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Sample records for burn scar contracture

  1. Initial Release of Severe Post-Burn Contracture Scar of the Neck for Intubation Under Ketamine

    PubMed Central

    Al-Zacko, S.M.; Al-Kazzaz, D.A.

    2009-01-01

    Summary Background. Severe anterior post-burn contracture (PBC) of the neck poses the anaesthesiologist some difficult problems and results in difficult intubation when extension of the atlanto-occipital joint is impaired. Such patients must therefore have the PBC scar released before other procedures are performed, in order to ensure airway control. Objectives. To show our experience with quick surgical neck release of patients with severe anterior PBC of the neck to facilitate direct laryngoscopy and orotracheal intubation (OTI). Material and methods. A prospective study of patients with severe anterior PBC of the neck was carried out from January 2003 to December 2007 in the Burns Unit of Mosul Teaching Hospital in Mosul, Iraq. The patients were given ketamine, after which a release incision was made over the anterior PBC of the neck scar. OTI was then performed successfully. Results. Twelve patients with severe neck PBC (3 males, 9 females; age range, 7-37 yr; mean age, 20 yr) all had successful OTI after PBC release under intravenous ketamine. None showed any complications attributed to the anaesthesia. PMID:21991181

  2. The post-burn elbow medial flexion scar contracture treatment with trapeze-flap plasty.

    PubMed

    Grishkevich, Viktor M

    2009-03-01

    A medial flexion elbow contracture is characterized by the presence of a fold which has a semi-lunar shape, the sheets of which are scars. The shortage in skin length and the excess in width occurs in the sheets. To estimate the size and form of length deficiency in the fold is the section from the top of the fold to the rotation axis of the joint. As a rule, the wound receives a trapeze form. To convert the sheets of the fold into trapeze-shaped flaps, several radial cross-sections from the tops of the fold to joint rotation axis are used. The flaps are mobilized with the full fat layer, and then transposed toward one another causing tension, therefore, covering the wound on the flexion surface of the joint. Flaps and the adjacent skin, displaced forward from lateral and back surfaces of the joint, participate in wound coverage. Trapezoid flaps have a wide end, stable blood circulation; they do not undergo rotation, therefore, do not undergo necrosis. Contractures are eliminated in full without relapse. As a rule, in all 35 patients the functional outcome was perfect. PMID:18848399

  3. [Burn scars: rehabilitation and skin care].

    PubMed

    Rochet, Jean-Michel; Zaoui, Affif

    2002-12-15

    Burn rehabilitation main goal is to minimize the consequences of hypertrophic scars and concomitant contractures. The treatment principles rely on the association of joint posture, continuous pressure completed with range of motion to prevent joint fusion (which happens to adults but not to children). Throughout the different treatment phases and wound evolution, reassessment is necessary to review rehabilitation goals and activities. During the acute phase the alternance of positioning is prioritized in order to keep the affected extremities in antideformity position using splint or other devices. At the rehabilitation phase, treatment is focussed on active/passive range of motion (skin posture) strengthening exercises and use of dynamic splint is introduced to correct contractures. After their discharge home, patients benefit from outpatient rehab until scar maturation (approximately 18 months). The treatment consists mainly on active/passive range of motion, scar massage, strengthening exercise and endurance retraining. Also modalities (such as thermal bath and high pressure water spray) are used to address itching problems and for scar softening. Finally, reconstructive surgery can be performed to correct excessive scarring or joint contracture for better functional or cosmetic outcome. PMID:12621946

  4. Post Burn Contracture Neck: Clinical Profile and Management

    PubMed Central

    Bankar, Sanket S.; Patil, Avinash

    2014-01-01

    Background: Morbidity related to hypertrophic scars and contractures which are well known sequel after burns remains high and in fact has increased as more severely burned patients are surviving. This study was undertaken in order to assess the varied clinical presentation, precipitating factors, preventive measures, treatment modalities of neck contractures and evaluate the results after surgical procedures. Materials and Methods: This hospital based study was conducted on patients admitted in our institution with proven cases of Post burn neck contracture from 1st August 2009 to 31st July 2011. Twenty two patients of post burn neck contracture who underwent operative treatment were included. Observation: 10 of 22 cases were in the middle age group i.e. between 21-30 years. There were 5 males and 17 females. Accidental flame burn was the commonest aetiology. Fourteen patients were treated within 1 year of burns for functional disability. Excisional release was performed in 13 and incisional release in 9 of our patients. Resurfacing with STSG (split thickness skin graft) was carried out in 19 cases and a local or regional flap with or without a graft in 3 patients. Hypertrophy and recontracture were the commonest late complications and occurred in 3 cases. Good to fair results were obtained in 19 patients Conclusion: Local flaps have many advantages and are to be used whenever possible. It is preferable to place the grafts if used in the area surrounding the neck (donor site of flap) or at least in the non-visible area of the neck (submental area). When a combination of flap & graft is used, it’s preferable to place the flap in a horizontal intersecting fashion in between the two patches of the graft. A follow up program for reasonable period is highly desired. PMID:25478392

  5. Burn Scar Neoplasm

    PubMed Central

    Kadir, A.R.

    2007-01-01

    Summary Marjolin's ulcer is a rare and aggressive cutaneous malignancy that occurs in previously traumatized and chronically inflamed skin, especially after burns. The majority of burn scar carcinomas are seen after a lag period in burns that were not grafted following injury. Between 2000 and 2006, 48 patients with Marjolin's ulcer were treated in our centre (Sulaimani Teaching Hospital and Emergency Hospital). All the lesions were secondary to burns from various causes. The medical records of these 48 patients were reviewed prospectively. The mean age at tumour diagnosis was 40 yr and the ratio of male to female was 2:1 (67% males and 33% female). Upon histological examination, all the cases were diagnosed as well-differentiated squamous cell carcinoma. The scalp was most frequently affected (16 patients = 33.3%), followed by the lower limb (14 patients = 29.1%). Treatment of the neoplasm consisted of excision and grafting in 36 patients (75.0%), excision and reconstruction with flaps in eight patients (16.6%), and amputation in three patients (6.2%). A chemotherapy combination of the above treatments was used in two patients (4.1%). Local recurrence was noted in 16 patients (33.3%) out of the 48, and all died from these recurrences. PMID:21991095

  6. Burns, hypertrophic scar and galactorrhea

    PubMed Central

    Karimi, Hamid; Nourizad, Samad; Momeni, Mahnoush; Rahbar, Hosein; Momeni, Mazdak; Farhadi, Khosro

    2013-01-01

    Abstract: An 18-year old woman was admitted to Motahari Burn Center suffering from 30% burns. Treatment modalities were carried out for the patient and she was discharged after 20 days. Three to four months later she developed hypertrophic scar on her chest and upper limbs. At the same time she developed galactorrhea in both breasts and had a disturbed menstrual cycle four months post-burn. On investigation, we found hyperprolactinemia and no other reasons for the high level of prolactin were detected. She received treatment for both the hypertrophic scar and the severe itching she was experiencing. After seven months, her prolactin level had decreased but had not returned to the normal level. It seems that refractory hypertrophic scar is related to the high level of prolactin in burns patients. PMID:23456048

  7. Burns, hypertrophic scar and galactorrhea.

    PubMed

    Karimi, Hamid; Nourizad, Samad; Momeni, Mahnoush; Rahbar, Hosein; Momeni, Mazdak; Farhadi, Khosro

    2013-07-01

    An 18-year-old woman was admitted to Motahari Burn Center suffering from 30% burns. Treatment modalities were carried out for the patient and she was discharged after 20 days. Three to four months later she developed hypertrophic scar on her chest and upper limbs. At the same time she developed galactorrhea in both breasts and had a disturbed menstrual cycle four months post-burn. On investigation, we found hyperprolactinemia and no other reasons for the high level of prolactin were detected.She received treatment for both the hypertrophic scar and the severe itching she was experiencing. After seven months, her prolactin level had decreased but had not returned to the normal level. It seems that refractory hypertrophic scar is related to the high level of prolactin in burns patients. PMID:23456048

  8. Treatment of scars with flexion contracture using carbon dioxide laser and fractional photothermolysis.

    PubMed

    Cho, Sung Bin; Lee, Sang Ju; Kang, Jin Moon; Kim, Young Koo; Kim, Dong Hyun

    2010-07-01

    Scars with flexion contracture of various origins are challenging problems which may cause not only cosmetic concerns, but also severe functional restriction. In this report, we describe a case presenting scars with flexion contracture: a 23-year-old Korean female with surgical scars on both axillae, which were treated by laser-cision (incision using carbon dioxide laser) with second intention wound healing followed by a non-ablative fractional photothermolysis system. PMID:19598038

  9. Ablative fractional resurfacing for the treatment of traumatic scars and contractures.

    PubMed

    Uebelhoer, Nathan S; Ross, E Victor; Shumaker, Peter R

    2012-06-01

    After a decade of military conflict, thousands of wounded warriors have suffered debilitating and cosmetically disfiguring scars and scar contractures. Clearly, there is a need for effective scar treatment regimens to assist in the functional and cosmetic rehabilitation of these patients. Traditional treatments, including aggressive physical and occupational therapy and dedicated wound care, are essential. Adjunctive treatments with established laser technologies, such as vascular lasers and full-field ablative lasers, have had a somewhat limited role in scar contractures due to modest efficacy and/or an unacceptable side effect profile in compromised skin. Refractory scar contractures often require surgical revision, which can be effective, but is associated with additional surgical morbidity and a significant risk of recurrence. Furthermore, current scar treatment paradigms often dictate scar maturation for approximately a year to allow for spontaneous improvement before surgical intervention. Since 2009, the Dermatology Clinic at the Naval Medical Center San Diego has been treating scars and scar contractures in wounded warriors and others using ablative fractionated laser technology. Although traditionally associated with the rejuvenation of aged and photo-damaged skin, our clinical experience and a handful of early reports indicate that laser ablative fractional resurfacing demonstrates promising efficacy and an excellent side effect profile when applied to the functional and cosmetic enhancement of traumatic scars and contractures. This article discusses our clinical experience with ablative fractional resurfacing and its potential prominent role in rehabilitation from traumatic injuries, including a possible shift in scar treatment paradigms toward earlier procedural intervention. Potential benefits include the optimization of scar trajectory and higher levels of full or adapted function in a more favorable time course. PMID:22640431

  10. Airway management in patients with burn contractures of the neck.

    PubMed

    Prakash, Smita; Mullick, Parul

    2015-12-01

    Airway management of patients with burn contracture of the neck (PBC neck) is a challenge to the anesthesiologist. Patient evaluation includes history, physical and airway examination. A safe approach in the airway management of a patient with moderate to severe PBC neck is to secure the airway with the patient awake. The anesthesiologist should have a pre-planned strategy for intubation of the difficult airway. The choices advocated for airway management of such patients include awake fiberoptic-guided intubation, use of intubating laryngeal mask airway, intubation without neuromuscular blocking agents, intubation with neuromuscular blocking agents after testing the ability to ventilate by mask, pre-induction neck scar release under local anesthesia and ketamine or sedation followed by direct laryngoscopy and intubation and video-laryngoscope guided intubation, amongst others. Preparation of the patient includes an explanation of the proposed procedure, sedation, administration of antisialogogues and regional anesthesia of the airway. The various options for intubation of patients with PBC neck, intraoperative concerns and safe extubation are described. Back-up plans, airway rescue strategies and a review of literature on this subject are presented. PMID:25868969

  11. Management of neck contractures by single-stage dermal substitutes and skin grafting in extensive burn patients

    PubMed Central

    Seo, Dong-Kook; Kym, Dohern

    2014-01-01

    Purpose Severe neck contracture is a problem that must be resolved by priority. We consider the best contracture treatment to be the full-thickness skin graft. However, clinicians often encounter patients, especially extensive burn patients, who have insufficient donor sites for the full-thickness skin graft. We treated extensive burn patients with neck scar contractures with a split-thickness skin graft (STSG) combined with dermal substitutes. The purpose of this study was to evaluate clinical outcomes of neck contracture treatment in extensive burn patients performing STSG with dermal substitutes as adjuvant treatment. Methods We analyzed the retrospective clinical and photographic records of 28 patients with severe neck contracture who were admitted to Hallym University Hangang Sacred Heart Hospital, Seoul, Korea, from January 2012 to December 2012. We performed STSG in combination with dermal substitutes to minimize the degree of contracture. Results The overall take rate of skin to dermal substitutes was 95.9%, and no grafts failed to affect recontracture except in one patient with a partial loss of artificial dermis who underwent a follow-up skin graft without any problems. Excellent/good outcomes were shown in 27 out of 28 patients. Conclusion In extensive burn patients, skin grafting in combination with dermal substitutes can be an alternative to STSG alone for contracture release. PMID:25368851

  12. [Evaluation of Cepan Cream after 15 years of treatment of burn scars].

    PubMed

    Stozkowska, Wiesława

    2002-01-01

    Cepan Cream is used for the topical treatment of scars and keloids resulting from burns, post-operative scars, and contractures. Cepan Cream makes scars more elastic, softer and paler. Plant extracts, heparin and allantoin in Cepan act on the biochemical processes in the developing connective tissue, preventing the formation of hyperplastic scars. These active ingredients enhance swelling, softening and loosening of connective tissue. It exerts softening and smoothing action on indurated and hyperplastic scar tissue, improving collagen structure. It promotes tissue regeneration and reduces exuberant granulation. Cepan is well tolerated. PMID:12731382

  13. Postburn contractures of the hand.

    PubMed

    Fufa, Duretti T; Chuang, Shiow-Shuh; Yang, Jui-Yung

    2014-09-01

    Several functionally limiting sequelae can follow deep thermal injury to the hand. Despite appropriate initial management, contractures are common. Whereas acute burn care is often managed by multidisciplinary, specialized burn units, postburn contractures may be referred to hand surgeons, who should be familiar with the patterns of burn contracture and nonsurgical and operative options to improve function and expected outcomes. The most common and functionally limiting sequelae are contractures of the webspace, hand, and digits. Webspace contractures and postburn syndactyly are managed with scar excision and local soft tissue rearrangement or skin grafting. The burn claw hand presents as extension contracture of the metacarpophalangeal joints and flexion contractures of the proximal interphalangeal joints. The mainstays of management of these contractures include complete surgical excision of scar tissue and resurfacing of the resultant soft tissue defect, most commonly with full-thickness skin grafts. If scar contracture release results in major exposure of the tendons or joints, distant tissue transfer may be required. Early motion and rehabilitative modalities are essential to prevent initial contracture formation and recontracture after surgical release. PMID:25154575

  14. Outcome after burns: an observational study on burn scar maturation and predictors for severe scarring.

    PubMed

    van der Wal, Martijn B A; Vloemans, Jos F P M; Tuinebreijer, Wim E; van de Ven, Peter; van Unen, Ella; van Zuijlen, Paul P M; Middelkoop, Esther

    2012-01-01

    Long-term outcome of burn scars as well as the relation with clinically relevant parameters has not been studied quantitatively. Therefore, we conducted a detailed analysis on the clinical changes of burn scars in a longitudinal setup. In addition, we focused on the differences in scar quality in relation to the depth, etiology of the burn wound and age of the patient. Burn scars of 474 patients were subjected to a scar assessment protocol 3, 6, and 12 months postburn. Three different age groups were defined (≤5, 5-18, and ≥18 years). The observer part of the patient and observer scar assessment scale revealed a significant (p < 0.001) improvement in scar quality at 12 months compared with the 3- and 6-month data. Predictors for severe scarring are depth of the wound (p < 0.001) and total body surface area burned (p < 0.001). Etiology (p = 0.753) and age (p > 0.230) have no significant influence on scar quality when corrected for sex, total body surface area burned, time, and age or etiology, respectively. PMID:22985039

  15. An idiosyncratic history of burn scars.

    PubMed

    Petro, Jane A

    2015-03-01

    The history of burn scars can best be found in military medical history. The care of wounded soldiers documented in the Illiad reflected the trauma of the weapons of war, arrow, spear, sword, and ax. The introduction of gunpowder in the 14th century, increasingly sophisticated explosives, and in modern times, petroleum-driven vehicles, including airplanes, created a new subset of wounds requiring attention and post-survival scars challenging the quality of survival. This article selects from among a myriad of examples of modern military treatments as they relate to those survivors. Larrey, with Napolean's Grand Army, Sir Harold Gilles during and following World War I, and the Boston area preparation and response to the Cocoanut Grove Fire in 1942 are the principle topics examined. Recent modern interventions, related to the survival of horrific blast and burn injuries, with modern wound care and scar manipulation techniques provide context to the current ability to modify healing and scars. PMID:25922950

  16. A novel immune competent murine hypertrophic scar contracture model: a tool to elucidate disease mechanism and develop new therapies.

    PubMed

    Ibrahim, Mohamed Magdy; Bond, Jennifer; Bergeron, Andrew; Miller, Kyle J; Ehanire, Tosan; Quiles, Carlos; Lorden, Elizabeth R; Medina, Manuel A; Fisher, Mark; Klitzman, Bruce; Selim, M Angelica; Leong, Kam W; Levinson, Howard

    2014-01-01

    Hypertrophic scar (HSc) contraction following burn injury causes contractures. Contractures are painful and disfiguring. Current therapies are marginally effective. To study pathogenesis and develop new therapies, a murine model is needed. We have created a validated immune-competent murine HSc model. A third-degree burn was created on dorsum of C57BL/6 mice. Three days postburn, tissue was excised and grafted with ear skin. Graft contraction was analyzed and tissue harvested on different time points. Outcomes were compared with human condition to validate the model. To confirm graft survival, green fluorescent protein (GFP) mice were used, and histologic analysis was performed to differentiate between ear and back skin. Role of panniculus carnosus in contraction was analyzed. Cellularity was assessed with 4',6-diamidino-2-phenylindole. Collagen maturation was assessed with Picro-sirius red. Mast cells were stained with Toluidine blue. Macrophages were detected with F4/80 immune. Vascularity was assessed with CD31 immune. RNA for contractile proteins was detected by quantitative real-time polymerase chain reaction (qRT-PCR). Elastic moduli of skin and scar tissue were analyzed using a microstrain analyzer. Grafts contracted to ∼45% of their original size by day 14 and maintained their size. Grafting of GFP mouse skin onto wild-type mice, and analysis of dermal thickness and hair follicle density, confirmed graft survival. Interestingly, hair follicles disappeared after grafting and regenerated in ear skin configuration by day 30. Radiological analysis revealed that panniculus carnosus doesn't contribute to contraction. Microscopic analyses showed that grafts show increase in cellularity. Granulation tissue formed after day 3. Collagen analysis revealed increases in collagen maturation over time. CD31 stain revealed increased vascularity. Macrophages and mast cells were increased. qRT-PCR showed up-regulation of transforming growth factor beta, alpha smooth muscle actin, and rho-associated protein kinase 2 in HSc. Tensile testing revealed that human skin and scar tissues are tougher than mouse skin and scar tissues. PMID:25327261

  17. Use of preputial skin for coverage of post-burn contractures of fingers in children

    PubMed Central

    Zaroo, Mohammed I.; Sheikh, Bashir A.; Wani, Adil H.; Darzi, Mohammad A.; Mir, Mohsin; Dar, Hameedullah; Baba Peerzada, U. F.; Zargar, Haroon R.

    2011-01-01

    Objective: Hand burns are common injuries. Children frequently sustain burn injuries, especially to their hands. Contractures are a common sequel of severe burns around joints. The prepuce, or foreskin, has been used as a skin graft for a number of indications. We conducted this study to evaluate the feasibility of utilising the preputial skin for the management of post-burn contractures of fingers in uncircumcised male children. Materials and Methods: Preputial skin was used for the coverage of released contractures of fingers in 12 patients aged 2-6 years. The aetiology of burns was “Kangri” burn in eight patients and scalding in four patients. Six patients had contracture in two fingers, four patients in one finger, and two patients had contractures in three fingers. Results: None of the patients had graft loss, and all the wounds healed within 2 weeks. All patients had complete release of contractures without any recurrence. Hyperpigmentation of the grafts was observed over a period of time, which was well accepted by the parents. Conclusions: Preputial skin can be used successfully for male children with mild-to-moderate contractures of 2-3 fingers for restoration of the hand function, minimal donor site morbidity. PMID:21713163

  18. Burn Scar Near the Hanford Nuclear Reservation

    NASA Technical Reports Server (NTRS)

    2002-01-01

    This Multi-angle Imaging Spectroradiometer (MISR) image pair shows 'before and after' views of the area around the Hanford Nuclear Reservation near Richland, Washington. On June 27, 2000, a fire in the dry sagebrush was sparked by an automobile crash. The flames were fanned by hot summer winds. By the day after the accident, about 100,000 acres had burned, and the fire's spread forced the closure of highways and loss of homes. These images were obtained by MISR's vertical-viewing (nadir) camera. Compare the area just above and to the right of the line of cumulus clouds in the May 15 image with the same area imaged on August 3. The darkened burn scar measures approximately 35 kilometers across. The Columbia River is seen wending its way around Hanford. Image courtesy NASA/GSFC/JPL, MISR Science Team

  19. The Use of CO2 Fractional Photothermolysis for the Treatment of Burn Scars.

    PubMed

    Levi, Benjamin; Ibrahim, Amir; Mathews, Katie; Wojcik, Brandon; Gomez, Jason; Fagan, Shawn; Austen, William Gerald; Goverman, Jeremy

    2016-01-01

    A recent advancement in the treatment of burn scars has been the use of the carbon dioxide (CO2) laser to perform fractional photothermolysis. In this analysis, we describe our results and patient-reported outcomes with the use of fractional CO2 laser for the treatment of burn-related scarring. We performed a retrospective study of all patients who underwent CO2 laser procedures for treatment of symptomatic burn scars and skin grafts at one accredited regional burn center. Burn injury and laser treatment demographics, as well as complications, are reported. A questionnaire was administered to all patients and included patient-reported outcome measures aimed at understanding the patient experience and their subjective response to treatment. A total of 387 CO2 laser procedures were performed on 131 patients for the treatment of symptomatic burn scars and skin grafts between October 1, 2011, and May 1, 2014 (average, 2.95 procedures/patient; range, 1-11). Average time between injury and first laser was 597.35 days (range, 60-13,475). Average time between laser treatments (when multiple) was 117.73 days (range, 22-514). There were no infections requiring treatment with oral antibiotics. Overall patient satisfaction with laser therapy was 96.7%. Patients reported reductions in neuropathic pain, tightness (contracture), and pruritus (54.0, 50.6, and 49.0%, respectively). Fractional photothermolysis utilizing the CO2 laser is a safe and effective modality for the treatment of symptomatic burn scars, donor sites, and skin grafts. Patient satisfaction with this procedure is high, and complications are low. Significant improvements in scar appearance, pliability, tightness, neuropathic pain, and pruritus were commonly reported. PMID:26536539

  20. Biology and principles of scar management and burn reconstruction.

    PubMed

    Tredget, Edward E; Levi, Benjamin; Donelan, Matthias B

    2014-08-01

    Hypertrophic scarring is extremely common and is the source of most morbidity related to burns. The biology of hypertrophic healing is complex and poorly understood. Multiple host and injury factors contribute, but protracted healing of partial thickness injury is a common theme. Hypertrophic scarring and heterotopic ossification may share some basic causes involving marrow-derived cells. Several traditional clinical interventions exist to modify hypertrophic scar. All have limited efficacy. Laser interventions for scar modification show promise, but as yet do not provide a definitive solution. Their efficacy is only seen when used as part of a multimodality scar management program. PMID:25085089

  1. The menace of post-burn contractures: a developing country’s perspective

    PubMed Central

    Saaiq, M.; Zaib, S.; Ahmad, S.

    2012-01-01

    Summary A study was carried out regarding 213 patients of either gender and all ages who presented with post-burn contractures. The commonest site of contracture was the neck. 92 patients (43.19%) had received their initial burn injury management in general surgery units in tertiary care hospitals compared to 43 patients (20.18%) in district headquarter hospitals. Only 26 patients (12.20%) were managed in plastic surgery/burn wards, and 52 patients (24.41%) received no regular treatment from any hospital. The majority of patients (n=197) had a history of conservative management, with only 16 patients (7.51%) having a split thickness skin graft for part of their initial burns. None of the patients had the appropriate anti-deformity splintage in the affected parts or any physiotherapy during the acute phase of their burns. PMID:23466805

  2. Free thin anterolateral thigh flap for post-burn neck contractures - a functional and aesthetic solution

    PubMed Central

    Sarkar, A.; Raghavendra, S.; Jeelani Naiyer, M.G.; Bhattacharya, D.; Dutta, G.; Bain, J.; Asha, J.

    2014-01-01

    Summary Neck contractures after burn injuries produce restrictions in motion and unacceptable aesthetic outcomes. Although different methods of reconstruction have been used in the treatment of this ailment, a limited and unsatisfactory outcome often results. Free thin anterolateral flaps have been found to be a good single stage option for reconstruction of post-burn contractures of the neck. In our study, 11 patients with post flame burn contractures of the neck underwent surgical release and coverage by a free thin anterolateral thigh flap. Patients were followed up for an average of five years and various aspects of functional and aesthetic rehabilitation were assessed. Our findings revealed that the free thin anterolateral flaps covered the defects over anterior and lateral aspects of the neck with good colour match and contour. Furthermore, none of the flaps had any significant early or delayed complications. Two cases had to be reoperated for partial loss of flaps and all patients were satisfied with functional and aesthetic outcomes. We therefore consider free thin anterolateral thigh flaps to provide a good single stage reconstruction for post-burn cervical contractures with good functional and aesthetic outcomes. PMID:26336369

  3. Free thin anterolateral thigh flap for post-burn neck contractures - a functional and aesthetic solution.

    PubMed

    Sarkar, A; Raghavendra, S; Jeelani Naiyer, M G; Bhattacharya, D; Dutta, G; Bain, J; Asha, J

    2014-12-31

    Neck contractures after burn injuries produce restrictions in motion and unacceptable aesthetic outcomes. Although different methods of reconstruction have been used in the treatment of this ailment, a limited and unsatisfactory outcome often results. Free thin anterolateral flaps have been found to be a good single stage option for reconstruction of post-burn contractures of the neck. In our study, 11 patients with post flame burn contractures of the neck underwent surgical release and coverage by a free thin anterolateral thigh flap. Patients were followed up for an average of five years and various aspects of functional and aesthetic rehabilitation were assessed. Our findings revealed that the free thin anterolateral flaps covered the defects over anterior and lateral aspects of the neck with good colour match and contour. Furthermore, none of the flaps had any significant early or delayed complications. Two cases had to be reoperated for partial loss of flaps and all patients were satisfied with functional and aesthetic outcomes. We therefore consider free thin anterolateral thigh flaps to provide a good single stage reconstruction for post-burn cervical contractures with good functional and aesthetic outcomes. PMID:26336369

  4. Drought and Burn Scars in Southeastern Australia

    NASA Technical Reports Server (NTRS)

    2003-01-01

    More than 2 million acres were consumed by hundreds of fires between December 2002 and February 2003 in southeastern Australia's national parks, forests, foothills and city suburbs. These images were acquired on February 14, 2002 (left) and February 17, 2003 (right) by the Multi-angle Imaging SpectroRadiometer (MISR) instrument onboard NASA's Terra satellite. The year 2002 was one of Australia's hottest and driest on record, and the acreage burnt during the summer 2002-2003 fire season in Victoria, the Australian Capital Territory and southern New South Wales, is the largest since 1938-1939, when more than 3 million acres were scorched.

    The extent of the burnt area and the dry conditions as of February 2003 are indicated by these contrasting false-color views. Both image panels display data from the near-infrared, red and blue spectral bands of MISR's downward-viewing (nadir) camera, as red, green and blue, respectively. This display technique causes healthy vegetation to appear red and burnt areas to show as dark brown. The data displayed from the two dates were processed identically to preserve relative brightness variations. Vegetation changes related to the dry conditions (not related to the brown burn scars) are also indicated in the February 2003 panel, where many previously red areas exhibit instead the pale yellow-brown of the underlying soils and geology. Significant reduction in the surface area of several large and important water bodies are also apparent. The diminished extent of Lake Hume (along the left-hand edge) in the later date provides a good example.

    The Multi-angle Imaging SpectroRadiometer observes the daylit Earth continuously and every 9 days views the entire globe between 82 degrees north and 82 degrees south latitude. These data products were generated from a portion of the imagery acquired during Terra orbits 14999 and 16858. The panels cover an area of about 208 kilometers x 286 kilometers, and utilize data from blocks 118 to 121 within World Reference System-2 path 91.

    MISR was built and is managed by NASA's Jet Propulsion Laboratory,Pasadena, CA, for NASA's Office of Earth Science, Washington, DC. The Terra satellite is managed by NASA's Goddard Space Flight Center, Greenbelt, MD. JPL is a division of the California Institute of Technology.

  5. Postburn Neck Lateral Contracture Anatomy and Treatment: A New Approach.

    PubMed

    Grishkevich, Viktor M; Grishkevich, Max

    2015-01-01

    Lateral contracture of the neck is a rare and insufficiently researched burn consequent. Contracture restricts head motion, can cause a secondary face deformity, presents severe cosmetic defects, and, therefore, requires surgical reconstruction. Literature does not sufficiently address the issue; therefore, anatomy not researched and treatment techniques not developed. The anatomy of postburn lateral cervical flexion contracture was studied in 21 operated patients. Using obtained data, new approaches were investigated, which were directed toward maximal efficacy of the local tissues use. Follow-up results were observed from 6 months to 9 years. Lateral cervical contractures were divided into two types based on their anatomy: edge and medial. Edge contractures were caused by burns and scars located on the posterior neck surface and were characterized by the presence of the fold in central lateral zone. In the fold, only one (posterior) sheet is scars that cause the contracture. Medial contractures were caused by scars located on the lateral cervical surface and were characterized by the presence of the fold in which both sheets were scars. In both types, contracture was caused by scar sheet surface deficiency in length, which has a trapezoid form (contracture cause). In all cases, there was surface surplus in the fold's sheets allowed contracture release with local tissue. The technique that allows the maximum local tissue use and ensures full contracture elimination is the trapeze-flap plasty. Two anatomic types of lateral cervical scar contractures were identified: edge and medial. An anatomically justified efficacy reconstructive technique for both types is trapeze-flap plasty. PMID:25501780

  6. Long-Term Followup of Dermal Substitution with Acellular Dermal Implant in Burns and Postburn Scar Corrections

    PubMed Central

    Juhasz, I.; Kiss, B.; Lukacs, L.; Erdei, I.; Peter, Z.; Remenyik, E.

    2010-01-01

    Full-thickness burn and other types of deep skin loss will result in scar formation. For at least partial replacement of the lost dermal layer, there are several options to use biotechnologically derived extracellular matrix components or tissue scaffolds of cadaver skin origin. In a survey, we have collected data on 18 pts who have previously received acellular dermal implant Alloderm. The age of these patients at the injury varied between 16 months and 84 years. The average area of the implants was 185 cm2. Among those, 15 implant sites of 14 patients were assessed at an average of 50 months after surgery. The scar function was assessed by using the modified Vancouver Scar Scale. We have found that the overall scar quality and function was significantly better over the implanted areas than over the surrounding skin. Also these areas received a better score for scar height and pliability. Our findings suggest that acellular dermal implants are especially useful tools in the treatment of full-thickness burns as well as postburn scar contractures. PMID:21234359

  7. Remote sensing and hydrological modeling of burn scars

    NASA Astrophysics Data System (ADS)

    Miller, Mary Ellen

    This study examined the potential usefulness of combining remote sensing data with hydrologic models and mapping tools available from Geographic Information Systems (GIS), to evaluate the effects of wildfire. Four subprojects addressed this issue: (1) validation of burn scar maps derived from the Advanced Very High Resolution Radiometer (AVHRR) with the National Fire Occurrence Database; (2) testing the potential of thermal MODIS (Moderate Resolution Imaging Spectroradiometer) data for near-real time burn scar and fire severity mapping; (3) evaluation of Landsat derived burn severity maps within WEPP through the Geo-spatial interface for the Water Erosion Prediction Project (GeoWEPP), and (4) predicting potential post-fire erosion for western U.S. forests utilizing existing datasets and models. Wildfire poses incredibly complex management problems in all of its stages. Today's land managers have the option of trying to mitigate the effects of a severe fire before it occurs by fuel management practices. This process is expensive especially considering the uncertainty of when and where the next fire in a given region will occur. When a wildfire does occur, deciding when to let it burn and when to suppress it may lead to controversial decisions. In addition to the threat to life and property from the fire itself, smoke emissions from large fires can cause air quality problems in distant airsheds. Even after the fire is extinguished, erosion and water quality problems may pose difficult management questions. Contributions stemming from these studies include improved burn scar maps for studying historical fire extent and demonstration of the feasibility of using thermal satellite data to predict burn scar extent when clouds and smoke obscure visible bands. The incorporation of Landsat derived burn severity maps was shown to improve post-fire erosion modeling results. Finally the potential post-fire burn severity and erosion risk maps generated for western US forests will be used for planning pre-fire fuel reduction treatments.

  8. Fat grafting for treatment of burns, burn scars, and other difficult wounds.

    PubMed

    Piccolo, Nelson Sarto; Piccolo, Mônica Sarto; Piccolo, Maria Thereza Sarto

    2015-04-01

    This article presents the authors' 3-year experience with the use of fat grafting, via the Coleman technique, for the adjuvant treatment of burn wounds, venous ulcers, diabetic ulcers, and burn scars. It demonstrates the regenerative effects of fat injected under the scar, and of fat injected under the wound, in the periphery of the wound, and within a bone fracture line or space, and of fat deposited over the wound. PMID:25827568

  9. Photoletter to the editor: Calcinosis cutis in a burn scar.

    PubMed

    Rosmaninho, Aristóteles; Carvalho, Sandrina; Lobo, Inês

    2015-12-31

    Calcinosis cutis is a rare condition characterized by the deposition of insoluble calcium salts in the skin and subcutaneous tissue. Dystrophic calcinosis cutis appears as a result of local tissue damage or abnormalities, such as alterations in extra-cellular matrix proteins or subcutaneous tissue with normal calcium and phosphate serum levels. It has been rarely described as a late complication of burns. Latency periods of 15-54 years have been reported. We describe the case of a 57-year-old man with dystrophic calcinosis cutis in a burn scar, which developed 42 years after the skin injury. The condition was successfully treated with surgical excision. PMID:26848324

  10. Marjolin's ulcers in the post-burned lesions and scars.

    PubMed

    Saaiq, Muhammad; Ashraf, Bushra

    2014-10-16

    Marjolin's ulcer (MU) represents malignant degeneration that typically ensues over a period of time in the post-burned lesions and scars or any other chronic wound. This review highlights various facets of the presentation and management of MUs that originate from post-burned lesions. The incidence of MUs in such lesions is reported to be 0.77%-2%. This malignancy characteristically develops in the areas of full thickness skin burns that had been allowed for weeks to months to heal spontaneously by secondary intention, or burn wounds which never healed completely over years and the unstable post-burned scars. In the majority of cases, the MU is a squamous cell carcinoma (SCC). The MUs contribute to an overall 2% of all SCCs and 0.03% of all basal cell carcinomas of the skin. Clinically MUs present in two major morphologic forms. The commoner form is the flat, indurated, ulcerative variety while the less common form is the exophytic papillary variety. Lower limbs represent the most frequently affected body parts. Surgical resection of the primary tumor with 2-4 cm horizontal clearance margin, nodal clearance and radiotherapy constitute the cornerstones of effective oncologic management. Despite best efforts, the overall mortality is reported to be 21%. PMID:25325060

  11. Pulsed dye laser in burn scars: current concepts and future directions.

    PubMed

    Parrett, Brian M; Donelan, Matthias B

    2010-06-01

    Hypertrophic scarring after partial-thickness burns is common, resulting in raised, erythematous, pruritic, and contracted scars. Treatment of hypertrophic scars, especially on the face, is challenging and has high failure rates. Excisional treatment has morbidity and can create iatrogenic deformities. After an extensive experience over 10 years with laser therapy for the treatment of difficult scars, the pulsed dye laser (PDL) has emerged as a successful alternative to excision in patients with hypertrophic burn scars. Multiple studies have shown its ability to decrease scar erythema and thickness while significantly decreasing pruritus and improving the cosmetic appearance of the scar. The history of laser therapy and the mechanism of action and results of the PDL in burn scars will be reviewed. The PDL should become an integral part of the management of burn scarring and will significantly decrease the need for excisional surgery. PMID:20022430

  12. Chromatic analysis of burn scar based on ANN by using photoelectrical technology

    NASA Astrophysics Data System (ADS)

    Wan, Baikun; Qi, Hongzhi; Ming, Dong; Zhang, Mingjian; Wang, Qifang

    2005-01-01

    In this paper a novel method for the chromatic analysis of burn scar is proposed. The aim of the algorithm is to evaluate the curative effect and set up the treatment plan pertinently, because the scar color is an impersonal parameter reflects the degree of scar hypertrophy. The method is based on artificial neural network (ANN) by using photoelectrical technique, and composed of three main parts: firstly capture the digital color images of the burn scar using CCD camera, then change the RGB color data of the burn scar into that of HSB color space and emend it using ANN, lastly judge the degree of burn scar hypertrophy by chromatic analysis using ANN again. The experimental results were good conformed to the degrees of scar hypertrophy given by clinical evaluations. It suggests that the chromatic analysis technique of the burn scar is valuable for further study and apply to the clinical engineering.

  13. Anesthetic management for a patient with severe mento-sternal contracture: difficult airway and scarce venous access -A case report-

    PubMed Central

    Lee, Hye-Kyoung; Yim, Ji-Yeon; Kang, Im-Hong

    2013-01-01

    There are many problems in the anesthetic management of patients with scar contracture. In this case, a 41-year-old male with severe scar contracture on his face, neck, anterior chest, and both shoulders underwent surgery for resurfacing with flaps. We tried to awake fiberoptic orotracheal intubation with GlideScope® Video laryngoscope guide after surgical release of contracture under local anesthesia. We report a successful management of a patient with severe burn contracture achieved by combined effort of surgeons and anesthesiologists. PMID:23372888

  14. Bipedicled “Superthin” Free Perforator Flaps for Facial Burn Scar Reconstruction: Expanded Scope of Superthin Flaps: A Case Series

    PubMed Central

    Van Anh, Tran; Tien, Nguyen Gia; Hyakusoku, Hiko; Ogawa, Rei

    2015-01-01

    Background: “Superthin flap” is a distinctively thin flap that is thinned primarily to the point that the subdermal vascular network can be seen through a minimal fat layer. Reconstruction of severely disfigured neck and face can be performed using the occipito-cervico-dorsal superthin flap that is harvested from the dorsal region and supercharged by the circumflex scapular vessels. We used bipedicled superthin free perforator flaps to reconstruct scar contractures on half of the face, whole face, or the whole chin-neck area in 17 postburn patients. Methods: This case series report includes all 17 cases. Flaps in the dorsal area were designed. In all cases, one pedicle consisted of the circumflex scapular vessels. In 11, 5, and 1 flaps, the second pedicle consisted of contralateral posterior intercostal perforators (type 1), ipsilateral posterior intercostal perforators (type 2), and ipsilateral circumflex scapular vessels (type 3), respectively. Four patients underwent whole-face reconstruction after acid burn with type 1 or type 3 perforator. The recipient vessels were the superficial temporal vessels and contralateral or ipsilateral facial vessels. Intraoperatively, all adipose tissue in the flap, including between the 2 pedicles, was thinned by scissors before the pedicles were detached from the donor sites. Maximum flap size was 35 × 15 cm. Donor sites were covered by a split full-thickness skin graft. Flap survival and functional and cosmetic results were assessed retrospectively. Results: Fifteen of the 17 flaps survived completely. Two developed partial necrosis due to perforator thrombosis. Some patients developed hypertrophic scars around the flap, but these improved naturally over time. All patients were satisfied with both the cosmetic and functional outcomes of the reconstruction. Conclusion: Bipedicled superthin free perforator flaps may be an excellent choice for reconstruction of severe neck scar contracture. This report expands the scope of previously used “superthin flaps.” PMID:26495206

  15. A Modeling Approach for Burn Scar Assessment Using Natural Features and Elastic Property

    SciTech Connect

    Tsap, L V; Zhang, Y; Goldgof, D B; Sarkar, S

    2004-04-02

    A modeling approach is presented for quantitative burn scar assessment. Emphases are given to: (1) constructing a finite element model from natural image features with an adaptive mesh, and (2) quantifying the Young's modulus of scars using the finite element model and the regularization method. A set of natural point features is extracted from the images of burn patients. A Delaunay triangle mesh is then generated that adapts to the point features. A 3D finite element model is built on top of the mesh with the aid of range images providing the depth information. The Young's modulus of scars is quantified with a simplified regularization functional, assuming that the knowledge of scar's geometry is available. The consistency between the Relative Elasticity Index and the physician's rating based on the Vancouver Scale (a relative scale used to rate burn scars) indicates that the proposed modeling approach has high potentials for image-based quantitative burn scar assessment.

  16. Advances in Research in Animal Models of Burn-Related Hypertrophic Scarring.

    PubMed

    Domergue, Sophie; Jorgensen, Christian; Noël, Danièle

    2015-01-01

    Skin burn injuries affect approximately 500,000 people per year in France. After deep burns, functional sequelae associated with hypertrophic and retractile scars are an important public health problem. To understand the pathophysiology of sequelae and evaluate new therapeutic approaches, the use of animal models that should be standard tools is necessary. Some pre-clinical models of hypertrophic scars after burns have been described, but the choice of the appropriate and relevant experimental model is crucial to accurately investigate any therapeutic approach. A variety of hypertrophic scar animal models have been described after burn lesions; none of which being totally satisfactory. The most frequently used is the hypertrophic scar model after skin excision of the ear rabbit, but this model does not reflect burn injuries. The red Duroc pig seems to be the more relevant model of human hypertrophic scarring after burns; however, because of costs and the lack of studies evaluating burn injuries in this species, the domestic pig is most commonly used in burn research. Elevated hypertrophic scars are obtained, but they spontaneously resolve within a year. Although mortality in small animals is higher and creates technical difficulties, many models on nude mice are used in research. Indeed, transplantation of human hypertrophic scar tissue or human skin grafts may induce hypertrophic scarring that can last more than a year permitting additional manipulation and experimentation. PMID:25356852

  17. Paediatric post-burn scar management in the UK: a national survey.

    PubMed

    Liuzzi, Francesca; Chadwick, Sarah; Shah, Mamta

    2015-03-01

    Thermal injuries affect 250,000 people annually in the United Kingdom. As burn survival improves, good scar management is paramount to help individuals living with the resultant scars lead a life without restrictions. Post-burn hypertrophic scars can limit growth in children, interfere with function and cause psychological problems. In the current literature there is great variation in post-burn scar management across the world and in the evidence available for the efficacy of these management modalities. The aim of this study was to investigate the variances if any, in the management of post-burn scarring in children across the UK. A telephone survey of UK paediatric burn services was conducted to obtain information on post-burn scar management and advice given to patients/carers. Of the 19 burn services that participated, all advised moisturising of scars but with variable emphasis on massaging. Silicones and pressure therapy were used by 18 services but commencement of use varied from soon after healing to onset of hypertrophic scarring. Laser therapy, ultrasound therapy and steroid therapy were used sporadically. This study highlights the common modalities of post-burn scar management in children across the UK. However, there is marked variation in timing and selection of the commonly used modalities. Although this study did not investigate the outcomes of scar management, it clearly identifies the need for a well-designed multi-centred study to establish evidence-based best practice in the management of post-burn scarring in children as these modalities are time consuming and not without potential complications. Evidence based practice could potentially lead to significant financial savings to the health service. PMID:25468478

  18. Clinical and Histological Correlation in Post-Burn Hypertrophic Scar for Pain and Itching Sensation

    PubMed Central

    Choi, Young-Hee; Kim, Kwang-Min; Kim, Hye-One; Jang, Young-Chul

    2013-01-01

    Background Hypertrophic scar following a burn is caused by the excessive deposit of collagen resulting in an exaggerated wound healing response. The burn patient complains of pain and itching over the scar, which can give rise to cosmetic and functional problems. Objective The aim of this study was to investigate the clinical and histological correlation of a hypertrophic burn scar for itching and pain sensations. Methods Thirty-eight patients underwent a scar release and skin graft. the modified Vancouver scar scale and the verbal numerical rating scale were recorded. All biopsies were taken from scar tissue (scar) and normal tissue (normal). Histologically, tissues were observed in the epidermis, the monocytes around the vessels, the collagen fiber, elastic fiber, and the mast cells. Results The mean total score of MVSS was 8.4±2.7 (pliability 2.0±0.9; thickness 1.8±0.9; vascularity 2.0± 0.9; and pigmentation 2.1±0.9). Pain and itching were 2.4±2.0 and 2.9±3.0. Epidermis were 7.9±2.8 layers (scar) and 4.0±0.8 layers (normal). The collagen fibers were thin and dense (scar) and thicker and loose (normal). The elastic fibers were thin and nonexistent (scar) and thin and loose (normal). Mast cells were 11.2±5.8/high power field (scar) and 7.4±4.1 (normal). Conclusion As the scar tissue thickens, the itching becomes more severe. The stiffness of the scar with the pain appeared to be associated with the condition of the tissue. The correlation between clinical and histological post-burn hypertrophic scars will help further studies on the scar. This helped with the development of the base material for therapeutic strategies. PMID:24371389

  19. Fasciocutaneous flaps based on a doppler detected perforator, an illustrative series as used for burn contracture reconstruction.

    PubMed

    Tucker, S C

    2011-07-01

    Perforator flaps are well established as a versatile option in reconstructive surgery that provide thin, pliable cutaneous or fasciocutaneous tissue. They are particularly useful in the reconstruction of large shallow defects, such as after the release of a burn contracture, however there are situations where the additional time spent islanding these flaps may be unnecessary, and the flap is then essentially a fasciocutaneous flap based, but not islanded, on a perforator artery. This paper documents a series of 22 severe burn contractures in 17 patients reconstructed with fasciocutaneous flaps in this way. The arteries were all located pre-operatively with a hand held Doppler probe, around half at the site of a known perforator and half by systematic scanning of the surrounding skin for an ad hoc perforator. All patients achieved a good functional range of motion. There were three cases of partial superficial flap necrosis treated with split skin grafting. The functional and aesthetic outcomes were far better then those expected with split skin grafting, and published series show that contractures treated with perforator flaps are unlikely to ever need further surgery. Without islanding the flap it becomes a feasible option for reconstructing these patients even in the extremely resource poor environment in which they often present, and is an option for all plastic surgeons to consider in the reconstruction of large superficial defects. PMID:21237734

  20. Study of Burn Scar Extraction Automatically Based on Level Set Method using Remote Sensing Data

    PubMed Central

    Liu, Yang; Dai, Qin; Liu, JianBo; Liu, ShiBin; Yang, Jin

    2014-01-01

    Burn scar extraction using remote sensing data is an efficient way to precisely evaluate burn area and measure vegetation recovery. Traditional burn scar extraction methodologies have no well effect on burn scar image with blurred and irregular edges. To address these issues, this paper proposes an automatic method to extract burn scar based on Level Set Method (LSM). This method utilizes the advantages of the different features in remote sensing images, as well as considers the practical needs of extracting the burn scar rapidly and automatically. This approach integrates Change Vector Analysis (CVA), Normalized Difference Vegetation Index (NDVI) and the Normalized Burn Ratio (NBR) to obtain difference image and modifies conventional Level Set Method Chan-Vese (C-V) model with a new initial curve which results from a binary image applying K-means method on fitting errors of two near-infrared band images. Landsat 5 TM and Landsat 8 OLI data sets are used to validate the proposed method. Comparison with conventional C-V model, OSTU algorithm, Fuzzy C-mean (FCM) algorithm are made to show that the proposed approach can extract the outline curve of fire burn scar effectively and exactly. The method has higher extraction accuracy and less algorithm complexity than that of the conventional C-V model. PMID:24503563

  1. Study of burn scar extraction automatically based on level set method using remote sensing data.

    PubMed

    Liu, Yang; Dai, Qin; Liu, Jianbo; Liu, ShiBin; Yang, Jin

    2014-01-01

    Burn scar extraction using remote sensing data is an efficient way to precisely evaluate burn area and measure vegetation recovery. Traditional burn scar extraction methodologies have no well effect on burn scar image with blurred and irregular edges. To address these issues, this paper proposes an automatic method to extract burn scar based on Level Set Method (LSM). This method utilizes the advantages of the different features in remote sensing images, as well as considers the practical needs of extracting the burn scar rapidly and automatically. This approach integrates Change Vector Analysis (CVA), Normalized Difference Vegetation Index (NDVI) and the Normalized Burn Ratio (NBR) to obtain difference image and modifies conventional Level Set Method Chan-Vese (C-V) model with a new initial curve which results from a binary image applying K-means method on fitting errors of two near-infrared band images. Landsat 5 TM and Landsat 8 OLI data sets are used to validate the proposed method. Comparison with conventional C-V model, OSTU algorithm, Fuzzy C-mean (FCM) algorithm are made to show that the proposed approach can extract the outline curve of fire burn scar effectively and exactly. The method has higher extraction accuracy and less algorithm complexity than that of the conventional C-V model. PMID:24503563

  2. Scars

    MedlinePlus

    ... Loss Sagging Skin Scars Skin Growths Skin Lesions Spider Veins Stretch Marks Sun-damaged Skin Unwanted Hair ... Loss Sagging Skin Scars Skin Growths Skin Lesions Spider Veins Stretch Marks Sun-damaged Skin Unwanted Hair ...

  3. Semi-stochastic cell-level computational modelling of cellular forces: application to contractures in burns and cyclic loading.

    PubMed

    Vermolen, F J; Gefen, A

    2015-11-01

    A phenomenological model is formulated to model cellular forces on extracellular material. The model is capable of modelling both expansion and contractile forces. This work is based on the assumption of linear elasticity, which allows a superposition argument to arrive at fundamental expressions for cellular forces. It is also shown how the cellular forces can be implemented using different strategies, as well as an extension to cellular point sources. Illustrations are given for modelling a (permanent) contraction (e.g. a contracture) of burns and for cyclic loading by the cells. PMID:25776519

  4. Fat Grafting in Burn Scar Alleviates Neuropathic Pain via Anti-Inflammation Effect in Scar and Spinal Cord

    PubMed Central

    Huang, Shu-Hung; Wu, Sheng-Hua; Lee, Su-Shin; Chang, Kao-Ping; Chai, Chee-Yin; Yeh, Jwu-Lai; Lin, Sin-Daw; Kwan, Aij-Lie; David Wang, Hui-Min; Lai, Chung-Sheng

    2015-01-01

    Burn-induced neuropathic pain is complex, and fat grafting has reportedly improved neuropathic pain. However, the mechanism of fat grafting in improving neuropathic pain is unclear. Previous investigations have found that neuroinflammation causes neuropathic pain, and anti-inflammatory targeting may provide potential therapeutic opportunities in neuropathic pain. We hypothesized that fat grafting in burn scars improves the neuropathic pain through anti-inflammation. Burn-induced scar pain was confirmed using a mechanical response test 4 weeks after burn injuries, and autologous fat grafting in the scar area was performed simultaneously. After 4 weeks, the animals were sacrificed, and specimens were collected for the inflammation test, including COX-2, iNOS, and nNOS in the injured skin and spinal cord dorsal horns through immunohistochemistry and Western assays. Furthermore, pro-inflammatory cytokines (IL-1 β and TNF-α) in the spinal cord were collected. Double immunofluorescent staining images for measuring p-IκB, p-NFκB, p-JNK, and TUNEL as well as Western blots of AKT, Bax/Bcl-2 for the inflammatory process, and apoptosis were analyzed. Fat grafting significantly reduced COX2, nNOS, and iNOS in the skin and spinal cord dorsal horns, as well as IL-1β and TNF-α, compared with the burn group. Moreover, regarding the anti-inflammatory effect, the apoptosis cells in the spinal cord significantly decreased after the fat grafting in the burn injury group. Fat grafting was effective in treating burn-induced neuropathic pain through the alleviation of neuroinflammation and ameliorated spinal neuronal apoptosis. PMID:26368011

  5. Visible scars and self-esteem in pediatric patients with burns.

    PubMed

    Abdullah, A; Blakeney, P; Hunt, R; Broemeling, L; Phillips, L; Herndon, D N; Robson, M C

    1994-01-01

    The supposition of often made that visible scarring is more psychologically damaging than are "hidden" burn scars, but little evidence exists to support that idea. We compared the self-evaluations of 28 male and 21 female pediatric patients with burns to the amount and visibility of scars. Males were 6 to 18 years old at the time of burn and sustained 15% to 99% total body surface area burns. They were evaluated 1 to 6 years after their burn injury. Females constituted a similar group. They were 5 to 18 years old at the time of burn, sustained 15% to 94% total body surface area burns, and were evaluated 1 to 7 years after their burn injury. All of the children underwent evaluation with the Piers-Harris Children's Concept Scale, evaluating themselves on intellectual and school status, physical appearance, anxiety, happiness and satisfaction, and behavior and popularity. Scores from these parameters were compared against each child's "visible" scars as seen on the face, head, neck, and hands. Also, comparisons were made with the numbers of reconstructive needs in these areas. Significant inverse correlations were found in the males. As the number of scars increased in these areas, the patient's scores for "physical appearance" and "happiness and satisfaction" decreased (p < 0.001). Other psychologic parameters were not affected. There was no effect by age of patient, and no significant correlations were found for the female group. The results emphasize the importance of the burn team's awareness that pediatric survivors of burns may appear superficially to be adjusting well, while harboring grave self-deprecating feelings. Those with "visible" scars will need special support to enhance self-esteem. PMID:8195258

  6. Shine on: Review of Laser- and Light-Based Therapies for the Treatment of Burn Scars

    PubMed Central

    Hultman, C. Scott; Edkins, Renee E.; Lee, Clara N.; Calvert, Catherine T.; Cairns, Bruce A.

    2012-01-01

    Restoration of form and function after burn injury remains challenging, but emerging laser and pulsed light technologies now offer hope for patients with hypertrophic scars, which may be associated with persistent hyperemia, chronic folliculitis, intense pruritis, and neuropathic pain. In addition to impairing body image, these scars may limit functional recovery, compromise activities of daily living, and prevent return to work. Three different platforms are now poised to alter our reconstructive algorithm: (1) vascular-specific pulsed dye laser (PDL) to reduce hyperemia, (2) ablative fractional CO2 laser to improve texture and pliability of the burn scar, and (3) intense pulsed light (IPL) to correct burn scar dyschromia and alleviate chronic folliculitis. In this paper, we will provide an overview of our work in this area, which includes a systematic review, a retrospective analysis of our preliminary experience, and interim data from our on-going, prospective, before-after cohort trial. We will demonstrate that laser- and light-based therapies can be combined with each other safely to yield superior results, often at lower cost, by reducing the need for reconstructive surgery. Modulating the burn scar, through minimally invasive modalities, may replace conventional methods of burn scar excision and yield outcomes not previously possible or conceivable. PMID:22778719

  7. Effect of intense pulsed light on immature burn scars: A clinical study

    PubMed Central

    Sarkar, Arindam; Dewangan, Yatindra Kumar; Bain, Jayanta; Rakshit, Pritha; Dhruw, Krishnanand; Basu, Sandip Kanti; Saha, Jayanta Kumar; Majumdar, Bijay Kumar

    2014-01-01

    Introduction: As intense pulsed light (IPL) is widely used to treat cutaneous vascular malformations and also used as non-ablative skin rejunuvation to remodel the skin collagen. A study has been undertaken to gauze the effect of IPL on immature burn scars with regard to vascularity, pliability and height. Materials and Methods: This study was conducted between June 2013 and May 2014, among patients with immature burn scars that healed conservatively within 2 months. Photographic evidence of appearance of scars and grading and rating was done with Vancouver Scar Scale parameters. Ratings were done for both case and control scar after the completion of four IPL treatment sessions and were compared. Results: Out of the 19 cases, vascularity, pliability and height improved significantly (P < 0.05) in 13, 14 and 11 scars respectively following IPL treatment. Conclusions: Intense pulsed light was well-tolerated by patients, caused good improvement in terms of vascularity, pliability, and height of immature burn scar. PMID:25593424

  8. Scars

    MedlinePlus

    ... never go away completely. If the way a scar looks bothers you, various treatments might minimize it. These include surgical revision, dermabrasion, laser treatments, injections, chemical peels, and creams.

  9. Wildfires, smoke, and burn scars, near Yakutsk, Russia

    NASA Technical Reports Server (NTRS)

    2002-01-01

    The Lena River in central Siberia is hidden beneath a veil of smoke from multiple wildfires burning around the city of Yakutsk, Russia. Fires have been burning in the region off and on since late May 2002, and may be agricultural in cause. This image was acquired by the Moderate Resolution Imaging Spectroradiometer (MODIS) on the Terra satellite on July 23, 2002. In the false=-color image, vegetation is bright green, smoke is blueish-white, and burned areas are reddish-brown. In both images, fire detections are marked with red outlines. Credit: Jacques Descloitres, MODIS Land Rapid Response Team, NASA/GSFC

  10. Palm oil thorn-induced squamous cell carcinoma with underlying burns scar

    PubMed Central

    Qi Qi, Choo; Ajit Singh, Vivek

    2012-01-01

    Marjolin's ulcers are malignancies that arise from previously traumatised, chronically inflamed or scarred skin. We present a case with childhood burns, who had repeated irritation of his forearm skin with palm oil thorns that eventually led to malignant change. PMID:22865804

  11. The role of the TGF-β family in wound healing, burns and scarring: a review

    PubMed Central

    Penn, Jack W; Grobbelaar, Adriaan O; Rolfe, Kerstin J

    2012-01-01

    It is estimated worldwide that over 6 million people per annum experience a burn injury. Despite advances in management and improved survival rates, the incidence of hypertrophic scarring remains high. These scars are particularly common after burns and are often raised, red, hard and may cause abnormal sensations. Such pathological scarring can lead to severe functional impairment, psychological morbidity, and costly long term healthcare. Wound healing is an inherent process which restores the integrity of the skin after injury and although scarring is a frequent by-product, the scarless wound healing observed in early human gestational fetuses suggests that it is not an essential component of the response. This has lead to a large body of research attempting to understand the mechanisms behind scarring and in turn prevent it. One of the main focuses of recent research has been the role played by the growth factor TGF-β in the process of both wound healing and scar formation. The three isoforms (TGF-β1, TGF-β2 and TGF-β3) appear to have overlapping functions and predominantly mediate their effects through the intracellular SMAD pathway. Initial research suggested that TGF-β1 was responsible for the fibrotic scarring response whereas the scarless wound healing seen in fetal wounds was due to increased levels of TGF-β3. However, the reality appears to be far more complex and it is unlikely that simply altering the ratio of TGF-β isoforms will lead to scarless wound healing. Other aspects of the TGF-β system that appear promising include the downstream mediator CTGF, the proteoglycan decorin and the binding protein p311. Other putative mechanisms which may underlie the pathogenesis of hypertrophic scars include excessive inflammation, excessive angiogenesis, altered levels of matrix metalloproteinases, growth factors, and delayed apoptosis of fibrotic myofibroblasts either due to p53 genetic alterations or tensile forces across the wound. If an effective treatment for hypertrophic scars following burns injury is to be developed then further work must be carried out to understand the basic mechanisms of pathological scarring. PMID:22928164

  12. Bone Mineral Density After Burn Injury and Its Relation to the Characteristics of Scar Tissue.

    PubMed

    Terzi, Rabia; Güven, Murat

    2016-01-01

    Burn injuries are associated with the negative effects on the musculoskeletal system and are important causes of severe disabilities. The aim of this study was to evaluate bone mineral density (BMD), bone turnover markers, and 25(OH) vitamin D levels in male patients with sustained at least 1 year postburns involving more than 30% of the TBSA in comparison to a control group and evaluate the relation between the characteristics of scar tissue and BMD and 25(OH) vitamin D levels. The study included 25 male patients who previously sustained burn injuries involving more than 30% of the TBSA and 20 healthy subjects as the control group. The burn scars were assessed using the Modified Vancouver Scar Scale Score (MVSSS). BMD at the lumbar spine and femoral neck were measured. The blood tests included calcium, phosphorus, bone-specific alkaline phosphatase, thyroid stimulating hormone, parathyroid hormone, 25(OH) vitamin D, osteocalcin, and β-isomerized form C-terminal telopeptide of type I collagen. The femoral neck z score and bone mass density values, 25(OH) vitamin D3, and bone-specific ALP were significantly lower in injured compared with the control group. There was a negative correlation between MVSSS and vitamin D levels. Femoral bone loss should be taken into consideration in patients who sustain burn injuries and preventive treatment strategies must be adopted in the early treatment of burn injuries. Particularly in patients with high MVSSS should be evaluated for possible vitamin D deficiency during the long term. PMID:25882515

  13. Exploring reliability of scar rating scales using photographs of burns from children aged up to 15 years.

    PubMed

    Simons, Megan; Ziviani, Jenny; Thorley, Michelle; McNee, Jessamine; Tyack, Zephanie

    2013-01-01

    Assessing burn scars from photographs is a common practice given the growing trend to support health service delivery via electronic media (eg, email, videoconferencing). Scar rating scales, originally designed for in-person assessment, have been used to rate scars from photographic images. Evidence for the reliability of this practice is lacking. Five raters completed three scar rating scales (Patient and Observer Scar Scale, Manchester Scar Scale, modified Vancouver Scar Scale), both in-person and using photographs on 12 participants (seven male, five female) with 18 scar areas (3 × 3 cm). Interrater reliability for the scar parameters of vascularity, color, contour, pliability, and overall opinion achieved intraclass correlation coefficient values of between 0.71 and 0.87 (in-person) and 0.72 and 0.77 (using photographs) for multiple raters. The level of agreement between in-person and photographic assessment was below acceptable levels, which brings into question construct validity when scar rating scales are used in a way for which they were not designed. Reliability estimates in this study were likely reduced by the underrepresentation of scars in the more severe range. This limitation needs to be addressed in future research. Advances are required in the development and refinement of burn scar rating scales, specifically for photographic use, given their routine use in clinical care. PMID:23271058

  14. Marjolin’s ulcers in the post-burned lesions and scars

    PubMed Central

    Saaiq, Muhammad; Ashraf, Bushra

    2014-01-01

    Marjolin’s ulcer (MU) represents malignant degeneration that typically ensues over a period of time in the post-burned lesions and scars or any other chronic wound. This review highlights various facets of the presentation and management of MUs that originate from post-burned lesions. The incidence of MUs in such lesions is reported to be 0.77%-2%. This malignancy characteristically develops in the areas of full thickness skin burns that had been allowed for weeks to months to heal spontaneously by secondary intention, or burn wounds which never healed completely over years and the unstable post-burned scars. In the majority of cases, the MU is a squamous cell carcinoma (SCC). The MUs contribute to an overall 2% of all SCCs and 0.03% of all basal cell carcinomas of the skin. Clinically MUs present in two major morphologic forms. The commoner form is the flat, indurated, ulcerative variety while the less common form is the exophytic papillary variety. Lower limbs represent the most frequently affected body parts. Surgical resection of the primary tumor with 2-4 cm horizontal clearance margin, nodal clearance and radiotherapy constitute the cornerstones of effective oncologic management. Despite best efforts, the overall mortality is reported to be 21%. PMID:25325060

  15. Ablative fractional photothermolysis for the treatment of hypertrophic burn scars in adult and pediatric patients: a single surgeon's experience.

    PubMed

    Khandelwal, Anjay; Yelvington, Miranda; Tang, Xinyu; Brown, Susan

    2014-01-01

    Many patients develop hypertrophic scarring after a burn injury. Numerous treatment modalities have been described and are currently in practice. Photothermolysis or laser therapy has been recently described as an adjunct for management of hypertrophic burn scars. This study is a retrospective chart review of adult and pediatric patients undergoing fractional photothermolysis at a verified burn center examining treatment parameters as well as pre- and post-Vancouver Scar Scale scores. Forty-four patients underwent fractional photothermolysis during the study period of 8 months. Mean pretreatment score was 7.6, and mean posttreatment score was 5.4. The mean decrease in score was 2.2, which was found to be statistically significant. There were no complications. Fractional photothermolysis is a safe and efficacious adjunct therapy for hypertrophic burn scars. Prospective trials would be beneficial to determine optimal therapeutic strategies. PMID:24823327

  16. Using MODIS imagery to assign dates to maps of burn scars in Portugal

    NASA Astrophysics Data System (ADS)

    DaCamara, C. C.; Libonati, R.; Barros, A.; Gaspar, G.; Calado, T. J.

    2012-04-01

    In the European context, Portugal presents the highest number of fire occurrences and has the largest area affected by wildfires. Like other southern regions of Europe, Portugal has experienced a dramatic increase in fire incidence during the last few decades that has been attributed to modifications in land-use as well as to climatic changes and associated occurrence of weather extremes. Wildfire activity also presents a large inter-annual variability that has been related to changes in the frequency of occurrence of atmospheric conditions favorable to the onset and spreading of large-fires. Since 1990, the Portuguese Authority for Forests (AFN) has been producing yearly maps of fire perimeters under a protocol with the Department of Forest Engineering of the Institute of Agronomy (DEF/ISA). The AFN fire atlas uses end of fire season Landsat TM/ETM imagery to map all fire perimeters with area larger than 5ha. Because it relies on end-of-season imagery, the atlas provides a spatial snapshot of the yearly area burned, and dates of burn for individual events cannot be estimated. Such information is nevertheless crucial to understand the fire regime and fire seasonality and to disentangle the complex interactions among fire, land cover and meteorology. The aim of the present work is to develop an automated procedure that allows using time series of moderate resolution imagery, such as the one provided by the MODIS instrument on-board TERRA and AQUA, to assign dates of burning to scars larger than 500 ha in the Landsat based fire atlas. The procedure relies on the so-called (V,W) burned index that uses daily reflectance obtained from the 1km MODIS Level 1B calibrated radiance from bands 2 (NIR) and 20 (MIR). The algorithm detects persistent changes in the (V,W) burned index time series, within each Landsat burned scar. The day of maximum change is then identified by means of a discrimination index, together with thresholds from the (V,W) time series. A spatial filter is finally applied to remove the outliers. An assessment of the temporal accuracy of the algorithm was conducted for the year 2005. For this year, Landsat based fire scars larger than 500ha have an associated detection date, based on field information provided by the AFN. The detection date is here assumed as ignition date of each scar. It is also assumed that each scar corresponds to a single fire event. Using 78 fire scars, we computed the time difference, in days, between the detection date and the date of burn, estimated by the algorithm. Our results show that 70% of all scars were correctly dated by the algorithm with differences to the AFN detection date up to three days. These correspond to 83% of the overall burned area used in the accuracy assessment.

  17. Interrater and intrarater reliability of the Semmes Weinstein aesthesiometer to assess touch pressure threshold in burn scars.

    PubMed

    Meirte, J; Moortgat, P; Truijen, S; Maertens, K; Lafaire, C; De Cuyper, L; Hubens, G; Van Daele, U

    2015-09-01

    Burn scars are frequently accompanied with sensory deficits often remaining present months or even years after injury. Clinimetric properties of assessment tools remain understudied within burn literature. Tactile sense of touch can be examined with the touch pressure threshold (TPT) method using the Semmes Weinstein monofilament test (SWMT). There is in recent research no consensus on the exact measurement procedure when using the SWMT. The aim of this paper was to determine the interrater and intrarater reliability of TPT within burn scars and healthy controls using the 'ascending descending' measurement procedure. We used the newly developed guidelines for reporting reliability and agreement studies (GRRAS) as a basis to report this reliability study. In total 36 individuals were tested; a healthy control group and a scar group. The interrater reliability was excellent in the scar group (ICC=0.908/SEM=0.21) and fair to good in the control group (ICC=0.731/SEM=0.12). In the scar group intrarater ICC value was excellent (ICC=0.822/SEM=0.33). Within the control group also an excellent intrarater reliability (ICC=0.807/SEM=0.27) was found. In conclusion this study shows that the SWMT with the 'ascending descending' measurement procedure is a feasible and reliable objective measure to evaluate TPT in (older) upper extremities burn scars as well as in healthy skin. PMID:25703663

  18. Neglected post burns contracture of hand in children: Analysis of contributory socio-cultural factors and the impact of neglect on outcome☆

    PubMed Central

    Gupta, Ravi Kumar; Jindal, Nipun; Kamboj, Kulbhushan

    2014-01-01

    Background No study has ever evaluated the causes and effect of neglect on the outcome of post burns contractures of hand in children. Methods 66 hands in 61 children (mean age 12.22 years) with a mean neglect of 11.6 years (range 5–17 years) were assessed for the causes of neglect and the outcome of surgery. Average follow up was 6.6 years. The results were assessed in two groups of 5–10 years neglect as group I and >10 years neglect as group II. Results In a total number of 134 contracted rays in 66 hands, the surgical procedures included local Z/V-Y flap (51 rays), cross finger flap (48 rays), full thickness graft (35 rays). Additional external fixator with a distracter was used in 3 patients treated at a delay of 14, 16 and 17 years. 50 (81.96%) patients belonged to rural and slum areas. The reasons for delayed treatment included poverty – 33 patients, lack of awareness of surgical treatment – 16 patients; and indifference of parents – 12 patients. 44 (72.13%) children were illiterates. With treatment the average DASH score improved from 65.10 to 36.90 (p < .000) and from 68.14 to 45.93 (p < .000) in group I and II respectively. The results were significantly superior in group I (p < .000). Conclusion The main factors for neglect in treatment of post burns contracture include poverty, lack of awareness and illiteracy. All the patients showed significant improvement in function after the surgery. Contractures with higher neglect had significantly inferior outcome. PMID:25983501

  19. Predicting severity of pathological scarring due to burn injuries: a clinical decision making tool using Bayesian networks.

    PubMed

    Berchialla, Paola; Gangemi, Ezio Nicola; Foltran, Francesca; Haxhiaj, Arber; Buja, Alessandra; Lazzarato, Fulvio; Stella, Maurizio; Gregori, Dario

    2014-06-01

    It is important for clinicians to understand which are the clinical signs, the patient characteristics and the procedures that are related with the occurrence of hypertrophic burn scars in order to carry out a possible prognostic assessment. Providing clinicians with an easy-to- use tool for predicting the risk of pathological scars. A total of 703 patients with 2440 anatomical burn sites who were admitted to the Department of Plastic and Reconstructive Surgery, Burn Center of the Traumatological Hospital in Torino between January 1994 and May 2006 were included in the analysis. A Bayesian network (BN) model was implemented. The probability of developing a hypertrophic scar was evaluated on a number of scenarios. The error rate of the BN model was assessed internally and it was equal to 24·83%. While classical statistical method as logistic models can infer only which variables are related to the final outcome, the BN approach displays a set of relationships between the final outcome (scar type) and the explanatory covariates (patient's age and gender, burn surface area, full-thickness burn surface area, burn anatomical area and wound-healing time; burn treatment options such as advanced dressings, type of surgical approach, number of surgical procedures, type of skin graft, excision and coverage timing). A web-based interface to handle the BN model was developed on the website www.pubchild.org (burns header). Clinicians who registered at the website could submit their data in order to get from the BN model the predicted probability of observing a pathological scar type. PMID:22958613

  20. Spatial and temporal corroboration of a fire-scar-based fire history in a frequently burned ponderosa pine forest.

    PubMed

    Farris, Calvin A; Baisan, Christopher H; Falk, Donald A; Yool, Stephen R; Swetnam, Thomas W

    2010-09-01

    Fire scars are used widely to reconstruct historical fire regime parameters in forests around the world. Because fire scars provide incomplete records of past fire occurrence at discrete points in space, inferences must be made to reconstruct fire frequency and extent across landscapes using spatial networks of fire-scar samples. Assessing the relative accuracy of fire-scar fire history reconstructions has been hampered due to a lack of empirical comparisons with independent fire history data sources. We carried out such a comparison in a 2780-ha ponderosa pine forest on Mica Mountain in southern Arizona (USA) for the time period 1937-2000. Using documentary records of fire perimeter maps and ignition locations, we compared reconstructions of key spatial and temporal fire regime parameters developed from documentary fire maps and independently collected fire-scar data (n = 60 plots). We found that fire-scar data provided spatially representative and complete inventories of all major fire years (> 100 ha) in the study area but failed to detect most small fires. There was a strong linear relationship between the percentage of samples recording fire scars in a given year (i.e., fire-scar synchrony) and total area burned for that year (y = 0.0003x + 0.0087, r2 = 0.96). There was also strong spatial coherence between cumulative fire frequency maps interpolated from fire-scar data and ground-mapped fire perimeters. Widely reported fire frequency summary statistics varied little between fire history data sets: fire-scar natural fire rotations (NFR) differed by < 3 yr from documentary records (29.6 yr); mean fire return intervals (MFI) for large-fire years (i.e., > or = 25% of study area burned) were identical between data sets (25.5 yr); fire-scar MFIs for all fire years differed by 1.2 yr from documentary records. The known seasonal timing of past fires based on documentary records was furthermore reconstructed accurately by observing intra-annual ring position of fire scars and using knowledge of tree-ring growth phenology in the Southwest. Our results demonstrate clearly that representative landscape-scale fire histories can be reconstructed accurately from spatially distributed fire-scar samples. PMID:20945762

  1. Assessment of human burn scars with optical coherence tomography by imaging the attenuation coefficient of tissue after vascular masking.

