average of 13 months (range, 12–17 months) of follow-up. The defect healed in all cases. We found an average static 2-point discrimination of 7 mm (range 4 to 14 mm). Scar formation was evident in all cases. The repair did not restore the bulkiness of the volar finger, especially in the finger with the bony exposure. Nail deformities and joint contracture were observed in some cases. Dermal template repair does not restore normal sensation and inevitably leads to scar formation when the defect is longer (>1.5 cm). Bulkiness of the volar finger is not restored in most patients, especially when there was bone or tendon exposure in the initial wound site. [ABSTRACT FROM AUTHOR]

Corm rot of saffron is the deadliest disease of saffron and a major bottleneck in its successful cultivation in Jammu and Kashmir, India. To date, only limited information has been made available for the monitoring, surveillance, and detection of plant pathogens associated with corm rot of saffron in this region. Incidence and severity of corm rot caused by multiple pathogens, viz., Fusarium oxysporum, Fusarium solani, Aspergillus niger, Penicillium corymbiferum, Rhizoctonia solani, and Macrophomina phaseolina, was assessed in saffron growing regions based on multiple field surveys conducted at the farmer's fields in Kishtwar district of Jammu and Kashmir, during June-July 2021 and 2022. Corm rot was prevalent in all the surveyed prefectures of the saffron growing region, with a maximum disease incidence (62.02%) and severity (43.68%) at Lower Pochhal. The disease manifested as yellowing, drooping, and wilting of shoots during flowering, resulting in dying of the foliage which subsequently led to rotting of corms. Association of six fungal species viz., Fusarium oxysporum, Fusarium solani, Aspergillus niger, Penicillium corymbiferum, Rhizoctonia solani and Macrophomina phaseolina was recorded from the infected saffron corms based on morphological characteristics. Out of these, F. oxysporum was the predominant pathogen, and was present in all the surveyed locations. Species specific SCAR (Sequence Characterized Amplified Region) primers (FO-SCAR-FP and FO-SCAR-RP) were designed for effective detection and diagnosis of F. oxysporum, as it emerged as the major pathogen. Results of the present study may provide new insights into the monitoring of the corm rot and the deployment of an effective disease management strategy that will enhance the production, and productivity of saffron. This being the first comprehensive survey in the region, it provides basic information regarding the occurrence of disease, the distribution of various pathogens associated with it and also about the detection and monitoring of F. oxysporum. [ABSTRACT FROM AUTHOR]

Aims Atrial fibrosis and autonomic remodelling are proposed pathophysiological mechanisms in atrial fibrillation (AF). Their impact on conduction velocity (CV) dynamics and wavefront propagation was evaluated. Methods and results Local activation times (LATs), voltage, and geometry data were obtained from patients undergoing ablation for persistent AF. LATs were obtained at three pacing intervals (PIs) in sinus rhythm (SR). LATs were used to determine CV dynamics and their relationship to local voltage amplitude. The impact of autonomic modulation- pharmacologically and with ganglionated plexi (GP) stimulation, on CV dynamics, wavefront propagation, and pivot points (change in wavefront propagation of ≥90°) was determined in SR. Fifty-four patients were included. Voltage impacted CV dynamics whereby at non-low voltage zones (LVZs) (≥0.5 mV) the CV restitution curves are steeper [0.03 ± 0.03 m/s ΔCV PI 600–400 ms (PI1), 0.54 ± 0.09 m/s ΔCV PI 400–250 ms (PI2)], broader at LVZ (0.2–0.49 mV) (0.17 ± 0.09 m/s ΔCV PI1, 0.25 ± 0.11 m/s ΔCV PI2), and flat at very LVZ (<0.2 mV) (0.03 ± 0.01 m/s ΔCV PI1, 0.04 ± 0.02 m/s ΔCV PI2). Atropine did not change CV dynamics, while isoprenaline and GP stimulation resulted in greater CV slowing with rate. Isoprenaline (2.7 ± 1.1 increase/patient) and GP stimulation (2.8 ± 1.3 increase/patient) promoted CV heterogeneity, i.e. rate-dependent CV (RDCV) slowing sites. Most pivot points co-located to RDCV slowing sites (80.2%). Isoprenaline (1.3 ± 1.1 pivot increase/patient) and GP stimulation (1.5 ± 1.1 increase/patient) also enhanced the number of pivot points identified. Conclusion Atrial CV dynamics is affected by fibrosis burden and influenced by autonomic modulation which enhances CV heterogeneity and distribution of pivot points. This study provides further insight into the impact of autonomic remodelling in AF. [ABSTRACT FROM AUTHOR]

While patient education materials (PEMs) across various specialties have been reported as being too difficult to read, the quality and understandability of PEMs related to scar management have not been assessed. In this study, we report the breadth of scar management interventions and readability of online PEMs authored by academic societies and university hospitals. Websites of academic medical societies and university hospitals with scar revision PEMs were assessed for relevance. PEM readability was assessed via Flesch Reading Ease, Flesch–Kincaid Grade Level, and Gunning-Fox Index scores. Understandability and actionability were evaluated using the Patient Education Material Assessment Tool (PEMAT). A total of 26 scar revision PEMs met the inclusion criteria. The most commonly mentioned scar management interventions were scar revision surgery (73%) and laser scar revision (70%), with minimal emphasis on noninvasive methods like scar massage or sun protection. Readability analysis yielded a mean Flesch reading level of 8.8. Overall, PEMAT understandability of online scar treatment PEMs was moderate, with a median of 76.0% (IQR 71.5%-80.5%). PEMs from all specialties and institution types were lacking in actionability, with median actionability of 40.8% (IQR 38.1%-60.0%). Online scar revision PEMs included a wide breadth of scar management interventions; however, the least costly interventions, such as sun protection and scar massage, were not commonly included. PEMs for scar management could be improved by simplifying language, including visual aids, and including checklists or specific steps, patients can take to take action on scar management interventions. [ABSTRACT FROM AUTHOR]

Hypertrophic scar development is a complication associated with wound healing, impacting local appearance and function. The type I/III collagen ratio affects the extent of hypertrophic scarring; a reduced ratio can ameliorate this. In this study, recombinant human collagen type III was developed. Liquid chromatography–tandem mass spectrometry was used to determine its amino acid sequence and confirm its high level of homology with natural human type III collagen. Recombinant human collagen type III displayed no cytotoxicity and did not confer skin irritation and sensitization. Immunofluorescence and western blot analyses of histidine following incubation with fibroblasts suggested cell entry of recombinant human collagen type III. Furthermore, recombinant human collagen type III promoted the synthesis of the natural type III collagen in fibroblasts, resulting in a more obvious increase of type III collagen content in fibroblasts than that of type I collagen, and then decreased the ratio of type I/III collagen. The results of 5-ethynyl-2ʹ-deoxyuridine staining assay suggested enhanced fibroblast proliferation. Following local injection of recombinant human collagen type III, rabbit ear scarring was significantly reduced after 60 days. Vancouver Scar Scale evaluation showed that all index scores were significantly reduced. Western blotting and Picro-Sirius red staining showed that the natural type III collagen increase in scar tissue was greater than that of type I collagen, decreasing the type I/III ratio. In summary, recombinant human collagen type III can be taken up by fibroblasts and promote natural collagen synthesis—especially that of type III—thereby reducing the type I/III ratio and improving hypertrophic scarring. [ABSTRACT FROM AUTHOR]

