Biomedical engineers at Johns Hopkins have developed a new liquid material that in early experiments in rats and humans shows promise in restoring damaged soft tissue relatively safely and durably. The material, a composite of biological and synthetic molecules, is injected under the skin, then “set” using light to form a more solid structure, like using cold to set gelatin in a mold. The researchers say the product one day could be used to reconstruct soldiers’ faces marred by blast injuries.

The researchers created their composite material from hyaluronic acid (HA), a natural component in skin of young people that confers elasticity, and polyethylene glycol (PEG), a synthetic molecule used successfully as surgical glue in operations and known not to cause severe immune reactions.

Jennifer Elisseeff, Ph.D. said the team has especially high hopes for the composite’s use in people with facial deformities, who endure social and psychological trauma. When rebuilding soft tissue, recreating natural shape often requires multiple surgeries and can result in scarring. “Many of the skin fillers available on the market consisting of HA-like materials used for face lifts are only temporarily effective, and are limited in their ability to resculpt entire areas of the face. Our hope is to develop a more effective product for people, like our war veterans, who need extensive facial reconstruction.”

More information from Johns Hopkins.

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An informative article on the subject of post-laser wound care was recently published on Plastic Surgery Practice web site.

The author, Joseph Niamtu III, DMD, FAACS, discusses recent trends in laser treatments and focuses on post-treatment care:

Inducing an intentional and controlled second-degree facial burn removes the entire epithelium and part of the dermis. This is obviously a giant insult to the normally intact integument. Patients who undergo fully ablative, high-fluence, high-density, multipass CO2 laser resurfacing have to understand in the preop period that this treatment will be their hobby for 4 to 6 weeks. I am very blunt with my patients who are considering this type of laser treatment, and I do not sugarcoat the recovery.

Read more of his discussion here.

Stratpharma AG, Swiss based specialty pharmaceutical company has developed Stratamed, the first silicone-based scar management product that may be applied to open wounds and compromised skin after procedures discussed in Dr Niamtu’s article, such as laser skin resurfacing. The new product helps with rapid epithelialization, reduces down-time, and is the only silicone gel treatment that improves the outcome of scarring by up to 78%.

With every wound there are certain individual and environmental factors that influence abnormal scarring (e.g. keloid scars or hypertrophic scars) which make the choice of appropriate scar treatment and scar prevention essential.

Age and Hormonal Influence

Although keloid scars and hypertrophic scars can develop at any age, they tend to develop more readily during and after puberty. Menopause tends to prompt the regression of scarring and pregnancy tends to exacerbate it. Scars from thyroid surgery (thyroidectomy scars) can be problematic due to hormonal changes.

Genetic Factors and Previous History

Abnormal scarring is 15 times more likely to occur in darker-skinned individuals. Keloid scar formation occurs in areas of high melanocyte concentration and is rarely found on the eyelids, genitalia, soles and palms. Individuals with ginger hair and freckles are also at an increased risk of keloid scars. People with a previous personal history of keloid scarring are more likely to scar again in an abnormal fashion and those with a family history are also at an increased risk.

Scar location and surgery technique

Scars over or near muscles that are particularly active often spread or become more visible than the scars formed on less active areas. Skin and wound tension during wound repair is also a contributor to increased scarring.

Wound Infection

Wound infection increases the risk of abnormal scarring.

Type of Skin Injury

A variety of different types of skin injuries can lead to the development of keloid and hypertrophic scarring including surgery, burns and inflammatory skin processes such as acne, psoriasis and chicken pox.

Silicone based products, like Strataderm silicone gel, have been recommended by International clinical recommendations on scar management and have become the standard care for plastic surgeons when it comes to scar treatment and prevention of keloid and hypertrophic scars. Silicone is not only considered first line treatment for scars but it is also recommended for use in conjunction with other scar therapy options, such as corticosteroid injections and pressure garments.

Read more about how to avoid abnormal scars.

The incidence of new scarring per year in the developed world is estimated to be at least 100 million; a large percentage will be affected by abnormal scarring, which can be categorized mainly as hypertrophic scars and keloids. There is also good evidence to suggest that atrophic scars and striae distensae (or stretch marks) are categories of abnormal scarring.

Abnormal Scar Types

Hypertrophic Scars

Hypertrophic Scars are typically raised, red or pink and sometimes itchy but do not exceed the margins of the original wound. Hypertrophic scars usually subside with time. Histologically, hypertrophic scars have flatter type III collagen bundles, with fibers arranged in a wavy pattern, but predominately oriented parallel to the epithelial surface.

