Acne Scars

J Orthop Res. 2009 Apr 28; Chen H, Sun J, Hoemann CD, Lascau-Coman V, Ouyang W, McKee MD, Shive MS, Buschmann MDBone marrow stimulation is performed using several surgical techniques that have not been systematically compared or optimized for a desired cartilage repair outcome. In this study, we investigated acute osteochondral characteristics following microfracture and comparing to drilling in a mature rabbit model of cartilage repair. Microfracture holes were made to a depth of 2 mm and drill holes to either 2 mm or 6 mm under cooled irrigation. Animals were sacrificed 1 day postoperatively and subchondral bone assessed by histology and micro-CT. We confirmed one hypothesis that microfracture produces fractured and compacted bone around holes, essentially sealing them off from viable bone marrow and potentially impeding repair. In contrast, drilling cleanly removed bone from the holes to provide access channels to marrow stroma. Our second hypothesis that drilling would cause greater osteocyte death than microfracture due to heat necrosis was not substantiated, because more empty osteocyte lacunae were associated with microfracture than drilling, probably due to shearing and crushing of adjacent bone. Drilling deeper to 6 mm versus 2 mm penetrated the epiphyseal scar in this model and led to greater subchondral hematoma. Our study revealed distinct differences between microfracture and drilling for acute subchondral bone structure and osteocyte necrosis. Additional ongoing studies suggest these differences significantly affect long-term cartilage repair outcome. (c) 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Zhonghua Zheng Xing Wai Ke Za Zhi. 2009 Jan; 25(1): 37-40Xu SJ, Teng JY, Xie J, Shen MQ, Chen DMOBJECTIVE: To investigate the effects of intralesional steroid, interferon alpha-2b or verapamil injection on proliferation, apoptosis and TGF-beta1 expression in keloid and hypertrophic scar in vivo. METHODS: 6 patients with keloids and 6 patients with hypertrophic scar were treated with intralesional injection of triamcinolone acetonide (40 mg/ml) or IFN alpha-2b (15 x 10(5) U/ml) or verapamil (2.5 mg/ml). Samples were collected on the 7th day after intralesional injection. Samples of untreated keloid and hypertrophic scar and normal skin were used as control. Expression of PCNA and TGF-beta1 was detected in situ by immunohistochemical staining, and apoptosis was detected in situ by terminal deoxynucleotidyl transferase-mediated deoxyuridinetriphosphate-biotin nick end labeling (TUNEL). RESULTS: 1) Triamcinolone acetonide could prohibit proliferative scars through inhibiting cell proliferation and TGF-beta1 expression, as well as inducing apoptosis. 2) IFN alpha-2b could prohibit proliferative scars through inhibiting cell proliferation and TGF-beta1 expression, but not inducing apoptosis; 3) Verapamil could also prohibit proliferative scars through inhibiting proliferation and TGF-beta1 expression in fibroblasts, as well as inducing apoptosis. While the effect of inducing apoptosis was stronger than that of triamcinolone acetonide, the effect of inhibiting TGF-beta1 expression was weaker than those of triamcinolone acetonide and IFN alpha-2b. CONCLUSIONS: Although intraleional injection of steroid, interferon alpha-2b or verapamil were all effective in the treatment of keloid and hypertrophic scar, their mechanisms are not similar.

Plast Reconstr Surg. 2009 May; 123(5): 1481-9Durani P, McGrouther DA, Ferguson MWBACKGROUND: There is a lack of rigorously validated patient-based outcomes measures of scarring. The aim of this study was to construct such a scale and demonstrate reliability and validity by applying the scale in a wide range of scarring samples. METHODS: The Patient Scar Assessment Questionnaire with five subscales (i.e., Appearance, Symptoms, Consciousness, Satisfaction with Appearance, and Satisfaction with Symptoms) was constructed using multiple categorical response items. The Patient Scar Assessment Questionnaire was applied to various surgical samples (total scar assessments n = 667) at months 3, 6, and 12 after surgery (and preoperatively in the scar revision group) and tested for internal consistency, test-retest reliability, convergent validity, known group differences, and sensitivity, against widely accepted criteria from psychometric measurement science. RESULTS: Subscales showed high internal consistency (Cronbach alpha, 0.73 to 0.93), except the Symptoms subscale. Test-retest reliability was high across all subscales (intraclass correlation coefficient, 0.74 to 0.87) across all groups except the scar revision group. Change in Patient Scar Assessment Questionnaire scores was significant between months 3 and 6 postoperatively (p < 0.001) and subscales demonstrated known group differences (p < 0.001). Convergent validity was demonstrated by significant moderate correlations with various measures of similar constructs (r = 0.26 to 0.61, p < 0.001). CONCLUSIONS: The Patient Scar Assessment Questionnaire is a reliable and valid measure of the patient's perception of scarring, although the Symptoms subscale requires further refinement. Subscales can be used independently of each other to allow assessment of scar change in specific domains.

Burns. 2009 Apr 29; Grishkevich VMThermal injuries to the anterior chest in pre-pubescent girls result in breast contracture. During puberty, the breast parenchyma develops and grows underneath the scars, resulting in being flattened and disfigured. The breast mound, as well as the nipple-areolar complex, is partially or completely levelled out and displaced. The contours are unclear and the inframammary fold is effaced. This feature of the most severe breast contracture still poses a challenge for most surgeons. This type of breast contracture can be successfully eliminated with the author-suggested, improved free-skin grafting technique. The scars are excised and the shifted area of parenchyma is mobilised symmetrically to the border of the undamaged breast. Then, the shape and positioning of the breast as well as the nipple-areolar complex are reconstructed with the help of circular suturing through the fat layer on two to three breast levels. The suture ends are led beyond the wound area and are affixed with certain tension contralateral to the breast displacement. The suture ends, being in state of tension, are tied into untied knots around bolsters and are retained in place for about 3 months. During this time, the form and the positioning of the breast can be corrected using the traction of the untied sutures; the skin transplants are stabilised, under which the scar tissue is formed. Skin transplant and the scar tissue hold the shape and positioning of the breast and the sutures can be removed at this stage. In this series, 11 patients were operated upon and 13 breasts were reconstructed. Good results were achieved in all cases: the breast's shape and skin was restored and the positioning was corrected.