Scar Care after Surgical Treatment in Oncology Patients
Paloma Tejero, Hernán Pinto in Aesthetic Treatments for the Oncology Patient, 2020
Hypertrophic scar formation is a complex problem, causing both aesthetic and physical difficulties. Hypertrophic scars are the result of an abnormal wound healing process where an excessive amount of collagen is deposited within the wound area, causing the scar to become raised above the skin surface. Both normal and pathological scars are the result of deposition of collagen types I and III, although collagen synthesis in hypertrophic scar is two to three times as great as in normotrophic scars [13]. These scars often appear red and shiny and cause pain, itching, and sometimes even restriction of motion when positioned above a joint, thereby causing significant morbidity (Figures 31.10 and 31.11). Hypertrophic scars are caused by a prolonged inflammatory phase and a delayed onset of epithelialization, which interferes with the resolution of granulation tissue, as reflected by the higher amount of myofibroblasts and collagen present in hypertrophic scars. In addition, remodeling is impaired in excessive scar formation, reflected by a higher amount of immature-type collagen [14]. Hypertrophic scars mostly develop within 1–3 months after deep skin injury [13]. They may stay within the boundaries of the original lesion and may spontaneously regress with time [15]. Studies concerning risk factors for hypertrophic scar formation are young age, bacterial colonization, and skin subjected to stretch. Chemotherapy, statins, and smoking seem to play a protective role in hypertrophic scar formation [14].
Tissue injury and repair
C. Simon Herrington in Muir's Textbook of Pathology, 2020
The dermis and subcutaneous tissues are repaired by the formation of small amounts of granulation tissue. From about day 3 angiogenesis occurs at the wound margins. The newly formed capillaries are delicate and lack a basement membrane. They leak protein-rich fluid and neutrophils emigrate from them. Within a few days, however, these structures differentiate into arterioles and venules. Fibroblasts stream from the perivascular connective tissue and begin to proliferate and move into the wound. Collagen and other matrix proteins are produced and these help to unite the cut edges from about day 7. By 3 weeks the total amount of collagen in the wound has reached a maximum. At this stage, the tensile strength is still low, but this increases over a period of months by a further modification to the matrix proteins, including cross-linking between collagen fibrils. From the second week onwards, there is devascularization, a process by which the newly formed blood vessels and proliferated fibroblasts gradually disappear. Some sensory nerves may gradually grow into the scar from about 4 weeks, but specialized nerve endings such as Pacinian corpuscles do not re-form. The end result of healing by first intention is usually a fine pale linear scar that is level with the adjacent surface. Occasionally, the connective tissue component of the healing process is excessive leading to a hypertrophic scar or keloid (Figure 3.18).
Non-Melanoma Skin Cancer
Pat Price, Karol Sikora in Treatment of Cancer, 2020
The tumor and 2–4 mm of adjacent normal tissue are removed by curettage under local anesthesia, and hemostasis is secured by cautery or electrosurgery (electrodesiccation or coagulation).106,110 Typically, two or three treatment cycles are recommended to completely remove the tumor. If the dermis and fatty layer are penetrated, then surgical excision should be performed. The wound is left to heal by secondary intention. Topical antibiotics may reduce infection of the open wound. Most patients develop a white scar or occasionally a hypertrophic scar. The main indication for this treatment is for selective low-risk lesions (small, well-defined primary lesions with non-aggressive histology in non-critical sites) with 5-year cure rates up to 92.3%.109 Recurrence rates are higher for tumors in nasal, paranasal, forehead, and mask areas and for tumors <6 mm on the cheek, forehead, scalp, and neck.111 However, a study using micrographic surgical techniques112 found that residual tumor was left in at least 30% of cases following curettage, which is far higher than the actual recurrence rate. It is possible that debulking of the tumor provokes an immune response that clears the residual tumor.113
MiR-486-5p inhibits the hyperproliferation and production of collagen in hypertrophic scar fibroblasts via IGF1/PI3K/AKT pathway
Published in Journal of Dermatological Treatment, 2021
Hypertrophic scar (HS) is an abnormal repair of cutaneous wounds caused by fibroblastic hyperproliferation and deposition of collagen (1). A recent study revealed that as normal scar usually has increased collagenase activity, lower TGF-β level, and Th1 phenotype macrophages, HS shows increased deposition of collagen, TGF-β expression, Th2 phenotype macrophages, myofibroblasts and PDGF, moreover, HS also has fibrocytes and is more easily to be grafted (2). Among the above features of HS, transition of fibroblasts is one of the crucial events (3). Under normal physiological conditions, fibroblasts play a positive role in wound healing and tissue regeneration (4). Collagens, which are main extracellular matrixes (ECM) components in skin tissue (5), are secreted by fibroblasts to provide physiological support to cells, and also regulate cell movements and proliferation (6,7), thus playing an important role in wound healing. However, under pathological conditions, hyperproliferation of fibroblasts and excessive production collagens by fibroblasts cannot be timely degraded, and thus forms HS (8). Therefore, suppression of hyperactive fibroblasts and collagen production may be two critical aspects of HS treatment. So far, therapeutic strategies for treating HS are limitedly available due to a lack of deep understanding of the molecular mechanisms in HS (9). Therefore, it is necessary to discover new and efficient targets for HS treatment.