Hypertrophic scarring is an aberrant wound-healing response to reestablish dermal integrity after an injury and can cause significant abnormalities in physical, aesthetic, functional, and psychological symptoms, impacting the patient's quality of life. There is currently no gold standard for preventing and treating hypertrophic scars. Therefore, many researchers have attempted to search for antihypertrophic scar agents with greater efficacy and fewer side effects. Natural therapeutics are becoming attractive as potential alternative anti-scarring agents because of their high efficacy, safety, biocompatibility, low cost, and easy accessibility. This review demonstrates various kinds of natural product-based therapeutics, including onion, vitamin E, Gotu kola, green tea, resveratrol, emodin, curcumin, and others, in terms of their mechanisms of action, evidence of efficacy and safety, advantages, and disadvantages when used as anti-scarring agents. We reviewed the literature based on data from in vitro, in vivo, and clinical trials. A total of 23 clinical trials were identified in this review; most clinical trials were ranked as having uncertain results (level of evidence 2b; n = 16). Although these natural products showed beneficial effects in both in vitro and in vivo studies of potential anti-scarring agents, there was limited clinical evidence to support their efficacy due to the limited quality of the studies, with individual flaws including small sample sizes, poor randomization, and blinding, and short follow-up durations. More robust and well-designed clinical trials with large-scale and prolonged follow-up durations are required to clarify the benefits and risks of these agents. [ABSTRACT FROM AUTHOR]

Scars can cause aesthetic or functional disturbance. Several interventions had been described to improve their appearance. We propose that the combination of some of those treatments can synergize their effects on the scar. We designed a prospective pilot study with ten patients using the patient as their own control to compare different interventions. In each patient, the scar was divided into four parts treated differently: 1. No treatment (control), 2. Fat grafting only, 3. Fat grafting and Hyaluronic Acid (HA), 4. Fat grafting, HA and with a non-fractional laser. Each part of the scar was evaluated by the Patient and Observer Scar Assessment Scale (POSAS). Treatment of the scar with the combination of the three modalities showed better results in the observer scale. In addition, a combination of fat injection, HA, and subsequent skin resurfacing with non-ablative laser showed better outcomes for all parameters on the Observer Scale except vascularity, while on the Patient Scale thickness, relief, pliability, surface area, and overall measurement were better. The combination of all three treatments tends to improve scarring results and appears to be safe and effective. However, further studies with larger samples are needed to explore the potential use of this combined treatment. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion The purpose of this retrospective patient chart review was to analyze the clinical data of 52 patients with benign parotid tumors who underwent modified buried vertical mattress sutures and to assess the postoperative complication rate and patient scarring.A total of 52 patients with benign parotid tumors underwent total parotidectomy and modified buried vertical mattress suture. Variables included general characteristics (age, gender, tumor diameter, and pathologic type), surgical indicators (suture time, wound healing time, operative time, hospital stay, bleeding volume, and drainage volume), complication rates, and Sunnybrook facial neurological function score, visual scar scale (VSS) score and patient and observer scar assessment scale (POSAS) score.Most tumors were less than 3 cm in diameter, with pleomorphic adenomas being the most common. Suture time was 14.83 ± 1.61 min, operative time was 58.90 ± 15.76 min and hospital stay were 5.12 ± 0.96 days. Postoperatively, salivary fistulae developed in one patient, Frey's syndrome in two patients, temporary facial paralysis in six patients and temporary numbness in the incision area in six patients. At 6 months postoperatively, 86.5% of patients had a Sunnybrook score of more than 80, and VSS scores and POSAS scores were between one and two.The postoperative complication rate was 30.8%, and the scarring in the facial incision area was mild and close to normal skin at 3 years postoperatively. [ABSTRACT FROM AUTHOR]

The purpose of dermal substitutes is to mimic the basic properties of the extracellular matrix of human skin. The application of dermal substitutes to the defect reduces the formation of hypertrophic scars and improves the scar quality. This study aims to develop an original dermal substitute enriched with stable fibroblast growth factor 2 (FGF2-STAB®) and test it in an animal model. Dermal substitutes based on collagen/chitosan scaffolds or collagen/chitosan scaffolds with nanofibrous layer were prepared and enriched with FGF2-STAB® at concentrations of 0, 0.1, 1.0, and 10.0 µg ‧ cm-2. The performance of these dermal substitutes was tested in vivo on artificially formed skin defects in female swine. The outcomes were evaluated using cutometry at 3 and 6 months. In addition, visual appearance was assessed based on photos of the scars at 1-month, 3-month and 6-month follow-ups using Yeong scale and Visual Analog Scale. The dermal substitute was fully integrated into all defects and all wounds healed successfully. FGF2-STAB®-enriched matrices yielded better results in cutometry compared to scaffolds without FGF2. Visual evaluation at 1, 3, and 6 months follow-ups detected no significant differences among groups. The FGF2-STAB® effectiveness in improving the elasticity of scar tissues was confirmed in the swine model. This effect was independently observed in the scaffolds with nanofibres as well as in the scaffolds without nanofibres. The formation of scars with the best elasticity was exhibited by addition 1.0 µg ‧ cm-2of FGF2-STAB® into the scaffolds, although it had no significant effect on visual appearance at longer follow-ups. This study creates the basis for further translational studies of the developed product and its progression into the clinical phase of the research. • The purpose of dermal substitutes is to mimic the basic properties of the extracellular matrix of human skin. • Dermal substitutes based on collagen/chitosan scaffolds. • Collagen-based scaffolds represent great potential for tissue engineering applications, where they serve as carriers for newly formed cells. • Fibroblast growth factor 2 plays an important role during regeneration and reparation of a variety of tissues. • FGF2-STAB® is a 9-point mutant of human FGF2 exhibiting enhanced resistance to elevated temperature and an extended half-life of up to 20 days at 37 °C. [ABSTRACT FROM AUTHOR]

Burns to the face and neck are a source of considerable distress and a challenge to manage with dressings. Further, these often superficial injuries pose a risk of scarring and altered pigmentation. Silicone gels have emerged as a potential solution to the challenges of conservative management for face and neck burn injuries. The aims of this study were to explore the effect of topical silicone compared to routine treatment of conservatively managed burns to the face and neck. This single-blind, randomised, controlled trial compared topical silicone film-forming dressing to standard of care for superficial partial thickness burns to the face and neck. Time to healing was the primary outcome and secondary outcomes included: 1) scar assessments (modified Vancouver Scar Scale, Dermalab Combo and Patient and Observer Scar Assessment Scale) at six weeks and three months; and 2) pain intensity scale at wound review appointments. Of the 55 participants in the face/neck study, 34 were male and 21 were female. Median age was 36 years (range from 25 to 47 years). The median time to healing for the silicone group was 9 days (CI 7.6 −10.4) and the control group was 7 days (CI 5.3- 8.7), p = 0.056. Analysis demonstrated significantly reduced pigmentation at six weeks in mVSS scores for the silicone group (Md = 0, IQR = 0) compared to the control group (Md = 0, IQR = 0 – 3), p = 0.043. We found no evidence of differences in reported pain between the groups (Silicone - Md = 1.15, IQR 0.3 – 4.5 vs control group - Md = 1.5, IQR 0.6 – 3.8, z = −0.63, p = 0.53). No other differences were observed, and no adverse events were associated with the topical silicone in the study whereas an infection and a reaction were experienced in the control group. Film-forming silicone gel had comparable effects to standard of care emollient on wound healing of superficial partial thickness burns of the face and neck. Silicone treated wounds were associated with a significant improvement in scar pigmentation outcome at six weeks post-burn. • Topical silicone gel was comparable to emollient for facial wound healing. • Silicone gel was associated with improved early scar pigmentation outcomes. • No adverse effects were reported with the use of topical silicone gel. [ABSTRACT FROM AUTHOR]

