Improving Scar Quality: A Prospective Clinical Study
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Abstract
Following traumatic or surgical injury to the skin, wounds do not heal by tissue regeneration but rather by scar formation. Though healing is definitely a welcomed event, the resultant scar, very often, is not aesthetically pleasing, and not infrequently, may be pathologic causing serious deformities and contractures. Management of problematic scars continues to be a frustrating endeavor with less than optimal results. Prophylactic methods of wound management to minimize serious scarring are being developed. In a previously published study, we have demonstrated improved healing of split thickness skin graft donor sites following treatment with Moist Exposed Burn Ointment (MEBO, Julphar Gulf Pharmaceutical Industries, Ras Al-Khaimah, UAE). At present, we are reporting the results of a comparative clinical prospective study evaluating scar quality following primary healing of elective surgical and traumatic facial wounds with prophylactic MEBO application, topical antibiotic ointment application, and no topical therapy at all. Scars were evaluated according to the Visual Analogue Scale for scar assessment. Statistical analysis of scar assessment scores demonstrated marked prevention of unfavorable scars with improved cosmetic results following MEBO prophylactic therapy.
Key words
Scar formation MEBO Scar evaluationPreview
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References
- 1.Ahn ST, Monafo WW, Mustoe TA: Topical silicone gel for the prevention and treatment of hypertrophic scar. Arch Surg 126:499, 1991CrossRefPubMedGoogle Scholar
- 2.Alster TS, Kurban AK, Grove GL, et al.: Alteration of argon laser-induced scars by the pulsed dye laser. Lasers Surg Med 13:368, 1993CrossRefPubMedGoogle Scholar
- 3.Alster TS: Improvement of erythematous and hypertrophic scars by the 585 nm pulsed dye laser. Ann Plast Surg 32:186, 1994CrossRefPubMedGoogle Scholar
- 4.Alster TS, West TB: Treatment of scars: a review. Ann Plast Surg 39:428, 1997CrossRefGoogle Scholar
- 5.Alster TS: Laser treatment of hypertrophic scars, keloids, and striae. Dermatol Clin 15:419, 1997CrossRefPubMedGoogle Scholar
- 6.Anderson RR, Parrish JA: Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 22:524, 1983CrossRefGoogle Scholar
- 7.Ang ES, Lee ST, Gan CS, See P, et al.: The role of alternative therapy in the management of partial thickness burns of the face experience with the use of moist exposed burn ointment (MEBO) compared with silver sulphadiazine. Ann Acad Med Singapore 29:7, 2000PubMedGoogle Scholar
- 8.Atiyeh BS, Ioannovich J, Al Amm CA: Pansements de sites donneurs de greffe de peau mince: Resultats preliminaires dune etude clinique limitee comparative de “MEBO” et de “Sofra-Tulle. Brulures Revue Française de brûlologie 1:155, 2000Google Scholar
- 9.Atiyeh BS, Ghanimeh G, Kaddoura IL, Al Amm C, Ioannovich J: Letter to the editor: Split thickness skin graft donor site dressing: Preliminary results of controlled clinical comparative study of MEBO and Sofra-Tulle. Ann Plast Surg 46:87, 2001CrossRefPubMedGoogle Scholar
- 10.Beausang E, Floyd H, Dunn KW, Orton GI, et al.: A new quantitative scale for clinical scar assessment. Plast Reconstr surg 102:1954, 1998CrossRefPubMedGoogle Scholar
- 11.Carr-Collins JA: Pressure techniques for the prevention of hypertrophic scar. Clin Plast Surg 19:733, 1992PubMedGoogle Scholar
- 12.Chang CC, Kuo YF, Chiu HC, Lee JL: Hydration not silicone, modulates the effects of keratinocytes on fibroblasts. J Surg Res 59:705, 1995CrossRefPubMedGoogle Scholar
- 13.Cohen KI: Wound healing: Key advances in research and clinical care. Contemp Surg Suppl Sept:2, 2000Google Scholar
- 14.Cohen KI: The biology of wound healing. Contemp Surg Suppl Sept:4–8, 2000Google Scholar
- 15.Cohen KI, Diegelmann RF, Yager DR, Wornum III IL, et al.: Wound care and wound healing. In: Spencer S, Galloway DF (eds). Principles of surgery. McGraw-Hill: New York, p 269Google Scholar
- 16.Cohen IK, McCoy BJ: The biology and control of surface overhealing. World J Surg 4:289, 1990CrossRefGoogle Scholar
- 17.Cruz-Korchin NI: Effectiveness of silicone sheets in the prevention of hypertrophic breast scars. Ann Plast Surg 37:345, 1996CrossRefPubMedGoogle Scholar
- 18.Datubo-Brown D: Keloids. A review of the literature. Brit J Plast Surg 43:70, 1990CrossRefPubMedGoogle Scholar
- 19.Davy RB, Wallis KA, Bowering K: Adhesive contact media: an update on graft fixation and bura scar management. Burns 17:313, 1991CrossRefGoogle Scholar
- 20.Garcia-Velasco M, Ley R, Mutch D, Surkes N, Williams HB: Compression treatment of hypertrophic scars in burned patients. Can J Surg 21:450, 1978PubMedGoogle Scholar