    PubMed

    Gong, Peijun; McLaughlin, Robert A; Liew, Yih Miin; Munro, Peter R T; Wood, Fiona M; Sampson, David D

    2014-02-01

    The formation of burn-scar tissue in human skin profoundly alters, among other things, the structure of the dermis. We present a method to characterize dermal scar tissue by the measurement of the near-infrared attenuation coefficient using optical coherence tomography (OCT). To generate accurate en face parametric images of attenuation, we found it critical to first identify (using speckle decorrelation) and mask the tissue vasculature from the three-dimensional OCT data. The resulting attenuation coefficients in the vasculature-masked regions of the dermis of human burn-scar patients are lower in hypertrophic (3.8±0.4  mm(-1)) and normotrophic (4.2±0.9  mm(-1)) scars than in contralateral or adjacent normal skin (6.3±0.5  mm(-1)). Our results suggest that the attenuation coefficient of vasculature-masked tissue could be used as an objective means to assess human burn scars. PMID:24192908

  2. Mechanical evaluation of the resistance and elastance of post-burn scars after topical treatment with tretinoin

    PubMed Central

    Dematte, Maria Fernanda; Gemperli, Rolf; Salles, Alessandra Grassi; Dolhnikoff, Marisa; Lanças, Tatiana; Saldiva, Paulo Hilário Nascimento; Ferreira, Marcus Castro

    2011-01-01

    OBJECTIVE: After burn injuries, scarred skin lacks elasticity, especially in hypertrophic scars. Topical treatment with tretinoin can improve the appearance and quality of the skin (i.e., texture, distensibility, color, and hydration). The objective of this prospective study was to examine the effects of treatment with 0.05% tretinoin for one year on the biomechanical behavior and histological changes undergone by facial skin with post-burn scarring. Setting: Tertiary, Institutional. METHOD: Fifteen female patients who had suffered partial thickness burns with more than two years of evolution were selected. Skin biopsies were obtained initially and after one year of treatment. The resistance and elastance of these skin biopsies were measured using a mechanical oscillation analysis system. The density of collagen fibers, elastic fibers, and versican were determined using immunohistochemical analysis. RESULTS: Tretinoin treatment significantly lowered skin resistance and elastance, which is a result that indicates higher distensibility of the skin. However, tretinoin treatment did not significantly affect the density of collagen fibers, elastic fibers, or versican. CONCLUSION: Topical tretinoin treatment alters the mechanical behavior of post-burn scarred skin by improving its distensibility and thus leads to improved quality of life for patients. PMID:22086527

  3. Nanolayered siRNA delivery platforms for local silencing of CTGF reduce cutaneous scar contraction in third-degree burns.

    PubMed

    Castleberry, Steven A; Golberg, Alexander; Sharkh, Malak Abu; Khan, Saiqa; Almquist, Benjamin D; Austen, William G; Yarmush, Martin L; Hammond, Paula T

    2016-07-01

    Wound healing is an incredibly complex biological process that often results in thickened collagen-enriched healed tissue called scar. Cutaneous scars lack many functional structures of the skin such as hair follicles, sweat glands, and papillae. The absence of these structures contributes to a number of the long-term morbidities of wound healing, including loss of function for tissues, increased risk of re-injury, and aesthetic complications. Scar formation is a pervasive factor in our daily lives; however, in the case of serious traumatic injury, scars can create long-lasting complications due to contraction and poor tissue remodeling. Within this report we target the expression of connective tissue growth factor (CTGF), a key mediator of TGFβ pro-fibrotic response in cutaneous wound healing, with controlled local delivery of RNA interference. Through this work we describe both a thorough in vitro analysis of nanolayer coated sutures for the controlled delivery of siRNA and its application to improve scar outcomes in a third-degree burn induced scar model in rats. We demonstrate that the knockdown of CTGF significantly altered the local expression of αSMA, TIMP1, and Col1a1, which are known to play roles in scar formation. The knockdown of CTGF within the healing burn wounds resulted in improved tissue remodeling, reduced scar contraction, and the regeneration of papillary structures within the healing tissue. This work adds support to a number of previous reports that indicate CTGF as a potential therapeutic target for fibrosis. Additionally, we believe that the controlled local delivery of siRNA from ultrathin polymer coatings described within this work is a promising approach in RNA interference that could be applied in developing improved cancer therapies, regenerative medicine, and fundamental scientific research. PMID:27108403

  4. [Dupuytren's contracture].

    PubMed

    Jemec, Barbara

    2003-04-28

    Dupuytren's contracture is a common disease affecting the palmar fascia. It is mostly found in the elderly population, although more aggressive cases are not uncommon in the younger population. After a historic and epidemiological review, the clinical picture, histology and pathogenesis, the surgical treatment, and the latest therapeutic options are presented. PMID:12772394

  5. Management of Hypertrophic Burn Scar: A Comparison between the Efficacy of Exercise-Physiotherapy and Pressure Garment-Silicone on Hypertrophic Scar

    PubMed Central

    Karimi, Hamid; Mobayen, Mohammadreza; Alijanpour, Aboulhasan

    2012-01-01

    Purpose Our study aims to investigate the effectiveness of other treatment methods for burn related scarring and to determine the possibility of their routine administration in similar clinical settings. Methods Through a prospective study, 66 patients were enrolled to receive either the conventional pressure garment therapy (PGT) and Silicone (control group) or exercise and physiotherapy (case group). Patients were visited regularly to be examined for the status of their scars’ regression, limbs’ dysfunction, and joint motion. Then, these two groups were compared to determine the efficacy of exercise and physiotherapy as an alternative to the conventional treatment with PGT. Results After about 20 months follow-up, decreased articular range of motion (ROM) was: 16 (51.5%) cases compared to 5 (15%) of controls had mild, 11 (35.5%) of the cases compared to 13 (39.5%) of the controls had moderate; and 4 (13%) of the cases compared to 15 (45.5%) of the controls had severe decreased ROM which revealed statistically significant difference (P<0.01). At the same time, Vancouver Scar Scale score was: 15 (48%) of the cases and 6 (18%) of the controls had mild Scar Scale, 12 (39%) of the cases and 14 (42.5%) of the controls had moderate score and 4 (3%) of the cases and 13 (39.5%) of the controls had severe score which revealed a statistically significant difference (P<0.05). Conclusion Our study showed that physical therapy andexercise are more effective than PGT, in management of burn hypertrophic scar, hence could be an alternative in cases that conventional therapy cannot be used for any reason. PMID:23785579

  6. Derivation of Burn Scar Depths with Airborne Light Detection and Ranging (LIDAR) in Indonesian Peatlands

    NASA Astrophysics Data System (ADS)

    Ballhorn, U.; Siegert, F.

    2009-04-01

    Tropical deforestation and forest degradation contribute to about 20% of the global greenhouse gas emissions and Indonesia is a leading emitter. Forests are certainly critical; but the peat soils beneath can store 30 times more carbon than the trees above. Indonesia has the fourth-largest area of peatland in the world, ranging from 30 to 45 million ha, which is approximately 10 - 12% of the global peatland resource. Fire has a long tradition in Indonesian land clearing, where almost all fires are related to human activities. The 1997 - 1998 fires throughout Indonesia caused significant haze and smoke-related health problems across Southeast Asia. Strong and weak El Niño events in 1998 and 2002 accelerated burning as soil was parched. Green house gas emissions from the fires were the source of 60% of all anomalies globally for 1997 - 2000, particularly from drained peatlands. In 2007/08 we participated in a study conducted by the World Wildlife Fund which focused on Sumatra's 8.3 million ha province of Riau, along the island's northeastern coastline. In this study CO2 emissions from deforestation and forest degradation, peat decomposition and burning over 17 years from 1990 - 2007 were estimated. Fire hotspot data for the years 1997 - 2000 from the NOAA AVHRR and MODIS sensors was used to identify burned peatland. Based on soil water availability the depths of peat burns were estimated. El Nino years with a water table of lower than 1.5 m propel intense burning so that a peat burn depth of 0.50 m was assumed, while normally only a peat burn depth of 0.15 m. Total emissions for the 1990 - 2007 period were estimated at 3.66 Gt CO2, composed of 1.17 Gt CO2 from deforestation, 0.32 Gt CO2 from forest degradation, 0.78 Gt CO2 from peat decomposition, and 1.39 Gt CO2 from peat burning. Average annual CO2 emissions were 0.22 Gt, equal to 58% of Australia's total CO2 annual emissions (including emissions/removals from LULUCF, in 2005); between 1990 and 2007, Riau produced more CO2 per year than the fourth-largest industrial nation, Germany, saved to achieve its Kyoto target. Since 1990, emissions from peat burning and peat decomposition have exceeded that of above ground biomass deforestation. These numbers show how important it is to have more accurate estimations for peat burn depth in the future. Until now few field measurements were made, which would require to know the fire affected area in advance or ignite peatland on purpose. Furthermore fire scars are quickly covered by regenerating vegetation. Another problem is the lack of a method without actually having to go into the field (e.g. through remote sensing techniques), due to the fact that many of the fire locations are remote and very difficult to access. We investigated if airborne light detection and ranging (LIDAR), an active laser pulse technology by which the height of objects can be precisely measured, can be used to determine the amount of peat burned during a fire event. From a LIDAR data set acquired in Central Kalimantan, Borneo, in 2007, one year after severe fires resulting from the 2006 El Niño drought, we calculated that the average depth of a burn scar was 0.30 ± 0.15 m .This was achieved through the construction of digital terrain models (DTMs) by interpolating the LIDAR ground return signals in burnt and adjacent unburned peatland. These calculated depths were compared to in situ measurements, which came to similar results. We believe that the method presented here to estimate burnt peat depth has the potential to considerably improve the accuracy of regional and global carbon emission models but would also be helpful for monitoring projects under the Kyoto Protocol like the Clean Development Mechanism (CDM) or the proposed Reducing Emissions from Deforestation and Degradation (REDD) mechanism.

  7. Scar modification. Techniques for revision and camouflage.

    PubMed

    Horswell, B B

    1998-09-01

    The surgery and management of scars is a protracted and staged process that includes preparation of the skin through hygienic measures, scar softening (if indicated) with steroids, massage and pressure dressings, skilled execution of the surgical plan, and thorough postoperative wound care. This process generally covers a 1-year period for the various stages mentioned. Many general host and local skin factors will directly affect the final revision result. The two most important indirect factors that the surgeon must endeavor to control are optimal patient preparation and cutaneous health, and patient compliance with, and an ability to carry out, those wound care measures that the surgeon prescribes. Keloid and burn contracture scars represent two entities that are complicated and challenging to treat owing to their abnormal morphophysiologic features. Management of these scars is prolonged, and the patient must understand that the ultimate result will usually be a compromise. New grafting techniques, such as cultured autodermal grafts, offer improved initial management of burn wounds that may subsequently optimize scar revision in these patients. Keloids, and to a lesser extent hypertrophic scars, require steroid injections, pressure treatment, careful surgery, and protracted wound support and pressure treatment (exceeding 6 months) after surgery. PMID:11905373

  8. Derivation of burn scar depths and estimation of carbon emissions with LIDAR in Indonesian peatlands

    PubMed Central

    Ballhorn, Uwe; Siegert, Florian; Mason, Mike; Limin, Suwido

    2009-01-01

    During the 1997/98 El Niño-induced drought peatland fires in Indonesia may have released 13–40% of the mean annual global carbon emissions from fossil fuels. One major unknown in current peatland emission estimations is how much peat is combusted by fire. Using a light detection and ranging data set acquired in Central Kalimantan, Borneo, in 2007, one year after the severe peatland fires of 2006, we determined an average burn scar depth of 0.33 ± 0.18 m. Based on this result and the burned area determined from satellite imagery, we estimate that within the 2.79 million hectare study area 49.15 ± 26.81 megatons of carbon were released during the 2006 El Niño episode. This represents 10–33% of all carbon emissions from transport for the European Community in the year 2006. These emissions, originating from a comparatively small area (approximately 13% of the Indonesian peatland area), underline the importance of peat fires in the context of green house gas emissions and global warming. In the past decade severe peat fires occurred during El Niño-induced droughts in 1997, 2002, 2004, 2006, and 2009. Currently, this important source of carbon emissions is not included in IPCC carbon accounting or in regional and global carbon emission models. Precise spatial measurements of peat combusted and potential avoided emissions in tropical peat swamp forests will also be required for future emission trading schemes in the framework of Reduced Emissions from Deforestation and Degradation in developing countries. PMID:19940252

  9. Derivation of burn scar depths and estimation of carbon emissions with LIDAR in Indonesian peatlands.

    PubMed

    Ballhorn, Uwe; Siegert, Florian; Mason, Mike; Limin, Suwido

    2009-12-15

    During the 1997/98 El Niño-induced drought peatland fires in Indonesia may have released 13-40% of the mean annual global carbon emissions from fossil fuels. One major unknown in current peatland emission estimations is how much peat is combusted by fire. Using a light detection and ranging data set acquired in Central Kalimantan, Borneo, in 2007, one year after the severe peatland fires of 2006, we determined an average burn scar depth of 0.33 +/- 0.18 m. Based on this result and the burned area determined from satellite imagery, we estimate that within the 2.79 million hectare study area 49.15 +/- 26.81 megatons of carbon were released during the 2006 El Niño episode. This represents 10-33% of all carbon emissions from transport for the European Community in the year 2006. These emissions, originating from a comparatively small area (approximately 13% of the Indonesian peatland area), underline the importance of peat fires in the context of green house gas emissions and global warming. In the past decade severe peat fires occurred during El Niño-induced droughts in 1997, 2002, 2004, 2006, and 2009. Currently, this important source of carbon emissions is not included in IPCC carbon accounting or in regional and global carbon emission models. Precise spatial measurements of peat combusted and potential avoided emissions in tropical peat swamp forests will also be required for future emission trading schemes in the framework of Reduced Emissions from Deforestation and Degradation in developing countries. PMID:19940252

  10. Acute assessment and management of burn injuries.

    PubMed

    Purdue, Gary F; Arnoldo, Brett D; Hunt, John L

    2011-05-01

    Burns are ubiquitous injuries in modern society, with virtually all adults having sustained a burn at some point in their lives. The skin is the largest organ of the body, basically functioning to protect self from non-self. Burn injury to the skin is painful, resource-intensive, and often associated with scarring, contracture formation, and long-term disability. Larger burns are associated with morbidity and mortality disproportionate to their initial appearance. Electrical and chemical burns are less common injuries but are often associated with significant morbidity. PMID:21624716

  11. Management of post burn hand deformities

    PubMed Central

    Sabapathy, S. Raja; Bajantri, Babu; Bharathi, R. Ravindra

    2010-01-01

    The hand is ranked among the three most frequent sites of burns scar contracture deformity. One of the major determinants of the quality of life in burns survivors is the functionality of the hands. Burns deformities, although largely preventable, nevertheless do occur when appropriate treatment is not provided in the acute situation or when they are part of a major burns. Reconstructive procedures can greatly improve the function of the hands. Appropriate choice of procedures and timing of surgery followed by supervised physiotherapy can be a boon for a burns survivor. PMID:21321661

  12. Efficacy and Safety of Fractional CO2 Laser Resurfacing in Non-hypertrophic Traumatic and Burn Scars

    PubMed Central

    Majid, Imran; Imran, Saher

    2015-01-01

    Background: Fractional photothermolysis is one of the most effective treatment options used to resurface scars of different aetiologies. Aim: To assess the efficacy and safety of fractional CO2 laser resurfacing treatment in the management of non-hypertrophic traumatic and burn scars. Materials and Methods: Twenty-five patients affected by non-hypertrophic traumatic and burn scars were treated with four sessions of fractional CO2 laser resurfacing treatment at 6-weekly intervals. Patients were photographed at each visit and finally, 3 months after the end of treatment schedule. Response to treatment was assessed clinically as well as by comparing the initial photograph of the patient with the one taken at the last follow-up visit 3-months after the final treatment session. Changes in skin texture, surface irregularity and pigmentation were assessed on a quartile grading scale and scored individually from 0 to 4. A mean of the three individual scores was calculated and the response was labelled as ‘excellent’ if the mean score achieved was >2. A score of 1-2 was labeled as good response while a score below 1 was labeled as ‘poor’ response. The subjective satisfaction of each patient with the treatment offered was also assessed at the last follow-up visit. Results: The commonest site of scarring treated was the face followed by hands. Response to treatment was rated as excellent in 60% (15/25) patients while 24% (6/25) and 16% (4/25) patients were labeled as good and poor responders, respectively. Skin texture showed better response than other variables with average score of 2.44. Linear post-traumatic scars were seen to respond less than other morphological types. Majority of the patients (19 out of 25) were highly satisfied with the treatment offered. No long-term adverse effects were noted in any patient. Conclusions: Fractional photothermolysis with a fractional CO2 laser gives excellent results in patients with post-burn scars with minimal adverse effects. Limitations: Lack of a control group and small sample size are limitations of this study. PMID:26644740

  13. Missense Variant in MAPK Inactivator PTPN5 Is Associated with Decreased Severity of Post-Burn Hypertrophic Scarring

    PubMed Central

    Sood, Ravi F.; Arbabi, Saman; Honari, Shari; Gibran, Nicole S.

    2016-01-01

    Background Hypertrophic scarring (HTS) is hypothesized to have a genetic mechanism, yet its genetic determinants are largely unknown. The mitogen-activated protein kinase (MAPK) pathways are important mediators of inflammatory signaling, and experimental evidence implicates MAPKs in HTS formation. We hypothesized that single-nucleotide polymorphisms (SNPs) in MAPK-pathway genes would be associated with severity of post-burn HTS. Methods We analyzed data from a prospective-cohort genome-wide association study of post-burn HTS. We included subjects with deep-partial-thickness burns admitted to our center who provided blood for genotyping and had at least one Vancouver Scar Scale (VSS) assessment. After adjusting for HTS risk factors and population stratification, we tested MAPK-pathway gene SNPs for association with the four VSS variables in a joint regression model. In addition to individual-SNP analysis, we performed gene-based association testing. Results Our study population consisted of 538 adults (median age 40 years) who were predominantly White (76%) males (71%) admitted to our center from 2007–2014 with small-to-moderate-sized burns (median burn size 6% total body surface area). Of 2,146 SNPs tested, a rare missense variant in the PTPN5 gene (rs56234898; minor allele frequency 1.5%) was significantly associated with decreased severity of post-burn HTS (P = 1.3×10−6). In gene-based analysis, PTPN5 (P = 1.2×10−5) showed a significant association and BDNF (P = 9.5×10−4) a borderline-significant association with HTS severity. Conclusions We report PTPN5 as a novel genetic locus associated with HTS severity. PTPN5 is a MAPK inhibitor expressed in neurons, suggesting a potential role for neurotrophic factors and neuroinflammatory signaling in HTS pathophysiology. PMID:26872063

  14. Use of an artificial dermis (Integra) for the reconstruction of extensive burn scars in children. About 22 grafts.

    PubMed

    Groos, N; Guillot, M; Zilliox, R; Braye, F M

    2005-06-01

    We used an artificial dermis (Integra) for the reconstruction of extensive burn scars in children. Integra was initially developed for the primary coverage of acute burns, but several authors report good experiences with Integra for reconstructive surgery. We present a group of 10 children who underwent Integra grafting at 22 different operational sites. Five children received several grafts with Integra. On average, 260 cm(2) per session were grafted. We compared the surface of Integra on the day of grafting and then again on the evaluation day to measure the secondary retraction of the grafts. Complications (infection of Integra, failure of the epidermal graft) were observed in 5 cases. At the final evaluation, 20 grafts were visible. The surface of the Integra graft represented less than 50% of the initial surface in 7 cases, 51-75% in 5 cases and more than 76% in 8 cases. The disadvantages of Integra in reconstructive surgery are that two operative procedures are necessary and the recurrence of contraction seems to be more significant than with full thickness auto grafts. However, Integra has many advantages: the immediate availability of large quantities, the simplicity and reliability of the technique, the pliability and the cosmetic aspect of the resulting coverage. In light of these preliminary results, Integra appears to offer a new alternative for the reconstruction of extensive burn scars in children. PMID:15999312

  15. A comparative analysis of a fixed thresholding vs. a classification tree approach for operational burn scar detection and mapping

    NASA Astrophysics Data System (ADS)

    Kontoes, C. C.; Poilvé, H.; Florsch, G.; Keramitsoglou, I.; Paralikidis, S.

    2009-10-01

    The scope of this paper is to demonstrate, evaluate and compare two burn scar mapping (BSM) approaches developed and applied operationally in the framework of the RISK-EOS service element project within the Global Monitoring for Environment and Security (GMES) program funded by ESA ( http://www.risk-eos.com). The first method is the BSM_NOA, a fixed thresholding method using a set of specifically designed and combined image enhancements, whilst the second one is the BSM_ITF, a decision tree classification approach based on a wide range of biophysical parameters. The two methods were deployed and compared in the framework of operational mapping conditions set by RISK-EOS standards, based either on sets of uni- or multi-temporal satellite images acquired by Landsat 5 TM and SPOT 4 HRV. The evaluation of the performance of the two methods showed that either in uni- or multi-temporal acquisition mode, the two methods reach high detection capability rates ranging from 80% to 91%. At the same time, the minimum burnt area detected was of 0.9-1.0 ha, despite the coarser spatial resolution of Landsat 5 TM sensor. Among the advantages of the satellite-based approaches compared to conventional burn scar mapping, are cost-efficiency, repeatability, flexibility, and high spatial and thematic accuracy from local to country level. Following the catastrophic fire season of 2007, burn scar maps were generated using BSM_NOA for the entirety of Greece and BSM_ITF for south France in the framework of the RISK-EOS/GMES Services Element project.

  16. Expression and role of IL-15 in post-burn hypertrophic scars.

    PubMed

    Castagnoli, C; Trombotto, C; Ariotti, S; Millesimo, M; Ravarino, D; Magliacani, G; Ponzi, A N; Stella, M; Teich-Alasia, S; Novelli, F; Musso, T

    1999-08-01

    Hypertrophic scarring is a skin disorder that occurs after wounding and thermal injury. There is accumulating evidence that immunologic processes such as infiltration of activated T lymphocytes and altered cytokine production may play a role in the formation of hypertrophic scars. Interleukin-15, a cytokine identified as a T cell growth factor, also acts as a chemoattractant for T cells and has pro-inflammatory properties. We investigated the expression and the role of this cytokine in hypertrophic scarring. IL-15 expression was compared in skin biopsies of hypertrophic scars (HS) both in active (AHS) and in remission (RHS) phases, in normotrophic scars (NTS) and in normal skin using reverse transcriptase-polymerase chain reaction and immunohistochemistry. IL-15 expression in HS was significantly higher than in NTS or normal skin. Furthermore, AHS expressed higher levels of IL-15 than RHS. Immunohistologic analysis of AHS samples showed strong IL-15 immunoreactivity in keratinocytes and Langerhans cells in the epidermis and in macrophages, fibroblasts, and dermal dendritic cells in the dermis. High levels of IL-15 expression in AHS correlated with abundant infiltration of activated CD3+ cells. Ex vivo experiments indicate that IL-15 can sustain the proliferative response of T cells derived from AHS but not from RHS and NTS. In addition, IL-15 prevents both cytokine deprivation and activation-induced apoptosis of T cells derived from AHS. Taken together, these results suggest that IL-15 can be involved in the recruitment, proliferation, and apoptosis inhibition of T cells in AHS. The findings that the evolution from an AHS to a RHS is associated with a decrease in IL15 expression, and with a loss of IL-15 responsiveness in ex vivo-cultured T cells, indicate that this cytokine plays an important role in the biology of pathologic scar formation. PMID:10469310

  17. Physical rehabilitation of pediatric burns

    PubMed Central

    Atiyeh, B.; Janom, H.H.

    2014-01-01

    Summary Significant improvements have been made in the acute treatment of pediatric burn injuries over the past 3 decades which have significantly decreased mortality. Each year, more burned children are necessitating serious medical attention during their convalescence. For children with serious consequences resulting from burns that can persist from childhood through adolescence into adulthood, the value of long-term rehabilitation cannot be over stated. Burn injury management should not focus only on the immediate treatment. Long-term functional outcome and the required rehabilitation that burn victims must go through should be given equal if not more attention. The present is a review of the available modalities utilized for the physical rehabilitation of convalescent pediatric burns in order to overcome the catabolic state, improve muscle power and fitness, reduce disfiguring scars and prevent contractures. PMID:25249846

  18. [The Treatment of Major Burn Injuries].

    PubMed

    Lin, Yu-Hsun; Lin, Hsiu-Hua; Shi, Li-Ping; Yeong, Eng-Kean

    2016-02-01

    Major burn injuries constitute a systemic disease. In addition to completely understanding the mechanisms of wound healing, precise burn depth and area assessment is critical to the successful management of burn injuries. The recent advancements in post-burn fluid resuscitation, tangential burn excision and grafting, effective enteral tube feeding, and aggressive sepsis treatment have helped greatly increase the survival rates for major burn injuries. However, the restricted joint motion that results from hypertrophic scar contracture remains the main challenge facing burn survivors. In conclusion, as the course of the treatment and rehabilitation is prolonged and multifaceted, a complete treatment plan is always necessary in addition to teamwork among physicians, nurses, social workers, physical therapists, and psychologists. Finally, social return is the final goal of treatment and may be achieved only through mutual support and understanding among the members of the burn treatment and rehabilitation team. PMID:26813057

  19. A histological study on the effect of pressure therapy on the activities of myofibroblasts and keratinocytes in hypertrophic scar tissues after burn.

    PubMed

    Li-Tsang, Cecilia W P; Feng, Beibei; Huang, Lin; Liu, Xusheng; Shu, Bin; Chan, Yvonne T Y; Cheung, Kwok-Kuen

    2015-08-01

    Although pressure therapy (PT) has been widely used as the first-line treatment for hypertrophic scars (HS), the histopathological changes involved have seldom been studied. This study aimed to examine the longitudinal effect of PT on the histopathological changes in HS. Ten scar samples were selected from six patients with HS after burn and they were given a standardized PT intervention for 3 months while 16 scar samples were obtained on those without PT. The scar biopsies were collected pre-treatment, 1 and 3 months post-intervention for both clinical and histopathological examinations. Clinical assessments demonstrated significant improvement in the thickness and redness of the scars after PT. Histological examination revealed that cell density in the dermal layer was markedly reduced in the 3-months post-pressurized scar tissues, while the arrangement of the collagen fiber was changed from nodular to wave-like pattern. The α-smooth muscle actin immunoreactivity was significantly decreased after 1-month pressure treatment. There was a significant reduction of myofibroblasts population and a concomitant increase in the apoptotic index in the dermal layer in the 3-months' post-pressurized scars. A significant negative correlation was found between the myofibroblasts population and the apoptotic index. The keratinocyte proliferation was found inhibited after PT. Results demonstrated that PT appeared to promote HS maturation by inhibiting the keratinocyte proliferation and suppressing myofibroblasts population, the latter possibly via apoptosis. PMID:25681960

  20. [I Am an Occupational Therapist. I Will Accompany You Through the Process of Burn Rehabilitation].

    PubMed

    Chen, Sheng-Sung

    2016-02-01

    Burn injuries nearly always occur by accident. Burn injuries that cover large areas of the body typically cause hypertrophic scarring and joint contractures that affect the ability of the burn patient to handle normal activities of daily living. Occupational therapists begin the related interventions as early as possible, and patients require rehabilitation continuously until scar maturation. The present article provides an overview of the approach that occupational therapists should take in treating burn patients. Key elements of this approach include creating a burn rehabilitation program and helping patients achieve independence in their activities of daily living by applying individual assistive devices. The goal of this program is to allow burn patients to return to the workplace and to a normal life. We hope that this article makes more specialists aware of the proper approach to occupational therapy for burn patients and reduces the incidence of post-burn-injury sequelae. PMID:26813062

  1. Quality of pediatric second-degree burn wound scars following the application of basic fibroblast growth factor: results of a randomized, controlled pilot study .

    PubMed

    Hayashida, Kenji; Akita, Sadanori

    2012-08-01

    Pediatric burn wounds present unique challenges. Second-degree burns may increase in size and depth, raising concerns about healing and long-term scarring. Results of a clinical study in adults with second-degree burn wounds suggest that application of basic fibroblast growth factor (bFGF) may reduce time to second-intention healing and result in a more cosmetically acceptable scar. To evaluate the effect of this treatment on pediatric patients with deep second- degree burn wounds, 20 pediatric patients ranging in age from 8 months to 3 years (average 1 year, 3 months [± 6 months]) with a total of 30 burn wounds from various causes were allocated either the growth factor (treatment, n = 15) or an impregnated gauze treatment (control, n = 15). Wounds still exudative (not healed) after 21 days were covered with a split-thickness skin graft. All wounds were clinically assessed until healed and after 1 year. A moisture meter was used to assess scars of wounds healing by secondary intention. A color meter was used to evaluate grafted wounds. Five wounds in each group required grafting. Skin/scar color match was significantly closer to 100% in the treatment than in the control group (P <0.01). Wounds not requiring grafting were no longer exudative after 13.8 (± 2.4) and 17.5 (± 3.1) days in the treatment (n = 10) and control group (n = 10), respectively (P <0.01). After 1 year, scar pigmentation, pliability, height, and vascularity were also significantly different (P <0.01) between the groups. Hypertrophic scars developed in 0 of 10 wounds in the treatment and in three of 10 wounds in the control group, and effective contact coefficient, transepidermal water loss, water content, and scar thickness were significantly greater in control group (P <0.01). Both the short- and long-term results of this treatment in pediatric burn patients are encouraging and warrant further research. PMID:22879314

  2. Comparing parent and child perceptions of stigmatizing behavior experienced by children with burn scars.

    PubMed

    Lawrence, John W; Rosenberg, Laura; Mason, Shawn; Fauerbach, James A

    2011-01-01

    This study examined perceptions of stigmatization in a sample of 85 pediatric burn survivors and their parents. Survivors and a parent independently completed the Perceived Stigmatization Questionnaire (PSQ) rating the frequency that the child experienced three types of stigmatizing behaviors: absence of friendly behavior, confused and staring behavior, and hostile behavior. The sample was divided into a high (top 25%) and low (bottom 75%) perceived stigmatization groups. The mean ratings of parents did not significantly differ from that of children reporting low stigmatization. The mean PSQ parent ratings were significantly lower than those of children reporting high stigmatization. Additionally, the concordance on PSQ subscale scores within child-parent dyads was significantly lower in children reporting high stigmatization relative to child-parent dyads of children reporting low stigmatization. Children surviving burns may experience stigmatization that is under-perceived by their parents. Clinicians should be alert to this potential discrepancy. PMID:21074503

  3. Rehabilitation of the burn patient

    PubMed Central

    Procter, Fiona

    2010-01-01

    Rehabilitation is an essential and integral part of burn treatment. It is not something which takes place following healing of skin grafts or discharge from hospital; instead it is a process that starts from day one of admission and continues for months and sometimes years after the initial event. Burns rehabilitation is not something which is completed by one or two individuals but should be a team approach, incorporating the patient and when appropriate, their family. The term ‘Burns Rehabilitation’ incorporates the physical, psychological and social aspects of care and it is common for burn patients to experience difficulties in one or all of these areas following a burn injury. Burns can leave a patient with severely debilitating and deforming contractures, which can lead to significant disability when left untreated. The aims of burn rehabilitation are to minimise the adverse effects caused by the injury in terms of maintaining range of movement, minimising contracture development and impact of scarring, maximising functional ability, maximising psychological wellbeing, maximising social integration PMID:21321643

  4. A fully automatic processing chain to produce Burn Scar Mapping products, using the full Landsat archive over Greece

    NASA Astrophysics Data System (ADS)

    Kontoes, Charalampos; Papoutsis, Ioannis; Herekakis, Themistoklis; Michail, Dimitrios; Ieronymidi, Emmanuela

    2013-04-01

    Remote sensing tools for the accurate, robust and timely assessment of the damages inflicted by forest wildfires provide information that is of paramount importance to public environmental agencies and related stakeholders before, during and after the crisis. The Institute for Astronomy, Astrophysics, Space Applications and Remote Sensing of the National Observatory of Athens (IAASARS/NOA) has developed a fully automatic single and/or multi date processing chain that takes as input archived Landsat 4, 5 or 7 raw images and produces precise diachronic burnt area polygons and damage assessments over the Greek territory. The methodology consists of three fully automatic stages: 1) the pre-processing stage where the metadata of the raw images are extracted, followed by the application of the LEDAPS software platform for calibration and mask production and the Automated Precise Orthorectification Package, developed by NASA, for image geo-registration and orthorectification, 2) the core-BSM (Burn Scar Mapping) processing stage which incorporates a published classification algorithm based on a series of physical indexes, the application of two filters for noise removal using graph-based techniques and the grouping of pixels classified as burnt to form the appropriate pixels clusters before proceeding to conversion from raster to vector, and 3) the post-processing stage where the products are thematically refined and enriched using auxiliary GIS layers (underlying land cover/use, administrative boundaries, etc.) and human logic/evidence to suppress false alarms and omission errors. The established processing chain has been successfully applied to the entire archive of Landsat imagery over Greece spanning from 1984 to 2012, which has been collected and managed in IAASARS/NOA. The number of full Landsat frames that were subject of process in the framework of the study was 415. These burn scar mapping products are generated for the first time to such a temporal and spatial extent and are ideal to use in further environmental time series analyzes, production of statistical indexes (frequency, geographical distribution and number of fires per prefecture) and applications, including change detection and climate change models, urban planning, correlation with manmade activities, etc.

  5. Race and melanocortin 1 receptor polymorphism R163Q are associated with post-burn hypertrophic scarring: a prospective cohort study

    PubMed Central

    Sood, Ravi F.; Hocking, Anne M.; Muffley, Lara A.; Ga, Maricar; Honari, Shari; Reiner, Alexander P.; Rowhani-Rahbar, Ali; Gibran, Nicole S.

    2015-01-01

    The genetic determinants of post-burn hypertrophic scarring (HTS) are unknown, and melanocortin 1 receptor (MC1R) loss-of-function leads to fibrogenesis in experimental models. To examine the associations between self-identified race and MC1R single- nucleotide polymorphisms (SNPs) with severity of post-burn HTS, we conducted a prospective cohort study of burned adults admitted to our institution over 7 years. Subjects were evaluated using the Vancouver Scar Scale (VSS), asked to rate their itching, and genotyped for 8 MC1R SNPs. Testing for association with severe HTS (VSS>7) and itch severity (0-10) was based on multivariate regression with adjustment for known risk factors. Of 425 subjects analyzed, 77% identified as White. The prevalence of severe HTS (VSS>7) was 49%, and the mean itch score was 3.9. In multivariate analysis, Asian (prevalence ratio [PR] 1.54; 95% CI: 1.13-2.10), Black/African American (PR 1.86; 95% CI: 1.42-2.45), and Native American (PR 1.87; 95% CI: 1.48-2.35) race were independently associated with severe HTS. MC1R SNP R163Q was also significantly (P<0.001) associated with severe HTS. Asian race (linear regression coefficient 1.32; 95% CI: 0.23-2.40) but not MC1R SNP genotype was associated with increased itch score. We conclude that MC1R genotype may influence post-burn scarring. PMID:26030184

  6. Laser scar revision: A review.

    PubMed

    Khatri, Khalil A; Mahoney, Danielle L; McCartney, Melissa J

    2011-04-01

    Surgery, burns, wounds, and inflammatory processes can lead to the development of a variety of different scars. Scars are categorized as hypertrophic, keloid, atrophic and acne scars. Different treatments are utilized for each scar type. The evolution of scar treatment has led to the advancement of lasers for the improvement of all scar types. Non-ablative lasers such as the pulsed dye laser have been shown to be effective in the treatment of hypertrophic and erythematous scars. Ablative lasers, the carbon dioxide (CO(2)) and erbium:YAG (Er:YAG), were some of the first lasers that were proven to be effective in the treatment of atrophic acne scars. Further developments in laser technology have led to non-ablative and ablative fractional devices that improve scar appearance and are better tolerated than ablative CO(2) and Er:YAG. This article will review scars and the laser options for scar revision. PMID:21401378

  7. Clinical outcomes from a foam wedge splinting program for axillary contracture prevention in the intensive care unit.

    PubMed

    Godleski, Matthew; Holden, Mary Sullivan; Luby, Darcie; Weitzenkamp, David; Boimbo, Sandra; Lindberg, Gordon

    2014-01-01

    Preventing scar contracture after burn injury is a critical goal during recovery. Although the need for intervention is well-understood, data on specific techniques are limited. The study's objective is to provide data for the use of a foam abduction wedge in terms of safety, effectiveness, and patient and caregiver satisfaction through a prospective, single-arm trial. All patients presenting with a burn injury that required grafting in the axillary region and placed them at risk for shoulder joint contracture were offered inclusion. Patient outcomes were recorded for the duration of their burn intensive care unit admission. Ten subjects completed the protocol with a mean duration of wedge use of 41.5 32.5 days. At discharge, the mean shoulder abduction was 132 38 on the left and 118 22 on the right. The mean shoulder flexion was 132 31 on the left and 123 29 on the right. As much as 90% of the subjects had greater than 90 of shoulder abduction and flexion at discharge. There were no observations of worsening burn injury wounds, graft failure, or new pressure-related wounds. One patient was found to have an upper-extremity peripheral nerve injury that was not clearly associated with the splint. Patient and nursing surveys indicated areas of satisfaction as well as areas for potential improvement. This study illustrates the anticipated clinical outcomes and care issues associated with the use of a specific contracture prevention method used in the burn intensive care unit setting as well as identifying areas for future research. PMID:24918948

  8. Race and Melanocortin 1 Receptor Polymorphism R163Q Are Associated with Post-Burn Hypertrophic Scarring: A Prospective Cohort Study.

    PubMed

    Sood, Ravi F; Hocking, Anne M; Muffley, Lara A; Ga, Maricar; Honari, Shari; Reiner, Alexander P; Rowhani-Rahbar, Ali; Gibran, Nicole S

    2015-10-01

    The genetic determinants of post-burn hypertrophic scarring (HTS) are unknown, and melanocortin 1 receptor (MC1R) loss-of-function leads to fibrogenesis in experimental models. To examine the associations between self-identified race and MC1R single-nucleotide polymorphisms (SNPs) with severity of post-burn HTS, we conducted a prospective cohort study of burned adults admitted to our institution over 7 years. Subjects were evaluated using the Vancouver Scar Scale (VSS), asked to rate their itching, and genotyped for 8 MC1R SNPs. Testing for association with severe HTS (VSS>7) and itch severity (0-10) was based on multivariate regression with adjustment for known risk factors. Of 425 subjects analyzed, 77% identified as White. The prevalence of severe HTS (VSS>7) was 49%, and the mean itch score was 3.9. In multivariate analysis, Asian (prevalence ratio (PR) 1.54; 95% CI: 1.13-2.10), Black/African American (PR 1.86; 95% CI: 1.42-2.45), and Native American (PR 1.87; 95% CI: 1.48-2.35) race were independently associated with severe HTS. MC1R SNP R163Q was also significantly (P<0.001) associated with severe HTS. Asian race (linear regression coefficient 1.32; 95% CI: 0.23-2.40) but not MC1R SNP genotype was associated with increased itch score. We conclude that MC1R genotype may influence post-burn scarring. PMID:26030184

  9. California Burn Scars

    Atmospheric Science Data Center

    2014-05-15

    ... Imaging SpectroRadiometer (MISR). The images were created by displaying red, near-infrared and green spectral band data from ... Multi-angle Imaging SpectroRadiometer observes the daylit Earth continuously and every 9 days views the entire Earth between 82 degrees ...

  10. [The treatment of a post-burn deformity and contracture of the neck, using extended flaps with axial type of blood supply].

    PubMed

    Zhernov, A A; Zhernov, An A

    2012-03-01

    Experience of treatment of 24 patients, suffering neck deformity and contracture, using stretched flaps with axial type of blood circulation, was summarized. In total 43 expanders were implanted. The cutaneo-fascial flaps stretching was performed in the neck and thorax. In all the flaps a nutrition artery was included. The neck-brachial flaps, including supraclavicular artery, were applied in 25 (58.1%) patients, the neck-thoracic flaps, using superficial neck artery--in 12 (27.91%), the occipital-neck flaps on a musculocutaneous perforating vessels of occipital artery--in 6 (13.95%). The methods of the expander implantation, the stretching, transposition regimes of plastic material and its fixation were elaborated. The donor sites were closed using stretched tissues, left in place after formation of flaps. Flaps were fixed, using mechanical method of the tissues connection with duplicature formation from deepidermized portion of cicatrix or with polypropylene mesh, which played a role of a dense framework. Then a strong connective tissue bolt was formed, securely fixing transposedstretched tissues. While application of a complex-component vascularized flaps a suppuration have occurred in 3 (6.97%), partial necrosis--in 2 (4.64%) observations. Inclusion of nutritive vessels permit to form large size flaps with a small risk of necrosis occurrence. The stretched perforant flaps application permits to achieve positive result in 95.3% of observations--in immediate and in 81.82%--in far remote period. PMID:22702123

  11. Joint Contracture Orthosis (JCO)

    NASA Technical Reports Server (NTRS)

    Lunsford, Thomas R.; Parsons, Ken; Krouskop, Thomas; McGee, Kevin

    1997-01-01

    The purpose of this project was to develop an advanced orthosis which is effective in reducing upper and lower limb contractures in significantly less time than currently required with conventional methods. The team that developed the JCO consisted of an engineer, orthotist, therapist, and physician.

  12. OUTCOME OF PHYSICAL THERAPY AND SPLINTING IN HAND BURNS INJURY. OUR LAST FOUR YEARS’ EXPERIENCE

    PubMed Central

    Rrecaj, Shkurta; Hysenaj, Hajrie; Martinaj, Merita; Murtezani, Ardiana; Ibrahimi-Kacuri, Dafina; Haxhiu, Bekim; Buja, Zene

    2015-01-01

    Objective: Burn injuries in hands are much more complex and the appearance of contractures is a common complication. Hand burn injuries often result in limited functionality, flexion and extension of fingers and present a major hindrance in rehabilitation. The aim of physical therapy and splinting after hand burn injury is to maintain mobility, prevent the development of the contracture and to promote the functionality of hand and good cosmetic results. The purpose of this study is to presents our experience of 38 children with hand burn injuries, admitted and treated at the Department of Plastic Surgery, UCCK-Pristina, Kosovo, during the years 2012-2015. Methods: Physical therapy is focused on active/passive range of motion in affected joints, management of cicatrix, strengthening exercise, coordination and use of splints for correction contractures. Patients were evaluated in three, six months and the definitive evaluation is done after 9 months of physical therapy and splinting. Results: We have improvement in range of motion (ROM), functionality, coordination, muscle force, decrease of keloids scars. Conclusion: This study shows the importance of physical therapy and splinting, achieving good results in preventing contracture, improving range of motion, muscle force and good cosmetic results. PMID:26889095

  13. Study on Surgical Management of Post Burn Hand Deformities

    PubMed Central

    Ahmed, Firdos; Jash, Prabir Kumar; Gupta, Madhumita; Suba, Santanu

    2015-01-01

    Context Functionality of the hands is the major determinants of the quality of life in burns survivors. If contractures or scarring affect the dominant hand, as they do on most occasions, the vocation and there by the economic status of the patient suffer. Aim The aim of this study is to evaluate the different surgical procedures for resurfacing after release of post-burn hand contractures in terms of functional recovery and aesthetic outcome. Settings and Design It’s a prospective, non-randomised study of 50 patients admitted and undergoing surgical reconstructive procedures for post burn hand contractures in our plastic surgery department. Materials and Methods Resurfacing procedures were done according to type of contracture with individualisation for each case. All cases were followed up with physiotherapy and splinting advices. Functional and aesthetic outcome and recurrence of contracture for each procedure was noted at 6 months. Results Forty seven percent of the cases were reconstructed with skin grafting, 30% cases with Z plasties and 23% with flap coverage. Split thickness skin grafts (STSG) and full thickness graft (FTSG) reconstructed cases had good recovery of joint mobility in 43% and 75% of cases respectively. Reconstructive procedures were aesthetically acceptable to the patients in 63%, 75% and 94% of STSG, FTSG and Z plasty cases respectively. Recurrence was seen in 17% of STSG done cases. Conclusion Most of the cases can be resurfaced with skin grafting and few cases have clear indication for flap coverage which needs to be planned and executed cautiously. Z plasties with proper planning gives maximum length gain with no donor morbidity as other procedures. Postoperative physiotherapy and splinting is must for better outcome in all cases. PMID:26435994

  14. Acne Scars

    MedlinePlus

    ... Loss Sagging Skin Scars Skin Growths Skin Lesions Spider Veins Stretch Marks Sun-damaged Skin Unwanted Hair ... Loss Sagging Skin Scars Skin Growths Skin Lesions Spider Veins Stretch Marks Sun-damaged Skin Unwanted Hair ...

  15. Scar revision

    PubMed Central

    Sharma, Mohit; Wakure, Abhijeet

    2013-01-01

    Most surgical patients end up with a scar and most of these would want at least some improvement in the appearance of the scar. Using sound techniques for wound closure surgeons can, to a certain extent, prevent suboptimal scars. This article reviews the principles of prevention and treatment of suboptimal scars. Surgical techniques of scar revision, i.e., Z plasty, W plasty, and geometrical broken line closure are described. Post-operative care and other adjuvant therapies of scars are described. A short description of dermabrasion and lasers for management of scars is given. It is hoped that this review helps the surgeon to formulate a comprehensive plan for management of scars of these patients. PMID:24516292

  16. Validation of a vertical progression porcine burn model.

    PubMed

    Singer, Adam J; Hirth, Douglas; McClain, Steve A; Crawford, Laurie; Lin, Fubao; Clark, Richard A F

    2011-01-01

    A major potential goal of burn therapy is to limit progression of partial- to full-thickness burns. To better test therapies, the authors developed and validated a vertical progression porcine burn model in which partial-thickness burns treated with an occlusive dressing convert to full-thickness burns that heal with scarring and wound contraction. Forty contact burns were created on the backs and flanks of two young swine using a 150 g aluminum bar preheated to 70°C, 80°C, or 90°C for 20 or 30 seconds. The necrotic epidermis was removed and the burns were covered with a polyurethane occlusive dressing. Burns were photographed at 1, 24, and 48 hours as well as at 7, 14, 21, and 28 days postinjury. Full-thickness biopsies were obtained at 1, 4, 24, and 48 hours as well as at 7 and 28 days. The primary outcomes were presence of deep contracted scars and wound area 28 days after injury. Secondary outcomes were depth of injury, reepithelialization, and depth of scars. Data were compared across burn conditions using analysis of variance and χ(2) tests. Eight replicate burns were created with the aluminum bar using the following temperature/contact-time combinations: 70/20, 70/30, 80/20, 80/30, and 90/20. The percentage of burns healing with contracted scars were 70/20, 0%; 70/30, 25%; 80/20, 50%; 80/30, 75%; and 90/20, 100% (P = .05). Wound areas at 28 days by injury conditions were 70/20, 8.1 cm(2); 70/30, 7.8 cm(2); 80/20, 6.6 cm(2); 80/30, 4.9 cm(2); and 90/20, 4.8 cm(2) (P = .007). Depth of injury judged by depth of endothelial damage for the 80/20 and 80/30 burns at 1 hour was 36% and 60% of the dermal thickness, respectively. The depth of injury to the endothelial cells 1 hour after injury was inversely correlated with the degree of scar area (Pearson's correlation r = -.71, P < .001). Exposure of porcine skin to an aluminum bar preheated to 80°C for 20 or 30 seconds results initially in a partial-thickness burn that when treated with an occlusive dressing progresses to a full-thickness injury and heals with significant scarring and wound contracture. PMID:21841494

  17. Emerging Therapies for Scar Prevention

    PubMed Central

    Block, Lisa; Gosain, Ankush; King, Timothy W.

    2015-01-01

    Significance: There are ∼12 million traumatic lacerations treated in the United States emergency rooms each year, 250 million surgical incisions created worldwide every year, and 11 million burns severe enough to warrant medical treatment worldwide. In the United States, over $20 billion dollars per year are spent on the treatment and management of scars. Recent Advances: Investigations into the management of scar therapies over the last decade have advanced our understanding related to the care of cutaneous scars. Scar treatment methods are presented including topical, intralesional, and mechanical therapies in addition to cryotherapy, radiotherapy, and laser therapy. Critical Issues: Current treatment options for scars have significant limitations. This review presents the current and emerging therapies available for scar management and the scientific evidence for scar management is discussed. Future Directions: Based upon our new understanding of scar formation, innovative scar therapies are being developed. Additional research on the basic science of scar formation will lead to additional advances and novel therapies for the treatment of cutaneous scars. PMID:26487979

  18. Flooding after fire: Impacts of the 2013 Colorado Front Range floods on the High Park Fire burn scar

    NASA Astrophysics Data System (ADS)

    Kampf, S. K.; Schmeer, S.; MacDonald, L. H.; Brogan, D. J.; Nelson, P. A.

    2014-12-01

    In June 2012, the High Park Fire west of Fort Collins, CO burned 350 km2 of steep forested terrain, leading to elevated runoff and erosion in watersheds draining the burned area. Under the auspices of a NSF RAPID grant we began monitoring precipitation, hillslope-scale sediment production, stream stage, and channel geomorphic change in Skin Gulch and Hill Gulch, two 15 km2 watersheds within the High Park Fire. Short-duration summer thunderstorms are typically the dominant cause of post-fire runoff and erosion in the central and southern Rocky Mountains, but in September 2013 an extreme, long duration storm dropped more than 200 mm of rain in 48 hours. This storm provided a unique opportunity to compare the hydrologic and geomorphic effects of smaller summer thunderstorms to those of the long duration, high magnitude September event. Mean June-August 2013 precipitation in these watersheds was 125 mm, less than half the total for the September 2013 event, but this summer precipitation led to a mean sediment yield of 8 Mg ha-1, about double the mean sediment yield of the much larger September storm. Hillslope sediment production was highest during summer storms that were shorter duration but had higher 5-15 minute precipitation intensities than the September storm. These localized summer 2013 storms led to flashy pulses of flow in the channel network that caused relatively small amounts of channel aggradation or incision. In contrast, the September 2013 event produced sustained high flows that led to substantial geomorphic change throughout the channel network, with more than 2 m of aggradation at the outlet of Skin Gulch. These results indicate that the high intensity summer thunderstorms were most effective at mobilizing sediment from hillslopes, but the more spatially uniform rainfall during the September event produced much more dramatic downstream channel geomorphic change.

  19. Changes in the expression of epidermal differentiation markers at sites where cultured epithelial autografts were transplanted onto wounds from burn scar excision.

    PubMed

    Kadoya, Kuniko; Amano, Satoshi; Nishiyama, Toshio; Inomata, Shinji; Tsunenaga, Makoto; Kumagai, Norio; Matsuzaki, Kyoichi

    2016-06-01

    This study investigated the recovery process during which grafted cultured epithelium formed normal epidermis. The subjects were 18 patients whose burn scars were excised at a depth not exposing the fat layer and who subsequently received cultured epithelial autografts. A total of 24 samples were obtained from the grafted sites: 6 samples within 6 weeks (stage 1), 5 samples after 6 weeks and within 6 months (stage 2), 6 samples after 6 months and within 18 months (stage 3) and 7 samples beyond 18 months (stage 4) after transplantation. These samples were stained for monoclonal antibodies against filaggrin, transglutaminase (TG), cytokeratin 6 and involucrin. Their expressions were examined in the epidermis. The expression patterns were classified using a six-grade scale. The grades of filaggrin and TG were significantly higher at stage 3 and 4 compared with stage 1. There was a marginally significant increase in the grade of cytokeratin 6 at stage 3 and it was significantly higher at stage 4 compared with stage 1. These results showed that wound healing continued at a molecular level until the end of stage 3. The recovery of involucrin was delayed compared with that of other markers. TG and involucrin are thought to be regulated independently at the grafted sites. PMID:25040836

  20. Burns.

    PubMed

    Ellison, Deborah L

    2013-06-01

    Burns are a leading cause of accidental injury and death. The American Burn Association statistics from 2001 to 2010 show that 68% of burns happen at home, 44% are from fires/flames, and 60% to 70% happen to white men. Smoke inhalation is the leading cause of adult death caused by fires. A patient with a 78% total body surface area burn has a 50% chance of survival. Burn injuries are described in terms of causative agents, depth, and severity. Crucial treatments for people with burns include assessment, stabilization, transfer to a burn unit, and fluid resuscitation. PMID:23692944

  1. Management of severe burn injuries with topical heparin: the first evidence-based study in Ghana

    PubMed Central

    Agbenorku, Pius; Fugar, Setri; Akpaloo, Joseph; Hoyte-Williams, Paa E; Alhassan, Zainab; Agyei, Fareeda

    2013-01-01

    Conventional therapy for burns has always produced a nightmarish illness for patients. The lack of the ability to prevent contractures often produces dysfunctional limbs and the ugly scars resulting from severe burns are an ongoing reminder of this lengthy painful illness. This study is to determine the effectiveness of topical heparin in burns management among some patients at the Burns Intensive Care Unit (BICU) of the Komfo Anokye Teaching Hospital (KATH), Kumasi, Ghana. Patients for this prospective study were burns victims who were transported to the Accident and Emergency Center of KATH. Complete clerking of the patients and related information were taken. Six patients with ages ranging from 5-35 years, TBSA 5-42% and a combination of 2° and 3° burns were enrolled in the case study. Anatomical locations of the burns included: face, neck, trunk and limbs. Using topical heparin produced smooth skin in two patients: Patients 3 and 5 who reported on Post-burn Day 85 and 116 at the BICU. Five out of the six patients assessed the degree of pain; before treatment with heparin, all five patients stated they were experiencing severe pains, however, three (60.0%) of the patients stated they experienced no pain at all while two (40.0%) were experiencing mild pain after topical heparin application. Heparin was observed to be very effective in the management of burn injuries in the patients studied. It was effective in reduction of pain and prevention of scars and contractures. However, due to the small number of patients and lack of control for the wound healing, a firm recommendation for the use of heparin therapy in burns cannot be made and further studies would be required to establish its use especially in the African population. PMID:23386983

  2. Burns

    MedlinePlus

    A burn is damage to your body's tissues caused by heat, chemicals, electricity, sunlight or radiation. Scalds from hot ... and gases are the most common causes of burns. Another kind is an inhalation injury, caused by ...

  3. Burns

    MedlinePlus

    ... sure the person is up to date on tetanus immunization. MAJOR BURNS If someone is on fire, ... Ointments or creams applied to the burned areas Tetanus immunization, if not up to date The outcome ...

  4. Burns

    MedlinePlus

    ... support. What is on the horizon for burn research? Improving methods for wound healing and tissue repair offer tremendous opportunities to enhance the quality of life for burn patients and may also help ... of burn research does the National Institute of General Medical Sciences ( ...

  5. Dynamics associated with total aboveground biomass, C, nutrient pools, and biomass burning of primary forest and pasture in Rondo?nia, Brazil during SCAR-B

    NASA Astrophysics Data System (ADS)

    Guild, Liane S.; Kauffman, J. Boone; Ellingson, Lisa J.; Cummings, Dian L.; Castro, Elmar A.; Babbitt, Ron E.; Ward, Darold E.

    1998-12-01

    Burning of slashed tropical forests and pastures is among the most significant global sources of atmospheric emissions, yet the composition of the fuels and fires that creates these emissions is not well characterized. As part of the Smoke, Clouds, and Radiation-Brazil (SCAR-B) experiment, we measured total aboveground biomass (TAGB) as well as carbon, nitrogen, and sulfur pools in one cattle pasture and two slashed primary forests in Rondnia, Brazil. These pools were measured before and immediately after fires. From these data, we calculated the quantities of biomass and elements lost to the atmosphere during biomass burning. Prefire biomass in the pasture was 66 Mg ha-1; fire consumed 31% of this mass. Woody debris from the forest that occupied this site 12 years previously comprised 81% of the pasture prefire TAGB. Elemental inputs into the atmosphere (site losses) from the pasture fire were 9 Mg C ha-1, 88 kg N ha-1, and 5 kg S ha-1. Combining previous studies with this one, we calculate that the mean TAGB of Amazonian pastures is 74 Mg ha-1 with a mean combustion factor of 46%. Mean nutrient losses from pasture fires in Amazonia are 14 Mg C ha-1, 199 kg N ha-1, and 16 kg S ha-1. The TAGB of the two slashed primary forests before fire was 355 and 399 Mg ha-1 and following fire was 188 and 185 Mg ha-1 (i.e., a combustion factor of 47 and 54%), respectively. Combining this study with other studies of Amazon slashed primary forests, we calculate that the mean TAGB is 349 Mg ha-1 and the mean combustion factor is 48%. Total elemental losses arising from the primary forest slash fires in this study were notably higher than losses from the pasture site: 79 and 102 Mg C ha-1; 1019 and 1196 kg N ha-1; and 87 and 96 kg S ha-1. From this study combined with previous research in Rondnia and Par, we calculate that mean nutrient losses from primary forest slash fires are 88 Mg C ha-1, 1181 kg N ha-1, and 107 kg S ha-1. As rates of deforestation are remaining high in the Brazilian Amazon and pastures are the most frequent end product, it can be expected that these will remain the dominant sources of atmospheric emissions from Amazonia in the future.

  6. Reconstruction of the burned hand.

    PubMed

    Parry, S W

    1989-07-01

    Several basic principles of burned hand care must be kept in mind at all times. Intervention should be early and aggressive, small splints should be placed within 24 hours, and early tangential excision of the burn should be done within 72 hours. Hemostasis should be absolutely meticulous prior to grafting. Depending upon the availability of donor site skin, full-thickness skin grafts, split-thickness grafts, or meshed split-thickness grafts (expanded or not expanded) are preferred. I have found the functional and cosmetic results to decrease with use in exactly the order stated. The skin graft should be placed with stent or bolster dressings and observed for "take" early. Light active range of motion is usually begun on the tenth postoperative day. Escharotomy or fasciotomy should be performed for any signs of ischemia. In order to control edema, one should be meticulous in the positioning of burned hands, emphasizing elevation, and early range of motion exercises. Pressure garments may be employed when the wound is stable and should continue for 6 to 12 months to control hypertrophic scar formation. Linear scars should not cross any hand joints; Z-plasties are employed over the web spaces. Whenever possible, flaps should be employed to preserve all web spaces and skin grafts used to cover the remainder of the hand. I am aggressive in releasing and reconstructing late deformities such as extension contractures of the wrist, the metacarpal hand, absence of the thumb, finger contractures, and burn syndactyly. These are listed in order of treatment priority. Only in this manner can the patient be returned to "normal life." Patient self-esteem will thus be increased markedly, as will quality of life. It is strongly urged that the surgeon be "captain of the team." The key person in this treatment regimen is the hand therapist, who uses appropriate splints, range of motion exercises, and desensitization programs. I encourage the use of multiple personnel on the "burn team." This may include psychotherapists and, in children, teachers with extraordinary qualities. PMID:2673637

  7. Management of the Acutely Burned Hand.

    PubMed

    Pan, Brian S; Vu, Anthony T; Yakuboff, Kevin P

    2015-07-01

    Despite contributing a small percentage to the total body surface area, hands are the most commonly burned body part and are involved in over 90% of severe burns. Although the mortality of isolated hand burns is negligible, morbidity can be substantial given our need for functioning hands when performing activities of daily living. The greatest challenges of treating hand burns are 2-fold. First, determining the depth of injury can be difficult even for the most experienced surgeon, but despite many diagnostic options, clinical examination remains the gold standard. Second, appropriate postoperative hand therapy is crucial and requires a multidisciplinary approach with an experienced burn surgeon, hand surgeon, and hand therapist. Ultimately, the goals of treatment should include preservation of function and aesthetics. In this review, we present an approach to the management of the acutely burned hand with discussion of both conservative and surgical options. Regardless of the initial treatment decision, subsequent care for this subset of patients should be aimed at preventing debilitating postburn scar contractures that can severely limit hand function and ultimately require reconstructive surgery. PMID:26043803

  8. Chemical burns from assault: a review of seven cases seen in a Nigerian tertiary institution

    PubMed Central

    Tahir, C.; Ibrahim, B.M.; Terna-Yawe, E.H.

    2012-01-01

    Summary Chemical burns represent a major challenge for reconstructive surgeons. They are caused by exposure to acids, alkalis or other corrosive substances which result in various degrees of injury. This report highlights the challenges faced in managing such patients in a Nigerian teaching hospital. The medical records of seven patients (four females and three males) treated for chemical burns injury from January 2001 to December 2010 were retrospectively reviewed. All patients were younger than 30, with a mean age of 23.3. Most of them (85.7%) had sustained full thickness burns ranging from 8% to 33% of their body surface area. All cases were result of assaults. The male to female ratio was 1:1.3, and the average duration of hospital stay was 7.5 months. The face was affected in all patients. Patients presented with multiple deformities, like ectropion of eyelids, keratopathies, blindness, nasal deformities, microstomia, loss or deformities of the pinna, mentosternal contractures, and severe scarring of the face. Twenty-nine surgical procedures were performed, which included nasal and lip reconstruction, ectropion release, commissuroplasty, contracture release, and wound resurfacing. Management of chemical burns, especially in a developing country lacking specialised burn centres with appropriate facilities, is challenging. Prevention through public awareness campaigns, legislation for control of corrosive substances, and severe punishment for perpetrators of assaults using these substances will go a long way in reducing the incidence of chemical burns. PMID:23467188

  9. Scar Tissue.

    PubMed

    McLean, Haydn J

    2015-12-01

    Scar tissue is associated with physical wounds and their mending, but it is also descriptive in portraying the emotional scarring that occurs following adversity, resulting in potential psychological morbidity. Provided the adversity is not severe, such challenges to adaptability may provoke Andrew Solomon's process of forging meaning and building identity. Perceiving an emotional constitution as analogous to the immune system provides a metaphor for appreciating the benefits of emotional challenges, which may provoke greater emotional resilience or posttraumatic growth. PMID:26631526

  10. [Burns].

    PubMed

    Arai, Takao

    2016-02-01

    Burns extending deep into the skin and those affecting a wide surface area trigger various responses in the body and pose a serious threat to life. Therefore, the degree of severity needs to be determined accurately, and appropriate transfusion and local management should be provided accordingly. Systematic and meticulous management that considers not just the risk of death but also functional prognosis is essential from the early stage of burn injuries. Such management requires comprehensive care by a medical team concerning infections, nutrition and rehabilitation. This article outlines the current status of intensive care for severe burns. PMID:26915244

  11. Scar Management in the Pediatric and Adolescent Populations.

    PubMed

    Krakowski, Andrew C; Totri, Christine R; Donelan, Matthias B; Shumaker, Peter R

    2016-02-01

    For most children and adolescents who have developed symptomatic scars, cosmetic concerns are only a portion of the motivation that drives them and their caregivers to obtain treatment. In addition to the potential for cosmetic disfigurement, scars may be associated with a number of physical comorbidities including hypertrichosis, dyshidrosis, tenderness/pain, pruritus, dysesthesias, and functional impairments such as contractures, all of which may be compounded by psychosocial factors. Although a plethora of options for treating scars exists, specific management guidelines for the pediatric and adolescent populations do not, and evidence must be extrapolated from adult studies. New modalities such as the scar team approach, autologous fat transfer, and ablative fractional laser resurfacing suggest a promising future for children who suffer symptomatically from their scars. In this state-of-the-art review, we summarize cutting-edge scar treatment strategies as they relate to the pediatric and adolescent populations. PMID:26743819

  12. Fetal Bovine Collagen Matrix in the Treatment of a Full Thickness Burn Wound: A Case Report With Long-Term Follow-Up.

    PubMed

    Strong, Amy L; Bennett, Danielle K; Spreen, Elizabeth B; Adhvaryu, Dhaval V; Littleton, Jeffrey C; Mencer, Ernest J

    2016-01-01

    The treatment of full thickness skin wounds commonly associated with large burns continues to represent a challenging clinical entity. The current treatment for large TBSA burns is split thickness autologous skin grafting; however, this treatment often results in poor textural durability, hypertrophic scarring, and fibrotic contractures. In this case report, we describe our experience and long-term follow-up results after the application of fetal bovine collagen (FBC) matrix (PriMatrix, TEI Biosciences, Boston, MA) to burn wounds clinically assessed as full thickness that healed without the need for subsequent skin grafting. The patient presented with 25% TBSA burns and was debrided and covered with FBC on postburn day 7. By postoperative day 12, the patient had large areas of reepithelialization distributed throughout the wound bed. By postoperative day 26, the patient had significantly more areas of wound closure and was discharged. Reepithelialization and repigmentation continued, and long-term follow-up after 26 months demonstrated complete reepithelialization and nearly complete repigmentation, without the appearance of contractures or hypertrophic scarring. This case report highlights the use of FBC as a scaffold capable of dermal regeneration and spontaneous reepithelialization with an excellent long-term functional and cosmetic outcome. PMID:25494213

  13. Fetal Bovine Collagen Matrix in the Treatment of a Full Thickness Burn Wound: A Case Report With Long-Term Follow-Up

    PubMed Central

    Strong, Amy L.; Bennett, Danielle K.; Spreen, Elizabeth B.; Adhvaryu, Dhaval V.; Littleton, Jeffrey C.

    2016-01-01

    The treatment of full thickness skin wounds commonly associated with large burns continues to represent a challenging clinical entity. The current treatment for large TBSA burns is split thickness autologous skin grafting; however, this treatment often results in poor textural durability, hypertrophic scarring, and fibrotic contractures. In this case report, we describe our experience and long-term follow-up results after the application of fetal bovine collagen (FBC) matrix (PriMatrix, TEI Biosciences, Boston, MA) to burn wounds clinically assessed as full thickness that healed without the need for subsequent skin grafting. The patient presented with 25% TBSA burns and was debrided and covered with FBC on postburn day 7. By postoperative day 12, the patient had large areas of reepithelialization distributed throughout the wound bed. By postoperative day 26, the patient had significantly more areas of wound closure and was discharged. Reepithelialization and repigmentation continued, and long-term follow-up after 26 months demonstrated complete reepithelialization and nearly complete repigmentation, without the appearance of contractures or hypertrophic scarring. This case report highlights the use of FBC as a scaffold capable of dermal regeneration and spontaneous reepithelialization with an excellent long-term functional and cosmetic outcome. PMID:25494213

  14. Chemical Burn Injury in Kumasi: The Trend and Complications following and Their Management

    PubMed Central

    Akpaloo, Joseph; Chirurgie, Facharzt; Aboah, Ken; Klutsey, Ellen; Hoyte-Williams, Paa Ekow; Farhat, Boutros; Turkson, Edmund; Yorke, Joseph; Chirurgie, Facharzt; Ametih, Richard; Hussey, Romeo

    2015-01-01

    Background: A chemical burn refers to irritation and destruction of human tissue caused by exposure to a chemical, usually by direct contact with the chemical or its fumes. The study investigated the trend and complications following chemical burns and their management. Methods: The study involved a retrospective review of Burns Registry at the Burns Intensive Care Unit of the Komfo Anokye Teaching Hospital on patients who were admitted for burns from May 1, 2009 to April 30, 2013. Results: Chemical burns admissions accounted for 3.5% (n = 17) out of the total 487 burns cases, consisting of 12 males (70.6%) and 5 females (29.4%). Mean total burns surface area was 21.9%; mean length of stay in Burns Intensive Care Unit was 9.5 days. The etiological agents for the chemical burns included the following: hot caustic soda 1 (5.9%); acid 9 (53.9%)—the most common; hot ethanol 3 (17.6%); and other chemicals such as other bases, oxidizers, solvents, etc. accounted for 4 (23.5%) etiological agents. Outcome included 11 discharges (64.7%), 6 transferred out to other wards (35.3%), and 0 deaths (0.0%). The complications included severe scar contractures in 5 patients (29.4%), loss of vision: partial/total = 2 (11.8%), gross keloidal/hypertrophic scars = 10 (58.8%). Conclusions: Chemical burns are severe and often cause severe debilitating sequelae including partial/total loss of vision. But the current study showed that only a small population (3.5%) were affected by chemical burns and no death was recorded; society has to be continually conscious of chemicals, especially caustic agents, and hence take the necessary precautions so as to prevent these avoidable complications. PMID:26579354

  15. Burns

    MedlinePlus

    ... Do not use butter, ointments or any other home remedy. Do not break the blisters or remove burned ... spread the fire. READ IN EMERGENCIES A-Z Stroke Head Injury Heart Attack Resources Home Safety Checklist ACEP Coloring Book Download the Coloring ...

  16. [Report on the diagnosis and treatment of muscular contracture. The Ad Hoc Committee of the Japanese Orthopaedic Association of Muscular Contracture].

    PubMed

    1985-02-01

    Muscular contracture due to repeated intramuscular injections raised urgent questions from the medico-legal standpoint when a large number of children with quadriceps contracture was found in Yamanashi Prefecture in 1973. In 1975, the Japanese Orthopaedic Association formed an Ad Hoc Committee on Muscular Contracture to investigate the diagnosis and treatment of this particular condition. Since then, the Committee has studied the symptomatology, diagnosis, natural history, orthotic and operative treatment of quadriceps, deltoideus and gluteus contractures. The results have been reported annually to the Japanese Orthopaedic Association, and guidelines for diagnosis and treatment have been made available to its members. Quadriceps contracture can be classified into three types: the rectus femoris, vastus, and mixed types. The rectus femoris type represents 80 to 90 per cent of cases with quadriceps contracture, while the vastus type is quite rare. In both the rectus femoris and mixed types, operative treatment is suggested when the knee flexion is limited to 30 degrees or less in the prone position. Transverse division of the rectus femoris at the muscle belly is the standard operative procedure recommended for the rectus femoris type and gives very satisfactory results in most cases. In the mixed type, an additional division of the scarred portion of the vasti is needed. The ideal age for such procedures is near or after the end of growth. The vastus type is difficult to cure, but to improve the condition to a certain extent an operation is suggested when the knee flexion is limited to 45 degrees or less in the supine position. The operative procedure recommended is either release of the affected vasti at their insertion to the patella or Z-lengthening of the common tendon of the quadriceps. In deltoideus contracture, the Committee proposed a scoring system for evaluating the severity with the grade of abduction contracture and the opposite shoulder test as parameters. A score of 5 points or more indicates operative treatment. The operative procedure recommended is release of both the acromial part and the anterior fibers of the spinal part of the deltoideus. The ideal age for this procedure is 12 years or older. A dent produced by the operation distal to the acromion, however, has to be regarded as a cosmetic complication. To avoid this complication, advancement of the severed fibers of the deltoideus from the scapular spine to the acromion is needed. Such an advancement procedure is suitable for children of 14 or 15 years of age and leaves the natural round contour of the shoulder intact.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:4020223

  17. Burns functional disabilities among burn survivors: a study in Komfo Anokye Teaching Hospital, Ghana

    PubMed Central

    Agbenorku, Pius

    2013-01-01

    Aim: To determine the types of functional disabilities in adult and paediatric burns survivors, with specific emphasis on potential risk and socio-economic factors of burn disabilities present in Ghana. Patients and Methods: The descriptive study was carried out in Komfo Anokye Teaching Hospital, Kumasi, Ghana from May 2011 to April 2012. Burn survivors who came for follow-up visits after been discharged home and had functional disability were the participants of the study. They were physically examined and interviewed using a pre-tested questionnaire after their informed consent/or that of their parents (in the cases of paediatrics burns survivors) was sought. Results: A total of 70 participants consented for the study. Their ages ranged from 8/12 – 78 years, with a mean age of 12±1.7 years. Majority (60.0%, N=42) of the participants had third degree burns. The nature of disabilities of participants were mostly scar contractures (42.9%, N=30) of which 36.7% (N=11) had impeded arm elevation; 23.3% (N=7) could not fold the palm or move the digits. From the multiple regression analysis risk factors for burn victim to have disability were paediatric age (OR=11.1, P=0.043), third degree of burn (OR=6.2, P=0.001) and anatomical part affected (OR=18.3, P=0.031). Socio-economic factors that affected burn disability victims were nuclear family compensation (OR=4.2, P=0.021), community mockery/stigmatization (OR=0.1, P=0.052) and caretakers time and finance (OR=5.2, P=0.033). Conclusion: The commonest functional disabilities recorded were scar contractions of the axilla region which had impeded the ability of the patients to lift the arm. Risk factors for burns disability included childhood age, third degree of burn incurred and anatomical part affected. Social factors influencing the lives of burn survivors with disability were good family and negative community interactions. Significant economical factors recorded were caretakers’ time and financial constrains. PMID:23638325

  18. Management of Radiation-induced Severe Anophthalmic Socket Contracture in Patients with Uveal Melanoma

    PubMed Central

    Nasser, Qasiem J.; Gombos, Dan S.; Williams, Michelle D.; Guadagnolo, B. Ashleigh; Morrison, William H.; Garden, Adam S.; Beadle, Beth M.; Canseco, Elvia; Esmaeli, Bita

    2012-01-01

    Purpose High-dose radiotherapy can cause contracture of the anophthalmic socket, but the incidence of this complication in patients with enucleation for uveal melanoma has not previously been reported. We reviewed the surgical management and outcomes in terms of successful prosthesis wear in patients with severe contracture of the anophthalmic socket treated with high-dose radiotherapy for high-risk uveal melanoma and estimated the relative risk of this complication. Methods The medical records of all consecutive patients enrolled in a prospective uveal-melanoma tissue-banking protocol at our institution who underwent enucleation between January 2003 and December 2010 were reviewed. Patients who underwent adjuvant radiotherapy of the enucleated socket were further studied. Results Of the 68 patients enrolled in the prospective tissue banking protocol, 12 had high-risk histologic features (e.g., extrascleral spread or vortex vein invasion) and were treated with 60 Gy of external-beam radiotherapy after enucleation. Five of these patients (41.7%) experienced severe socket contracture precluding prosthesis wear. The median time to onset of contracture following completion of radiotherapy was 20 months. Three patients underwent surgery, which entailed scar tissue release, oral mucous membrane grafting, and socket reconstruction; 2 patients declined surgery. All 3 patients who had surgery experienced significant improvement of socket contracture that enabled patients to wear a prosthesis again. Conclusion High-dose radiotherapy after enucleation in patients with uveal melanoma caused severe socket contracture and inability to wear a prosthesis in approximately 40% of patients. Surgical repair of the contracted socket using oral mucous membrane grafting can allow resumption of prosthesis wear. PMID:22581085

  19. Facial Scar Revision: Understanding Facial Scar Treatment

    MedlinePlus

    ... Contact Us Trust your face to a facial plastic surgeon Facial Scar Revision Understanding Facial Scar Treatment ... face like the eyes or lips. A facial plastic surgeon has many options for treating and improving ...