Scar contracture bands after burns are frequent problems that cause discomfort and physical limitation. This study investigates the efficacy of a minimally invasive contracture band release technique (MICBR) inspired by closed platysmotomy. Patients with burn scars treated with MICBR in our center were included retrospectively. Our routine scar and contracture treatments (non-invasive and invasive) were utilized prior to undergoing MICBR. Range of motion (ROM) and Vancouver Scar Scale was measured before and after the procedure when feasible. Forty-five patients were included, with 97 total contracture sites treated all over the body. An average of 1.6 sites were treated per patient, with a maximum of six. Patients age was 6–68 years; total burn surface area ranged from 0.5% to 85%. 24% were performed under local anesthesia. 84% were in originally skin grafted areas. We found significant improvements in ROM and VSS. 84% of patients surveyed were "satisfied" or "very satisfied". 95% reported improved mobility. No significant adverse events occurred. This MICBR technique is a versatile, safe, and well-tolerated adjunct procedure that can help patients regain mobility after a burn injury. • Burn injuries can cause scar contractures that have severe functional consequences. • Minimally invasive contracture release can be performed on patients of any age or burn surface area. • This contracture release is safe and can be performed under local anesthesia. • Patients undergoing this contracture release had significant range-of-motion increases. • 95% of patients reported improved mobility. [ABSTRACT FROM AUTHOR]

Background: Acne is the most common skin disorder which is known as a chronic inflammatory disease with psychological burden and reduced quality of life. Objective: The objective of this study is to determine, in a real-world effectiveness and clinical experience in treating acne scars which includes evaluating reduction in depth, diameter, erythema and pigmentation, with an acne scar gel, and to evaluate the effect of the product on quality of life. Methods: Overall, 435 patients were assessed for 90 days. The acne scars were counted and classified as mild, moderate or severe and the type of acne scar was registered. The study participants had gone through both oral and topical treatment for a time range of 1 week to over a month depending on the severity of the scars. They had also gone through medical procedures as per the requirement. The results were assessed at an interval of 30 days to 90 days and were graded between 1-5. Results: Overall facial appearance of atrophic acne scars improved after treatment with acne scar gel. Clinical experience with acne scar gel (in terms of reduction of scar depth, diameter, erythema, and pigmentation), and subject satisfaction (happiness and confidence) score along with the sensation and perception of the skin improved in most subjects. Conclusions: Acne scar gel was effective and safe for treatment of moderate-to-severe acne scars. The acne scar gel can be used as topical treatment for acne scars, thereby reducing the need of procedural treatment for acne scars. [ABSTRACT FROM AUTHOR]

Objective: We investigated motivation levels across the general Brazilian population and subgroups and their willingness to spend for surgery without a cervical scar. Methods: This random‐sample survey was performed by a specialized third‐party research institute. In this study, we created a hypothetical thyroidectomy scenario, and the transcervical and transoral endoscopic thyroidectomy vestibular approach (TOETVA) were used. The survey included sociocultural data and questions regarding participants' surgical preferences. Results: Data were obtained from 1250 participants; 42.4% were of the opinion that a cervical scar affects social or professional life. Young and childless women were most likely to be affected (p <0.001). All respondents accepted the transoral approach to avoid cervical scarring. However, 30.7% and 31.9% of respondents maintained their preference for TOETVA despite understanding the risks of a hypothetical increase in complications and unfavorable oncological outcomes and 98.6% were of the opinion that this approach was likely associated with greater postoperative pain. Only 16.2% were unwilling to spend for TOETVA. The variable that most affected patients' willingness to spend was a salary greater than 10 Brazilian minimum wages (odds ratio 9.797, 95% confidence interval, p <0.005). Upper class respondents were 10 times more likely to spend for TOETVA than lower class patients. Conclusion: This study highlights patients' interest in TOETVA. Cervical scar perception is affected by concerned about appearance, particularly in certain societal subgroups. Our study population showed significant motivation to undergo TOETVA, which was emphasized by their acceptance of the complication rate, poor postoperative outcomes, greater postoperative pain, and willingness to spend on surgery with an invisible scar. Level of Evidence: 4 Laryngoscope, 134:3862–3867, 2024 [ABSTRACT FROM AUTHOR]

Controversy remains regarding the optimal technique and suture type for wound closure after carpal tunnel surgery. Adult patients undergoing open carpal tunnel release were prospectively randomized to receive either interrupted, buried Monocryl sutures or traditional nylon horizontal mattress sutures for their wound closures. At the 2-week and 6-week postoperative visits, Patient and Observer Scar Assessment Scale questionnaires were completed. At 2 weeks, patients and observers had a significantly better opinion of incisions closed with Monocryl. By 6 weeks, neither patients nor observers found a difference between suture types in any category. Scars of wounds closed with Monocryl did not change appreciably in appearance between 2 and 6 weeks. However, patients and observers noted significant improvement in scar appearance in the nylon group over time. Monocryl suture represents an effective method for carpal tunnel closure that leads to improved patient- and observer-reported outcome scores in the early postoperative period compared with nylon.Level of evidence: II.

Xiangan Gong,1,2 Qian Zhao,1,2 Huimin Zhang,1,2 Rui Liu,1,2 Jie Wu,1,2 Nanxin Zhang,3 Yuanxian Zou,1,2 Wen Zhao,1,2 Ran Huo,1,2,4 Rongtao Cui1– 4 1Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China; 2Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, People’s Republic of China; 3School of Clinical Medicine, Shandong Second Medical University, Weifang, People’s Republic of China; 4Department of Burn and Plastic Surgery, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, People’s Republic of ChinaCorrespondence: Rongtao Cui, Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, People’s Republic of China, Tel +86 18653170822, Email cuirt1986@outlook.comAbstract: Pathological scarring results from aberrant cutaneous wound healing due to the overactivation of biological behaviors of human skin fibroblasts, characterized by local inordinate inflammation, excessive extracellular matrix and collagen deposition. Yet, its underlying pathogenesis opinions vary, which could be caused by increased local mechanical tension, enhanced and continuous inflammation, gene mutation, as well as cellular metabolic disorder, etc. Metabolic reprogramming is the process by which the metabolic pattern of cells undergoes a systematic adjustment and transformation to adapt to the changes of the external environment and meet the needs of their growth and differentiation. Therefore, the abnormality of metabolic reprogramming in cells within wounds and scars attaches great importance to scar formation. Mesenchymal stem cells-derived exosomes (MSC-Exo) are the extracellular vesicles that play an important role in tissue repair, cancer treatment as well as immune and metabolic regulation. However, there is not a systematic work to detail the relevant studies. Herein, we gave a comprehensive summary of the existing research on three main metabolisms, including glycometabolism, lipid metabolism and amino acid metabolism, and MSC-Exo regulating metabolic reprogramming in wound healing and scar formation for further research reference.Keywords: mesenchymal stem cells-derived exosomes, metabolic reprogramming, scar, wound healing, fibroblast

