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Burn scars are significant consequence of thermal burn injuries, causing cosmetic concerns and potentially leading to symptomatic discomfort or functional limitations; therefore, continuous adoption of novel methods is warranted to improve outcomes. This study aims to assess and compare the effectiveness, safety, and satisfaction of fractional CO2 laser treatment alone versus its combination with oral pentoxifylline at a dosage of 400 mg twice daily for four months in patients with hypertrophic/keloid burn scars. In a assessor and analyst blinded randomized controlled trial, patients with hypertrophic/keloidal thermal burn scars were allocated into two intervention groups. Both groups underwent treatment with a fractional CO2 laser, while one group additionally received oral pentoxifylline at a dosage of 400 mg twice daily for four months. The assessment of scar improvement was performed using the modified Vancouver Scar Scale (mVSS) at baseline and during subsequent follow-up sessions. Significant improvements were noted within both groups, with mVSS scores decreasing from 7.73 to 4.73 in the CO2 laser group and from 7.36 to 3.91 in the combination therapy group ( p  < 0.001 for both). However, the between-group difference in mVSS score reduction was not statistically significant ( p  = 0.39). Confidence intervals for the mean change in mVSS scores from baseline to endpoint were [2.45, 3.10] for the CO2 laser group and [3.15, 3.85] for the combination therapy group. The combination therapy group also showed a more pronounced improvement in pigmentation subscore of mVSS and higher patient satisfaction rates. No adverse effects were reported in either group. Fractional CO2 laser with or without Pentoxifylline appears to be an effective and safe option for the improvement of hypertrophic/keloidal burn scars. Patient satisfaction seems to increase when the laser is combined with oral Pentoxifylline. Nevertheless, further studies involving larger patient cohorts are warranted to draw more robust conclusions. Capsule summary What is known in this topic Burn scars from thermal burn injuries can have significant cosmetic and functional complications. Multiple treatment approaches, such as fractional CO2 laser therapy, have been extensively studied to enhance scar outcomes. However, the investigation of Pentoxifylline, an oral medication, in scar management remains somewhat limited. What this article adds We discovered total mVSS score reduction was indifferent between Pentoxifylline combined with CO2 laser versus laser monotherapy. However the combination treatment elicited more improvements in pigmentation and higher satisfaction rates versus CO2 laser alone. Both treatment regimens were effective, safe, and tolerable.

Various types of lasers and energy-based devices have been used to prevent scar formation following primary surgical wound closure. While picosecond lasers have demonstrated potential in treating hypertrophic scars, limited data exists regarding their role in minimizing surgical scar formation. This study aimed to evaluate the safety and effectiveness of a fractional 1064-nm picosecond laser in reducing scar formation after mammoplasty in Asian patients. Eighteen patients with bilateral mammoplasty scars were enrolled, and treatment commenced within one month after surgery. For each patient, one side was randomly selected to receive four laser treatment sessions at four-week intervals, while the contralateral side served as an untreated control. Scar width and thickness were measured using a calibrated caliper, and additional evaluations were performed using the Antera ® 3D imaging system and the Patient and Observer Scar Assessment Scale (POSAS). Seventeen patients completed the study. Significant reductions in scar width and thickness were observed on the treated side, with average reductions of 75.3% and 84.9%, respectively, six months post-treatment. In contrast, no significant changes were found in the untreated scars. Imaging and subjective assessments further supported the efficacy of the laser treatment. The procedure was well-tolerated, with only mild and transient postinflammatory hyperpigmentation (PIH) reported in 11% of patients. These findings support the fractional 1064-nm picosecond laser as a safe and effective prophylactic option for minimizing postsurgical scarring in Asian patients.

Acne scarring results from a common inflammatory condition present in many people. These scars can have an impact on quality of life by influencing self-esteem and social acceptance. Current acne scarring treatments, such as chemical peels and laser treatments, often have limited success due to their time-consuming nature and the variability of acne scar types. The subcision technique has shown promise for the treatment of rolling acne scars. There are few studies to date that examine the effects of multiple subcision treatments on rolling acne scars. We evaluated whether the use of multiple subcision treatments improved the appearance of rolling acne scars compared to no treatment. Five patients with rolling acne scars on both sides of their face who met inclusion and exclusion criteria were enrolled in the study. One side of the face was randomized to receive treatment, while the contralateral side of the face received no treatment. Subjects underwent five sequential subcision treatments, spaced 4 weeks apart, with two follow-up visits at weeks 20 and 36 from the 1st treatment. Photographs were taken before and after the initial treatment visit and at each subsequent visit. Acne scar appearance was evaluated by the subject, a blinded live rater, and two double-blinded dermatologist raters. Evaluations of treatment outcomes involved overall acne scar appearance on a 5-point scale, acne scar improvement on a percentage scale, a modified quantitative global scarring grading system, and potential treatment side effects. There was a greater decrease in global scarring scores in the multiple subcision side compared to the control side. There was a greater difference in the average acne scar appearance scores between the Week 36 follow-up visit and baseline for the multiple subcision side compared to that of the control side. 50% of patients reported being more satisfied with the treatment side compared to the control side in regard to overall improvement. The study results suggest that multiple subcision treatments may improve the appearance of rolling acne scars compared to no treatment.

