Creating a curvilinear scar

A technique is presented by which predictable curvilinear scars can be produced by using asymmetrical lenticular excisions. This is particularly useful for the excision of skin tumors of the cheeks and lateral to the commissures of the lips. It must be remembered not to compromise the surgical resection margins in order to achieve the optimal aesthetic result.     

A simplified model of scar contraction

The healing of wounds is a complex process and the contraction of the resulting scar can have a negative impact on the neighbouring skin. A finite element model of skin simulating the contraction of a scar and deformation of the surrounding skin is presented. The skin is represented by an orthotropic–viscoelastic constitutive law, which is validated against experimental data in the literature. A simplified experimental model of a contracting scar in real skin is also developed. The pattern and size of the wrinkles formed around the contracting scar in the finite element model compare favourably with those formed in the experimental model. The orthotropic nature of skin plays a significant role in the behaviour of skin around scars—the wrinkles have a preferential orientation that corresponds to a direction perpendicular to the Langer's lines in the skin. The pre-stress in skin (a property that is ignored in many skin models) is shown to be an important factor in wrinkle formation around scars. The proposed model can be used to analyse the suturing and closure of wounds of various shapes.     

The molecular mechanism of hypertrophic scar

Hypertrophic scar (HTS) is a dermal form of fibroproliferative disorder which often develops after thermal or traumatic injury to the deep regions of the skin and is characterized by excessive deposition and alterations in morphology of collagen and other extracellular matrix (ECM) proteins. HTS are cosmetically disfiguring and can cause functional problems that often recur despite surgical attempts to remove or improve the scars. In this review, the roles of various fibrotic and anti-fibrotic molecules are discussed in order to improve our understanding of the molecular mechanism of the pathogenesis of HTS. These molecules include growth factors, cytokines, ECM molecules, and proteolytic enzymes. By exploring the mechanisms of this form of dermal fibrosis, we seek to provide some insight into this form of dermal fibrosis that may allow clinicians to improve treatment and prevention in the future.     

The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation

At present, various scar assessment scales are available, but not one has been shown to be reliable, consistent, feasible, and valid at the same time. Furthermore, the existing scar assessment scales appear to attach little weight to the opinion of the patient. The newly developed Patient and Observer Scar Assessment Scale consists of two numeric scales: the Patient Scar Assessment Scale (patient scale) and the Observer Scar Assessment Scale (observer scale). The patient and observer scales have to be completed by the patient and the observer, respectively. The patient scale's consistency and the observer scale's consistency, reliability, and feasibility were tested. For the Vancouver Scar Scale, which is the most frequently used scar assessment scale at present, the same statistical measurements were examined and the results of the observer scale and the Vancouver scale were compared. The concurrent validity of the observer scale was tested with a correlation to the Vancouver scale. Furthermore, the authors examined which specific characteristics significantly influence the general opinion of the patient and the observers on the scar areas. Four independent observers have each used the observer scale and the Vancouver scale to assess 49 burn scar areas of 3 x 3 cm belonging to 20 different patients. Subsequently, the patients completed the patient scale for their scar areas. The (internal) consistency of both the patient and the observer scales was acceptable (Cronbach's alpha, 0.76 and 0.69, respectively), whereas the consistency of the Vancouver scale appeared not to be acceptable (alpha, 0.49). The reliability of the observer scale completed by a single observer was acceptable (r = 0.73). The reliability of the Vancouver scale completed by a single observer was lower (r = 0.69). The observer scale showed better agreement than the Vancouver scale because the coefficient of variation was lower (18 percent and 22 percent, respectively). The concurrent validity of the observer scale in relation to the Vancouver scale is high (r = 0.89, p < 0.001). Linear regression of the general opinions on scars of the observer and the patient showed that the observer's opinion is influenced by vascularization, thickness, pigmentation, and relief, whereas the patient's opinion is mainly influenced by itching and the thickness of the scar. Such an impact of itching and thickness of the scar on the patient's opinion is an important and novel finding. The Patient and Observer Scar Assessment Scale offers a suitable, reliable, and complete scar evaluation tool.     

Unsatisfactory forehead scar following face lift

The W-plasty scar revision technique has been found to be effective in the repair of the difficult and cosmetically unsatisfactory hairline scar following the ill-advised face lift technique that excises forehead skin.     

Elastin fibers in scar tissue.

Scar tissue, obtained from humans, was stained for elastin fibers by a new staining method. Elastin fibers were noted at sites where they must have been formed de novo. The morphology and the distribution of elastin in various types of scars are described. Practically no elastin was found in keloids.     

International clinical recommendations on scar management

Many techniques for management of hypertrophic scars and keloids have been proven through extensive use, but few have been supported by prospective studies with adequate control groups. Several new therapies showed good results in small-scale trials, but these have not been repeated in larger trials with long-term follow-up. This article reports a qualitative overview of the available clinical literature by an international panel of experts using standard methods of appraisal. The article provides evidence-based recommendations on prevention and treatment of abnormal scarring and, where studies are insufficient, consensus on best practice. The recommendations focus on the management of hypertrophic scars and keloids, and are internationally applicable in a range of clinical situations. These recommendations support a move to a more evidence-based approach in scar management. This approach highlights a primary role for silicone gel sheeting and intralesional corticosteroids in the management of a wide variety of abnormal scars. The authors concluded that these are the only treatments for which sufficient evidence exists to make evidence-based recommendations. A number of other therapies that are in common use have achieved acceptance by the authors as standard practice. However, it is highly desirable that many standard practices and new emerging therapies undergo large-scale studies with long-term follow-up before being recommended conclusively as alternative therapies for scar management.     

Breast reduction with short L scar

I didactically compared the breast as a glandular cone with an envelope of skin and subcutaneous tissue. The aesthetic alterations of the breast are classified in four groups related to form, to volume, to grams, and to ptosis in centimeters. An imaginary plane that passes by the mammary sulcus (plane A) will determine the area of the breast that is ptotic. The projection of this plane in the anterior part of the breast is called point A. The distance between point A and the nipple will give in centimeters the amount of ptosis. I use this distance to draw geometrically in the breast the amount of excess of skin to be removed to correct the ptosis. In group I, the volume is normal and part of the mammary gland is under plane A. In this type of breast, the skin is resected, and since there is no excess of breast tissue, the breast that is under plane A is used as an inferior pedicle flap to give a better volume to the new breast. In group II, the base of the breast is large, the height is normal, and the volume is increased by the enlargement of the base. In this type of breast, the excess of breast under plane A and a wedge under the nipple are resected to reach the normal volume at the end of the surgery. In group III, the base is normal and the volume of the breast is increased by the height. For treatment, I resect the excess of breast under plane A as well as a segment at the base to reduce its height. In group IV, the volume of the breast is increased by the size of the base and the height of the cone, and I treat by resection of the excess of tissue under the ptotic area, a wedge under the areola, and a transversal segment in the base to reduce all the dimensions. In the final result of this technique in the majority of patients I will obtain a short scar. This technique was used in 1083 patients from January of 1979 to May of 1988.     

Cleft lip scar camouflage using dermal micrografts

The use of dermal micrografts to camouflage cleft lip scars is a simple and effective method. We have used dermal micrografts, some hairbearing, to camouflage hypopigmented scars in 10 patients. This method improves the color of the scar, corrects wound distortion and direction to a certain degree, and enables the resultant scar to blend into the adjacent tissue more naturally. Unlike with other methods of scar revision, additional tissue is not sacrificed and new incision lines are not created.