Abstract Background Despite the popularity and usage of tattoos in modern society, various complications can occur such as allergic tattoo reactions, infections, tattoo removal complications and chronic granulomatous inflammatory tattoo reactions such as sarcoidosis. Histopathology of skin biopsies in tattoos is crucial in the diagnostic process of complications. As tattoos are frequently obtained for cosmetic reasons, cosmetic consequences of a skin biopsy in a tattoo are important. Remarkably, no studies have been performed regarding the consequences and expected outcome of taking a punch biopsy of tattooed skin. Objectives The objective of this study is to report on the possible complications and patient‐reported cosmetic outcomes after punch biopsies in tattooed skin. Specifically, this study aims to assess the impact on appearance, symptoms and psychosocial burden of biopsies in tattooed skin, using the SCAR‐Q. Methods Patients who underwent a punch biopsy of tattooed skin at the Tattoo Clinic in the Alrijne Hospital between 2021 and 2023 were included. To evaluate patient satisfaction of the biopsy scar the SCAR‐Q and a questionnaire regarding the recovery of the punch biopsy was used. Results The final cohort consisted of 50 patients. Across all scales, the median scores on the SCAR‐Q questionnaire were consistent with the maximum score. Patients scored significantly better on the appearance scale when the biopsy was taken longer than 8 months ago. Two‐third of the patients reported no postbiopsy symptoms, with the remainder experiencing itch, pain or redness, which typically resolved within 10 days (88%). Remarkably, 42% of the patients reported the biopsy scar was not visible on the skin anymore. Scars on the lower extremities and trunk were significantly more frequently visible, as well as scars among patients aged 40 and above. Conclusions This study demonstrates that the cosmetic and psychological impact of punch biopsies in tattooed skin is minimal and the recovery is fast with minimal symptoms. For this reason, biopsies of tattooed skin should not be avoided in the diagnostic process.

The connection between military trauma and cancer is not sufficiently studied. We present a clinical observation of metastasis of cancer of unknown primary localization into a keloid scar of the neck, which occurred after surgical treatment of a wound due to a previously suffered mine-explosive injury. There are no similar descriptions in the literature. The aim of this article is analysis of a clinical case of adenocarcinoma metastases in keloid scar tissue, which occurred after gunshot wounds to the body. Clinical observation. A young man, a military serviceman, developed a keloid scar after a landmine-explosive wound and primary surgical treatment of a neck wound, in which 2 years after excision, a metastasis of intestinal-type adenocarcinoma was detected (Cytokeratin-20+, Cytokeratin-7-, CDX-2+ and SATB 2+). With the help of clinical, endoscopic and radiological methods (computed tomography and positron emission tomography / computed tomography), the primary tumor and additional metastases in the neck, chest, abdominal cavity and pelvis could not be detected. The article analyzes the possible mechanisms of the rare case of metastasis of adenocarcinoma in the tissue of an uninfected keloid scar and discusses the concept of the formation of a premetastatic niche in the early stages of carcinogenesis of a preclinical tumor. Conclusions. This observation raises new questions for fundamental and translational studies of the process of hematogenous metastasis during the parallel progression of the primary tumor and its metastases.

The pathological mechanism of pathological scar is highly complex, encompassing the abnormalities of diverse cytokines, signaling pathways and regulatory factors. To discover more preferable scar treatment options, a variety of distinct approaches have been utilized clinically. Nevertheless, these treatments possess certain side effects and are inclined to relapse. Presently, pathological scar treatment remains a clinical conundrum, and there is an urgent demand for treatment methods that are safe, less traumatic and have lower recurrence rates. New drug delivery systems, novel therapeutic drugs and therapy strategies can enable drugs to permeate the skin effectively, decrease side effects, enhance drug efficacy and even achieve pain-free self-administration. Currently, novel nanotechnologies such as nanomicroneedles, photodynamics mediated by novel photosensitizers, bioelectrical stimulation and 3D printed dressings have been developed for the effective treatment of pathological scars. Additionally, innovative nanoscale fillers, including nano-fat and engineered exosomes, can serve as novel therapeutic agents for the efficient treatment of pathological scars. The intervention of nanomaterials can enhance drug absorption, stabilize and safeguard the active ingredients of drugs, delay or control drug release and enhance bioavailability. This article reviews these new treatment strategies for scar to explore novel approaches for efficient and safe for keloid treatment. Article highlights The pathological mechanism of pathological scars is highly complex, encompassing abnormalities in various cytokines, signaling pathways and regulatory factors. The treatment of pathological scars remains a challenging clinical issue and there is an urgent demand for methods that are safe, less traumatic and have a low recurrence rate. Nanomicroneedles constitute an emerging therapeutic modality that can be utilized either independently or as a delivery system for directly transporting drugs to the epidermis or dermis. It possesses the merits of being painless, minimally invasive, efficient, safe and convenient. The newly developed photosensitizers can ensure the depth of treatment and prompt PDT response. Particularly, the combination of photosensitizer-mediated PDT and nanozymes boosts the efficacy of PDT. The integration of the self-powered system and the nanocarriers is capable of generating bioelectrical stimulation and achieving synergistic antibacterial and anti-inflammatory effects, thereby significantly expediting wound healing and preventing the formation of scar tissue. By integrating 3D printing technology with nanomaterials, it becomes feasible to acquire a dressing scaffold featuring a complex structure, precise size and the ability to promote wound healing and to achieve personalized wound dressings for facilitating wound healing. The treatment involving nanofat and combined platelet components can inhibit scar formation through influencing the signaling pathway, which constitutes a potential therapeutic strategy for scar treatment as well. Mesenchymal stem cell-derived exosomes and their derivatives suppress ECM deposition in keloids through influencing the TGF-β/Smad and Notch-1 signaling pathways. [ABSTRACT FROM AUTHOR]

