Advertisement

Aesthetic Plastic Surgery

, Volume 27, Issue 5, pp 411–417 | Cite as

Improved Scar Quality Following Primary and Secondary Healing of Cutaneous Wounds

  • Bishara S. AtiyehEmail author
  • Christian A. Amm
  • Kusai A. El Musa
Article

Abstract

Poor wound healing remains a critical problem in our daily practice of surgery, exerting a heavy toll on our patients as well as on the health care system. In susceptible individuals, scars can become raised, reddish, and rigid, may cause itching and pain, and might even lead to serious cosmetic and functional problems. Hypertrophic scars do not occur spontaneously in animals, which explains the lack of experimental models for the study of pathologic scar modulation. We present the results of three clinical comparative prospective studies that we have conducted. In the first study, secondary healing and cosmetic appearance following healing of partial thickness skin graft donor sites under dry (semi-open Sofra-Tulle dressing) and moist (moist exposed burn ointment, MEBO) was assessed. In the second study, healing of the donor sites was evaluated following treatment with Tegaderm or MEBO, two different types of moisture-retentive dressings. In the third study, 3 comparable groups of primarily healed wounds were evaluated. One group was treated by topical antibiotic ointment, the second group was treated by Moist Exposed Burn Ointment (MEBO), and the third group did not receive any topical treatment. In the second study, secondary healing of partial thickness skin graft donor sites was evaluated following treatment with Tegaderm or MEBO, two different types of moisture-retentive dressings. In the second and third studies, healed wounds were evaluated with the quantitative scale for scar assessment described by Beausang et al. [1] Statistical analysis revealed that for both types of wound healing, scar quality was significantly superior in those wounds treated with MEBO.

Keywords

Split Thickness Skin Graft Cosmetic Appearance Fitzpatrick Skin Type Ointment Application Skin Graft Donor Site 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgements

This paper was presented at the XVI Congress of ISAPS, Istanbul, Turkey, 26–29 May 2002.