Background Cardiovascular magnetic resonance (CMR) imaging has been used to visualise post-ablation atrial scar (PAAS), generally employing a three-dimensional (3D) late gadolinium enhancement (LGE) technique. However the reproducibility of PAAS imaging has not been determined. This cross-over study is the first to investigate the reproducibility of the technique, crucial for both future research design and clinical implementation. Methods Forty subjects undergoing first time ablation for atrial fibrillation (AF) had detailed CMR assessment of PAAS. Following baseline pre-ablation scan, two scans (separated by 48 h) were performed at three months post-ablation. Each scan session included 3D LGE acquisition at 10, 20 and 30 min post administration of gadolinium-based contrast agent (GBCA). Subjects were allocated at second scan post-ablation to identical imaging parameters (‘Repro’, n  = 10), 3 T scanner (‘3 T’, n = 10), half-slice thickness (‘Half-slice’, n = 10) or half GBCA dose (‘Half-gad’, n = 10). PAAS was compared to baseline scar and then reproducibility was assessed for two measures of thresholded scar (% left atrial (LA) occupied by PAAS (%LA PAAS) and Pulmonary Vein Encirclement (PVE)), and then four measures of non-thresholded scar (point-by-point assessment of PAAS, four normalisation methods). Thresholded measures of PAAS were evaluated against procedural outcome (AF recurrence). Results A total of 271 3D acquisitions (out of maximum 280, 96.7%) were acquired. At 20 and 30 min, inter-scan reproducibility was good to excellent (coefficient of variation at 20 min and 30 min: %LA PAAS 0.41 and 0.20; PVE 0.13 and 0.04 respectively for ‘Repro’ group). Changes in imaging parameters, especially reduced GBCA dose, reduced inter-scan reproducibility, but for most measures remained good to excellent (ICC for %LA PAAS 0.454–0.825, PVE 0.618–0.809 at 30 min). For non-thresholded scar, highest reproducibility was observed using blood pool z-score normalisation technique: inter-scan ICC 0.759 (absolute agreement, ‘Repro’ group). There was no significant relationship between indices of PAAS and AF recurrence. Conclusion PAAS imaging is a reproducible finding. Imaging should be performed at least 20 min post-GBCA injection, and a blood pool z-score should be considered for normalisation of signal intensities. The clinical implications of these findings remain to be established in the absence of a simple correlation with arrhythmia outcome. Trial registration United Kingdom National Research Ethics Service 08/H0802/68 – 30th September 2008.

Introduction A symptomatic uterine niche is a long‐term complication after a cesarean section (CS). A group of international niche experts reached consensus on a standardized definition of a disorder caused by a symptomatic niche, named cesarean scar disorder (CSDi). However, the prevalence of this disorder is unclear. The aim of this study was to assess the prevalence of CSDi in patients 3 years after a first CS. Material and Methods A secondary analysis was performed on the 3‐year follow‐up results of the 2Close study. The 2Close study was a multicenter randomized controlled trial that evaluated single‐ versus double‐layer uterine closure at CS in 32 hospitals in the Netherlands and included 2292 patients (registered in Dutch trial register: [NTR5480]). Patients, aged ≥18 years, undergoing a first CS were included. Three months after their CS, transvaginal ultrasonography was performed to evaluate the uterine scar for the presence of a niche. Three years after their CS, a digital questionnaire was sent to evaluate the primary and secondary symptoms of CSDi. For this secondary analysis, patients were excluded if they were pregnant, breastfeeding, or using hormonal contraception. The primary outcome of the study was the prevalence of CSDi. Results Of the 1648 participants who completed the 3‐year questionnaire, patients were excluded due to pregnancy or breastfeeding (n = 305), use of hormonal contraception (n = 509), missing ultrasound evaluations (n = 76), and incomplete responses (n = 88). Of the 670 patients included in this analysis, 543 (81.0%) had a uterine niche visible on ultrasound and 127 (19.0%) were without a niche. The prevalence of CSDi at 3 years following a first CS was 42.5% (285/670). Most reported symptoms were chronic pelvic pain (35.0%), postmenstrual spotting (32.8%), and abnormal vaginal discharge (23.2%). Conclusions Our study found a high prevalence of CSDi 3 years following their first CS. Symptoms were self‐reported and the exclusion criteria of pregnancy, breastfeeding, or hormonal contraception use could have introduced selection bias. Therefore, this percentage could be an overestimation of the actual prevalence. However, this high prevalence should be included in counseling patients with a scheduled CS. Three years following a first caesarean section 42.5% of all patients develop Caesarean Scar Disorder. Most reported symptoms within the Caesarean Scar Disorder are chronic pelvic pain, postmenstrual spotting and abnormal vaginal discharge. The long‐term consequences of a Caesarean Section on patients’ health should be structurally investigated.