The Patient and Observer Scar Assessment Scale (POSAS) is frequently used to assess scar quality after burns. It is important to be aware of the minimal important change (MIC) and the minimal clinically important difference (MCID) to establish if a POSAS score represents a clinically relevant change or difference. The aim of this study is to explore the MIC and MCID of POSAS version 2.0. This prospective study included 127 patients with deep dermal burns that underwent split thickness skin grafting with a mean age of 44 years (range 0 – 87) and total body surface area burned of 10 % (range 0.5 – 55). POSAS data was obtained for one burn scar area at three, six, and 12 months after split skin grafting. At the second and third visits, patients rated the degree of clinical change in scar quality in comparison to the previous visit. At 12 months, they completed the POSAS for a second burn scar area and rated the degree of clinical difference between the two scar areas. Two anchor-based methods were used to determine the MIC and MCID. MIC values of the patient POSAS ranged from − 0.59 to − 0.29 between three and six months and from − 0.75 to − 0.38 between six and 12 months follow-up. Both had a poor discriminatory value. MCID values ranged from − 0.39 and − 0.08, with a better discriminatory value. Results suggest that patients consider minor differences (less than 0.75 on the 1–10 scale) in POSAS scores as clinically important scar quality changes. MCID values can be used to evaluate the effects of burn treatment and perform sample-size calculations. • This study is the first to explore minimal important changes and differences in scar outcome measured by the POSAS. • Results are significant for the evaluation and interpretation of outcomes in the field of burns research. • Patients consider minor differences (less than 0.75 on the 1–10 scale) in POSAS scores as clinically important. [ABSTRACT FROM AUTHOR]

A glance is enough to assign psychological attributes to others. Attractiveness is associated with positive attributes ('beauty‐is‐good' stereotype). Here, we raise the question of a similar but negative bias. Are people with facial anomalies associated with negative personal characteristics? We hypothesized that biases against faces with anomalies arise because of negative stereotypes (less warmth and competence) and forms of dehumanization (animalistic and mechanistic). We enrolled 1493 mTurk participants (N = 1306 after exclusion) to assess 31 traits of photographed people using 60 pairs of photographs of the same person before and after plastic surgery. Half anomalous faces had a scar and the other half had a palsy. To calculate warmth and competence, we conducted a principal components analysis of the 31 attributes. Animalistic dehumanization was assessed by averaging reverse‐scored ratings corresponding to moral sensibility and rationality/logic, and mechanistic dehumanization by averaging across reverse‐scored ratings corresponding to emotional responsiveness and interpersonal warmth. We found that both kinds of anomalous faces were seen as less warm, competent and were dehumanized. Our findings suggest that an 'anomalous‐is‐bad' stereotype generalizes regardless of the aetiology of the anomaly. This effect may be related to a reverse halo effect, that is, the horn effect. [ABSTRACT FROM AUTHOR]

Abstract Unlike adult mammalian wounds, early embryonic mouse skin wounds completely regenerate and heal without scars. Analysis of the underlying molecular mechanism will provide insights into scarless wound healing. Twist2 is an important regulator of hair follicle formation and biological patterning; however, it is unclear whether it plays a role in skin or skin appendage regeneration. Here, we aimed to elucidate Twist2 expression and its role in fetal wound healing. ICR mouse fetuses were surgically wounded on embryonic day 13 (E13), E15, and E17, and Twist2 expression in tissue samples from these fetuses was evaluated via in situ hybridization, immunohistochemistry, and reverse transcription-quantitative polymerase chain reaction. Twist2 expression was upregulated in the dermis of E13 wound margins but downregulated in E15 and E17 wounds. Twist2 knockdown on E13 left visible marks at the wound site, inhibited regeneration, and resulted in defective follicle formation. Twist2-knockdown dermal fibroblasts lacked the ability to undifferentiate. Furthermore, Twist2 hetero knockout mice (Twist + /-) formed visible scars, even on E13, when all skin structures should regenerate. Thus, Twist2 expression correlated with skin texture formation and hair follicle defects in late mouse embryos. These findings may help develop a therapeutic strategy to reduce scarring and promote hair follicle regeneration.

Introduction: Indian senna (Senna alexandrina Mill.) (formerly Cassia angustifolia Vahl.) is an important medicinal plant of the family Fabaceae. The leaves and pods of Indian senna yield sennosides and rhein-based laxative. Adulteration of Indian senna is a serious issue as with most of the medicinal plants used in the Indian systems of traditional medicine. The bulk of dried leaves and pods of morphologically related species, such as Cassia fistula, Senna occidentalis, Senna sophera, and Senna tora, is usually mixed with those of the Indian senna, and the admixture is used in laxative-based formulations. The present investigation is a modest attempt at developing species-specific start codon targeted (SCoT) polymorphism- and CAAT-box-derived polymorphism (CBDP)- based sequence-characterized amplified region (SCAR) markers for the identification and authentication of Indian senna and four adulterant species (C. fistula, S. occidentalis, S. sophera, and S. tora species). Methods: In this study, genomic DNA extracted from 44 accessions of Indian senna and four adulterant species was subjected to SCoT and CBDP PCR. The polymorphic amplicons were identified, eluted, ligated, and transformed into Escherichia coli DH5 a strain. PCR, restriction analysis, and DNA sequencing confirmed the transformed recombinant plasmid clones. Results: Post-sequencing, the sequence of the primary SCoT and CBDP primers was analyzed and extended into the unique signature sequence of the concerned accessions. This resulted in development of one SCoT-44- and two CBDP-25-based SCARs. SCoT-44 SCAR produced a signature amplicon of 287 bp for accession DCA120, and CBDP-25 SCAR yielded signature amplicons of 575 and 345 bp for accessions DCA13 and DCA119, respectively. The developed SCAR markers were validated across 48 samples (44 accessions of Indian senna and 4 adulterant species) and produced distinct amplicons in Indian senna only, while no such amplicon was observed in the other four adulterant species. Discussion: The information generated using these markers have been faithfully converted to single-locus, unequivocal, highly reproducible, and informative sequence-based SCAR markers. These markers will enable discrimination of individual plants on the basis of unique sequence-specific amplicons, which could be used as diagnostic markers to settle issues pertaining to the true identity of Indian senna. [ABSTRACT FROM AUTHOR]

Background: Scarring at the incision site represents one of the most impactful outcomes in breast augmentation surgery for both the patient and the surgeon. Few studies exist with the aim of assessing patient perception of scarring outcomes in primary breast augmentation. The aim of this study was to evaluate the impact on quality of life of scars by submitting the SCAR-Q in patients who underwent primary augmentation mammoplasty. Methods: The SCAR-Q was administered at one and at 6 months after surgery to 54 consecutive patients underwent primary breast augmentation with inferior hemi-periareolar or inframammary incision. A total of 50 patients were divided into two groups of 21 patients with inferior hemi-periareolar incision and 29 patients with inframammary fold incision, respectively. Statistical analysis was performed with Prism 9. Results: All mean values of the three SCAR-Q scales tend to decrease at the second administration meaning that the perception of the scar is better at time 6 from the patient perspective. In the "Psychosocial scale," lower values at both 1 month and 6 months for group 2 compared to group 1 were shown. Unpaired T tests with Welch's correction showed significance for delta values variations between the two groups with P values <0.0001. Conclusion: Data show that patients undergoing primary breast augmentation have a scar that has no significant impact. Patients with inframammary fold scar have less psychosocial impact than those with inferior hemi-periareolar scar. There were no statistically significant differences in scar-related symptoms and scar appearance between scar along the inframammary groove and inferior hemi-periareolar scar. Level of Evidence IV: Case series study. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. [ABSTRACT FROM AUTHOR]