References

  1. 1.
    Beausang, E, Floyd, H, Dunn, KW, Orton, GI,  et al. 1998A new quantitative scale for clinical scar assessment.Plast Reconstr Surg1021954PubMedGoogle Scholar
  2. 2.
    Cohen, KI 2000The biology of wound healing.Contemp Surg (Suppl) Sept 4..Google Scholar
  3. 3.
    Grinnel, F 1994Fibroblasts, myofibroblasts, and wound contraction.J Cell Biol124401PubMedGoogle Scholar
  4. 4.
    Cohen, KI, Diegelmann, RF, Yager, DR, Wornum III, IL 1999Principles of Surgery, 7th ed. Schwartz, International Edition.Spencer, SGalloway, DF eds. Wound Care and Wound Healing.McGraw-HillNew York269290Google Scholar
  5. 5.
    Peacock, EE 1984Wound Repair (3rd ed)W.B. SaundersPhiladelphiaGoogle Scholar
  6. 6.
    Mast, BA 1992Repair of specific tissues: The skin.Diegelman, RFLindblad, WJ eds. Wound Healing: Biochemical and Clinical Aspects, IKW.B. SaundersPhiladelphia344355Google Scholar
  7. 7.
    Niessen, FB, Spauwen, PHM, Robinson, PH,  et al. 1998The use of silione occlusive sheeting (Sil-K) and silicone occlusive gel (Epiderm) in the prevention of hypertrophic scar formation.Plast Reconstr Surg1021962PubMedGoogle Scholar
  8. 8.
    Ahn, ST, Monafo, WW, Mustoe, TA 1991Topical silicone gel for the prevention and treatment of hypertrophic scar.Arch Surg126499PubMedGoogle Scholar
  9. 9.
    Peacock, E 1984Wound Repair, 2nd ed.W SaundersPhiladelphia485503Google Scholar
  10. 10.
    Magliacani, G, Stella, M, Costagliola, C,  et al. 1997Post-burn pathologic scar: Clinical aspects and therapeutic approach.Ann Burn Fire Disasters10105Google Scholar
  11. 11.
    Murray, JC 1993Scars and keloids.Dermatol Clin11697PubMedGoogle Scholar
  12. 12.
    Cohen, KI 2000Wound healing: Key advances in research and clinical care.Contemp Surg (Suppl) Sept 2..Google Scholar
  13. 13.
    McCraw, JB, McCraw, JA, McMellin, A, Bettencourt, N 1999Prevention of unfavorable scars using early pulse dye laser treatments: A preliminary report.Ann Plast Surg427Google Scholar
  14. 14.
    Muti, E, Ponzio, E 1983Cryotherapy in the treatment of keloids.Ann Plast surg11227PubMedGoogle Scholar
  15. 15.
    Garcia-Velasco, M, Ley, R, Mutch, D, Surkes, N, Williams, HB 1978Compression treatment of hypertrophic scars in burned patients.Can J Surg21450PubMedGoogle Scholar
  16. 16.
    Sherris, DA, Larrabee Jr, WF, Murakami, CS 1995Management of scar contractures, hypertrophic scars, and keloids.Otolaryngol Clin North Am281057Google Scholar
  17. 17.
    Larson, DL, Abston, ., Evans, EB, Dorbkovsky, M, Linares, HA 1971Techniques for decreasing scar formation and contractures in the burned patient.J Trauma11807PubMedGoogle Scholar
  18. 18.
    Gold, MH 1994A controlled clinical trial of topical silicone gel sheeting in the treatment of hypertrophic scars and keloids.J Am Acad Dermatol30506PubMedGoogle Scholar
  19. 19.
    Krusche, T, Worret, WI 1995Mechanical properties of keloids in vivo during treatment with intralesional triamcinolone acetonide.Arch Dermatol Res287289PubMedGoogle Scholar
  20. 20.
    Larabee Jr, WF, East, CA, Jaffe, HS, Stephenson, C, Peterson, KE 1990Intralesional interferon gamma treatment for keloids and hypertrophic scars.Arch Otolaryngol Head Neck Surg1161159PubMedGoogle Scholar
  21. 21.
    Lawrence, WT 1991In search of the optimal treatment of keloids: Report of a series and a review of the literature.Ann Plast Surg27164PubMedGoogle Scholar
  22. 22.
    Carr-Colloins, JA 1992Pressure techniques for the prevention of hypertrophic scar.Clin plast Surg19733Google Scholar
  23. 23.
    Svensjo, T, Pomahac, B, Yao, F, Slama, J,  et al. 2000Accelerated healing of full-thickness skin wounds in a wet environment.Plast Reconstr Surg106663Google Scholar
  24. 24.
    Erikson, E, Perez, N, Slama, J, Page, CP,  et al. 1996Treatment of chronic, nonhealing abdominal wound in a liquid environment.Ann Plast Surg3680PubMedGoogle Scholar
  25. 25.
    Breuing, K, Erikson, E, Liu, P, Miller, DR 1992Healing of partial thickness porcine skin wounds in a liquid environment.L Surg Res5250Google Scholar
  26. 26.
    Dyson, M, Young, S, Pendle, L, Webster, DF,  et al. 1988Comparison of the effects of moist and dry conditions on dermal repair.J Invest Dermatol91434Google Scholar
  27. 27.
    Vogt, PM, Andree, C, Breuing, K, Liu, PY,  et al. 1995Dry, moist, and wet skin wound repair.Ann Plast Surg34493PubMedGoogle Scholar
  28. 28.
    Atiyeh, BS, Ghanimeh, G, Kaddoura, IL, Al Amm, C, Ioannovich, J 2001Split thickness skin graft donor site dressing: Preliminary results of controlled clinical comparative study of MEBO and Sofra-Tulle.Ann Plast Surg4687PubMedGoogle Scholar
  29. 29.
    Atiyeh, BS, Ioannovich, J, Al Amm, CA 2000Pansements de sites donneurs De greffe de peau mince: Resultats preliminaires d’une etude clinique limitee comparative de “MEBO” et de “Sofra-Tulle”.Brulures, Revue Francçaise de Brûlologie1155Google Scholar
  30. 30.
    Atiyeh, BS, Al-Amm, CA, Nasser, AA 2002Improved healing of split thickness skin graft donor sites.J Applied Res2114121Google Scholar
  31. 31.
    Atiyeh, BS, Al-Amm, CA, El-Musa, KA, Sawwaf, A, Dham, R 2003Scar quality and physiologic barrier function restoration following moist and moist exposed dressings of partial thickness wounds.Dermatol Surg2914CrossRefPubMedGoogle Scholar
  32. 32.
    Atiyeh, BS, Ioannovich, J, Al-Amm, CA, El-Musa, KA, Dham, R 2002Improving scar quality: A prospective clinical study.Aesth Plast Surg26470CrossRefGoogle Scholar
  33. 33.
    Feldman, L 1991Which dressing for split-thickness skin graft donor sites?Ann Plast Surg27288PubMedGoogle Scholar
  34. 34.
    Feldman, D, Rogers, A, Karpinski, R 1991A prospective trial comparing Biobrane, Duoderm and Xeroform for skin graft donor sites.Surg Gyn Obstet1731Google Scholar
  35. 35.
    Vanstraelen, P 1992Comparison of calcium sodium alginate (KALTOSTAT) and porcine xenograft (E-Z DERM) in the healing of split-thickness skin graft donor sites.Burns18145PubMedGoogle Scholar
  36. 36.
    Kelton Jr, P 1992Skin grafts.Selec Read Plast Surg71Google Scholar
  37. 37.
    Nemeth, AJ 1991Faster healing and less pain in skin biopsy sites treated with an occlusive dressing.Arch Dermatol1271679PubMedGoogle Scholar
  38. 38.
    Sawada, Y, Yotsuyanagi, T, Sone, K 1990A silicone gel sheet dressing containing an antimicrobial agent for split thickness donor site wounds.Br J Plast Surg4388Google Scholar
  39. 39.
    Winter, GD, Scales, JT 1963Effect of air drying and dressings on the surface of a wound.Nature19791Google Scholar
  40. 40.
    Xu, R 1989The medicine of burns and ulcers, a general introduction.Chinese J Burns Wounds Surf Ulcers.68Google Scholar
  41. 41.
    Cohen, IK, McCoy, BJ 1990The biology and control of surface overhealing.World J Surg4289Google Scholar
  42. 42.
    Peacock, EE 1981Pharmacologic control of surface scarring in human beings.Ann Surg193592PubMedGoogle Scholar
  43. 43.
    Topol, BM, Lewis, VL, Benvensite, K 1981The use of antihistamine to retard growth of fibroblasts derived from human skin, scar and keloid.Plast Reconstr Surg38227Google Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  • Bishara S. Atiyeh
    • 1
    Email author
  • Christian A. Amm
    • 1
  • Kusai A. El Musa
    • 1
  1. 1.American University of Beirut, BeirutLebanon

Personalised recommendations