BackgroundIn this study, we investigated the effect of matrix metalloproteinase-1 (MMP-1) on wound healing on skin in a model produced in rats.MethodsSixteen Sprague–Dawley male rats were included in the study. The four full-thickness skin wound was created on the dorsal area of each rat with 4.4 mm punch. The rats were randomly divided into two groups. MMP-1 and saline were administered intraperitoneally once daily for 7 days. The biopsies were taken from the separate wounds on the 4th, 7th, 14th and 21st days of the experiment. The lymphocytic response, vascular proliferation, fibroblast proliferation, epithelial hyperplasia, foreign body reaction, ulcer formation, acute inflammation, keloid scar formation and hypertrophic scar formation were compared in each group in histopathologically.ResultsIn our study, epithelial hyperplasia on 14th day was significantly higher in the MMP-1 group compared to the control group (p < 0.05). The lymphocytic response on 4th and 21th days, the vascular proliferation on 4th day, the fibroblast proliferation on 4th and 7th days, the acute inflammation on 4th day and the hypertrophic scar formation on 7th, 14th, 21st days were significantly lower in the MMP-1 group compared to the control group (p < 0.05). No statistically significant difference was found in comparison with other parameters (p > 0.05).ConclusionsMMP-1 improves the wound-healing process of skin with higher epithelial hyperplasia and reduces scar formation in the animal model. Therefore, MMP-1 can potentially be used as an effective anti-fibrogenic agent for preventing or treating the hypertrophic scar.No Level AssignedThis 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.

Scar formation, the most common complication of burns, significantly impacts patients’ quality of life. This study evaluates how the hospital-to-home care transition program reduces scar-related complications and improves health-related quality of life in patients with deep partial-thickness burns. This semi-experimental study involved 80 patients with deep partial-thickness burns, selected through convenience sampling and randomly assigned—by coin flipping—to the intervention group ( n  = 40) or the control group ( n  = 40). We used the Patient and Observer Scar Assessment Scale and the Burn Specific Health Scale-Brief to assess outcomes. The hospital-to-home care transition program was delivered to the intervention group through three face-to-face educational sessions during discharge from the emergency department and clinic visits, along with two telephone counseling and follow-up sessions in the second and third weeks post-discharge. Data collection occurred at three time points: baseline, the third week after emergency department discharge, and the 12th week post-discharge. We analyzed the data using SPSS v.22 with a significance level set at 0.05. The findings showed that time and group each contributed to reducing scars by 5.71 and 8.81 units, respectively, with an interactive effect of 5.22 units ( P  < 0.001). Similarly, time and group individually improved health-related quality of life by 21.68 and 26.74 units, respectively, with an interactive improvement of 24.71 units ( P  < 0.001). The results indicate that the hospital-to-home care transition program helped prevent excessive scar complications and promoted a more favorable scar maturation process, thereby enhancing health-related quality of life in patients with deep partial-thickness burns. Nurses and healthcare planners can apply these findings to improve outcomes for this patient group.