  20. Monitoring the influence of compression therapy on pathophysiology and structure of a swine scar model using multispectral imaging system

    NASA Astrophysics Data System (ADS)

    Ghassemi, Pejhman; Travis, Taryn E.; Shuppa, Jeffrey W.; Moffatt, Lauren T.; Ramella-Romana, Jessica C.

    2014-03-01

    Scar contractures can lead to significant reduction in function and inhibit patients from returning to work, participating in leisure activities and even render them unable to provide care for themselves. Compression therapy has long been a standard treatment for scar prevention but due to the lack of quantifiable metrics of scar formation scant evidence exists of its efficacy. We have recently introduced a multispectral imaging system to quantify pathophysiology (hemoglobin, blood oxygenation, melanin, etc) and structural features (roughness and collagen matrix) of scar. In this study, hypertrophic scars are monitored in-vivo in a porcine model using the imaging system to investigate influence of compression therapy on its quality.

  1. Genetics Home Reference: congenital contractural arachnodactyly

    MedlinePlus

    ... E, Delorme CV, Thong MK, Adès LC, Milewicz DM. Ten novel FBN2 mutations in congenital contractural arachnodactyly: ... Northrup H, Tran-Fadulu VT, Towbin JA, Milewicz DM. FBN2 mutation associated with manifestations of Marfan syndrome ...

  2. Story on Scars

    MedlinePlus

    ... Skiing, Snowboarding, Skating Crushes What's a Booger? The Story on Scars KidsHealth > For Kids > The Story on Scars Print A A A Text Size ... happened. Do any of your scars have a story? How Do I Get a Scar? No matter ...

  3. Scars of torture: a Sri Lankan study.

    PubMed

    Perera, Priyanjith

    2007-04-01

    Interpretation of scars of torture is not an easy task as our understanding of evolution of scars of different methods of torture is still in its infancy. The objectives of this study were to produce the features of a typical scar of a few selected methods of torture and determine their characteristic distribution. To achieve this, 100 medico-legal records of victims of torture examined at the Judicial Medical Officer's Office, Colombo between 1998 and 2001 were perused. Scars caused by seven selected methods of torture were taken into consideration. They were, assault with both non-pliable and pliable blunt objects, cigarette burns, burns with heated solid objects and molten plastic, ligature application with different forms of suspension and cuts with sharp objects. Total number of scars analyzed in this study was 1846, which included 740 scars of non-pliable blunt weapons, 182 of pliable blunt weapons, 102 of ligature, 59 of molten polythene, 55 of heated objects and 82 of razor blades and knives. Typical scars of each method of torture and their characteristic distribution were determined. PMID:16919991

  4. Hypertrophic Scarring and Keloids: Pathomechanisms and Current and Emerging Treatment Strategies

    PubMed Central

    Gauglitz, Gerd G; Korting, Hans C; Pavicic, Tatiana; Ruzicka, Thomas; Jeschke, Marc G

    2011-01-01

    Excessive scars form as a result of aberrations of physiologic wound healing and may arise following any insult to the deep dermis. By causing pain, pruritus and contractures, excessive scarring significantly affects the patient’s quality of life, both physically and psychologically. Multiple studies on hypertrophic scar and keloid formation have been conducted for decades and have led to a plethora of therapeutic strategies to prevent or attenuate excessive scar formation. However, most therapeutic approaches remain clinically unsatisfactory, most likely owing to poor understanding of the complex mechanisms underlying the processes of scarring and wound contraction. In this review we summarize the current understanding of the pathophysiology underlying keloid and hypertrophic scar formation and discuss established treatments and novel therapeutic strategies. PMID:20927486

  5. Application of acellular dermal xenografts in full-thickness skin burns

    PubMed Central

    CHEN, XIAODONG; FENG, XIANGSHENG; XIE, JULIN; RUAN, SHUBIN; LIN, YAN; LIN, ZEPENG; SHEN, RUI; ZHANG, FENGGANG

    2013-01-01

    The aim of this study was to explore the clinical value of the porcine acellular dermal xenograft (ADX) in combination with autologous split-thickness skin and pure autologous split-thickness skin grafting applied in deep full-thickness burns and scar wounds. A total of 30 patients with deep burns were randomly divided into experimental and control groups following escharectomy. The patients were separately treated with porcine acellular dermal xenograft (ADX) in combination with autologous split-thickness skin and pure autologous split-thickness skin graft. The wound healing was observed routinely and the scores were evaluated using Vancouver scar scale at different times following transplant surgery. The samples of cograft regions and the control group (pure transplant split-thickness skin autograft) were observed using light microscopy and electron microscopy, and the follow-up results were recorded. No conspicuous rejections on the cograft wound surface were observed. Compared with the control group, the cograft wounds were smooth, presented no scar contracture and exhibited good skin elasticity and recovery of the joint function. The cografted skin combined well and displayed a clear and continuous basal membrane, as well as gradually combined skin structure, a mature stratum corneum, downward extended rete pegs, a mainly uniform dermal collagen fiber structure, regular alignment, and fewer blood capillaries. Clear desmosome cograft regions were identified among heckle cells, as well as a clear and continuous basal membrane. The cografted skin of the combined split-thickness autograft and the acellular heterologous (porcine) dermal matrix showed an improved shape and functional recovery compared with the pure split-thickness skin autograft. The combination of the meshed ADX and the split-thickness skin autograft applied in deep full-thickness burns and scar wounds may induce tissue regeneration via dermis aiming. This method also has superior shape and functional recovery, and has an extensive clinical application value. PMID:23935745

  6. Epidemiology and Outcome of Chemical Burn Patients Admitted in Burn Unit of JNMC Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India: A 5-year Experience

    PubMed Central

    Akhtar, Md Sohaib; Ahmad, Imran; Khurram, M. Fahud; Kanungo, Srikanta

    2015-01-01

    Aims and Objective: The objectives of this study were to evaluate the epidemiology, clinical variable of chemical burns, and their outcomes to prevent or reduce the frequency and morbidity of such injuries. Materials and Methods: A retrospective analysis was performed on all the patients with chemical burns admitted at author's center between November 2008 and December 2013. All the patients were evaluated in terms of age, sex, total body surface area, etiology, treatment given, morbidity, mortality, final outcome, and then educated regarding specific preventive measures. Results: A total of 96 patients (2.4% of total burn admissions) (42 males and 54 females) were admitted to our hospital with chemical burn injuries. Most of the patients were in the age group of 1630 years. Incidence in females was slightly higher than in males. Acid was found to be the most common cause of injury. We found 55% patients admitted had <10% total body surface area (TBSA) involvement, 35% had burns involving between 11 and 20% TBSA, and 4% had burns involving 2130% TBSA, and 6% had burns in >30% TBSA. Morbidity was noticed in the form of skin defect in 80% of cases, soft tissue defect with exposed tendon, bone, or vessels in 16% of cases, and 4% of patients developed contracture and hypertrophic scar. Eighty-six percent of patients required operative intervention. A total of three deaths (3%) were recorded. Conclusion: It was found that chemical burns, though not very common, are deeper burns and can be accidental or non-accidental, and the high-risk age group is 1625 years. Chemical burns are largely preventable and if properly managed have a good outcome. PMID:25810999

  7. Arthrogryposis Multiplex Congenita: Multiple Congenital Joint Contractures

    PubMed Central

    Sucuoglu, Hamza; Ornek, Nurettin Irem; Caglar, Cagkan

    2015-01-01

    Arthrogryposis multiplex congenita (AMC) is a syndrome characterized by nonprogressive multiple congenital joint contractures. The etiology of disease is multifactorial; it is most commonly suspected from absent fetal movements and genetic defects. AMC affects mainly limbs; also it might present with other organs involvement. It is crucial that the diagnosis of AMC should be kept in mind by musculoskeletal physicians in newborns with multiple joint contractures and patients must begin rehabilitation in early stage after accurate diagnosis in terms of functional independence. We present the diagnosis, types, clinical features, and treatment approaches of this disease in our case with literature reviews. PMID:26604929

  8. Models of Abnormal Scarring

    PubMed Central

    Seo, Bommie F.; Lee, Jun Yong; Jung, Sung-No

    2013-01-01

    Keloids and hypertrophic scars are thick, raised dermal scars, caused by derailing of the normal scarring process. Extensive research on such abnormal scarring has been done; however, these being refractory disorders specific to humans, it has been difficult to establish a universal animal model. A wide variety of animal models have been used. These include the athymic mouse, rats, rabbits, and pigs. Although these models have provided valuable insight into abnormal scarring, there is currently still no ideal model. This paper reviews the models that have been developed. PMID:24078916

  9. A new flap design for release of parallel contracture bands: dual opposing five-flap z-plasty.

    PubMed

    Ersoy, Burak

    2014-12-01

    Skin contractures secondary to burn and other types of trauma can be encountered on almost every part of human body, best addressed by a custom treatment protocol tailored for each patient. Skin graft, local flap as well as distant flap options are available, each with intrinsic advantages and disadvantages. In the presence of weblike contracture the utilization of local tissue, when available, is a prefered approach for a relatively better appearance through a reasonably simpler surgical intervention, compared to skin graft applications and distant flap options. Among many other techniques and modalities utilized for this purpose, the dual opposing five-flap z-plasty method which is a novel method designed as a modification of the paired five-flap z-plasty technique promises to be a useful treatment option for the release of parallel contracture bands with satisfactory results in selected patients. PMID:24931824

  10. [Recommendations for the prevention and therapy of hypertrophic scars and keloids].

    PubMed

    Gauglitz, G G; Kunte, C

    2011-05-01

    Hypertrophic scars and keloids form due to aberrations in the physiologic wound healing cascade characterized by greater and more sustained ECM deposition. Both entities are frequently associated with pain, pruritus and contractures, and are thus significantly affecting the patient's quality of life. Genetic susceptibility, specific anatomic locations, prolonged inflammation and delayed epithelialization significantly contribute to excessive scar formation. However, despite intensive scientific work in this field the complex mechanisms underlying the processes of scarring and wound contraction remain poorly understood and most therapeutic approaches are clinically unsatisfactory. Nevertheless, based on a rising number of clinical studies next to well-known therapeutic concepts including cryotherapy and intralesional triamcinolone, recent techniques extend the spectrum for treating excessive scars. Nonetheless, prevention of pathologic scarring is undoubtedly more effective than to later attempts to treat it. PMID:21468729

  11. Multidisciplinary, multimodal approach for a child with a traumatic facial scar.

    PubMed

    Admani, Shehla; Gertner, Jeffrey W; Grosman, Amanda; Shumaker, Peter R; Uebelhoer, Nathan S; Krakowski, Andrew C

    2015-03-01

    The treatment of disfiguring and disabling scars remains a field of active study, reinvigorated with recent advances in techniques and technologies. A variety of approaches can be utilized depending on scar characteristics, location, degree of tissue loss, and associated contractures. Just as traumatic scars can be complex and heterogeneous, the corresponding paradigm for treatment must also be flexible and multimodal for optimal improvement. This report describes a 3-year-old girl with a "mixed" (atrophic/hypertrophic), violaceous, contracted facial scar from a dog bite. It was treated with a novel approach utilizing a multidisciplinary pediatric scar team to combine autologous fat grafting, ablative fractional laser resurfacing, pulsed-dye laser, and laser-assisted delivery of a corticosteroid as concurrent, multimodal therapy to optimize the outcome. PMID:25922954

  12. Lasers and adjunctive treatments for facial scars: a review.

    PubMed

    Sawcer, D; Lee, H R; Lowe, N J

    1999-04-01

    A variety of facial scars--erythematous, pigmented, atrophic and hypertrophic--may occur as a result of trauma, surgery, burns and skin disease such as acne. Surgery with other adjunctive methods including radiotherapy, intralesional steroids and pressure therapy have shown variable results. Laser treatment has been attempted for scar revision since the 1980s. The continuous wave lasers, including continuous wave carbon dioxide (CO2), argon and Nd:YAG achieved some improvement; however, their use was limited by the inherent problems of continuous mode lasers. The pulsed dye laser has been successfully used in erythematous and hypertrophic scars. Pigment-specific Q-switched lasers have shown a good improvement for pigmented scars. Skin resurfacing lasers (both CO2 and erbium-YAG) have been used successfully to improve selected atrophic facial scars. The results may be improved by using lasers together with scar subcision and injectable or implantable fillers. PMID:11357293

  13. Laser Scar Management Technique

    PubMed Central

    Ohshiro, Toshio; Sasaki, Katsumi

    2013-01-01

    Background and Aims: Scars are common and cause functional problems and psychological morbidity. Recent advances in optical technologies have produced various laser systems capable of revising the appearance of scars from various etiologies to optimize their appearance. Methods: Laser treatment can commence as early as the time of the initial injury and as late as several years after the injury. Several optical technologies are currently available and combined laser/light treatments are required for treatment of scars. Since 2006, we have set up a scar management department in our clinic and more than 2000 patients have been treated by our combined laser irradiation techniques. Herein, we review several available light technologies for treatment of surgical, traumatic, and inflammatory scars, and discuss our combined laser treatment of scars, based upon our clinical experience. Results and Conclusions: Because scars have a variety of potential aetiologies and take a number of forms, no single approach can consistenty provide good scar treatment and management. The combination of laser and devices is essential, the choice of wavelength and approach being dictated by each patient as an individual. PMID:24511202

  14. Genetic risk factors for hypertrophic scar development.

    PubMed

    Thompson, Callie M; Hocking, Anne M; Honari, Shari; Muffley, Lara A; Ga, Maricar; Gibran, Nicole S

    2013-01-01

    Hypertrophic scars (HTSs) occur in 30 to 72% patients after thermal injury. Risk factors include skin color, female sex, young age, burn site, and burn severity. Recent correlations between genetic variations and clinical conditions suggest that single-nucleotide polymorphisms (SNPs) may be associated with HTS formation. The authors hypothesized that an SNP in the p27 gene (rs36228499) previously associated with decreased restenosis after coronary stenting would be associated with lower Vancouver Scar Scale (VSS) measurements and decreased itching. Patient and injury characteristics were collected from adults with thermal burns. VSS scores were calculated at 4 to 9 months after injury. Genotyping was performed using real-time polymerase chain reaction. Logistic regression was used to determine risk factors for HTS as measured by a VSS score >7. Three hundred subjects had a median age of 39 years (range, 18-91); 69% were male and median burn size was 7% TBSA (range, 0.25-80). Consistent with literature, the p27 variant SNP had an allele frequency of 40%, but was not associated with reduced HTS formation or lower itch scores in any genetic model. HTS formation was associated with American Indian/Alaskan Native race (odds ratio [OR], 12.2; P = .02), facial burns (OR, 9.4; P = .04), and burn size ≥20% TBSA (OR, 1.99; P = .03). Although the p27 SNP may protect against vascular fibroproliferation, the effect cannot be generalized to cutaneous scars. This study suggests that American Indian/Alaskan Native race, facial burns, and higher %TBSA are independent risk factors for HTS. The American Indian/Alaskan Native association suggests that there are potentially yet-to-be-identified genetic variants. PMID:23966119

  15. Capsular Contracture after Breast Augmentation: An Update for Clinical Practice

    PubMed Central

    Headon, Hannah; Kasem, Adbul

    2015-01-01

    Capsular contracture is the most common complication following implant based breast surgery and is one of the most common reasons for reoperation. Therefore, it is important to try and understand why this happens, and what can be done to reduce its incidence. A literature search using the MEDLINE database was conducted including search terms 'capsular contracture breast augmentation', 'capsular contracture pathogenesis', 'capsular contracture incidence', and 'capsular contracture management', which yielded 82 results which met inclusion criteria. Capsular contracture is caused by an excessive fibrotic reaction to a foreign body (the implant) and has an overall incidence of 10.6%. Risk factors that were identified included the use of smooth (vs. textured) implants, a subglandular (vs. submuscular) placement, use of a silicone (vs. saline) filled implant and previous radiotherapy to the breast. The standard management of capsular contracture is surgical via a capsulectomy or capsulotomy. Medical treatment using the off-label leukotriene receptor antagonist Zafirlukast has been reported to reduce severity and help prevent capsular contracture from forming, as has the use of acellular dermal matrices, botox and neopocket formation. However, nearly all therapeutic approaches are associated with a significant rate of recurrence. Capsular contracture is a multifactorial fibrotic process the precise cause of which is still unknown. The incidence of contracture developing is lower with the use of textured implants, submuscular placement and the use of polyurethane coated implants. Symptomatic capsular contracture is usually managed surgically, however recent research has focussed on preventing capsular contracture from occurring, or treating it with autologous fat transfer. PMID:26430623

  16. Atrophic Acne Scarring

    PubMed Central

    Graber, Emmy M.

    2015-01-01

    Background: Scarring is an unfortunate and frequent complication of acne, resulting in significant psychological distress for patients. Fortunately, numerous treatment options exist for acne scarring. Objectives: To extensively review the literature on treatment options for atrophic acne scarring. Materials and methods: A comprehensive literature search was conducted on the following topics: dermabrasion, subcision, punch techniques, chemical peels, tissue augmentation, and lasers. Results: The literature supports the use of various treatment modalities; superior results may be achieved when multiple modalities are combined for a multi-step approach to scarring. Conclusion: The safety and efficacy of various treatment devices for acne scarring is well established, but there is a paucity of split-face trials comparing modalities. PMID:25610524

  17. PREVENTION AND MANAGEMENT OF LIMB CONTRACTURES IN NEUROMUSCULAR DISEASES

    PubMed Central

    Skalsky, Andrew J.; McDonald, Craig M.

    2012-01-01

    Synopsis Limb contractures are a common impairment in neuromuscular diseases (NMD). They contribute to increased disability due to decreased motor performance, mobility limitations, reduced functional range of motion, loss of function for activities of daily living (ADL), and increased pain. The pathogenesis of contractures is multifactorial. Myopathic conditions are associated with more severe limb contractures in comparison to neuropathic disorders. Although the evidence supporting the efficacy of multiple interventions to improve ROM in NMD in a sustained manner is lacking, there are generally accepted principles with regard to splinting, bracing, stretching, and surgery that help minimize the impact or disability from the contractures. PMID:22938881

  18. Use of dermal regeneration template in contracture release procedures: a multicenter evaluation.

    PubMed

    Frame, James D; Still, Joseph; Lakhel-LeCoadou, Anne; Carstens, Michael H; Lorenz, Christian; Orlet, Hermann; Spence, Robert; Berger, Alfred C; Dantzer, Eric; Burd, Andrew

    2004-04-15

    Integra dermal regeneration template (Integra Life Sciences, Plainsboro, N.J.) is an effective treatment for full-thickness burns. It can also be useful in contracture release procedures; however, the clinical utility of a dermal regeneration template in contracture release procedures has not been adequately characterized. In this multicenter investigation, the outcomes of release procedures incorporating a dermal regeneration template for 89 consecutive patients, who underwent a total of 127 contracture releases, were retrospectively evaluated. The procedures involved the application of Integra, which includes a temporary silicone epidermal substitute and an artificial dermal layer. After formation of a neodermis, the silicone layer is removed and replaced with an epidermal autograft. Data on patient and contracture site history, treatment methods, physician assessments of range of motion or function, patient satisfaction, recurrence, and adverse events were collected with a standardized questionnaire. Release procedures for the study patients involved the neck, axilla, trunk, elbow, knee, hand, and other anatomical sites. The mean postoperative follow-up period was 11.4 months. At 76 percent of the release sites, range of motion or function was rated as good (significant improvement in range of motion or function) or excellent (maximal range of motion or function possible) by physicians. Responding patients expressed satisfaction with the overall results of treatment at 82 percent of the sites. No recurrence of contracture at 75 percent of the sites was observed during follow-up monitoring. Patient age and prior surgical treatment at the site did not significantly affect the results of treatment. However, outcomes were superior at mature sites, i.e., those for which more than 12 months had elapsed since the original injury. Postoperative complications rarely necessitated regrafting. These results indicate that a dermal regeneration template provides a useful alternative technique for contracture release procedures. The study data indicate that this approach leads to favorable functional outcomes and a high rate of patient satisfaction. This modality also seems to be versatile, because a range of anatomical sites are amenable to treatment with a dermal regeneration template, regardless of prior surgical treatment, and both pediatric and adult patients respond well to this form of therapy. Furthermore, Integra confers functional and cosmetic benefits similar to those of full-thickness grafts but without comparable potential for donor-site morbidity. PMID:15060344

  19. A polarized multispectral imaging system for quantitative assessment of hypertrophic scars.

    PubMed

    Ghassemi, Pejhman; Travis, Taryn E; Moffatt, Lauren T; Shupp, Jeffrey W; Ramella-Roman, Jessica C

    2014-10-01

    Hypertrophic scars (HTS) are a pathologic reaction of the skin and soft tissue to burn or other traumatic injury. Scar tissue can cause patients serious functional and cosmetic issues. Scar management strategies, specifically scar assessment techniques, are vital to improve clinical outcome. To date, no entirely objective method for scar assessment has been embraced by the medical community. In this study, we introduce for the first time, a novel polarized multispectral imaging system combining out-of-plane Stokes polarimetry and Spatial Frequency Domain Imaging (SFDI). This imaging system enables us to assess the pathophysiology (hemoglobin, blood oxygenation, water, and melanin) and structural features (cellularity and roughness) of HTS. To apply the proposed technique in an in vivo experiment, dermal wounds were created in a porcine model and allowed to form into scars. The developed scars were then measured at various time points using the imaging system. Results showed a good agreement with clinical Vancouver Scar Scale assessment and histological examinations. PMID:25360354

  20. A polarized multispectral imaging system for quantitative assessment of hypertrophic scars

    PubMed Central

    Ghassemi, Pejhman; Travis, Taryn E.; Moffatt, Lauren T.; Shupp, Jeffrey W.; Ramella-Roman, Jessica C.

    2014-01-01

    Hypertrophic scars (HTS) are a pathologic reaction of the skin and soft tissue to burn or other traumatic injury. Scar tissue can cause patients serious functional and cosmetic issues. Scar management strategies, specifically scar assessment techniques, are vital to improve clinical outcome. To date, no entirely objective method for scar assessment has been embraced by the medical community. In this study, we introduce for the first time, a novel polarized multispectral imaging system combining out-of-plane Stokes polarimetry and Spatial Frequency Domain Imaging (SFDI). This imaging system enables us to assess the pathophysiology (hemoglobin, blood oxygenation, water, and melanin) and structural features (cellularity and roughness) of HTS. To apply the proposed technique in an in vivo experiment, dermal wounds were created in a porcine model and allowed to form into scars. The developed scars were then measured at various time points using the imaging system. Results showed a good agreement with clinical Vancouver Scar Scale assessment and histological examinations. PMID:25360354

  1. 77 FR 66419 - Eligibility of Disabled Veterans and Members of the Armed Forces With Severe Burn Injuries for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-05

    ... severe burn that is a deep partial thickness or full-thickness burn resulting in scar formation that... severe damage to the dermal layer. Healing may occur with hypertrophic scars and keloid formation. In a... damage to the underlying subcutaneous fat layer. Scar tissue from these types of burns is thin,...

  2. Survey of Early Complications of Primary Skin Graft and Secondary Skin Graft (Delayed) Surgery after Resection of Burnwaste in Hospitalized Burn Patients

    PubMed Central

    Enshaei, A.; Masoudi, N.

    2014-01-01

    Introduction: Burning is the second most common cause of home injuries in Iran that is often the cause of conflicts between children and young adults. Burning can lead to early and late complications that scar and contracture are the most common. Burn waste treatment is done by two methods: excision and then skin graft after the formation of granulation tissue; and excision and graft simultaneously that in this study, these two methods are compared. Methods: This was performed as a quasi-experimental analysis and retrospective study on all patients who were hospitalized for burn scar. All patients who have associated with weak eningimmune diseases such as diabetes, acquired immunodeficiency or congenital, taking steroids and patients undergoing chemotherapy etc. are excluded. The method of grafting in patients is primary graft procedure that was compared with patients who are treated using secondary graft. Data collected through review of patients’ hospital and clinic chart. Results: The mean burn percentage in the primary repair group was 14.4% and in the delayed repair group was 16.6%, respectively. The incidence of hematoma in both groups was zero. Skin necrosis and graft rejection and infection in the primary repair group was in 3.7% of patients and in the delayed repair group was in 1.2% of cases (P=0.5) Conclusion: Based on the findings of this study, no difference was observed between the two methods of excision and primary graft with delayed graft in the incidence of graft rejection. Due to the shorter treatment of primary graft and patient satisfaction and also according to the findings of this study excision and primary graft method seems appropriate method for treating old waste burning. PMID:25363185

  3. Nonsurgical scar management of the face: does early versus late intervention affect outcome?

    PubMed

    Parry, Ingrid; Sen, Soman; Palmieri, Tina; Greenhalgh, David

    2013-01-01

    Special emphasis is placed on the clinical management of facial scarring because of the profound physical and psychological impact of facial burns. Noninvasive methods of facial scar management include pressure therapy, silicone, massage, and facial exercises. Early implementation of these scar management techniques after a burn injury is typically accepted as standard burn rehabilitation practice, however, little data exist to support this practice. This study evaluated the timing of common noninvasive scar management interventions after facial skin grafting in children and the impact on outcome, as measured by scar assessment and need for facial reconstructive surgery. A retrospective review of 138 patients who underwent excision and grafting of the face and subsequent noninvasive scar management during a 10-year time frame was conducted. Regression analyses were used to show that earlier application of silicone was significantly related to lower Modified Vancouver Scar Scale scores, specifically in the subscales of vascularity and pigmentation. Early use of pressure therapy and implementation of facial exercises were also related to lower Modified Vancouver Scar Scale vascularity scores. No relationship was found between timing of the interventions and facial reconstructive outcome. Early use of silicone, pressure therapy, and exercise may improve scar outcome and accelerate time to scar maturity. PMID:23816994

  4. Incomplete Cesarean Scar Rupture

    PubMed Central

    Ahmadi, Firoozeh; Siahbazi, Shiva; Akhbari, Farnaz

    2013-01-01

    Background Uterine rupture at the site of a previous cesarean scar is an uncommon but catastrophic complication of pregnancy, which is associated with significant maternal and fetal morbidity and mortality. Case Presentation A 30-year old woman at 24th week of gestation and complaint of pain, contractions and spotting was admitted in Royan Institute in Tehran, Iran. She had a past medical history of an EP and a cesarean section delivery, respectively 4 and 2 years before hospitalization. Herniation of an amniotic membrane into the maternal bladder was found on ultrasound examination. Conclusion Risk factors of cesarean scar rupture should be considered in women undergoing subsequent pregnancies as they need extra care. Ultrasonography can be used to evaluate women with previous cesarean section to assess the risks of scar rupture during subsequent pregnancies. PMID:23926561

  5. Surgical Scar Revision: An Overview

    PubMed Central

    Garg, Shilpa; Dahiya, Naveen; Gupta, Somesh

    2014-01-01

    Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods. PMID:24761092

  6. Can Acne Scars Be Removed?

    MedlinePlus

    ... depression (sometimes called "rolling" scars) scars that are deep and narrow A person's acne needs to be ... or spinning diamond instrument to wear down the surface of the skin. As the skin heals, a ...

  7. Process of Hypertrophic Scar Formation: Expression of Eukaryotic Initiation Factor 6

    PubMed Central

    Yang, Qing-Qing; Yang, Si-Si; Tan, Jiang-Lin; Luo, Gao-Xing; He, Wei-Feng; Wu, Jun

    2015-01-01

    Background: Hypertrophic scar is one of the most common complications and often causes the disfigurement or deformity in burn or trauma patients. Therapeutic methods on hypertrophic scar treatment have limitations due to the poor understanding of mechanisms of hypertrophic scar formation. To throw light on the molecular mechanism of hypertrophic scar formation will definitely improve the outcome of the treatment. This study aimed to illustrate the negative role of eukaryotic initiation factor 6 (eIF6) in the process of human hypertrophic scar formation, and provide a possible indicator of hypertrophic scar treatment and a potential target molecule for hypertrophic scar. Methods: In the present study, we investigated the protein expression of eIF6 in the human hypertrophic scar of different periods by immunohistochemistry and Western blot analysis. Results: In the hypertrophic scar tissue, eIF6 expression was significantly decreased and absent in the basal layer of epidermis in the early period, and increased slowly and began to appear in the basal layer of epidermis by the scar formation time. Conclusions: This study confirmed that eIF6 expression was significantly related to the development of hypertrophic scar, and the eIF6 may be a target molecule for hypertrophic scar control or could be an indicator of the outcomes for other treatment modalities. PMID:26481747

  8. Mechanical properties of normal skin and hypertrophic scars.

    PubMed

    Clark, J A; Cheng, J C; Leung, K S

    1996-09-01

    The non-linear viscoelastic properties of skin tissue were characterized by modulus of elasticity E, which represents stiffness, and percentage extension (strain, xi) at load intensities of 20, 40 and 100 gm. The latter property is a measure of the extensibility for both normal skin and hypertrophic scar. A quasi-static extensometer applies a standard rate of extension to the skin and its mechanical properties were obtained from 15 Chinese patients with burn injuries of superficial to full skin thickness burns. Clinical evaluation of hypertrophic scar is qualitative and depends on colour, thickness and hardness or firmness. Using mechanical properties assists in the characterization by providing a quantitative indicator. Higher scar grading is synonymous with increased stiffness and decreased extensibility. Correlation with clinical assessment was achieved with these in vivo viscoelastic properties. PMID:8884002

  9. Basic fibroblast growth factor in Dupuytren's contracture.

    PubMed Central

    Gonzalez, A. M.; Buscaglia, M.; Fox, R.; Isacchi, A.; Sarmientos, P.; Farris, J.; Ong, M.; Martineau, D.; Lappi, D. A.; Baird, A.

    1992-01-01

    Lesions excised from nine patients undergoing surgery for Dupuytren's contracture (DC) and three normal fascia were examined for the presence of the angiogenic protein basic fibroblast growth factor (basic FGF). Endothelial cell proliferation assays established basic FGF-like activity in extracts of DC. Western blotting confirmed the presence of an 18,000-dalton protein which was localized in the lesions by immunohistochemical staining. All of the cells implicated in the progression of the disease (endothelial cells, fibroblasts, and myofibroblasts) contain the growth factor. Endothelial cells within the narrowed or occluded vessels, as well as fibroblasts surrounding these vessels, stained intensely positive. In situ hybridization using an antisense probe for human basic FGF and its receptor's (FGFR-1) mRNA established the major difference between normal and DC tissues: their levels are significantly higher than in the normal tissues. Thus the cells in DC also express both basic FGF and FGFR-1, suggesting a potential autocrine/paracrine role for basic FGF in the pathogenesis of DC. This finding is thus the first description of a nontumoral proliferative disease that can be directly associated with increased basic FGF mRNA. The possibility that therapies can be developed on the basis that basic FGF and its receptor are expressed in DC is discussed. Images Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 PMID:1325742

  10. Establishing a Reproducible Hypertrophic Scar following Thermal Injury: A Porcine Model

    PubMed Central

    Rapp, Scott J.; Rumberg, Aaron; Visscher, Marty; Billmire, David A.; Schwentker, Ann S.

    2015-01-01

    Background: Our complete understanding of hypertrophic scarring is still deficient, as portrayed by the poor clinical outcomes when treating them. To address the need for alternative treatment strategies, we assess the swine animal burn model as an initial approach for immature scar evaluation and therapeutic application. Methods: Thermal contact burns were created on the dorsum of 3 domestic swine with the use of a branding iron at 170°F for 20 seconds. Deep partial-thickness burns were cared for with absorptive dressings over 10 weeks and wounds evaluated with laser and negative pressure transduction, histology, photographic analysis, and RNA isolation. Results: Overall average stiffness (mm Hg/mm) increased and elasticity (mm) decreased in the scars from the initial burn injury to 8 weeks when compared with normal skin (P < 0.01). Scars were thicker, more erythematous, and uniform in the caudal dorsum. The percent change of erythema in wounds increased from weeks 6 to 10. Histology demonstrated loss of dermal papillae, increased myofibroblast presence, vertically oriented vessels, epidermal and dermal hypercellularity, and parallel-layered collagen deposition. Immature scars remained elevated at 10 weeks, and minimal RNA was able to be isolated from the tissue. Conclusions: Deep partial-thickness thermal injury to the back of domestic swine produces an immature hypertrophic scar by 10 weeks following burn with thickness appearing to coincide with the location along the dorsal axis. With minimal pig to pig variation, we describe our technique to provide a testable immature scar model. PMID:25750848

  11. Update on hypertrophic scar treatment

    PubMed Central

    Rabello, Felipe Bettini; Souza, Cleyton Dias; Júnior, Jayme Adriano Farina

    2014-01-01

    Scar formation is a consequence of the wound healing process that occurs when body tissues are damaged by a physical injury. Hypertrophic scars and keloids are pathological scars resulting from abnormal responses to trauma and can be itchy and painful, causing serious functional and cosmetic disability. The current review will focus on the definition of hypertrophic scars, distinguishing them from keloids and on the various methods for treating hypertrophic scarring that have been described in the literature, including treatments with clearly proven efficiency and therapies with doubtful benefits. Numerous methods have been described for the treatment of abnormal scars, but to date, the optimal treatment method has not been established. This review will explore the differences between different types of nonsurgical management of hypertrophic scars, focusing on the indications, uses, mechanisms of action, associations and efficacies of the following therapies: silicone, pressure garments, onion extract, intralesional corticoid injections and bleomycin. PMID:25141117

  12. Update on hypertrophic scar treatment.

    PubMed

    Rabello, Felipe Bettini; Souza, Cleyton Dias; Farina Júnior, Jayme Adriano

    2014-08-01

    Scar formation is a consequence of the wound healing process that occurs when body tissues are damaged by a physical injury. Hypertrophic scars and keloids are pathological scars resulting from abnormal responses to trauma and can be itchy and painful, causing serious functional and cosmetic disability. The current review will focus on the definition of hypertrophic scars, distinguishing them from keloids and on the various methods for treating hypertrophic scarring that have been described in the literature, including treatments with clearly proven efficiency and therapies with doubtful benefits. Numerous methods have been described for the treatment of abnormal scars, but to date, the optimal treatment method has not been established. This review will explore the differences between different types of nonsurgical management of hypertrophic scars, focusing on the indications, uses, mechanisms of action, associations and efficacies of the following therapies: silicone, pressure garments, onion extract, intralesional corticoid injections and bleomycin. PMID:25141117

  13. Activated keratinocytes in the epidermis of hypertrophic scars.

    PubMed Central

    Machesney, M.; Tidman, N.; Waseem, A.; Kirby, L.; Leigh, I.

    1998-01-01

    The etiology of hypertrophic scarring, a pathological end point of wound healing, is unknown. The scars most commonly occur when epithelialization has been delayed during, for example, the healing of deep dermal burn wounds. Hypertrophic scars are conventionally described as a dermal pathology in which the epidermis has only a passive role. In this study, the expression of keratin intermediate filament proteins and filaggrin has been investigated in the epidermis of hypertrophic scars and site-matched controls from the same patients. Hypertrophic scar epidermis was found to express the hyperproliferative keratins K6 and K16 in interfollicular epidermis in association with K17 and precocious expression of filaggrin. K16 mRNA was localized by in situ hybridization using a highly specific cRNA probe. In contrast to the immunohistochemical location of K16 protein, the K16 mRNA was found to be expressed in the basal cell layer of normal skin. In hypertrophic scars the mRNA distribution corroborated the abnormal K16 protein distribution. These results suggest the keratinocytes in hypertrophic scar epidermis have entered an alternative differentiation pathway and are expressing an activated phenotype. Activated keratinocytes are a feature of the early stages of wound healing producing growth factors that influence fibroblasts, endothelial cells, and the inflammatory response. We propose that cellular mechanisms in the pathogenesis of hypertrophic scarring are more complex than isolated dermal phenomena. The persistence of activated keratinocytes in hypertrophic scar epidermis implicates abnormal epidermal-mesenchymal interactions. Images Figure 1 Figure 3 PMID:9588880

  14. SCAR-B MAS

    Atmospheric Science Data Center

    2013-01-10

    ... properties. Study the impact of biomass burning and urban/industrial aerosol on the atmosphere and climate by measuring the properties of urban and industrial pollution dominated by sulfate particles. Project Title:  MAS ...

  15. Purinergic signaling in scarring.

    PubMed

    Ferrari, Davide; Gambari, Roberto; Idzko, Marco; Mller, Tobias; Albanesi, Cristina; Pastore, Saveria; La Manna, Gaetano; Robson, Simon C; Cronstein, Bruce

    2016-01-01

    Adenosine (ADO) and nucleotides such as ATP, ADP, and uridine 5'-triphosphate (UTP), among others, may serve as extracellular signaling molecules. These mediators activate specific cell-surface receptors-namely, purinergic 1 and 2 (P1 and P2)-to modulate crucial pathophysiological responses. Regulation of this process is maintained by nucleoside and nucleotide transporters, as well as the ectonucleotidases ectonucleoside triphosphate diphosphohydrolase [ENTPD; cluster of differentiation (CD)39] and ecto-5'-nucleotidase (5'-NT; CD73), among others. Cells involved in tissue repair, healing, and scarring respond to both ADO and ATP. Our recent investigations have shown that modulation of purinergic signaling regulates matrix deposition during tissue repair and fibrosis in several organs. Cells release adenine nucleotides into the extracellular space, where these mediators are converted by CD39 and CD73 into ADO, which is anti-inflammatory in the short term but may also promote dermal, heart, liver, and lung fibrosis with repetitive signaling under defined circumstances. Extracellular ATP stimulates cardiac fibroblast proliferation, lung inflammation, and fibrosis. P2Y2 (UTP/ATP) and P2Y6 [ADP/UTP/uridine 5'-diphosphate (UDP)] have been shown to have profibrotic effects, as well. Modulation of purinergic signaling represents a novel approach to preventing or diminishing fibrosis. We provide an overview of the current understanding of purinergic signaling in scarring and discuss its potential to prevent or decrease fibrosis.-Ferrari, D., Gambari, R., Idzko, M., Mller, T., Albanesi, C., Pastore, S., La Manna, G., Robson, S. C., Cronstein, B. Purinergic signaling in scarring. PMID:26333425

  16. Dune Avalanche Scars

    NASA Technical Reports Server (NTRS)

    2004-01-01

    05 August 2004 This Mars Global Surveyor (MGS) Mars Orbiter Camera (MOC) image shows large, low albedo (dark) sand dunes in Kaiser Crater near 47.2oS, 340.4oW. The dunes are--ever so slowly--moving east to west (right to left) as sand avalanches down the steeper, slip face slopes of each. Avalanching sand in the Kaiser dune field has left deep scars on these slopes, suggesting that the sand is not loose but is instead weakly cemented. The image covers an area approximately 3 km (1.9 mi) wide and is illuminated by sunlight from the upper left.

  17. Cutaneous Scar Prevention and Management

    PubMed Central

    Al-Shaqsi, Sultan; Al-Bulushi, Taimoor

    2016-01-01

    Cutaneous scarring is common after trauma, surgery and infection and occurs when normal skin tissue is replaced by fibroblastic tissue during the healing process. The pathophysiology of scar formation is not yet fully understood, although the degree of tension across the wound edges and the speed of cell growth are believed to play central roles. Prevention of scars is essential and can be achieved by attention to surgical techniques and the use of measures to reduce cell growth. Grading and classifying scars is important to determine available treatment strategies. This article presents an overview of the current therapies available for the prevention and treatment of scars. It is intended to be a practical guide for surgeons and other health professionals involved with and interested in scar management. PMID:26909210

  18. Involvement of impaired desmosome-related proteins in hypertrophic scar intraepidermal blister formation.

    PubMed

    Tan, Jianglin; He, Weifeng; Luo, Gaoxing; Wu, Jun

    2015-11-01

    Hypertrophic scar is one of the unique fibrotic diseases in human. Intraepidermal blister is a common clinical symptom following the hypertrophic scar formation. However, little is known about the reason of blister creation. In this study, we selected three patients with hypertrophic scar as manifested by raised, erythematous, pruritic, blister and thickened appearance undergoing scar resection. The first scar sample was 6 months after burn from the neck of a 3 years old male patient with 10 score by Vancouver Scar Scale (VSS). The second scar sample was 12 months after burn from the dorsal foot of a 16 years old female patient with 13 score by VSS. The third one was 9 months after burn from the elbow of a 34 years old male patients with 13 score by VSS. In order to understand the molecular mechanism of blister formation, we screened the different protein expression between hypertrophic scar and normal skin tissue by means of isobaric tags for relative and absolute quantitation (iTRAQ) labeling technology and high throughput 2D LC-MS/MS. There were 48 proteins found to be downregulated in hypertrophic scar. Among the downregulated ones, plakophilin1 (PKP1), plakophilin3 (PKP3) and desmoplakin (DSP) were the desmosome-related proteins which were validated by immunohistochemistry and western blotting assay. Transmission electron microscopy further showed the considerably reduced size and intensity of hemidesmosome and desmosome in hypertrophic scar tissue, compared to control normal skin. Our data indicted for the first time that downregulation of DSP, PKP1 and PKP3 in hypertrophic scar might be responsible for intraepidermal blister formation. PMID:25922301

  19. Extracorporeal Shock Wave Therapy: An Emerging Treatment Modality for Retracting Scars of the Hands.

    PubMed

    Saggini, Raoul; Saggini, Andrea; Spagnoli, Anna Maria; Dodaj, Ira; Cigna, Emanuele; Maruccia, Michele; Soda, Giuseppe; Bellomo, Rosa Grazia; Scuderi, Nicolò

    2016-01-01

    Prolonged and abnormal scarring after trauma, burns and surgical procedures often results in a pathologic scar. We evaluated the efficacy of unfocused shock wave treatment, alone or in combination with manual therapy, on retracting scars on the hands. Scar appearance was assessed by means of the modified Vancouver Scar Scale; functional hand mobility was evaluated using a range-of-motion scale, whereas a visual analogue score was implemented for detecting any improvements in referred pain. Additionally, biopsy specimens were collected for clinico-pathologic correlation. For each active treatment group, statistically significant improvements in modified Vancouver Scar Scale were recorded as early as five treatment sessions and confirmed 2 wk after the last treatment session. Analogous results were observed when assessing pain and range of movement. Histopathological examination revealed significant increases in dermal fibroblasts in each active treatment group, as well as in neoangiogenetic response and type-I collagen concentration. PMID:26454624

  20. Pulmonary Nontuberculous Mycobacterial Infection in Congenital Contractural Arachnodactyly

    PubMed Central

    Paulson, Michelle L.; Olivier, Kenneth N.; Holland, Steven M.

    2013-01-01

    SUMMARY Congenital contractural arachnodactyly (CCA) is caused by mutations within fibrillin-2 (FBN2), which is crucial for microfibril structure. Affected individuals may have contractures, chest wall deformities, scoliosis, abnormal ear folding and elongated limbs. We describe a novel FBN2 mutation in a woman with CCA who also has pulmonary nontuberculous mycobacterial infection. The population with pulmonary nontuberculous mycobacterial infections shares phenotypic features with CCA, such as elongated body habitus, scoliosis and pectus deformities. While it is unlikely that FBN2 defects account for susceptibility to nontuberculous mycobacterial infection in the majority of cases, the overlap between these two diseases suggests some shared pathophysiology. PMID:22325249

  1. Treatment of hypertrophic scars using a long-pulsed dye laser with cryogen-spray cooling.

    PubMed

    Kono, Taro; Eren, Ali Rza; Nakazawa, Hiroaki; Nozaki, Motohiro

    2005-05-01

    Hypertrophic scars are common and cause functional and psychologic morbidity. The conventional pulsed dye laser (585 nm) has been shown previously to be effective in the treatment of a variety of traumatic and surgical scars, with improvement in scar texture, color, and pliability, with minimal side effects. This prospective study was performed to determine the effectiveness of the long-pulsed dye laser (595 nm) with cryogen-spray cooling device in the treatment of hypertrophic scars. Fifteen Asian patients with 22 hypertrophic scars were treated by the long-pulsed dye laser (595 nm) with cryogen-spray cooling device. In 5 patients, the scar area was divided into halves, one half of which was treated with the laser, whereas the other half was not treated and was used as a negative control. All patients received 2 treatments at 4-week intervals, and evaluations were done by photographic and clinical assessment and histologic evaluation before the treatment and 1 month after the last laser treatment. Treatment outcome was graded by a blind observer using the Vancouver General Hospital (VGH) Burn Scar Assessment Scale. Symptoms such as pain, pruritus, and burning of the scar improved significantly. VGH scores improved in all treated sites, and there was a significant difference between the baseline and posttreatment scores, corresponding to an improvement of 51.4 +/- 14.7% (P < 0.01). Compared with the baseline, the mean percentage of scar flattening and erythema elimination was 40.7 +/- 20.7 and 65.3 +/- 25.5%, respectively (P < 0.01). The long-pulsed dye laser (595-nm) equipped with cryogen spray cooling device is an effective treatment of hypertrophic scars and can improve scar pliability and texture and decrease scar erythema and associated symptoms. PMID:15838209

  2. Assessment of burn depth and burn wound healing potential.

    PubMed

    Monstrey, Stan; Hoeksema, Henk; Verbelen, Jos; Pirayesh, Ali; Blondeel, Phillip

    2008-09-01

    The depth of a burn wound and/or its healing potential are the most important determinants of the therapeutic management and of the residual morbidity or scarring. Traditionally, burn surgeons divide burns into superficial which heal by rapid re-epithelialization with minimal scarring and deep burns requiring surgical therapy. Clinical assessment remains the most frequent technique to measure the depth of a burn wound although this has been shown to be accurate in only 60-75% of the cases, even when carried out by an experienced burn surgeon. In this article we review all current modalities useful to provide an objective assessment of the burn wound depth, from simple clinical evaluation to biopsy and histology and to various perfusion measurement techniques such as thermography, vital dyes, video angiography, video microscopy, and laser Doppler techniques. The different needs according to the different diagnostic situations are considered. It is concluded that for the initial emergency assessment, the use of telemetry and simple burn photographs are the best option, that for research purposes a wide range of different techniques can be used but that, most importantly, for the actual treatment decisions, laser Doppler imaging is the only technique that has been shown to accurately predict wound outcome with a large weight of evidence. Moreover this technique has been approved for burn depth assessment by regulatory bodies including the FDA. PMID:18511202

  3. The prosthetic problems of below knee amputees with flexion contractures.

    PubMed

    Bannister, P J

    1978-03-01

    It has always been difficult to provide the patient who has had a below knee amputation and has a fixed flexion contracture, with a suitable artificial limb. The adaptation of the Patellar Tendon Bearing (PTB) below knee prosthesis and the subsequent Supracondylar Variation (PTS) of this type of prosthesis has been applied to this problem. PMID:25025498

  4. Abnormal growth factor and cytokine expression in Dupuytren's contracture.

    PubMed Central

    Baird, K S; Crossan, J F; Ralston, S H

    1993-01-01

    AIM--To analyse patterns of gene expression for peptide regulatory factors in patients with Dupuytren's contracture. METHODS--Tissue samples (palmer fascia) from 12 patients with Dupuytren's contracture and 12 controls were studied using the reverse transcription/polymerase chain reaction (RT/PCR) technique. RESULTS--Tissue from patients with Dupuytren's contracture expressed a higher percentage of peptide regulatory factors than that of controls: interleukin-1 alpha (83% v 16%; p < 0.01); interleukin-1 beta (66% v 8%; p < 0.01); transforming growth factor beta (75% v 25%; p < 0.02); and basic fibroblast growth factor (66% v 25%; p < 0.05). Platelet derived growth factors alpha and beta were also expressed more commonly (66% v 33% and 25% v 16%, respectively), but these differences were not significant. CONCLUSIONS--The increased prevalence of expression for the above mRNAs in Dupuytren's tissue is relevant as interleukin-1, basic fibroblast growth factor, and transforming growth factor beta stimulate the growth of fibroblasts and transforming growth factor beta also enhances production of collagen and other extracellular matrix proteins. Excessive local release of these peptide regulatory factors may have an important role in the pathogenesis of Dupuytren's contracture. Images PMID:8320323

  5. The treatment of flexion contracture of the knee in myelomeningocele.

    PubMed

    Abraham, E; Verinder, D G; Sharrard, W J

    1977-11-01

    A follow-up study, on average four years after operation, of seventy-six cildren with myelomeningocele who had surgical treatment for flexion contracture of the knee, is reported. After a single operation sixty-eight knees (55 per cent) had a contracture of less than 20 degrees, which was the main criterion of success. About half of the cases of transplantation of the hamstrings to the femur, division or elongation of the hamstrings, or supracondylar osteotomy had successful results. Transfer of the hamstring tendons to the patella was successful in nine of twelve instances, so giving the lowest rate of failure. Forty-five patients were active walkers at follow-up as compared to eighteen before operation. However, only one of the eleven patients over twelve years of age with a motor level above T.12 was an active walker at review. Several conclusions are drawn. A flexion contracture of the hip greater than 30 degress should be corrected before operation of the knee. Supracondylar osteotomy as a primary procedure should only be used to correct flexion contracture of the knee secondary to malunited fractures. Faradic stimulation is useful in the evaluation of muslce function before operation. An intelligence quotient below 65 and weakness of the arms are relative contraindications for correction of the deformity of the knee. PMID:925053

  6. Mapping Fire Scars in the Brazilian Cerrado Using AVHRR Imagery

    NASA Technical Reports Server (NTRS)

    Hlavka, C. A.; Ambrosia, V. G.; Brass, J. A.; Rezendez, A.; Alexander, S.; Guild, L. S.; Peterson, David L. (Technical Monitor)

    1995-01-01

    The Brazilian cerrado, or savanna, spans an area of 1,800,000 square kilometers on the great plateau of Central Brazil. Large fires covering hundreds of square kilometers, frequently occur in wildland areas of the cerrado, dominated by grasslands or grasslands mixed with shrubs and small trees, and also within area in the cerrado used for agricultural purposes, particularly for grazing. Smaller fires, typically extending over arm of a few square kilometers or less, are associated with the clewing of crops, such as dry land rice. A method for mapping fire scars and differentiating them from extensive areas of bare sod with AVHRR bands 1 (.55 -.68 micrometer) and 3 (3.5 - 3.9 micrometers) and measures of performance based on comparison with maps of fires with Landsat imagery will be presented. Methods of estimating total area burned from the AVHRR fire scar map will be discussed and related to land use and scar size.

  7. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2011 CFR

    2011-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule...

  8. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2010 CFR

    2010-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule...

  9. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule...

  10. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2013 CFR

    2013-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule...

  11. 9 CFR 11.3 - Scar rule.

    Code of Federal Regulations, 2012 CFR

    2012-01-01

    ... WELFARE HORSE PROTECTION REGULATIONS § 11.3 Scar rule. The scar rule applies to all horses born on or after October 1, 1975. Horses subject to this rule that do not meet the following scar rule...

  12. [Scalp burns due to hair bleach].

    PubMed

    Wagenblast, Lene

    2011-02-28

    We present two cases of scalp burn or possible chemical reaction due to use of hair highlight products. One case was treated with serial excision of the scarred bald area after the burn, and the other case was treated with implantation of expanders and subsequent excision of the bald area. PMID:21362396

  13. An automated image processing method to quantify collagen fiber organization within cutaneous scar tissue

    PubMed Central

    Quinn, Kyle P.; Golberg, Alexander; Broelsch, G. Felix; Khan, Saiqa; Villiger, Martin; Bouma, Brett; Austen, William G.; Sheridan, Robert L.; Mihm, Martin C.; Yarmush, Martin L.; Georgakoudi, Irene

    2014-01-01

    Standard approaches to evaluate scar formation within histological sections rely on qualitative evaluations and scoring, which limits our understanding of the remodeling process. We have recently developed an image analysis technique for the rapid quantification of fiber alignment at each pixel location. The goal of this study was to evaluate its application for quantitatively mapping scar formation in histological sections of cutaneous burns. To this end, we utilized directional statistics to define maps of fiber density and directional variance from Masson’s Trichrome stained sections for quantifying changes in collagen organization during scar remodeling. Significant increases in collagen fiber density are detectable soon after burn injury in a rat model. Decreased fiber directional variance in the scar was also detectable between 3 weeks and 6 months after injury, indicating increasing fiber alignment. This automated analysis of fiber organization can provide objective surrogate endpoints for evaluating cutaneous wound repair and regeneration. PMID:25256009

  14. Internet-based survey on current practice for evaluation, prevention, and treatment of scars, hypertrophic scars, and keloids.

    PubMed

    Lumenta, David B; Siepmann, Eva; Kamolz, Lars-Peter

    2014-01-01

    No universally accepted standard for evaluation, prevention, and treatment of scars, hypertrophic scars, and keloids exists. Following development of a questionnaire, we performed a closed Web-based survey among burn centers. Server-based data collection was performed over 4 weeks and closed thereafter. The poll revealed emerging new treatment schemes, but the majority of participants adhered to evaluation (Patient and Observer Scar Assessment Scale, Matching Assessment of Scars and Photographs, Vancouver Scar Scale, two-dimensional photography) and prevention (silicone gel sheets and compression garments) strategies that were in line with the currently available recommendations from the literature. We noted a low penetration for the use of objective evaluation tools in our poll and detected differences in surgical approaches to keloids. Based on the results of our survey and the power of currently available clinical recommendations, we expect future guidelines to gain more evidence-based power, especially when more high-quality clinical trials with objective evaluation support, clearly defined disease entities, and therapeutic outcome factors have become available. PMID:25041618

  15. Neonatal Volkmann Ischemic Contracture: Case Report and Review of Literature

    PubMed Central

    Agrawal, Hitesh; Dokania, Gunjan; Wu, Shou-Yien

    2014-01-01

    Background Neonatal Volkmann ischemic contracture in newborns is a devastating condition with lifelong consequences. Case Report We report a neonate born with necrotic skin lesions and bullae on right dorsal thenar aspect of hand, who subsequently developed compartment syndrome requiring fasciotomy. Review and Conclusion Necrotic skin lesions with/without swelling, bullae are invariably present at birth in these patients and should be recognized as a sentinel finding of underlying tissue ischemia/compartment syndrome. Early recognition and prompt surgical intervention can be limb saving. A range of radiologic abnormalities and contractures were noted in upto 84% of such patients followed long term. Hence, we recommend close follow-up until occurrence of epiphyseal fusion in these patients. PMID:25452886

  16. Comparison of the effectiveness of nonablative fractional laser versus ablative fractional laser in thyroidectomy scar prevention: A pilot study.

    PubMed

    Kim, Hei Sung; Lee, Ji Hae; Park, Young Min; Lee, Jun Young

    2012-04-01

    A scar is a mark that remains after the healing of a wound or other morbid processes. In the past, treatment was mainly focused on severe scarring, such as the hypertrophic and burn scars. However, scars from relatively minor wounds can also be stressful. The site of an open thyroidectomy is the anterior neck, a prominently exposed part of the body, where postoperative scarring can cause patients distress. The cosmetic outcome of the scar after thyroidectomy is of particular importance to women, who constitute the majority of patients with thyroid disease. Active prevention is more likely to yield better cosmetic results and would require fewer treatment sessions and less expense than scar revision procedures. Many interventions have been proposed, but there is yet no universal consensus on optimal treatment. Recently, focus has been made on 'laser scar prevention', where various types of lasers have been used to improve the appearance of scars. The purpose of this study was to improve the appearance of scars, by laser intervention of the wound healing process. In this pilot study, we comparatively examined the effect of non-ablative 1550-nm fractional Er: glass laser and ablative 2940-nm fractional Er: YAG laser on fresh surgical scars of patients with Fitzpatrick skin type III-IV. PMID:22409153

  17. Hair bleaching and skin burning.

    PubMed

    Forster, K; Lingitz, R; Prattes, G; Schneider, G; Sutter, S; Schintler, M; Trop, M

    2012-12-31

    Hairdressing-related burns are preventable and therefore each case is one too many. We report a unique case of a 16-yr-old girl who suffered full-thickness chemical and thermal burns to the nape of her neck and superficial burns to the occiput after her hair had been dyed blond and placed under a dryer to accelerate the highlighting procedure. The wound on the nape of the neck required surgical debridement and skin grafting. The grafted area resulted in subsequent scar formation. PMID:23766754

  18. Generation and characterization of a novel shoulder contracture mouse model.

    PubMed

    Oki, Satoshi; Shirasawa, Hideyuki; Yoda, Masaki; Matsumura, Noboru; Tohmonda, Takahide; Yuasa, Kazuki; Nakamura, Masaya; Matsumoto, Morio; Horiuchi, Keisuke

    2015-11-01

    Frozen shoulder is a relatively common disorder that leads to severe pain and stiffness in the shoulder joint. Although this disorder is self-limiting in nature, the symptoms often persist for years, resulting in severe disability. Recent studies using human specimens and animal models have shown distinct changes in the gene expression patterns in frozen shoulder tissue, indicating that novel therapeutic intervention could be achieved by controlling the genes that are potentially involved in the development of frozen shoulder. To achieve this goal, it is imperative to develop a reliable animal joint contracture model in which gene expression can be manipulated by gene targeting and transgenic technologies. Here, we describe a novel shoulder contracture mouse model. We found that this model mimics the clinical presentation of human frozen shoulder and recapitulates the changes in the gene expression pattern and the histology of frozen shoulder and joint contracture in humans and other larger animal models. The model is highly reproducible, without any major complications. Therefore, the present model may serve as a useful tool for investigating frozen shoulder etiology and for identifying its potential target genes. PMID:26014262

  19. Fillers for the improvement in acne scars

    PubMed Central

    Wollina, Uwe; Goldman, Alberto

    2015-01-01

    Acne is a common inflammatory disease. Scarring is an unwanted end point of acne. Both atrophic and hypertrophic scar types occur. Soft-tissue augmentation aims to improve atrophic scars. In this review, we will focus on the use of dermal fillers for acne scar improvement. Therefore, various filler types are characterized, and available data on their use in acne scar improvement are analyzed. PMID:26491364

  20. Scar remodeling after strabismus surgery.

    PubMed Central

    Ludwig, I H

    1999-01-01

    PURPOSE: Patients with overcorrected strabismus (and several patients with undercorrection after extraocular muscle resection) underwent exploration of previously operated muscles, with the intention of advancing their tendons to prevent the need for surgery on additional muscles. Unexpectedly, it was found that, in many cases, an elongated scar segment of variable length was interposed between the muscle and its insertion site on the sclera. Laboratory investigations were carried out to elucidate the underlying mechanism(s) and to create an animal model of the disorder. METHODS: Lengthened scars were repaired on 198 muscles during 134 procedures performed on 123 patients. The scars consisted of amorphous connective tissue interposed between the globe and normal tendon. Repair was accomplished by excision of the scar and reattachment of the muscle to sclera, using absorbable sutures in 64 cases and nonabsorbable sutures in 70 cases. Histopathologic examination was performed on 82 clinical specimens, and tissue culture studies were performed on 7 specimens. To develop an animal model, 10 New Zealand white rabbits underwent bilateral superior rectus resection. Half of the eyes received sub-Tenon's injections of collagenase over the operative site during weeks 2, 3, 5, and 6 postoperatively; the other half received saline solution injections on the same schedule. At 10 weeks, half the sites were studied histologically, and the other half underwent collagen creep analysis. In a second study, the use of absorbable versus nonabsorbable sutures was compared in the rabbit model. RESULTS: In the clinical cases, the mean length of the elongated scar segments was 4.2 mm. A total of 105 of the 134 repair procedures were judged successful. Thirty-one procedures resulted in recurrence of the original overcorrection; 7 of these had documented restretches. Factors that distinguished patients with stretched scars from patients with classic slipped muscles included minimal or no limitation of versions, less separation of the tendons from sclera, and thicker appearance of the scar segments. The use of nonabsorbable sutures in the repair procedure reduced the recurrence rate. Histologic examination of the clinical stretched scar specimens showed dense connective tissue that was less well organized compared with normal tendon. In the tissue culture studies, cells cultured from the stretched scar specimens grew rapidly and were irregularly shaped. A high-molecular-weight protein was identified in the culture medium. By contrast, cells cultured from normal tendon (controls) grew more slowly and regularly, stopped growing at 4 days, and produced less total protein than cultured stretched scar specimens. In the animal model studies, the collagenase-treated sites showed elongated scars with increased collagen between the muscle and the sclera, as well as increased collagen creep rates, compared with the saline-treated controls. The use of nonabsorbable sutures in collagenase-treated animal model surgery sites was associated with shorter, thicker scars compared with similar sites sutured with absorbable sutures. CONCLUSIONS: A lengthened or stretched, remodeled scar between an operated muscle tendon and sclera is a common occurrence and is a factor contributing to the variability of outcome after strabismus repair, even years later. This abnormality may be revealed by careful exploration of previously operated muscles. Definitive repair requires firm reattachment of tendon to sclera with nonabsorbable suture support. Images FIGURE 3 FIGURE 4 FIGURE 5 FIGURE 6 FIGURE 7 FIGURE 8 FIGURE 9 FIGURE 10 FIGURE 11 FIGURE 12 FIGURE 13 FIGURE 14 FIGURE 15 FIGURE 16 FIGURE 17 FIGURE 18 FIGURE 19 FIGURE 20 FIGURE 21 FIGURE 22 FIGURE 23 FIGURE 24 FIGURE 25 FIGURE 26 FIGURE 27 FIGURE 28 FIGURE 29 FIGURE 30 FIGURE 31 FIGURE 32 FIGURE 33 FIGURE 34 FIGURE 35 FIGURE 36 FIGURE 37 FIGURE 38 FIGURE 39 FIGURE 40 FIGURE 41 FIGURE 42 FIGURE 43 FIGURE 44 FIGURE 45 FIGURE 46 FIGURE 52 FIGURE 53 FIGURE 54 FIGURE 55 FIGURE 58 FIGURE 59 FIGURE 60 FIGURE 61 FIGURE 62 FIGURE 63 FIGURE 64 PMID:10703142

  1. The in-vitro caffeine contracture test: influence of the muscle histochemical profile on test results.

    PubMed

    Brownell, A K; Szabo, M

    1982-05-01

    In vitro caffeine contracture tests were carried out on whole rat muscle composed primarily of either histochemical type I or type II fibers. Muscles composed primarily of type I fibers developed contractures at lower concentrations of caffeine and had lower caffeine specific concentrations than muscles composed primarily of type II fibers. These findings indicate that the histochemical profile of a muscle can influence the results of the in-vitro caffeine contracture test. PMID:7074401

  2. MISR Views a Fire-Scarred Landscape

    NASA Technical Reports Server (NTRS)

    2000-01-01

    This MISR image pair shows 'before and after' views of the area around the Hanford Nuclear Reservation near Richland, Washington. On June 27, 2000, a fire in the dry sagebrush was sparked by an automobile crash. The flames were fanned by hot summer winds. By the day after the accident, about 100,000 acres had burned, and the fire's spread forced the closure of highways and loss of homes.

    These images, from Terra orbits 2176 and 3341, were obtained by MISR's vertical-viewing (nadir) camera. Compare the area just above and to the right of the line of cumulus clouds in the May 15 image with the same area imaged on August 3. The darkened burn scar measures approximately 35 kilometers across. The Columbia River is seen wending its way around the area, and the Snake River branches off to the right.

    According to Idaho's National Interagency Fire Center, the US has been experiencing the worst fire season since 1996.

    MISR was built and is managed by NASA's Jet Propulsion Laboratory, Pasadena, CA, for NASA's Office of Earth Science, Washington, DC. The Terra satellite is managed by NASA's Goddard Space Flight Center, Greenbelt, MD. JPL is a division of the California Institute of Technology.

  3. Biologicals and Fetal Cell Therapy for Wound and Scar Management

    PubMed Central

    Hirt-Burri, Nathalie; Ramelet, Albert-Adrien; Raffoul, Wassim; de Buys Roessingh, Anthony; Scaletta, Corinne; Pioletti, Dominique; Applegate, Lee Ann

    2011-01-01

    Few biopharmaceutical preparations developed from biologicals are available for tissue regeneration and scar management. When developing biological treatments with cellular therapy, selection of cell types and establishment of consistent cell banks are crucial steps in whole-cell bioprocessing. Various cell types have been used in treatment of wounds to reduce scar to date including autolog and allogenic skin cells, platelets, placenta, and amniotic extracts. Experience with fetal cells show that they may provide an interesting cell choice due to facility of outscaling and known properties for wound healing without scar. Differential gene profiling has helped to point to potential indicators of repair which include cell adhesion, extracellular matrix, cytokines, growth factors, and development. Safety has been evidenced in Phase I and II clinical fetal cell use for burn and wound treatments with different cell delivery systems. We present herein that fetal cells present technical and therapeutic advantages compared to other cell types for effective cell-based therapy for wound and scar management. PMID:22363853

  4. Fire scars and ancient sand dunes in southern Australia

    NASA Technical Reports Server (NTRS)

    1994-01-01

    The rectangular green areas in this view of southern Australia are protected areas of natural forest (national parks and biospheric reserves), and the lighter surrounding colors (tan-brown) are agricultural croplands occupying land which once must have looked as green as the nature reserves but are now cleared of forest. The major green patch has been recently burned, as shown by the irregular pattern of a large, multiple burn scar. The pattern of the fire scar indicates that the fires were driven by winds blowing from left to right. Close examination of the view shows that the forests are rooted in a soil made up of a widespread sheet of ancient dune sand. The dunes can be seen best within the area of the large fire scar where the characteristic wavy, scalloped pattern of crescent dunes can be detected. The crescents indicate that the sand was heaped up by winds blowing from right to left in this view, in the opposite direction to the winds which fanned the fires. A few straight dunes

  5. Potassium Chloride Versus Voltage Clamp Contractures in Ventricular Muscle

    NASA Astrophysics Data System (ADS)

    Morad, M.; Reeck, S.; Rao, M.

    1981-01-01

    In frog ventricle, developed tension was markedly larger in response to depolarization caused by a voltage clamp step than to depolarization induced by high concentrations of potassium chloride. Measurement of extracellular potassium activity at the surface and at the depth of muscle during the development of contractures showed that the diffusion of potassium is much slower than the spread of depolarization through the cross section of muscle. These two observations suggest that competition between the depolarizing and the negative inotropic effects of an increase in the extracellular potassium ion concentration may determine the time course and magnitude of contractile tension in heart muscle.

  6. Rhinoplasty with Cartilage and Alloplastic Materials, Nasal SMAS Management in Asian Rhinoplasty, Contracture Classification, and Secondary Rhinoplasty with Contracture.

    PubMed

    Kim, Yong Kyu; Kania, Katarzyna; Nguyen, Anh H

    2015-11-01

    Rhinoplasty for Asians is quite different from that of Westerners. Most Asians desire a raised nasal bridge with a projected nasal tip, similar to that of Westerners. Nevertheless, most Asian nasal bones, and upper and lower lateral cartilages are inadequately developed. This largely necessitates the use of a nasal alloplastic material such as a silicone implant, most frequently utilized in nasal cosmetic surgery for Asians. Shaping of the silicone implant is rather easy and its removal is also simple, in the case of a complication or undesired result. The disadvantage of a nasal silicone implant, like that of silicone implants of the breast, is the fibrous capsular formation, which may lead to capsular contracture. The frequently employed types of nasal silicone implant include (1) the boat type in which the silicone implant descends down to the nasal tip, (2) the L-shape in which the silicone implant further extends to the anterior nasal spine (ANS) after passing the tip, and (3) the three-quarter type for which the silicone implant extends down to the upper lateral cartilage. In conjunction with the silicone implant, the cartilages of the ear and the nasal septum are commonly used to create or lengthen tip projection. Asians generally have cartilage with inadequate anatomical development. Instead, they often have an anatomically thick fibrous fatty layer including underdeveloped superficial musculoaponeurotic system (SMAS). Patients with a thick fibrous tissue layer have a bulbous tip. This nasal tip is the area where severe capsular contracture occurs after insertion of a silicone implant. It is imperative that the surgeon properly understands the nasal anatomical characteristics of Asians, and selects an appropriate implant together with a suitable donor cartilage to attain a safe and aesthetically pleasing nose. The same principle should apply to reoperation cases; the fibrofatty layer of SMAS along with the capsular contracture must be removed or released to gain a sufficient soft tissue volume. This provides further stability to the cartilage framework. PMID:26648805

  7. Soft tissue trauma and scar revision.

    PubMed

    Mobley, Steven R; Sjogren, Phayvanh P

    2014-11-01

    Numerous techniques and treatments have been described for scar revision, with most studies focusing on the adult population. A comprehensive review of the literature reveals a paucity of references related specifically to scar revision in children. This review describes the available modalities in pediatric facial scar revision. The authors have integrated current practices in soft tissue trauma and scar revision, including closure techniques and materials, topical therapy, steroid injection, cutaneous laser therapy, and tissue expanders. PMID:25444734

  8. Congenital Heart Disease in Adolescents With Gluteal Muscle Contracture

    PubMed Central

    You, Tian; Zhang, Xin-tao; Zha, Zhen-gang; Zhang, Wen-tao

    2015-01-01

    Abstract Gluteal muscle contracture (GMC), presented with hip abduction and external rotation when crouching, is common in several ethnicities, particularly in Chinese. It remains unclear that the reasons why these children are weak and have no choice to accept repeated intramuscular injection. Here, we found some unique cases which may be useful to explain this question. We describe a series of special GMC patients, who are accompanied with congenital heart disease (CHD). These cases were first observed in preoperative examinations of a patient with atrial septal defect (ASD), which was proved by chest X-ray and cardiac ultrasound. From then on, we gradually identified additional 3 GMC patients with CHD. The original patient with ASD was sent to cardiosurgery department to repair atrial septal first and received arthroscopic surgery later. While the other 3 were cured postoperative of ventricular septal defect (VSD), tetralogy of fallot (TOF), patent ductus arteriosus (PDA), respectively, and had surgery directly. The study gives us 3 proposals: (1) as to CHD children, it is essential to decrease the use of intramuscular injection, (2) paying more attention to cardiac examination especially cardiac ultrasound in perioperative period, and (3) taking 3D-CT to reconstruct gluteal muscles for observing contracture bands clearly in preoperation. However, more larger series of patients are called for to confirm these findings. PMID:25654394

  9. Biomass Burning

    Atmospheric Science Data Center

    2015-07-27

    Projects:  Biomass Burning Definition/Description:  Biomass Burning: This data set represents the geographical and temporal distribution of total amount of biomass burned. These data may be used in general circulation models (GCMs) and ...