Severe spinal cord injuries (SCI) lead to loss of functional activity of the body below the injury site, affect a person's ability to self-care and have a direct impact on performance. Due to the structural features and functional role of the spinal cord in the body, the consequences of SCI cannot be completely overcome at the expense of endogenous regenerative potential and, developing over time, lead to severe complications years after injury. Thus, the primary task of this type of injury treatment is to create artificial conditions for the regenerative growth of damaged nerve fibers through the area of the SCI. Solving this problem is possible using tissue neuroengineering involving the technology of replacing the natural tissue environment with synthetic matrices (for example, hydrogels) in combination with stem cells, in particular, neural/progenitor stem cells (NSPCs). This approach can provide maximum stimulation and support for the regenerative growth of axons of damaged neurons and their myelination. In this review, we consider the currently available options for improving the condition after SCI (use of NSC transplantation or/and replacement of the damaged area of the SCI with a matrix, specifically a hydrogel). We emphasise the expediency and effectiveness of the hydrogel matrix + NSCs complex system used for the reconstruction of spinal cord tissue after injury. Since such a complex approach (a combination of tissue engineering and cell therapy), in our opinion, allows not only to creation of conditions for supporting endogenous regeneration or mechanical reconstruction of the spinal cord, but also to strengthen endogenous regeneration, prevent the spread of the inflammatory process, and promote the restoration of lost reflex, motor and sensory functions of the injured area of spinal cord. [ABSTRACT FROM AUTHOR]

Keloid disorder is a morbid and disfiguring benign fibroproliferative disease with a higher incidence in groups with darker skin pigmentation. Predicting keloidogenesis in patients is difficult with treatment primarily aimed at preventing further scar expansion and improving aesthetics without addressing their unknown underlying pathophysiology. We aimed to identify potential genetic predispositions to keloid scarring in the literature. A search was conducted on 21 August 2023, by the first and second authors independently from 1985 to August 2023 using PubMed, MEDLINE, Embase, Web of Science, Scopus and CINAHL. The following MeSH terms were used: ‘Keloid’, ‘Risk’ and ‘Genetic’. Two researchers independently searched for studies based on titles and abstracts and screened filtered articles by reviewing full text. If no agreement could be reached, a third senior author designated whether the article should be included. We used the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses 2020 statement as the basis of our organisation. Human studies with genetic analysis to determine an association of a protein or gene to keloidogenesis were selected for inclusion. Studies in languages other than English, reviews, conference articles, and book chapters were excluded. Fifty studies met inclusion criteria. The human leukocyte antigen (HLA) system was broadly implicated, and the DRB1*15 allele was associated with an increased risk of keloid in three separate ethnic groups. Some HLA Class I alleles were associated with keloid in one population but not in others. Additionally, polymorphisms in the E3 ubiquitin‐protein ligase (NEDD4) signal cascade and vitamin D receptor (VDR) have been implicated in diverse groups. No current genetic test can predict keloid risk. Our review identified candidate predisposing genes, including NEDD4, VDR and components of the HLA system. Further studies in heterogeneous populations are needed to identify reliable screening targets. [ABSTRACT FROM AUTHOR]

Objective To explore the use of shear wave elastography(SWE) and optical coherence tomography angiography (OCTA) to measure and compare the differences in biomechanics and vascular microstructure between incisional hypertrophic scar and normal skin. Methods From September 2022 to December 2023, twenty-five patients with incisional hypertrophic scar after cesarean section and thyroidectomy were collected from the Department of Plastic and Reconstructive Surgery, the First Medical Center of PLA General Hospital. The basic information of the patients was collected. The vancouver scar scale (VSS) and the patient and observer scar assessment scale (POSAS) were used to evaluate the basic situation of the scar, and the objective assessment methods, including SWE and OCTA, were used to quantify the thickness, stiffness, vascular density, vascular diameter, and vascular complexity of scar and its surrounding skin, so as to estimate the differences between scar and its surrounding skin. Results Compared with normal skin, the thickness [(0.212±0.074) cm: (0.116±0.025) cm, P<0.001) and stiffness [(42.032±23.825) kPa:(10.879±3.436) kPa, P<0.001] of incisional hypertrophic scar were significantly increased. For the micro-vascular situation, the vascular density of scar was larger than that of normal skin [(0.394±0.073): (0.339±0.090), P<0.05], and the average and maximum diameter of vessels were significantly increased [(109.303±19.187) μm :(88.288± 12.425) μm, P<0.001; (524.118±120.964) μm:(438.805±70.193) μm, P<0.05], but there was no significant difference in vascular complexity between scar and normal skin [(0.405±0.087):(0.451±0.090), P=0.06]. Conclusion SWE and OCTA can objectively and quantitatively evaluate the incisional hypertrophic scar and its surrounding normal skin. Compared with the normal skin around the incision, the incisional hypertrophic scar is thicker and harder, and the blood vessel diameter is thicker and the blood vessel density is larger. There is no significant difference in the complexity between the both of them. [ABSTRACT FROM AUTHOR]

Objective To observe the efficacy and safety of monopolar radiofrequency in the treatment of immature scarring by promoting the transdermal absorption of cumenex cream ointment. Methods From May 2022 to May 2023, 42 patients were randomly divided into two groups, each with 21 patients. Patients in the control group were topically treated with Centella Triterpenes Cream, while those in the research group were treated with monopolar radiofrequency combined with Centella Triterpenes Cream. Vancouver Scar Scale (VSS) was used to evaluate the scars of the two groups before and after treatment. Then we observe and compare the efficacy, adverse reactions, and so on. Results The VSS score of the research group was (7.67±1.96) before treatment, and decreased to (1.10±0.61) after treatment 12 months. In the control group, the preoperative score was (7.62±2.16), and it decreased to (2.24±1.02) after treatment 12 months. The VSS score of the research group was significantly lower than the control group, and the difference was statistically significant (P<0.05). There were no adverse reactions in both groups. The satisfaction rate of patients was 85.71% in the research group and 66.19% in the control group. Conclusion Unipolar radiofrequency combined with cumeneoside cream ointment is better than simple topical medicine in the treatment of immature scars, and the combined treatment method is safe without obvious side effects, which is worthy of clinical promotion. [ABSTRACT FROM AUTHOR]

We aimed to verify the feasibility of using shear wave elastography (SWE) to quantify knee scars and the elastic modulus of scar tissues. Overall, 16 participants underwent SWE assessments and range-of-motion measurement and completed the Knee Injury and Osteoarthritis Outcome Score. The inter-rater reliability for SWE in the suprapatellar bursa, below the patellar tendon, and in the medial and lateral trochlear groove remained within 0.861–0.907. The SWE values in the four regions increased with increasing knee angle, and significant differences were observed between the values for below the patellar tendon and the suprapatellar bursa at knee flexion angles of 60° and 90°. The SWE values of the medial and lateral trochlear groove at 30°, 60°, and 90° knee flexion were higher on the affected side. A negative correlation was observed between the SWE values for the lateral trochlear groove at 0°, 30°, and 60° and those for below the patellar tendon at 0° and the suprapatellar bursa at 30° with both active and passive knee extension. The suprapatellar bursa value at 60° exhibited a positive correlation with both knee flexion and passive knee flexion, whereas that of the suprapatellar bursa at 90° exhibited a positive correlation with both the range of motion and passive range of motion. SWE is a replicable and effective method for detecting scar strength in the knee joint. [ABSTRACT FROM AUTHOR]