Collagen synthesis is 6 times as great as in normal unscarred skin and the ratio of type I to type II collagen is also higher. Hypertrophic scars also have nodular structures of alpha-smooth muscle actin, which expresses myofibroblasts, small vessels and fine collagen fibers.

Keloids

Keloids on the other hand range in consistency from soft and doughy to hard and rubbery. They do not infiltrate into the surrounding normal tissue and continue to evolve over time with no regress phase. Histologically, collagen bundles are not present but instead the collagen type I and type III fibers lie in a haphazardly connected loose sheet randomly orientated to the epithelial surface. In addition, the collagen synthesis is approximately 20 times greater as that in normal unscarred skin and the ratio of type I to type II collagen is also higher. Keloids  also have an overproduction of the growth factors TGF-B and PDGF produced by fibroblast proteins.

In comparison to the above two abnormal histological feature, normal skin contains collagen bundles running parallel to the epithelial surface.

In 2002, an International Advisory Panel on Scar Management published Clinical Recommendations on Scar Management, based on a qualitative overview of 300 published references and expert consensus on best practices. Silicone was recommended as first line therapy for prevention of scarring and first line treatment for the initial management of scarring, in addition to the recommended management modality with adjunct therapies for secondary management.

Sources:

1. Wolfram D et al. Dermatol Surg 2009; 35:171–181

2. Babu M et al. Mol Cell Biol 1989; 9:1642–1650

3. Niessen FB et al. Plast Reconst Surg 1999; 104:1435–1458

4. Haisa M et al. Invest Dermatol 1994; 103:560–563

5. Luo S et al. Plast Reconstr Sugr 2001; 107:87–96

Scientists at Wake Forest Institute for Regenerative Medicine have developed a device based on an inkjet printer that prints skin cells on burns and other wounds.

The device contains a tank holding a mixture of harvested skin cells, stem cells and nutrients and a computerized nozzle which first sprays a layer of fibroblast skin cells and then a layer of protective keratinocyte cells.

In initial tests on wounded lab mice, burns treated with the cell printer healed in two weeks, compared with the usual five weeks skin grafts take to heal. Additionally, the mice with the printed-on skin showed less scarring and more hair regeneration, as the sprayed-on stem cells better incorporated themselves into all the various cell types of the burned flesh.

Successful mouse tests have driven the Wake Forest scientists onward to tests with pigs, whose skin more closely resembles that of humans. After the tests with pigs conclude, the doctors can finally move on to human trials, and eventual FDA approval. Additionally, the Wake Forest team is working with the U.S. Armed Forces Institute of Regenerative Medicine to utilize this technology on the battlefield.

These steps will help you take care of minor wounds and scrapes. A wound that is more than 1/4-inch (6 millimeters) deep or is gaping or jagged edged and has fat or muscle protruding usually requires stitches. Adhesive strips or butterfly tape may hold a minor cut together, but if you can’t easily close the wound, see your doctor as soon as possible. Proper closure within a few hours reduces the risk of infection. For minor wounds, cuts and scrapes a trip to the ER is usually not required but proper care is still essential to avoid infections and other complications:

  1. Stop the bleeding. Minor cuts and scrapes usually stop bleeding on their own. If they don’t, apply gentle pressure with a clean cloth or bandage. Keep the pressure without interruption for 20-30 minutes. (don’t check in between if the bleeding has stopped – this might damage the fresh clot and restart the bleeding). If the bleeding does not stop, seek medical help.
  2. Clean the wound. Rinse the wound with clean water. Soap may irritate the wound so don’t put it on the actual wound. Use clean tweezers to remove dirt or other particles. Thorough cleaning reduces the risk of infection and tetanus. To clean the area around the wound, use soap and a washcloth. Don’t use hydrogen peroxide, iodine or an iodine-containing cleanser.
  3.  Apply an antibiotic. After the wound is clean, apply a thin layer of an antibiotic cream like Neosporin or Polysporin. These product prevent infection so the wound can heal faster.
  4. Cover the wound. Use clean bandages to keep the wound clean and keep harmful bacteria out. Change the dressing at least daily. After the wound has healed enough to make the infection unlikely remove the bandages, the air will speed wound healing.
  5. Tetanus. Doctors recommend you get a tetanus shot every 10 years. If your wound is deep or dirty and your last shot was more than five years ago, your doctor may recommend a tetanus shot booster. Get the booster as soon as possible after the injury.
  6.  Prevent and reduce scarring. After the wound is closed, 2–3 after injury, use a silicone gel like Strataderm to reduce scarring. Silicone reduces redness, flattens and softens the scar, relieves itching.

 

References: Cuts and scrapes: First Aid, Mayo Clinic