  10. Scar Wars: Preferences in Breast Surgery

    PubMed Central

    Murphy, Siun; Murphy, Stephen; Kelly, Jack L; Morrison, Colin M

    2015-01-01

    Background The uptake of breast reconstruction is ever increasing with procedures ranging from implant-based reconstructions to complex free tissue transfer. Little emphasis is placed on scarring when counseling patients yet they remain a significant source of morbidity and litigation. The aim of this study was to examine the scarring preferences of men and women in breast oncoplastic and reconstructive surgery. Methods Five hundred men and women were asked to fill out a four-page questionnaire in two large Irish centres. They were asked about their opinions on scarring post breast surgery and were also asked to rank the common scarring patterns in wide local excisions, oncoplastic procedures, breast reconstructions as well as donor sites. Results Fifty-eight percent of those surveyed did not feel scars were important post breast cancer surgery. 61% said that their partners' opinion of scars were important. The most preferred wide local excision scar was the lower lateral quadrant scar whilst the scars from the deep inferior epigastric artery perforator (DIEP) flap were most favoured. The superior gluteal artery perforator flap had the most preferred donor site while surprisingly, the DIEP had the least favourite donor site. Conclusions Scars are often overlooked when planning breast surgery yet the extent and position of the scar needs to be outlined to patients and it should play an important role in selecting a breast reconstruction option. This study highlights the need for further evaluation of patients' opinions regarding scar patterns. PMID:26430631

  11. Adult Hip Flexion Contracture due to Neurological Disease: A New Treatment Protocol-Surgical Treatment of Neurological Hip Flexion Contracture.

    PubMed

    Nicodemo, Alberto; Arrigoni, Chiara; Bersano, Andrea; Massè, Alessandro

    2014-01-01

    Congenital, traumatic, or extrinsic causes can lead people to paraplegia; some of these are potentially; reversible and others are not. Paraplegia can couse hip flexion contracture and, consequently, pressure sores, scoliosis, and hyperlordosis; lumbar and groin pain are strictly correlated. Scientific literature contains many studies about children hip flexion related to neurological diseases, mainly caused by cerebral palsy; only few papers focus on this complication in adults. In this study we report our experience on surgical treatment of adult hip flexion contracture due to neurological diseases; we have tried to outline an algorithm to choose the best treatment avoiding useless or too aggressive therapies. We present 5 cases of adult hips flexion due to neurological conditions treated following our algorithm. At 1-year-follow-up all patients had a good clinical outcome in terms of hip range of motion, pain and recovery of walking if possible. In conclusion we think that this algorithm could be a good guideline to treat these complex cases even if we need to treat more patients to confirm this theory. We believe also that postoperation physiotherapy it is useful in hip motility preservation, improvement of muscular function, and walking ability recovery when possible. PMID:24707293

  12. Burns: Treatment and Outcomes

    PubMed Central

    Burd, Andrew

    2010-01-01

    Burns can cause extensive and devastating injuries of the head and neck. Prevention of the initial injury must always be a priority, but once an injury has occurred, then prevention of progression of the damage together with survival of the patient must be the immediate goals. The acute care will have a major influence on the subsequent scarring, reconstructive need, and long-term outcome. In the majority of cases, the reconstruction will involve restoration of form and function to the soft tissues, and the methods used will depend very much on the extent of scarring locally and elsewhere in the body. In nearly all cases, a significant improvement in functional and aesthetic outcomes can be achieved, which, in conjunction with intensive psychosocial rehabilitation, can lead to high-quality patient outcomes. With the prospect of facial transplantation being a clinical reality, the reconstructive spectrum has opened up even further, and, with appropriate reconstruction and support, no patient should be left economically deprived or socially isolated after a burn injury. PMID:22550448

  13. Physiological Implications of Myocardial Scar Structure.

    PubMed

    Richardson, William J; Clarke, Samantha A; Quinn, T Alexander; Holmes, Jeffrey W

    2015-10-01

    Once myocardium dies during a heart attack, it is replaced by scar tissue over the course of several weeks. The size, location, composition, structure, and mechanical properties of the healing scar are all critical determinants of the fate of patients who survive the initial infarction. While the central importance of scar structure in determining pump function and remodeling has long been recognized, it has proven remarkably difficult to design therapies that improve heart function or limit remodeling by modifying scar structure. Many exciting new therapies are under development, but predicting their long-term effects requires a detailed understanding of how infarct scar forms, how its properties impact left ventricular function and remodeling, and how changes in scar structure and properties feed back to affect not only heart mechanics but also electrical conduction, reflex hemodynamic compensations, and the ongoing process of scar formation itself. In this article, we outline the scar formation process following a myocardial infarction, discuss interpretation of standard measures of heart function in the setting of a healing infarct, then present implications of infarct scar geometry and structure for both mechanical and electrical function of the heart and summarize experiences to date with therapeutic interventions that aim to modify scar geometry and structure. One important conclusion that emerges from the studies reviewed here is that computational modeling is an essential tool for integrating the wealth of information required to understand this complex system and predict the impact of novel therapies on scar healing, heart function, and remodeling following myocardial infarction. PMID:26426470

  14. Two dimensional unstable scar statistics.

    SciTech Connect

    Warne, Larry Kevin; Jorgenson, Roy Eberhardt; Kotulski, Joseph Daniel; Lee, Kelvin S. H. (ITT Industries/AES Los Angeles, CA)

    2006-12-01

    This report examines the localization of time harmonic high frequency modal fields in two dimensional cavities along periodic paths between opposing sides of the cavity. The cases where these orbits lead to unstable localized modes are known as scars. This paper examines the enhancements for these unstable orbits when the opposing mirrors are both convex and concave. In the latter case the construction includes the treatment of interior foci.

  15. Renal cortical scarring in acute pyelonephritis.

    PubMed

    Tsugaya, M; Hirao, N; Sakagami, H; Ohtaguro, K; Washida, H

    1992-03-01

    A series of 14 patients with acute pyelonephritis was evaluated for the formation of renal scarring by serial computed tomography (CT) and intravenous urography. Although the urography results were normal, CT showed renal parenchymal atrophy (cortical scarring) in 6 patients. Cortical scarring was observed to occur after 61 to 187 days, and it was slower to develop in the patients with recurrent fever lasting for 2 weeks or more in total than in those with fever for less than 2 weeks. Scarring was significantly more frequent in patients with severe renal involvement than in those with mild involvement, and scars developed at the sites of the most extensive lesions seen on the initial CT scans. Cortical scars were detected in 6 of the 7 patients in whom the lesions occupied 30% or more of the renal parenchyma. We conclude that the extent of the initial renal parenchymal involvement was the most important determinant of eventual scar formation. PMID:1568097

  16. Scar-free healing: from embryonic mechanisms to adult therapeutic intervention.

    PubMed Central

    Ferguson, Mark W J; O'Kane, Sharon

    2004-01-01

    In man and domestic animals, scarring in the skin after trauma, surgery, burn or sports injury is a major medical problem, often resulting in adverse aesthetics, loss of function, restriction of tissue movement and/or growth and adverse psychological effects. Current treatments are empirical, unreliable and unpredictable: there are no prescription drugs for the prevention or treatment of dermal scarring. Skin wounds on early mammalian embryos heal perfectly with no scars whereas wounds to adult mammals scar. We investigated the cellular and molecular differences between scar-free healing in embryonic wounds and scar-forming healing in adult wounds. Important differences include the inflammatory response, which in embryonic wounds consists of lower numbers of less differentiated inflammatory cells. This, together with high levels of morphogenetic molecules involved in skin growth and morphogenesis, means that the growth factor profile in a healing embryonic wound is very different from that in an adult wound. Thus, embryonic wounds that heal without a scar have low levels of TGFbeta1 and TGFbeta2, low levels of platelet-derived growth factor and high levels of TGFbeta3. We have experimentally manipulated healing adult wounds in mice, rats and pigs to mimic the scar-free embryonic profile, e.g. neutralizing PDGF, neutralizing TGFbeta1 and TGFbeta2 or adding exogenous TGFbeta3. These experiments result in scar-free wound healing in the adult. Such experiments have allowed the identification of therapeutic targets to which we have developed novel pharmaceutical molecules, which markedly improve or completely prevent scarring during adult wound healing in experimental animals. Some of these new drugs have successfully completed safety and other studies, such that they have entered human clinical trials with approval from the appropriate regulatory authorities. Initial trials involve application of the drug or placebo in a double-blind randomized design, to experimental incision or punch biopsy wounds under the arms of human volunteers. Based on encouraging results from such human volunteer studies, the lead drugs have now entered human patient-based trials e.g. in skin graft donor sites. We consider the evolutionary context of wound healing, scarring and regeneration. We hypothesize that evolutionary pressures have been exerted on intermediate sized, widespread, dirty wounds with considerable tissue damage e.g. bites, bruises and contusions. Modem wounds (e.g. resulting from trauma or surgery) caused by sharp objects and healing in a clean or sterile environment with close tissue apposition are new occurrences, not previously encountered in nature and to which the evolutionary selected wound healing responses are somewhat inappropriate. We also demonstrate that both repair with scarring and regeneration can occur within the same animal, including man, and indeed within the same tissue, thereby suggesting that they share similar mechanisms and regulators. Consequently, by subtly altering the ratio of growth factors present during adult wound healing, we can induce adult wounds to heal perfectly with no scars, with accelerated healing and with no adverse effects, e.g. on wound strength or wound infection rates. This means that scarring may no longer be an inevitable consequence of modem injury or surgery and that a completely new pharmaceutical approach to the prevention of human scarring is now possible. Scarring after injury occurs in many tissues in addition to the skin. Thus scar-improving drugs could have widespread benefits and prevent complications in several tissues, e.g. prevention of blindness after scarring due to eye injury, facilitation of neuronal reconnections in the central and peripheral nervous system by the elimination of glial scarring, restitution of normal gut and reproductive function by preventing strictures and adhesions after injury to the gastrointestinal or reproductive systems, and restoration of locomotor function by preventing scarring in tendons and ligaments. PMID:15293811

  17. Student Attitudes toward Children and Adolescents with Severe Burns.

    ERIC Educational Resources Information Center

    Holaday, Margot; McPhearson, Ruth

    1996-01-01

    Color photographs of burned and nonburned children were used to study the attitudes of 218 practice teachers, nursing students, and counselors-in-training. Findings revealed that children with severe burns and facial scarring were regarded less favorably. Stresses that professionals should be well-trained and empathic in order to assist burned…

  18. In vitro contracture tests in patients with various neuromuscular diseases.

    PubMed

    Heytens, L; Martin, J J; Van de Kelft, E; Bossaert, L L

    1992-01-01

    In order to investigate the relationship between neuromuscular disease and malignant hyperthermia (MH) susceptibility, the caffeine and halothane in vitro contracture test (European Malignant Hyperthermia Group Protocol) were performed in 60 patients who underwent muscle biopsy for investigation of a clinically suspected neuromuscular disorder. Two test results were classified as MH susceptible, 10 as MH equivocal and 48 MH negative. The large number of equivocal results is thought to indicate the lack of specificity of the individual components of this test in patients with clinical or histological evidence of neuromuscular disease. The increased in vitro sensitivity to the drugs tested may nevertheless provide some explanation for several in vivo "MH-like reactions" reported frequently in these patients. These reactions, however, are likely to be based on pathophysiological mechanisms different from those responsible for a true MH crisis. PMID:1739572

  19. [Dupuytren's contracture: percutaneous needle aponeurotomy is an alternative to surgery].

    PubMed

    Manet, M-P; Roulot, E; Teyssedou, J-P; Lahalle, S; Ziza, J-M

    2011-04-01

    Dupuytren's contracture is a retractile fibrosis of the superficial palmar aponeurosis of the hand, resulting in a progressive and fixed flexion of the fingers that may result in severe limitation of hand function. It affects several millions of people in Europe and North America. Risk factors are genetic and sometimes related to mellitus diabetes. There is no spontaneous remission. Until recently, surgery was the only treatment, but now needle aponeurotomy emerges as a therapeutic alternative. It should be performed as first line treatment by a trained practitioner. Short and long-term results of needle aponeurotomy appear identical to those of surgery, with milder complications. It is indicated in palmar, palmo-digital, as well as in strictly digital forms of the disorder. The "table-test" is used to assess the loss of extension of the digit and to select the indication to needle aponeurotomy. A medico-surgical consensus should define the optimum treatment strategy in this affection. PMID:20828892

  20. Bilateral carpal contracture in a neonatal addax (Addax nasomaculatus).

    PubMed

    Watson, Megan K; Langan, Jennifer; Adkesson, Michael J

    2013-09-01

    A neonate male addax calf displayed an inability to extend its forelimbs bilaterally (range of motion restricted to 45 degrees-50 degrees on full extension) with resultant inability to stand. Based on examination and radiographs, the congenital defect was attributed to contracted soft tissue structures (joint capsule and/or intercarpal ligaments). Splinting, support of the limbs, and physical therapy resulted in moderate improvement of the angle of contraction (full flexion to approximately 120 degrees on extension at day 10). The animal was able to walk with splints but died at 10 days from acute head trauma, presumably related to a traumatic fall caused by challenges with ambulation. Postmortem examination confirmed soft-tissue contracture of the forelimbs. Malposition of the calf in utero was considered a possible cause of the defect. PMID:24063116

  1. [DIAGNOSTIC VARIATIONS OF X-LINKED MUSCULAR DYSTROPHY WITH CONTRACTURES].

    PubMed

    Kvirkvelia, N; Shakarishvili, R; Gugutsidze, D; Khizanishvili, N

    2015-01-01

    Case report with review describes X-linked muscular dystrophy with contractures in 28 years old man and his cousin. The disease revealed itself in an early stage (age 5-10), the process was progressing with apparent tendons retraction and contraction, limited movement in the areas of the neck and back of spine, atrophy of shoulder and pelvic yard and back muscles. Intellect was intact. Cardyomyopathy was exhibited. CK was normal. EMG showed classic myopathic features. Muscle biopsy showed different caliber groups of muscle fibers, growth of endo-perimesial connective tissue. Clinical manifestations together with electrophysiological and histological data suggest consistency with Rotthauwe-Mortier-Bayer X-linked muscular dystrophy. PMID:26177134

  2. Burn wound: How it differs from other wounds?

    PubMed

    Tiwari, V K

    2012-05-01

    Management of burn injury has always been the domain of burn specialists. Since ancient time, local and systemic remedies have been advised for burn wound dressing and burn scar prevention. Management of burn wound inflicted by the different physical and chemical agents require different regimes which are poles apart from the regimes used for any of the other traumatic wounds. In extensive burn, because of increased capillary permeability, there is extensive loss of plasma leading to shock while whole blood loss is the cause of shock in other acute wounds. Even though the burn wounds are sterile in the beginning in comparison to most of other wounds, yet, the death in extensive burns is mainly because of wound infection and septicemia, because of the immunocompromised status of the burn patients. Eschar and blister are specific for burn wounds requiring a specific treatment protocol. Antimicrobial creams and other dressing agents used for traumatic wounds are ineffective in deep burns with eschar. The subeschar plane harbours the micro-organisms and many of these agents are not able to penetrate the eschar. Even after complete epithelisation of burn wound, remodelling phase is prolonged. It may take years for scar maturation in burns. This article emphasizes on how the pathophysiology, healing and management of a burn wound is different from that of other wounds. PMID:23162236

  3. Noninflammatory Joint Contractures Arising from Immobility: Animal Models to Future Treatments

    PubMed Central

    Wong, Kayleigh; Trudel, Guy; Laneuville, Odette

    2015-01-01

    Joint contractures, defined as the limitation in the passive range of motion of a mobile joint, can be classified as noninflammatory diseases of the musculoskeletal system. The pathophysiology is not well understood; limited information is available on causal factors, progression, the pathophysiology involved, and prediction of response to treatment. The clinical heterogeneity of joint contractures combined with the heterogeneous contribution of joint connective tissues to joint mobility presents challenges to the study of joint contractures. Furthermore, contractures are often a symptom of a wide variety of heterogeneous disorders that are in many cases multifactorial. Extended immobility has been identified as a causal factor and evidence is provided from both experimental and epidemiology studies. Of interest is the involvement of the joint capsule in the pathophysiology of joint contractures and lack of response to remobilization. While molecular pathways involved in the development of joint contractures are being investigated, current treatments focus on physiotherapy, which is ineffective on irreversible contractures. Future treatments may include early diagnosis and prevention. PMID:26247029

  4. Dupuytren's disease or Cooper's contracture?: Kenneth Fitzpatrick Russell Memorial Lecture.

    PubMed

    Thurston, Alan

    2003-07-01

    In his position as curator of the Cowlishaw collection of historical medical books in the Library of the College, Kenneth Russell prepared the definitive catalogue of the collection. This catalogue is comprehensive and for almost all entries there is an annotation that demonstrates his meticulous attention to detail and the love of the book collection that he managed to secure for the College. It is from this catalogue that I have chosen two books in particular that bring together two great surgeons of the turn of the 19th century. Although he was a pupil of the great John Hunter, the young Astley Cooper possessed good manners and a gift of oratory of which the Scot, his teacher, was devoid. After his apprenticeship with Henry Cline senior, Cooper came to share the podium with Cline at Guy's and St Thomas' hospitals and the two dominated surgical teaching in London for some 22 years, until Cline's retirement in 1811. It was the latter who was first to recognize the true nature of the condition now known as Dupuytren's disease. Later, in 1822, Cooper wrote a detailed description of the contracture of the palmar aponeurosis and recommended fasciotomy as being curative. His book A Treatise on Dislocations and Fractures of the Joints, which contains this description of Dupuytren's contracture, is held in the Cowlishaw Collection. On the other side of the English Channel, M. le Baron Dupuytren repeatedly misquoted Cooper and stated that Cooper believed that the disease was incurable. In his famous lecture given to the staff of the Htel Dieu in Paris on 5th December 1931, he admitted to having seen 30 or 40 cases over 20 years of practice. It seems likely that he was not aware of the true cause of the condition before 1831 when he treated his first case. This lecture, along with others, are recorded in his Leons Orales de Clinique Chirurgicale, a copy of which is also to be found in the Cowlishaw Collection. PMID:12864830

  5. The Relationship of Bacterial Biofilms and Capsular Contracture in Breast Implants.

    PubMed

    Ajdic, Dragana; Zoghbi, Yasmina; Gerth, David; Panthaki, Zubin J; Thaller, Seth

    2016-03-01

    Capsular contracture is a common sequelae of implant-based breast augmentation. Despite its prevalence, the etiology of capsular contracture remains controversial. Numerous studies have identified microbial biofilms on various implantable materials, including breast implants. Furthermore, biofilms have been implicated in subclinical infections associated with other surgical implants. In this review, we discuss microbial biofilms as a potential etiology of capsular contracture. The review also outlines the key diagnostic modalities available to identify the possible infectious agents found in biofilm, as well as available preventative and treatment measures. PMID:26843099

  6. Smoke, Clouds, and Radiation-Brazil (SCAR-B) Experiment

    NASA Technical Reports Server (NTRS)

    Kaufman, Y. J.; Hobbs, P. V.; Kirchoff, V. W. J. H.; Artaxo, P.; Remer, L. A.; Holben, B. N.; King, M. D.; Ward, D. E.; Prins, E. M.; Longo, K. M.; Mattos, L. F.; Nobre, C. A.; Spinhirne, J. D.; Ji, Q.; Thompson, A. M.; Gleason, J. F.; Christopher, S. A.; Tsay, S.-C.

    1998-01-01

    The Smoke, Clouds, and Radiation-Brazil (SCAR-B) field project took place in the Brazilian Amazon and cerrado regions in August-September 1995 as a collaboration between Brazilian and American scientists. SCAR-B, a comprehensive experiment to study biomass burning, emphasized measurements of surface biomass, fires, smoke aerosol and trace gases, clouds, and radiation. their climatic effects, and remote sensing from aircraft and satellites. It included aircraft and ground-based in situ measurements of smoke emission factors and the compositions, sizes, and optical properties of the smoke particles; studies of the formation of ozone; the transport and evolution of smoke; and smoke interactions with water vapor and clouds. This overview paper introduces SCAR-B and summarizes some of the main results obtained so far. (1) Fires: measurements of the size distribution of fires, using the 50 m resolution MODIS Airborne Simulator, show that most of the fires are small (e.g. 0.005 square km), but the satellite sensors (e.g., AVHRR and MODIS with I km resolution) can detect fires in Brazil which are responsible for 60-85% of the burned biomass: (2) Aerosol: smoke particles emitted from fires increase their radius by as much as 60%, during their first three days in the atmosphere due to condensation and coagulation, reaching a mass median radius of 0.13-0.17 microns: (3) Radiative forcing: estimates of the globally averaged direct radiative forcing due to smoke worldwide, based on the properties of smoke measured in SCAR-B (-O.l to -0.3 W m(exp -2)), are smaller than previously modeled due to a lower single-scattering albedo (0.8 to 0.9), smaller scattering efficiency (3 square meters g(exp -2) at 550 nm), and low humidification factor; and (4) Effect on clouds: a good relationship was found between cloud condensation nuclei and smoke volume concentrations, thus an increase in the smoke emission is expected to affect cloud properties. In SCAR-B, new techniques were developed for deriving the absorption and refractive index of smoke from ground-based remote sensing. Future spaceborne radiometers (e.g., MODIS on the Earth Observing System), simulated on aircraft, proved to be very useful for monitoring smoke properties, surface properties, and the impacts of smoke on radiation and climate.

  7. A Case of Multiple Spontaneous Keloid Scars

    PubMed Central

    Jfri, Abdulhadi; Rajeh, Nawal; Karkashan, Eman

    2015-01-01

    Keloid scars result from an abnormal healing response to cutaneous injury or inflammation that extends beyond the borders of the original wound. Spontaneous keloid scars forming in the absence of any previous trauma or surgical procedure are rare. Certain syndromes have been associated with this phenomenon, and few reports have discussed the evidence of single spontaneous keloid scar, which raises the question whether they are really spontaneous. Here, we present a 27-year-old mentally retarded single female with orbital hypertelorism, broad nasal bridge, repaired cleft lip and high-arched palate who presented with progressive multiple spontaneous keloid scars in different parts of her body which were confirmed histologically by the presence of typical keloidal collagen. This report supports the fact that keloid scars can appear spontaneously and are possibly linked to a genetic factor. Furthermore, it describes a new presentation of spontaneous keloid scars in the form of multiple large lesions in different sites of the body. PMID:26351423

  8. Nonoperative techniques for scar management and revision.

    PubMed

    Chang, C W; Ries, W R

    2001-11-01

    Facial plastic surgeons are frequently called upon to manage facial scars, whether iatrogenic or traumatic. Numerous treatment modalities are available for scar management depending upon scar characteristics, age, and patient expectations. The focus of this article is to review commonly used nonsurgical methods of scar revision. These include topical applications (silicone, vitamin E, pressure dressing, herbal extracts), intralesional medication (steroids, antimitotics), soft tissue augmentation (collagen, fat), laser applications (585-nm flashlamp-pumped pulsed dye, CO(2)), cryotherapy, and make-up camouflage. Nonsurgical modalities can be used as prophylactic prevention of adverse scar formation, as definitive treatment, as intervening therapy until further surgical repair can be made, or as adjunctive treatment following surgical scar revision. PMID:11735062

  9. Chiral scars in chaotic Dirac fermion systems.

    PubMed

    Xu, Hongya; Huang, Liang; Lai, Ying-Cheng; Grebogi, Celso

    2013-02-01

    Do relativistic quantum scars in classically chaotic systems possess unique features that are not shared by nonrelativistic quantum scars? We report a class of relativistic quantum scars in massless Dirac fermion systems whose phases return to the original values or acquire a 2π change only after circulating twice about some classical unstable periodic orbits. We name such scars chiral scars, the successful identification of which has been facilitated tremendously by our development of an analytic, conformal-mapping-based method to calculate an unprecedentedly large number of eigenstates with high accuracy. Our semiclassical theory indicates that the physical origin of chiral scars can be attributed to a combined effect of chirality intrinsic to massless Dirac fermions and the geometry of the underlying classical orbit. PMID:23432246

  10. Acne Scars: Pathogenesis, Classification and Treatment

    PubMed Central

    Fabbrocini, Gabriella; Annunziata, M. C.; D'Arco, V.; De Vita, V.; Lodi, G.; Mauriello, M. C.; Pastore, F.; Monfrecola, G.

    2010-01-01

    Acne has a prevalence of over 90% among adolescents and persists into adulthood in approximately 12%–14% of cases with psychological and social implications. Possible outcomes of the inflammatory acne lesions are acne scars which, although they can be treated in a number of ways, may have a negative psychological impact on social life and relationships. The main types of acne scars are atrophic and hypertrophic scars. The pathogenesis of acne scarring is still not fully understood, but several hypotheses have been proposed. There are numerous treatments: chemical peels, dermabrasion/microdermabrasion, laser treatment, punch techniques, dermal grafting, needling and combined therapies for atrophic scars: silicone gels, intralesional steroid therapy, cryotherapy, and surgery for hypertrophic and keloidal lesions. This paper summarizes acne scar pathogenesis, classification and treatment options. PMID:20981308

  11. Scar Revision Surgery: The Patient's Perspective

    PubMed Central

    Allan, Anna Y; Butler, Daniel P; Cussons, Paul D

    2015-01-01

    Background Insufficient satisfaction outcome literature exists to assist consultations for scar revision surgery; such outcomes should reflect the patient's perspective. The aim of this study was to prospectively investigate scar revision patient satisfaction outcomes, according to specified patient-selection criteria. Methods Patients (250) were randomly selected for telephone contacting regarding scar revisions undertaken between 2007-2011. Visual analogue scores were obtained for scars pre- and post-revision surgery. Surgery selection criteria were; 'presence' of sufficient time for scar maturation prior to revision, technical issues during or wound complications from the initial procedure that contributed to poor scarring, and 'absence' of site-specific or patient factors that negatively influence outcomes. Patient demographics, scar pathogenesis (elective vs. trauma), underlying issue (functional/symptomatic vs. cosmetic) and revision surgery details were also collected with the added use of a real-time, hospital database. Results Telephone contacting was achieved for 211 patients (214 scar revisions). Satisfaction outcomes were '2% worse, 16% no change, and 82% better'; a distribution maintained between body sites and despite whether surgery was functional/symptomatic vs. cosmetic. Better outcomes were reported by patients who sustained traumatic scars vs. those who sustained scars by elective procedures (91.80% vs. 77.78%, P=0.016) and by females vs. males (85.52% vs. 75.36%, P<0.05), particularly in the elective group where males (36.17%) were more likely to report no change or worse outcomes versus females (16.04%) (P<0.01). Conclusions Successful scar revision outcomes may be achieved using careful patient selection. This study provides useful information for referring general practitioners, and patient-surgeon consultations, when planning scar revision. PMID:26618120

  12. [Present and future of cell therapy in burns].

    PubMed

    Bargues, L; Prat, M; Leclerc, T; Bey, E; Lataillade, J-J

    2011-06-01

    Severe burned patients need definitive and efficient wound coverage. Outcome of massive burns has been improved by using cultured epithelial autografts (CEA). Despite fragility, percentages of success take, cost of treatment and long-term tendency to contracture, this surgical technique has been developed in few burn centres. First improvements were to combine CEA and dermis-like substitute. Cultured skin substitutes provide earlier skin closure and satisfying functional result. These methods have been used successfully in massive burns. Second improvement was to allow skin regeneration by using epidermal stem cells. Stem cells have capacity to differentiate into keratinocytes, to promote wound repair and to regenerate skin appendages. Human mesenchymal stem cells contribute to wound healing and were evaluated in cutaneous radiation syndrome. Skin regeneration and tissue engineering methods remain a complex challenge and offer the possibility of new treatment for injured and burned patients. PMID:20167439

  13. Effective Treatments of Atrophic Acne Scars

    PubMed Central

    Zhou, Bingrong

    2015-01-01

    Atrophic scarring is often an unfortunate and permanent complication of acne vulgaris. It has high prevalence, significant impact on quality of life, and therapeutic challenge for dermatologists. The treatment of atrophic acne scars varies depending on the types of acne scars and the limitations of the treatment modalities in their ability to improve scars. Therefore, many options are available for the treatment of acne scarring, including chemical peeling, dermabrasion, laser treatment, punch techniques, fat transplantation, other tissue augmenting agents, needling, subcision, and combined therapy. Various modalities have been used to treat scars, but limited efficacy and problematic side effects have restricted their application. In order to optimally treat a patient’s scar, we need to consider which treatment offers the most satisfactory result. There are also promising procedures in the future, such as stem cell therapy. In this article, the authors review the different treatment options of atrophic acne scars. This may be useful for selecting the best therapeutic strategy, whether it be single or combined therapy, in the treatment of atrophic acne scars while reducing or avoiding the side effects and complications. PMID:26029333

  14. No relationship between fiber type and halothane contracture test results in malignant hyperthermia.

    PubMed

    Heiman-Patterson, T; Fletcher, J E; Rosenberg, H; Tahmoush, A J

    1987-07-01

    Previous studies in cat, rat, and swine have implicated fiber type as influencing the halothane and caffeine contracture test used to diagnose malignant hyperthermia (MH). The authors performed fiber type analysis using myosin ATPase stains on 31 fascicles of skeletal muscle from nine patients following contracture testing. There was no significant difference in fiber type composition between fascicles from MH negative (n = 5) and MH positive (n = 4) patients. Furthermore, examining each of the 31 fascicles, the authors found no correlation (P greater than .05) of contracture magnitude with percentage of either Type I or Type II fibers using the Pearson Product-Moment correlation calculation. The authors conclude that fiber type composition does not influence contracture test results in human biopsies. PMID:2440353

  15. Absence of capsular contracture in 319 consecutive augmentation mammaplasties: Dependent drains as a possible factor

    PubMed Central

    Fanous, Nabil; Salem, Iman; Tawil, Carolyne; Bassas, AE

    2004-01-01

    Capsular contracture is one of the major complications of augmentation mammaplasty. A review of 638 augmented breasts in 319 consecutive patients who underwent primary augmentation, with an average follow-up of 17.2 months and without a single case of capsular contracture of any degree to date, is presented, along with a discussion of the surgical technique and complications, and an analysis of measures used to prevent capsular contraction. Each patient received a pair of smooth saline-filled implants (Mentor, USA) placed in the submuscular space through an inframammary incision. In all operated breasts, many of the known measures commonly used for capsular contracture prevention were implemented. As well, a dependent drain was used as the final hemostatic step to prevent blood accumulation in the pocket. Leaving a dependent drain in the dissected pocket overnight, as one of the sequence of measures aimed at eliminating blood accumulation, is believed to be a contributing factor in capsular contracture prevention. PMID:24115895

  16. Hinged cast brace for persistent flexion contracture following total knee replacement.

    PubMed

    Karam, Matthew D; Pugely, Andrew; Callaghan, John J; Shurr, Donald

    2011-01-01

    The reported incidence of persistent knee flexion contracture following total knee arthroplasty (TKA) has varied from 1-15 percent Various treatment modalities have been described in attempts to manage this often difficult problem. This paper describes a novel method of treatment by using a hinged cast brace (previously reported for treatment of femur fractures and knee contractures secondary to hemophilia and cerebral palsy) for use in patients with symptomatic knee flexion contractures. Application of this cast brace with frequent adjustment (every three to four days, initially) toward full extension can often improve knee extension, after physical therapy and other modalities such as extension-assist braces have failed. Care must be taken in the application and use of this device which utilizes frequent manipulations to reduce and maintain the knee flexion angle. We report two clinical cases in which this protocol was effectively used in decreasing symptomatic knee flexion contractures. PMID:22096423

  17. Absence of capsular contracture in 319 consecutive augmentation mammaplasties: Dependent drains as a possible factor.

    PubMed

    Fanous, Nabil; Salem, Iman; Tawilé, Carolyne; Bassas, Ae

    2004-01-01

    Capsular contracture is one of the major complications of augmentation mammaplasty. A review of 638 augmented breasts in 319 consecutive patients who underwent primary augmentation, with an average follow-up of 17.2 months and without a single case of capsular contracture of any degree to date, is presented, along with a discussion of the surgical technique and complications, and an analysis of measures used to prevent capsular contraction. Each patient received a pair of smooth saline-filled implants (Mentor, USA) placed in the submuscular space through an inframammary incision. In all operated breasts, many of the known measures commonly used for capsular contracture prevention were implemented. As well, a dependent drain was used as the final hemostatic step to prevent blood accumulation in the pocket. Leaving a dependent drain in the dissected pocket overnight, as one of the sequence of measures aimed at eliminating blood accumulation, is believed to be a contributing factor in capsular contracture prevention. PMID:24115895

  18. Limb contractures in progressive neuromuscular disease and the role of stretching, orthotics, and surgery.

    PubMed

    McDonald, C M

    1998-02-01

    Contractures are exceedingly common impairments in selected progressive NMD conditions, particularly those with excessive fibrosis and fatty infiltration into muscle (i.e., dystrophic myopathies) and more severe NMD conditions, resulting in significant weakness and wheel-chair reliance, such as SMA. Less than antigravity strength produces an inability to achieve full active range of motion. Static positioning of limbs (generally in flexion) and lack of weight bearing results in fixed contractures. This article has reviewed the prevalence and distribution of contractures in specific NMD conditions. Aggressive rehabilitation strategies, including stretching, positioning, splinting, upright weight bearing, and orthopaedic surgical management may help minimize the degree of disability in NMD patients with contractures. PMID:9894140

  19. Scars after second intention healing.

    PubMed

    Donaldson, Matthew R; Coldiron, Brett M

    2012-10-01

    Second intention healing (SIH) is useful for many defects after skin cancer removal. SIH decreases intraoperative morbidity and reduces procedure costs. Granulating wounds are rarely infected, have minimal pain or bleeding, and care is simple. Location is the key determinant in cosmetic outcomes of SIH. Concavities of the face including the medial canthus and conchal bowl often heal imperceptibly. Defects on convex surfaces such as the nasal tip and malar cheek can heal poorly with depressed scars. Flat areas of the cheeks, forehead, and chin heal favorably but cosmesis can be unpredictable. These regions are often described by NEET (concavities of the nose, eyes, ears, and temple), NOCH (convexities of nose, oral lips, cheek, chin, and helix), and FAIR (flat areas of the forehead, antihelix of the ear, eyelids, and rest of the nose, lips, and cheeks). We review the limited literature describing SIH based on regional anatomy of the face. Complications of SIH include exuberant granulation tissue, hypopigmented or telangiectatic scars, and distortion of free lid margins. SIH should be an integral part of the surgeon's reconstructive algorithm after skin cancer removal. PMID:23027216

  20. Controlled Burn

    GULF OF MEXICO — Dark clouds of smoke and fire emerge as oil burns during a controlled burn in the Gulf of Mexico. The U.S. Coast Guard working in partnership with BP PLC, local residents, and other Federal agencies conducted the controlled burn to aid in preventing the spread of oil following...

  1. Minimally invasive soft tissue release of foot and ankle contracture secondary to stroke.

    PubMed

    Boffeli, Troy J; Collier, Rachel C

    2014-01-01

    Lower extremity contracture associated with stroke commonly results in a nonreducible, spastic equinovarus deformity of the foot and ankle. Rigid contracture deformity leads to gait instability, pain, bracing difficulties, and ulcerations. The classic surgical approach for stroke-related contracture of the foot and ankle has been combinations of tendon lengthening, tendon transfer, osteotomy, and joint fusion procedures. Recovery after traditional foot and ankle reconstructive surgery requires a period of non-weightbearing that is not typically practical for these patients. Little focus has been given in published studies on minimally invasive soft tissue release of contracture. We present the case of a 61-year-old female with an equinovarus foot contracture deformity secondary to stroke. The patient underwent Achilles tendon lengthening, posterior tibial tendon Z lengthening, and digital flexor tenotomy of each toe with immediate weightbearing in a walking boot, followed by transition to an ankle-foot orthosis. The surgical principles and technique tips are presented to demonstrate our minimally invasive approach to release of foot and ankle contracture secondary to stroke. The main goal of this approach is to improve foot and ankle alignment for ease of bracing, which, in turn, will improve gait, reduce the risk of falls, decrease pain, and avoid the development of pressure sores. PMID:23890795

  2. Identification and function analysis of contrary genes in Dupuytren's contracture.

    PubMed

    Ji, Xianglu; Tian, Feng; Tian, Lijie

    2015-07-01

    The present study aimed to analyze the expression of genes involved in Dupuytren's contracture (DC), using bioinformatic methods. The profile of GSE21221 was downloaded from the gene expression ominibus, which included six samples, derived from fibroblasts and six healthy control samples, derived from carpal-tunnel fibroblasts. A Distributed Intrusion Detection System was used in order to identify differentially expressed genes. The term contrary genes is proposed. Contrary genes were the genes that exhibited opposite expression patterns in the positive and negative groups, and likely exhibited opposite functions. These were identified using Coexpress software. Gene ontology (GO) function analysis was conducted for the contrary genes. A network of GO terms was constructed using the reduce and visualize gene ontology database. Significantly expressed genes (801) and contrary genes (98) were screened. A significant association was observed between Chitinase-3-like protein 1 and ten genes in the positive gene set. Positive regulation of transcription and the activation of nuclear factor-?B (NF-?B)-inducing kinase activity exhibited the highest degree values in the network of GO terms. In the present study, the expression of genes involved in the development of DC was analyzed, and the concept of contrary genes proposed. The genes identified in the present study are involved in the positive regulation of transcription and activation of NF-?B-inducing kinase activity. The contrary genes and GO terms identified in the present study may potentially be used for DC diagnosis and treatment. PMID:25760233

  3. Dupuytren’s Contracture in Alabama HFE Hemochromatosis Probands

    PubMed Central

    Barton, James C.; Barton, J. Clayborn

    2012-01-01

    Background Dupuytren’s contracture (DC) and HFE hemochromatosis occur in some of the same at-risk populations and present with similar comorbid conditions. Methods We estimated DC prevalence in two cohorts of white Alabama hemochromatosis probands (294 C282Y homozygotes, 67 C282Y/H63D compound heterozygotes) in a retrospective study. We performed logistic regressions on DC using the following independent variables: age, body mass index, heavy ethanol consumption, serum ferritin, elevated serum AST/ALT, non-alcoholic fatty liver disease, viral hepatitis, cirrhosis, and diabetes. Results One man and two women with C282Y homozygosity had DC (prevalence 1.02%; 95% CI 0.35%–2.96%). A man with C282Y/H63D had DC (prevalence 1.49%; 95% CI 0.26%–7.98%). DC occurred as an autosomal dominant trait in his kinship. In regression analyses, no single variable predicted DC. We observed no new DC cases after the diagnosis of hemochromatosis (mean follow-up 12.9 ± 7.5 years (1 SD), and 9.0 ± 5.1 years, respectively). Conclusions Our prevalence estimates of DC in white Alabama hemochromatosis probands are similar to those found in the white US population cohorts. DC risk was unrelated to the variables we studied. PMID:22952417

  4. Fibroblasts from phenotypically normal palmar fascia exhibit molecular profiles highly similar to fibroblasts from active disease in Dupuytren's Contracture

    PubMed Central

    2012-01-01

    Background Dupuytren's contracture (DC) is a fibroproliferative disorder characterized by the progressive development of a scar-like collagen-rich cord that affects the palmar fascia of the hand and leads to digital flexion contractures. DC is most commonly treated by surgical resection of the diseased tissue, but has a high reported recurrence rate ranging from 27% to 80%. We sought to determine if the transcriptomic profiles of fibroblasts derived from DC-affected palmar fascia, adjacent phenotypically normal palmar fascia, and non-DC palmar fascial tissues might provide mechanistic clues to understanding the puzzle of disease predisposition and recurrence in DC. Methods To achieve this, total RNA was obtained from fibroblasts derived from primary DC-affected palmar fascia, patient-matched unaffected palmar fascia, and palmar fascia from non-DC patients undergoing carpal tunnel release (6 patients in each group). These cells were grown on a type-1 collagen substrate (to better mimic their in vivo environments). Microarray analyses were subsequently performed using Illumina BeadChip arrays to compare the transcriptomic profiles of these three cell populations. Data were analyzed using Significance Analysis of Microarrays (SAM v3.02), hierarchical clustering, concordance mapping and Venn diagram. Results We found that the transcriptomic profiles of DC-disease fibroblasts and fibroblasts from unaffected fascia of DC patients exhibited a much greater overlap than fibroblasts derived from the palmar fascia of patients undergoing carpal tunnel release. Quantitative real time RT-PCR confirmed the differential expression of select genes validating the microarray data analyses. These data are consistent with the hypothesis that predisposition and recurrence in DC may stem, at least in part, from intrinsic similarities in the basal gene expression of diseased and phenotypically unaffected palmar fascia fibroblasts. These data also demonstrate that a collagen-rich environment differentially alters gene expression in these cells. In addition, Ingenuity pathway analysis of the specific biological pathways that differentiate DC-derived cells from carpal tunnel-derived cells has identified the potential involvement of microRNAs in this fibroproliferative disorder. Conclusions These data show that the transcriptomic profiles of DC-disease fibroblasts and fibroblasts from unaffected palmar fascia in DC patients are highly similar, and differ significantly from the transcriptomic profiles of fibroblasts from the palmar fascia of patients undergoing carpal tunnel release. PMID:22559715

  5. Global Burned Area and Biomass Burning Emissions from Small Fires

    NASA Technical Reports Server (NTRS)

    Randerson, J. T.; Chen, Y.; vanderWerf, G. R.; Rogers, B. M.; Morton, D. C.

    2012-01-01

    In several biomes, including croplands, wooded savannas, and tropical forests, many small fires occur each year that are well below the detection limit of the current generation of global burned area products derived from moderate resolution surface reflectance imagery. Although these fires often generate thermal anomalies that can be detected by satellites, their contributions to burned area and carbon fluxes have not been systematically quantified across different regions and continents. Here we developed a preliminary method for combining 1-km thermal anomalies (active fires) and 500 m burned area observations from the Moderate Resolution Imaging Spectroradiometer (MODIS) to estimate the influence of these fires. In our approach, we calculated the number of active fires inside and outside of 500 m burn scars derived from reflectance data. We estimated small fire burned area by computing the difference normalized burn ratio (dNBR) for these two sets of active fires and then combining these observations with other information. In a final step, we used the Global Fire Emissions Database version 3 (GFED3) biogeochemical model to estimate the impact of these fires on biomass burning emissions. We found that the spatial distribution of active fires and 500 m burned areas were in close agreement in ecosystems that experience large fires, including savannas across southern Africa and Australia and boreal forests in North America and Eurasia. In other areas, however, we observed many active fires outside of burned area perimeters. Fire radiative power was lower for this class of active fires. Small fires substantially increased burned area in several continental-scale regions, including Equatorial Asia (157%), Central America (143%), and Southeast Asia (90%) during 2001-2010. Globally, accounting for small fires increased total burned area by approximately by 35%, from 345 Mha/yr to 464 Mha/yr. A formal quantification of uncertainties was not possible, but sensitivity analyses of key model parameters caused estimates of global burned area increases from small fires to vary between 24% and 54%. Biomass burning carbon emissions increased by 35% at a global scale when small fires were included in GFED3, from 1.9 Pg C/yr to 2.5 Pg C/yr. The contribution of tropical forest fires to year-to-year variability in carbon fluxes increased because small fires amplified emissions from Central America, South America and Southeast Asia-regions where drought stress and burned area varied considerably from year to year in response to El Nino-Southern Oscillation and other climate modes.

  6. Global burned area and biomass burning emissions from small fires

    NASA Astrophysics Data System (ADS)

    Randerson, J. T.; Chen, Y.; van der Werf, G. R.; Rogers, B. M.; Morton, D. C.

    2012-12-01

    In several biomes, including croplands, wooded savannas, and tropical forests, many small fires occur each year that are well below the detection limit of the current generation of global burned area products derived from moderate resolution surface reflectance imagery. Although these fires often generate thermal anomalies that can be detected by satellites, their contributions to burned area and carbon fluxes have not been systematically quantified across different regions and continents. Here we developed a preliminary method for combining 1-km thermal anomalies (active fires) and 500 m burned area observations from the Moderate Resolution Imaging Spectroradiometer (MODIS) to estimate the influence of these fires. In our approach, we calculated the number of active fires inside and outside of 500 m burn scars derived from reflectance data. We estimated small fire burned area by computing the difference normalized burn ratio (dNBR) for these two sets of active fires and then combining these observations with other information. In a final step, we used the Global Fire Emissions Database version 3 (GFED3) biogeochemical model to estimate the impact of these fires on biomass burning emissions. We found that the spatial distribution of active fires and 500 m burned areas were in close agreement in ecosystems that experience large fires, including savannas across southern Africa and Australia and boreal forests in North America and Eurasia. In other areas, however, we observed many active fires outside of burned area perimeters. Fire radiative power was lower for this class of active fires. Small fires substantially increased burned area in several continental-scale regions, including Equatorial Asia (157%), Central America (143%), and Southeast Asia (90%) during 2001-2010. Globally, accounting for small fires increased total burned area by approximately by 35%, from 345 Mha/yr to 464 Mha/yr. A formal quantification of uncertainties was not possible, but sensitivity analyses of key model parameters caused estimates of global burned area increases from small fires to vary between 24% and 54%. Biomass burning carbon emissions increased by 35% at a global scale when small fires were included in GFED3, from 1.9 Pg C/yr to 2.5 Pg C/yr. The contribution of tropical forest fires to year-to-year variability in carbon fluxes increased because small fires amplified emissions from Central America, South America and Southeast Asia—regions where drought stress and burned area varied considerably from year to year in response to El Nino-Southern Oscillation and other climate modes.

  7. Novel Technology in the Treatment of Acne Scars: The Matrix-tunable Radiofrequency Technology

    PubMed Central

    Ramesh, M; Gopal, MG; Kumar, Sharath; Talwar, Ankur

    2010-01-01

    Background: Despite the many advances, scarring, particularly acne or pimple scarring, does not have a satisfactory treatment. A new armamentarium in this field is this recently devised matrix-tunable radiofrequency technology, which utilizes radiofrequency emission in the treatment of acne scars. Aims: To evaluate the efficiency of the new matrix-tunable radiofrequency technology in patients with acne scars of varying sizes. Settings and Design: A prospective study of 30 randomly selected patients with acne scars was carried out. Material and Methods: Thirty healthy patients with different types of acne scars – ice pick, box and rolling type – were randomly selected. The scars were either shallow or deep, varied in size from 2 to 20 mm and ranged in number from 10 to 50. These patients were first treated with broad-spectrum antibiotics and local exfoliating agents (topical tretinoin 0.025%) and then subjected to matrix-tunable radiofrequency technology. Each scar was treated at intervals of 1 month. A maximum of four such sittings were carried out. Patients were followed-up every 15 days. Results were noted at the end of 2 months and 6 months. Improvement was assessed by using the visual analog scale (VAS) at 2 months and 6 months, and results were noted in terms of percentage improvement of the whole face by calculating an average of percentage improvement on the basis of interviews of the patient and his/her accompanying relatives. The visual analog scaling was performed by means of high-resolution digital photographs taken at the baseline and at each subsequent visit. Results: The VAS improvement in scars ranged from 10 to 50% at the end of 2 months to 20 to 70% at the end of 6 months. Of the 30 patients of acne scars, the cosmetic result was excellent (>60% improvement) in four, good (35–60% improvement) in 18 and moderate to poor (<35% improvement) in eight. A few patients reported burning sensation and a mild sunburn-like sensation for about 1 h after treatment. The patients reported a pinkish tone for 2–3 days. Importantly, with the help of some slight make up, all the 30 patients could return to work the following day. Conclusion: Matrix-tunable radiofrequency technology is a safe and economically viable option for the dermatologists for the treatment of acne scars, because of the effective results coupled with a low downtime. PMID:21031069

  8. Scald Burns From Hair Braiding.

    PubMed

    Meizoso, Jonathan P; Ramaley, Stephen R; Ray, Juliet J; Allen, Casey J; Guarch, Gerardo A; Varas, Robin; Teisch, Laura F; Pizano, Louis R; Schulman, Carl I; Namias, Nicholas

    2016-01-01

    Only one previous case report has described scald burns secondary to hair braiding in pediatric patients. The present case study is the largest to date of scald burns as a result of hair braiding in children and adults. Charts of all 1609 female patients seen at a single burn center from 2008 to 2014 were retrospectively reviewed to identify patients with scald burns attributed to hair braiding. Demographics, injury severity, injury patterns, and complications were analyzed. Twenty-six patients (1.6%) had scald burns secondary to hair braiding with median TBSA 3%. Eighty-five percent of patients were pediatric with median age 8 years. Injury patterns were as follows: back (62%), shoulder (31%), chest (15%), buttocks (15%), abdomen (12%), arms (12%), neck (12%), and legs (4%). No patients required operative intervention. Three patients were admitted to the hospital. Two patients required time off from school for 6 and 10 days post burn for recovery. Complications included functional limitations (n = 2), hypertrophic scarring (n = 1), cellulitis requiring antibiotics (n = 1), and anxiety requiring medical/psychological therapy (n = 2). This peculiar mechanism of injury not only carries inherent morbidity that includes the risks of functional limitations, infection, and psychological repercussions but also increases usage of resources through hospital admissions and multiple clinic visits. Further work in the form of targeted outreach programs is necessary to educate the community regarding this preventable mechanism of injury. PMID:26594857

  9. Collagenase Dupuytren Contracture: Achieving Single Treatment Success with a Hand Therapist-Based Protocol

    PubMed Central

    Malafa, Menyoli M.; Lehrman, Craig; Criley, Jerry W.

    2016-01-01

    Background: Surgery remains the gold standard in the treatment of Dupuytren contracture but is technically demanding, carries significant risk of complications, and requires prolonged recovery time. Collagenase injection is an efficacious alternative to surgery; however, contracture release often requires multiple treatments spaced a month apart. We report our experience with a new collagenase treatment protocol aimed to minimize the total treatment time per joint contracture. Methods: We performed a single institution retrospective review of patients with Dupuytren contracture treated with collagenase using our protocol from 2011 to 2013. Patients returned 24 hours after collagenase injection for cord manipulation by a certified hand therapist while under digital block. Treatment success was defined as reduction in contracture to 5 degrees or less. Successfully treated joints were evaluated for recurrence (>10 degrees contracture) at 30-day and 6-month follow-up appointments. Serious adverse events, including skin tears, were recorded. Results: Success was achieved in 36 of 47 treated joints (76.6%) after a single injection. There were 2 recurrences in 32 joints at 30-day follow-up (6.2%) and no recurrences in 17 joints available at 6-month follow-up. Skin tears were the only serious adverse event occurring in 18 of 47 cord ruptures (38.3%). All healed secondarily without complication. Conclusions: Our protocol preserves treatment efficacy while maximizing efficiency. Achieving successful cord rupture with a single injection allows earlier return of function, reduced cost of treatment, and increased convenience for the patient. Patients, particularly those with greater contractures, should be counseled regarding the risk of skin tear during cord manipulation. PMID:27014558

  10. A Quantitative Approach to Scar Analysis

    PubMed Central

    Khorasani, Hooman; Zheng, Zhong; Nguyen, Calvin; Zara, Janette; Zhang, Xinli; Wang, Joyce; Ting, Kang; Soo, Chia

    2011-01-01

    Analysis of collagen architecture is essential to wound healing research. However, to date no consistent methodologies exist for quantitatively assessing dermal collagen architecture in scars. In this study, we developed a standardized approach for quantitative analysis of scar collagen morphology by confocal microscopy using fractal dimension and lacunarity analysis. Full-thickness wounds were created on adult mice, closed by primary intention, and harvested at 14 days after wounding for morphometrics and standard Fourier transform-based scar analysis as well as fractal dimension and lacunarity analysis. In addition, transmission electron microscopy was used to evaluate collagen ultrastructure. We demonstrated that fractal dimension and lacunarity analysis were superior to Fourier transform analysis in discriminating scar versus unwounded tissue in a wild-type mouse model. To fully test the robustness of this scar analysis approach, a fibromodulin-null mouse model that heals with increased scar was also used. Fractal dimension and lacunarity analysis effectively discriminated unwounded fibromodulin-null versus wild-type skin as well as healing fibromodulin-null versus wild-type wounds, whereas Fourier transform analysis failed to do so. Furthermore, fractal dimension and lacunarity data also correlated well with transmission electron microscopy collagen ultrastructure analysis, adding to their validity. These results demonstrate that fractal dimension and lacunarity are more sensitive than Fourier transform analysis for quantification of scar morphology. PMID:21281794

  11. Microneedling Therapy for Atrophic Acne Scars

    PubMed Central

    Barakat, Manal; Awad, Sherif; Medhat, Walid; El-Fakahany, Hasan; Farag, Hanna

    2015-01-01

    Objective: Treatment of acne scarring is always a challenge. Microneedling therapy or percutaneous collagen induction is a new addition to the treatment modalities for such scars and has been reported to be simple and effective in atrophic acne scar treatment. The aim of this study is to evaluate the clinical effect and objectively quantify the histological changes of acne scarring in response to skin microneedling. Design: A prospective clinical study. Participants: Ten patients with different types of atrophic acne scars were subjected to three months of skin microneedling treatment (six sessions at two-week intervals). Measurements: Patients were photographed, and skin biopsies were obtained at baseline as well as one and three months from the start of treatment. Histometry for epidermal thickness and quantitative evaluation of total elastin; newly synthesized tropoelastin; collagen types I, III, and VII; and newly synthesized collagen were performed for all biopsies. Results: Compared to the baseline, patients’ evaluations revealed noticeable clinical improvement in atrophic post-acne scars in response to skin microneedling. There was a statistically significant increase (p<0.05) in the mean of collagen types I, III, and VII and newly synthesized collagen, while total elastin was significantly decreased (p<0.05) after the end of treatment. Conclusions: Multiple minimally invasive sessions of skin microneedling are an effective treatment for post-acne atrophic scars as it stimulates the repair processes with the advantage of being a relatively risk-free, in-office procedure with minimal patient recovery time. PMID:26203319

  12. MicroRNA 181b Regulates Decorin Production by Dermal Fibroblasts and May Be a Potential Therapy for Hypertrophic Scar

    PubMed Central

    Kwan, Peter; Ding, Jie; Tredget, Edward E.

    2015-01-01

    Hypertrophic scarring is a frequent fibroproliferative complication following deep dermal burns leading to impaired function and lifelong disfigurement. Decorin reduces fibrosis and induces regeneration in many tissues, and is significantly downregulated in hypertrophic scar and normal deep dermal fibroblasts. It was hypothesized that microRNAs in these fibroblasts downregulate decorin and blocking them would increase decorin and may prevent hypertrophic scarring. Lower decorin levels were found in hypertrophic scar as compared to normal skin, and in deep as compared to superficial dermis. A decorin 3’ un-translated region reporter assay demonstrated microRNA decreased decorin in deep dermal fibroblasts, and microRNA screening predicted miR- 24, 181b, 421, 526b, or 543 as candidates. After finding increased levels of mir-181b in deep dermal fibroblasts, it was demonstrated that TGF-β1 stimulation decreased miR-24 but increased miR-181b and that hypertrophic scar and deep dermis contained increased levels of miR-181b. By blocking miR-181b with an antagomiR, it was possible to increase decorin protein expression in dermal fibroblasts. This suggests miR-181b is involved in the differential expression of decorin in skin and wound healing. Furthermore, blocking miR-181b reversed TGF-β1 induced decorin downregulation and myofibroblast differentiation in hypertrophic scar fibroblasts, suggesting a potential therapy for hypertrophic scar. PMID:25837671

  13. Analysis of Frequency of Use of Different Scar Assessment Scales Based on the Scar Condition and Treatment Method

    PubMed Central

    Bae, Seong Hwan

    2014-01-01

    Analysis of scars in various conditions is essential, but no consensus had been reached on the scar assessment scale to select for a given condition. We reviewed papers to determine the scar assessment scale selected depending on the scar condition and treatment method. We searched PubMed for articles published since 2000 with the contents of the scar evaluation using a scar assessment scale with a Journal Citation Report impact factor >0.5. Among them, 96 articles that conducted a scar evaluation using a scar assessment scale were reviewed and analyzed. The scar assessment scales were identified and organized by various criteria. Among the types of scar assessment scales, the Patient and Observer Scar Assessment Scale (POSAS) was found to be the most frequently used scale. As for the assessment of newly developed operative scars, the POSAS was most used. Meanwhile, for categories depending on the treatment methods for preexisting scars, the Vancouver Scar Scale (VSS) was used in 6 studies following a laser treatment, the POSAS was used in 7 studies following surgical treatment, and the POSAS was used in 7 studies following a conservative treatment. Within the 12 categories of scar status, the VSS showed the highest frequency in 6 categories and the POSAS showed the highest frequency in the other 6 categories. According to our reviews, the POSAS and VSS are the most frequently used scar assessment scales. In the future, an optimal, universal scar scoring system is needed in order to better evaluate and treat pathologic scarring. PMID:24665417

  14. Analysis of frequency of use of different scar assessment scales based on the scar condition and treatment method.

    PubMed

    Bae, Seong Hwan; Bae, Yong Chan

    2014-03-01

    Analysis of scars in various conditions is essential, but no consensus had been reached on the scar assessment scale to select for a given condition. We reviewed papers to determine the scar assessment scale selected depending on the scar condition and treatment method. We searched PubMed for articles published since 2000 with the contents of the scar evaluation using a scar assessment scale with a Journal Citation Report impact factor >0.5. Among them, 96 articles that conducted a scar evaluation using a scar assessment scale were reviewed and analyzed. The scar assessment scales were identified and organized by various criteria. Among the types of scar assessment scales, the Patient and Observer Scar Assessment Scale (POSAS) was found to be the most frequently used scale. As for the assessment of newly developed operative scars, the POSAS was most used. Meanwhile, for categories depending on the treatment methods for preexisting scars, the Vancouver Scar Scale (VSS) was used in 6 studies following a laser treatment, the POSAS was used in 7 studies following surgical treatment, and the POSAS was used in 7 studies following a conservative treatment. Within the 12 categories of scar status, the VSS showed the highest frequency in 6 categories and the POSAS showed the highest frequency in the other 6 categories. According to our reviews, the POSAS and VSS are the most frequently used scar assessment scales. In the future, an optimal, universal scar scoring system is needed in order to better evaluate and treat pathologic scarring. PMID:24665417

  15. Outcomes of outpatient management of pediatric burns.

    PubMed

    Brown, Matthew; Coffee, Tammy; Adenuga, Paul; Yowler, Charles J

    2014-01-01

    The literature surrounding pediatric burns has focused on inpatient management. The goal of this study is to characterize the population of burned children treated as outpatients and assess outcomes validating this method of burn care. A retrospective review of 953 patients treated the burn clinic and burn unit of a tertiary care center. Patient age, burn etiology, burn characteristics, burn mechanism, and referral pattern were recorded. The type of wound care and incidence of outcomes including subsequent hospital admission, infection, scarring, and surgery served as the primary outcome data. Eight hundred and thirty children were treated as outpatients with a mean time of 1.8 days for the evaluation of burn injury in our clinic. Scalds accounted for 53% of the burn mechanism, with burns to the hand/wrist being the most frequent area involved. The mean percentage of TBSA was 1.4% for the outpatient cohort and 8% for the inpatient cohort. Burns in the outpatient cohort healed with a mean time of 13.4 days. In the outpatient cohort, nine (1%) patients had subsequent admissions and three (0.4%) patients had concern for infection. Eight patients from the outpatient cohort were treated with excision and grafting. The vast majority of pediatric burns are small, although they may often involve more critical areas such as the face and hand. Outpatient wound care is an effective treatment strategy which results in low rates of complications and should become the standard of care for children with appropriate burn size and home support. PMID:25055004

  16. Lightning burns.

    PubMed

    Russell, Katie W; Cochran, Amalia L; Mehta, Sagar T; Morris, Stephen E; McDevitt, Marion C

    2014-01-01

    We present the case of a lightning-strike victim. This case illustrates the importance of in-field care, appropriate referral to a burn center, and the tendency of lightning burns to progress to full-thickness injury. PMID:23799482

  17. The incidence of burns among sex-trafficking victims in India.

    PubMed

    Rahman, Nadia; Sinha, Indranil; Husain, Fatima; Shah, Ajul; Patel, Anup

    2014-09-01

    Sex trafficking remains a flagrant violation of human rights, creating many public health concerns. During the initiation period, these victims experience acts of violence including gang rapes, subjecting them to traumatic injuries that include burns. Furthermore, lack of access to health care, particularly surgical, keeps them from receiving treatment for these functionally debilitating contractures caused by burns. This piece provides an overview of burns among sex-trafficked victims in India and the efforts by Cents of Relief to address the associated surgical burden of disease. PMID:25191142

  18. The Incidence of Burns Among Sex-Trafficking Victims in India

    PubMed Central

    Rahman, Nadia; Sinha, Indranil; Husain, Fatima; Shah, Ajul; Patel, Anup

    2014-01-01

    Sex trafficking remains a flagrant violation of human rights, creating many public health concerns. During the initiation period, these victims experience acts of violence including gang rapes, subjecting them to traumatic injuries that include burns. Furthermore, lack of access to health care, particularly surgical, keeps them from receiving treatment for these functionally debilitating contractures caused by burns. This piece provides an overview of burns among sex-trafficked victims in India and the efforts by Cents of Relief to address the associated surgical burden of disease. PMID:25191142

  19. Pressure therapy for hypertrophic scarrings: preliminary communication1

    PubMed Central

    Robertson, J C; Druett, J E; Hodgson, B; Druett, Jane

    1980-01-01

    A six-point programme for the prevention and pressure therapy of hypertrophic scarring started in 1975 at Odstock Hospital. The work reported here includes a pressure calibration of batches of the material chosen for pressure bandaging; a pressure study of the bandages on volunteers' limbs; and the formation of a pressure therapy clinic. The clinic results were similar to those reported by Thomson (1974) and were considered sufficiently favourable to justify continuing the clinic and instituting a policy of close review and early therapy for all burns patients. The programme proved the accuracy of the pressure sensor and attempted to develop an objective method of recording progress. Arguments for pressure versus occlusion as the therapeutic agent are discussed and supported by a case report. It is suggested that a controlled trial of pressure therapy should be carried out. PMID:7241460

  20. Unexplained Facial Scar: Child Abuse or Ehlers-Danlos Syndrome?

    PubMed Central

    Abtahi-Naeini, Bahareh; Shapouri, Javad; Masjedi, Mohsen; Saffaei, Ali; Pourazizi, Mohsen

    2014-01-01

    Context: Child abuse is a serious problem, and its physical manifestations can be mimicked by certain diseases and conditions. These conditions can include genetic, congenital and other disorders that may result in poor weight gain, bone fractures or skin lesions that look like bruises or burns. Case Report: This paper reports the case of a seven-year-old girl with Ehlers-Danlos Syndrome (EDS), which was misdiagnosed as child abuse. This child was referred to us for treatment of an unexplained facial scar that was alleged to be the result of child abuse. Conclusion: When unusual skin presentations are observed, dermatologists should consider the possibility of child abuse to protect the child. Furthermore, they should be aware of the cutaneous abnormalities that mimic injuries associated with abuse to avoid the unnecessary reporting of child abuse. PMID:25535610

  1. SCAR-A Data and Information

    Atmospheric Science Data Center

    2015-11-19

    ... and Information Smoke/Sulfates, Clouds and Radiation - America (SCAR-A) data include physical and chemical components of ... Search and Order:  ASDC Order Tool Parameters:  Infrared Radiance Visible Radiance Order Data:  ...

  2. Medical makeup for concealing facial scars.

    PubMed

    Mee, Donna; Wong, Brian J F

    2012-10-01

    Surgical, laser, and pharmacological therapies are all used to correct scars and surgical incisions, though have limits with respect to how well facial skin can be restored or enhanced. The use of cosmetics has long been a relevant adjunct to all scar treatment modalities. In recent years, technical advancements in the chemistry and composition of cosmetic products have provided the patient with a broader range of products to employ for concealing scars. This review will provide an overview of contemporary methods for concealing facial scars, birthmarks, and pigmentary changes without the use of traditional/dated, heavy appearing camouflage products. Additionally, general guidelines and information will be provided with respect to identifying competent makeup artists for care of the medical patient. The article by no means is meant to be a tutorial, but rather serves as a starting point in this allied field of medicine. PMID:23027221

  3. Proceedings of the SCAR Conference, Part 1

    NASA Technical Reports Server (NTRS)

    1976-01-01

    The Supersonic Cruise Aircraft Research (SCAR) team analyzed six major topics: (1) aerodynamics, (2) stability and control, (3) propulsion, (4) environmental factor, (5) airframe structures and materials, and (6) design integration.

  4. An accumulation of proteoglycans in scarred fascia.

    PubMed

    Koźma, E M; Olczyk, K; Głowacki, A; Bobiński, R

    2000-01-01

    A little is known about proteoglycan (PG) changes, occuring in the course of scarring of tissues another than skin. The aim of present study was biochemical characterization of glycosaminoglycans (GAGs) and proteoglycans (PGs) of normal and scarred fascia. Samples of normal fascia lata were taken at autopsy from 23 individuals and samples of scarred fascia lata were removed from 23 patients at reoperations for femoral fracture. The obtained tissues were divided into two samples: first of them was submitted to GAG isolation and the second one to PG isolation. GAGs were extracted by extensive papain digestion followed by the fractionation using cetylpyridinium chloride. In order to qualitative and quantitative characterization GAGs were submitted to electrophoresis on cellulose acetate before and after treatment with enzymes, specifically depolymerizing some kinds of GAGs. PGs were extracted using 4 M guanidine HCl followed by purification by forming complexes with Alcian blue. PGs were submitted to gel permeation chromatography on Sepharose 4B. In order to obtain core proteins PGs were depolymerized with chondroitinase ABC. The purified PGs and their core proteins were separated with sodium dodecyl sulphate/polyacrylamide gel electrophoresis (SDS/PAGE). It was found that total GAGs content was significantly elevated in scarred fascia. Both types of fascia contained chondroitin-, dermatan- and heparan sulphates and hyaluronic acid. Dermatan sulphates (DS) were the predominant GAGs of normal and scarred fascia. The contents of all GAG types were increased in scarred fascia. Both types of fascia contained two kinds of dermatan sulphate proteoglycans (DSPGs); first being similar to biglycan and the second one similar to decorin, as it was judged by molecular weight of their native molecules and core proteins as well as type of GAG components. Densitometric analysis showed that decorin is a predominant DSPG in both fascia types, but in scarred tissue the ratio of biglycan to decorin is considerably higher. Moreover, in scarred fascia a large chondroitin sulphate proteoglycan (CSPG) was also observed. The obtained results have shown that the scar formation is accompanied by quantitative and qualitative alterations in GAGs/PGs resembling those observed in hypertrophic skin scars. The biochemical modification of the scarred fascia lata may partly explain the clinically manifested damage to biomechanical properties of this tissue. PMID:10724338

  5. Presence of modified fibroblasts in ischemic contracture of the intrinsic musculature of the hand.

    PubMed

    Madden, J W; Carlson, E C; Hines, J

    1975-04-01

    Biopsies of fibrotic interosseous muscles were obtained from three patients with ischemic contracture of the intrinsic muscles of the hand. Control biopsies were taken from normal contralateral interossei and from normal interossei crushed three weeks earlier. Examination of the specimens from the affected muscles under the electron microscope demonstrated large numbers of modified fibroblasts with ultrastructural features of both fibroblasts and smooth muscle cells. The atypical fibroblasts observed resembled myofibroblasts seen in contracting wounds, Dupuytren's contracture, stenosing tenosynovitis, and idiopathic carpel tunnel syndrome. Biopsies from normal muscle and crushed normal muscle contained normal fibroblasts and smooth muscle cells but no modified fibroblasts. Active contraction of modified fibroblasts could be responsible for progressive muscle shortening seen in intrinsic contracture. PMID:1129660

  6. Acute double flexor tendon ruptures following injection of collagenase clostridium histolyticum (Xiapex) for Dupuytren's contracture

    PubMed Central

    Povlsen, Bo; Singh, Sarvpreet

    2014-01-01

    We report a case of acute (24 h) double flexor tendon rupture of the little finger after a single injection of collagenase clostridium histolyticum into a palmar Dupuytren's contracture cord which caused metacarpophalangeal joint contracture. Tendon surgery was performed 48 h postinjury with primary repair and standard rehabilitation but it resulted in poor active flexion due to adhesions. Previous papers have suggested that a needle inserted into the flexor tendon can be detected prior to the injection of collagenase by asking the patient to actively move the finger, but our test on an awake patient showed that when a 27-gauge needle was inserted into the flexor tendons through a thick palmar cord, the syringe did not move significantly when the patient moved the finger, and therefore this test does not minimise the risk of iatrogenic tendon injury when using collagenase (Xiapex) for Dupuytren's contracture. PMID:24729115

  7. Dynamic splinting for knee flexion contracture following total knee arthroplasty: a case report

    PubMed Central

    Finger, Eric; Willis, F Buck

    2008-01-01

    Total Knee Arthroplasty operations are increasing in frequency, and knee flexion contracture is a common pathology, both pre-existing and post-operative. A 61-year-old male presented with knee flexion contracture following a total knee arthroplasty. Physical therapy alone did not fully reduce the contracture and dynamic splinting was then prescribed for daily low-load, prolonged-duration stretch. After 28 physical therapy sessions, the active range of motion improved from -20° to -12° (stiff knee still lacking full extension), and after eight additional weeks with nightly wear of dynamic splint, the patient regained full knee extension, (active extension improved from -12° to 0°). PMID:19113998

  8. Do postsurgical interventions optimize ultimate scar cosmesis.

    PubMed

    Viera, M H; Amini, S; Konda, S; Berman, B

    2009-06-01

    Keloids and other scars are different manifestations of the normal wound healing process. If located in visible areas, scars may have a psychological impact that could affect the quality of life of the scar-bearing population. Good preoperatory planning including hiding incisions in natural anatomical landmarks or placing them parallel to relaxed skin tension lines are among the techniques used to improve the cosmesis of scars. Once a prominent or noticeable scar has developed, multiple therapeutic modalities can be applied including surgical excision, although high recurrence rates precludes its use as monotherapy. Several advanced surgical correction techniques including Z-plasty and W-plasty may be useful in repositioning scars. Other modalities that have been reported to improve scar cosmesis include cryosurgery, radiotherapy, lasers, and skin substitute grafts. Adjuvant postsurgical treatment modalities have reduced dramatically the recurrence rates associated with the removal of the scar. In this review of the literature the authors discuss evidence based data related to the abovementioned modalities and other topical and intralesional therapies including occlusion, compression, silicone, corticosteroids, interferons, imiquimod, resiquimod, tacrolimus, 5-fluorouracil, retinoids, as well as the role of several over-the-counter agents such as onion extract, vitamin E and the combination of hydrocortisone, vitamin E and silicone. Finally, they address newer modalities including vascular endothelial growth factor inhibitor, transforming growth factor-3, interleukin-10, mannose-6-phosphate, UVA-1, narrowband UVB, intense pulsed light and photodynamic therapy. Ultimately, the decision of choosing the most appropriate postexcisional management treatment should be taken by physicians on a case-by-case basis in order to obtain the best cosmetically acceptable results. PMID:19528906

  9. Management of acid burns: experience from Bangladesh.

    PubMed

    Das, Kishore Kumar; Olga, Loren; Peck, Michael; Morselli, Paolo G; Salek, A J M

    2015-05-01

    Acid burn injuries in Bangladesh primarily occur as a result of intentional attacks although there are incidences of accidental acid burns in industry, on the street, and at home. A total of 126 patients with acid burns, 95 from attacks and 31 from accidents, were studied from July 2004 to December 2012. A diagnosis of acid burn was made from history, physical examination and in some cases from chemical analysis of the patients' clothing. Alkali burns were excluded from the study. In the burn unit of Dhaka Medical College Hospital, we applied a slightly different protocol for management of acid burns, beginning with plain water irrigation of the wound, which effectively reduced burn depth and the requirement of surgical treatment. Application of hydrocolloid dressing for 48-72 h helped with the assessment of depth and the course of treatment. Early excision and grafting gives good results but resultant acid trickling creates a marble cake-like appearance of the wound separated by the vital skin. Excision with a scalpel and direct stitching of the wounds are often a good option. Observation of patients on follow-up revealed that wounds showed a tendency for hypertrophy. Application of pressure garments and other scar treatments were given in all cases unless the burn was highly superficial. PMID:25440856

  10. Frequency of placenta previa in previously scarred and non scarred uterus

    PubMed Central

    Majeed, Tayyaba; Waheed, Fatima; Mahmood, Zahid; Saba, Kanwal; Mahmood, Hamis; Bukhari, Mulazim Hussain

    2015-01-01

    Objective: To determine the frequency of placenta Previa in patients coming to a tertiary care unit with previously scarred and non-scarred uterus. Methods: A descriptive cross sectional study was carried on 114 cases who underwent caesarean sections (37 cases out of 645 cases with non scarred uterus and 77 cases from 721 cases with scarred uterus) in the department of obstetrics and gynecology Lady Willingdon Hospital from January 2008– December 2011. Results: Most patients (47.36%) were between 26-30 years age group, presented with gestational age between 36-40 weeks (70.17%), were mostly G2-4, while frequency of placenta Previa in non-scarred uterus was 32.45% (37 cases), and frequency in previously scarred uterus was 67.54% (77 cases). Major degree Previa was found in 88 cases (77.19%). There were 5.70% cases of placenta Previa from non-scarred uteruses and 10.67% cases of placenta Previa (10.67%) from already scarred uteruses. Stratification revealed a higher trend of the morbidity with the increase in number of previous caesarean sections. Conclusion: A significantly higher frequency of placenta Previa was found among patients coming to a tertiary care hospital with previously scarred uterus. PMID:26101491

  11. Collagenase treatment of Dupuytren’s contracture using a modified injection method

    PubMed Central

    Nordenskjöld, Jesper; Lauritzson, Anna; Ahlgren, Eva; Waldau, Johanna; Waldén, Markus

    2015-01-01

    Background and purpose Treatment of Dupuytren’s contracture (DC) with collagenase Clostridium histolyticum (CCH) consists of injection followed by finger manipulation. We used a modified method, injecting a higher dose than recommended on the label into several parts of the cord, which allows treatment of multiple joint contractures in 1 session and may increase efficacy. We studied the occurrence of skin tears and short-term outcome with this procedure. Patients and methods We studied 164 consecutive hands with DC, palpable cord, and extension deficit of ≥ 20º in the metacarpophalangeal (MCP) and/or proximal interphalangeal (PIP) joint (mean patient age 70 years, 82% men). A hand surgeon injected all the content of 1 CCH vial (approximately 0.80 mg) into multiple spots in the cord and performed finger extension under local anesthesia after 1 or 2 days. A nurse recorded skin tears on a diagram and conducted a standard telephone follow-up within 4 weeks. A hand therapist measured joint contracture before injection and at a median of 23 (IQR: 7–34) days after finger extension. Results A skin tear occurred in 66 hands (40%). The largest diameter of the tear was ≤ 5 mm in 30 hands and > 10 mm in 14 hands. Hands with skin tear had greater mean pretreatment MCP extension deficit than those without tear: 59º (SD 26) as opposed to 32º (SD 23). Skin tear occurred in 21 of 24 hands with MCP contracture of ≥ 75º. All tears healed with open-wound treatment. No infections occurred. Mean improvement in total (MCP + PIP) extension deficit was 55º (SD 28). Interpretation Skin tears occurred in 40% of hands treated with collagenase injections, but only a fifth of them were larger than 1 cm. Tears were more likely in hands with severe MCP joint contracture. All tears healed without complications. Short-term contracture reduction was good. PMID:25695745

  12. Burning Issue: Handling Household Burns

    MedlinePlus

    ... Burns For minor burns: Immerse in fresh, cool water, or apply cool compresses for 10-15 minutes. Dry the area with a clean cloth. Cover with sterile gauze or a non-adhesive bandage. Don’t apply ointments or butter; these ...

