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%.

Dog bites can be complicated with deep punctures and some tissue shredding dependent upon the type of dog.

Minor cuts generally only require a thorough cleaning and bandaging of the wound. However, if infection is suspected, it is important to immediately contact a doctor who can provide the dog bite treatment needed. Signs of infection may include redness, swelling, red streaking, and fever. Seeking proper dog bite treatment is crucial to patient recovery.

Other reasons to seek medical care include: a gaping wound, a wound that does not stop bleeding, open wounds on the face. Some dog bite scars are best treated with scar revision, sometimes tissue expansion, and secondary treatments, e.g. silicone gel like Strataderm.

A recent study showed that 1,000 Americans per day are treated in emergency rooms as a result of dog bites. In 2007 there were 33 fatal dog attacks in the USA. Most of the victims who receive medical attention are children, half of whom are bitten in the face.

A non-superficial burn (e.g. the deep partial thickness and full thickness burns) will always result in a burn scar. The scar’s severity will depend on the wound’s thickness as well as other factors, such as site of the scar, its healing process, age, sex, race of the patient, etc.

Burn scars may lead to three different types of abnormal scarring:  keloid scars, hypertrophic scars, and scar contractures. Keloid scars are an overgrowth of scar tissue with the scar growing beyond the site of the injury. These scars are generally red or pink and will become dark over time. Hypertrophic scars are red, thick and raised, however they differ from keloid scars in that they do not develop beyond the site of the injury or incision. A contracture scar is a permanent tightening of the skin that may affect the underlying muscles and tendons, limit mobility and possibly lead to damage or degeneration of the nerves.

To prevent abnormal scar tissue International Clinical Recommendations on Scar Management recommend treatment of widespread burn scars with a first-line therapy of silicone gel sheeting and pressure garments.

Widespread Hypertrophic Burn Scar:

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.

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