A Randomized Controlled Trial of the embrace Advanced Scar Therapy Device to Reduce Incisional Scar Formation.
Plastic and reconstructive surgery
2014; 134 (3): 536-546
Scarring represents a significant biomedical burden in clinical medicine. Mechanomodulation has been linked to scarring through inflammation, but until now a systematic approach to attenuate mechanical force and reduce scarring has not been possible.The authors conducted a 12-month, prospective, open-label, randomized, multicenter clinical trial to evaluate abdominoplasty scar appearance following postoperative treatment with the embrace Advanced Scar Therapy device to reduce mechanical forces on healing surgical incisions. Incisions from 65 healthy adult subjects were randomized to receive embrace treatment on one half of an abdominoplasty incision and control treatment (surgeon's optimal care methods) on the other half. The primary endpoint for this study was the difference between assessments of scar appearance for the treated and control sides using the visual analogue scale scar score.Final 12-month study photographs were obtained from 36 subjects who completed at least 5 weeks of dressing application. The mean visual analogue scale score for embrace-treated scars (2.90) was significantly improved compared with control-treated scars (3.29) at 12 months (difference, 0.39; 95 percent confidence interval, 0.14 to 0.66; p = 0.027). Both subjects and investigators found that embrace-treated scars demonstrated significant improvements in overall appearance at 12 months using the Patient and Observer Scar Assessment Scale evaluation (p = 0.02 and p < 0.001, respectively). No serious adverse events were reported.These results demonstrate that the embrace device significantly reduces scarring following abdominoplasty surgery. To the authors' knowledge, this represents the first level I evidence for postoperative scar reduction.Therapeutic, II.
View details for DOI 10.1097/PRS.0000000000000417
View details for PubMedID 24804638
Improving Cutaneous Scar Formation by Controlling the Mechanical Environment Large Animal and Phase I Studies
ANNALS OF SURGERY
2011; 254 (2): 217-225
To test the hypothesis that the mechanical environment of cutaneous wounds can control scar formation.Mechanical forces have been recognized to modulate myriad biologic processes, but the role of physical force in scar formation remains unclear. Furthermore, the therapeutic benefits of offloading cutaneous wounds with a device have not been rigorously tested.A mechanomodulating polymer device was utilized to manipulate the mechanical environment of closed cutaneous wounds in red Duroc swine. After 8 weeks, wounds subjected to different mechanical stress states underwent immunohistochemical analysis for fibrotic markers. In a phase I clinical study, 9 human patients undergoing elective abdominal surgery were treated postoperatively with a stress-shielding polymer on one side whereas the other side was treated as standard of care. Professional photographs were taken between 8 and 12 months postsurgery and evaluated using a visual analog scale by lay and professional panels. This study is registered with ClinicalTrials.gov, number NCT00766727.Stress shielding of swine incisions reduced histologic scar area by 6- and 9-fold compared to control and elevated stress states, respectively (P < 0.01 for both) and dramatically decreased the histologic expression of profibrotic markers. Closure of high-tension wounds induced human-like scar formation in the red Duroc, a phenotype effectively mitigated with stress shielding of wounds. In the study on humans, stress shielding of abdominal incisions significantly improved scar appearance (P = 0.004) compared with within-patient controls.These results indicate that mechanical manipulation of the wound environment with a dynamic stress-shielding polymer device can significantly reduce scar formation.
View details for DOI 10.1097/SLA.0b013e318220b159
View details for Web of Science ID 000292908700007
View details for PubMedID 21606834
LIGHT-MICROSCOPIC AND IMMUNOHISTOCHEMICAL FEATURES IN SERIAL BIOPSIES OF EPIDERMAL VERSUS DERMAL ALLOGRAFTS
ANNALS OF PLASTIC SURGERY
1994; 33 (3): 295-299
The local immune response to allograft dermis and epidermis was studied in a rat skin-graft model. Biopsies taken at varying times after transplantation were analyzed using routine light microscopy and a panel of monoclonal antibodies. The dermis appeared to be spared by the rejection process, whereas the epithelium and adnexal elements of the dermis were destroyed. The persistence of dermis transplanted across major histoincompatibilities may allow it to be useful in reconstructing large skin losses.
View details for Web of Science ID A1994PF49900011
View details for PubMedID 7985966
BREAST IMPLANTS AS ARTIFACTS
PLASTIC AND RECONSTRUCTIVE SURGERY
1991; 87 (4): 806-806
View details for Web of Science ID A1991FE05900037
A 30-YEAR FOLLOW-UP OF WAX INJECTION FOR THE PREVENTION OF ANDROGENIC ALOPECIA
PLASTIC AND RECONSTRUCTIVE SURGERY
1986; 78 (6): 815-816
In summary, we present a 30-year follow-up of injected wax for the prevention of male-pattern baldness. Removal was precipitated by the presence of a fibroxanthoma of the scalp. No other scalp lesions were found, nor were there any manifestations of an autoimmune disease. The injected wax failed to prevent androgenic alopecia and created a remodeling of the outer table of the cortex of the skull.
View details for Web of Science ID A1986F373300019
View details for PubMedID 3786537