  13. Forest Fire Burned Biomass Estimation Using Satellite Images and Reference Data

    NASA Astrophysics Data System (ADS)

    Qin, Xianlin; Zu, Xiaofeng; Deng, Guang; Li, Zengyuan; Zhang, Zihui; Casanova, J. L. Sanz, Julia; Salvador, Pablo

    2014-11-01

    Vegetation biomass burning has been identified as a significant source of aerosols, carbon fluxes, and trace gases, which pollute the atmosphere and contribute to radiative forcing responsible for global climate change. To estimate the total biomass burned by forest fire using satellite images in Dragon 3, basing on the fuel load from reference data,the combustion factor getting from fieldwork at the sub-compartment level, and the results of burned scar mapping by using HJ-1A CCD and the monthly MODIS burned production datasets (MCD45A1), the biomass burned of the selected experiment area has been estimated by combining these data. The result showed that the accuracy of the biomass burned estimation mainly was affected by the accuracy of burned scar edge using the spatial resolution of satellite data.

  14. Burn Institute

    MedlinePlus

    ... Since... Read More Survivors Archive Our Partners Senior Smoke Alarm Program If you are 62 or older and ... you are qualified for the Burn Institute’s FREE smoke alarms for seniors program. Take the Online Challenge The ...

  15. Scald Burns

    MedlinePlus

    ... the stove. • Avoid wearing loose clothing around open flames and roll up your sleeves. • Never leave cooking ... first, second and third degree burns depending on temperature and length of exposure. • At 155 degrees, a ...

  16. 77 FR 70389 - Eligibility of Disabled Veterans and Members of the Armed Forces With Severe Burn Injuries for...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-26

    .... SUMMARY: In a document published in the Federal Register on November 5, 2012 (77 FR 66419), the Department... injury: Deep partial thickness or full thickness burns resulting in scar formation that...

  17. Biomass Burning

    NASA Technical Reports Server (NTRS)

    Levine, Joel S.; Cofer, Wesley R., III; Pinto, Joseph P.

    1993-01-01

    Biomass burning may be the overwhelming regional or continental-scale source of methane (CH4) as in tropical Africa and a significant global source of CH4. Our best estimate of present methane emissions from biomass burning is about 51.9 Tg/yr, or 10% of the annual methane emissions to the atmosphere. Increased frequency of fires that may result as the Earth warms up may result in increases in this source of atmospheric methane.

  18. Cooling of burns: Mechanisms and models.

    PubMed

    Wright, E H; Harris, A L; Furniss, D

    2015-08-01

    The role of cooling in the acute management of burns is widely accepted in clinical practice, and is a cornerstone of basic first aid in burns. This has been underlined in a number of animal models. The mechanism by which it delivers its benefit is poorly understood, but there is a reduction in burns progression over the first 48 h, reduced healing time, and some subjective improvements in scarring when cooling is administered after burning. Intradermal temperature normalises within a matter of seconds to a few minutes, yet the benefits of even delayed cooling persist, implying it is not simply the removal of thermal energy from the damaged tissues. Animal models have used oedema formation, preservation of dermal perfusion, healing time and hair retention as indicators of burns severity, and have shown cooling to improve these indices, but pharmacological or immunological blockade of humoural and cellular mediators of inflammation did not reproduce the benefit of cooling. More recently, some studies of tissue from human and animal burns have shown consistent, reproducible, temporal changes in gene expression in burned tissues. Here, we review the experimental evidence of the role and mechanism of cooling in burns management, and suggest future research directions that may eventually lead to improved treatment outcomes. PMID:25820085

  19. Facial scars after a road accident: combined treatment with PDL and Q-switched ND:YAG laser.

    PubMed

    Martins, Andrea; Trindade, Felicidade; Leite, Luiz

    2008-09-01

    We report the case of a woman who presented with several facial scars following a road accident. Treatment was carried out using combined laser treatment with pulsed dye laser (PDL) and the Q-switched neodymium:yttrium-aluminum-garnet laser (QS Nd:YAG laser). No side effects or complications from treatment were noted or reported. The patient had very good cosmetic results with this combined technique. A variety of facial scars--erythematous, pigmented, atrophic and hypertrophic--may occur as a result of trauma, surgery, burns and skin disease. Surgery with other adjunctive methods including radiotherapy, intralesional steroids and pressure therapy has shown variable results. Laser treatment has been attempted for scar revision since the 1980s. The PDL is the optimal treatment for reducing scar bulk and symptoms. It also decreases the erythema and telangiectasia associated with scars, normalizes the skin surface texture and improves scar pliability. The QS Nd:YAG laser (1064 nm) is highly effective for traumatic tattoo removal, resulting in complete clearance in the majority of cases. PMID:18608707

  20. Evaluating the accuracy of a MODIS direct broadcast algorithm for mapping burned areas over Russia

    NASA Astrophysics Data System (ADS)

    Petkov, A.; Hao, W. M.; Nordgren, B.; Corley, R.; Urbanski, S. P.; Ponomarev, E. I.

    2012-12-01

    Emission inventories for open area biomass burning rely on burned area estimates as a key component. We have developed an automated algorithm based on MODerate resolution Imaging Spectroradiometer (MODIS) satellite instrument data for estimating burned area from biomass fires. The algorithm is based on active fire detections, burn scars from MODIS calibrated radiances (MOD02HKM), and MODIS land cover classification (MOD12Q1). Our burned area product combines active fires and burn scar detections using spatio-temporal criteria, and has a resolution of 500 x 500 meters. The algorithm has been used for smoke emission estimates over the western United States. We will present the assessed accuracy of our algorithm in different regions of Russia with intense wildfire activity by comparing our results with the burned area product from the Sukachev Institute of Forest (SIF) of the Russian Academy of Sciences in Krasnoyarsk, Russia, as well as burn scars extracted from Landsat imagery. Landsat burned area extraction was based on threshold classification using the Jenks Natural Breaks algorithm to the histogram for each singe scene Normalized Burn Ratio (NBR) image. The final evaluation consisted of a grid-based approach, where the burned area in each 3 km x 3 km grid cell was calculated and compared with the other two sources. A comparison between our burned area estimates and those from SIF showed strong correlation (R2=0.978), although our estimate is approximately 40% lower than the SIF burned areas. The linear fit between the burned area from Landsat scenes and our MODIS algorithm over 18,754 grid cells resulted with a slope of 0.998 and R2=0.7, indicating that our algorithm is suitable for mapping burned areas for fires in boreal forests and other ecosystems. The results of our burned area algorithm will be used for estimating emissions of trace gasses and aerosol particles (including black carbon) from biomass burning in Northern Eurasia for the period of 2002-2011.

  1. The Burn Wound Exudate – an under-utilized resource

    PubMed Central

    Widgerow, Alan D; King, Kassandra; Tussardi, Ilaria Tocco; Banyard, Derek A.; Chiang, Ryan; Awad, Antony; Afzel, Hassan; Bhatnager, Shweta; Melkumyan, Satenik; Wirth, Garrett; Evans, Gregory R.D

    2014-01-01

    Introduction The burn wound exudate represents the burn tissue microenvironment. Extracting information from the exudate relating to cellular components, signaling mediators and protein content can provide much needed data relating to the local tissue damage, depth of the wound and probable systemic complications. This review examines the scientific data extracted from burn wound exudates over the years and proposes new investigations that will provide useful information from this underutilized resource. Method A literature review was conducted using the electronic database PubMed to search for literature pertaining to burn wound or blister fluid analysis. Key words included burn exudate, blister fluid, wound exudate, cytokine burn fluid, subeschar fluid, cytokine burns, serum cytokines. 32 relevant article were examined and 29 selected as relevant to the review. 3 papers were discarded due to questionable methodology or conclusions. The reports were assessed for their affect on management decisions and diagnostics. Furthermore, traditional blood level analysis of these mediators was made to compare the accuracy of blood versus exudate in burn wound management. Extrapolations are made for new possibilities of burn wound exudate analysis. Results Studies pertaining to burn wound exudate, subeschar fluid and blister fluid analyses may have contributed to burn wound management decisions particularly related to escharectomies and early burn wound excision. In addition, information from these studies have the potential to impact on areas such as healing, scarring, burn wound conversion and burn wound depth analysis. Conclusion Burn wound exudate analysis has proven useful in burn wound management decisions. It appears to offer a far more accurate reflection of the burn wound pathophysiology than the traditional blood/serum investigations undertaken in the past. New approaches to diagnostics and treatment efficacy assessment are possible utilizing data from this fluid. Burn wound exudate is a useful, currently under-utilized resource that is likely to take a more prominent role in burn wound management. PMID:24986597

  2. A recessive form of congenital contractures and torticollis associated with malignant hyperthermia.

    PubMed Central

    Froster-Iskenius, U G; Waterson, J R; Hall, J G

    1988-01-01

    Two families are presented, each with two affected sibs, all four of whom seem to have a newly described and specific form of congenital contractures (arthrogryposis). The affected subjects have congenital torticollis, dysmorphic, asymmetrical, myopathic facial features, and progressive scoliosis. Two sibs had cleft palate. Malignant hyperthermia has occurred in two of the patients. Images PMID:3346884

  3. Fraxelated radiofrequency device for acne scars

    NASA Astrophysics Data System (ADS)

    Rao, Babar K.; Khokher, Sairah

    2012-09-01

    Acne scars can be improved with various treatments such as topical creams, chemical peels, dermal fillers, microdermabrasion, laser, and radiofrequency devices. Some of these treatments especially lasers and deep chemical peels can have significant side effects such as post inflammatory hyperpigmentation in darker skin types. Fraxelated RF Laser devices have been reported to have lower incidence of side effects in all skin phototypes. Nine patients between ages 18 and 35 of various skin phototypes were selected from a private practice and treated with a RF fraxelated device (E-matrix) for acne scars. Outcomes were measured by physician observation, subjective feedback received by patients, and comparison of before and after photographs. In this small group of patients with various skin phototypes, fraxelated radiofrequency device improved acne scars with minimal side effects and downtime.

  4. Early second trimester uterine scar rupture

    PubMed Central

    Bharatnur, Sunanda; Hebbar, Shripad; G, Shyamala

    2013-01-01

    Spontaneous uterine scar rupture can be lethal in pregnant women. A spontaneous uterine scar rupture in the early mid-trimester is rare and difficult to diagnose. This is a case of a 30-year-old woman (G2P1L1) at 19?weeks of gestation and having undergone a previous caesarean section presented with acute abdomen in shock. Laparotomy revealed a uterine scar rupture, which was resutured after evacuation of products of conception. This case merits that the uterine rupture should be considered as a differential diagnosis in pregnant women presenting with acute abdomen. In this case, although there was uterine rupture in the second trimester and a complete placental separation, fetus was alive which is quite unusual in patients presenting with rupture uterus. PMID:24326433

  5. Early second trimester uterine scar rupture.

    PubMed

    Bharatnur, Sunanda; Hebbar, Shripad; Shyamala, G

    2013-01-01

    Spontaneous uterine scar rupture can be lethal in pregnant women. A spontaneous uterine scar rupture in the early mid-trimester is rare and difficult to diagnose. This is a case of a 30-year-old woman (G2P1L1) at 19 weeks of gestation and having undergone a previous caesarean section presented with acute abdomen in shock. Laparotomy revealed a uterine scar rupture, which was resutured after evacuation of products of conception. This case merits that the uterine rupture should be considered as a differential diagnosis in pregnant women presenting with acute abdomen. In this case, although there was uterine rupture in the second trimester and a complete placental separation, fetus was alive which is quite unusual in patients presenting with rupture uterus. PMID:24326433

  6. Modifications in vertical scar breast reduction.

    PubMed

    Beer, G M; Morgenthaler, W; Spicher, I; Meyer, V E

    2001-06-01

    The use of vertical-scar breast reduction techniques is only slowly increasing, even though they have been advocated by Lassus and Lejour and are requested by patients. Possible reasons why surgeons are reluctant to use these techniques are that they are said to be more difficult to learn, they require considerable experience and intuition, and their applicability is confined to small breasts. Several surgeons have developed modifications, combining vertical-scar breast reduction techniques with details of the familiar inverted-T-scar technique. We present a procedure involving two further modifications of the vertical-scar breast reduction technique: first, a standardised, geometrical preoperative drawing from our superior-pedicle T technique, with the aim of establishing a reproducible method of reduction requiring no particular intuitive touch, and, second, the addition of a periareolar skin resection, to give the breast the desired round shape. Between September 1998 and December 1999 we used this technique in a prospective series of 52 patients. The median resection weight was 450 g. The maximal postoperative follow-up was 15 months. There were no acute postoperative complications necessitating reoperation. The late complication rate was within the expected range for such procedures (seven patients, 13.5%) and included vertical-scar widening, areolar distortion, residual wrinkles due to incomplete shrinkage of the undermined skin in the inferior pole and asymmetry of the breast. This procedure enables us to offer patients with moderate to marked hypertrophy a reproducible versatile vertical breast reduction technique. The technique is easy to teach and easy to learn, especially for those who are familiar with the superior pedicle inverted-T-scar technique. PMID:11355991

  7. Treatment of hypertrophic scars and keloids with a fractional CO2 laser: a personal experience.

    PubMed

    Scrimali, Luca; Lomeo, Giuseppe; Nolfo, Corrado; Pompili, Gianluca; Tamburino, Serena; Catalani, Alexei; Sirag, Paolo; Perrotta, Rosario Emanuele

    2010-10-01

    Keloids and hypertrophic scars are both abnormal wound responses in predisposed individuals but they differ in that keloids extend beyond the original wound and almost never regress, while hypertrophic scars remain within the original wound and tend to regress. How keloids grow is not totally clear because there is no animal model; in fact, keloids affect only humans. Different injuries can result in keloids, including burns, surgery, ear piercing, lacerations, abrasions, tattooing, vaccinations, injections, insect bites and any process causing skin inflammation (chicken pox, acne, folliculitis, zoster). Skin or wound tension is considered a critical factor in the formation of keloids and hypertrophic scars. This study is based on eight consecutive patients (four females and four males, F:M = 1:1) with a total of 12 keloids. All of whom were treated monthly with a MiXto SX CO(2) laser, using 13 W of power, 8 SX of index and 40% coverage (density) in combination with Same Plast Gel() twice a day. Each scar required 12 treatments, and all the patients, followed up for 1 year after the last treatment, had optimum results and no recurrence. PMID:20825256

  8. The effect of full-thickness abdominal wall burns sustained during childhood on subsequent childbearing ability.

    PubMed

    Kitzmiller, W J; Neale, H W; Warden, G D; Smith, D

    1998-02-01

    The effect of full-thickness burns of the abdomen during childhood on subsequent pregnancy was evaluated. Eight hundred female pediatric patients treated for acute burns during a 14-year period (1975-1989) at the Shriners Burns Institute were reviewed. Through a combination of clinical follow-up, questionnaires, or phone interviews, data were obtained regarding the histories of 31 pregnancies in 19 patients who had required excision and skin grafting of > or = 50% of their abdominal wall during management of their acute burns. These patients sustained a mean burn size of 59.8% total body surface area (TBSA; range, 23-87%) with a mean full-thickness burn of 43.8% TBSA (range, 10-78%). The mean age at the time of burn was 7.6 years (range, 1.5-15 years). Normal rates of vaginal and cesarean section deliveries, prematurity, and infant mortality were observed in these 31 pregnancies. Despite a subjective sensation of increased tension on the scar in 25% of the patients, no interference with these patients carrying a full-term pregnancy directly attributable to the burn scar was identified. Follow-up and examination during the third trimester of pregnancy demonstrated how the burned and unburned portion of the abdominal wall accommodated the enlarged uterus. This review demonstrates that after extensive burns to the abdomen, which have been treated with excision and skin grafting during childhood, the scarred abdominal wall accommodates full-term pregnancy without the need for surgical release. PMID:9495456

  9. Inflammation and cutaneous nervous system involvement in hypertrophic scarring

    PubMed Central

    Li, Shao-hua; Yang, Heng-lian; Xiao, Hu; Wang, Yi-bing; Wang, De-chang; Huo, Ran

    2015-01-01

    This study aimed to use a mouse model of hypertrophic scarring by mechanical loading on the dorsum of mice to determine whether the nervous system of the skin and inflammation participates in hypertrophic scarring. Results of hematoxylin-eosin and immunohistochemical staining demonstrated that inflammation contributed to the formation of a hypertrophic scar and increased the nerve density in scar tissue.Western blot assay verified that interleukin-13 expression was increased in scar tissue. These findings suggest that inflammation and the cutaneous nervous system play a role in hypertrophic scar formation. PMID:26692869

  10. Burning rubber

    SciTech Connect

    Not Available

    1987-09-01

    Mario Andretti, look out You are about to be surpassed in the burning rubber category by a joint venture between Oxford Energy Company and General Electric. The two companies are building the first whole tire-to-energy facility in the US in Modesto, California. This $41 million facility does not require tires to be shredded prior to incineration; it has the capacity to burn 700 tires per minute. The electricity generated will be provided to a utility company. Oxford says there are two billion waste tires on the ground and this number is increasing by 220 million a year. Of that amount, only 18 million a year are recycled.

  11. Wetland fire scar monitoring and analysis using archival Landsat data for the Everglades

    USGS Publications Warehouse

    Jones, John W.; Hall, Annette E.; Foster, Ann M.; Smith, Thomas J., III

    2013-01-01

    The ability to document the frequency, extent, and severity of fires in wetlands, as well as the dynamics of post-fire wetland land cover, informs fire and wetland science, resource management, and ecosystem protection. Available information on Everglades burn history has been based on field data collection methods that evolved through time and differ by land management unit. Our objectives were to (1) design and test broadly applicable and repeatable metrics of not only fire scar delineation but also post-fire land cover dynamics through exhaustive use of the Landsat satellite data archives, and then (2) explore how those metrics relate to various hydrologic and anthropogenic factors that may influence post-fire land cover dynamics. Visual interpretation of every Landsat scene collected over the study region during the study time frame produced a new, detailed database of burn scars greater than 1.6 ha in size in the Water Conservation Areas and post-fire land cover dynamics for Everglades National Park fires greater than 1.6 ha in area. Median burn areas were compared across several landscape units of the Greater Everglades and found to differ as a function of administrative unit and fire history. Some burned areas transitioned to open water, exhibiting water depths and dynamics that support transition mechanisms proposed in the literature. Classification tree techniques showed that time to green-up and return to pre-burn character were largely explained by fire management practices and hydrology. Broadly applicable as they use data from the global, nearly 30-year-old Landsat archive, these methods for documenting wetland burn extent and post-fire land cover change enable cost-effective collection of new data on wetland fire ecology and independent assessment of fire management practice effectiveness.

  12. A practical and objective approach to scar colour assessment.

    PubMed

    Hallam, M J; McNaught, K; Thomas, A N; Nduka, C

    2013-10-01

    Scarring is a significant clinical problem following dermal injury. However, scars are not a single describable entity and huge phenotypic variability is evident. Quantitative, reproducible inter-observer scar assessment is essential to monitor wound healing and the effect of scar treatments. Scar colour, reflecting the biological processes occurring within a scar, is integral to any assessment. The objective of this study was to analyse scar colour using the non-invasive Eykona® Wound Measurement System (the System) as compared against the Manchester Scar Scale (MSS). Three dimensional images of 43 surgical scars were acquired post-operatively from 35 patients at 3-6 months and the colour difference between the scar and surrounding skin was calculated (giving ΔLab values). The colourimetric results were then compared against subjective MSS gradings. A significant difference in ΔLab values between MSS gradings of "slight mismatch" and "obvious mismatch" (p<0.025) and between "obvious mismatch" and "gross mismatch" (p<0.05) were noted. The System creates objective, reproducible data, without the need for any specialist expertise and compares favourably with the MSS. Greater scar numbers are required to further clinically validate this device--however, with this potential to calculate scar length, width, volume and other characteristics, it could provide a complete, objective, quantitative record of scarring throughout the wound-healing process. PMID:23880014

  13. Reclaiming body image: the hidden burn.

    PubMed

    Willis-Helmich, J J

    1992-01-01

    At the age of 4, I incurred a major burn injury that left 45% of my body with permanent scars. Normal clothing covers most of the scars. I was able to reclaim a positive body image through a gradual process of verbal and "body" disclosure. As an adult, I joined a burn survivors' self-help group; as a result of talking with other burn survivors, my self expectations increased. Later, I joined a facilitated group in which nudity and personal growth were the norm. In this group, I was the only person who had experienced a major physical trauma. I replaced my strongly held beliefs that others could not accept my unclothed, burn-injured body with the belief that some persons can, and I came to a personal understanding of why others could not. Fun, exercise, and relaxation led to a reclamation of positive feelings about my unclothed body and allowed my femininity and the character of my body image to emerge and become integrated. PMID:1572860

  14. Prescribed Burn

    Iowa State Grad students Devan McGranahan and Torre Hovick, along with DNR private land specialist Josh Rusk and ISU Research Technician Shannon Rusk ignite a prescribed fire on a patch-burn grazing research pasture in southern Iowa. The goals of the prescribed fire include reducing invasive eastern...

  15. Burning Man

    ERIC Educational Resources Information Center

    Cech, Scott J.

    2006-01-01

    Former Baltimore cop and teacher Ed Burns isn't a masochist. The writer-producer for "The Wire," a critically applauded HBO series about life and death on the streets of Baltimore, is just feverishly trying to save public schools. He thinks American education is hopelessly screwed up, but that it's also the country's only hope. So it makes sense…

  16. Treatment modalities in severe mento-sternal synechia

    PubMed Central

    Ayhan, Meltem; Sevim, Kamuran Z; Gorgu, Metin

    2013-01-01

    Objective: Scar contracture of the neck after a burn-injury can cause both functional and aesthetic problems, and still presents a challenge for plastic surgeons. The anatomic area and adjacent structures such as the lower lip, trachea and neuro-vascular structures which are affected by the scar make treatment diffucult. Scarring and contracture of the neck region may severely limit function, cause alterations of normal posture and make intubation for surgery difficult. When a burn scar extends toward the face, eating and swallowing may be restricted and facial distortion may develop as the scar pulls the mouthdownwards even the lower eyelids. Method: Following the upper extremity, the neck is the most common site affected by burn contracture. The method chosen for contracture release, depends on the severity of scarring and extent of involvement. If the contracture area is limited, z-plasties, skin grafts or local skin flaps are adequate for the treatment but when the whole anterior neck is affected, the treatment modalities are limited and mostly skin grafts either meshed or unmeshed are used. Results: In this study we evaluated the usage of alternative teatment methods involving skin grafts and local flaps for severe neck contractures and tried to discuss oftenly encounered difficulties in treating these group of patients. Conclusion: Many techniques have been described for correction of neck contractures, including skin grafting, expanders, local regional flaps and free flaps. The treatment of choice should be modified for every patient. PMID:23638326

  17. Before and After Photos: Treatment of Hypertrophic Scars

    MedlinePlus

    ... Loss Sagging Skin Scars Skin Growths Skin Lesions Spider Veins Stretch Marks Sun-damaged Skin Unwanted Hair ... Loss Sagging Skin Scars Skin Growths Skin Lesions Spider Veins Stretch Marks Sun-damaged Skin Unwanted Hair ...

  18. Soil surface CO2 flux increases with successional time in a fire scar chronosequence of Canadian boreal jack pine forest

    NASA Astrophysics Data System (ADS)

    Smith, D. R.; Kaduk, J. D.; Balzter, H.; Wooster, M. J.; Mottram, G. N.; Hartley, G.; Lynham, T. J.; Studens, J.; Curry, J.; Stocks, B. J.

    2010-05-01

    To fully understand the carbon (C) cycle impacts of forest fires, both C emissions during the fire and post-disturbance fluxes need to be considered. The latter are dominated by soil surface CO2 flux (Fs), which is still subject to large uncertainties. Fire is generally regarded as the most important factor influencing succession in the boreal forest biome and fire dependant species such as jack pine are widespread. In May 2007, we took concurrent Fs and soil temperature (Ts) measurements in boreal jack pine fire scars aged between 0 and 59 years since fire. To allow comparisons between scars, we adjusted Fs for Ts (FsT) using a Q10 of 2. Mean FsT ranged from 0.56 (± 0.30 sd) to 1.94 (± 0.74 sd) μmol CO2 m-2 s-1. Our results indicate a difference in mean FsT between recently burned (4 to 8 days post fire) and non-burned mature (59 years since fire) forest (P < 0.001), though no difference was detected between recently burned (4 to 8 days post fire) and non-burned young (16 years since fire) forest (P = 0.785). There was a difference in mean FsT between previously young (16 years since fire) and intermediate aged (32 years since fire) scars that were both subject to fire in 2007 (P < 0.001). However, there was no difference in mean FsT between mature (59 years since fire) and intermediate aged (32 years since fire) scars that were both subjected to fire in 2007 (P = 0.226). Furthermore, there was no difference in mean FsT between mature (59 years since fire) and young scars (16 years since fire) that were both subjected to fire in 2007 (P = 0.186). There was an increase in FsT with time since fire for the chronosequence 0, 16 and 59 years post fire (P < 0.001). Our results lead us to hypothesise that the autotrophic:heterotrophic soil respiration ratio increases over post-fire successional time in boreal jack pine systems, though this should be explored in future research. The results of this study contribute to a better quantitative understanding of Fs in boreal jack pine fire scars and will facilitate meta-analyses of Fs in fire scar chronosequences.

  19. A nude mouse model of hypertrophic scar shows morphologic and histologic characteristics of human hypertrophic scar.

    PubMed

    Momtazi, Moein; Kwan, Peter; Ding, Jie; Anderson, Colin C; Honardoust, Dariush; Goekjian, Serge; Tredget, Edward E

    2013-01-01

    Hypertrophic scar (HSc) is a fibroproliferative disorder that occurs following deep dermal injury. Lack of a relevant animal model is one barrier toward better understanding its pathophysiology. Our objective is to demonstrate that grafting split-thickness human skin onto nude mice results in survival of engrafted human skin and murine scars that are morphologically, histologically, and immunohistochemically consistent with human HSc. Twenty nude mice were xenografted with split-thickness human skin. Animals were euthanized at 30, 60, 120, and 180 days postoperatively. Eighteen controls were autografted with full-thickness nude mouse skin and euthanized at 30 and 60 days postoperatively. Scar biopsies were harvested at each time point. Blinded scar assessment was performed using a modified Manchester Scar Scale. Histologic analysis included hematoxylin and eosin, Masson's trichrome, toluidine blue, and picrosirius red staining. Immunohistochemistry included anti-human human leukocyte antigen-ABC, ?-smooth muscle actin, decorin, and biglycan staining. Xenografted mice developed red, shiny, elevated scars similar to human HSc and supported by blinded scar assessment. Autograft controls appeared morphologically and histologically similar to normal skin. Xenografts survived up to 180 days and showed increased thickness, loss of hair follicles, adnexal structures and rete pegs, hypercellularity, whorled collagen fibers parallel to the surface, myofibroblasts, decreased decorin and increased biglycan expression, and increased mast cell density. Grafting split-thickness human skin onto nude mice results in persistent scars that show morphologic, histologic, and immunohistochemical consistency with human HSc. Therefore, this model provides a promising technique to study HSc formation and to test novel treatment options. PMID:23126488

  20. Treatment of microstomia caused by burn with a nasolabial flap--an ingenious approach for tugging and fixation of the oral commissure.

    PubMed

    Makiguchi, Takaya; Yokoo, Satoshi; Koitabashi, Atsushi; Ogawa, Masaru; Miyazaki, Hidetaka; Terashi, Hiroto

    2014-03-01

    The objectives of surgical treatment for microstomia due to cicatricial contracture after burn are to obtain sufficient oral aperture, while maintaining sphincter function of the orbicularis oris muscle, and to secure favorable function for eating and conversation in addition to good oral health.The lips of the mouth have a free border, and the oral aperture, which has been enlarged by the operation, tends to be reduced, because of the actions of the orbicularis oris muscle. When the orbicularis oris muscle is resected, putting a priority on sufficient oral aperture and prevention of redevelopment of contracture, the function of the sphincter is often damaged. With the exception of those cases with deep extensive burn that damages a wide area of orbicularis oris muscle, the muscle should be preserved as expeditiously as is practical. In such cases, however, preventive measures for the redevelopment of microstomia should be established. As a postoperative adjuvant therapy, the usefulness of splint therapy has been suggested in many reports. However, a splint should be used for a long period after the surgery, and in some cases, pain is observed with therapy. When a splint is not used for an appropriate period, microstomia may redevelop. It would be ideal to take preventive measures against the redevelopment of contracture during surgery.We provided treatment with some ingenious attempts for the nasolabial flap to a patient with microstomia caused by cicatricial contracture after burn. We obtained favorable results with no postoperative use of a splint. PMID:24561375

  1. Surgical correction of ear curling caused by scar tissue formation in a horse.

    PubMed

    Massoni, Sabrina; Vlaminck, Lieven E; Cokelaere, Stefan M; Martens, Ann M

    2005-10-01

    An 18-month-old Belgian Warmblood mare was evaluated because it had injured the outer convex aspect of the left auricle. Second intention healing of the wound area caused tissue contracture, which resulted in the tip of the ear curling backward. By use of a technique involving undermining of the skin and a flap of granulation tissue on the medial aspect of the wound area and multiple incisions of the auricular cartilage, the curling was relieved and the ear regained a more normal shape. A skin graft was applied to cover the existing wound defect in an attempt to accelerate wound healing; thermoplastic material was contoured to fit the inner concave surface of the ear for immobilization and fixation of the ear in its final shape after surgery. Thirty days after surgery, the graft had healed completely and the ear had a normal conformation. The successful outcome of this treatment suggests that correction of an ear deformity secondary to scar tissue formation by use of an adapted surgical technique and appropriate materials can be achieved with good cosmetic results in horses. PMID:16220675

  2. Different Surgical Reconstruction Modalities of the Post-Burn Mutilated Hand Based on a Prospective Review of a Cohort of Patients*

    PubMed Central

    Saleh, Y.; El-Shazly, M.; Adly, S.; El-Oteify, M.

    2008-01-01

    Summary This study covered 40 patients (22 females and 18 males) suffering from post-burn hand deformities admitted to Assiut University Hospital and Luxor International Hospital (Egypt) from June 2004 to May 2006. Their ages ranged between 4 and 45 yr (mean, 24.5 yr). They presented a variety of post-burn hand deformities, e.g. dorsal hand contracture (14 cases), volar contracture (10 cases), first web space contracture (3 cases), post-burn syndactyly (2 cases), wrist deformity (3 cases), skin and tendon affection (2 cases), and complex deformity (6 cases). All the patients underwent a variety of surgical procedures specific to the individual post-burn hand deformity. Post-operative splinting of the hand for 10 days was performed in patients with skin graft to prevent recontracture. The post-operative physiotherapy programme started in the second week in order to achieve good functional results. The follow-up period ranged from 6 to 20 months. The results were satisfactory in most of the cases as regards the quality of coverage, which was achieved in the majority of cases. In one case there was partial loss of the skin graft, which healed by secondary intention; full range of motion was achieved in most patients, but not those with joint affections. On the basis of our results, we can conclude that the management of post-burn hand deformities depends on several factors. Initial treatment of the burned hand is of great importance for the prevention of secondary deformities. In secondary burn management the first step is the release of the contracture, which should be complete and include all contracted structures. The second step is the proper selection of methods of coverage for resultant defects, using either skin grafts or flaps depending on the presence of exposed tendons, nerves, or joints. The third step in order to obtain a very good function is the activation of an intensive physiotherapy programme immediately after the operation. PMID:21991127

  3. Different Surgical Reconstruction Modalities of the Post-Burn Mutilated Hand Based on a Prospective Review of a Cohort of Patients

    PubMed Central

    Saleh, Y.; El-Shazly, M.; Adly, S.; El-Oteify, M.

    2008-01-01

    Summary This study covered 40 patients (22 females and 18 males) suffering from post-burn hand deformities admitted to Assiut University Hospital and Luxor International Hospital (Egypt) from June 2004 to May 2006. Their ages ranged between 4 and 45 yr (mean, 24.5 yr). They presented a variety of post-burn hand deformities, e.g. dorsal hand contracture (14 cases), volar contracture (10 cases), first web space contracture (3 cases), post-burn syndactyly (2 cases), wrist deformity (3 cases), skin and tendon affection (2 cases), and complex deformity (6 cases). All the patients underwent a variety of surgical procedures specific to the individual post-burn hand deformity. Post-operative splinting of the hand for 10 days was performed in patients with skin graft to prevent recontracture. The post-operative physiotherapy programme started in the second week in order to achieve good functional results. The follow-up period ranged from 6 to 20 months. The results were satisfactory in most of the cases as regards the quality of coverage, which was achieved in the majority of cases. In one case there was partial loss of the skin graft, which healed by secondary intention; full range of motion was achieved in most patients, but not those with joint affections. On the basis of our results, we can conclude that the management of post-burn hand deformities depends on several factors. Initial treatment of the burned hand is of great importance for the prevention of secondary deformities. In secondary burn management the first step is the release of the contracture, which should be complete and include all contracted structures. The second step is the proper selection of methods of coverage for resultant defects, using either skin grafts or flaps depending on the presence of exposed tendons, nerves, or joints. The third step in order to obtain a very good function is the activation of an intensive physiotherapy programme immediately after the operation. PMID:21991117

  4. The Use of Silicone Adhesives for Scar Reduction

    PubMed Central

    Bleasdale, Benjamin; Finnegan, Simon; Murray, Kathyryn; Kelly, Sean; Percival, Steven L.

    2015-01-01

    Significance: This article discusses the history and developments of silicone gel sheeting (SGS) scar therapy. Furthermore, we review a breadth of literature to gain an insight into how and why topical silicone gels remain the favored treatment of medical experts in scar management. We also analyze an ever increasing number of alternative therapies claiming to provide enhanced scar reduction performance. Recent Advances: Topical silicone gel treatments seem to remain the first point of clinical recommendation in scar management. SGS has been used in scar therapy for over 30 years, during which its efficacy has been the subject of numerous clinical evaluations. Critical Issues: While the exact mechanisms by which SGS improves hypertrophic scars, keloid development and recovery are yet to be fully agreed upon, its ability to do so remains largely undisputed at present. However, there still is ongoing deliberation over the exact mechanism of action of silicone in improving a scar. At present it is likely that through occlusion of the scar site and hydration of the wound bed, the overactivity of scar-related cells is suppressed, and their activity normalized. Future Direction: The clinical support of topical silicone gel products, relative to all alternative scar therapies, is considered the internationally recommended first-line form of scar management, and favored by consensus among healthcare professionals. However, there still remains the need for further clinical evidence and a better understanding of the mechanism behind the benefit of silicone gel for use in the prevention of abnormal scarring. PMID:26155385

  5. A Rat Excised Larynx Model of Vocal Fold Scar

    ERIC Educational Resources Information Center

    Welham, Nathan V.; Montequin, Douglas W.; Tateya, Ichiro; Tateya, Tomoko; Choi, Seong Hee; Bless, Diane M.

    2009-01-01

    Purpose: To develop and evaluate a rat excised larynx model for the measurement of acoustic, aerodynamic, and vocal fold vibratory changes resulting from vocal fold scar. Method: Twenty-four 4-month-old male Sprague-Dawley rats were assigned to 1 of 4 experimental groups: chronic vocal fold scar, chronic vocal fold scar treated with 100-ng basic…

  6. Scar formation and revision after the removal of orthodontic miniscrews

    PubMed Central

    Choi, Yoon Jeong; Lee, Dong-Won; Kim, Kyung-Ho

    2015-01-01

    Many clinicians expect complete healing after the removal of temporary anchorage devices, but clinical examination may reveal scar-like tissue. This report presents the typical features of scarring detected after the removal of miniscrews, and the clinical outcome of scar revision along with its pathologic features. PMID:26023543

  7. A Rat Excised Larynx Model of Vocal Fold Scar

    ERIC Educational Resources Information Center

    Welham, Nathan V.; Montequin, Douglas W.; Tateya, Ichiro; Tateya, Tomoko; Choi, Seong Hee; Bless, Diane M.

    2009-01-01

    Purpose: To develop and evaluate a rat excised larynx model for the measurement of acoustic, aerodynamic, and vocal fold vibratory changes resulting from vocal fold scar. Method: Twenty-four 4-month-old male Sprague-Dawley rats were assigned to 1 of 4 experimental groups: chronic vocal fold scar, chronic vocal fold scar treated with 100-ng basic

  8. An unusual case of rapidly progressive contractures: Case report and brief review

    PubMed Central

    Subasree, R.; Panda, Samhita; Pal, Pramod Kumar; Ravishankar, S.

    2008-01-01

    An 8-year-old boy, diagnosed as cervical dystonia, was referred to our tertiary center. After a trivial trauma he had developed painful lumps in the axial region, which was followed by restricted movements of neck, shoulder, and abdominal muscles over 4 months. He had kyphoscoliosis, torticollis, rigid abdomen, and multiple muscle contractures. He also had short great toes. A detailed skeletal survey showed calcification in the soft tissues surrounding the shoulder anterior chest wall, thorax, and paraspinal muscles; there was also beaking of vertebrae, which was confirmed by CT thorax. This report showcases the diagnostic challenge posed by myositis ossificans progressiva, which can rarely cause rapidly progressing muscle contractures. A brief review of literature is also presented. PMID:19893652

  9. Endoscopic extracapsular capsulectomy of the elbow: a neurovascularly safe technique for high-grade contractures.

    PubMed

    Kamineni, Srinath; Savoie, Felix H; ElAttrache, Neil

    2007-07-01

    Arthroscopic management of elbow contractures is rapidly becoming the primary operative form of treatment for many physicians. Safety concerns remain the primary limiting factor in its more widespread use. We use an extra-articular starting point in extremely difficult fixed contractures, and this technique is documented in this report. The ulnar nerve is initially identified and protected with a palpating finger, while a periosteal elevator is introduced through a proximal medial skin portal. A channel between the anterior humeral cortex and anterior musculature is created, and an arthroscope is introduced through a proximal lateral portal at the lateral aspect of the channel. The anterior capsule is dissected from the musculature/neurovasculature under direct vision and safely excised once the medial and lateral margins are safely identified. A useful technical tip is that retractors can be placed in auxiliary portals to deflect the muscles and fat pad to improve the ability to perform dissection under direct vision. PMID:17637419

  10. Perspectives on glenohumeral joint contractures and shoulder dysfunction in children with perinatal brachial plexus palsy.

    PubMed

    Gharbaoui, Idris S; Gogola, Gloria R; Aaron, Dorit H; Kozin, Scott H

    2015-01-01

    Shoulder joint deformities continue to be a challenging aspect of treating upper plexus lesions in children with perinatal brachial plexus palsy (PBPP). It is increasingly recognized that PBPP affects the glenohumeral joint specifically, and that abnormal scapulothoracic movements are a compensatory development. The pathophysiology and assessment of glenohumeral joint contractures, the progression of scapular dyskinesia and skeletal dysplasia, and current shoulder imaging techniques are reviewed. PMID:25835253

  11. Roles of TGF-β/Smad signaling pathway in pathogenesis and development of gluteal muscle contracture

    PubMed Central

    Zhang, Xintao; Ma, Yukun; You, Tian; Tian, Xiaopeng; Zhang, Honglei; Zhu, Qi

    2015-01-01

    Purpose of the study Gluteal muscle contracture (GMC) is a chronic fibrotic disease of gluteal muscles which is characterized by excessive deposition of collagen in the extracellular matrix. Transforming growth factor (TGF)-βs have been shown to play an important role in the progression of GMC. However, the underlying mechanisms are not entirely clear. We sought to explore the expression of TGF-β/Smad pathway proteins and their downstream targets in gluteal muscle contracture disease. Materials and methods The expression levels of collagens type I/III, TGF-β1, Smad2/3/4/7 and PAI-1 (plasminogen activator inhibitor type 1) in gluteal muscle contraction (GMC) patients were measured using immunohistochemistry, reverse transcription and polymerase chain reaction (RT-PCR) and western blot assays. Results The expressions of collagens type I/III and TGF-β1 were significantly increased in the contraction band compared with unaffected muscle. In addition, R-Smad phosphorylation and Smad4 protein expression in the contraction band were also elevated, while the expression of Smad7 was significantly decreased in the fibrotic muscle of the GMC patients compared to the unaffected adjacent muscle. The protein and mRNA levels of PAI-1 were also remarkably increased in the contraction band compared with adjacent muscle. Immunohistochemical analysis also demonstrated that the expression levels of TGF-β1 and PAI-1 were higher in contraction band than those in the adjacent muscle. Conclusion Our data confirm the stimulating effects of the TGF-β/Smad pathway in gluteal muscle contracture disease and reveal the internal changes of TGF-β/Smad pathway proteins and their corresponding targets in gluteal muscle contracture patients. PMID:25207745

  12. Occurrence and severity of upper eyelid skin contracture in facial nerve palsy.

    PubMed

    Ziahosseini, K; Venables, V; Neville, C; Nduka, C; Patel, B; Malhotra, R

    2016-05-01

    PurposeTo describe the occurrence and severity of upper eyelid skin contracture in facial nerve palsy (FNP).MethodsWe enroled consecutive patients with unilateral FNP into this study. Patients with previous upper eyelid surgery for either side were excluded. We developed a standardised technique to measure the distance between the upper eyelid margin and the lower border of brow (LMBD). FNP was graded using the Sunnybrook grading scale. Its aetiology, duration, and treatment were noted. Upper and lower marginal reflex distance and lagophthalmos were also noted.ResultsSixty-six patients (mean age 51 years) were included. FNP was owing to a variety of aetiologies. LMBD on the paralytic side was shorter than the normal contralateral side in 47 (71%), equal in 15 (23%), and larger in four (6%) patients. The mean contracture was 3.4 mm (median: 3, range: 1-12) with 11 (17%) patients showing 5 mm or more of skin contracture. The mean LMBD on the paralytic side in all patients was significantly smaller than the contralateral side; 30±3.7 (median: 30; 95% CI 29-31) compared with 32±3.7 (median: 32; 95% CI 32-33), respectively, P<0.0001, two-tailed paired t-test.ConclusionTo our knowledge, this is the first study that quantitatively demonstrates contraction of the upper eyelid skin in FNP. This finding is valuable in directing optimal early management to minimise skin contracture and to caution surgeons against unnecessary upper eyelid skin excision. PMID:26939561

  13. Burning vasculitis.

    PubMed

    Chadha, Priyanka; Hobday, Dorian; Fitzgerald O'Connor, Edmund; D'Cruz, David

    2016-01-01

    We present the case of a 69-year-old man who was found collapsed close to a heat source and admitted to hospital for severe sepsis. He was also found to have widespread blistering and ulceration of his right leg; however, a history was unobtainable due to reduced consciousness levels. The leg lesions had the initial appearance of mixed depth burns and a management plan was made to transfer the patient to a burns unit for debridement. It was subsequently noted that the patient had a previous diagnosis of seropositive erosive rheumatoid arthritis. A biopsy of the leg lesion was performed and a diagnosis of rheumatoid vasculitis confirmed. Treatment with systemic steroids, intravenous antibiotics and intravenous immunoglobulin therapy for severe hypogammaglobulinaemia was started, and the patient was not transferred for surgical debridement. Rheumatoid vasculitis is a rare and extremely serious complication of rheumatoid arthritis that can manifest in a number of ways, occasionally mimicking other conditions. This case is essential to raise awareness of rare, severe rheumatoid vasculitis and of the potential for its misdiagnosis as a mixed depth burn. PMID:27118745

  14. Using transurethral Ho:YAG-laser resection to treat urethral stricture and bladder neck contracture

    NASA Astrophysics Data System (ADS)

    Bo, Juanjie; Dai, Shengguo; Huang, Xuyuan; Zhu, Jing; Zhang, Huiguo; Shi, Hongmin

    2005-07-01

    Objective: Ho:YAG laser had been used to treat the common diseases of urinary system such as bladder cancer and benign prostatic hyperplasia in our hospital. This study is to assess the efficacy and safety of transurethral Ho:YAG-laser resection to treat the urethral stricture and bladder neck contracture. Methods: From May 1997 to August 2004, 26 cases of urethral stricture and 33 cases of bladder neck contracture were treated by transurethral Ho:YAG-laser resection. These patients were followed up at regular intervals after operation. The uroflow rate of these patients was detected before and one-month after operation. The blood loss and the energy consumption of holmium-laser during the operation as well as the complications and curative effect after operation were observed. Results: The therapeutic effects were considered successful, with less bleeding and no severe complications. The Qmax of one month postoperation increased obviously than that of preoperation. Of the 59 cases, restenosis appeared in 11 cases (19%) with the symptoms of dysuria and weak urinary stream in 3-24 months respectively. Conclusions: The Ho:YAG-laser demonstrated good effect to treat the obstructive diseases of lower urinary tract such as urethral stricture and bladder neck contracture. It was safe, minimal invasive and easy to operate.

  15. Suppressed inflammatory gene expression during human hypertrophic scar compared to normotrophic scar formation.

    PubMed

    van den Broek, Lenie J; van der Veer, Willem M; de Jong, Etty H; Gibbs, Susan; Niessen, Frank B

    2015-08-01

    Hypertrophic scar formation is a result of adverse cutaneous wound healing. The pathogenesis of hypertrophic scar formation is still poorly understood. A problem next to the lack of suitable animal models is that often normal skin is compared to hypertrophic scar (HTscar) and not to normotrophic scar (NTscar) tissue. Another drawback is that often only one time period after wounding is studied, while scar formation is a dynamic process over a period of several months. In this study, we compared the expression of genes involved in inflammation, angiogenesis and extracellular matrix (ECM) formation and also macrophage infiltration in biopsies obtained before and up to 52 weeks after standard surgery in five patients who developed HTscar and six patients who developed NTscar. It was found that HTscar formation coincided with a prolonged decreased expression of inflammatory genes (TNF?, IL-1?, IL-1RN, CCL2, CCL3, CXCL2, CXCR2, C3 and IL-10) and an extended increased expression of ECM-related genes (PLAU, Col3A1, TGF?3). This coincided with a delayed but prolonged infiltration of macrophages (type 2) in HTscar tissue compared to NTscar tissue. These findings were supported by immunohistochemical localization of proteins coding for select genes named above. Our study emphasizes that human cutaneous wound healing is a dynamic process that is needed to be studied over a period of time rather than a single point of time. Taken together, our results suggest innate immune stimulatory therapies may be a better option for improving scar quality than the currently used anti-inflammatory scar therapies. PMID:25939875

  16. Current treatment of severely burned patients.

    PubMed Central

    Nguyen, T T; Gilpin, D A; Meyer, N A; Herndon, D N

    1996-01-01

    OBJECTIVE: The authors provide an update on a multidisciplinary approach to the treatment of severely burned patients. A review of studies and clinical trials from the past to the present include fluid resuscitation, sepsis, immune function, hypermetabolism, early excision, wound healing, scar formation, and inhalation injury. SUMMARY BACKGROUND DATA: Advances in treating initial burn shock, infection control, early wound closure, and modulation of the hypermetabolic response have decreased morbidity and mortality in the last two decades. Specialized burn care centers, using a multidisciplinary approach, not only successfully treat large burns and their complications, but provide the necessary rehabilitation and psychological support required for readjustment back into society. CONCLUSIONS: Thermal injury results in a number of physiologic alterations that can be minimized by adequate fluid resuscitation to maintain tissue perfusion, early excision of burn wounds, and rapid wound coverage. These measures, in combination with antibiotic coverage and nutritional support in the form of early enteral tube feedings, will decrease the hypermetabolic response and the incidence of sepsis that can lead to hemodynamic instability and organ failure. Ongoing clinical trials using anabolic agents (e.g., recombinant human growth hormone) and pharmacologic agents that modulate inflammatory and endocrine mediators (e.g., ibuprofen and propranolol) show promise in the treatment of severe burn injuries. PMID:8554414

  17. Current options for the treatment of pathological scarring.

    PubMed

    Poetschke, Julian; Gauglitz, Gerd G

    2016-05-01

    Scarring is the consequence of surgery, trauma or different skin diseases. Apart from fresh, immature scars,that transform into mature scars over the course of would healing and that do not require further treatment,linear hypertrophic scars, widespread hypertrophic scars, keloids and atrophic scars exist. Symptoms like pruritusand pain, stigmatization as well as functional and aesthetic impairments that are very disturbing for the affected patients can bethe basis for the desire for treatment. Today, a multitude of options for the treatment and prevention of scars exists. Topical agents based on silicone or onion extract, intralesional injections of cristalline glucocorticoids (oftentimes in combinationwith cryotherapy) or 5-Fluorouracil as well as ablative and nonablative laser treatment are used. Current guidelines summarize the multitude of available treatment options and the currently available datafor the treating physicians, allowing them to make clear therapy recommendations for every single scar type. Relieving patients of their discomfort and doing their aesthetic demands justice is thus possible. Apart from scar prevention becoming more and more important, the increased use of modernlaser treatment options constitutes a key point in clinical scar treatment. At the same time the attention is turned to evaluating current therapeutic options with the help of contemporary study designs so as to graduallyimprove the level of evidence in scar treatment. PMID:27119465

  18. Repigmentation of cutaneous scars depends on original wound type

    PubMed Central

    Chadwick, Sarah L; Yip, Christina; Ferguson, Mark W J; Shah, Mamta

    2013-01-01

    Cutaneous scarring is currently an inevitable outcome following skin injury. Abnormal pigmentation within scars makes them more noticeable, causing distress for patients, particularly as there is no reliable and effective treatment available to date. The Duroc pig, known to scar badly, was used to investigate repigmentation of scars resulting from three different wound types: incisional, partial thickness excisional and full thickness excisional. Wounds were created on the backs of Duroc pigs and the resulting scars harvested at days 35, 56, 70 and 90 days post-injury. Scars were processed for histology and immunohistochemistry, quantitatively analysed using image analysis software and subjected to statistical analysis. Photographs of the macroscopic appearance of scars were scored for pigmentation using a visual analogue scale. Results demonstrated temporal and spatial differences in melanocyte repopulation and function within scars from different wound types. The microscopic pigment deposition did not correlate with macroscopic appearances in mature scars. Pigmentation of scars is dependent on the width and depth of wounds. This study has provided important information on which we can base future studies to investigate factors controlling the repigmentation of scars. PMID:23668313

  19. Granuloma annulare in herpes zoster scars.

    PubMed

    Ohata, C; Shirabe, H; Takagi, K; Kawatsu, T

    2000-03-01

    A 54-year-old Japanese female developed granuloma annulare twice in herpes zoster scars. Soon after the second event, she developed ulcerative colitis, which was well controlled by sulfonamides and corticosteroid suppository. She had no history of diabetes mellitus. There was no recurrence of granuloma annulare by June of 1999. Granuloma annulare might have contributed to the complications of ulcerative colitis, although this had not been noticed before. PMID:10774142

  20. Eliciting health state utilities for Dupuytren’s contracture using a discrete choice experiment

    PubMed Central

    2013-01-01

    Background and purpose An internet-based discrete choice experiment (DCE) was conducted to elicit preferences for a wide range of Dupuytren’s contracture (DC)-related health states. An algorithm was subsequently developed to convert these preferences into health state utilities that can be used to assess DC’s impact on quality of life and the value of its treatments. Methods Health state preferences for varying levels of DC hand severity were elicited via an internet survey from a sample of the UK adult population. Severity levels were defined using a combination of contractures (0, 45, or 90 degrees) in 8 proximal interphalangeal and metacarpophalangeal joints of the index, middle, ring, and little fingers. Right-handed, left-handed, and ambidextrous respondents indicated which hand was preferable in each of the 10 randomly-selected hand-pairings comparing different DC severity levels. For consistency across comparisons, anatomically precise digital hand drawings were used. To anchor preferences onto the traditional 0–1 utility scale used in health economic evaluations, unaffected hands were assigned a utility of 1.0 whereas the utility for a maximally affected hand (i.e., all 8 joints set at 90 degrees of contracture) was derived by asking respondents to indicate what combination of attributes and levels of the EQ-5D-5L profile most accurately reflects the impact of living with such hand. Conditional logistic models were used to estimate indirect utilities, then rescaled to the anchor points on the EQ-5D-5L. Results Estimated utilities based on the responses of 1,745 qualified respondents were 0.49, 0.57, and 0.63 for completely affected dominant hands, non-dominant hands, or ambidextrous hands, respectively. Utility for a dominant hand with 90-degree contracture in t h e metacarpophalangeal joints of the ring and little fingers was estimated to be 0.89. Separately, reducing the contracture of metacarpophalangeal joint for a little finger from 50 to 12 degrees would improve utility by 0.02. Interpretation DC is associated with substantial utility decre- ments. The algorithms presented herein provide a robust and flexible framework to assess utility for varying degrees of DC severity. PMID:24286567

  1. Digital imaging analysis to assess scar phenotype

    PubMed Central

    Smith, Brian J.; Nidey, Nichole; Miller, Steven F.; Moreno, Lina M.; Baum, Christian L.; Hamilton, Grant S.; Wehby, George L.; Dunnwald, Martine

    2015-01-01

    In order to understand the link between the genetic background of patients and wound clinical outcomes, it is critical to have a reliable method to assess the phenotypic characteristics of healed wounds. In this study, we present a novel imaging method that provides reproducible, sensitive and unbiased assessments of post-surgical scarring. We used this approach to investigate the possibility that genetic variants in orofacial clefting genes are associated with suboptimal healing. Red-green-blue (RGB) digital images of post-surgical scars of 68 patients, following unilateral cleft lip repair, were captured using the 3dMD image system. Morphometric and colorimetric data of repaired regions of the philtrum and upper lip were acquired using ImageJ software and the unaffected contralateral regions were used as patient-specific controls. Repeatability of the method was high with interclass correlation coefficient score > 0.8. This method detected a very significant difference in all three colors, and for all patients, between the scarred and the contralateral unaffected philtrum (P ranging from 1.20−05 to 1.95−14). Physicians’ clinical outcome ratings from the same images showed high inter-observer variability (overall Pearson coefficient = 0.49) as well as low correlation with digital image analysis results. Finally, we identified genetic variants in TGFB3 and ARHGAP29 associated with suboptimal healing outcome. PMID:24635173

  2. The Scarbase Duo(®): Intra-rater and inter-rater reliability and validity of a compact dual scar assessment tool.

    PubMed

    Fell, Matthew; Meirte, Jill; Anthonissen, Mieke; Maertens, Koen; Pleat, Jonathon; Moortgat, Peter

    2016-03-01

    Objective scar assessment tools were designed to help identify problematic scars and direct clinical management. Their use has been restricted by their measurement of a single scar property and the bulky size of equipment. The Scarbase Duo(®) was designed to assess both trans-epidermal water loss (TEWL) and colour of a burn scar whilst being compact and easy to use. Twenty patients with a burn scar were recruited and measurements taken using the Scarbase Duo(®) by two observers. The Scarbase Duo(®) measures TEWL via an open-chamber system and undertakes colorimetry via narrow-band spectrophotometry, producing values for relative erythema and melanin pigmentation. Validity was assessed by comparing the Scarbase Duo(®) against the Dermalab(®) and the Minolta Chromameter(®) respectively for TEWL and colorimetry measurements. The intra-class correlation coefficient (ICC) was used to assess reliability with standard error of measurement (SEM) used to assess reproducibility of measurements. The Pearson correlation coefficient (r) was used to assess the convergent validity. The Scarbase Duo(®) TEWL mode had excellent reliability when used on scars for both intra- (ICC=0.95) and inter-rater (ICC=0.96) measurements with moderate SEM values. The erythema component of the colorimetry mode showed good reliability for use on scars for both intra-(ICC=0.81) and inter-rater (ICC=0.83) measurements with low SEM values. Pigmentation values showed excellent reliability on scar tissue for both intra- (ICC=0.97) and inter-rater (ICC=0.97) with moderate SEM values. The Scarbase Duo(®) TEWL function had excellent correlation with the Dermalab(®) (r=0.93) whilst the colorimetry erythema value had moderate correlation with the Minolta Chromameter (r=0.72). The Scarbase Duo(®) is a reliable and objective scar assessment tool, which is specifically designed for burn scars. However, for clinical use, standardised measurement conditions are recommended. PMID:26774602

  3. Effect of Ca2+ channel blockers on K+ contractures in twitch fibres of the frog (Rana pipiens).

    PubMed Central

    Gamboa-Aldeco, R; Huerta, M; Stefani, E

    1988-01-01

    1. The effects of Ca2+ channel blockers (nifedipine, nitrendipine and diltiazem) were tested on K+ contractures in single muscle fibres of the frog, Rana pipiens. 2. Nifedipine (1 microM) reduced the area under K+ contractures to 24 +/- 9% (4) (100 mM-K+) and 34 +/- 24% (4) (190 mM-K+). Nitrendipine (0.1 microM) reduced the area to 30 +/- 10% (4) (120 mM-K+). The blockade of the contractures was reversible. 3. Diltiazem (1 microM) shortened the first 190 mM-K+ contracture without affecting the peak amplitude. The first contractures, performed at 15-20 min after the removal of diltiazem, were greatly reduced to 29 +/- 14% (4). This effect was reversed after three to five contractures in the absence of the drug. Similar results were obtained with 60 and 100 mM-K+. 4. The resting potential in control saline and after a brief exposure to 120 mM-K+ was not affected by the dihydropyridines and diltiazem. 5. Slow and fast Ca2+ currents were not modified by 1 microM-diltiazem at any stimulation rate or with pre-pulse depolarizations. Diltiazem (50 microM) did not affect the fast Ca2+ current and reduced the slow one to 48 +/- 10% (4). 7. The reduction of K+ contractures by Ca2+ channel blocking agents was not related to a blockade of Ca2+ currents. This can be tentatively explained by interactions of these compounds on membranes sites which regulate the coupling between membrane depolarization and contraction. PMID:2457700

  4. Burn due to misuse of an acetylene gas burner: a case report.

    PubMed

    Shimada, K; Aoki, Y; Ide, Y; Ishikura, N; Kawakami, S

    1999-11-01

    A rare case of deep penetrating burn injury caused by misuse of a high-pressure acetylene burner is reported. A 35 year old man was admitted with second and third degree burns involving the right arm cubital area and a subcutaneous burn on his right arm caused by a high-pressure acetylene gas flame. Early surgical debridement and secondary skin grafting using a preserved subcutaneous vascular network skin graft (PSVNSG) proved effective in this patient. Skin contracture was prevented and function was recovered. The basis of PSVNSG is that the vascular system existing in the graft is used as a permanent vascular system without degeneration. This case shows that, in this kind of burn injury, subcutaneous tissue damage should be suspected and that it is important to perform surgical debridement early after admission. PMID:10563697

  5. Detecting Moorland Wildfire Scars and their Persistence in the Landscape using Synthetic Aperture Radar (SAR) in the Peak District National Park, UK

    NASA Astrophysics Data System (ADS)

    Millin-chalabi, G. R.; McMorrow, J.; Agnew, C.

    2012-12-01

    The overall aim of this research is to assess the ability of SAR to detect moorland wildfire scars and their persistence in the landscape using the Peak District National Park (PDNP) in the UK as a case study. Spatially-robust data to monitor wildfire scar size and severity in UK moorlands is currently rare. Fires can burn deep into peat soils and contribute to the release of carbon dioxide into the atmosphere and may also affect the water quality of nearby streams. Information on fire extent would be useful for conservation organisations such as Moors For The Future who are trying to preserve the delicate peatland environment. Knowing the size and location of fire scars would help the Fire and Rescue Service to plan future response to moorland fires. Fire scar boundaries can be mapped in the field using Global Positioning Systems (GPS), however this is labour intensive. Indeed in the PDNP wildfire scar mapping is conducted by park rangers which provides essential ground truth data for assessing against the SAR data. Therefore this particular area provides a unique opportunity for testing an alternative SAR technique for monitoring wildfire scars in the moorland landscape. Previous research shows that SAR has been successfully applied for wildfire scar detection in other types of environments such as boreal (Bourgeau-Chavez et al, 1997) and the tropics (Huang and Siegert, 2004). This research presents some of the first results of the project which tests the capability of ERS 2; ASAR (C-band) and PALSAR (L-band) data to detect several wildfire scars from 2003 - 2008 of various spatial scales and fire severity. Some of the key areas of interest the paper will explore are at Bleaklow and the Kinder plateau. The Bleaklow peat fire of 18th April 2003 was larger (7km2) and more severe than at Kinder, which burned between 26-29th May 2008 and covered an area of 10 ha. All the wildfire scars were GPS, mapped just after the fire event. Archival time-series SAR imagery was supplied by the Landmap Service, originally sourced from the European Space Agency (ESA). C-band ASAR and ERS 2 data and L-band PALSAR data were pre-processed in SARscape 4.2. The results of this research will report on (a) the affect of land cover on backscatter and coherence results (b) the affect of precipitation on the backscatter signal (c) whether fire intensity and size affects the detectability of wildfire scars using SAR and InSAR (d) the degree that SAR and InSAR can be used to assess the persistence of wildfire scars in a UK moorland landscape.;

  6. Iontophoretic drug delivery for the treatment of scars.

    PubMed

    Manda, Prashanth; Angamuthu, Muralikrishnan; Hiremath, Shobharani R; Raman, Vijayasankar; Murthy, S Narasimha

    2014-06-01

    Topical treatment of hypertrophic scars is challenging because of poor penetrability of drugs into the scar tissue. The objective of the study was to investigate the effectiveness of iontophoresis to deliver medicaments across the scar epidermis. Initially, biophysical studies were performed to investigate the differences between scar and normal skin epidermis obtained from cadaver. In case of scar skin epidermis, the transepidermal water loss was not significantly different from the normal skin epidermis, whereas the electrical resistivity was significantly higher. The passive permeation flux of sodium fluorescein was approximately one-third of that across the normal skin epidermis. Scanning electron microscopy studies revealed that the two membranes were alike except that the scar skin epidermis lacked follicles. Cathodal iontophoresis enhanced the delivery of sodium fluorescein across the scar skin epidermis by approximately 46 folds [51.90 ± 8.82 ng/(cm(2) h)]. However, the transport of sodium fluorescein across the scar skin epidermis was about an order of magnitude less than the normal skin epidermis. Overall, the studies suggest that iontophoresis could be utilized to overcome the barrier resistance of scar skin epidermis and treat the scar regionally. PMID:24648369

  7. Burn surgery.

    PubMed

    Tenenhaus, Mayer; Rennekampff, Hans Oliver

    2007-10-01

    The challenges posed by thermal injury often are daunting emotionally and physically for the survivor, family, and staff. Morbidity and mortality have improved with advances in emergent and multidisciplinary care; the establishment of dedicated burn centers; and increased education, prevention, and experience. The role of surgery in the treatment of these complex injury patterns continues to evolve, incorporating refined concepts of tissue preservation, wound bed preparation, and early attention to functional and esthetic parameters. Societal reintegration, psychosocial support, and new pain control strategies have dramatically improved the quality of life for our patients during and after the acute course of care. With improved survivability and a changing demographic, fundamental reconstructive surgical principles have found increased applicability and are instituted at the time of admission whenever possible. PMID:17967624

  8. The use of a polylactide-based copolymer as a temporary skin substitute in deep dermal burns: 1-year follow-up results of a prospective clinical noninferiority trial.

    PubMed

    Selig, Harald F; Keck, Maike; Lumenta, David B; Mittlböck, Martina; Kamolz, Lars P

    2013-01-01

    Deep dermal burns can be covered with different kind of materials and techniques; one of them is a polylactide-based temporary skin substitute. The aim of this study was to intraindividually compare its 1-year outcome with the results obtained by use of autologous skin grafts in patients suffering from deep dermal burns. A prospective noninferiority trial was designed in order to assess skin quality and scar formation by use of subjective (Vancouver Scar Scale; Patient and Observer Scar Assessment Scale) and objective (noninvasive cutometry) burn scar assessment tools. All items of the Patient and Observer Scar Assessment Scale, except vascularity, were found to be noninferior in the areas covered with the temporary skin substitute vs. autologous skin. Results of objective scar evaluation showed comparable viscoelastic parameters without reaching noninferiority. Overall, the outcome of deep dermal burns covered with a polylactide-based temporary skin substitute revealed satisfactory results in terms of scar formation and skin quality as compared with autologous skin. This paper supports its use in deep dermal burns, where autologous skin donor sites require either to be reserved for coverage of full-thickness skin defects in severe burns or to be saved for reduction of additional morbidity in selected patient collectives. PMID:23627672

  9. Saturday night burns: an increasing problem?

    PubMed Central

    Bollero, D.; Malvasio, V.; Gangemi, E.N.; Giunta, G.; Collard, B.; Stella, M.

    2015-01-01

    Summary In Italy the economic crisis has caused changes in behavior in daily as well as leisure activities. For instance, night clubs have changed both their scenography and what they can offer. From simply providing a place to dance, they can now offer more complex scenography with spectacular fireworks and lit cocktails. While this can be amazing for all of us it can also be another cause of burn injuries. We conducted a retrospective study of all burns patients admitted to the Accident and Emergency Department at CTO Hospital in Turin from 2009 to 2013, after a night clubbing. A total of five patients were identified with an average age of 20 years old: four were burned by flaming cocktails and one was burned by a firework. Two received outpatient treatment, while orotracheal intubation and admission were needed for three, and two required surgical debridement and resurfacing with split skin graft. All patients had permanent sequelae caused by pathologic scarring and/or dyschromia. Our findings show that the risk of burn injuries is higher at weekends, mainly in summer, if all correct safety procedures are not followed. Meanwhile it is important to highlight that the promotion of inappropriate behavior at night clubs during firework displays and the passing of flaming cocktails should be avoided. PMID:26668565

  10. Saturday night burns: an increasing problem?

    PubMed

    Bollero, D; Malvasio, V; Gangemi, E N; Giunta, G; Collard, B; Stella, M

    2015-03-31

    In Italy the economic crisis has caused changes in behavior in daily as well as leisure activities. For instance, night clubs have changed both their scenography and what they can offer. From simply providing a place to dance, they can now offer more complex scenography with spectacular fireworks and lit cocktails. While this can be amazing for all of us it can also be another cause of burn injuries. We conducted a retrospective study of all burns patients admitted to the Accident and Emergency Department at CTO Hospital in Turin from 2009 to 2013, after a night clubbing. A total of five patients were identified with an average age of 20 years old: four were burned by flaming cocktails and one was burned by a firework. Two received outpatient treatment, while orotracheal intubation and admission were needed for three, and two required surgical debridement and resurfacing with split skin graft. All patients had permanent sequelae caused by pathologic scarring and/or dyschromia. Our findings show that the risk of burn injuries is higher at weekends, mainly in summer, if all correct safety procedures are not followed. Meanwhile it is important to highlight that the promotion of inappropriate behavior at night clubs during firework displays and the passing of flaming cocktails should be avoided. PMID:26668565

  11. Endoscopic-Assisted Total Thyroidectomy via Lateral Keloid Scar Incision

    PubMed Central

    2014-01-01

    Thyroidectomy is traditionally performed by the transcervical approach. To avoid or reduce visible scarring, diverse innovative surgical trials have been reported. Here we report a patient who underwent endoscopic thyroidectomy via a lateral keloid scar due to a previous traffic accident. A 30-year-old woman presented with a papillary thyroid carcinoma. Total thyroidectomy was performed via a keloid scar incision. The keloid scar was then revised. The total thyroidectomy was successful, resulting in no acute complications, such as neural injury, hematoma, or seroma formation. The keloid scar healed with excellent cosmetic results and the patient remains free of disease 12 months after excision. Endoscopic total thyroidectomy via a lateral keloid scar incision healed not only the physical disease but also the mental disease. PMID:25436057

  12. [Diagnosis of susceptibility to malignant hyperthermia using the in vitro contracture test].

    PubMed

    Klein, W; Spiess-Kiefer, C; Küther, G; Pongratz, D; Lehmann-Horn, F

    1987-12-01

    Though a malignant hyperthermia (MH) crisis is still a critical event during general anesthesia, recent developments in prophylaxis and treatment should help in avoiding fatal episodes. The best means to avoid MH episodes would be early recognition of MH susceptibility. Today the only reliable test to identify MH susceptibility is the in vitro contracture test. Thus, to diagnose MH susceptibility we performed this test on muscle biopsies from 26 individuals who: (1) had an event during general anesthesia that may have been indicative of MH (4 patients); (2) had a family member with a medical history of MH (20 patients); or (3) had unexplained elevated CK levels (1 patient). The criteria according to which patients were submitted to the testing are shown in detail in Table 1. We used the standardized version of the contracture test that has been proposed by the European Malignant Hyperpyrexia Group. Muscle biopsies (20-30 mm long, 8 mm diameter) were dissected into 8-10 small bundles (2-3 mm diameter) and tested within 3 h post-biopsy in four independent tissue baths with various concentrations of caffeine or halothane. According to the concentration of caffeine or halothane necessary to elicit contractures exceeding a predefined force threshold (20 mN), it was possible to classify the patients as MHS (MH-susceptible), MHE (equivocal), or MHN (negative). In addition to the in vitro test, clinical, laboratory, and neurophysiological data were collected from these patients and correlated with the individual test results (Table 2). Thirteen patients were classified as MHS, five were MHE, and seven patients MHN (Fig. 3).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2830805

  13. The Impact of Aerosols Generated from Biomass Burning, Dust Storms, and Volcanoes Upon the Earth's Radiative Energy Budget

    NASA Technical Reports Server (NTRS)

    Christopher, Sundar A.

    1997-01-01

    A new technique for detecting aerosols from biomass burning and dust is developed. The radiative forcing of aerosols is estimated over four major ecosystems in South America. A new smoke and fire detection scheme is developed for biomass burning aerosols over South America. Surface shortware irradiance calculations are developed in the presence of biomass burning aerosols during the SCAR-B experiment. This new approach utilizes ground based, aircraft, and satellite measurements.