Secondary malignancies are rare but devastating complications of longstanding burn scars. Squamous cell carcinoma is the most common, followed by basal cell carcinoma and melanomas. There are fewer than 50 total reported cases of malignant melanomas arising in burn scars. We report a case of malignant melanoma arising within a longstanding burn scar confirmed by histology, FISH, and PRAME staining to further characterize melanomas arising in burn scars and to illustrate the diagnostic challenges they present. [ABSTRACT FROM AUTHOR]

The columellar incision and dissection which were integral steps in open rhinoplasty play a crucial role in achieving optimal results. However, scarring in the supratip region may pose challenges to skin circulation, potentially leading to complications such as flap loss. This study aims to establish the safety and efficacy of the open rhinoplasty technique as a viable alternative for patients with substantial scars in the supratip region typically addressed using the closed rhinoplasty technique. Patients with scars on the tip or supratip region were operated clinic between February 2010 and March 2023. To mitigate the risk of tip necrosis, a meticulous two-step delay approach was employed. In the initial outpatient procedure, performed under local anesthesia, we opted for a columellar incision. Subsequently, the columellar arteries were identified and cauterized to facilitate the delay procedure. Following a ten-day interval, all patients underwent standard open rhinoplasty. The columellar artery delay procedure proved instrumental in executing successful open rhinoplasty without compromising skin circulation between the scarred supratip and columellar incision line. Our findings suggest that the columellar delay procedure effectively prevents flap loss in open rhinoplasty patients with scars in the supratip and columellar regions. This brief outpatient intervention, lasting approximately ten minutes, provides a reliable method for adopting the open approach in primary rhinoplasty cases, irrespective of prior scarring. Level IV, therapeutic study. [ABSTRACT FROM AUTHOR]

This review aims to assess the efficacy and safety of laser therapy in managing scars resulting from cleft lip and/or palate (CL/P) repair surgeries, as well as to determine the optimal timing for intervention. A systematic search was conducted across four databases using a predefined search strategy. Studies included were randomized controlled trials, non-randomized studies, and case series focusing on laser therapy for CL/P scars. Data extraction and analysis were performed using Revman Software. A total of two randomized controlled trials, four non-randomized studies, and three case series were included in the analysis. The fractional CO2 laser was the most commonly utilized type of laser. Following laser therapy, there was a significant decrease in Vancouver Scar Scale (VSS) scores by 4.05 (95% CI, 2.10–5.99). Meta-analysis revealed that laser treatment groups exhibited a significantly lower mean VSS score (1.3; 95% CI, 0.02–2.67) compared to control groups. Moreover, initiating laser therapy intervention at one month postoperatively resulted in a significantly lower VSS score compared to initiation at three months postoperatively (difference of 1.70; 95% CI, 1.33–2.08). No severe complications were reported. Laser therapy demonstrates effectiveness and safety in improving CL/P scars, with earlier intervention yielding greater benefits. [ABSTRACT FROM AUTHOR]

Research indicates that long noncoding RNAs (lncRNAs) contribute significantly to fibrotic diseases. Although lncRNAs may play a role in hypertrophic scars after burns, its mechanisms remain poorly understood. Using chip technology, we compared the lncRNA expression profiles of burn patients and healthy controls (HCs). Microarray results were examined by quantitative reverse-transcription polymerase chain reaction (RT-PCR) to verify their reliability. The biological functions of differentially expressed mRNAs and the relationships between genes and signaling pathways were investigated by Gene Ontology (GO) and pathway analyses, respectively. In contrast with HCs, it was found that 2738 lncRNAs (1628 upregulated) and 2166 mRNAs (1395 upregulated) were differentially expressed in hypertrophic scars after burn. Results from RT-PCR were consistent with those from microarray. GO and pathway analyses revealed that the differentially expressed mRNAs are mainly associated with processes related to cytokine secretion in the immune system, notch signaling, and MAPK signaling. The lncRNA expression profiles of hypertrophic scars after burn changed significantly compared with HCs. It was believed that the transcripts could be used as potential targets for inhibiting abnormal scar formation in burn patients. ● Chip technology was used to detect the differences in lncRNAs and mRNAs expression. ● The lncRNAs and mRNAs expression profiles of hypertrophic scars after burn differed. ● Processes presented in hypertrophic scars related to immune system、signaling pathway. ● The study may provide ideas for the treatment of hypertrophic scar after burn. [ABSTRACT FROM AUTHOR]

Scarring, a pervasive issue spanning across medical disciplines, lacks a comprehensive terminology for effective communication, patient engagement, and outcome assessment. Existing scar classification systems are constrained by specific pathologies, physician-centric features, and inadequately account for emerging technologies. This study refrains from proposing yet another classification system and instead revisits the foundational language of scar morphology through a theme analysis of primary patient complaints. Data encompassing five years of a high-volume scar practice was analysed. Primary complaints were aggregated into collective descriptors and further organized into theme domains. The resulting hierarchical map of presenting complaints revealed five key domains: Loss of Function, Contour, Texture, Vector, and Colour Presenting complaints were codified into 42 items, which were then categorised into 14 collective descriptor terms. The latter were in turn organised into five overarching themes. Loss of Function, accounting for 10% of primary concerns, signifies reduced function attributed solely to the scar. Contour, encompassing 41% of concerns, pertains to scar height, shape, and depth. Texture, representing 12% of concerns, denotes tactile variations such as hardness, roughness, and moisture. Vector, comprising 13% of concerns, refers to scar tissue tension and associated distortions. Colour, the concern in 24% of cases, encompasses variations in pigmentation, vascularity, and exogenous pigments. Standardized terminology enhances patient care, communication, and research. This study underscores the fundamental question of "what bothers the patient," reviving a patient-centred approach to scar management. By prioritizing themes based on patient complaints, this study innovatively integrates function, aesthetics, and patient experience. In conclusion, this study pioneers a paradigm shift in scar management by presenting a patient-driven theme framework that offers a common language for healthcare professionals and patients. Embracing this language harmonizes scar treatment, fosters innovation, and transforms scars from silent reminders into stories of resilience and healing. [Display omitted] • Scars lack a unified descriptive morphological terminology. Existing classification systems are inconsistent, not patient-focused, and don't account for new technology. • This study proposes a basic scar morphology nomenclature based on patient complaints, rather than creating a new classification system. • Primary complaints from 2520 patients seeking scar treatment were analysed and grouped into themes: Loss of Function (10%), Contour (41%), Texture (12%), Vector (13%), and Color (24%). • The resulting patient-centred terminology addresses the need for standardized scar treatment terminology that bridges communication gaps, supports education, and facilitates research. • The proposed framework adapts to new technologies, guiding treatment decisions and empowering patients and practitioners in the evolving field of scar management. [ABSTRACT FROM AUTHOR]