Post-circumcision penile skin loss: reporting the outcome of one-stage anterolateral scrotal based flaps in children
Published in Arab Journal of Urology, 2023
Abdelqawey Yousef, Salah Nagla, Mohamed Fathy, Mohamed Negm
This study included 46 patients; their mean age was 4.5 ± 1.5 years. All cases have reported previous circumcision (Table 1). The mean operative time was 139.67 ± 11.52 min (120–160 min). The scrotal drain was left in ten (21.7%) patients. Penile skin coverage with preservation of penoscrotal angle was achieved in all cases (100%). Good results were obtained during patients’ follow-up (Figure 3), but minor self-limited complications occurred in nine (19.56%) cases (Table 2). Partial wound disruption at the neo-penoscrotal angle developed in three (6.5%) cases managed conservatively. Penile edema for more than 2 weeks occurred in three (6.5%) patients and resolved with time in all patients. Two patients presented with hypertrophic scar (one improved after local application of triamcinolone acetonide, and the other needed scar revision). Self-limited scrotal hematoma occurred in one (2.2%) case. We neither reported flap necrosis nor contracture. The mean follows up was 23.33 ± 9.13 (6–40) months. The patient’s satisfaction was assessed using a 0–4 score (Table 3) obtained from the parents at the 6-month visit. The mean patients’ satisfaction score was 3.26 ± 0.68 (1–4). The primary outcome was achieved in 45 (97.8%) out of the 46 cases.
Wound dressings as growth factor delivery platforms for chronic wound healing
Published in Expert Opinion on Drug Delivery, 2021
Ovidio Catanzano, Fabiana Quaglia, Joshua S. Boateng
The wound healing process after skin injury involves a complex cascade of cellular and biochemical events between the different cellular constituents of the skin and its extracellular matrix (ECM). If this normal repair response is interrupted for some reason, two major outcomes can occur: i) an ulcerative skin defect (chronic wound) and ii) an excessive formation of scar (hypertrophic scar or keloid). Despite the enormous impact of chronic wounds and fibrosis on human health, there are currently no effective treatments to counteract these pathological challenges. The cellular and molecular mechanisms that underpin tissue repair and its failure to heal are still poorly understood, and this has affected the development of new treatments. Exogenous therapeutic biological molecules, such as growth factors (GFs), have great potential, however, inherent difficulties in reaching therapeutic concentrations at the wound site and effectively targeting the interconnected and complex signal pathways that drive the wound healing process are major clinical challenges. As the new generation of products, bioactive dressings are made of materials which play an active role in the healing process and can also deliver incorporated GFs represent the new frontier in wound repair.
Related Knowledge Centers
- Collagen
- Cryosurgery
- Keloid
- Transforming Growth Factor Beta
- Dermis
- Skin Condition
- Scar
- Ehlers–Danlos Syndromes
- Silicone Gel Sheeting