- 21.Gold MH: A controlled clinical trial of topical silicone gel sheeting in the treatment of hypertrophic scars and keloids. J Am Acad Derrnatol 30:506, 1994CrossRefGoogle Scholar
- 22.Griffith BH: The treatment of keloids with triamcinolone acetonide. Plast Reconstr Surg 38:202, 1966CrossRefPubMedGoogle Scholar
- 23.Grinnel F: Fibroblasts, myofibroblasts, and wound contraction. J Cell Biol 124:401, 1994CrossRefGoogle Scholar
- 24.Huang QS, Zhou G, Su BP, Huang EX: A comparative study of fibronectin and MEBO in the treatment of experimental rabbit corneal alkaline burn. Chinese J Burns Wounds Surf Ulcers 1:18, 1995Google Scholar
- 25.Ioannovich J, Tsati E, Tsoutsos D, Frangia K, et al.: Moist exposed burn therapy: evaluation of the epithelial repair process (an experimental model). Ann Burns Fire Disast 8:3, 2000Google Scholar
- 26.Janssen de Limpens AM: The local treatment of hypertrophic scars and keloids with retinoic acid. Br J Dermatol 103:319, 1980CrossRefPubMedGoogle Scholar
- 27.Kovalic JJ, Perez CA: Radiation therapy following keloidectomy: A 20-year experience. Int J Radiat Oncol Biol Phys 17:77, 1989CrossRefPubMedGoogle Scholar
- 28.Kischer H, Shetlar MR, Shetlar CL: Alteration of hypertrophic sternal scars induced by mechanical pressure. Arch Dermatol 8:60, 1975CrossRefGoogle Scholar
- 29.Krusche T, Worret WI: Mechanical properties of keloids in vivo during treatment with intralesional triamcinolone acetonide. Arch Dermatol Res 287:289, 1995CrossRefPubMedGoogle Scholar
- 30.Larrabee Jr, WF, East CA, Jaffe HS, Stephenson C, Peterson KE: Intralesional interferon gamma treatment for keloids and hypertrophic scars. Arch Otolaryngol Head Neck Surg 116:1159, 1990CrossRefPubMedGoogle Scholar
- 31.Larson DL, Abston S, Evans EB, Dobrkovsky M, Linares HA: Techniques for decreasing scar formation and contractures in the burned patient. J Trauma 11:807, 1971CrossRefPubMedGoogle Scholar
- 32.Lawrence WT: In search of the optimal treatment of keloids: report of a series and a review of the literature. Ann Plast Surg 27:164, 1991CrossRefPubMedGoogle Scholar
- 33.Li L: Experiment on inhibiting constriction of the ileum from a white mouse. Chinese J Burns Wounds Surf Ulcers 1:50, 1990Google Scholar
- 34.Magliacani G, Stella M, Costagliola C, Trombotto C, et al.: Post-burn pathologic scar: Clinical aspects and therapeutic approach. Ann Burn Fire Disasters 10:105, 1997Google Scholar
- 35.Mast BA: Repair of specific tissues: The skin. In: Diegelman RF and Lindblad WJ (eds) Wound healing: Biochemical and clinical aspects. Saunders Co: Philadelphia, p 344, 1992Google Scholar
- 36.McCraw JB, McCraw JA, McMellin A, Bettencourt N: Prevention of unfavorable scars using early pulse dye laser treatments: A preliminary report. Ann Plast Surg 42:7, 1999CrossRefPubMedGoogle Scholar
- 37.Murray JC: Sears and keloids. Dermatol Clin 11:697, 1993PubMedGoogle Scholar
- 38.Muti E, Ponzio E: Cryotherapy in the treatment of keloids. Ann Plast Surg 11:227, 1983CrossRefPubMedGoogle Scholar
- 39.Nissen FB, Spauwen PHM, Robinson PH, Fidler V, et al.: The use of silione occlusive sheeting (Sil-K) and silicone occlusive gel (Epiderm) in the prevention of hypertrophic scar formation. Plast Reconstr Surg 102:1962, 1998CrossRefGoogle Scholar
- 40.Peacock E: Pharmacologic control of surface scarring in human beings. Ann Surg 193:592, 1981CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Peacock E: Wound repair. Saunders Co: Philadelphia, p 485, 1984Google Scholar
- 42.Qu YY, Wang YP, Qiu SC, et al.: Experimental research on the mechanism of the effect of MEBO. Chinese J Burns Wounds Surf Ulcers 4:4, 1997Google Scholar
- 43.Robb EC, Waymack JP, Warden GD, Nathan P, et al.: A newmodel for studying the development of human hypertrophic burn scar formation. J Burn Care Rehabil 8:371, 1987CrossRefPubMedGoogle Scholar
- 44.Sherris DA, Larrabee Jr, WF, Murakami CS: Management of scar contractures, hypertrophic scars, and keloids. Otolaryngol Clin North Am 28:1057, 1995PubMedGoogle Scholar
- 45.Topol BM, Lewis VL, Benvensite K: The use of antihistamine to retard growth of fibroblasts derived from human skin, scar and keloid. Plast Reconstr Surg 68:227, 1981CrossRefPubMedGoogle Scholar
- 46.Wang GS, Zhang YM, Liu RS, et al.: Experimental study of the effect of MEBO on blood rheology in the treatment of burned rabbits. Chinese J Burns Wounds Surf Ulcers 4:30, 1993Google Scholar
- 47.Wang GS, Jian WG, Xu XS, et al.: The exploration of pathological changes and their mechanism of experimentally burned rabbits after treatment. Chinese J Burns Wounds Surf Ulcers 3:7, 1992Google Scholar
- 48.Weber S, Kruger-Kragasakes S, Grabbe J, Zuberbier T, et al.: Mast cells. Int J Dermatol 34:1, 1995CrossRefPubMedGoogle Scholar