Improving Cutaneous Scar Formation by Controlling the Mechanical Environment: Large Animal and Phase I Studies

  title={Improving Cutaneous Scar Formation by Controlling the Mechanical Environment: Large Animal and Phase I Studies},
  author={Geoffrey C. Gurtner and Reinhold H. Dauskardt and Victor W. Wong and Kirit A. Bhatt and Kenneth S. Wu and Ivan N. Vial and Karine Padois and Joshua M. Korman and Michael T. Longaker},
  journal={Annals of Surgery},
Objective: To test the hypothesis that the mechanical environment of cutaneous wounds can control scar formation. Background: 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. Methods: A mechanomodulating polymer device was utilized to manipulate the mechanical environment of closed… 
Pathophysiology of post-operative scars
Post-operative scar forms as the result of a highly conserved cascade of events following surgery that seeks to restore skin integrity and is influenced by the wound environment's physical properties likely through cellular mechanotransduction.
Mechanical Forces in Cutaneous Wound Healing: Emerging Therapies to Minimize Scar Formation.
The development of therapies that reduce mechanical forces in the wound environment would decrease the risk of developing excessive scars, and thus, continued studies on therapies that utilize mechanical offloading and mechanomodulation are needed.
Splinting Strategies to Overcome Confounding Wound Contraction in Experimental Animal Models.
Small animals (rodents) are extensively utilized to model human cutaneous wound healing, but they heal by wound contraction, a process that is limited in the human and confounds quantitative and qualitative evaluation of experimental wound repair.
A Randomized Controlled Trial of the embrace Advanced Scar Therapy Device to Reduce Incisional Scar Formation
These results demonstrate that the embrace device significantly reduces scarring following abdominoplasty surgery, and represents the first level I evidence for postoperative scar reduction.
New strategy of modulating incision tension: A wound tension offloading device applied before surgery
Application of a tension offloading device preoperatively can reduce tensile forces acting on the incision, thereby resulting in faster wound healing and enhanced efficacy on postsurgical reapplication, and the effectiveness of the device in preventing hypertrophic scar is likely to be improved by long‐term application after operation.
Burn Scar Biomechanics after Pressure Garment Therapy
Pressure garment therapy was effective at reducing scar contraction and improving biomechanics compared with control scars, and the need to further investigate the role of pressure magnitude and the time of therapy application is highlighted to enhance efficacy for optimal biomechanic and patient mobility.
A Novel Model for Cutaneous Wound Healing and Scarring in the Rat
The rat tail model exhibits minor wound contraction and biological features analogous to both normotrophic and hypertrophic scar in humans when generated with or without stretching, respectively, and is a promising new model for studies of both cutaneous wound healing and scarring.
Effects of Autologous Fat and ASCs on Swine Hypertrophic Burn Scars: A Multimodal Quantitative Analysis
Early results suggest that autologous fat and/or ASCs may improve healing of hypertrophic scarring by altering the cellular and structural components during wound remodeling up to 20 weeks after injury.
The Role of Wound Healing and Its Everyday Application in Plastic Surgery: A Practical Perspective and Systematic Review
An overview of incisional wound healing is presented with a focus on 2 principles that guide postoperative recommendations: the gain of tensile strength of a wound over time and the effect of mechanical stress on wound healing.
The Immediate Use of a Silicone Sheet Wound Closure Device in Scar Reduction and Prevention
Early silicone application and tissue tension distribution contributed to an overall more aesthetically pleasing scar compared to those seen with standard suturing techniques, although more testing is required.


Mechanical load initiates hypertrophic scar formation through decreased cellular apoptosis
  • S. Aarabi, Kirit A. Bhatt, G. Gurtner
  • Biology, Medicine
    FASEB journal : official publication of the Federation of American Societies for Experimental Biology
  • 2007
It is demonstrated for the first time that mechanical stress applied to a healing wound is sufficient to produce hypertrophic scars in mice, and it is concluded that mechanical loading early in the proliferative phase of wound healing produces hypertrophic scar formation by inhibiting cellular apoptosis through an Akt‐dependent mechanism.
A Randomized, Controlled Trial to Determine the Efficacy of Paper Tape in Preventing Hypertrophic Scar Formation in Surgical Incisions that Traverse Langer's Skin Tension Lines
The development of hypertrophic and stretched scars in the treatment group only after the tape was removed suggests that tension acting on a scar is the trigger for hypertrophic scarring.
Histology of the thick scar on the female, red Duroc pig: final similarities to human hypertrophic scar.
Is There an Ideal Animal Model to Study Hypertrophic Scarring?
Most recently, the female red Duroc pigs were validated as a new model, demonstrating its similarity to human conditions in different ways and representing improvement in the search of an ideal hypertrophic scarring animal model.
Negative pressure wound therapy for soft tissue injuries around the foot and ankle
NPWT was found to facilitate the rapid formation of healthy granulation tissue on open wounds in the foot and ankle region, and thus, to shorten healing time and minimize secondary soft tissue defect coverage procedures.
Mechanical Strain Alters Gene Expression in an in Vitro Model of Hypertrophic Scarring
Results suggest that mechanical strain up-regulates matrix remodeling genes and down-regulate normal cellular apoptosis, resulting in more cells, each of which produces more matrix, which may underlie the pathophysiology of hypertrophic scars and other fibrotic processes in vivo.
Evolution of Silicone Therapy and Mechanism of Action in Scar Management
Results from clinical trials and clinical experience suggest that silicone gel is equivalent in efficacy to traditional silicone gel sheeting but easier to use.
Wound Repair and Regeneration
This review focuses on the healing processes of the skin and highlights the classical wound healing phases and the physiological endpoint of mammalian wound repair displays the formation of a scar, which is directly linked to the extent of the inflammatory process throughout wound healing.
[International clinical recommendations on scar management].
A qualitative overview of the available clinical literature by an international panel of experts using standard methods of appraisal highlights a primary role for silicon gel sheeting and intralesional corticosteroids in the management of a wide variety of abnormal scars.