  14. Clinical effectiveness of post-operative splinting after surgical release of Dupuytren's contracture: a systematic review

    PubMed Central

    Larson, Debbie; Jerosch-Herold, Christina

    2008-01-01

    Background Splinting after contracture release for Dupuytren's disease of the hand is widely advocated. The purpose of this systematic review was to evaluate the quantity and quality of evidence regarding the effectiveness of splinting in the post-surgical management of Dupuytren's contractures. Methods Studies were identified by searching the electronic databases Medline, AMED, CINAHL and EMBASE. Studies were included if they met the following inclusion criteria: prospective or retrospective, experimental, quasi-experimental or observational studies investigating the effectiveness of static or dynamic splints worn day and/or night-time for at least 6 weeks after surgery and reporting either individual joint or composite finger range of motion and/or hand function. The methodological quality of the selected articles was independently assessed by the two authors using the guidelines for evaluating the quality of intervention studies developed by McDermid. Results Four studies, with sample sizes ranging from 23 to 268, met the inclusion criteria for the systematic review. Designs included retrospective case review, prospective observational and one controlled trial without randomisation. Interventions included dynamic and static splinting with a mean follow-up ranging from 9 weeks to 2 years. Pooling of results was not possible due to the heterogeneity of interventions (splint type, duration and wearing regimen) and the way outcomes were reported. Conclusion There is empirical evidence to support the use of low load prolonged stretch through splinting after hand surgery and trauma, however only a few studies have investigated this specifically in Dupuytren's contracture. The low level evidence regarding the effect of post-operative static and dynamic splints on final extension deficit in severe PIP joint contracture (>40°) is equivocal, as is the effect of patient adherence on outcome. Whilst total active extension deficit improved in some patients wearing a splint there were also deficits in composite finger flexion and hand function. The lack of data on the magnitude of this effect makes it difficult to interpret whether this is of clinical significance. There is a need for well designed controlled trials with proper randomisation to evaluate the short-term and long-term effectiveness of splinting following Dupuytren's surgery. PMID:18644117

  15. Intramuscular hemangioma complicated by a Volkmann's like contracture of the forearm muscles.

    PubMed

    Sunil, T M

    2004-03-01

    Intramuscular hemagiomas are rare tumors constituting less than 1% of all hemangiomas. The clinical picture is usually unlike a conventional vascular tumor. Pre-operative diagnosis is very difficult and most often, the condition is recognized only during surgery or after histopathological examination. This is a report of one such rare tumor,which presented as a painful mass in the Flexor Digitorum Superficialis. It was accompanied by the hitherto unreported complication of a Volkmann's like contracture of the deeper forearm muscles. The peculiar feature of this tumor are highlighted and are discussed with a review of relevant literature. PMID:15064516

  16. [Scarring linear IgA dermatosis in the adult].

    PubMed

    Kurz, K; Mahrle, G

    1986-10-15

    A 54-year-old woman had a six-months history of a scarring blistering disease with clinical signs of dermatitis herpetiformis and bullous pemphigoid. Direct immunofluorescence examination showed homogeneously linear deposits of IgA along the dermo-epidermal junction. Electron microscopic studies revealed blistering above and beneath the lamina densa. Referring to this new case of a scarring linear IgA disease we discuss some other forms of scarring bullous diseases in adults. PMID:3541412

  17. Analysis of state of vehicular scars on Arctic Tundra, Alaska

    NASA Technical Reports Server (NTRS)

    Lathram, E. H.

    1974-01-01

    Identification on ERTS images of severe vehicular scars in the northern Alaska tundra suggests that, if such scars are of an intensity or have spread to a dimension such that they can be resolved by ERTS sensors (20 meters), they can be identified and their state monitored by the use of ERTS images. Field review of the state of vehicular scars in the Umiat area indicates that all are revegetating at varying rates and are approaching a stable state.

  18. Facial scars after a road accident--combined treatment with pulsed dye laser and Q-switched Nd:YAG laser.

    PubMed

    Martins, Andréa; Trindade, Felicidade; Leite, Luiz

    2008-09-01

    We report the case of a woman who presented with several facial scars following a road accident. Treatment was carried out using combined laser treatment with pulsed dye laser (PDL) and Q-switched neodymium:yttrium-aluminum-garnet laser (QS Nd:YAG laser). No side effects or complications from treatment were noted or reported. The patient had very good cosmetic results with this combined technique. A variety of facial scars - erythematous, pigmented, atrophic, and hypertrophic - may occur as a result of trauma, surgery, burns, and skin disease. Surgery with other adjunctive methods including radiotherapy, intralesional steroids, and pressure therapy have shown variable results. Laser treatment has been attempted for scar revision since the 1980s. The PDL is the optimal treatment for reducing scar bulk and symptoms. It also decreases erythema and telangiectasia associated with scars, normalizes the skin surface texture, and improves the scar pliability. The QS Nd:YAG laser (1064 nm) is highly effective for traumatic tattoo removal, resulting in complete clearance in the majority of cases. PMID:18789060

  19. Total obstetric brachial plexus palsy in children with internal rotation contracture of the shoulder, flexion contracture of the elbow, and poor hand function: improving the cosmetic appearance of the limb with rotation osteotomy of the humerus.

    PubMed

    Al-Qattan, Mohammad M

    2010-07-01

    Rotation osteotomy of the humerus has been described by several authors to treat the internal rotation contracture of the shoulder in Erb palsy. The main aim of the osteotomy in Erb patients is to bring the functioning hand to the face which greatly improves function. The author has performed the rotation humeral osteotomy in children with total obstetric brachial plexus palsy aiming for the improvement of the cosmetic appearance of the limb rather than improvement function. This article specifically reports on this group of patients.Over the last 15 years, the author has performed rotation humeral osteotomy in 13 children (mean age 6 years; range, 4.5-9 years) with total obstetric brachial plexus palsy aiming for improvement of the cosmetic appearance of the limb rather than improvement of function. All children had a triad of severe internal rotation contracture of the shoulder, severe flexion contracture of the elbow, and poor hand function.After a mean follow-up of 2 years following the humeral osteotomy, all patients/parents were satisfied with the result and a panel of plastic surgeons confirmed the significant improvement in aesthetics. Reasons for this improvement following the osteotomy were as follows: the child no longer needed to stand with shoulder slightly abducted, the antecubital fossa became visible in the standing position, and the forearm no longer appeared excessively pronated. Of more importance, was the improvement in elbow flexion contracture which had major contribution in improving limb appearance and the perception of length discrepancy between the affected and the contralateral normal limb.The humeral osteotomy improves the cosmetic appearance of children with total palsy and the triad of severe internal rotation contracture of the shoulder, severe flexion contracture of the elbow and poor hand function. PMID:20548233

  20. Intralesional Cryotherapy for the Treatment of Keloid Scars: Evaluating Effectiveness

    PubMed Central

    Bulstra, Anne Eva J.; Ket, Johannes C. F.; Ritt, Marco J. P. F.; van Leeuwen, Paul A. M.; Niessen, Frank B.

    2015-01-01

    Background: Intralesional (IL) cryotherapy is a novel treatment technique for keloid scars, in which the scar is frozen from inside. Over the past decade, several studies have been published with varying outcomes. A critical analysis of the current literature is, therefore, warranted to determine whether IL cryotherapy is an alternative to established keloid scar treatments. Methods: A comprehensive review was performed, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. PubMed and EMBASE were searched from inception. Studies and level of recommendation were graded according to the American Society of Plastic Surgeons criteria. Results: Eight studies meeting the inclusion criteria were selected. The average scar volume decrease ranged from 51% to 63%, but no complete scar eradication was achieved on average. Scar recurrence ranged from 0% to 24%. Hypopigmentation posttreatment was seen mostly in Fitzpatrick 4–6 skin type patients. Finally, complaints of pain and pruritus decreased significantly in most studies. Conclusions: IL cryotherapy for the treatment of keloid scars shows favorable results in terms of volume reduction and alleviated complaints of pain and pruritus. However, no complete scar eradication is established, and recurrences are seen. Also, persistent hypopigmentation proved a problem in Fitzpatrick 4–6 skin type patients. Summarized, the evidence proved limited and inconsistent resulting in an American Society of Plastic Surgeons grade C recommendation for this type of treatment of keloid scars. PMID:26180738

  1. Lasers for scars: a review and evidence-based appraisal.

    PubMed

    Elsaie, Mohamed L; Choudhary, Sonal

    2010-11-01

    Numerous treatment modalities are available for scar management depending upon scar characteristics, age and patient expectations. The focus of this article is to review commonly used nonsurgical methods of scar revision. These include topical applications (e.g., silicone, vitamin E, pressure dressing, herbal extracts), intralesional medication (e.g., steroids, antimitotics), soft-tissue augmentation (e.g., collagen, fat), laser applications (e.g., 585-nm flashlamp-pumped pulsed dye, CO2), cryotherapy and make-up camouflage. Nonsurgical modalities can be used as prophylactic prevention of adverse scar formation, as definitive treatment, as intervening therapy until further surgical repair can be made, or as adjunctive treatment following surgical scar revision. There are several laser systems available that permit successful treatment of various types of scars. The 585-nm PDL remains the gold standard for laser treatment of hypertrophic scars and keloids. Although atrophic scars may best be treated with ablative CO2 and Er:YAG lasers, the intense interest in procedures with reduced morbidity profiles has increased the popularity of nonablative laser procedures. This paper will focus on the use of lasers for scar revision. PMID:21061757

  2. Abnormal pigmentation within cutaneous scars: A complication of wound healing

    PubMed Central

    Chadwick, Sarah; Heath, Rebecca; Shah, Mamta

    2012-01-01

    Abnormally pigmented scars are an undesirable consequence of cutaneous wound healing and are a complication every single individual worldwide is at risk of. They present a challenge for clinicians, as there are currently no definitive treatment options available, and render scars much more noticeable making them highly distressing for patients. Despite extensive research into both wound healing and the pigment cell, there remains a scarcity of knowledge surrounding the repigmentation of cutaneous scars. Pigment production is complex and under the control of many extrinsic and intrinsic factors and patterns of scar repigmentation are unpredictable. This article gives an overview of human skin pigmentation, repigmentation following wounding and current treatment options. PMID:23162241

  3. Current understanding and review of the literature: vocal fold scarring.

    PubMed

    Hansen, Jennifer K; Thibeault, Susan L

    2006-03-01

    Vocal fold scarring is the greatest cause of poor voice after vocal fold injury. Scarring causes a disruption of the viscoelastic layered structure of the lamina propria, an increase in stiffness of the vibratory structure, and glottic incompetence. Current treatments for this complex condition are inconsistent and often produce suboptimal results. Research investigating this condition has dramatically increased over the last several years. The literature has been directed toward understanding vocal fold scarring at the biological level and translating this to the clinical forum. We present an up-to-date, thorough, and scholarly review of the literature in vocal fold scarring since 1996. PMID:15964741

  4. Current trends and future considerations in scar treatment.

    PubMed

    Waibel, Jill S; Rudnick, Ashley

    2015-03-01

    The goal of scar therapy is the restoration of the patient to their preinjury state. A combination of injected antimetabolites, surgery, laser, and laser-assisted delivery of drugs is needed for minimally invasive surgical correction of scars. As a result, laser therapy is emerging as an essential treatment element. It has been noted that fractional lasers normalize both the clinical and histological appearance of scars. Laser- and light-based therapies complement existing approaches of surgery and physical therapy, resulting in significant gains with minimal associated morbidity. Emerging and future laser technologies are creating a new paradigm in the management of scar rehabilitation. PMID:25922952

  5. Bladder Contracture - A Rare and Serious Side Effect of Intravesical Bacillus Calmette-Guérin Therapy.

    PubMed

    Garcia, Cindy; Jina, Hamesh; Bergersen, Philip; Chalasani, Venu

    2016-01-01

    Instillation of intravesical bacillus Calmette-Guérin (BCG) is an effective treatment for non-muscle invasive bladder cancer (NMIBC). The high incidence of side effects may limit its tolerability in patients. Local side effects including cystitis and hematuria are common but generally self-limiting. Bladder contractures are a rare but serious consequence of BCG treatment. In this case, an 82 year-old male developed BCG reactivation and subsequent bladder contractures following transurethral resection of the prostate (TURP) three years post-BCG. To our knowledge, this is the first reported case of BCG reactivation post-TURP leading to the rare but serious effect of bladder contractures. PMID:26793570

  6. Bladder Contracture – A Rare and Serious Side Effect of Intravesical Bacillus Calmette-Guérin Therapy

    PubMed Central

    Garcia, Cindy; Jina, Hamesh; Bergersen, Philip; Chalasani, Venu

    2015-01-01

    Instillation of intravesical bacillus Calmette-Guérin (BCG) is an effective treatment for non-muscle invasive bladder cancer (NMIBC). The high incidence of side effects may limit its tolerability in patients. Local side effects including cystitis and hematuria are common but generally self-limiting. Bladder contractures are a rare but serious consequence of BCG treatment. In this case, an 82 year-old male developed BCG reactivation and subsequent bladder contractures following transurethral resection of the prostate (TURP) three years post-BCG. To our knowledge, this is the first reported case of BCG reactivation post-TURP leading to the rare but serious effect of bladder contractures. PMID:26793570

  7. Proximally based sural adipose-cutaneous/scar flap in elimination of ulcerous scar soft-tissue defect over the achilles tendon and posterior heel region: a new approach.

    PubMed

    Grishkevich, Viktor M

    2014-01-01

    Scar ulcers that spread over the Achilles tendon and posterior heel disturb patients by causing pain, impeding hygiene, and creating difficulty in finding appropriate shoe wear. As this region undergoes pressure, effective reconstruction is based on the flap use. The most popular flaps currently used are distally based sural fasciocutaneous flap, calcaneal artery skin flap, and free flaps. These flaps, however, are insensate, can create soft-tissue excess, and cause donor site morbidity. Ulcerous soft-tissue defects over Achilles tendon and posterior heel after burns, frost, and trauma were studied and reconstructed in 16 patients, using proximally based sural adipose-cutaneous flap, the anatomy of which was studied on lower extremities of 27 cadavers. Ulcerous soft-tissue defect consists of two parts: ulcer and surrounding pathologic scars that should be excised in one block. Resulting soft-tissue defects with exposed tendon and calcaneal bone varied from 6 to 20 cm in length and 6 cm in width. For such wound resurfacing a flap was developed that was sensate, thin, large, and having steady blood circulation. The flap was harvested from the lower third of the leg and lateral foot, consisting of skin and subcutaneous fat layer (without fascia), including the sural nerve and lesser vein. The blood supply was ensured through peroneal and anterior tibial artery perforators, which formed a vascular net in the flap. In 14 of 16 cases excellent and stable functional and good cosmetic results with acceptable donor site morbidity were achieved. In two patients the distal flap loss took place because of arteriitis obliterans (one case) and because of the cross-cutting of the sural nerve and vessels during previous surgeries (another case). Proximally based sural adipose-cutaneous/scar flap is the only flap that satisfies all requirements for Achilles tendon and posterior heel region resurfacing. The author believes that this technique, based on this flap use, is anatomically justified, clinically profitable, and should be considered as the first choice operation. PMID:24043244

  8. Vicious Cycle of Multiple Invasive Treatments in a Hemophilic Inhibitor Positive Child with Resistant Knee Flexion Contracture, A Case Report

    PubMed Central

    Kachooei, Amir Reza; Badiei, Zahra; Zandinezhad, Mohammad E

    2013-01-01

    Uncontrolled recurrent hemarthrosis can end to contracture, deformity, pain, joint destruction and gait disorders which are disabling. We are going to report a challenge, a unilateral knee flexion contracture in a child with severe hemophilia A and inhibitor who underwent different treatment options with unsatisfactory improvement of knee range of motion. Mismanaging postoperatively, patient and parents irresponsibility in managing self-care, lack of access and affordability to treatment and unavailability of proper treatment can be the reasons of recurrence in addition to the tough nature of a patient with inhibitor. PMID:25207302

  9. Nd:YAG Laser Treatment of Keloids and Hypertrophic Scars

    PubMed Central

    Akaishi, Satoshi; Koike, Sachiko; Dohi, Teruyuki; Kobe, Kyoko; Hyakusoku, Hiko; Ogawa, Rei

    2012-01-01

    Pathological cutaneous scars such as keloids and hypertrophic scars (HSs) are characterized by a diffuse redness that is caused by the overgrowth of capillary vessels due to chronic inflammation. Our group has been using long-pulsed, 1064-nm Nd:YAG laser in noncontact mode with low fluence and a submillisecond pulse duration to treat keloids and hypertrophic scars since 2006 with satisfactory results. The present study examined the efficacy of this approach in 22 Japanese patients with keloids (n = 16) or hypertrophic scars (n = 6) who were treated every 3 to 4 weeks. Treatment settings were as follows: 5 mm spot size diameter; 14 J/cm2 energy density; 300 μs exposure time per pulse; and 10 Hz repetition rate. The responses of the pathological scars to the treatment were assessed by measuring their erythema, hypertrophy, hardness, itching, and pain or tenderness. Moreover, skin samples from 3 volunteer patients were subjected to histological evaluation and 5 patients underwent thermography during therapy. The average total scar assessment score dropped from 9.86 to 6.34. Hematoxylin and eosin staining and Elastica Masson-Goldner staining showed that laser treatment structurally changed the tissue collagen. This influence reached a depth of 0.5 to 1 mm. Electron microscopy revealed plasma protein leakage, proteoglycan particles, and a change in the collagen fiber fascicles. Further analyses revealed that noncontact mode Nd:YAG laser treatment is highly effective for keloids and hypertrophic scars regardless of patient age, the origin and multiplicity of scarring, the location of the scar(s), or the tension on the scar. PMID:22259645

  10. An Autosomal Recessive Syndrome of Joint Contractures, Muscular Atrophy, Microcytic Anemia, and Panniculitis-Associated Lipodystrophy

    PubMed Central

    Garg, Abhimanyu; Hernandez, Maria Dolores; Sousa, Ana Berta; Subramanyam, Lalitha; Martínez de Villarreal, Laura; dos Santos, Heloísa G.; Barboza, Oralia

    2010-01-01

    Context: Genetic lipodystrophies are rare disorders characterized by partial or complete loss of adipose tissue and predisposition to insulin resistance and its complications such as diabetes mellitus, hypertriglyceridemia, hepatic steatosis, acanthosis nigricans, and polycystic ovarian syndrome. Objective: The objective of the study was to report a novel autosomal recessive lipodystrophy syndrome. Results: We report the detailed phenotype of two males and one female patient, 26–34 yr old, belonging to two pedigrees with an autosomal recessive syndrome presenting with childhood-onset lipodystrophy, muscle atrophy, severe joint contractures, erythematous skin lesions, and microcytic anemia. Other variable clinical features include hypergammaglobulinemia, hepatosplenomegaly, generalized seizures, and basal ganglia calcification. None of the patients had diabetes mellitus or acanthosis nigricans. Two had mild hypertriglyceridemia and all had low levels of high-density lipoprotein cholesterol. Skin biopsy of an erythematous nodular skin lesion from one of the patients revealed evidence of panniculitis. The lipodystrophy initially affected the upper body but later became generalized involving abdomen and lower extremities as well. Conclusions: We conclude that these patients represent a novel autoinflammatory syndrome resulting in joint contractures, muscle atrophy, microcytic anemia, and panniculitis-induced lipodystrophy. The molecular genetic basis of this disorder remains to be elucidated. PMID:20534754

  11. Neonatal spinal muscular atrophy with multiple contractures, bone fractures, respiratory insufficiency and 5q13 deletion.

    PubMed

    García-Cabezas, M A; García-Alix, A; Martín, Y; Gutiérrez, M; Hernández, C; Rodríguez, J I; Morales, C

    2004-05-01

    We present the case of a floppy neonate with marked and generalized weakness, respiratory insufficiency and fetal akinesia deformation sequence. The infant showed multiple joint contractures, two bone fractures and needed mechanical ventilation from birth to death at 16 days of age. Electrophysiological assessment showed electrically unexcitable motor and sensory nerves. Muscle biopsy showed diffuse atrophy of type I and type II fibers. Necropsy confirmed the diagnosis of infantile spinal muscular atrophy (SMA) with severe loss of motor neurons in anterior horns and motor nuclei of brainstem. There were also neuronal loss, gliosis, chromatolysis, ballooned cells, empty cell beds and neuronophagia figures in other brainstem and brain nuclei. Genetic analysis of the patient revealed homozygous deletions of survival motor neuron gene 1 (SMN1) and a single copy of SMN2 in region 5q13. This case confirms that the loss of spinal motor neurons underlies the muscular atrophy in severe cases of 5q SMA. This case also shows that the presence of multiple joint contractures, bone fractures and respiratory insufficiency in SMA in the neonatal period does not necessarily exclude the occurrence of classical deletions in the SMA 5q13 region. Rather, these atypical clinical findings show the extreme severity and prenatal onset of the disease in these SMA cases, which may be related with the occurrence of a single copy of SMN2 gene. More reports of clinically, pathologically and genetically well-documented cases are essential to define the different types of this disease. PMID:14968368

  12. Forelimb contractures and abnormal tendon collagen fibrillogenesis in fibulin-4 null mice.

    PubMed

    Markova, Dessislava Z; Pan, Te-Cheng; Zhang, Rui-Zhu; Zhang, Guiyun; Sasaki, Takako; Arita, Machiko; Birk, David E; Chu, Mon-Li

    2016-06-01

    Fibulin-4 is an extracellular matrix glycoprotein essential for elastic fiber formation. Mice deficient in fibulin-4 die perinatally because of severe pulmonary and vascular defects associated with the lack of intact elastic fibers. Patients with fibulin-4 mutations demonstrate similar defects, and a significant number die shortly after birth or in early childhood from cardiopulmonary failure. The patients also demonstrate skeletal and other systemic connective tissue abnormalities, including joint laxity and flexion contractures of the wrist. A fibulin-4 null mouse strain was generated and used to analyze the roles of fibulin-4 in tendon fibrillogenesis. This mouse model displayed bilateral forelimb contractures, in addition to pulmonary and cardiovascular defects. The forelimb and hindlimb tendons exhibited disruption in collagen fibrillogenesis in the absence of fibulin-4 as analyzed by transmission electron microscopy. Fewer fibrils were assembled, and fibrils were disorganized compared with wild-type controls. The organization of developing tenocytes and compartmentalization of the extracellular space was also disrupted. Fibulin-4 was co-localized with fibrillin-1 and fibrillin-2 in limb tendons by using immunofluorescence microscopy. Thus, fibulin-4 seems to play a role in regulating tendon collagen fibrillogenesis, in addition to its essential function in elastogenesis. PMID:26711913

  13. The Use of Dermal Substitutes in Burn Surgery: Acute Phase

    PubMed Central

    Shahrokhi, Shahriar; Anna, Arno; Jeschke, Marc G.

    2013-01-01

    Dermal substitutes are increasingly becoming an essential part of the burn care strategy. During the acute phase of burn treatment, dermal substitutes improve functional and cosmetic results long-term and thus increase quality of life. In the chronic wound setting, dermal substitutes are used to reconstruct and improve burn scars and other defects. Despite some successes in the use of dermal substitutes there are more needs and requirements to further improve outcomes and hence further research is required not only to strengthen scientific evidence regarding their effects but also to develop new technology and products. Dermal substitutes also emerge as pivotal research strategies to develop adequate scaffolds for stem cells, tissue engineering and regenerative medicine applications to obtain long-lasting and scarless artificial skin. This review discusses status-quo of dermal substitutes and novel strategies in the use of dermal substitutes with a focus on burn care. PMID:24393152

  14. Dupuytren contracture

    MedlinePlus

    Calandruccio JH. Carpal tunnel syndrome, ulnar tunnel syndrome, and stenosing tenosynovitis. In: Canale ST, Beaty JH, eds. Campbell's Operative Orthopaedics . 12th ed. Philadelphia, PA: Elsevier Mosby; 2013: ...

  15. Improving global fire carbon emissions estimates by combining moderate resolution burned area and active fire observations

    NASA Astrophysics Data System (ADS)

    Randerson, J. T.; Chen, Y.; Giglio, L.; Rogers, B. M.; van der Werf, G.

    2011-12-01

    In several important biomes, including croplands and tropical forests, many small fires exist that have sizes that are well below the detection limit for the current generation of burned area products derived from moderate resolution spectroradiometers. These fires likely have important effects on greenhouse gas and aerosol emissions and regional air quality. Here we developed an approach for combining 1km thermal anomalies (active fires; MOD14A2) and 500m burned area observations (MCD64A1) to estimate the prevalence of these fires and their likely contribution to burned area and carbon emissions. We first estimated active fires within and outside of 500m burn scars in 0.5 degree grid cells during 2001-2010 for which MCD64A1 burned area observations were available. For these two sets of active fires we then examined mean fire radiative power (FRP) and changes in enhanced vegetation index (EVI) derived from 16-day intervals immediately before and after each active fire observation. To estimate the burned area associated with sub-500m fires, we first applied burned area to active fire ratios derived solely from within burned area perimeters to active fires outside of burn perimeters. In a second step, we further modified our sub-500m burned area estimates using EVI changes from active fires outside and within of burned areas (after subtracting EVI changes derived from control regions). We found that in northern and southern Africa savanna regions and in Central and South America dry forest regions, the number of active fires outside of MCD64A1 burned areas increased considerably towards the end of the fire season. EVI changes for active fires outside of burn perimeters were, on average, considerably smaller than EVI changes associated with active fires inside burn scars, providing evidence for burn scars that were substantially smaller than the 25 ha area of a single 500m pixel. FRP estimates also were lower for active fires outside of burn perimeters. In our analysis we quantified how including sub-500m burned area influenced global burned area, carbon emissions, and net ecosystem exchange (NEE) in different continental regions using the Global Fire Emissions Database (GFED) biogeochemical model. We conclude by discussing validation needs using higher resolution visible and thermal imagery.

  16. Topical modalities for treatment and prevention of postsurgical hypertrophic scars.

    PubMed

    Foo, Chong Wee; Tristani-Firouzi, Payam

    2011-08-01

    There is no universally accepted treatment regimen and no evidence-based literature to guide management of hypertrophic scars. This article summarizes the existing literature regarding topical treatments such as silicone gel sheeting and ointment, onion extract, vitamin E, pressure garment therapy, massage therapy, and topical imiquimod 5% cream in the management of hypertrophic scars. PMID:21856542

  17. Regenerative healing, scar-free healing and scar formation across the species: current concepts and future perspectives.

    PubMed

    Ud-Din, Sara; Volk, Susan W; Bayat, Ardeshir

    2014-09-01

    All species have evolved mechanisms of repair to restore tissue function following injury. Skin scarring is an inevitable and permanent endpoint for many postnatal organisms except for non-amniote vertebrates such as amphibians, which are capable of tissue regeneration. Furthermore, mammalian foetuses through mid-gestation are capable of rapid wound repair in the absence of scar formation. Notably, excessive cutaneous scar formation, such as hypertrophic and keloid scars, is a species limited clinical entity as it occurs only in humans, although wounds on the distal limbs of horses are also prone to heal with fibroproliferative pathology known as equine exuberant granulation tissue. Currently, there are no reliable treatment options to eradicate or prevent scarring in humans and vertebrates. The limited number of vertebrate models for either hypertrophic or keloid scarring has been an impediment to mechanistic studies of these diseases and the development of therapies. In this viewpoint essay, we highlight the current concepts of regenerative, scar-free and scar-forming healing compared across a number of species and speculate on areas for future research. Furthermore, in-depth investigative research into the mechanisms of scarless repair may allow for the development of improved animal models and novel targets for scar prevention. As the ability to heal in both a scarless manner and propensity for healing with excessive scar formation is highly species dependent, understanding similarities and differences in healing across species as it relates to the regenerative process may hold the key to improve scarring and guide translational wound-healing studies. PMID:24863070

  18. Subcutaneous sarcoidosis in a rhinoplasty scar.

    PubMed

    Dulguerov, Nicolas; Vankatova, Lenka; Landis, Basile Nicolas

    2015-01-01

    The presence of a subcutaneous hard bony-like lump at the lateral nasal wall after a septorhinoplasty procedure is an unfavourable result. The reported patient developed this complication 2 years after a revision surgery, in which percutaneous osteotomies were performed. An excision biopsy of the lump took place and the histopathological analysis revealed a granulomatous gigantocellular inflammation with absence of birefringent particles on polarised lamp and negative mycobacteria culture. After additional investigations, the final diagnosis was consistent with grade 2 pulmonary sarcoidosis associated with subcutaneous sarcoidosis. No treatment was initiated. The facial symptoms resolved without any additional treatment and the pulmonary function tests have not deteriorated after 1 year of follow-up. The polymorphism of cutaneous lesions in sarcoidosis, the absence of systemic symptoms and the unrecognised entity of subcutaneous sarcoidosis in a scar illustrate the diagnostic challenge with this patient. PMID:25819832

  19. Posttraumatic scar revision: a review and case presentation.

    PubMed

    Zakkak, T B; Griffin, J E; Max, D P

    1998-01-01

    Scar revision is a well-established procedure, but the achievement of satisfying long-term results may present a challenge. An appropriate initial management of wounds is of importance, since it has a role in determining the degree of revision required postoperatively. In addition to the conventional treatment and maturation of the scar tissue, a combination of procedures are now available which may alter the appearance of the final scar. Scar revision, followed by wound care that consists of silastic sheeting, steroid injection, and laser skin resurfacing with carbon dioxide laser (CO2), may be used as adjuncts to achieve camouflage of facial scars. Two case reports are presented to document the procedure, followed by treatment evaluation and protocol. PMID:11951437

  20. Scar tissue graft as a filler for soft tissue augmentation.

    PubMed

    Sariguney, Yakup; Demir, Yucel Hakki; Yavuzer, Reha; Elmas, Cigdem; Atabay, Kenan

    2007-01-01

    Soft tissue augmentation with autogenous tissue has been used to correct various defects during aesthetic facial contouring and reconstructive procedures. Although dermal grafts have longer survival rates, fat grafts always have been more popular because of the simple harvesting and grafting methods used. The authors aimed to use existing scar tissue as an injectable graft and to compare its effectiveness as a soft tissue filler substance with that of dermal grafts. In this study, scar tissue was created on 24 male Wistar rats. The created scar and normal healthy skin were removed from the rat dorsal scapular donor site. After depithelialization, the harvested tissues were minced until they were thin enough to pass through a 16-gauge needle. The grafts then were injected into the recipient site between the abdominal muscles. Volumetric analyses and histologic evaluation of the grafts were performed 1, 3, and 5 months after transplantation. The first month after the injection, the amount of remaining dermis graft was more than the scar graft, and this difference was statistically significant. However, at the end of months 3 and 5, there was no marked difference between the groups. The remaining volume of injected scar tissue graft was comparable with that of the dermis graft. The scar grafts were composed mainly of dense connective tissue during all the evaluation periods. In this study, scar tissue provided results comparable with those of dermal grafts up to 5 months when used as a soft tissue filler. It seems that neovascularization of the scar graft may be inadequate for maintenance of graft viability, as compared with dermis grafts. On the other hand, the scar graft formed fibrous tissue, which may be responsible for providing adequate volume as a filler. This may have clinical implications for the patient who needs both scar revision and soft tissue augmentation procedures simultaneously. PMID:17486399

  1. Coin and currency burn.

    PubMed

    Bhatti, Asif Zubair; Chapman, William Thomas; Naveed, Masroor; McDiarmid, James R

    2006-01-01

    We describe a case of burns purposefully sustained in a patient performing a bizarre pub game while under the influence of alcohol. Full-thickness burns were sustained through contact with a 50-p UK currency coin essentially heated with burning paper. We discuss the nature and ease by which such burns can be sustained in the community and the increasing awareness of alcohol abuse as a factor in a significant proportion of such self-inflicted burns. PMID:16566547

  2. Different roles for contracture and calpain in calcium paradox-induced heart injury.

    PubMed

    Zhang, Jian-Ying; Tong, Wei; Wu, Feng; Bi, Sheng-Hui; Xu, Ming; Jin, Zhen-Xiao; Yang, Yang; Jiang, Xiao-Fan; Zhou, Jing-Jun

    2012-01-01

    The Ca(2+) paradox represents a good model to study Ca(2+) overload injury in ischemic heart diseases. We and others have demonstrated that contracture and calpain are involved in the Ca(2+) paradox-induced injury. This study aimed to elucidate their roles in this model. The Ca(2+) paradox was elicited by perfusing isolated rat hearts with Ca(2+)-free KH media for 3 min or 5 min followed by 30 min of Ca(2+) repletion. The LVDP was measured to reflect contractile function, and the LVEDP was measured to indicate contracture. TTC staining and the quantification of LDH release were used to define cell death. Calpain activity and troponin I release were measured after Ca(2+) repletion. Ca(2+) repletion of the once 3-min Ca(2+) depleted hearts resulted in almost no viable tissues and the disappearance of contractile function. Compared to the effects of the calpain inhibitor MDL28170, KB-R7943, an inhibitor of the Na(+)/Ca(2+) exchanger, reduced the LVEDP level to a greater extent, which was well correlated with improved contractile function recovery and tissue survival. The depletion of Ca(2+) for 5 min had the same effects on injury as the 3-min Ca(2+) depletion, except that the LVEDP in the 5-min Ca(2+) depletion group was lower than the level in the 3-min Ca(2+) depletion group. KB-R7943 failed to reduce the level of LVEDP, with no improvement in the LVDP recovery in the hearts subjected to the 5-min Ca(2+) depletion treatment; however, KB-R7943 preserved its protective effects in surviving tissue. Both KB-R7943 and MDL28170 attenuated the Ca(2+) repletion-induced increase in calpain activity in 3 min or 5 min Ca(2+) depleted hearts. However, only KB-R7943 reduced the release of troponin I from the Ca(2+) paradoxic heart. These results provide evidence suggesting that contracture is the main cause for contractile dysfunction, while activation of calpain mediates cell death in the Ca(2+) paradox. PMID:23284963

  3. Effects of Modified Dynamic Metacarpophalangeal Joint Flexion Orthoses after Hand Burn

    PubMed Central

    Choi, Ji Soo; Mun, Jeong Hyeon; Lee, Ju Youn; Jeon, Jong Hyun; Jung, Yun Jae; Seo, Cheong Hoon

    2011-01-01

    Objective To assess the effectiveness of modified dynamic metacarpophalangeal joint flexion orthoses for treatment of post-burn hand contractures. Method We enrolled 42 hand burn patients with limited range of motion at the metacarpophalangeal joints in this study. The patients were randomly assigned into either a control or an orthotic group. Both groups received the standard rehabilitation therapy focused on hand therapy; 21 subjects in the orthotic group wore a splint for 3 hours per day for 8 weeks. Hand function was measured by active range of motion, grip strength and other assessment tools. All parameters were estimated using the Mann-Whitney U test at the beginning and the end of the treatment after 8 weeks. Results The 21 subjects that had an orthotic intervention showed significant improvement in the range of motion at 2nd, 3rd, 4th and 5th metacarpophalangeal joints (p<0.05). However, the grip strength was not significantly increased after the 8 weeks of treatment compared to control group (p>0.05). There was a significant difference in the hand function scales between the 2 groups (p<0.05). Conclusion The modified dynamic metacarpophalangeal joint flexion orthoses provide continuous flexion to metacarpophalangeal joint that is needed for the restoration of range of motion in post-burn hand contractures. For the clinical application of hand orthoses in patients with hand disorders, additional research into its affects are required. PMID:22506218

  4. Clinical forensic evidence in burns: rescuer burns.

    PubMed

    Kumar, Pramod; Gopal, Kirun; Ramnani, Sunil

    2006-12-01

    In the literature no systematic study is available on rescuer burn for victims of burn injury. This is a retrospective study of nine patients (five admitted and four outpatients) were treated in this hospital as rescuer burns in 3.5 years. All nine patients were males. Average age of the patient treated on outpatient basis was 47 years (ranging between 44 and 52) and total burn area ranged for 1-4%. Average age of the five patients treated on inpatient basis was 32.6 years (ranging between 30 and 34). The total burn area ranged from 14.5 to 38%. During the period of study, in addition to nine rescuer burns, one patient sustained burn before the rescue attempt due to the victim hugging the rescuer. Based on the study of patterns of burn, these patients were found to have three grades of burn injury: Grade 1--upper extremity involvement only. (A) only one upper extremity involvement, (B) both upper extremities involvement, Grade 2--upper extremity/extremities and face involvement, Grade 3--upper extremity/extremities, face-neck, adjacent chest and lower extremity involvement. PMID:17011132

  5. Congenital contractural arachnodactyly complicated with aortic dilatation and dissection: Case report and review of literature.

    PubMed

    Takeda, Norifumi; Morita, Hiroyuki; Fujita, Daishi; Inuzuka, Ryo; Taniguchi, Yuki; Imai, Yasushi; Hirata, Yasunobu; Komuro, Issei

    2015-10-01

    Congenital contractural arachnodactyly (CCA) is a connective tissue disease caused by mutations of the FBN2, which encodes fibrillin-2. CCA patients have a marfanoid habitus; however, aortic dilatation and/or dissection as observed in Marfan syndrome have been rarely documented. Here, we report on a Japanese familial case of CCA resulting from a FBN2 splicing mutation (IVS32+5g→a), which leads to exon 32 being skipped, and the patients developed aortic dilatation and type A dissection. Although CCA patients have been believed to have favorable prognoses, repetitive aortic imaging studies must be performed in some patients to detect possible aortic disease early, and genetic testing of FBN2 might be useful to identify such high-risk patients. PMID:25975422

  6. A newborn with complex skeletal abnormalities, joint contractures, and bilateral corneal clouding with sclerocornea.

    PubMed

    Sellars, Elizabeth A; Bosanko, Katherine A; Lepard, Tiffany; Garnica, Adolfo; Schaefer, Gerald Bradley

    2014-06-01

    A newborn presented to genetics with complex skeletal abnormalities, joint contractures, and bilateral corneal clouding with sclerocornea. The patient survived for 8 months before succumbing to respiratory failure. Exome sequencing revealed a compound heterozygous mutation in theB3GALT6gene. Mutations in this gene have been associated with both Ehlers- Danlos syndrome, progeroid type 2 and spondyloepimetaphyseal dysplasia with joint laxity type 1. These diagnoses encompass the skeletal and joint findings. Our patient expands the phenotype of these diagnoses, as anterior segment eye anomalies have not been described with either syndrome, and he is much more profoundly affected. Interestingly, our patient fits the description of a rare genetic disease referred to as Al-Gazali syndrome, for which the genetic cause is unknown. PMID:25149931

  7. [Dupuytren contracture in Mosel wine dressers with arsenic-induced aftereffect damage].

    PubMed

    Grobe, J W

    1982-01-01

    Between 1972 and 1981 a total of 121 male and female wine-dressers with late after-effects from arsenic were medically examined and treated. Skin and liver were examined regularly every 3 months. With advancing years an increase in typically arsenic melanosis, precancerous, carcinomas and hyperkeratosis in palmae and plantae was observed. A significant increase in Dupuytren's contracture was found in the age groups between 50 and 80 with a growing progression of typically arsenic horned pearls on the palms of the hands and soles of the feet. The typically arsenic horned pearls and arsenical keratosis occurred most frequently in the Dupuytrenical changes of the skin. The liver parameters showed no pathological results such as cirrhosis of the liver as compared with the other patients. PMID:6218979

  8. Astrocyte scar formation aids central nervous system axon regeneration.

    PubMed

    Anderson, Mark A; Burda, Joshua E; Ren, Yilong; Ao, Yan; O'Shea, Timothy M; Kawaguchi, Riki; Coppola, Giovanni; Khakh, Baljit S; Deming, Timothy J; Sofroniew, Michael V

    2016-04-14

    Transected axons fail to regrow in the mature central nervous system. Astrocytic scars are widely regarded as causal in this failure. Here, using three genetically targeted loss-of-function manipulations in adult mice, we show that preventing astrocyte scar formation, attenuating scar-forming astrocytes, or ablating chronic astrocytic scars all failed to result in spontaneous regrowth of transected corticospinal, sensory or serotonergic axons through severe spinal cord injury (SCI) lesions. By contrast, sustained local delivery via hydrogel depots of required axon-specific growth factors not present in SCI lesions, plus growth-activating priming injuries, stimulated robust, laminin-dependent sensory axon regrowth past scar-forming astrocytes and inhibitory molecules in SCI lesions. Preventing astrocytic scar formation significantly reduced this stimulated axon regrowth. RNA sequencing revealed that astrocytes and non-astrocyte cells in SCI lesions express multiple axon-growth-supporting molecules. Our findings show that contrary to the prevailing dogma, astrocyte scar formation aids rather than prevents central nervous system axon regeneration. PMID:27027288

  9. Development of new renal scars: a collaborative study.

    PubMed Central

    Smellie, J M; Ransley, P G; Normand, I C; Prescod, N; Edwards, D

    1985-01-01

    In a study of the factors surrounding the development of renal scars clinical data and serial radiographs were analysed in 74 infants and children (66 girls and eight boys) without duplex kidney or obstruction. The development of new scars was seen radiologically in 87 kidneys (74 previously normal and 13 previously scarred). New scarring was extensive in 16 kidneys. Thirty four children were aged 5 or over when scarring occurred. Urinary infection occurred in all the children. Diagnosis and effective treatment were delayed in 45 of them; 58 suffered further urinary infections between the baseline intravenous urogram and the first showing new scarring. Vesicoureteric reflux was seen in 67 of the children. Investigation and treatment varied widely, and few children received long term prophylaxis. Social problems interfered with the management of 22 children. Early diagnosis, prompt effective treatment, investigation, and long term supervision of children with urinary infection are essential if renal scarring is to be reduced; those over the age of 5 are still vulnerable. PMID:3924325

  10. Medicinal Plants for the Treatment of Hypertrophic Scars

    PubMed Central

    Ye, Qi; Wang, Su-Juan; Chen, Jian-Yu; Xin, Hai-Liang; Zhang, Hong

    2015-01-01

    Hypertrophic scar is a complication of wound healing and has a high recurrence rate which can lead to significant abnormity in aesthetics and functions. To date, no ideal treatment method has been established. Meanwhile, the underlying mechanism of hypertrophic scarring has not been clearly defined. Although a large amount of scientific research has been reported on the use of medicinal plants as a natural source of treatment for hypertrophic scarring, it is currently scattered across a wide range of publications. Therefore, a systematic summary and knowledge for future prospects are necessary to facilitate further medicinal plant research for their potential use as antihypertrophic scar agents. A bibliographic investigation was accomplished by focusing on medicinal plants which have been scientifically tested in vitro and/or in vivo and proved as potential agents for the treatment of hypertrophic scars. Although the chemical components and mechanisms of action of medicinal plants with antihypertrophic scarring potential have been investigated, many others remain unknown. More investigations and clinical trials are necessary to make use of these medical plants reasonably and phytotherapy is a promising therapeutic approach against hypertrophic scars. PMID:25861351

  11. Investigation of accolate and singulair for treatment of capsular contracture yields safety concerns.

    PubMed

    Gryskiewicz, Joe M

    2003-03-01

    At The Aesthetic Meeting 2002 of the American Society for Aesthetic Plastic Surgery, the Aesthetic Surgery Education and Research Foundation/Plastic Surgery Educational Foundation (ASERF/PSEF) Emerging Trends Task Force and Innovative Procedures Committee requested an update on zafirlukast (Accolate; AstraZeneca Pharmaceuticals, Wilmington, DE) and montelukast (Singulair; Merck & Co, West Point, PA) - what they are and how they work. These two asthma medications were reported to possibly treat and prevent capsular contracture after breast augmentation. On further analysis of postmarketing complications associated with zafirlukast based on information obtained through the Freedom of Information Act, it was discovered that between November 1, 1997, and October 31, 2002, 66 cases of hepatitis or liver failure in asthma patients occurred after a normal dose (13 of these 66 patients were taking no other medication). Two patients required liver transplants. Twenty-three deaths were reported (8 of these 23 patients were taking no other medication); 12 of these deaths followed liver failure. It should be noted that the Adverse Event Reporting System contains a disclaimer saying, "The reports have not been scientifically or otherwise verified as to a cause-and-effect relationship and cannot be used to estimate the incidence of adverse drug reactions." Many physicians entered the specific code to indicate zafirlukast as the "primary suspect" in the adverse event. Merck & Co reported no postmarketing cases of hepatitis or liver failure associated with montelukast. This article summarizes the proposed logic behind using these two asthma medications for the prevention and treatment of breast implant capsular contracture. (Aesthetic Surg J 2003;23:98-102.). PMID:19336059

  12. Identification of differentially expressed genes in fibroblasts derived from patients with Dupuytren's Contracture

    PubMed Central

    Satish, Latha; LaFramboise, William A; O'Gorman, David B; Johnson, Sandra; Janto, Benjamin; Gan, Bing Siang; Baratz, Mark E; Hu, Fen Z; Post, J Christopher; Ehrlich, Garth D; Kathju, Sandeep

    2008-01-01

    Dupuytren's contracture (DC) is the most common inherited connective tissue disease of humans and is hypothesized to be associated with aberrant wound healing of the palmar fascia. Fibroblasts and myofibroblasts are believed to play an important role in the genesis of DC and the fibroproliferation and contraction that are hallmarks of this disease. This study compares the gene expression profiles of fibroblasts isolated from DC patients and controls in an attempt to identify key genes whose regulation might be significantly altered in fibroblasts found within the palmar fascia of Dupuytren's patients. Total RNA isolated from diseased palmar fascia (DC) and normal palmar fascia (obtained during carpal tunnel release; 6 samples per group) was subjected to quantitative analyses using two different microarray platforms (GE Code Link™ and Illumina™) to identify and validate differentially expressed genes. The data obtained was analyzed using The Significance Analysis of Microarrays (SAM) software through which we identified 69 and 40 differentially regulated gene transcripts using the CodeLink™ and Illumina™ platforms, respectively. The CodeLink™ platform identified 18 upregulated and 51 downregulated genes. Using the Illumina™ platform, 40 genes were identified as downregulated, eleven of which were identified by both platforms. Quantitative RT-PCR confirmed the downregulation of three high-interest candidate genes which are all components of the extracellular matrix: proteoglycan 4 (PRG4), fibulin-1 (FBLN-1) transcript variant D, and type XV collagen alpha 1 chain. Overall, our study has identified a variety of candidate genes that may be involved in the pathophysiology of Dupuytren's contracture and may ultimately serve as attractive molecular targets for alternative therapies. PMID:18433489

  13. MRI evaluation of RF ablation scarring for atrial fibrillation treatment

    NASA Astrophysics Data System (ADS)

    Ishihara, Yuri; Nazafat, Reza; Wylie, John V.; Linguraru, Marius G.; Josephson, Mark E.; Howe, Robert D.; Manning, Warren J.; Peters, Dana C.

    2007-03-01

    This study presents a multi-modality image registration method that evaluates left atrial scarring after radiofrequency (RF) ablation for pulmonary vein (PV) isolation. Our group has recently developed a delayed enhancement magnetic resonance imaging (DE-MRI) method with the potential to visualize and monitor non-invasively post-ablation scarring in the left atrium and the PV ostia. We wished to compare the 3D configuration of scarring in the DE-MRI image and the ablation points recorded by electroanatomical mapping (EAM) system, hypothesizing that scarring detected by DE-MRI overlaps with ablation points recorded by the EAM system used in the procedure. Methods and Results: Three data sets, DE-MRI images and pulmonary vein MR angiography (PV-MRA) images, and EAM data (CARTO-XP, Biosense-Webster, Inc., Diamond Bar, CA) from a patient who underwent PV ablation, were used for the multi-modal image registration. Contrast-enhanced MR imaging was performed 38 days after the ablation procedure. PV-MRA and DE-MRI were fused by intensity-based rigid registration. Scar tissue was extracted from the DE-MRI images using multiple threshold values. EAM data was further fused with segmented PV-MRA by the iterative closest point algorithm (ICP). After registration, the distance from PV-MRA to the scar was 2.6 +/- 2.1 mm, and from ablation points to the surface of the scar was 2.5 +/- 2.3 mm. The fused image demonstrates the 3D relationship between the PV ostia, the scar and the EAM recording of ablation points. Conclusion: Multimodal data fusion indicated that the scar tissue lesion after PV isolation showed good overlap with the ablation points.

  14. External rhinoplasty for the Arabian nose: a columellar scar analysis.

    PubMed

    Foda, Hossam M T

    2004-01-01

    This study aimed to evaluate columellar scar problems after external rhinoplasty in the Arabian population, and to analyze the technical factors that help prevent such problems and maximize the scar cosmesis. The investigation was conducted in university and private practice settings of the author in Alexandria, Egypt. A total of 600 Arab patients who underwent external rhinoplasty were included in the study. All the patients underwent surgery using the external rhinoplasty approach, in which bilateral alar marginal incisions were connected by an inverted V-shaped transcolumellar incision. At completion of the procedure, a two-layer closure of the columellar incision was performed. At a minimum of 1 year postoperatively, the columellar scar was evaluated subjectively by means of a patient questionnaire, and objectively by clinical examination and comparison of the close-up pre- and postoperative basal view photographs. Objectively, anything less than a barely visible, leveled, thin, linear scar was considered unsatisfactory. Subjectively, 95.5% of the patients rated the scar as unnoticeable, 3% as noticeable but acceptable, and 1.5% as unacceptable. Objectively, the scar was unsatisfactory in 7% of the cases. This was because of scar widening with or without depression (5%), hyperpigmentation (1.5%), and columellar rim notching (0.5%). The use of a deep 6/0 polydioxanon (PDS) suture significantly decreased the incidence of scar widening (p < 0.005).The columellar incision can be used safely in the Arab population regardless of their thick, dark, and oily skin. Technical factors that contributed to the favorable outcome of the columellar scar included proper planning of location and design of the incision used, precise execution, meticulous multilayered closure, and good postoperative care. PMID:15666046

  15. The spatial and temporal distribution of crop residue burning in the contiguous United States.

    PubMed

    McCarty, Jessica L; Korontzi, Stefania; Justice, Christopher O; Loboda, Tatiana

    2009-10-15

    Burning crop residue before and/or after harvest is a common farming practice however; there is no baseline estimate for cropland burned area in the contiguous U.S. (CONUS). We present the results of a study, using five years of remotely sensed satellite data to map the location and areal extent of crop residue burning in the CONUS. Our burned area approach combines 500 m Moderate Resolution Imaging Spectroradiometer (MODIS) Normalized Burn Ratio (dNBR) data, with 1 km MODIS active fire counts calibrated using coincident high resolution satellite data to generate area estimates. Our results show that cropland burning is an extensive and recurring annual event in several states in the CONUS. On average, 1,239,000 ha of croplands burn annually, which is equivalent to 43% of the annual average area of wildland fires in the U.S., as reported by the United States Forest Service for the same period. Several states experience high levels (>30,000 ha yr(-1)) of crop residue burning, including Arkansas, California, Colorado, Florida, Idaho, Kansas, Louisiana, North Dakota, Oklahoma, Oregon, South Dakota, Texas, and Washington. Validation with high resolution burn scar imagery and GPS data collected during targeted field campaigns showed a moderate to high-level accuracy for our burned area estimates, ranging from 78 to 90%. Our approach provides a more consistent methodology for quantifying cropland burned area at regional scales than the previously available U.S. national and state-level statistics on crop residue burning. PMID:19647857

  16. Outcome of post-infectious renal scarring.

    PubMed

    Tullus, Kjell

    2015-09-01

    In this issue of Pediatric Nephrology, Gebäck et al. from Gothenburg, Sweden, show that after a mean follow-up after childhood urinary tract infection of 41 years, kidney function decreases from a mean of 93 ml/min/1.73m(2) to 81 ml/min/1.73m(2). This was found in women with severe bilateral renal scarring. They had experienced their UTI during childhood in the 1950s and 1960s and had been drawn from a population-based cohort of more than 1,000 children. A previous paper on this same group of women had shown a higher systolic blood pressure of 3 mmHg during the day and 5 mmHg during the night compared with a control group. This contrasted with a follow-up study published earlier by the same group on two different cohorts in which no impairment of kidney function or increase in hypertension could be found. The present follow-up time was 13 years longer than that of any previous studies. Data on the long-term outcome of children who have had one or several urine infections is very important, as the fear of long-term complications has been driving the extensive investigations to which these children have traditionally been subjected. Further population-based follow-up data can help us to outline modern guidance on imaging after UTI. PMID:26037738

  17. First Aid: Burns

    MedlinePlus

    ... You can get burned by heat, fire, radiation, sunlight, electricity, chemicals or hot or boiling water. There ... skin. The burned area will be sensitive to sunlight for up to one year, so you should ...

  18. Treating and Preventing Burns

    MedlinePlus

    ... Issues Listen Español Text Size Email Print Share Treating and Preventing Burns Page Content Article Body Burns ... home, out of children’s reach, and away from heat or ignition sources. Lower the temperature of your ...

  19. 15. Newfound Gap parking area with construction scar looking W. ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    15. Newfound Gap parking area with construction scar looking W. - Great Smoky Mountains National Park Roads & Bridges, Newfound Gap Road, Between Gatlinburg, TN & Cherokee, NC, Gatlinburg, Sevier County, TN

  20. Suppression of scarring in peripheral nerve implants by drug elution

    NASA Astrophysics Data System (ADS)

    FitzGerald, James J.

    2016-04-01

    Objective. Medical implants made of non-biological materials provoke a chronic inflammatory response, resulting in the deposition of a collagenous scar tissue (ST) layer on their surface, that gradually thickens over time. This is a critical problem for neural interfaces. Scar build-up on electrodes results in a progressive decline in signal level because the scar tissue gradually separates axons away from the recording contacts. In regenerative sieves and microchannel electrodes, progressive scar deposition will constrict and may eventually choke off the sieve hole or channel lumen. Interface designs need to address this issue if they are to be fit for long term use. This study examines a novel method of inhibiting the formation and thickening of the fibrous scar. Approach. Research to date has mainly focused on methods of preventing stimulation of the foreign body response by implant surface modification. In this paper a pharmacological approach using drug elution to suppress chronic inflammation is introduced. Microchannel implants made of silicone doped with the steroid drug dexamethasone were implanted in the rat sciatic nerve for periods of up to a year. Tissue from within the microchannels was compared to that from control devices that did not release any drug. Main results. In the drug eluting implants the scar layer was significantly thinner at all timepoints, and unlike the controls it did not continue to thicken after 6 months. Control implants supported axon regeneration well initially, but axon counts fell rapidly at later timepoints as scar thickened. Axon counts in drug eluting devices were initially much lower, but increased rather than declined and by one year were significantly higher than in controls. Significance. Drug elution offers a potential long term solution to the problem of performance degradation due to scarring around neural implants.

  1. [Estimating Biomass Burned Areas from Multispectral Dataset Detected by Multiple-Satellite].

    PubMed

    Yu, Chao; Chen, Liang-fu; Li, Shen-shen; Tao, Jin-hua; Su, Lin

    2015-03-01

    Biomass burning makes up an important part of both trace gases and particulate matter emissions, which can efficiently degrade air quality and reduce visibility, destabilize the global climate system at regional to global scales. Burned area is one of the primary parameters necessary to estimate emissions, and considered to be the largest source of error in the emission inventory. Satellite-based fire observations can offer a reliable source of fire occurrence data on regional and global scales, a variety of sensors have been used to detect and map fires in two general approaches: burn scar mapping and active fire detection. However, both of the two approaches have limitations. In this article, we explore the relationship between hotspot data and burned area for the Southeastern United States, where a significant amount of biomass burnings from both prescribed and wild fire took place. MODIS (Moderate resolution imaging spectrometer) data, which has high temporal-resolution, can be used to monitor ground biomass. burning in time and provided hot spot data in this study. However, pixel size of MODIS hot spot can't stand for the real ground burned area. Through analysis of the variation of vegetation band reflectance between pre- and post-burn, we extracted the burned area from Landsat-5 TM (Thematic Mapper) images by using the differential normalized burn ratio (dNBR) which is based on TM band4 (0.84 μm) and TM band 7(2.22 μm) data. We combined MODIS fire hot spot data and Landsat-5 TM burned scars data to build the burned area estimation model, results showed that the linear correlation coefficient is 0.63 and the relationships vary as a function of vegetation cover. Based on the National Land Cover Database (NLCD), we built burned area estimation model over different vegetation cover, and got effective burned area per fire pixel, values for forest, grassland, shrub, cropland and wetland are 0.69, 1.27, 0.86, 0.72 and 0.94 km2 respectively. We validated the burned area estimates by using the ground survey data from National interagency Fire Center (NIFC), our results are more close to the ground survey data than burned area from Global Fire Emissions Database (GFED) and MODIS burned area product (MCD45), which omitted many small prescribed fires. We concluded that our model can provide more accurate burned area parameters for developing fire emission inventory, and be better for estimating emissions from biomass burning. PMID:26117890

  2. Wound Coverage Technologies in Burn Care: Novel Techniques

    PubMed Central

    Jeschke, Marc G.; Finnerty, Celeste C.; Shahrokhi, Shahriar; Branski, Ludwik K.; Dibildox, Manuel

    2013-01-01

    Improvements in burn wound care have vastly decreased morbidity and mortality in severely burned patients. Development of new therapeutic approaches to increase wound repair has the potential to reduce infection, graft rejection, and hypertrophic scarring. The incorporation of tissue engineering techniques, along with the use of exogenous proteins, genes, or stem cells to enhance wound healing, heralds new treatment regimens based on the modification of already existing biological activity. Refinements to surgical techniques have enabled the creation of protocols for full facial transplantation. With new technologies and advances such as these, care of the severely burned will undergo massive changes over the next decade. This review centers on new developments that have recently shown great promise in the investigational arena. PMID:23877140

  3. Extensive burns caused by the abusive use of photosensitizing agents.

    PubMed

    Braye, F; Latarjet, J; Foyatier, J L; Comparin, J P; Tranchand, P; Boucaud, C

    1997-01-01

    Psoralens are photosensitizing agents used in dermatology as reinforcements in psoralen ultraviolet A-range therapy. We report observations of 14 young women hospitalized for severe burns caused by abusive use of psoralens. The burns were of superficial and deep second-degree depth and covered more than 76% of the body surface on average. All patients needed fluid resuscitation. Hospital stay was 11 days on average. Healing was obtained without skin grafting in all cases. Among the six patients who responded to the mailed questionnaire, negative effects are now present in all patients as inflammatory peaks. Two patients have esthetic sequelae such as dyschromia and scars. The misuse of photosensitizing agents poses many problems. These accidents are very expensive. The largeness of the burned surface can involve a fatal prognosis. And finally, one can suspect that a much larger portion of the population regularly uses these products without any serious accident. In this case carcinogenesis can be expected. PMID:9261698

  4. Custom-made approach to a patient with post-burn breast deformity.

    PubMed

    Bayram, Yalcin; Sahin, Cihan; Sever, Celalettin; Karagoz, Huseyin; Kulahci, Yalcin

    2014-01-01

    Second and third degree burns on breasts at preadolescent period may cause severe breast deformations. This deformation can be variable depending on severity and location of the burns, personal adolescent patterns, and treatment modality in acute burn period. A 21 year old female patient admitted to our department for her breast deformation due to burn contracture at the inferior pole of the right breast. On physical examination we defined that development of the volume of the right breast was equal to the left, and inferior pole of the right breast was flattened due to contracture, and nipple was projected to inferior. We found that inframammary crease of the right breast was 2 cm lower than that of left; andthe distance of nipple-inframamary crease was 4.7 cm while areola-inframmary crease was 2 cm. New nipple-areola complex level was identified according to left breast's level. Medial and lateral lines were planned to merge inferiorly at 2 cm above inframmary crease in a plan similar to vertical mammaplasty. Superior pedicle carrying nipple areola was desepitelised. Lower parenchymal V flap was transposed superiorly and attached to the pectoral muscle. Inferior parts of the lateral and medial glandular flaps were excised to form new inframammary crease. The desired laxity of skin at the lower pole was obtained by performing a new Z- plasty between lateral and medial skin flaps. Breast symmetry was confirmed by postoperative objective measurements between left and right breasts. Patient's satisfaction and aesthetic appearance levels were high. Breasts deformation patterns caused by burns, trauma and mass exsicion due to cancer could not be addressed with traditional defined techniques. Special deformations can be corrected by custom made plannings as we presented here. PMID:24987218

  5. Custom-made approach to a patient with post-burn breast deformity

    PubMed Central

    Bayram, Yalcin; Sahin, Cihan; Sever, Celalettin; Karagoz, Huseyin; Kulahci, Yalcin

    2014-01-01

    Second and third degree burns on breasts at preadolescent period may cause severe breast deformations. This deformation can be variable depending on severity and location of the burns, personal adolescent patterns, and treatment modality in acute burn period. A 21 year old female patient admitted to our department for her breast deformation due to burn contracture at the inferior pole of the right breast. On physical examination we defined that development of the volume of the right breast was equal to the left, and inferior pole of the right breast was flattened due to contracture, and nipple was projected to inferior. We found that inframammary crease of the right breast was 2 cm lower than that of left; andthe distance of nipple-inframamary crease was 4.7 cm while areola-inframmary crease was 2 cm. New nipple-areola complex level was identified according to left breast's level. Medial and lateral lines were planned to merge inferiorly at 2 cm above inframmary crease in a plan similar to vertical mammaplasty. Superior pedicle carrying nipple areola was desepitelised. Lower parenchymal V flap was transposed superiorly and attached to the pectoral muscle. Inferior parts of the lateral and medial glandular flaps were excised to form new inframammary crease. The desired laxity of skin at the lower pole was obtained by performing a new Z- plasty between lateral and medial skin flaps. Breast symmetry was confirmed by postoperative objective measurements between left and right breasts. Patient's satisfaction and aesthetic appearance levels were high. Breasts deformation patterns caused by burns, trauma and mass exsicion due to cancer could not be addressed with traditional defined techniques. Special deformations can be corrected by custom made plannings as we presented here. PMID:24987218

  6. [Multiple trauma and burns].

    PubMed

    Carsin, H; Dutertre, G; Le Bever, H; Ainaud, P; Le Rveill, R; Rives, J M

    1995-01-01

    In peace time, burn injury combined with traumatic, chemical or radioactive casualties is rarely encountered and often unrecognized; during disasters, burn injury is unlikely the only trauma. The authors try to bring out the main pathophysiological, diagnostic and therapeutic characteristics of changes induced by combined lesions on burn injury and vice-versa. PMID:7671090

  7. Learn Not To Burn.

    ERIC Educational Resources Information Center

    English, Nancy; Hendricks, Charlotte M.

    1997-01-01

    Describes the "Learn Not to Burn Preschool Program," a low-cost fire safety awareness and burn prevention curriculum for young children. The program promotes eight burn prevention methods--including practicing an escape plan--using developmentally appropriate learning objectives to increase children's fire safety knowledge, skill, and…

  8. Management of keloids and hypertrophic scars: current and emerging options

    PubMed Central

    Gauglitz, Gerd G

    2013-01-01

    In the context of growing aesthetic awareness, a rising number of patients feel disappointed with their scars and are frequently seeking help for functional and aesthetic improvement. However, excessive scarring following surgery or trauma remains difficult to improve despite a plethora of advocated treatment strategies as frequently observed in daily clinical routine. It is thus still preferable to prevent scarring by minimizing risk factors as much as possible. Hence, it remains crucial for the physician to be aware of basic knowledge of healing mechanisms and skin anatomy, as well as an appreciation of suture material and wound closure techniques to minimize the risk of postoperative scarring. Next to existing, well known prophylactic and therapeutic strategies for the improvement of excessive scarring, this article discusses emerging techniques such as intralesional cryotherapy, intralesional 5-fluorouracil, interferon, and bleomycin. Some of them have been successfully tested in well-designed trials and already have extended or may extend the current spectrum of excessive scar treatment in the near future. Innovative options such as imiquimod 5% cream, photodynamic therapy, or botulinum toxin A may also be of certain importance; however, the data currently available is too contradictory for definite recommendations. PMID:23637546

  9. Impact of Postthyroidectomy Scar on the Quality of Life of Thyroid Cancer Patients

    PubMed Central

    Choi, Yuri; Lee, Ji Hye; Kim, Yeon Hee; Lee, Yong Sang; Chang, Hang-Seok; Park, Cheong Soo

    2014-01-01

    Background Surgical scars are crucial cosmetic problem, especially when in exposed areas such as the anterior neck following thyroidectomy. Objective To evaluate the impact of post-thyroidectomy scars on quality of life (QoL) of thyroid cancer patients and identify the relationship between scar characteristics and QoL. Methods Patients with post-thyroidectomy scars on the neck were recruited. QoL was measured using the Dermatology Life Quality Index (DLQI). Scar characteristics were graded according to Vancouver scar scale (VSS) score. Results Ninety-seven patients completed a battery of questions at the time of enrollment. Post-thyroidectomy scars were classified according to morphology as linear flat scars, linear bulging scars, hypertrophic scars or adhesive scars. There were 32 patients (33.0%), 9 patients (9.3%), 41 patients (42.3%) and 15 patients (15.5%), respectively, in each group. The mean total DLQI score was 9.02. Domain 2 (daily activities, 2.87 points), which includes questions about clothing, was the most greatly impacted among patients. The total DLQI scores of patients who have experienced scar-related symptoms were significantly higher than those of patients without symptoms (p<0.05). The VSS scores were 3.09 for linear flat scars, 6.89 for linear bulging scars, 6.29 for hypertrophic scars and 5.60 for adhesive scars. However, the DLQI scores did not significantly differ among scar types or VSS scores. Conclusion Post-thyroidectomy scars on the neck affect the QoL of thyroid cancer patients regardless of scar type. Therefore, clinicians should pay attention to the psychological effects of scars on patients and take care to minimize post-thyroidectomy scar. PMID:25473220

  10. Scar prevention by laser-assisted scar healing (LASH) using thermal post-conditioning

    NASA Astrophysics Data System (ADS)

    Gossé, Alban; Iarmarcovai, Gwen; Capon, Alexandre; Cornil, Alain; Mordon, Serge

    2009-02-01

    An 810-nm diode laser system was developed to accelerate and improve the healing process in surgical scars. Using thermal post-conditioning, the laser system provides a localised moderate heating whose maximum temperature is controlled to prevent tissue damage and stimulate the heat shock proteins (HSP) synthesis. The 810-nm wavelength allows a deep penetration of the light into the dermis, without damaging the epidermis. The time along which surgical incision is treated (continuous wave) must therefore be selected carefully with respect to the temperature precision achieved within the heated volume. A top-hat profile is preferred to a Gaussian profile in order to ensure the skin surface temperature is homogenised, as is the temperature of the heated volume. The spot shape will depend on the medical indication. The treatment should be made safe and controlled by means of a safety strip containing an RFID chip which will transmit the various operating settings to the laser device. A clinical trial aims at evaluating the 810 nm-diode laser in surgical incisions, with only one laser treatment immediately after skin closure, of patients with Fitzpatrick skin types I to IV. Surgical incisions were divided into two fields, with only portions randomly selected receiving laser treatment. At the final scar analysis (12 months) of the pilot study, the treated portion scored significantly better for both surgeon (P = 0.046) and patients (P = 0.025). Further studies may be warranted to better understand the cellular mechanisms leading to Laser-Assisted Skin Healing (LASH).

  11. To burn or not to burn

    SciTech Connect

    Busch, L.

    1993-01-01

    While taking a match to an oil slick may sound like the making of a chaotic inferno, emergency response specialists say burning may be the most efficient way to remove large oil spills from the ocean's surface. But tests of this technique are being resisted by environmentalists as well as the Environmental Protection Agency (EPA), which has final authority over the matter. The debate over test burning arose most recently in Alaska when a proposal to spill and then ignite 1,000 barrels of crude on the Arctic Ocean this past summer was rejected by the EPA. The EPA didn't object to the technique or to the notion of burning spilled oil. However, it contends that it's not necessary to spill thousands of gallons of oil to conduct tests, and unnecessarily pollute the environment, when plenty of oil is already available from accidental spills. Researchers disagree, claiming they won't be able to use the burning technique on an actual spill until it has been tested in a controlled experiment. Despite such concerns, the Canadian government is going ahead with a test burn off the coast of Newfoundland next year. Faced with a choice of test burning or the kind of shoreline contamination left in the wake of the Exxon Valdez disaster, Environment Canada opts for testing. Learning valuable lessons about rapid oil-spill cleanup is worth the relatively minor risks to the environment that test burning would pose.

  12. Evaluation of Acne Scars: How to Assess Them and What to Tell the Patient.

    PubMed

    Fife, Douglas

    2016-04-01

    The prevalence and emotional impact of acne scarring are underestimated by the medical community. Dermatology providers should be able to evaluate the acne scar patient and discuss treatment options. Important aspects of the patient history include current treatments, prior acne scar procedures, and the patient's goals for treatment. During the physical examination, the scars are assessed and classified by scar morphology and overall severity of scarring. Finally, a treatment plan is developed in which the most appropriate procedures are matched with the scars that will work the best. Helping the patient understand likely expectations for improvement will increase overall satisfaction. PMID:27015781

  13. Shikonin reduces TGF-β1-induced collagen production and contraction in hypertrophic scar-derived human skin fibroblasts

    PubMed Central

    FAN, CHEN; DONG, YING; XIE, YAN; SU, YONGHUA; ZHANG, XUFANG; LEAVESLEY, DAVID; UPTON, ZEE

    2015-01-01

    Hypertrophic scarring/hypertrophic scars (HS) is a highly prevalent condition following burns and trauma wounds. Numerous studies have demonstrated that transforming growth factor-β1 (TGF-β1) plays an essential role in the wound healing process by regulating cell differentiation, collagen production and extracellular matrix degradation. The increased expression of TGF-β1 is believed to result in the formation of HS. Shikonin (SHI), an active component extracted from the Chinese herb, Radix Arnebiae, has previously been found to downregulate the expression of TGF-β1 in keratinocyte/fibroblast co-culture conditioned medium. In view of this, in this study, we aimed to further investigate the effects of SHI on TGF-β1-stimulated hypertrophic scar-derived human skin fibroblasts (HSFs) and examined the underlying mechanisms. Cell viability and proliferation were measured using alamarBlue and CyQUANT assays. The total amount of collagen and cell contraction were examined using Sirius red staining and the cell contraction assay kit. Gene expression and signalling pathway activation were detected using reverse transcription-quantitative polymerase chain reaction and western blot analysis. Our results revealed that SHI reduced TGF-β1-induced collagen production through the ERK/Smad signalling pathway and attenuated TGF-β1-induced cell contraction by downregulating α-smooth muscle actin (αSMA) expression in the HSFs. The data from this study provide evidence supporting the potential use of SHI as a novel treatment for HS. PMID:26239419

  14. Double elevator weakening for unilateral congenital superior oblique palsy with ipsilateral superior rectus contracture and lax superior oblique tendon.

    PubMed

    Khan, Arif O

    2012-06-01

    In unilateral congenital superior oblique palsy, a large hypertropia is sometimes associated with ipsilateral contracture of the superior rectus muscle and apparent overaction of the contralateral superior oblique. Ipsilateral double elevator weakening is one surgical approach; however, this procedure could compromise supraduction. We report a series of three consecutive patients who underwent ipsilateral superior rectus and inferior oblique recessions for unilateral superior oblique palsy. Intraoperatively, all three patients were found to have a lax ipsilateral superior oblique tendon. Postoperatively, all three patients had satisfactory correction of the hypertropia and abnormal head position with minimal supraduction defect. This procedure seems to be an acceptable initial surgical option for treating congenital superior oblique muscle palsy with ipsilateral contracture of the superior rectus muscle, even when the ipsilateral superior oblique tendon is lax. PMID:22681951

  15. Treatment of sandal burns of the feet in children in a moist environment.

    PubMed

    Shakirov, Babur M

    2014-05-01

    Burns to children's feet are often due to scalds, from hot tap water, as an infant's skin is thinner and hence more susceptible to a full-thickness injury. In Central Asia, and particularly in Uzbekistan, many episodes of burns take place at homes because of using sandal heaters. In the case of sandal burns of the foot, it usually is not only skin that is injured but also underlying tissues: subcutaneous fat, fasciae, muscles and even bones. Many controlled studies have confirmed that wounds heal more readily in a moist, physiological environment. After performing the toilet of burn wounds of the foot, we applied Dermazin cream on the affected areas and then the foot was placed onto a polyethylene packet of large size and fixed by a bandage. Measurement of wound water evaporation was performed every day post-burn. Surgery was usually performed 15-17 days after burn by applying a perforated skin graft or a 0.2-0.3-mm-thick non-perforated skin graft. The procedures helped to improve the general condition of patients, shortened their stay in hospital and also reduced expenses and lessened joint deformities and contracture deformities. PMID:24094987

  16. Facial Burns - Our Experience

    PubMed Central

    Zatriqi, Violeta; Arifi, Hysni; Zatriqi, Skender; Duci, Shkelzen; Rrecaj, Sh.; Martinaj, M.

    2013-01-01

    Facial burns are generally considered severe. This is due to the possibility of respiratory complications. First responders check the nostrils for singed hairs. In severe cases there may be soot around the nose and mouth and coughing may produce phlegm that includes ash. Facial and inhalational burns compromise airways. They pose difficulties in pre-hospital resuscitation and are challenge to clinicians managing surviving burn victims in the intensive care setting. Management problems – resuscitation, airway maintenance and clinical treatment of facial injuries are compounded if the victim is child. Inhalational burns reduce survivability, certainly in adult victim. In our retrospective study we found that facial burns dominated in male gender, liquids and scalds are the most common causes of facial burns in children whereas the flame and electricity were the most common causes of facial burns in adults. We came to the conclusion in our study that surgical treatment minimizes complications and duration of recovery. PMID:23687458

  17. Timing constraints on remote sensing of wildland fire burned area in the southeastern US

    USGS Publications Warehouse

    Picotte, J.J.; Robertson, K.