Female patients with thyroid cancer have a greater desire for not only curing the disease but also leaving an inconspicuous scar. Systematic nursing has a comprehensive effect on reducing scar formation. However, comprehensive nursing guidance for postoperative scar management are not usually available for patients with thyroid cancer. This study aimed to compare the comprehensive effect of systematic nursing compared to traditional nursing measures on postoperative scar management in patients with thyroid cancer. One hundred patients who underwent radical thyroidectomy between January 2019 and June 2019 were selected and randomly assigned to two groups. Patients in the experimental group ( n  = 50) received nursing care under systematic nursing guidance, while those in the control group ( n  = 50) received traditional nursing care. In the 3rd, 6th, and 12th months after surgery, all patients returned to the general surgery department for scar evaluation. Scarring was evaluated using the Vancouver Scar Scale (VSS). Patients’ self-evaluated satisfaction scores for scar appearance and nursing guidance were also collected. Compared with the control group, scars in the experimental group were less inconspicuous. At the 6th and 12th months after surgery, the total VSS score in the experimental group was significantly lower than that in the control group ( P  < 0.001). By the 12th month after surgery, patients in the experimental group were more satisfied with the final scar appearance (experimental group: 4.69 ± 0.48; control group: 4.06 ± 0.57; P  < 0.01) and nursing care (experimental group: 4.88 ± 0.34; control group: 4.50 ± 0.52; P  < 0.05). Systematic nursing guidance had positive effects on reducing scar formation and enhancing patient satisfaction.

Keloids and hypertrophic scars are caused by cutaneous injury and irritation, including trauma, insect bite, burn, surgery, vaccination, skin piercing, acne, folliculitis, chicken pox, and herpes zoster infection. Notably, superficial injuries that do not reach the reticular dermis never cause keloidal and hypertrophic scarring. This suggests that these pathological scars are due to injury to this skin layer and the subsequent aberrant wound healing therein. The latter is characterized by continuous and histologically localized inflammation. As a result, the reticular layer of keloids and hypertrophic scars contains inflammatory cells, increased numbers of fibroblasts, newly formed blood vessels, and collagen deposits. Moreover, proinflammatory factors, such as interleukin (IL)-1α, IL-1β, IL-6, and tumor necrosis factor-α are upregulated in keloid tissues, which suggests that, in patients with keloids, proinflammatory genes in the skin are sensitive to trauma. This may promote chronic inflammation, which in turn may cause the invasive growth of keloids. In addition, the upregulation of proinflammatory factors in pathological scars suggests that, rather than being skin tumors, keloids and hypertrophic scars are inflammatory disorders of skin, specifically inflammatory disorders of the reticular dermis. Various external and internal post-wounding stimuli may promote reticular inflammation. The nature of these stimuli most likely shapes the characteristics, quantity, and course of keloids and hypertrophic scars. Specifically, it is likely that the intensity, frequency, and duration of these stimuli determine how quickly the scars appear, the direction and speed of growth, and the intensity of symptoms. These proinflammatory stimuli include a variety of local, systemic, and genetic factors. These observations together suggest that the clinical differences between keloids and hypertrophic scars merely reflect differences in the intensity, frequency, and duration of the inflammation of the reticular dermis. At present, physicians cannot (or at least find it very difficult to) control systemic and genetic risk factors of keloids and hypertrophic scars. However, they can use a number of treatment modalities that all, interestingly, act by reducing inflammation. They include corticosteroid injection/tape/ointment, radiotherapy, cryotherapy, compression therapy, stabilization therapy, 5-fluorouracil (5-FU) therapy, and surgical methods that reduce skin tension.

Background Hypertrophic scars and keloids are human cutaneous fibroproliferative conditions that develop after burns, trauma, surgery, and inflammation. Vitamin D inhibits keloid fibroblast proliferation by reducing TGF‐β‐induced extracellular matrix formation, boosting matrix metalloproteinase activity, and reducing inflammation. Aim To study the effect of intralesional and systemic Vitamin D3 injection on hypertrophic scars and keloids and whether vitamin D3 deficiency increases scarring. Patients and Methods This study included 30 hypertrophic scars and keloid patients divided into groups depending on serum vitamin D levels. Every patient was tested for vitamin D using ELISA. Group I: patients with vitamin D deficiency or insufficiency received a systemic injection of vitamin D (cholecalciferol 200 000 I.U.) once monthly for 3 months with a calcium oral supplement and intralesional vitamin D injections on hypertrophic scars and keloids. Group II: patients with sufficient vitamin D received only intralesional vitamin D injections. Results Vitamin D deficiency did not affect scar formation or severity (total Vancouver scar scale before assessment) with a p value > 0.05. All instances showed a substantial drop in vascularity, pliability, and total Vancouver scale score (p value < 0.05) following intervention, but no change in scar pigmentation or height. Scar assessment following intervention did not significantly differ between research groups (p > 0.05). Conclusion Injection of vitamin on hypertrophic scars and keloids enhances vascularity and pliability in patients with sufficient serum vitamin D levels and those with deficient or insufficient serum vitamin D levels after improving them by systemic injection of vitamin D without any effect on height and pigmentation of scars. Trial Registration NCT06301178