Simple Summary: The quality of life of patients with facial basal cell carcinoma significantly improves after surgery. Nevertheless, it remains inferior to those without the disease. Facial scarring has been identified as a contributing factor to adverse psychosocial changes. In this study, we explore the aesthetic assessment of facial scars within this specific patient group, aiming to uncover potential correlations between the severity of scars and the quality of life. This study comprises two phases as follows: scale validation and pilot with a sample size of 100 patients. The Lithuanian version of the POSAS 2.0 was established after a thorough psychometric evaluation, surpassing acceptable validity thresholds. The pilot phase findings show a notable improvement in scars during the later stages of postoperative recovery, with the initial identification of specific groups that perceive their scars more negatively. Given the observed correlations between the scar assessment and the quality of life, this study highlights the crucial role of addressing the aesthetic satisfaction of patients with surgically treated basal cell carcinoma. Facial basal cell carcinoma (BCC) surgery enhances the quality of life (QoL) but leaves patients with inferior QoL, presumably caused by scarring, emphasizing the need to understand post-surgery aesthetic satisfaction. This study aimed to validate the Lithuanian version of the Patient and Observer Scar Assessment Scale (POSAS) 2.0 and utilise it to identify scar evaluation differences and correlations among POSAS scores and specific aesthetic facial regions, age, gender, surgery types, and short- and long-term QoL. Employing a prospective longitudinal design, 100 patients with facial scars after surgical BCC removal were enrolled. The validation phase confirmed the translated POSAS 2.0 psychometric properties, while the pilot phase used statistical analyses to compare scores among demographic and clinical groups and evaluate correlations between scar assessment and QoL. The findings indicate that the translated Lithuanian version of POSAS 2.0 exhibits good psychometric properties, revealing insights into aesthetic satisfaction with post-surgical facial scars and their impact on QoL. The Lithuanian version of the POSAS 2.0 was established as a valid instrument for measuring post-surgical linear scars. QoL with scar assessment statistically significantly correlates, 6 months after surgery, with worse scores, particularly notable among women, younger patients, and those with tumours in the cheek region. [ABSTRACT FROM AUTHOR]

Background: Acne vulgaris often results in permanent scars, with atrophic scars being the most common type and posing a significant therapeutic challenge due to their prevalence and impact on patients' quality of life. Various treatment options exist, including the use of poly‐d,l‐lactic acid delivered via different methods. Objective: This study aimed to assess the efficacy and safety of poly‐d,l‐lactic acid delivered via laser‐assisted needle‐free microjet injection for treating atrophic scars. Methods: Five Korean participants with atrophic facial scars were recruited. Poly‐d,l‐lactic acid solution was administered via the Mirajet system in five sessions, with clinical assessments conducted at baseline, before each session, and at 12‐week and 22‐week follow‐ups. Outcome measures included the Global Aesthetic Improvement Scale and patient satisfaction scores. Results: Positive results were observed at the 12‐week and 22‐week follow‐ups, with high patient satisfaction and improvements in atrophic scars and skin texture. Mild discomfort and transient side effects were reported, with no adverse events observed during the follow‐up period. Conclusion: Poly‐d,l‐lactic acid delivered by a laser‐assisted needle‐free microjet injector was judged to be effective for improving atrophic the facial area. Further research, particularly through randomized controlled trials, is needed to validate these findings and assess the longer‐term safety and sustainability of outcomes. [ABSTRACT FROM AUTHOR]

Background Macrostomia is a rare congenital anomaly characterized by enlargement of mouth at oral commissure. It is also known as tessier cleft 7. There are various techniques described for achieving optimal function and aesthetic results. We describe inferiorly based vermillion square flap with z plasty on the skin for correction of macrostomia. Methods A retrospective analysis of 7 patients with macrostomia operated over a period of last 9 year were included in the study. All operations were conducted by senior surgeon. Pre operative and post operative documentation was done by photography. Age at presentation, operative technique and outcome were analyzed. Parameters used for assessing outcome are position of commissure, symmetry, thickness of vermilion, scar result. Results In all the patients repaired with myoplasty and modified lower vermillion square flap, lip commissure was formed with satisfactory shape, position, thickness with no commissure contracture. One patient had hypertrophy scar. Conclusion Inferiorly based vermillion square flap with z plasty method produces satisfactory aesthetic and functional result in all patients. [ABSTRACT FROM AUTHOR]

Introduction: Burn is a skin injury causing hypertrophic scars. Platelet-rich plasma (PRP) represents a therapeutic method used for wound healing. Aim of the Work: To study the possible therapeutic effect of PRP on healing of second-degree skin burn and scar formation. Materials and Methods: This study was done on 70 adult male albino rats, randomly divided into three main groups; I, II & III. Group I included 30 rats that were randomly divided equally into three subgroups; I-A (for blood collection), I-B (control group kept without treatment) and I-C (control group which received a single subcutaneous injection of PRP, then skin specimens were obtained after 1week and 4weeks). Group II included 20 rats in which second-degree burn was induced by heated metal rod then subdivided into 2 equal subgroups; II-A (examined after 1week) and II-B (examined after 4weeks). Group III included 20 rats in which second-degree burn was induced then the rats were immediately treated locally by one subcutaneous injection of 0.4ml of PRP and further subdivided into two equal subgroups; III-A (examined after 1week) and III-B (examined after 4weeks). Skin specimens were examined using light microscopy (H&E, toluidine blue, Mallory's trichrome, anti α SMA and CD34 immunostaining) and electron microscopy. Morphometric study and statistical analysis were done to measure mean epidermal thickness, mean collagen area percentage and mean color intensity of α SMA and CD34 immunoreaction. Results: In comparison to the untreated subgroups II-A and II-B, both treated subgroups III-A and III-B exhibited enhanced healing and accelerated scar maturation respectively that was more prominent after four weeks from PRP injection. Conclusion: PRP is effective in healing and scar maturation of second-degree skin burn. [ABSTRACT FROM AUTHOR]

Patients undergoing stoma reversal may experience surgical site infections and poor scarring. A purse-string closure approach may lower the incidence of surgical site infections due to its inherent ability to drain wound exudates. This study compared the frequency of surgical site infections and the cosmetic outlook of the scar among patients undergoing stoma reversal with linear and purse-string skin closure techniques. Department of Pediatric Surgery, University of Child Health Sciences Lahore with a duration of one year (June 2021 to June 2022). This randomized controlled trial (TCTR20210417001) was conducted with IRB approval. A total of 124 patients undergoing stoma reversal were randomly assigned to two groups (62 in each): Group A received conventional linear skin closure, while Group B received purse-string wound closure. The study evaluated surgical site infection, cosmetic outcome, and length of stay. Both groups had similar age, gender ratio, indication for surgery, and length of stay. The purse-string group had a significantly lower incidence of SSI (38.7 % vs. 14.5 %; p = 0.002) and better scar quality (Manchester scar scale showed 'good' scar quality in 63 % of patients vs. 22.6 % in the linear closure group, p-value <0.0001). The purse-string technique for skin closure resulted in fewer surgical site infections and improved scar appearance. [ABSTRACT FROM AUTHOR]

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