    2011-01-01

    Remote sensing using Landsat Thematic Mapper (TM) satellite imagery is increasingly used for mapping wildland fire burned area and burn severity, owing to its frequency of collection, relatively high resolution, and availability free of charge. However, rapid response of vegetation following fire and frequent cloud cover pose challenges to this approach in the southeastern US. We assessed these timing constraints by using a series of Landsat TM images to determine how rapidly the remotely sensed burn scar signature fades following prescribed burns in wet flatwoods and depression swamp community types in the Apalachicola National Forest, Florida, USA during 2006. We used both the Normalized Burn Ratio (NBR) of reflectance bands sensitive to vegetation and exposed soil cover, as well as the change in NBR from before to after fire (dNBR), to estimate burned area. We also determined the average and maximum amount of time following fire required to obtain a cloud-free image for burns in each month of the year, as well as the predicted effect of this time lag on percent accuracy of burn scar estimates. Using both NBR and dNBR, the detectable area decreased linearly 9% per month on average over the first four months following fire. Our findings suggest that the NBR and dNBR methods for monitoring burned area in common southeastern US vegetation community types are limited to an average of 78-90% accuracy among months of the year, with individual burns having values as low as 38%, if restricted to use of Landsat 5 TM imagery. However, the majority of burns can still be mapped at accuracies similar to those in other regions of the US, and access to additional sources of satellite imagery would improve overall accuracy. ?? 2011 by the authors.

  18. Timing constraints on remote sensing of wildland fire burned area in the southeastern US

    USGS Publications Warehouse

    Picotte, Joshua J.; Robertson, Kevin

    2011-01-01

    Remote sensing using Landsat Thematic Mapper (TM) satellite imagery is increasingly used for mapping wildland fire burned area and burn severity, owing to its frequency of collection, relatively high resolution, and availability free of charge. However, rapid response of vegetation following fire and frequent cloud cover pose challenges to this approach in the southeastern US. We assessed these timing constraints by using a series of Landsat TM images to determine how rapidly the remotely sensed burn scar signature fades following prescribed burns in wet flatwoods and depression swamp community types in the Apalachicola National Forest, Florida, USA during 2006. We used both the Normalized Burn Ratio (NBR) of reflectance bands sensitive to vegetation and exposed soil cover, as well as the change in NBR from before to after fire (dNBR), to estimate burned area. We also determined the average and maximum amount of time following fire required to obtain a cloud-free image for burns in each month of the year, as well as the predicted effect of this time lag on percent accuracy of burn scar estimates. Using both NBR and dNBR, the detectable area decreased linearly 9% per month on average over the first four months following fire. Our findings suggest that the NBR and dNBR methods for monitoring burned area in common southeastern US vegetation community types are limited to an average of 78–90% accuracy among months of the year, with individual burns having values as low as 38%, if restricted to use of Landsat 5 TM imagery. However, the majority of burns can still be mapped at accuracies similar to those in other regions of the US, and access to additional sources of satellite imagery would improve overall accuracy.

  19. [Integration of burn treatment and rehabilitation for a child with extremely severe burn].

    PubMed

    Li, Hongming; Zhang, Jiaping; Chen, Jian; Song, Huapei; Liu, Qiushi; Fan, Xin; Peng, Yizhi; Wu, Jun

    2015-04-01

    This article reports the successful experience of integration of burn treatment and rehabilitation for a child suffering from 91% TBSA flame burn injury (with 60% TBSA full-thickness injury, 30% TBSA deep partial-thickness injury, and 1% TBSA superficial partial-thickness injury), severe inhalation injury, severe burn shock, stress ulcer, gastrointestinal bleeding and atelectasis of the right upper lung. The patient was given effective fluid infusion against shock, treatment for gastrointestinal bleeding, and other effective supportive treatment for functions of various organs after being admitted to our burn ward. When vital signs became stable at 30 hours post injury, bedside rehabilitation was begun. On post injury day (PID) 4, escharectomy was performed for both lower limbs, followed by microskin grafting and allogeneic skin covering. On PID 10, invasive infection of multi-drug resistant bacteria was found with accompanied high fever, and at the same time allograft began to disintegrate, with dissolution of large area of eschar, leading to a raw surface reaching 86% TBSA. Following debridement, dressing, application of compound polymyxin B ointment, temporary covering of wounds with porcine acellular dermal matrix, adjustment of antibiotics, patient's condition was finally stabilized. From PID 28 on, split-thickness skin grafting was conducted 7 times, and the raw surface of 75% TBSA involving the upper and lower limbs and trunk was successfully covered. At the same time, our rehabilitation team launched comprehensive rehabilitation measures comprising active exercise, occupational therapy, prevention of scar formation, organ function training and psychological intervention. Finally, the patient was able to walk unaided and fed herself when the wounds were almost entirely healed in 3 months after injury. Oriented forwards functional rehabilitation, strong cooperation between team members, and synchronous effective implementation of burn treatment and rehabilitation in the whole process are the keys to achieve successful integration of burn treatment and rehabilitation of this child. PMID:26320319

  20. Transmitter-mediated local contracture of the endplate region of the focally innervated mouse diaphragm treated with anticholinesterase.

    PubMed

    Hong, S J; Chang, C C

    1993-08-01

    1. Local contraction of the endplate region in response to nerve stimulation was studied in isolated mouse diaphragms. In normal preparations, muscle contractions involved the whole length of the muscle fibre with rise and decay times in the order of tens of ms whether evoked with a single or train of pulses. 2. When acetylcholinesterase was inhibited with neostigmine, tetanic stimulation produced a twitch-like phasic contraction and a delayed tonic contracture. A brief train of pulse (10 ms, 300 Hz) was enough to trigger a full size tonic contracture which reached an amplitude about one tenth that of control tetanus and had a duration of about 4 s. 3. Tetanic stimulation evoked a non-propagating prolonged depolarization at the endplate region lasting for about 1 s following a few muscle action potentials. 4. mu-Conotoxin, a specific inhibitor of muscle Na+ channel, selectively abolished the phasic contraction and the muscle action potentials leaving the tonic contracture and the prolonged depolarization unaffected. 5. Both the tonic contracture and the prolonged depolarization were highly sensitive to blockade by tubocurarine (IC50 0.05-0.1 microM) and vesamicol (1 microM, an inhibitor of packaging acetylcholine into synaptic vesicles), were attenuated by increasing Ca2+ concentration and were prolonged by decreasing Ca2+. 6. The results suggest that prolonged activation of endplate nicotinic receptors by endogenously released transmitter can produce substantial contractions of the endplate region when acetylcholinesterase are inhibited. The source of Ca2+ for the contraction seems to come mainly from intracellular stores. PMID:8104646

  1. Should we consider Dupuytren's contracture as work-related? A review and meta-analysis of an old debate

    PubMed Central

    2011-01-01

    Background In view of the conflicting opinions published, a meta-analysis was undertaken on epidemiological studies in order to assess any association between Dupuytren's contracture and work exposure. Methods Using the key words: "occupational disease", "work" and "Dupuytren contracture" without limitation on language or year of publication, epidemiological studies were selected from four databases (Pub-Med, Embase, Web of science, BDSP) after two rounds (valid control group, valid work exposure). A quality assessment list was constructed and used to isolate papers with high quality methodological criteria (scores of 13 or above, HQMC). Relevant associations between manual work, vibration exposure (at work) and Dupuytren's contracture were extracted from the articles and a metarisk calculated using the generic variance approach (meta-odds ratios, meta-OR). Results From 1951 to 2007, 14 epidemiological studies (including 2 cohort studies, 3 case-control studies, and 9 cross-sectional studies/population surveys) were included. Two different results could be extracted from five studies (based on different types of exposure), leading to 19 results, 12 for manual work (9 studies), and 7 for vibration exposure (5 studies). Six studies met the HQMC, yielding 9 results, 5 for manual work and 4 for vibration exposure. Five studies found a dose-response relationship. The meta-OR for manual work was 2.02[1.57;2.60] (HQMC studies only: 2.01[1.51;2.66]), and the meta-OR for vibration exposure was 2.88 [1.36;6.07] (HQMC studies only: 2.14[1.59;2.88]). Conclusion These results support the hypothesis of an association between high levels of work exposure (manual work and vibration exposure) and Dupuytren's contracture in certain cases. PMID:21575231

  2. Transmitter-mediated local contracture of the endplate region of the focally innervated mouse diaphragm treated with anticholinesterase.

    PubMed Central

    Hong, S. J.; Chang, C. C.

    1993-01-01

    1. Local contraction of the endplate region in response to nerve stimulation was studied in isolated mouse diaphragms. In normal preparations, muscle contractions involved the whole length of the muscle fibre with rise and decay times in the order of tens of ms whether evoked with a single or train of pulses. 2. When acetylcholinesterase was inhibited with neostigmine, tetanic stimulation produced a twitch-like phasic contraction and a delayed tonic contracture. A brief train of pulse (10 ms, 300 Hz) was enough to trigger a full size tonic contracture which reached an amplitude about one tenth that of control tetanus and had a duration of about 4 s. 3. Tetanic stimulation evoked a non-propagating prolonged depolarization at the endplate region lasting for about 1 s following a few muscle action potentials. 4. mu-Conotoxin, a specific inhibitor of muscle Na+ channel, selectively abolished the phasic contraction and the muscle action potentials leaving the tonic contracture and the prolonged depolarization unaffected. 5. Both the tonic contracture and the prolonged depolarization were highly sensitive to blockade by tubocurarine (IC50 0.05-0.1 microM) and vesamicol (1 microM, an inhibitor of packaging acetylcholine into synaptic vesicles), were attenuated by increasing Ca2+ concentration and were prolonged by decreasing Ca2+. 6. The results suggest that prolonged activation of endplate nicotinic receptors by endogenously released transmitter can produce substantial contractions of the endplate region when acetylcholinesterase are inhibited. The source of Ca2+ for the contraction seems to come mainly from intracellular stores. PMID:8104646

  3. A Randomized, Prospective Study of the Treatment of Superficial Partial-Thickness Burns: AWBAT-S Versus Biobrane

    PubMed Central

    Greenwood, John E

    2011-01-01

    The aim of this study was to prospectively evaluate AWBAT-S in comparison with Biobrane for the treatment of superficial partial-thickness burns using the patient as his or her own control. Primary outcome measures included length of hospital inpatient stay and patient-reported perception of pain. Secondary outcome measures included time to healing, clinical outcome of burn sites (scarring) and a comparison of cost of care for patients treated with AWBAT-S versus Biobrane. PMID:21369369

  4. Postmastectomy radiotherapy with integrated scar boost using helical tomotherapy

    SciTech Connect

    Rong Yi; Yadav, Poonam; Welsh, James S.; Fahner, Tasha; Paliwal, Bhudatt

    2012-10-01

    The purpose of this study was to evaluate helical tomotherapy dosimetry in postmastectomy patients undergoing treatment for chest wall and positive nodal regions with simultaneous integrated boost (SIB) in the scar region using strip bolus. Six postmastectomy patients were scanned with a 5-mm-thick strip bolus covering the scar planning target volume (PTV) plus 2-cm margin. For all 6 cases, the chest wall received a total cumulative dose of 49.3-50.4 Gy with daily fraction size of 1.7-2.0 Gy. Total dose to the scar PTV was prescribed to 58.0-60.2 Gy at 2.0-2.5 Gy per fraction. The supraclavicular PTV and mammary nodal PTV received 1.7-1.9 dose per fraction. Two plans (with and without bolus) were generated for all 6 cases. To generate no-bolus plans, strip bolus was contoured and overrode to air density before planning. The setup reproducibility and delivered dose accuracy were evaluated for all 6 cases. Dose-volume histograms were used to evaluate dose-volume coverage of targets and critical structures. We observed reduced air cavities with the strip bolus setup compared with what we normally see with the full bolus. The thermoluminescence dosimeters (TLD) in vivo dosimetry confirmed accurate dose delivery beneath the bolus. The verification plans performed on the first day megavoltage computed tomography (MVCT) image verified that the daily setup and overall dose delivery was within 2% accuracy compared with the planned dose. The hotspot of the scar PTV in no-bolus plans was 111.4% of the prescribed dose averaged over 6 cases compared with 106.6% with strip bolus. With a strip bolus only covering the postmastectomy scar region, we observed increased dose uniformity to the scar PTV, higher setup reproducibility, and accurate dose delivered beneath the bolus. This study demonstrates the feasibility of using a strip bolus over the scar using tomotherapy for SIB dosimetry in postmastectomy treatments.

  5. Scar carcinoma of the lung: a historical perspective.

    PubMed

    Bobba, Ravi K; Holly, Jason Scott; Loy, Tim; Perry, Michael C

    2011-05-01

    Lung scar carcinoma (SC) was first described by Friedrich in 1939 as a type of lung cancer that originates around peripheral scars in the lung. Scarring in the lung can result from a variety of infections, injuries, and lung diseases. Scars can also be due to repeated episodes of tumor necrosis and healing. SCs are typically found as subpleural adenocarcinomas with retraction or puckering of the overlying pleura. They were considered a histologic curiosity that was promoted for decades until doubts about their existence were raised in the 1980s. Finding type III collagen, type V collagen, and myofibroblasts characteristic of fibrosis in the scars, finally reversed the original SC concept. The presence of type III collagen and extracellular matrix suggested an ongoing fibrosing process secondary to host response to the neoplasm. The high concentration of type III collagen in SC indicates that the fibrous tissue is in an active immature state compared with noneuplastic fibrous tissue, which is mature and contains type I and type V collagen. A recent cohort analysis of data from the PLCO (Prostate, Lung, Colorectal and Ovarian) cancer screening trial demonstrated a correlation between the presence of scar and the development of carcinoma, but the causation of this association has to be determined by future studies. The role of inflammation, infections, and smoking in the development of cancer is discussed in this article. Additional research is necessary to determine if lung scarring detected by imaging requires clinical monitoring in the context of the development of lung cancer when a defined set of risk factors is identified. PMID:21663856

  6. The Urban-Rural Disparity in Nursing Home Quality Indicators: The Case of Facility-Acquired Contractures

    PubMed Central

    Bowblis, John R; Meng, Hongdao; Hyer, Kathryn

    2013-01-01

    Objective To identify and quantify the sources of the urban-rural disparity in facility-acquired contracture rates in nursing homes. Data Sources Survey inspection data of U.S. nursing homes from 1999 to 2008 and standardized national rural definition file from the Rural-Urban Commuting Area Codes. Study Design We estimated regressions of facility-level contracture rate as a function of urban-rural categories (urban, micropolitan, small rural town, and isolated small rural town) and other related facility characteristics to identify size of the urban-rural disparity. We used Blinder–Oaxaca decomposition techniques to determine the extent to which the disparity is attributable to the differences in facility and aggregate resident characteristics. Principal Findings Rural nursing homes have higher contracture rates than urban nursing homes. About half of the urban-rural disparity is explained by differences in observable characteristics among urban and rural nursing homes. Differences in staffing levels explain less than 5 percent of the disparity, case-mix explains 6–8 percent, and structure and operational characteristics account for 10–22 percent of the disparity. Conclusion While a lower level and quality of staffing are a concern for rural nursing homes, facility structure and funding sources explain a larger proportion of the urban-rural disparity in the quality of care. PMID:22670847

  7. The effect of post-mastectomy radiation therapy on breast implants: Unveiling biomaterial alterations with potential implications on capsular contracture.

    PubMed

    Ribuffo, Diego; Lo Torto, Federico; Giannitelli, Sara M; Urbini, Marco; Tortora, Luca; Mozetic, Pamela; Trombetta, Marcella; Basoli, Francesco; Licoccia, Silvia; Tombolini, Vincenzo; Cassese, Raffaele; Scuderi, Nicol; Rainer, Alberto

    2015-12-01

    Post-mastectomy breast reconstruction with expanders and implants is recognized as an integral part of breast cancer treatment. Its main complication is represented by capsular contracture, which leads to poor expansion, breast deformation, and pain, often requiring additional surgery. In such a scenario, the debate continues as to whether the second stage of breast reconstruction should be performed before or after post-mastectomy radiation therapy, in light of potential alterations induced by irradiation to silicone biomaterial. This work provides a novel, multi-technique approach to unveil the role of radiotherapy in biomaterial alterations, with potential involvement in capsular contracture. Following irradiation, implant shells underwent mechanical, chemical, and microstructural evaluation by means of tensile testing, Attenuated Total Reflectance Fourier Transform InfraRed spectroscopy (ATR/FTIR), Scanning Electron Microscopy (SEM), high resolution stylus profilometry, and Time of Flight Secondary Ion Mass Spectrometry (ToF-SIMS). Our findings are consistent with radiation-induced modifications of silicone that, although not detectable at the microscale, can be evidenced by more sophisticated nanoscale surface analyses. In light of these results, biomaterial irradiation cannot be ruled out as one of the possible co-factors underlying capsular contracture. PMID:26354273

  8. Burn therapist contributions to the American Burn Association and the Journal of Burn Care and Research: a 45th anniversary review.

    PubMed

    Richard, Reginald

    2014-01-01

    The year 2013 marked the 45th anniversary of American Burn Association (ABA) annual meetings. At this significant juncture, a review of contributions of its members is appropriate to celebrate this milestone. Since the first ABA annual meeting and the initiation of the Journal of Burn Care and Research (JBCR), burn therapists, including both occupational and physical therapists, have grown to become integral members of the ABA, and their contributions among all members are highlighted. A systematic manual review of both ABA annual meeting proceedings and the JBCR was performed. The contributions of burn therapists to the ABA as a whole were classified, cataloged, and hand counted. Areas included: 1) quantifying ABA abstract and JBCR articles on authorship and subject matter, 2) representation on ABA committees; 3) participation in special activities; and 4) other recognitions. Burn therapists comprise 9.7% of ABA members overall. During the course of the first 44 ABA meetings, 8381 abstracts have been presented. Of this number, 634 (7.6%) have been delivered by burn therapists as lead authors. Through the end of 2011, no less than 3207 publications by all disciplines have appeared in JBCR. The vast majority of articles have been written by physicians, followed by doctorate-trained professionals. One hundred-forty therapists have 249 publications (7.8%) to their credit. For both abstracts and articles, the top three subject matter topics have been: scarring, splints and casts, and outcomes. Numerous burn therapists have served as faculty and moderators at ABA annual meetings and on ABA committees including JBCR. Burn therapists have made significant contributions to the JBCR and in support of the ABA and its annual meetings over the past 45 years from the clinical, scientific, and Association perspectives. PMID:24823340

  9. Scar prevention and remodeling: a review of the medical, surgical, topical and light treatment approaches.

    PubMed

    Kerwin, Leonard Y; El Tal, Abdel Kader; Stiff, Mark A; Fakhouri, Tarek M

    2014-08-01

    Cosmetic, functional, and structural sequelae of scarring are innumerable, and measures exist to optimize and ultimately minimize these sequelae. To evaluate the innumerable methods available to decrease the cosmetic, functional, and structural repercussions of scarring, pubMed search of the English literature with key words scar, scar revision, scar prevention, scar treatment, scar remodeling, cicatrix, cicatrix treatment, and cicatrix remodeling was done. Original articles and reviews were examined and included. Seventy-nine manuscripts were reviewed. Techniques, comparisons, and results were reviewed and tabulated. Overall, though topical modalities are easier to use and are usually more attractive to the patient, the surgical approaches still prove to be superior and more reliable. However, advances in topical medications for scar modification are on the rise and a change towards medical treatment of scars may emerge as the next best approach. Comparison studies of the innumerable specific modalities for scar revision and prevention are impossible. Standardization of techniques is lacking. Scarring, the body's natural response to a wound, can create many adverse effects. At this point, the practice of sound, surgical fundamentals still trump the most advanced preventative methods and revision techniques. Advances in medical approaches are available, however, to assist the scarring process, which even the most advanced surgical fundamentals will ultimately lead to. Whether through newer topical therapies, light treatment, or classical surgical intervention, our treatment armamentarium of scars has expanded and will allow us to maximize scar prevention and to minimize scar morbidity. PMID:24697346

  10. The reported effects of bullying on burn-surviving children.

    PubMed

    Rimmer, Ruth B; Foster, Kevin N; Bay, Curtis R; Floros, Jim; Rutter, Cindy; Bosch, Jim; Wadsworth, Michelle M; Caruso, Daniel M

    2007-01-01

    There is a trend of increasing childhood aggression in America, which has been tied to bullying. Although there is growing research concerning bullying in the general pediatric population, there are limited data on bullying and its effects on children with disfigurements and physical limitations. This study was conducted to assess burned children's experience with bullying. A pretest was administered regarding experience with bullying and teasing. A curriculum regarding bullying, which incorporated the Harry Potter and the Sorcerer's Stone movie, was presented. After reviewing bullying depicted in the film and participating in a class regarding bullying, children were invited to complete a survey regarding their experience with bullying. A total of 61% of these children reported being bullied at school; 25% reported experiencing headaches or stomachaches due to bullying, and 12% reported staying home from school. Nearly 25% reported bullying as a big problem. Of those with visible scars (55%), a full 68% reported bullying as a problem, versus 54% with hidden scars (P < .05). However, those with visible scars were no more likely to tell an adult (54%) than those without (56%). Children were much more willing to disclose personal bullying experiences after participating in the class (57%) than before (45%) (P < .01). This study revealed that bullying impacts many burn-injured children and has negative effects on their physical and mental well-being. Many children (with visible or hidden scars) did not seek adult intervention for the problem. Participation in a bullying course appears to give children a forum that increases their willingness to disclose personal bullying experiences and can provide them with prevention information and a safe place to seek help. PMID:17438488

  11. Emergent burn care.

    PubMed

    Harvey, J S; Watkins, G M; Sherman, R T

    1984-02-01

    The estimated 32,600,000 fires that occur annually in the United States produce over 300,000 injuries and 7,500 deaths. Ten percent of hospitalized burn victims die as a direct result of the burn. Initial evaluation and management of the burn patient are critical. The history should include the burn source, time of injury, burn environment, and combustible products. The burn size is best estimated by the Lund and Browder chart, and the burn depth is determined by clinical criteria. Pulmonary involvement and circumferential thoracic or extremity burns require detection and aggressive treatment to maintain organ viability. Hospitalization is usually necessary for adults with burns larger than 10% of the total body surface area (TBSA) or children with burns larger than 5% of TBSA. Major burns, those of 25% or more of TBSA or of 10% or more of full thickness, should be considered for treatment at a burn center, as well as children or elderly victims with burns of greater than 10% TBSA. Lactated Ringer's solution, infused at 4 ml/kg/% TBSA, is generally advocated for initial fluid restoration. After the acute phase (48 hours), replacement of evaporative and hypermetabolic fluid loss is necessary. These losses may constitute 3 to 5 liters per day for a 40% to 70% TBSA burn. Blood transfusion is often required because of persistent loss of red blood cells (8% per day for about ten days). Many electrolyte abnormalities may occur in the first two weeks. Pulmonary injury commonly is lethal. Circumoral burns, oropharyngeal burns, and carbonaceous sputum are indicative of inhalation injury, but arterial blood gas determinations, fiberoptic bronchoscopy, and xenon lung scans are useful for confirming the diagnosis. Humidified oxygen, intubation, positive-pressure ventilation, and pulmonary toilet are the mainstays of therapy for inhalation injury. Wound care is initially directed at preservation of vital function by escharotomy, if restrictive eschar impairs ventilatory or circulatory function. Antibacterial agents may be applied to the burn, but invasive sepsis, defined as greater than 10(5) organisms per gram of tissue with invasion of subjacent viable tissue, requires systemic antibiotic therapy. Wound debridement is done by daily hydrotherapy, tangential excision, chemicals, primary excision, and grafting, tailoring the technique to the individual burn.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:6367073

  12. High Resolution Muscle Measurements Provide Insights into Equinus Contractures in Patients with Cerebral Palsy

    PubMed Central

    Mathewson, Margie A.; Ward, Samuel R.; Chambers, Henry G.; Lieber, Richard L.

    2015-01-01

    Muscle contractures that occur after upper motor neuron lesion are often surgically released or lengthened. However, surgical manipulation of muscle length changes a muscle’s sarcomere length (Ls), which can affect force production. To predict effects of surgery, both macro- (fascicle length (Lf)) and micro- (Ls) level structural measurements are needed. Therefore, the purpose of this study was to quantify both Ls and Lf in patients with cerebral palsy (CP) as well as typically developing (TD) children. Soleus ultrasound images were obtained from children with CP and TD children. Lf was determined and, with the joint in the same position, CP biopsies were obtained, formalin fixed and Ls measured by laser diffraction. Since soleus Ls values were not measurable in TD children, TD Ls values were obtained using three independent methods. While average Lf did not differ between groups (CP=3.6±1.2 cm, TD=3.5±0.9 cm; p>0.6), Ls was dramatically longer in children with CP (4.07±0.45 μm vs. TD=2.17±0.24 μm; p<0.0001). While Lf values were similar between children with CP and TD children, this was due to highly stretched sarcomeres within the soleus muscle. Surgical manipulation of muscle-tendon unit length will thus alter muscle sarcomere length and change force generating capacity of the muscle. PMID:25242618

  13. ZBTB42 mutation defines a novel lethal congenital contracture syndrome (LCCS6).

    PubMed

    Patel, Nisha; Smith, Laura L; Faqeih, Eissa; Mohamed, Jawahir; Gupta, Vandana A; Alkuraya, Fowzan S

    2014-12-15

    Lethal congenital contracture syndrome (LCCS) is a lethal autosomal recessive form of arthrogryposis multiplex congenita (AMC). LCCS is genetically heterogeneous with mutations in five genes identified to date, all with a role in the innervation or contractile apparatus of skeletal muscles. In a consanguineous Saudi family with multiple stillbirths presenting with LCCS, we excluded linkage to all known LCCS loci and combined autozygome analysis and whole-exome sequencing to identify a novel homozygous variant in ZBTB42, which had been shown to be enriched in skeletal muscles, especially at the neuromuscular junction. Knockdown experiments of zbtb42 in zebrafish consistently resulted in grossly abnormal skeletal muscle development and myofibrillar disorganization at the microscopic level. This severe muscular phenotype is successfully rescued with overexpression of the human wild-type ZBTB42 gene, but not with the mutant form of ZBTB42 that models the human missense change. Our data assign a novel muscular developmental phenotype to ZBTB42 in vertebrates and establish a new LCCS6 type caused by ZBTB42 mutation. PMID:25055871

  14. Preclinical Study of Novel Gene Silencer Pyrrole-Imidazole Polyamide Targeting Human TGF-β1 Promoter for Hypertrophic Scars in a Common Marmoset Primate Model

    PubMed Central

    Igarashi, Jun; Fukuda, Noboru; Inoue, Takashi; Nakai, Shigeki; Saito, Kosuke; Fujiwara, Kyoko; Matsuda, Hiroyuki; Ueno, Takahiro; Matsumoto, Yoshiaki; Watanabe, Takayoshi; Nagase, Hiroki; Bando, Toshikazu; Sugiyama, Hiroshi; Itoh, Toshio; Soma, Masayoshi

    2015-01-01

    We report a preclinical study of a pyrrole-imidazole (PI) polyamide that targets the human transforming growth factor (hTGF)-β1 gene as a novel transcriptional gene silencer in a common marmoset primate model. We designed and then synthesized PI polyamides to target the hTGF-β1 promoter. We examined effects of seven PI polyamides (GB1101-1107) on the expression of hTGF-β1 mRNA stimulated with phorbol 12-myristate 13-acetate (PMA) in human vascular smooth muscle cells. GB1101, GB1105 and GB1106 significantly inhibited hTGF-β1 mRNA expression. We examined GB1101 as a PI polyamide to hTGF-β1 for hypertrophic scars in marmosets in vivo. Injection of GB1101 completely inhibited hypertrophic scar formation at 35 days post-incision and inhibited cellular infiltration, TGF-β1 and vimentin staining, and epidermal thickness. Mismatch polyamide did not affect hypertrophic scarring or histological changes. Epidermis was significantly thinner with GB1101 than with water and mismatch PI polyamides. We developed the PI polyamides for practical ointment medicines for the treatment of hypertrophic scars. FITC-labeled GB1101 with solbase most efficiently distributed in the nuclei of epidermal keratinocytes, completely suppressed hypertropic scarring at 42 days after incision, and considerably inhibited epidermal thickness and vimentin-positive fibroblasts. PI polyamides targeting hTGF-β1 promoter with solbase ointment will be practical medicines for treating hypertrophic scars after surgical operations and skin burns. PMID:25938472

  15. Outcome studies for burn patients in Hong Kong: patients' satisfaction.

    PubMed

    Cheng, S; Chan, A; Fong, S; Lam, M; Leung, A; Lee, P; Tsang, J; Wong, J; Wu, A

    1996-12-01

    With the recent advances in burns treatment, many more survive the burn to experience pain, scarring, physical deformity, loss of function and psychological trauma. Pressure therapy prescribed by occupational therapists for more than 20 years in Hong Kong has proved its effectiveness in treating the visible scars. However, the inconvenience and impaired appearance that is brought about by these garments during the long phase of therapy bears some weight in worsening patients' social acceptance and happiness in life, also their families especially in children. The objects of the studies were to measure the subjective rating of the effectiveness of pressure therapy through patients' satisfaction towards treatment effectiveness and its effect on daily life. Seventy cases with burn injuries over 1 year previously were selected randomly among the centres for the survey. The scale used was ordinal from 1 to 6. Eleven items concerning treatment effectiveness, life at home, work and leisure aspects were questioned. Results were analysed into two streams-satisfaction towards pressure therapy and change of life satisfaction pre- and post-injury. Non-parametric tests were used for data analysis. Through the Wilcoxon Sign Rank Test and Cluster analysis, major determinants were identified. These factors also showed significant correlation with this demographic data. The conclusions helped to evaluate and improve the existing service in both the garment properties and our scope of therapy for these patients, especially in work rehabilitation and finally (sexual) counselling which should be addressed by a team with interdepartmental support. PMID:8982541

  16. Burns associated with fondues.

    PubMed Central

    Laliberté, D; Beaucage, C; Watts, N

    1992-01-01

    OBJECTIVE: To describe the causes of burns associated with fondues. DESIGN: Descriptive case series. PATIENTS: All 17 patients admitted to a burn centre between Apr. 1, 1985, and Mar. 31, 1990, whose burns were associated with fondue. Eleven agreed to complete a telephone interview. RESULTS: The age of the 17 patients varied from 2 to 56 (mean 27) years. Two causes were identified: spilling of the contents of the fondue pot and explosion of the fondue fuel when added to the burner during a meal. The telephone interview revealed that eight people other than the respondents were burned during the same accidents. CONCLUSION: Although we identified only badly burned patients the problem may be more extensive. The knowledge of specific causes of burns from handling fondue equipment indicates that preventive action should be undertaken. More epidemiologic information is needed to obtain a precise estimate of the magnitude of this public health problem. PMID:1393897

  17. Outpatient burn management.

    PubMed

    Warner, Petra M; Coffee, Tammy L; Yowler, Charles J

    2014-08-01

    Most burn patients have injuries that may be treated on an outpatient basis. Newer silver-based dressings and improved medications for the treatment of pain and pruritus have led to further growth of outpatient care. The final barrier of distance from the burn center will decrease with the growth of telemedicine. It is incumbent for burn centers to develop outpatient guidelines to facilitate this growth of outpatient care. PMID:25085094

  18. Ultrasonographic Evaluation of Uterine Scar Niche before and after Laparoscopic Surgical Repair: A Case Report

    PubMed Central

    Drouin, Olivier; Bergeron, Tessa; Beaudry, Ariane; Demers, Suzanne; Roberge, Stéphanie; Bujold, Emmanuel

    2014-01-01

    Context Uterine scar defects or scar niche are relatively common after cesarean delivery. An association has been observed between the severity of scar defect, also known as isthmocele, some gynecologic symptoms, and the risk of uterine scar dehiscence at the next delivery. It has been suggested that surgical repair of scar defect could improve the gynecological symptoms, but it remains unclear whether such surgery mends the uterine scar itself. Case Report We report the case of a woman with uterine scar defect in whom laparoscopic repair significantly improved the gynecological symptoms without affecting the uterine scar, evaluated by hysterosonography. Conclusion This case highlights the significant dearth of knowledge surrounding the diagnosis, consequences, and benefits of surgical repair of uterine scar defect after cesarean. PMID:25452883

  19. Ultrasonographic Evaluation of Uterine Scar Niche before and after Laparoscopic Surgical Repair: A Case Report.

    PubMed

    Drouin, Olivier; Bergeron, Tessa; Beaudry, Ariane; Demers, Suzanne; Roberge, Stéphanie; Bujold, Emmanuel

    2014-11-01

    Context Uterine scar defects or scar niche are relatively common after cesarean delivery. An association has been observed between the severity of scar defect, also known as isthmocele, some gynecologic symptoms, and the risk of uterine scar dehiscence at the next delivery. It has been suggested that surgical repair of scar defect could improve the gynecological symptoms, but it remains unclear whether such surgery mends the uterine scar itself. Case Report We report the case of a woman with uterine scar defect in whom laparoscopic repair significantly improved the gynecological symptoms without affecting the uterine scar, evaluated by hysterosonography. Conclusion This case highlights the significant dearth of knowledge surrounding the diagnosis, consequences, and benefits of surgical repair of uterine scar defect after cesarean. PMID:25452883

  20. Burns and Diabetes

    PubMed Central

    Shalom, A.; Friedman, T.; Wong, L.

    2005-01-01

    Summary Diabetes is often considered a risk factor for poor wound healing and increased complication rates for plastic surgery procedures. Burn injury in diabetic patients may have implications for the length of stay and number of operations required. We therefore we examined the characteristics of diabetic patients admitted to our burn unit and the impact of their condition on their hospital course. Charts of all patients with diabetes admitted to the burn unit from 1995 to 2000 were reviewed (n = 73). Demographic data, percent body surface area burned, anatomical location of the burn, number of surgical procedures required, length and cost of stay, and outcome were noted. The control population included 150 consecutive patients without diabetes treated during the same period. Diabetic patients were older and underwent a higher number of surgical procedures, with increased length of stay and increased mortality, despite an equivalent body surface area burned. They had a higher incidence of scald burns in the lower extremities than the non-diabetic population. This work shows that diabetic patients constitute a unique group. They are significantly older, have an increased rate of surgical interventions, increased hospital stay, and significantly increased mortality compared to a control group with similar surface area burns. This group is also more likely to have scald burns in the lower extremities, mostly due to diabetic neuropathy. This work emphasizes the importance of education and prevention programmes directed towards this group of patients, in order to decrease morbidity, mortality, and hospital costs. PMID:21990975

  1. Burn Wound Infections

    PubMed Central

    Church, Deirdre; Elsayed, Sameer; Reid, Owen; Winston, Brent; Lindsay, Robert

    2006-01-01

    Burns are one of the most common and devastating forms of trauma. Patients with serious thermal injury require immediate specialized care in order to minimize morbidity and mortality. Significant thermal injuries induce a state of immunosuppression that predisposes burn patients to infectious complications. A current summary of the classifications of burn wound infections, including their diagnosis, treatment, and prevention, is given. Early excision of the eschar has substantially decreased the incidence of invasive burn wound infection and secondary sepsis, but most deaths in severely burn-injured patients are still due to burn wound sepsis or complications due to inhalation injury. Burn patients are also at risk for developing sepsis secondary to pneumonia, catheter-related infections, and suppurative thrombophlebitis. The introduction of silver-impregnated devices (e.g., central lines and Foley urinary catheters) may reduce the incidence of nosocomial infections due to prolonged placement of these devices. Improved outcomes for severely burned patients have been attributed to medical advances in fluid resuscitation, nutritional support, pulmonary and burn wound care, and infection control practices. PMID:16614255

  2. Fire Scars Detection Using Full Polarimetric SAR Data

    NASA Astrophysics Data System (ADS)

    Wang, Peng; Li, Yang; Hong, Wen

    2010-10-01

    In this paper a fire scars detection procedure based on Jong-Sen Lee's classification method which combines the Freeman-Durden 3 components decomposition and the Wishart classifier was applied. We applied Jong-Sen Lee's classification method to the PolSAR data being studied to get several clusters preserving scattering mechanisms. Then merged the clusters according to their scattering mechanism and scattering intensity into three final classes: fire scars, forests and others. To satisfy the basic condition of Freeman-Durden decomposition, reflection asymmetry compensation was applied. Fire scars detection results with and without reflection asymmetry compensation were compared. Better detection result was obtained after compensation, and the detection result was good compared with the SPOT5 reference image.

  3. Scars and the stability of crystalline shells under external pressure

    NASA Astrophysics Data System (ADS)

    Wan, Duanduan; Bowick, Mark; Sknepnek, Rastko

    2015-03-01

    While continuum elastic theory predicts the mechanical properties of ideal spherical shells under external pressure, on microscopic scale the response of shells to pressure may be affected by their crystalline order and defect structure. Here we compare the stability, under external pressure, of shells with a minimal set of topologically-required defects to shells with extended defect arrays (grain boundary ``scars''). In particular, we perform Monte Carlo simulations to compare how shells with and without scars deform quasi-statically under external hydrostatic pressure. We find that the critical pressure at which shells collapse is lowered when the scar distribution breaks icosahedral symmetry and raised when symmetry is preserved. The particular shapes resulting from collapses which break icosahedral symmetry depend crucially on the Föppl-von Kármán number. We thank the Soft Matter Program of Syracuse University for support.

  4. A multidisciplinary approach to scars: a narrative review.

    PubMed

    Zanier, Emiliano; Bordoni, Bruno

    2015-01-01

    The purpose of this article is to carry out a narrative review regarding the approach to scars through complementary and alternative medicine focusing on osteopathy, naturopathy, and other minor methods and traditional rehabilitative medicines, such as physiotherapy and manual therapies. We analyzed the existing literature regarding the possible influences of techniques relaxing the diaphragm - both manual and psychophysical relaxing techniques - and the consequent local response to events leading to scar tissue healing. The objective of the study is to become a useful instrument of knowledge for those manual therapists and professionals who deal with patients affected by discontinuity of the skin surface due to trauma or surgery. This article also intends to stimulate research in order to find and propose new methods of scar treatment, taking into consideration the information gained so far from other complementary and alternative disciplines. PMID:26316774

  5. Verapamil inhibits scar formation after peripheral nerve repair in vivo

    PubMed Central

    Han, A-chao; Deng, Jing-xiu; Huang, Qi-shun; Zheng, Huai-yuan; Zhou, Pan; Liu, Zhi-wei; Chen, Zhen-bing

    2016-01-01

    The calcium channel blocker, verapamil, has been shown to reduce scar formation by inhibiting fibroblast adhesion and proliferation in vitro. It was not clear whether topical application of verapamil after surgical repair of the nerve in vivo could inhibit the formation of excessive scar tissue. In this study, the right sciatic nerve of adult Sprague-Dawley rats was transected and sutured with No. 10-0 suture. The stoma was wrapped with gelfoam soaked with verapamil solution for 4 weeks. Compared with the control group (stoma wrapped with gelfoam soaked with physiological saline), the verapamil application inhibited the secretion of extracellular matrix from fibroblasts in vivo, suppressed type I and III collagen secretion and increased the total number of axons and the number of myelinated axons. These findings suggest that verapamil could reduce the formation of scar tissue and promote axon growth after peripheral nerve repair. PMID:27127494

  6. A multidisciplinary approach to scars: a narrative review

    PubMed Central

    Zanier, Emiliano; Bordoni, Bruno

    2015-01-01

    The purpose of this article is to carry out a narrative review regarding the approach to scars through complementary and alternative medicine focusing on osteopathy, naturopathy, and other minor methods and traditional rehabilitative medicines, such as physiotherapy and manual therapies. We analyzed the existing literature regarding the possible influences of techniques relaxing the diaphragm – both manual and psychophysical relaxing techniques – and the consequent local response to events leading to scar tissue healing. The objective of the study is to become a useful instrument of knowledge for those manual therapists and professionals who deal with patients affected by discontinuity of the skin surface due to trauma or surgery. This article also intends to stimulate research in order to find and propose new methods of scar treatment, taking into consideration the information gained so far from other complementary and alternative disciplines. PMID:26316774

  7. Verapamil inhibits scar formation after peripheral nerve repair in vivo.

    PubMed

    Han, A-Chao; Deng, Jing-Xiu; Huang, Qi-Shun; Zheng, Huai-Yuan; Zhou, Pan; Liu, Zhi-Wei; Chen, Zhen-Bing

    2016-03-01

    The calcium channel blocker, verapamil, has been shown to reduce scar formation by inhibiting fibroblast adhesion and proliferation in vitro. It was not clear whether topical application of verapamil after surgical repair of the nerve in vivo could inhibit the formation of excessive scar tissue. In this study, the right sciatic nerve of adult Sprague-Dawley rats was transected and sutured with No. 10-0 suture. The stoma was wrapped with gelfoam soaked with verapamil solution for 4 weeks. Compared with the control group (stoma wrapped with gelfoam soaked with physiological saline), the verapamil application inhibited the secretion of extracellular matrix from fibroblasts in vivo, suppressed type I and III collagen secretion and increased the total number of axons and the number of myelinated axons. These findings suggest that verapamil could reduce the formation of scar tissue and promote axon growth after peripheral nerve repair. PMID:27127494

  8. Developing and piloting a multifactorial intervention to address participation and quality of life in nursing home residents with joint contractures (JointConImprove): study protocol

    PubMed Central

    Müller, Martin; Bartoszek, Gabriele; Beutner, Katrin; Klingshirn, Hanna; Saal, Susanne; Stephan, Anna-Janina; Strobl, Ralf; Grill, Eva; Meyer, Gabriele

    2015-01-01

    Background: Joint contractures are common problems in frail older people in nursing homes. Irrespective of the exact extent of older individuals in geriatric care settings living with joint contractures, they appear to be a relevant problem. Also, the new emphasis on the syndrome of joint contractures, e. g. by the German statutory long term care insurance, led to an increase in assessment and documentation efforts and preventive interventions in clinical care. However, more attention should be paid to the actual situation of older individuals in nursing homes with prevalent joint contractures, particularly their experience of related activity limitations and participation restrictions. Thus, the aim of this study is 1) to develop a tailored intervention to improve functioning, and especially participation and quality of life in older residents with joint contractures in nursing homes and 2) to test the feasibility of the intervention accompanied by a rigorous process evaluation. Methods: The complex intervention, which will be developed in this project follows the UK Medical Research Council (MRC) framework and integrates the perspectives of all potentially relevant user groups, from the affected individuals to clinicians and researchers. The development process will comprise a systematic literature review, reanalysis of existing data and the integration of the knowledge of the affected individuals and experts. The developed intervention including a comprehensive process evaluation will be pilot tested with residents with joint contractures in three nursing homes. Discussion: The projected study will provide a tailored intervention to improve functioning, participation and quality of life in older residents with joint contractures in nursing homes. With this focus, the intervention will support patient relevant outcomes. The pilot study including process evaluation will offer a first opportunity to indicate the size of the intervention’s effect and prepare further studies. PMID:26195926

  9. Recontouring, resurfacing, and scar revision in skin cancer reconstruction.

    PubMed

    Brenner, Michael J; Perro, Christopher A

    2009-08-01

    Residual disfigurement is a common problem for patients who have undergone skin cancer reconstruction. Restoring form and function in these patients is an artistic and technical endeavor. The efficacy of surgical scar revision, dermabrasion, chemical peels, and laser resurfacing is predicated upon the skin's innate ability to regenerate over time in response to mechanical, chemical, and thermal or ablative stresses. The patient and surgeon should be accepting of a process that is often gradual and may proceed in stages. Achieving proficiency with the secondary procedures for improving scars and local flaps may allow the motivated surgeon to mold an initially passable surgical result into an excellent one. PMID:19698924

  10. Treatment and Rehabilitation of Knee Joints Straight Stiffness After Burns.

    PubMed

    Tang, Jinshu; Xu, Minghuo; Wu, Wenwen; Hu, Yuan; Shi, Xiuxiu; Hou, Shuxun

    2015-12-01

    The knee release surgery and postoperative rehabilitation of patients after burns and knee straight stiffness were investigated. Eleven patients were treated for 16 side burns and knee stiffness who consisted of nine males and two females, aged 19 to 54 years (mean = 33.2). The duration of the patients' knee stiffness ranged from 8 to 26 months, with an average of 12.6 months. Their preoperative flexion ranged from 5° to 50°, with an average of 26.2°. Their preoperative Hospital for Special Surgery (HSS) knee scores ranged from 46 to 72 points, with an average of 55.8 points. All stiff knees were treated with release surgery, along with total release of intra-articular adhesion and excision of vastus intermedius. After the arthrolysis of the stiff knee joint, the tight skin was completely loose in the adhesions. The soft tissue contracture was not grafted, but the shade fascia was freed to increase skin ductility. All knee joints were released to more than 90° of flexion in the operation, and reversed fascia flaps were used to suture the loss of the deep fascia at the position of flexion of 90°. After the operation, the knee joint was fixed in flexion for 72 h while being actively cared for by early rehabilitation. Subsequently, the patient's skin coverage, joint motion, and joint function recovery were observed. Based on the follow-up of the patients for the following 16 to 36 months (mean = 25.7), the knee flexion of the patients ranged from 110° to 135°, with an average of 122.2° and 96° increase (P < 0.01). Furthermore, the patients had better skin ductility to meet the increase in joint flexion. HSS knee function scores at the end of follow-up ranged from 93 to 100 points, with an average of 97.5 points and an increase of 41.7 points (P < 0.01). The joint function improved significantly. The arthrolysis of straight stiff knee joints after burns can ease muscle contracture and free the shade fascia, thus avoiding the need to undergo skin grafting. Short-term fixation of the joints after surgery and active flexion rehabilitation may also be the key to improve skin ductility and joint function of the patients. PMID:27011516

  11. Burns and military clothing.

    PubMed

    McLean, A D

    2001-02-01

    Burn injury is a ubiquitous threat in the military environment. The risks during combat are well recognised, but the handling of fuel, oil, munitions and other hot or flammable materials during peacetime deployment and training also imposes an inherent risk of accidental burn injury. Over the last hundred years, the burn threat in combat has ranged from nuclear weapons to small shoulder-launched missiles. Materials such as napalm and white phosphorus plainly present a risk of burn, but the threat extends to encompass personnel in vehicles attacked by anti-armour weapons, large missiles, fuel-air explosives and detonations/conflagrations on weapons platforms such as ships. Large numbers of burn casualties were caused at Pearl Harbor, in Hiroshima and Nagasaki, Vietnam, during the Arab/Israeli Wars and in the Falkland Islands conflict. The threat from burns is unlikely to diminish, indeed new developments in weapons seek to exploit the vulnerability of the serviceman and servicewoman to burns. Clothing can be a barrier to some types of burn--both inherently in the properties of the material, but also by trapping air between clothing layers. Conversely, ignition of the clothing may exacerbate a burn. There is hearsay that burnt clothing products within a wound may complicate the clinical management, or that materials that melt (thermoplastic materials) should not be worn if there is a burn threat. This paper explores the incidence of burn injury, the mechanisms of heat transfer to bare skin and skin covered by materials, and the published evidence for the complication of wound management by materials. Even light-weight combat clothing can offer significant protection to skin from short duration flash burns; the most vulnerable areas are the parts of the body not covered--face and hands. Multilayered combat clothing can offer significant protection for short periods from engulfment by flames; lightweight tropical wear with few layers offers little protection. Under high heat loads in the laboratory, combat clothing can ignite, but there is little evidence that clothing ignition is a common occurrence in military burn casualties. Thermoplastic materials have many benefits in civil and military clothing. There is little objective evidence that they exacerbate burns, or complicate burn management. Their use in military clothing must be based on objective evidence, not hearsay. PMID:11307683

  12. The Modified POSAS: A Novel Approach to Defining Pathologic and Non-Pathologic Scarring

    PubMed Central

    Fearmonti, Regina; Bond, Jennifer; Erdmann, Detlev; Levin, L. Scott; Pizzo, Salvatore V; Levinson, Howard

    2010-01-01

    Background Scarring is a highly prevalent and multifactorial process, yet no studies to date have attempted to distinguish pathologic from non-pathologic scarring. Methods This article defines and proposes methods of classifying pathologic scarring as it pertains to clinical presentation. Results We propose a new scar scale that incorporates pain and functional impairment. Conclusion The modified POSAS scar assessment scale is the first of its kind to factor in the functional deficits, pain and pruritus of scarring into measurements of associated morbidity. This has great potential in evaluating patient response to treatment and analyzing clinical outcomes. PMID:21200219

  13. Zinc burns: a rare burn injury.

    PubMed

    de Juan, A; Ramon, P; Santoyo, F; Alonso, S

    2000-08-01

    A patient was presented with significant burns resulting from a workplace accident in a zinc production unit. This occurred as a result of the spontaneous combustion of zinc bleed under high pressure. The patient sustained burns to the face, body, and hands and suffered significant injury to the left cornea. Computed imaging revealed solid particles in the ethmoid sinus and also in the right nasal fossa, dissecting the right lacrimal duct. Photographic documentation is presented. This injury was potentially preventable and resulted from poor observance of safety procedures. PMID:10812277

  14. Screening of candidate genes in fibroblasts derived from patients with Dupuytren's contracture using bioinformatics analysis.

    PubMed

    Liu, Haoyu; Yin, Weitian; Liu, Biao; Liu, Yan; Guo, Baofeng; Wei, Zhuang

    2015-08-01

    Our study aimed to identify candidate genes associated with Dupuytren's contracture (DC) and elucidate their roles in DC development. The microarray data of GSE21221 were downloaded from Gene Expression Omnibus database, including six samples from carpal tunnel-derived fibroblasts and six samples from DC-derived fibroblasts. The differentially expressed genes (DEGs) in DC samples were screened using limma package. GO annotation and KEGG pathway analyses were performed by DAVID online tool. Protein-protein interaction network and expression correlation network were constructed to identify crucial relationships between DEGs. Finally, candidate DC-associated genes were predicted based on comparative toxicogenomics database. A total of 529 DEGs (138 up- and 391 down-regulated) in DC-derived fibroblasts were screened and compared with carpal tunnel-derived fibroblasts. Only ten DC-associated genes, such as neurotrophin 3 (NTF3) and protein kinase C, epsilon (PRKCE), were further screened. In addition, NTF3 was significantly enriched in MAPK signaling pathway, in which other DEGs, such as nuclear receptor subfamily 4, group A, member 1 (NR4A1), fibroblast growth factor 22 (FGF22) and BDNF, were enriched. Besides, NTF3 could co-express with fibrillin 2 (FBN2), and PRKCE could co-express with zinc finger protein 516 (ZNF516), solute carrier organic anion transporter family, member 2A1 (SLCO2A1), chromosome 10 open reading frame 10 (C10orf10) and Kelch domain containing 7A (KLHDC7A). Our study indicates that these DEGs, including NTF3, FBN2, NR4A1, FGF22, BDNF, PRKCE, ZNF516, SLCO2A1, C10orf10 and KLHDC7A, may play important roles in DC development and serve as candidate molecular targets for treating DC. PMID:25963801

  15. American Burn Association

    MedlinePlus

    ... website MONTHLY HEADLINES from MSKTC (Model Systems Knowledge Translation Center) The American Burn Association Web site contains general information for burn care professionals. The ABA Web site is not intended to respond to requests for medical information, and the ABA is unable to respond ...

  16. Scar-free cutaneous wound healing in the leopard gecko, Eublepharis macularius.

    PubMed

    Peacock, Hanna M; Gilbert, Emily A B; Vickaryous, Matthew K

    2015-11-01

    Cutaneous wounds heal with two possible outcomes: scarification or near-perfect integumentary restoration. Whereas scar formation has been intensively investigated, less is known about the tissue-level events characterising wounds that spontaneously heal scar-free, particularly in non-foetal amniotes. Here, a spatiotemporal investigation of scar-free cutaneous wound healing following full-thickness excisional biopsies to the tail and body of leopard geckos (Eublepharis macularius) is provided. All injuries healed without scarring. Cutaneous repair involves the development of a cell-rich aggregate within the wound bed, similar to scarring wounds. Unlike scar formation, scar-free healing involves a more rapid closure of the wound epithelium, and a delay in blood vessel development and collagen deposition within the wound bed. It was found that, while granulation tissue of scarring wounds is hypervascular, scar-free wound healing conspicuously does not involve a period of exuberant blood vessel formation. In addition, during scar-free wound healing the newly formed blood vessels are typically perivascular cell-supported. Immunohistochemistry revealed widespread expression of both the pro-angiogenic factor vascular endothelial growth factor A and the anti-angiogenic factor thrombospondin-1 within the healing wound. It was found that scar-free wound healing is an intrinsic property of leopard gecko integument, and involves a modulation of the cutaneous scar repair program. This proportional revascularisation is an important factor in scar-free wound healing. PMID:26360824

  17. Burns following petrol sniffing.

    PubMed

    Janezic, T F

    1997-02-01

    Two patients with burns following petrol sniffing are presented. They sustained an 8 per cent and a 70 per cent total body surface area burn. The majority of the burned areas of both patients were full thickness and were treated by early excision and autografting, and in one patient with cultured epidermal autografts also. Both patients came from disorganized families, had behavioural problems and poor school performance. Clothes soaked with petrol, altered mental state and cigarette smoking are major risk factors for thermal injury while inhaling petrol. In order to recognize acute and chronic intoxication, burns unit staff should be aware of the clinical signs related to inhalation of petrol, especially because some of the burned petrol sniffers might not admit to petrol abuse. The social worker and psychologist are very likely to be vital in the rehabilitation of such patients. PMID:9115618

  18. Burning Mouth Syndrome

    PubMed Central

    Kamala, KA; Sankethguddad, S; Sujith, SG; Tantradi, Praveena

    2016-01-01

    Burning mouth syndrome (BMS) is multifactorial in origin which is typically characterized by burning and painful sensation in an oral cavity demonstrating clinically normal mucosa. Although the cause of BMS is not known, a complex association of biological and psychological factors has been identified, suggesting the existence of a multifactorial etiology. As the symptom of oral burning is seen in various pathological conditions, it is essential for a clinician to be aware of how to differentiate between symptom of oral burning and BMS. An interdisciplinary and systematic approach is required for better patient management. The purpose of this study was to provide the practitioner with an understanding of the local, systemic, and psychosocial factors which may be responsible for oral burning associated with BMS, and review of treatment modalities, therefore providing a foundation for diagnosis and treatment of BMS. PMID:26962284

  19. Hand chemical burns.

    PubMed

    Robinson, Elliot P; Chhabra, A Bobby

    2015-03-01

    There is a vast and ever-expanding variety of potentially harmful chemicals in the military, industrial, and domestic landscape. Chemical burns make up a small proportion of all skin burns, yet they can cause substantial morbidity and mortality. Additionally, the hand and upper extremity are the most frequently involved parts of the body in chemical burns, and therefore these injuries may lead to severe temporary or permanent loss of function. Despite this fact, discussion of the care of these injuries is sparse in the hand surgery literature. Although most chemical burns require only first response and wound care, some require the attention of a specialist for surgical debridement and, occasionally, skin coverage and reconstruction. Exposure to certain chemicals carries the risk of substantial systemic toxicity and even mortality. Understanding the difference between thermal and chemical burns, as well as special considerations for specific compounds, will improve patient treatment outcomes. PMID:25653184

  20. Electrospun Poly(L-Lactide) Fiber with Ginsenoside Rg3 for Inhibiting Scar Hyperplasia of Skin

    PubMed Central

    Hu, Changmin; Li, Haiyan; Zhang, Yuguang; Chang, Jiang

    2013-01-01

    Hypertrophic scarring (HS) has been considered as a great concern for patients and a challenging problem for clinicians as it can be cosmetically disfiguring and functionally debilitating. In this study, Ginsenoside Rg3/Poly(l-lactide) (G-Rg3/PLLA) electrospun fibrous scaffolds covering on the full-thickness skin excisions location was designed to suppress the hypertrophic scar formation in vivo. SEM and XRD results indicated that the crystal G-Rg3 carried in PLLA electrospun fibers was in amorphous state, which facilitates the solubility of G-Rg3 in the PLLA electrospun fibrous scaffolds, and solubility of G-Rg3 in PBS is increased from 3.2 µg/ml for pure G-Rg3 powders to 19.4 µg/ml for incorporated in PLLA-10% fibers. The released G-Rg3 content in the physiological medium could be further altered from 324 to 3445 µg in a 40-day release period by adjusting the G-Rg3 incorporation amount in PLLA electrospun fibers. In vitro results demonstrated that electrospun G-Rg3/PLLA fibrous scaffold could significantly inhibit fibroblast cell growth and proliferation. In vivo results confirmed that the G-Rg3/PLLA electrospun fibrous scaffold showed significant improvements in terms of dermis layer thickness, fibroblast proliferation, collagen fibers and microvessels, revealing that the incorporation of the G-Rg3 in the fibers prevented the HS formation. The above results demonstrate the potential use of G-Rg3/PLLA electrospun fibrous scaffolds to rapidly minimize fibroblast growth and restore the structural and functional properties of wounded skin for patients with deep trauma, severe burn injury, and surgical incision. PMID:23874757

  1. Physical and quality of life outcomes of patients with isolated hand burns--a prospective audit.

    PubMed

    Williams, Nicola; Stiller, Kathy; Greenwood, John; Calvert, Philip; Masters, Margot; Kavanagh, Sheila

    2012-01-01

    Hand burns can have major implications on function, appearance, and quality of life. Our clinical practice has changed over the last 10 years, with a steady increase in the proportion of hand burns receiving early and aggressive surgical management using Biobrane® sheets/gloves and a concomitant fall in the proportion requiring excision and split skin grafting. The aim of this study was to measure a comprehensive range of outcomes for patients admitted with isolated hand burns to review our outcomes and provide us with the "expected" patterns of recovery. A prospective audit was performed over a 14-month period, with outcomes measured during hospital admission and at 2 weeks, 1, 3, 6, and 12 months postinjury (depending on the method of management). Outcomes comprised pain, the Burns Specific Health Scale (abbreviated version B), return to work/leisure, total active range of motion, grip strength, the Michigan Hand Questionnaire, and scar appearance using Matching Assessment with Photographs of Scars. A total of 52 patients (35 male, mean age 39 years) with 57 burned hands participated. Patients whose burn injuries were such that they were able to be managed conservatively or with Biobrane® showed rapid recovery in all outcomes, with normal or near-normal values achieved within 2 weeks to 1 month postinjury. The patients whose burn injuries required excision and split skin grafting demonstrated more marked initial deterioration, a slower rate of improvement, but eventual good recovery. In conclusion, for this sample of patients with isolated hand burns, recovery was good and rapid for those whose burn injuries were such that they were managed conservatively or with Biobrane®. PMID:22210079

  2. Prevention of severe contractures might replace multilevel surgery in cerebral palsy: results of a population-based health care programme and new techniques to reduce spasticity.

    PubMed

    Hgglund, Gunnar; Andersson, Sofia; Dppe, Henrik; Lauge-Pedersen, Henrik; Pedertsen, Henrik Lauge; Nordmark, Eva; Westbom, Lena

    2005-07-01

    During the 1990s three new techniques to reduce spasticity and dystonia in children with cerebral palsy (CP) were introduced in southern Sweden: selective dorsal rhizotomy, continuous intrathecal baclofen infusion and botulinum toxin treatment. In 1994 a CP register and a health care programme, aimed to prevent hip dislocation and severe contractures, were initiated in the area. The total population of children with CP born 1990-1991, 1992-1993 and 1994-1995 was evaluated and compared at 8 years of age. In non-ambulant children the passive range of motion in hip, knee and ankle improved significantly from the first to the later age groups. Ambulant children had similar range of motion in the three age groups, with almost no severe contractures. The proportion of children treated with orthopaedic surgery for contracture or skeletal torsion deformity decreased from 40 to 15% (P = 0.0019). One-fifth of the children with spastic diplegia had been treated with selective dorsal rhizotomy. One-third of the children born 1994-1995 had been treated with botulinum toxin before 8 years of age. With early treatment of spasticity, early non-operative treatment of contracture and prevention of hip dislocation, the need for orthopaedic surgery for contracture or torsion deformity is reduced, and the need for multilevel procedures seems to be eliminated. PMID:15931031

  3. Rapid cooling-induced contractures in rat skinned skeletal muscle fibres originate from sarcoplasmic reticulum Ca2+ release through ryanodine and inositol trisphosphate receptors.

    PubMed

    Talon, S; Huchet-Cadiou, C; Léoty, C

    2000-11-01

    Previous reports have shown that cooling striated muscles induces contractile responses that are related to Ca2+ release from the sarcoplasmic reticulum. However, the effect of cooling has generally been studied in the presence of pharmacological agents that potentiate rapid cooling-induced contractures. The present study shows that in saponin-skinned rat skeletal muscle preparations, a drop in temperature from 22 degrees C to 2 degrees C per se induces a contracture which relaxes on return to 22 degrees C. In fast-twitch fibres, rapid cooling-induced contractures are fully blocked by ryanodine, an inhibitor of ryanodine receptors. By contrast, in slow-twitch fibres, ryanodine partially inhibits the rapid cooling-induced contractile response, leaving a residual tension that dissipates after application of inositol 1,4,5-trisphosphate (InsP3). At low concentrations, heparin, an inhibitor of InsP3 receptors, decreases rapid cooling-induced contractures in both types of muscle. The present results suggest that in skeletal muscle, rapid cooling-induced contractures are due to both ryanodine-sensitive and InsP3-sensitive Ca2+ release from the sarcoplasmic reticulum. PMID:11205048

  4. 4. VIEW OF DOWNSTREAM FACE OF DAM, WITH SCARS FROM ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    4. VIEW OF DOWNSTREAM FACE OF DAM, WITH SCARS FROM EARTH MOVING TO CONSTRUCT DAM IN FOREGROUND, LOOKING NORTHWEST - High Mountain Dams in Upalco Unit, Five Point Lake Dam, Ashley National Forest, 12 miles Northwest of Swift Creek Campground, Mountain Home, Duchesne County, UT

  5. 8. VIEW OF BASIN BEHIND DAM, SHOWING SCARS FROM EARTH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. VIEW OF BASIN BEHIND DAM, SHOWING SCARS FROM EARTH MOVING TO CONSTRUCT DAM, LOOKING NORTH - High Mountain Dams in Upalco Unit, East Timothy Lake Dam, Ashley National Forest, 8.4 miles North of Swift Creek Campground, Mountain Home, Duchesne County, UT

  6. 9. VIEW OF BASIN BEHIND DAM, SHOWING SCARS FROM EARTH ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    9. VIEW OF BASIN BEHIND DAM, SHOWING SCARS FROM EARTH MOVING TO CONSTRUCT DAM, LOOKING EAST - High Mountain Dams in Upalco Unit, East Timothy Lake Dam, Ashley National Forest, 8.4 miles North of Swift Creek Campground, Mountain Home, Duchesne County, UT

  7. Histologic features of alopecias: part II: scarring alopecias.

    PubMed

    Bernárdez, C; Molina-Ruiz, A M; Requena, L

    2015-05-01

    The diagnosis of disorders of the hair and scalp can generally be made on clinical grounds, but clinical signs are not always diagnostic and in some cases more invasive techniques, such as a biopsy, may be necessary. This 2-part article is a detailed review of the histologic features of the main types of alopecia based on the traditional classification of these disorders into 2 major groups: scarring and nonscarring alopecias. Scarring alopecias are disorders in which the hair follicle is replaced by fibrous scar tissue, a process that leads to permanent hair loss. In nonscarring alopecias, the follicles are preserved and hair growth can resume when the cause of the problem is eliminated. In the second part of this review, we describe the histologic features of the main forms of scarring alopecia. Since a close clinical-pathological correlation is essential for making a correct histopathologic diagnosis of alopecia, we also include a brief description of the clinical features of the principal forms of this disorder. PMID:25439143

  8. [Nonablative fractional lasers: Acne scars and other indications].

    PubMed

    Degitz, K

    2015-10-01

    Nonablative photothermolysis has become an established technique in laser dermatology. It is mainly used for restructuring dermal connective tissue in order to treat, for example, acne scars or solar elastosis. It is also applied to the treatment of melasma and other benign cutaneous pigment disorders. This article discusses various indications in light of published observations and with regard to practical considerations. PMID:26253115

  9. Occlusion Regulates Epidermal Cytokine Production and Inhibits Scar Formation

    PubMed Central

    Gallant-Behm, Corrie L; Mustoe, Thomas A

    2010-01-01

    Hypertrophic scars are a major clinical problem, yet there are few therapeutics available to prevent or treat scar formation. One of the oldest known and most effective treatments is occlusion with silicone gel. However, little is known about its mode of action. It is hypothesized that occlusion increases the hydration state of the epidermis, and that this affects the epidermal and dermal cell behavior. This study investigated that possibility. Using the rabbit hypertrophic scar model, we determined that occlusion was able to increase the hydration state of the epidermis in a dose dependent manner, and significantly reduced the scar hypertrophy. Quantitative RT-PCR and immunohistochemistry demonstrated that occlusion altered the keratinocyte behavior, including keratin expression. Furthermore, occlusion significantly decreased the epidermal expression of the pro-fibrotic cytokine IL-1? and increased the epidermal expression of the anti-fibrotic cytokine TNF-?. Those alterations in epidermal gene expression resulted in concomitant changes in the expression of TGF-? family members by cells in the dermis, resulting in a decrease in pro-fibrotic signaling within the dermis. In summary, the results of this study indicate that occlusive therapy was able to decrease dermal fibrosis by hydrating the epidermis and altering the pro- and anti-fibrotic signals produced following injury. PMID:20419876

  10. Ectopic Pregnancy in caesarean section scar: A case report.

    PubMed

    Aich, Rajarshi; Solanki, Narayan; Kakadiya, Ketan; Bansal, Ashank; Joshi, Manisha; Nawale, Ajita

    2015-12-01

    We report a rare case of ectopic pregnancy occurring in the scar of a previous caesarean section, diagnosed by ultrasonography and confirmed by 3.0-T magnetic resonance imaging of pelvis. We present the clinical details and imaging findings, followed by discussion of the etiology, pathogenesis, and imaging of this condition. PMID:26649124

  11. Ectopic Pregnancy in caesarean section scar: A case report

    PubMed Central

    Aich, Rajarshi; Solanki, Narayan; Kakadiya, Ketan; Bansal, Ashank; Joshi, Manisha; Nawale, Ajita

    2015-01-01

    We report a rare case of ectopic pregnancy occurring in the scar of a previous caesarean section, diagnosed by ultrasonography and confirmed by 3.0-T magnetic resonance imaging of pelvis. We present the clinical details and imaging findings, followed by discussion of the etiology, pathogenesis, and imaging of this condition. PMID:26649124

  12. Molecular mechanisms of scar-sourced axon growth inhibitors.

    PubMed

    Ohtake, Yosuke; Li, Shuxin

    2015-09-01

    Astrogliosis is a defense response of the CNS to minimize primary damage and to repair injured tissues, but it ultimately generates harmful effects by upregulating inhibitory molecules to suppress neuronal elongation and forming potent barriers to axon regeneration. Chondroitin sulfate proteoglycans (CSPGs) are highly expressed by reactive scars and are potent contributors to the non-permissive environment in mature CNS. Surmounting strong inhibition by CSPG-rich scar is an important therapeutic goal for achieving functional recovery after CNS injuries. Currently, enzymatic digestion of CSPGs with locally applied chondroitinase ABC is the main in vivo approach to overcome scar inhibition, but several disadvantages may prevent using this bacterial enzyme as a therapeutic option for patients. A better understanding of molecular mechanisms underlying CSPG function may facilitate development of new effective therapies to overcome scar-mediated inhibition. Previous studies support that CSPGs act by non-specifically hindering the binding of matrix molecules to their cell surface receptors through steric interactions, but two members of the leukocyte common antigen related (LAR) phosphatase subfamily, protein tyrosine phosphatase σ and LAR, are functional receptors that bind CSPGs with high affinity and mediate CSPG inhibition. CSPGs may also act by binding two receptors for myelin-associated growth inhibitors, Nogo receptors 1 and 3. Thus, CSPGs inhibit axon growth through multiple mechanisms, making them especially potent and difficult therapeutic targets. Identification of CSPG receptors is not only important for understanding the scar-mediated growth suppression, but also for developing novel and selective therapies to promote axon sprouting and/or regeneration after CNS injuries. This article is part of a Special Issue entitled SI: Spinal cord injury. PMID:25192646

  13. Serious occupational burn injuries treated at a regional burn center.

    PubMed

    Taylor, Allison J; McGwin, Gerald; Cross, James M; Smith, Donald R; Birmingham, Barbara R; Rue, Loring W

    2002-01-01

    This article will present the epidemiology of occupational burn injuries among patients admitted to a regional burn center. Patients admitted to University of Alabama at Birmingham University Hospital Burn Center between November 1994 and December 1999 for occupational burn injuries were studied. Descriptive statistics were generated for demographic, clinical, and outcome characteristics. Approximately one-quarter of all burn center admissions had sustained occupational burn injuries. The most common burns were flame, electrical, and scald burns. The most heavily represented occupations were "manufacturing" (19.1%), "electrician" (16.2%), and "laborer" (16.2%). Burn type varied with occupation. Over $16 million in hospital charges was accrued by patients sustaining occupational burn injuries. Understanding the epidemiology of serious burn injuries in the workplace is crucial to directing prevention efforts toward worker groups at highest risk. PMID:12142576

  14. Cell therapy of burns.

    PubMed

    Leclerc, T; Thepenier, C; Jault, P; Bey, E; Peltzer, J; Trouillas, M; Duhamel, P; Bargues, L; Prat, M; Bonderriter, M; Lataillade, J-J

    2011-04-01

    Severe burns remain a life-threatening local and general inflammatory condition often with serious sequelae, despite remarkable progress in their treatment over the past three decades. Cultured epidermal autografts, the first and still most up-to-date cell therapy for burns, plays a key role in that progress, but drawbacks to this need to be reduced by using cultured dermal-epidermal substitutes. This review focuses on what could be, in our view, the next major breakthrough in cell therapy of burns - use of mesenchymal stromal cells (MSCs). After summarizing current knowledge, including our own clinical experience with MSCs in the pioneering field of cell therapy of radiation-induced burns, we discuss the strong rationale supporting potential interest in MSCs in treatment of thermal burns, including limited but promising pre-clinical and clinical data in wound healing and acute inflammatory conditions other than burns. Practical options for future therapeutic applications of MSCs for burns treatment, are finally considered. PMID:21481044

  15. Sequential treatment with intradermal incision (intracision) and 2,940-nm Er:YAG laser for chicken pox scars.

    PubMed

    Lee, Sang Ju; Kim, Young Koo; Choi, Sun Young; Park, Kui Young; Seo, Seong Jun

    2014-01-01

    Boxcar scars, such as chicken pox scars, are round to oval depressions with sharply defined vertical edges. Subcision is a simple and safe procedure for treatment of atrophic and depressed scars, but boxcar scars are generally not eliminated by subcision. Intradermal incision technique (intracision) can treat chicken pox scars by untethering fibrotic strands, raising collagen synthesis, and having additional intradermal blood pocket formation. We have found that chicken pox scars further improve when intracision is followed by laser skin resurfacing. PMID:24502307

  16. The therapeutic potential of a C-X-C chemokine receptor type 4 (CXCR-4) antagonist on hypertrophic scarring in vivo.

    PubMed

    Ding, Jie; Ma, Zengshuan; Liu, Hongbin; Kwan, Peter; Iwashina, Takashi; Shankowsky, Heather A; Wong, Donald; Tredget, Edward E

    2014-01-01

    Effective prevention and treatment of hypertrophic scars (HTSs), a dermal form of fibrosis that frequently occurs following thermal injury to deep dermis, are unsolved significant clinical problems. Previously, we have found that stromal cell-derived factor 1/CXCR4 signaling is up-regulated during wound healing in burn patients and HTS tissue after thermal injury. We hypothesize that blood-borne mononuclear cells are recruited into wound sites after burn injury through the chemokine pathway of stromal cell-derived factor 1 and its receptor CXCR4. Deep dermal injuries to the skin are often accompanied by prolonged inflammation, which leads to chemotaxis of mononuclear cells into the wounds by chemokine signaling where fibroblast activation occurs and ultimately HTS are formed. Blocking mononuclear cell recruitment and fibroblast activation, CXCR4 antagonism is expected to reduce or minimize scar formation. In this study, the inhibitory effect of CXCR4 antagonist CTCE-9908 on dermal fibrosis was determined in vivo using a human HTS-like nude mouse model, in which split-thickness human skin is transplanted into full-thickness dorsal excisional wounds in athymic mice, where these wounds subsequently develop fibrotic scars that resemble human HTS as previously described. CTCE-9908 significantly attenuated scar formation and contraction, reduced the accumulation of macrophages and myofibroblasts, enhanced the remodeling of collagen fibers, and down-regulated the gene and protein expression of fibrotic growth factors in the human skin tissues. These findings support the potential therapeutic value of CXCR4 antagonist in dermal fibrosis and possibly other fibroproliferative disorders. PMID:25139227

  17. [Keloid scars (part I): Clinical presentation, epidemiology, histology and pathogenesis].

    PubMed

    Philandrianos, C; Kerfant, N; Jaloux, C; Martinet, L; Bertrand, B; Casanova, D

    2016-04-01

    Keloid scars are a dysregulated response to cutaneous wound healing and are characterized by excessive deposition of collagen. Clinical and histological aspects are typical but they are often confused with hypertrophic scars. Principal pathogenesis is abnormal regulation of the collagen equilibrium because of TGFβ. In this first part, clinical characteristics, physiopathology and histology of keloid scars are explained. PMID:26545809

  18. Reliability of biomass burning estimates from savanna fires: Biomass burning in northern Australia during the 1999 Biomass Burning and Lightning Experiment B field campaign

    NASA Astrophysics Data System (ADS)

    Russell-Smith, Jeremy; Edwards, Andrew C.; Cook, Garry D.

    2003-02-01

    This paper estimates the two-daily extent of savanna burning and consumption of fine (grass and litter) fuels from an extensive 230,000 km2 region of northern Australia during August-September 1999 encompassing the Australian continental component of the Biomass Burning and Lightning Experiment B (BIBLE B) campaign [, 2002]. The extent of burning for the study region was derived from fire scar mapping of imagery from the advanced very high resolution radiometer (AVHRR) on board the National Oceanic and Atmospheric Administration (NOAA) satellite. The mapping was calibrated and verified with reference to one Landsat scene and associated aerial transect validation data. Fine fuel loads were estimated using published fuel accumulation relationships for major regional fuel types. It is estimated that more than 43,000 km2 was burnt during the 25 day study period, with about 19 Mt of fine (grass and litter) fuels. This paper examines assumptions and errors associated with these estimates. It is estimated from uncalibrated fire mapping derived from AVHRR imagery that 417,500 km2 of the northern Australian savanna was burnt in 1999, of which 136,405 km2, or 30%, occurred in the Northern Territory study region. Using generalized fuel accumulation equations, such biomass burning consumed an estimated 212.3 Mt of fine fuels, but no data are available for consumption of coarse fuels. This figure exceeds a recent estimate, based on fine fuels only, for the combined Australian savanna and temperate grassland biomass burning over the period 1990-1999 but is lower than past estimates derived from classification approaches. We conclude that (1) fire maps derived from coarse-resolution optical imagery can be applied relatively reliably to estimate the extent of savanna fires, generally with 70-80% confidence using the approach adopted here, over the major burning period in northern Australia and (2) substantial further field assessment and associated modeling of fuel accumulation, especially of coarse fuels, is required.

  19. Bladder neck contractureincidence and management following contemporary robot assisted radical prostatectomy technique

    PubMed Central

    Parihar, Jaspreet Singh; Ha, Yun-Sok; Kim, Isaac Yi

    2014-01-01

    Purpose: Bladder neck contracture (BNC) is a well-recognized complication following robot-assisted radical prostatectomy (RARP) for treatment of localized prostate cancer with a reported incidence of up to 1.4%. In this series, we report our institutional experience and management results. Methods: A prospectively collected database of patients who underwent RARP by a single surgeon from 2006 to 2012 was reviewed. Watertight bladder neck to urethral anastomosis was performed over 18-French foley catheter. BNC was diagnosed by flexible cystoscopy in patients who developed symptoms of bladder outlet obstruction. Subsequently, these patients underwent cold knife bladder neck incisions. Patients then followed a strict self regimen of clean intermittent catheterization (CIC). We identify the patient demographics, incidence of BNC, associated risk factors and success of subsequent management. Results: Total of 930 patients who underwent RARP for localized prostate cancer was identified. BNC was identified in 15 patients, 1.6% incidence. Mean patient age and preoperative prostate-specific antigen was 58.8 years old and 7.83 ng/mL (range, 2.514.55 ng/mL) respectively. Mean estimated blood loss was 361193 mL (range, 50650 mL). Follow-up was mean of 23.4 months. Average time to BNC diagnosis was 5.5 months. In three patients, a foreign body was identified at bladder neck. On multivariate analysis, estimated blood loss was significantly associated with development of BNC. All patients underwent cystoscopy and bladder neck incision with a 3-month CIC regimen. Out of 15 index patients, none had a BNC recurrence over the follow-up period. Conclusions: BNC was identified in 1.6% of patients in our series following RARP. Intraoperative blood loss was a significant risk factor for BNC. In 20% of BNC patients a migrated foreign body was noted at vesicourethral anastomosis. Primary management of patients with BNC following RARP should be bladder neck incision and self CIC regimen. PMID:24693529

  20. Reliability and validity of the body image quality of life inventory: version for Brazilian burn victims.

    PubMed

    Assunção, Flávia Fernanda Oliveira; Dantas, Rosana Aparecida Spadoti; Ciol, Márcia Aparecida; Gonçalves, Natália; Farina, Jayme Adriano; Rossi, Lidia Aparecida

    2013-06-01

    The aims of this study were to adapt the Body Image Quality of Life Inventory (BIQLI) into Brazilian Portuguese (BP) and to assess the psychometric properties of the adapted version. Construct validity was assessed by correlating the BIQLI-BP scores with the Rosenberg's Self-Esteem Scale, with Burns Specific Health Scale-Revised (BSHS-R), and with gender, total body surface area burned, and visibility of the scars. Participants were 77 adult burn patients. Cronbach's alpha for the adapted version was .90 and moderate linear correlations were found between body image and self-esteem and between BIQLI-BP scores and two domains of the BSHS-R: affect and body image and interpersonal relationships. The BIQLI-BP showed acceptable levels of reliability and validity for Brazilian burn patients. PMID:23494960

  1. ["Raw and charred flesh": the experience of burned women in Northeast Brazil].

    PubMed

    Arruda, Cristiani Nobre de; Braide, Andrea Stopglia Guedes; Nations, Marilyn

    2014-10-01

    In Northeast Brazil, death from burns is a widespread, pervasive threat to poor women. This anthropological study describes the experience of personal suffering among female burn patients. In 2009, six "information-rich" cases were investigated at the Burn Center in Fortaleza, Ceará State, Brazil. Open ethnographic interviews with key informants, narratives of lived experiences, and participant observation at the clinic and patients' home were conducted. The methods included content analysis, systems of signs, meanings, and actions, and contextualized semantic interpretation. The emerging metaphors are embued with the cultural meaning of "monstrosity" and gender violence by fire - inscribed mercilessly in the woman's body. "Accidents" caused by flammable liquids (alcohol) hide the cruel reality of "raw and charred flesh". The scars can disfigure the victims as "non-persons", destroying their moral reputation and leading to social rejection. In the Brazilian Northeast, the social vulnerability caused by sequelae from burns demands a policy for humanized care. PMID:25388309

  2. Effect of pERK2 on extracellular matrix turnover of the fibrotic joint capsule in a post-traumatic joint contracture model

    PubMed Central

    SUN, YANGBAI; LI, FENGFENG; FAN, CUNYI

    2016-01-01

    Lentivirus (LV)-mediated extracellular signal-regulated kinase (ERK)2 small interfering RNA (siRNA) has previously been demonstrated to reduce post-traumatic joint contractures: In the present study, the effect of ERK2 siRNA on extracellular matrix turnover within fibrotic joint capsules in post-traumatic joint contractures was examined. Rats were randomly assigned to one of three groups as follows: The non-operated control (CON), operated contracture (ORC) and contracture-treatment (CNT) groups. Representative post-traumatic joint contracture was created through 8 weeks of immobilization following intra-articular injury. In the CNT group, LV-mediated ERK2 siRNA was injected into the model knee at days 3 and 7 after surgery. The posterior joint capsule was examined by western blotting, histology and immunohistochemistry to evaluate alterations in ERK2, phosphorylated (p)ERK2, total collagen, collagen I, collagen III, matrix metalloproteinase (MMP)-1, MMP-13 and tissue inhibitor of metalloproteinase (TIMP)-13. In the ORC group, pERK2 was elevated and total collagen, collagen I, MMP-1 and MMP-13 were significantly increased (P<0.01 vs. CON group); however, these were significantly decreased in the CNT group, and pERK2 was downregulated (P<0.01 vs. ORC group). Collagen III and TIMP-13 were markedly decreased in the ORC group (P<0.01 vs. CON group), but elevated in the CNT group (P<0.01 vs. ORC group). The present res4ults demonstrate unique pathological changes of the fibrotic joint capsule that are responsible for joint contracture following traumatic injury, and reveal that extracellular matrix turnover can be affected by pERK2. PMID:26893645

  3. 'Burns Cliff' Beckons

    NASA Technical Reports Server (NTRS)

    2004-01-01

    This approximate true-color image taken by the panoramic camera on the Mars Exploration Rover Opportunity highlights a feature called 'Burns Cliff' within the impact crater known as 'Endurance.' Scientists are eager to explore this layered ridge for clues to the red planet's past. The only problem is its location: Burns Cliff is a vertical drop, which poses an interesting challenge for rover planners. Burns Cliff was named after the late scientist Roger Burns, who was one of the first to correctly propose the importance of sulfate and jarosite to the study of Mars' geologic history.

    This image is a portion of a larger mosaic taken with the panoramic camera's 480-, 530- and 750-nanometer filters on sols 97 and 98.

  4. Burns (For Parents)

    MedlinePlus

    ... medical assistance. Do not use wet compresses or ice because they can cause the child's body temperature to drop. Instead, cover the area with a clean, soft cloth or towel. The burn comes from a ...

  5. Self-inflicted burns.

    PubMed

    Hammond, J S; Ward, C G; Pereira, E

    1988-01-01

    Suicide by self-inflicted burns is uncommon in Western cultures. The majority of patients who attempt suicide in this manner have preexisting psychiatric illness, including a history of prior suicide attempts. A history of previous self-inflicted burn is rare, however, as are further suicide attempts in survivors. In this series of 33 patients, a cultural trend can be identified, with an increased incidence among Latin women. PMID:3360822

  6. Burning Mouth Syndrome

    PubMed Central

    Mock, David; Chugh, Deepika

    2010-01-01

    Most clinicians dread seeing the patient presenting with a primary complaint of a burning pain on one or more oral mucosal surfaces. Unlike most other clinical conditions presenting in a dental office, burning mouth syndrome is poorly understood with few evidence based remedies. More recently, advances have been made towards clarifying the possible etiology of the disorder and testing the possible therapeutic modalities available. This article attempts to summarize the “state of the art” today. PMID:20690412

  7. Burn Depth Monitor

    NASA Technical Reports Server (NTRS)

    1993-01-01

    Supra Medical Systems is successfully marketing a device that detects the depth of burn wounds in human skin. To develop the product, the company used technology developed by NASA Langley physicists looking for better ultrasonic detection of small air bubbles and cracks in metal. The device is being marketed to burn wound analysis and treatment centers. Through a Space Act agreement, NASA and the company are also working to further develop ultrasonic instruments for new medical applications

  8. Burn Depth Monitor

    NASA Technical Reports Server (NTRS)

    1993-01-01

    Supra Medical Systems is successfully marketing a device that detects the depth of burn wounds in human skin. To develop the product, the company used technology developed by NASA Langley physicists looking for better ultrasonic detection of small air bubbles and cracks in metal. The device is being marketed to burn wound analysis and treatment centers. Through a Space Act agreement, NASA and the company are also working to further develop ultrasonic instruments for new medical applications.

  9. Burn Depth Monitor

    NASA Technical Reports Server (NTRS)

    1993-01-01

    Supra Medical Systems is successfully marketing a device that detects the depth of burn wounds in human skin. To develop the product, the companyused technology developed by NASA Langley physicists looking for better ultrasonic detection of small air bubbles and cracks in metal. The device is being marketed to burn wound analysis and treatment centers. Through a Space Act agreement, NASA and the company are also working to further develop ultrasonic instruments for new medical applications.

  10. A novel mutation in two Hmong families broadens the range of STRA6-related malformations to include contractures and camptodactyly.

    PubMed

    Marcadier, Julien L; Mears, Alan J; Woods, Elizabeth A; Fisher, Jamie; Airheart, Cory; Qin, Wen; Beaulieu, Chandree L; Dyment, David A; Innes, A Micheil; Curry, Cynthia J

    2016-01-01

    PDAC (also termed Matthew Wood) syndrome is a rare, autosomal recessive disorder characterized by pulmonary hypoplasia/aplasia, diaphragmatic defects, bilateral anophthalmia, and cardiac malformations. The disorder is caused by mutations in STRA6, an important regulator of vitamin A and retinoic acid metabolism. We describe six cases from four families of Hmong ancestry, seen over a 30 years period in California. These include: (i) consanguineous siblings with a combination of bilateral anophthalmia, diaphragmatic abnormalities, truncus arteriosus, and/or pulmonary agenesis/hypoplasia; (ii) a singleton fetus with bilateral anophthalmia, pulmonary agenesis, cardiac malformation, and renal hypoplasia; (iii) a sibling pair with a combination of antenatal contractures, camptodactyly, fused palpebral fissures, pulmonary agenesis, and/or truncus arteriosus; (iv) a fetus with bilateral anophthalmia, bushy eyebrows, pulmonary agenesis, heart malformation, and abnormal hand positioning. The phenotypic spectrum of PDAC syndrome has until now not included contractures or camptodactyly. Sequencing of STRA6 in unrelated members of families three and four identified a novel, shared homozygous splice site alteration (c.113 + 3_4delAA) that is predicted to be pathogenic. We hypothesize this may represent a unique disease allele in the Hmong. We also provide a focused review of all published PDAC syndrome cases with confirmed or inferred STRA6 mutations, illustrating the phenotypic and molecular variability that characterizes this disorder. © 2015 Wiley Periodicals, Inc. PMID:26373900

  11. Release of insulin from PLGA-alginate dressing stimulates regenerative healing of burn wounds in rats.

    PubMed

    Dhall, Sandeep; Silva, João P; Liu, Yan; Hrynyk, Michael; Garcia, Monika; Chan, Alex; Lyubovitsky, Julia; Neufeld, Ronald J; Martins-Green, Manuela

    2015-12-01

    Burn wound healing involves a complex set of overlapping processes in an environment conducive to ischaemia, inflammation and infection costing $7.5 billion/year in the U.S.A. alone, in addition to the morbidity and mortality that occur when the burns are extensive. We previously showed that insulin, when topically applied to skin excision wounds, accelerates re-epithelialization and stimulates angiogenesis. More recently, we developed an alginate sponge dressing (ASD) containing insulin encapsulated in PLGA [poly(D,L-lactic-co-glycolic acid)] microparticles that provides a sustained release of bioactive insulin for >20 days in a moist and protective environment. We hypothesized that insulin-containing ASD accelerates burn healing and stimulates a more regenerative, less scarring healing. Using heat-induced burn injury in rats, we show that burns treated with dressings containing 0.04 mg insulin/cm(2) every 3 days for 9 days have faster closure, a higher rate of disintegration of dead tissue and decreased oxidative stress. In addition, in insulin-treated wounds, the pattern of neutrophil inflammatory response suggests faster clearing of the burned dead tissue. We also observe faster resolution of the pro-inflammatory macrophages. We also found that insulin stimulates collagen deposition and maturation with the fibres organized more like a basket weave (normal skin) than aligned and cross-linked (scar tissue). In summary, application of ASD-containing insulin-loaded PLGA particles on burns every 3 days stimulates faster and more regenerative healing. These results suggest insulin as a potential therapeutic agent in burn healing and, because of its long history of safe use in humans, insulin could become one of the treatments of choice when repair and regeneration are critical for proper tissue function. PMID:26310669

  12. Ball lightning burn.

    PubMed

    Selvaggi, Gennaro; Monstrey, Stan; von Heimburg, Dennis; Hamdi, Mustapha; Van Landuyt, Koen; Blondeel, Phillip

    2003-05-01

    Ball lightning is a rare physical phenomenon, which is not yet completely explained. It is similar to lightning but with different, peculiar characteristics. It can be considered a mix of fire and electricity, concentrated in a fireball with a diameter of 20-cm that most commonly appears suddenly, even in indoor conditions, during a thunderstorm. It moves quickly for several meters, can change direction, and ultimately disappears. During a great storm, a 28-year-old man and his 5-year-old daughter sustained burn wounds after ball lightning came from the outdoors through a chimney. These two patients demonstrated signs of fire and electrical injuries. The father, who lost consciousness, sustained superficial second-degree burn wounds bilaterally on the zygomatic area and deep second-degree burn wounds on his right hand (total body surface area, 4%). His daughter demonstrated superficial second-degree burn wounds on the left part of the face and deep second-degree and third-degree burn wounds (total body surface area, 30%) on the left neck, both upper arms, and the back. In this article, the authors report the first two cases of burn injuries resulting from ball lightning contact indoors. The literature on this rare phenomenon is reviewed to elucidate the nature of ball lightning. Emphasis is placed on the nature of injuries after ball lightning contact, the therapy used, and the long-term complications. PMID:12792547

  13. Use of makeup, hairstyles, glasses, and prosthetics as adjuncts to scar camouflage.

    PubMed

    Sidle, Douglas M; Decker, Jennifer R

    2011-08-01

    Scars after facial trauma or surgery can be a source of distress for patients, and facial plastic surgeons are frequently called upon to help manage them. Although no technique can remove a scar, numerous treatment modalities have been developed to improve facial scar appearance with varying levels of invasiveness. This article reviews techniques that camouflage scars without surgical intervention. Topical scar treatments, camouflage cosmetics, use of hairstyling and glasses, and facial prosthetics are discussed. In addition, professional counseling is provided on selection and application of topical cosmetics for use as part of an office practice. PMID:21856536

  14. PBXN-110 Burn Rate Estimate

    SciTech Connect

    Glascoe, E

    2008-08-11

    It is estimated that PBXN-110 will burn laminarly with a burn function of B = (0.6-1.3)*P{sup 1.0} (B is the burn rate in mm/s and P is pressure in MPa). This paper provides a brief discussion of how this burn behavior was estimated.

  15. Burns in Nigeria: a Review

    PubMed Central

    Oladele, A.O.; Olabanji, J.K.

    2010-01-01

    Summary Burn injuries continue to be a major source of mortality and morbidity in low- and middle-income countries of the world, of which Nigeria is a part. Overview data on burn care in Nigeria are sparse but the available literature on burns and burn care in Nigeria was retrieved through Internet-based search engines, collated, and reviewed. Peculiarities of epidemiology, types of burn, pattern of injuries, complications, and outcome of burn care were reviewed. There were no broad-based overview statistical data on burns in Nigeria in all the articles reviewed. There was no documentation on the regionalization of care and there were no national databases. All reports on epidemiology were hospital-based. Flame is emerging as the predominant cause of burns, and burn injury is occurring increasingly away from the domestic setting. The severity of the injuries is also increasing. Deliberate burn injury remains a practice and a wide range of complications occur as burns sequelae in Nigeria. Several challenges militate against optimal care for burn victims. Burn injuries continue to contribute significantly to the burden of disease in Nigeria. There is a need for broad-based data collection systems. Avoidable complications are common and mortality remains high. Pooling of resources by regionalization of care could increase focus on burn prevention and improve the care of burn victims. Nongovernmental and governmental support to reduce the burden of burns is advocated. PMID:21991210

  16. The media glorifying burns: a hindrance to burn prevention.

    PubMed

    Greenhalgh, David G; Palmieri, Tina L

    2003-01-01

    The media have a profound influence on the actions of children and adults. Burns and burn prevention tend to be ignored or even mocked. The purpose of this presentation is to reveal the callousness of the media in its dealings with burns and burn prevention. Printed materials with a relationship to burns, risk of burning, or disrespect for the consequences of burns were collected. The materials were tabulated into four categories: comics, advertisements (ads), articles that made light of burns, and television shows that portrayed behavior that would risk burn injury. Most burn-related materials were found in comics or advertisements. Several comics made light of high-risk behavior with flames, scald injury, contact injury, or burns. In addition, several advertisements showed people on fire or actions that could easily lead to burns. Several articles and televisions shows portrayed high-risk behavior that, in some instances, led to copycat injuries. Flames are frequently used to sell items that target adolescent boys or young men. The high incidence injuries that frequent this population parallel the high-risk behaviors portrayed by the media. The media portrays flames and high-risk behavior for burn injury as being cool, funny, and without consequence. The use of flames on clothing and recreational equipment (skateboards, hot rods) particularly targets the high-risk adolescent male. The burn community should make the media aware of the harm it causes with its callous depiction and glorification of burns. PMID:12792237

  17. Keloids and Hypertrophic Scars: A Spectrum of Clinical Challenges.

    PubMed

    Trace, Anthony P; Enos, Clinton W; Mantel, Alon; Harvey, Valerie M

    2016-06-01

    Since their earliest description, keloids and hypertrophic scars have beleaguered patients and clinicians alike. These scars can be aesthetically disfiguring, functionally debilitating, emotionally distressing, and psychologically damaging, culminating in a significant burden for patients. Our current understanding of keloid pathophysiology has grown and continues to advance while molecular biology, genetics, and technology provide ever-deepening insight into the nature of wound healing and the pathologic perturbations thereof. Greater understanding will lead to the development and application of refined therapeutic modalities. This article provides an overview of our current understanding of keloids, highlighting clinical characteristics and diagnostic criteria while providing a comprehensive summary of the many therapeutic modalities available. The proposed mechanism, application, adverse events, and reported efficacy of each modality is evaluated, and current recommendations are summarized. PMID:26894654

  18. Skin, fascias, and scars: symptoms and systemic connections

    PubMed Central

    Bordoni, Bruno; Zanier, Emiliano

    2014-01-01

    Every element or cell in the human body produces substances that communicate and respond in an autocrine or paracrine mode, consequently affecting organs and structures that are seemingly far from each other. The same also applies to the skin. In fact, when the integrity of the skin has been altered, or when its healing process is disturbed, it becomes a source of symptoms that are not merely cutaneous. The skin is an organ, and similar to any other structure, it has different functions in addition to connections with the central and peripheral nervous system. This article examines pathological responses produced by scars, analyzing definitions and differences. At the same time, it considers the subcutaneous fascias, as this connective structure is altered when there is a discontinuous cutaneous surface. The consequence is an ample symptomatology, which is not limited to the body area where the scar is located, such as a postural or trigeminal disorder. PMID:24403836

  19. Quantitative assessment of graded burn wounds in a porcine model using spatial frequency domain imaging (SFDI) and laser speckle imaging (LSI)

    PubMed Central

    Ponticorvo, Adrien; Burmeister, David M.; Yang, Bruce; Choi, Bernard; Christy, Robert J.; Durkin, Anthony J.

    2014-01-01

    Accurate and timely assessment of burn wound severity is a critical component of wound management and has implications related to course of treatment. While most superficial burns and full thickness burns are easily diagnosed through visual inspection, burns that fall between these extremes are challenging to classify based on clinical appearance. Because of this, appropriate burn management may be delayed, increasing the risk of scarring and infection. Here we present an investigation that employs spatial frequency domain imaging (SFDI) and laser speckle imaging (LSI) as non-invasive technologies to characterize in-vivo burn severity. We used SFDI and LSI to investigate controlled burn wounds of graded severity in a Yorkshire pig model. Burn wounds were imaged starting at one hour after the initial injury and daily at approximately 24, 48 and 72 hours post burn. Biopsies were taken on each day in order to correlate the imaging data to the extent of burn damage as indicated via histological analysis. Changes in reduced scattering coefficient and blood flow could be used to categorize burn severity as soon as one hour after the burn injury. The results of this study suggest that SFDI and LSI information have the potential to provide useful metrics for quantifying the extent and severity of burn injuries. PMID:25360365

  20. Sprayed cultured mucosal epithelial cell for deep dermal burns.

    PubMed

    Ueda, Minoru

    2010-11-01

    Mucosal epithelial cells have various advantages compared with epidermal cells, such as their high proliferation ability and long biologic activity. The objective of this study was to assess the clinical results after sprayed application of cultured mucosal epithelial autograft (CMEA) suspensions onto deep dermal burn wounds. Ten patients with deep dermal burns were included in a prospective study. The average total-body-surface-area burn was 17.7% (8%-45%). The average Abbreviated Burn Severity Index was 6.3 points (4-9 points). The application of sprayed CMEA suspension was performed onto an average body surface area of 2.05% (0.5%-5%; median, 2%). Eight patients were recruited for clinical follow-up after an average of 10 months (3-18 months). The average Vancouver Scar Scale score at follow-up was 1.5 points (range, 0-5 points). The average period of epithelialization in wound surface was 12.5 days. Our data show that enzymatic and careful surgical debridement and consecutive application of CMEA suspensions using a spray technique result in excellent cosmetic outcomes compared with any other methods. PMID:21119409

  1. Burns due to acid assaults in Bogotá, Colombia.

    PubMed

    Guerrero, Linda

    2013-08-01

    Acid burns are not very frequent, occupying between 3% and maximum 14% of all etiologies. They mostly occur at home or at work, however there has been an increase in publications outlining chemical burns where aggression is the cause of this burn. There is a different epidemiological profile between developed countries and developing ones. It seems an ongoing upsurge is occurring in the number of registered attacks within developing countries in recent years. A cross sectional retrospective review of attacks by acid was done in Bogota, Colombia from 1995 to the first trimester 2012. A cumulative number of 35 burn patients were registered during the study period. It is found that the main target, almost the unique target, of this attack are young women belonging to low socioeconomic status with low education degree and high dependence on her partner. The patient's age mean was 22.7 years, ranging from 13 to 41 years. The physical and psychological scars were very severe. PMID:23260999

  2. Clinimetric properties and clinical utility in rehabilitation of postsurgical scar rating scales: a systematic review.

    PubMed

    Vercelli, Stefano; Ferriero, Giorgio; Sartorio, Francesco; Cisari, Carlo; Bravini, Elisabetta

    2015-12-01

    The aim of this study was to review and critically assess the most used and clinimetrically sound outcome measures currently available for postsurgical scar assessment in rehabilitation. We performed a systematic review of the Medline and Embase databases to June 2015. All published peer-reviewed studies referring to the development, validation, or clinical use of scales or questionnaires in patients with linear scars were screened. Of 922 articles initially identified in the literature search, 48 full-text articles were retrieved for assessment. Of these, 16 fulfilled the inclusion criteria for data collection. Data were collected pertaining to instrument item domains, validity, reliability, and Rasch analysis. The eight outcome measures identified were as follows: Vancouver Scar Scale, Dermatology Life Quality Index, Manchester Scar Scale, Patient and Observer Scar Assessment Scale, Bock Quality of Life (Bock QoL) questionnaire, Stony Brook Scar Evaluation Scale, Patient-Reported Impact of Scars Measure, and Patient Scar Assessment Questionnaire. Scales were examined for their clinimetric properties, and recommendations for their clinical or research use and selection were made. There is currently no absolute gold standard to be used in rehabilitation for the assessment of postsurgical scars, although the Patient and Observer Scar Assessment Scale and the Patient-Reported Impact of Scars Measure emerged as the most robust scales. PMID:26426285

  3. A Time Course Study of Different Methods of Extraneural Scar Induction in a Rat Model.

    PubMed

    Zanjani, Leila Oriady; Firouzi, Masoumeh; Nabian, Mohammad Hossein; Zadegan, Shayan Abdollah; Nategh, Mohsen; Erfanian, Reza; Ashtiani, Ahmad Mohebbi; Kamrani, Reza Shahryar

    2016-05-01

    Background Extraneural scar formation is a challenging problem in nerve repair. Rodent models of scar induction, with their high regenerative capacity, suffer from lack of comparable similarities with human cases. In this study, we attempted to find a reliable and reproducible method of extraneural scarring with a significant impact on the peripheral nerve function. Methods A total of 60 rats were divided into three scar induction groups: abrasion (with a small piece of compressed steel wool), mincing (with extracorporeal mincing of adductor muscle and a 5-mm wide strip of the anterior border of the biceps femoris), and electrocoagulation (with a bipolar coagulator). Extraneural scarring was evaluated macroscopically and histologically during 8 weeks. The tibial functional index was used for behavioral analysis. Results Among three different physical methods of scar induction that were applied, electrocoagulation had the most functional impairment (p < 0.001, two-way analysis of variance); whereas mincing produced the most adhesive and intensive scar, morphologically (p < 0.001). Conclusion We conclude that: (1) the impact of the extraneural scar on the nerve is morphologically and functionally different, based on the method of scarring; (2) to achieve a scar model comparable to the human situation, a method in which the involved nerve is functionally impaired, is preferred over the ones that merely produce a bulky scar. PMID:26848565

  4. Slippery Scar: A New Mushroom Disease in Auricularia polytricha

    PubMed Central

    Sun, Jie

    2012-01-01

    A new disease, the slippery scar, was investigated in cultivated bags of Auricularia polytricha. This fungus was isolated from the infected mycelia of cultivated bags. Based on morphological observation, rDNA-internal transcribed spacer and 18S sequence analysis, this pathogen was identified as the Ascomycete Scytalidium lignicola. According to Koch's Postulation, the pathogenicity of S. lignicola to the mycelia of A. polytricha was confirmed. The parasitism of this fungus on mushroom mycelia in China has not been reported before. PMID:22870056

  5. The Use of Chemotherapeutics for the Treatment of Keloid Scars.

    PubMed

    Jones, Christopher David; Guiot, Luke; Samy, Mike; Gorman, Mark; Tehrani, Hamid

    2015-05-21

    Keloid scars are pathological scars, which develop as a result of exaggerated dermal tissue proliferation following cutaneous injury and often cause physical, psychological and cosmetic problems. Various theories regarding keloidogenesis exist, however the precise pathophysiological events remain unclear. Many different treatment modalities have been implicated in their management, but currently there is no entirely satisfactory method for treating all keloid lesions. We review a number of different chemotherapeutic agents which have been proposed for the treatment of keloid and hypertrophic scars while giving insight into some of the novel chemotherapeutic drugs which are currently being investigated. Non-randomized trials evaluating the influence of different chemotherapeutic agents, such as 5-fluorouracil (5-FU); mitomycin C; bleomycin and steroid injection, either alone or in combination with other chemotherapeutic agents or alternative treatment modalities, for the treatment of keloids were identified using a predefined PubMed search strategy. Twenty seven papers were identified. Scar improvement ≥50% was found in the majority of cases treated with 5-FU, with similar results found for mitomycin C, bleomycin and steroid injection. Combined intralesional 5-FU and steroid injection produced statistically significant improvements when compared to monotherapy. Monotherapy recurrence rates ranged from 0-47% for 5-FU, 0-15% for bleomycin and 0-50% for steroid injection. However, combined therapy in the form of surgical excision and adjuvant 5-FU or steroid injections demonstrated lower recurrence rates; 19% and 6% respectively. Currently, most of the literature supports the use of combination therapy (usually surgery and adjuvant chemotherapy) as the mainstay treatment of keloids, however further investigation is necessary to determine success rates over longer time frames. Furthermore, there is the potential for novel therapies, but further investigation is required to elucidate their true efficacy. PMID:26236447

  6. The Use of Chemotherapeutics for the Treatment of Keloid Scars

    PubMed Central

    Jones, Christopher David; Guiot, Luke; Samy, Mike; Gorman, Mark; Tehrani, Hamid

    2015-01-01

    Keloid scars are pathological scars, which develop as a result of exaggerated dermal tissue proliferation following cutaneous injury and often cause physical, psychological and cosmetic problems. Various theories regarding keloidogenesis exist, however the precise pathophysiological events remain unclear. Many different treatment modalities have been implicated in their management, but currently there is no entirely satisfactory method for treating all keloid lesions. We review a number of different chemotherapeutic agents which have been proposed for the treatment of keloid and hypertrophic scars while giving insight into some of the novel chemotherapeutic drugs which are currently being investigated. Non-randomized trials evaluating the influence of different chemotherapeutic agents, such as 5-fluorouracil (5-FU); mitomycin C; bleomycin and steroid injection, either alone or in combination with other chemotherapeutic agents or alternative treatment modalities, for the treatment of keloids were identified using a predefined PubMed search strategy. Twenty seven papers were identified. Scar improvement ≥50% was found in the majority of cases treated with 5-FU, with similar results found for mitomycin C, bleomycin and steroid injection. Combined intralesional 5-FU and steroid injection produced statistically significant improvements when compared to monotherapy. Monotherapy recurrence rates ranged from 0-47% for 5-FU, 0-15% for bleomycin and 0-50% for steroid injection. However, combined therapy in the form of surgical excision and adjuvant 5-FU or steroid injections demonstrated lower recurrence rates; 19% and 6% respectively. Currently, most of the literature supports the use of combination therapy (usually surgery and adjuvant chemotherapy) as the mainstay treatment of keloids, however further investigation is necessary to determine success rates over longer time frames. Furthermore, there is the potential for novel therapies, but further investigation is required to elucidate their true efficacy. PMID:26236447

  7. Photoletter to the editor: Topical 0.5% brimonidine gel to camouflage redness of immature scars.

    PubMed

    Reinholz, Markus; Heppt, Markus; Tietze, Julia K; Ruzicka, Thomas; Gauglitz, Gerd G; Schauber, Jürgen

    2015-09-30

    Cutaneous scars develop as a result of a defective wound healing process. Scars are commonly visible as erythematous, sometimes disfiguring lesions which might be stigmatizing for the affected patient. Only a few therapies to improve the appearance of scars are available. Recently, brimonidine - a selective α2-receptor-agonist which causes vasoconstriction of small cutaneous vessels - was approved for the treatment of erythemato-telangiectatic rosacea. Topical brimonidine might also be helpful to improve redness of immature scars. Here we report on the effect of brimonidine 0.5% gel on a flat, erythematous scar in a 25-year-old female patient. Whitening of the scar could be observed immediately after application of brimonidine 0.5% gel and a good clinical result was observed within one hour. This effect lasted for up to three hours. We conclude that brimonidine 0.5% gel is a suitable topical therapy to reduce erythema in visible cutaneous scars. PMID:26512307

  8. Comparison of different laser systems in the treatment of hypertrophic and atrophic scars and keloids

    NASA Astrophysics Data System (ADS)

    Scharschmidt, D.; Algermissen, Bernd; Willms-Jones, J.-C.; Philipp, Carsten M.; Berlien, Hans-Peter

    1997-12-01

    Different laser systems and techniques are used for the treatment of hypertrophic scars, keloids and acne scars. Significant criteria in selecting a suitable laser system are the scar's vascularization, age and diameter. Flashlamp- pumped dye-lasers, CO2-lasers with scanner, Argon and Nd:YAG-lasers are used. Telangiectatic scars respond well to argon lasers, erythematous scars and keloids to dye-laser treatment. Using interstitial Nd:YAG-laser vaporization, scars with a cross-section over 1 cm can generally be reduced. For the treatment of atrophic and acne scars good cosmetic results are achieved with a CO2-laser/scanner system, which allows a precise ablation of the upper dermis with low risk of side-effects.

  9. Three-Dimensional Electromagnetic High Frequency Axisymmetric Cavity Scars.

    SciTech Connect

    Warne, Larry K.; Jorgenson, Roy E.

    2014-10-01

    This report examines the localization of high frequency electromagnetic fi elds in three-dimensional axisymmetric cavities along periodic paths between opposing sides of the cavity. The cases where these orbits lead to unstable localized modes are known as scars. This report treats both the case where the opposing sides, or mirrors, are convex, where there are no interior foci, and the case where they are concave, leading to interior foci. The scalar problem is treated fi rst but the approximations required to treat the vector fi eld components are also examined. Particular att ention is focused on the normalization through the electromagnetic energy theorem. Both projections of the fi eld along the scarred orbit as well as point statistics are examined. Statistical comparisons are m ade with a numerical calculation of the scars run with an axisymmetric simulation. This axisymmetric cas eformstheoppositeextreme(wherethetwomirror radii at each end of the ray orbit are equal) from the two -dimensional solution examined previously (where one mirror radius is vastly di ff erent from the other). The enhancement of the fi eldontheorbitaxiscanbe larger here than in the two-dimensional case. Intentionally Left Blank

  10. Direct visualization of dislocation dynamics in grain-boundary scars.

    PubMed

    Lipowsky, Peter; Bowick, Mark J; Meinke, Jan H; Nelson, David R; Bausch, Andreas R

    2005-05-01

    Mesoscale objects with unusual structural features may serve as the analogues of atoms in the design of larger-scale materials with novel optical, electronic or mechanical behaviour. In this paper we investigate the structural features and the equilibrium dynamics of micrometre-scale spherical crystals formed by polystyrene particles adsorbed on the surface of a spherical water droplet. The ground state of sufficiently large crystals possesses finite-length grain boundaries (scars). We determine the elastic response of the crystal by measuring single-particle diffusion, and quantify the fluctuations of individual dislocations about their equilibrium positions within a scar by determining the dislocation spring constants. We observe rapid dislocation glide with fluctuations over the barriers separating one local Peierls minimum from the next and rather weak binding of dislocations to their associated scars. The long-distance (renormalized) dislocation diffusion glide constant is extracted directly from the experimental data and is found to be moderately faster than single-particle diffusion. We are also able to determine the parameters of the Peierls potential induced by the underlying crystalline lattice. PMID:15834411

  11. Overcoming the Low-Learning Scar Effect: Narratives of Learning and Resilience of Italian Low-Skilled

    ERIC Educational Resources Information Center

    Tomassini, Massimo

    2016-01-01

    The idea of the "low-learning scar" is borrowed from recent labour economics literature in which concepts such as "unemployment scarring", "wage scarring" and "scarred generation" are increasingly used for the interpretation of problems (the NEETs problem, for instance) which presently plague all Western…

  12. A myofibroblast-mast cell-neuropeptide axis of fibrosis in post-traumatic joint contractures: an in vitro analysis of mechanistic components.

    PubMed

    Hildebrand, Kevin A; Zhang, Mei; Befus, A Dean; Salo, Paul T; Hart, David A

    2014-10-01

    Previous studies have implicated a myofibroblast-mast cell-neuropeptide axis of fibrosis in pathologic joint capsules from post-traumatic contractures. The hypothesis to be tested is that joint capsule cells (JC) from human elbows with post-traumatic contractures and their interactions with mast cells (MC) and neuropeptides in the microenvironment underlie the pathogenesis of contractures. The hypothesis was tested using an in vitro collagen gel contraction model. The JC were isolated from human elbow capsules and mixed with neutralized PureCol collagen I. The gels were treated in various ways, including addition of MC (HMC-1), the neuropeptide substance P (SP), an NK1 receptor (SP receptor) antagonist RP67580 and the mast cell stabilizer ketotifen fumarate (KF). The collagen gels were released from the wells and gel size (contraction) was measured optically at multiple time points. The JC contracted collagen gels in a dose-dependent manner. This was enhanced in the presence of MC and increased further with SP. Increasing concentrations of the SP receptor antagonist, RP67580 or the mast cell stabilizer, KF decreased the magnitude of contraction. These observations identify putative mechanistic components of a myofibroblast-mast cell-neuropeptide axis of fibrosis in the joint capsules in post-traumatic contractures and potential prophylactic or therapeutic interventions. PMID:24985721

  13. Co-delivery of VEGF and bFGF via a PLGA nanoparticle-modified BAM for effective contracture inhibition of regenerated bladder tissue in rabbits

    NASA Astrophysics Data System (ADS)

    Jiang, Xincheng; Lin, Houwei; Jiang, Dapeng; Xu, Guofeng; Fang, Xiaoliang; He, Lei; Xu, Maosheng; Tang, Bingqiang; Wang, Zhiyong; Cui, Daxiang; Chen, Fang; Geng, Hongquan

    2016-02-01

    Graft contracture is a common problem associated with the regeneration processes of tissue-engineered bladders. Currently, most strategies used for incorporating bioactive molecules into biomaterial designs do not work during all phases of tissue regeneration. In this study, we used a growth factor-PLGA nanoparticle thermo-sensitive gel system (i.e., BAM with incorporated VEGF and bFGF-loaded PLGA nanoparticles and mixed with a hydrophilic gel) to promote bladder tissue regeneration in a rabbit model. At 4 and 12 weeks after surgery, contracture rate assessment and histological examination were conducted to evaluate bladder tissue regeneration. The results indicated that the functional composite scaffold continuously and effectively released VEGF and bFGF and promoted bladder reconstruction with a significant decrease in graft contracture. In addition, the number and arrangement of regenerated urothelial cells and smooth muscle cells as well as microvascular density and maturity were improved in the VEGF/bFGF nanoparticle group compared with the single factor VEGF or bFGF nanoparticle group and BAM alone. The nanoparticle thermo-sensitive gel system, which exhibited favourable performance, may effectively inhibit graft contracture and promote bladder tissue regeneration in rabbits.

  14. Co-delivery of VEGF and bFGF via a PLGA nanoparticle-modified BAM for effective contracture inhibition of regenerated bladder tissue in rabbits

    PubMed Central

    Jiang, Xincheng; Lin, Houwei; Jiang, Dapeng; Xu, Guofeng; Fang, Xiaoliang; He, Lei; Xu, Maosheng; Tang, Bingqiang; Wang, Zhiyong; Cui, Daxiang; Chen, Fang; Geng, Hongquan

    2016-01-01

    Graft contracture is a common problem associated with the regeneration processes of tissue-engineered bladders. Currently, most strategies used for incorporating bioactive molecules into biomaterial designs do not work during all phases of tissue regeneration. In this study, we used a growth factor-PLGA nanoparticle thermo-sensitive gel system (i.e., BAM with incorporated VEGF and bFGF-loaded PLGA nanoparticles and mixed with a hydrophilic gel) to promote bladder tissue regeneration in a rabbit model. At 4 and 12 weeks after surgery, contracture rate assessment and histological examination were conducted to evaluate bladder tissue regeneration. The results indicated that the functional composite scaffold continuously and effectively released VEGF and bFGF and promoted bladder reconstruction with a significant decrease in graft contracture. In addition, the number and arrangement of regenerated urothelial cells and smooth muscle cells as well as microvascular density and maturity were improved in the VEGF/bFGF nanoparticle group compared with the single factor VEGF or bFGF nanoparticle group and BAM alone. The nanoparticle thermo-sensitive gel system, which exhibited favourable performance, may effectively inhibit graft contracture and promote bladder tissue regeneration in rabbits. PMID:26854200

  15. Co-delivery of VEGF and bFGF via a PLGA nanoparticle-modified BAM for effective contracture inhibition of regenerated bladder tissue in rabbits.

    PubMed

    Jiang, Xincheng; Lin, Houwei; Jiang, Dapeng; Xu, Guofeng; Fang, Xiaoliang; He, Lei; Xu, Maosheng; Tang, Bingqiang; Wang, Zhiyong; Cui, Daxiang; Chen, Fang; Geng, Hongquan

    2016-01-01

    Graft contracture is a common problem associated with the regeneration processes of tissue-engineered bladders. Currently, most strategies used for incorporating bioactive molecules into biomaterial designs do not work during all phases of tissue regeneration. In this study, we used a growth factor-PLGA nanoparticle thermo-sensitive gel system (i.e., BAM with incorporated VEGF and bFGF-loaded PLGA nanoparticles and mixed with a hydrophilic gel) to promote bladder tissue regeneration in a rabbit model. At 4 and 12 weeks after surgery, contracture rate assessment and histological examination were conducted to evaluate bladder tissue regeneration. The results indicated that the functional composite scaffold continuously and effectively released VEGF and bFGF and promoted bladder reconstruction with a significant decrease in graft contracture. In addition, the number and arrangement of regenerated urothelial cells and smooth muscle cells as well as microvascular density and maturity were improved in the VEGF/bFGF nanoparticle group compared with the single factor VEGF or bFGF nanoparticle group and BAM alone. The nanoparticle thermo-sensitive gel system, which exhibited favourable performance, may effectively inhibit graft contracture and promote bladder tissue regeneration in rabbits. PMID:26854200

  16. Burning trees and bridges

    NASA Technical Reports Server (NTRS)

    Levine, Joel S.

    1990-01-01

    Most burning of biomass is the result of human activity, and on a global scale it is increasing. Tropospheric concentrations of CO2, CO, CH4, non-methane hydrocarbons, and ozone are all increasing with time; global biomass burning may make an important contribution to this increase and thus to potential global climate change. The nitrogen cycle also can have important climatic effects. Nitrous oxide put into the atmosphere by biomass burning is a greenhouse gas 250 times more powerful (molecule for molecule) than carbon dioxide. Nitric oxide, as well as being a photochemical precursor of ozone, a major pollutant in the troposphere, produces nitric acid, the fastest-growing component of acid rain. Hence, the new bridge in the nitrogen cycle is of more than mere technical interest.

  17. 'Special effects' burn injuries.

    PubMed

    Peters, W

    1991-02-01

    Three patients are presented with significant flame burns, resulting from accidents occurring during 'special effects' situations in the entertainment industry. These occurred as a result of the spontaneous combustion of various materials, during events in live theatre (gun powder), a television commercial (artificial 'rocket fuel'), and a video presentation (magnesium oxide). All three patients sustained flash burns to the face and hands. One patient sustained a significant bilateral corneal injury, a gamekeeper's thumb, and a permanent continuous right-sided high frequency tinnitus, in addition to his burn injury. Photographic documentation of all three patients is presented. The total loss of time from work for all patients was 6 months. All these injuries were potentially preventable. PMID:2031675

  18. Aesthetic restoration of the severely disfigured face in burn victims: a comprehensive strategy.

    PubMed

    Rose, E H

    1995-12-01

    Although highly specialized burn centers have significantly reduced mortality rates following extensive total body surface area burns, survivors are often left with grotesque facial disfigurement. The strategy of modern facial restoration emphasizes enhancement of aesthetic appearance as significantly as mitigation of functional impairment. Criteria for success are (1) an undistracted "normal" look at conversational distance, (2) facial balance and symmetry, (3) distinct aesthetic units fused by inconspicuous scars, (4) "doughy" skin texture appropriate for corrective makeup, and (5) dynamic facial expression. Since 1985, the author has successfully restored 17 severely disfigured burned faces by replacement of entire aesthetic units with microvascular "prepatterned" composite flaps blended into the facial canvas by cosmetic camouflage techniques. The series includes hemiface (2), neck/jaw (5), chin/lower lip (3), cheek/malar (5), peri-orbital (2), nose (3), upper lip (4), and ear reconstructions (4). Flaps represented are free preauricular (1), radial forearm (6), ulnar forearm (1), free scapular (6), ilio-osteocutaneous (2), temporoparietal (8), vascularized forehead island (3), supraclavicular (1), and SMAS (1). Important to outcome is extensive initial intraoperative "sculpting" to simulate normal planes and contours. Seams are placed at junctions of facial components. Three-dimensional imaging is used to assess architectural asymmetries, and bone grafts are aided by computer-generated acrylic models. Adjunctive procedures include tensor fasciae latae slings, intraoperative tissue expansion, suction-assisted lipectomy, and scar management. After restoration of facial form and texture, flesh color make-up and/or tattooing of beard, lips, scars, eyebrows, etc., aid to hide scars and pigment the skin to harmonize with the rest of the face. In all cases, facial integrity has been aesthetically restored and, in most instances, with makeup, is near normal in social settings at conversational distances. Facial animation is retained and color matches are excellent. One flap was lost early in the series. PMID:7480277

  19. Carbon dioxide laser ablation with immediate autografting in a full-thickness porcine burn model.

    PubMed Central

    Glatter, R D; Goldberg, J S; Schomacker, K T; Compton, C C; Flotte, T J; Bua, D P; Greaves, K W; Nishioka, N S; Sheridan, R L

    1998-01-01

    OBJECTIVE: To compare the long-term clinical and histologic outcome of immediate autografting of full-thickness burn wounds ablated with a high-power continuous-wave CO2 laser to sharply débrided wounds in a porcine model. SUMMARY BACKGROUND DATA: Continuous-wave CO2 lasers have performed poorly as tools for burn excision because the large amount of thermal damage to viable subeschar tissues precluded successful autografting. However, a new technique, in which a high-power laser is rapidly scanned over the eschar, results in eschar vaporization without significant damage to underlying viable tissues, allowing successful immediate autografting. METHODS: Full-thickness paravertebral burn wounds measuring 36 cm2 were created on 11 farm swine. Wounds were ablated to adipose tissue 48 hours later using either a surgical blade or a 150-Watt continuous-wave CO2 laser deflected by an x-y galvanometric scanner that translated the beam over the tissue surface, removing 200 microm of tissue per scan. Both sites were immediately autografted and serially evaluated clinically and histologically for 180 days. RESULTS: The laser-treated sites were nearly bloodless. The mean residual thermal damage was 0.18+/-0.05 mm. The mean graft take was 96+/-11% in manual sites and 93+/-8% in laser sites. On postoperative day 7, the thickness of granulation tissue at the graft-wound bed interface was greater in laser-debrided sites. By postoperative day 180, the manual and laser sites were histologically identical. Vancouver scar assessment revealed no differences in scarring at postoperative day 180. CONCLUSIONS: Long-term scarring, based on Vancouver scar assessments and histologic evaluation, was equivalent at 6 months in laser-ablated and sharply excised sites. Should this technology become practical, the potential clinical implications include a reduction in surgical blood loss without sacrifice of immediate engraftment rates or long-term outcome. Images Figure 1. Figure 2. Figure 3. Figure 4. PMID:9712572

  20. Fast burning propellants

    SciTech Connect

    Colgate, S.A.; Roos, G.E.

    1987-07-21

    A solid or semisolid propellant is described comprising grains of propellant or propellant components bonded together to create voids within the propellant volume. The grains are of near-uniform size and have less than about a 20% size variation between the largest and smallest grains, the voids comprising from about 10% to about 50% of the propellant volume. The grains are bonded together with sufficient strength to substantially delay the fluidization of the propellant by the onset of Taylor unstable burning. The propellant has a rapid burn rate of from about 10 cm sec/sup -1/ to about 10/sup 4/cm sec/sup -1/.

  1. Full-thickness burn to the hand from an automobile airbag.

    PubMed

    Vitello, W; Kim, M; Johnson, R M; Miller, S

    1999-01-01

    An 18-year-old male was involved in a single car motor vehicle accident in which the driver's side airbag was deployed. He presented to the trauma center with complex injuries to the left hand, lacerations to the scalp, and a full-thickness burn to the ulnar aspect of the right hand that included the hypothenar area and the fifth digit. The patient was admitted to the trauma center and received immediate consultation from the burn service. He underwent debridement and split-thickness skin grafting of 50 cm2 of the right hand on postburn day 3. The graft became necrotic and the patient underwent debridement of the skin and the abductor minimi muscle of the right hand on postburn day 32. Split-thickness skin grafting and release of flexion contracture were successfully completed 18 days later. The police and fire departments reported that the airbag showed signs of thermal destruction. Upon request, Honda motors submitted information from the TRW safety systems and material safety data sheet (Mesa, Ariz, issued 1989) that showed that airbag canisters contain the chemicals sodium azide and cupric oxide. Water may react with sodium azide to form highly toxic and explosive hyfrazoic acid. These chemicals are converted to sodium hydroxide, which can cause significant chemical burns. In addition, these chemicals may ignite when exposed to live electrical wires or temperatures greater than 300 degrees F. We conclude that burns associated with damaged deployed airbags in motor vehicle accidents may be the results of both chemical and thermal injury. The extent of the burn wound may be underestimated, as our case illustrates. Full-thickness burns resulting from airbag deployment may require more aggressive initial debridement and treatment. PMID:10342473

  2. Non-invasive evaluation of therapeutic response in keloid scar using diffuse reflectance spectroscopy

    PubMed Central

    Hsu, Chao-Kai; Tzeng, Shih-Yu; Yang, Chao-Chun; Lee, Julia Yu-Yun; Huang, Lynn Ling-Huei; Chen, Wan-Rung; Hughes, Michael; Chen, Yu-Wen; Liao, Yu-Kai; Tseng, Sheng-Hao

    2015-01-01

    The pathogenesis and ideal treatment of keloid are still largely unknown, and it is essential to develop an objective assessment of keloid severity to evaluate the therapeutic response. We previously reported that our diffuse reflectance spectroscopy (DRS) system could assist clinicians in understanding the functional and structural condition of keloid scars. The purpose of this study was to understand clinical applicability of our DRS system on evaluating the scar severity and therapeutic response of keloid. We analyzed 228 spectral data from 71 subjects with keloid scars. The scars were classified into mild (0-3), moderate (4-7) and severe (8-11) according to the Vancouver scar scale. We found that as the severity of the scar increased, collagen concentration and water content increased, and the reduced scattering coefficient at 800 nm and oxygen saturation (SaO2) decreased. Using the DRS system, we found that collagen bundles aligned in a specific direction in keloid scars, but not in normal scars. Water content and SaO2 may be utilized as reliable parameters for evaluating the therapeutic response of keloid. In conclusion, the results obtained here suggest that the DRS has potential as an objective technique with which to evaluate keloid scar severity. In addition, it may be useful as a tool with which to track longitudinal response of scars in response to various therapeutic interventions. PMID:25780731

  3. Non-invasive evaluation of therapeutic response in keloid scar using diffuse reflectance spectroscopy.

    PubMed

    Hsu, Chao-Kai; Tzeng, Shih-Yu; Yang, Chao-Chun; Lee, Julia Yu-Yun; Huang, Lynn Ling-Huei; Chen, Wan-Rung; Hughes, Michael; Chen, Yu-Wen; Liao, Yu-Kai; Tseng, Sheng-Hao

    2015-02-01

    The pathogenesis and ideal treatment of keloid are still largely unknown, and it is essential to develop an objective assessment of keloid severity to evaluate the therapeutic response. We previously reported that our diffuse reflectance spectroscopy (DRS) system could assist clinicians in understanding the functional and structural condition of keloid scars. The purpose of this study was to understand clinical applicability of our DRS system on evaluating the scar severity and therapeutic response of keloid. We analyzed 228 spectral data from 71 subjects with keloid scars. The scars were classified into mild (0-3), moderate (4-7) and severe (8-11) according to the Vancouver scar scale. We found that as the severity of the scar increased, collagen concentration and water content increased, and the reduced scattering coefficient at 800 nm and oxygen saturation (SaO2) decreased. Using the DRS system, we found that collagen bundles aligned in a specific direction in keloid scars, but not in normal scars. Water content and SaO2 may be utilized as reliable parameters for evaluating the therapeutic response of keloid. In conclusion, the results obtained here suggest that the DRS has potential as an objective technique with which to evaluate keloid scar severity. In addition, it may be useful as a tool with which to track longitudinal response of scars in response to various therapeutic interventions. PMID:25780731

  4. β2-Adrenoceptor Activation Modulates Skin Wound Healing Processes to Reduce Scarring

    PubMed Central

    Le Provost, Gabrielle S; Pullar, Christine E

    2015-01-01

    During wound healing, excessive inflammation, angiogenesis, and differentiated human dermal fibroblast (HDF ) function contribute to scarring, whereas hyperpigmentation negatively affects scar quality. Over 100 million patients heal with a scar every year. To investigate the role of the beta 2 adrenergic receptor (β2AR) in wound scarring, the ability of beta 2 adrenergic receptor agonist (β2ARag) to alter HDF differentiation and function, wound inflammation, angiogenesis, and wound scarring was explored in HDFs, zebrafish, chick chorioallantoic membrane assay (CAM), and a porcine skin wound model, respectively. Here we identify a β2AR-mediated mechanism for scar reduction. β2ARag significantly reduced HDF differentiation, via multiple cAMP and/or fibroblast growth factor 2 or basic FGF (FGF2)-dependent mechanisms, in the presence of transforming growth factor betaβ1, reduced contractile function, and inhibited mRNA expression of a number of profibrotic markers. β2ARag also reduced inflammation and angiogenesis in zebrafish and CAMs in vivo, respectively. In Red Duroc pig full-thickness wounds, β2ARag reduced both scar area and hyperpigmentation by almost 50% and significantly improved scar quality. Indeed, mechanisms delineated in vitro and in other in vivo models were evident in the β2ARag-treated porcine scars in vivo. Both macrophage infiltration and angiogenesis were initially decreased, whereas DF function was impaired in the β2ARag-treated porcine wound bed. These data collectively reveal the potential of β2ARag to improve skin scarring. PMID:25050597

  5. Probability mapping of scarred myocardium using texture and intensity features in CMR images

    PubMed Central

    2013-01-01

    Background The myocardium exhibits heterogeneous nature due to scarring after Myocardial Infarction (MI). In Cardiac Magnetic Resonance (CMR) imaging, Late Gadolinium (LG) contrast agent enhances the intensity of scarred area in the myocardium. Methods In this paper, we propose a probability mapping technique using Texture and Intensity features to describe heterogeneous nature of the scarred myocardium in Cardiac Magnetic Resonance (CMR) images after Myocardial Infarction (MI). Scarred tissue and non-scarred tissue are represented with high and low probabilities, respectively. Intermediate values possibly indicate areas where the scarred and healthy tissues are interwoven. The probability map of scarred myocardium is calculated by using a probability function based on Bayes rule. Any set of features can be used in the probability function. Results In the present study, we demonstrate the use of two different types of features. One is based on the mean intensity of pixel and the other on underlying texture information of the scarred and non-scarred myocardium. Examples of probability maps computed using the mean intensity of pixel and the underlying texture information are presented. We hypothesize that the probability mapping of myocardium offers alternate visualization, possibly showing the details with physiological significance difficult to detect visually in the original CMR image. Conclusion The probability mapping obtained from the two features provides a way to define different cardiac segments which offer a way to identify areas in the myocardium of diagnostic importance (like core and border areas in scarred myocardium). PMID:24053280

  6. Proper Wound Care: How to Minimize a Scar

    MedlinePlus

    ... a similar ointment, cover the skin with an adhesive bandage. For large scrapes, sores, burns or persistent ... If you have skin that is sensitive to adhesives, try a non-adhesive gauze pad with paper ...

  7. A comparison of the caffeine halothane muscle contracture test with the molecular genetic diagnosis of malignant hyperthermia.

    PubMed

    MacKenzie, A E; Allen, G; Lahey, D; Crossan, M L; Nolan, K; Mettler, G; Worton, R G; MacLennan, D H; Korneluk, R

    1991-07-01

    Malignant hyperthermia (MH) is currently diagnosed by the caffeine-halothane contracture (CHC) test. In a previous study, this test was used to establish linkage between the human gene for MH susceptibility and the ryanodine receptor (RYR) gene. The current study extends the genetic linkage analysis to a large French-Canadian kindred. In this family, genetic linkage between RYR and MH genes was not demonstrable using the currently recommended limits of normal for the CHC test in the identification of MH-susceptible individuals. With CHC test threshold limits below those currently recommended, however, complete linkage between the RYR and MH genes was seen. Comparisons of CHC test results with genetic linkage studies will increase the diagnostic accuracy of both tests as well as generate new insights into the biology of MH. PMID:2064058

  8. van den Ende-Gupta syndrome of blepharophimosis, arachnodactyly, and congenital contractures: clinical delineation and recurrence in brothers.

    PubMed

    Schweitzer, Daniela N; Lachman, Ralph S; Pressman, Barry D; Graham, John M

    2003-04-30

    We describe two Hispanic brothers born to unrelated parents with van den Ende-Gupta syndrome (VDEGS), a distinctive combination of characteristic dysmorphic features, skeletal abnormalities, and cerebellar hyperplasia. This syndrome was previously delineated by van den Ende et al. [1992: Am J Med Genet 42:467-469] and Gupta et al. [1995: J Med Genet 32:809-812], with additional reports by Phadke et al. [1998: Am J Med Genet 77:16-18] and Bistritzer et al. [1993: Clin Genet 44:15-19]. This is the fifth report of VDEGS, which is characterized by blepharophimosis, narrow nose with hypoplastic alae nasi, hypoplastic maxilla, everted lower lip, slender and elongated hands and feet, arachnodactyly, self-limiting joint contractures, and distinctive skeletal findings. This report of affected siblings, and a previous report of double second cousins born to consanguineous parents [Bistritzer et al. [1993: Clin Genet 44:15-19

  9. Long QT, Syndactyly, Joint Contractures, Stroke and Novel CACNA1C Mutation: Expanding the Spectrum of Timothy Syndrome

    PubMed Central

    Gillis, Jane; Burashnikov, Elena; Antzelevitch, Charles; Blaser, Susan; Gross, Gil; Turner, Lesley; Babul-Hirji, Riyana; Chitayat, David

    2011-01-01

    Timothy syndrome (TS) is described as an autosomal dominant condition with the constellation of features including prolonged QT interval, hand and foot abnormalities and mental retardation or autism. Splawski et al. [2004] previously described two phenotypes associated with TS distinguished by two unique and different mutations within the CACNA1C gene. We report on a newborn who presented with prolonged QT interval and associated polymorphic ventricular tachycardia, dysmorphic facial features, syndactyly of the hands and feet and joint contractures, suggestive of TS. He developed a stroke, subsequent intractable seizures and was found to have cortical blindness and later profound developmental delay. Initial targeted mutation analysis did not identify either of the previously described TS associated mutations; however, full gene sequencing detected a novel CACNA1C gene mutation (p.Ala1473Gly). The clinical and genetic findings in our case expand both the clinical and molecular knowledge of TS. PMID:22106044

  10. Familial occurrence of typical and severe lethal congenital contractural arachnodactyly caused by missplicing of exon 34 of fibrillin-2

    SciTech Connect

    Wang, Mei; Godfrey, M.; Clericuzio, C.L.

    1996-11-01

    Genetic linkage studies have linked congenital contractual arachnodactyly (CCA), a usually mild heritable connective-tissue disorder, to FBN2, the fibrillin gene on chromosome 5. Recently, FBN2 mutations in two patients with CCA have been described. Here we report an A{r_arrow}T transversion at the -2 position of the consensus acceptor splice site, resulting in the missplicing of exon 34, a calcium-binding epidermal growth factor-like repeat in fibrillin-2 in a mother and daughter with CCA. Significantly, the mother exhibited a classic CCA phenotype with arachnodactyly, joint contractures, and abnormal pinnae, whereas her daughter exhibited a markedly more severe CCA phenotype, which included cardiovascular and gastrointestinal anomalies that led to death in infancy. Analysis of cloned fibroblasts showed that the mother is a somatic mosaic for the exon 34 missplicing mutation, whereas all the daughter`s cells harbored the mutation. 48 refs., 6 figs., 2 tabs.

  11. Burn Safety Awareness on Playgrounds: Thermal Burns from Playground Equipment

    MedlinePlus

    ... Safety Awareness on Playgrounds Thermal Burns from Playground Equipment The U.S. Consumer Product Safety Commission CPSC wants ... of the risk of thermal burns from playground equipment. You may remember the metal slides of your ...

  12. Clinical study of cultured epithelial autografts in liquid suspension in severe burn patients.

    PubMed

    Yim, Haejun; Yang, Hyeong Tae; Cho, Yong Suk; Seo, Cheong Hoon; Lee, Boung Chul; Ko, Jang Hyu; Kwak, In Suk; Kim, Dohern; Hur, Jun; Kim, Jong Hyun; Chun, Wook

    2011-09-01

    We address the clinical application of the suspension type cultured epithelial autografts (CEAs), Keraheal (MCTT, Seoul, Korea), along with the effects, application method, merits and demerits thereof. From February 2007 to June 2010, 29 burn patients with extensive burns, participated in the suspension type of CEA clinical test. A widely meshed autograft (1:4-6 ratio) was applied to the wound bed and the suspension type CEA was sprayed with a Tissomat cell sprayer, followed by a Tissucol spray, a fibrin sealant. The patients' (men/women=26/3) median (interquartile ranges) age was 42 (30-49) years old, the burned TBSA was 55 (44-60) %, and the full thickness burn area was 40 (30-46.5) %. The area of Keraheal applied was 800 (400-1200) cm(2). The take rate was 96 (90.5-99) % and 100 (98.5-100) % at 2 and 4 weeks after treatment with Keraheal, respectively. The Vancouver burn scar scale was 5 (4-6.5), 4 (3-6), and 3 (2-4) at 8, 12 and 24 weeks after the Keraheal application. Widely meshed autograft must be applied in massive burns but it's take rate is greatly reduced. The CEAs enhance the take rate of a wide meshed autograft in massive burns and allow for grafting wide meshed autograft together with acellular dermal matrix in some cases. PMID:21531079

  13. Intralesional Injection of Mitomycin C at Transurethral Incision of Bladder Neck Contracture May Offer Limited Benefit: TURNS Study Group

    PubMed Central

    Redshaw, Jeffrey D.; Broghammer, Joshua A.; Smith, Thomas G.; Voelzke, Bryan B.; Erickson, Bradley A.; McClung, Christopher D.; Elliott, Sean P.; Alsikafi, Nejd F.; Presson, Angela P.; Aberger, Michael E.; Craig, James R.; Brant, William O.; Myers, Jeremy B.

    2015-01-01

    Purpose Injection of mitomycin C may increase the success of transurethral incision of the bladder neck for the treatment of bladder neck contracture. We evaluated the efficacy of mitomycin C injection across multiple institutions. Materials and Methods Data on all patients who underwent transurethral incision of the bladder neck with mitomycin C from 2009 to 2014 were retrospectively reviewed from 6 centers in the TURNS. Patients with at least 3 months of cystoscopic followup were included in the analysis. Results A total of 66 patients underwent transurethral incision of the bladder neck with mitomycin C and 55 meeting the study inclusion criteria were analyzed. Mean ± SD patient age was 64 ± 7.6 years. Dilation or prior transurethral incision of the bladder neck failed in 80% (44 of 55) of patients. Overall 58% (32 of 55) of patients achieved resolution of bladder neck contracture after 1 transurethral incision of the bladder neck with mitomycin C at a median followup of 9.2 months (IQR 11.7). There were 23 patients who had recurrence at a median of 3.7 months (IQR 4.2), 15 who underwent repeat transurethral incision of the bladder neck with mitomycin C and 9 of 15 (60%) who were free of another recurrence at a median of 8.6 months (IQR 8.8), for an overall success rate of 75% (41 of 55). Incision with electrocautery (Collins knife) was predictive of success compared with cold knife incision (63% vs 50%, p=0.03). Four patients experienced serious adverse events related to mitomycin C and 3 needed or are planning cystectomy. Conclusions The efficacy of intralesional injection of mitomycin C at transurethral incision of the bladder neck was lower than previously reported and was associated with a 7% rate of serious adverse events. PMID:25200807

  14. Manifestations of acute opiate withdrawal contracture in rabbit jejunum after mu-, kappa- and delta-receptor agonist exposure.

    PubMed Central

    Valeri, P.; Morrone, L. A.; Romanelli, L.

    1992-01-01

    1. Following a 5 min in vitro exposure to morphine (1.3 x 10(-7) M), U-50,488H (2.5 x 10(-8) M) and deltorphin (1.6 x 10(-8)-6.5 x 10(-9) M), the rabbit isolated jejunum exhibited a precipitated contracture after the addition of naloxone (2.75 x 10(-7) M). 2. The precipitated responses to U-50,488H and deltorphin but not to morphine were reproducible in the same tissue. 3. The precipitated contractures were blocked completely by tetrodotoxin (3 x 10(-7) M), partially by atropine (1.5 x 10(-7) M) and not affected by hexamethonium (1.4 x 10(-5) M). 4. Naloxone administration (2.75 x 10(-7) M) before the agonist prevented the development of the adaptive response to morphine and U-50,488H but not to deltorphin. 5. The selective antagonists norbinaltorphimine (2.7 x 10(-8)-2.7 x 10(-9) M) and naltrindole (1.1 x 10(-7) M) prevented the adaptive response development only to the respective agonists. 6. The opioid agonists partially inhibited the spontaneous activity of the tissue. This study has shown that independent activation of mu-, kappa- and delta-opioid receptors can induce dependence in this isolated tissue. Rabbit jejunum is a suitable tissue for studying the acute effects of opioids on the adaptative processes determined by their administration. PMID:1354541

  15. Effectiveness and Complications of Percutaneous Needle Tenotomy with a Large Needle for Muscle Contractures: A Cadaver Study

    PubMed Central

    Chesnel, Camille; Genêt, François; Almangour, Waleed; Denormandie, Philippe; Parratte, Bernard; Schnitzler, Alexis

    2015-01-01

    Background Twenty-two percent of institutionalised elderly persons have muscle contractures. Contractures have important functional consequences, rendering hygiene and positioning in bed or in a chair difficult. Medical treatment (such as botulinum toxin injections, physiotherapy or positioning) is not very effective and surgery may be required. Surgery is carried out in the operating theatre, under local or general anaesthesia but is often not possible in fragile patients. Mini-invasive tenotomy could be a useful alternative as it can be carried out in ambulatory care, under local anaesthesia. Objective To evaluate the effectiveness of percutaneous needle tenotomy and the risks of damage to adjacent structures in cadavers. Method Thirty two doctors who had never practiced the technique (physical medicine and rehabilitation specialists, geriatricians and orthopaedic surgeons) carried out 401 tenotomies on the upper and lower limbs of 8 fresh cadavers. A 16G needle was used percutaneous following location of the tendons. After each tenotomy, a neuro-orthopaedic surgeon and an anatomist dissected the area in order to evaluate the success of the tenotomy and any adjacent lesions which had occurred. Results Of the 401 tenotomies, 72% were complete, 24.9% partial and 2.7% failed. Eight adjacent lesions occurred (2%): 4 (1%) in tendons or muscles, 3 (0.7%) in nerves and 1 (0.2%) in a vessel. Conclusion This percutaneous needle technique effectively ruptured the desired tendons, with few injuries to adjacent structures. Although this study was carried out on cadavers, the results suggest it is safe to carry out on patients. PMID:26624990

  16. A novel method of using mini external fixator for maintaining web space after the release of contracture and syndactyly.

    PubMed

    Kamath, Jagannath B; Vardhan, Harsh; Naik, Deepak M; Bansal, Ankush; Rai, Mayur; Kumar, Anup

    2013-03-01

    Syndactyly and postburn contracture of the digits are the common cases seen in a hand clinic. Their management can be roughly divided into 3 stages. In stage 1, syndactyly/postburn contracture of the digits are surgically released; in stage 2, surgical wound care is provided; and in stage 3, the patient undergoes physiotherapy (rehabilitation). The most common method of immobilizing the digit after the release is by plaster of Paris splints. Its demerit includes loss of correction, painful postoperative dressing, and suboptimal graft uptake due to improper immobilization and maceration. We describe a simple and effective method of mitigating the above-mentioned drawbacks using a mini external fixator, after the release of the contracted fingers. The use of this fixator also helps during the surgery (stage 1) as resurfacing of the raw areas becomes quick because 2 surgeons can perform this simultaneously. The web can be further opened up using the fixator to facilitate the suturing of the FTG/flap, after which it can be brought back to its normal position. As the dimension of the raw area created is fully defined it becomes easier to suture the flap/graft with appropriate tension and tie-over dressing. The postoperative dressings become easier and pain free. The maceration of the skin graft and skin margin is reduced as the compressive dressing can be applied to individual fingers rather than a collective dressing. It is advantageous even in stage 3 as it allows the surgeon to customize the splint for each finger. PMID:23423234

  17. Fat burn X: burning more than fat.

    PubMed

    Hannabass, Kyle; Olsen, Kevin Robert

    2016-01-01

    A 50-year-old man presented with a 2-day history of bilateral lower extremity cramping and dark urine. The patient was found to have a creatine phosphokinase (CPK) elevated of up to 2306 U/L, a serum uric acid of 9.7 mg/dL and 101 red blood cell's per high-powered field on urinalysis. On questioning, the patient endorsed daily exercise with free weights. There were no changes in his regular exercise and medication regimen, no muscle trauma, no recent drug use and no illness. The patient did mention using a new fat burner known as 'Fat Burn X', which he had begun taking 2 days prior to the onset of his muscle cramps. The patient was given normal saline intravenous fluid resuscitation for 48 h with resultant normalisation of his CPK and creatinine, and was discharged with primary care follow-up. PMID:26811412

  18. TIRES, OPEN BURNING

    EPA Science Inventory

    The chapter describes available information on the health effects from open burning of rubber tires. It concentrates on the three known sources of detailed measurements: (1) a small-scale emissions characterization study performed by the U.S. EPA in a facility designed to simulat...

  19. The Earth Could Burn.

    ERIC Educational Resources Information Center

    Yarrow, Ruth

    1982-01-01

    Environmental educators are worried about the ultimate ecological threat--nuclear war, which could burn thousands of square miles, sterilize the soil, destroy 70 percent of the ozone layer letting in lethal ultraviolet rays, and cause severe radiation sickness. Educators must inform themselves, teach others, contact government representatives, and

  20. Burning Your Own CDs.

    ERIC Educational Resources Information Center

    Ekhaml, Leticia

    2001-01-01

    Discusses the use of CDs (Compact Disks) for backing up data as an alternative to using floppy disks and explains how to burn, or record, a CD. Topics include differences between CD-R (CD-Recordable) and CD-RW (CD-Rewritable); advantages of CD-R and CD-RW; selecting a CD burner; technology trends; and care of CDs. (LRW)