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In the current research, two porous Co(II)-containing metal–organic frameworks (MOFs) whose chemical formulae can be teamed as [Co2(bptc)(H2O)2]·5DMA (1, H4bptc = biphenyl-3,3′,5,5′-tetracarboxylic acid) and [Co2(Hatta)2·(H2O)3]·3DMA (2, H4atta = 2′-amino-[1,1′:4′,1″-terphenyl]-3,3″,5,5″- tetracarboxylic acid) have been solvothermally synthesized by using two similar tetracarboxylic ligands and structurally characterized. The complex 2 with amino-functionalized pores could be used as recoverable heterogeneous catalytic agent for Knoevenagel condensation without solvents. The inhibitory activity of compounds on the scar tissue hyperplasia was evaluated and the related mechanism was discussed as well. First of all, the proliferation of the human hypertrophic scar fibroblasts was measured after indicated treatment was measured by CCK-8 assay. Next, the real time RT-PCR was applied to determine the activation power of the VEGF signaling pathway after using compounds.

Background The scalpel was once the gold standard for surgical incisions. Electrosurgery has started to supplant scalpels but is not yet acceptable for skin incisions due to the risk of burns and deeper injury relative to the scalpels' neat incision with less tissue damage. The unnecessary burden of excessive scar formation makes comparing these two methods challenging. Therefore, this study aims to compare post-incision skin scarring created after monopolar electrosurgery and scalpel surgery, and evaluate the Patient and Observer Scar Assessment Scale (POSAS) suitability for assessing skin incision scars by comparing patients' and observers’ scores. Methods This self-controlled study involved patients undergoing elective and emergency skin surgery procedures. A singular wound site was created using two incision methods (monopolar electrosurgery and scalpel) simultaneously. Post-incision scar tissue formation was evaluated using the POSAS, a subjective scar assessment tool that involved patients self-reporting on pain, itching, color, thickness flexibility, and surface relief. Observer-rated vascularity, pigmentation, thickness, flexibility, and surface relief both using a 5-point Likert-type scale. We performed this assessment three months post-surgery, and the results were analyzed by a battery of statistical tests and linear mixed models. Results Twenty patients were included in this study. Data analyzed using the paired t-test or Wilcoxon rank-sum test indicated no statistically significant differences between the scar tissue created by monopolar electrosurgery and scalpels according to both the patients and the observers. Correlation analyses between the patients' and observers’ total POSAS scores indicated these followed a moderate linear relationship (r = 0.51; p, Highlights • The scalpel was once the gold standard for surgical incisions. • Electrosurgery has started to supplant scalpels but is not yet acceptable for skin incisions due to the risk of burns. • The Patient and Observer Scar Assessment Scale (POSAS) is a subjective scar assessment. • Our results show that electrosurgery was not inferior to the scalpel technique. • The POSAS instrument is an acceptable means of assessing scar formation on the skin.

Pathologies within the fat pad can have either intrinsic or extrinsic causes. Most of them are the consequences of trauma and degeneration, but inflammatory and neoplastic diseases can arise in the fat pad. Pigmented villonodular synovitis is the most common space-occupying lesion of the Hoffa fat pad, followed by ganglion. The purpose of this Technical Note is to describe the details of endoscopic resection of localized pigmented villonodular synovitis in the Hoffa fat pad. Hopefully, this can allow complete resection of the lesion with minimal surgical trauma and scar tissue formation.

Hand surgeons often encounter painful posttraumatic neuromas in daily practice and the treatment of these neuromas is still challenging for them, because of the tendency of recurrence.1,2 The patient injured his left middle finger and was treated by amputation in a previous hospital. After this operation, the patient started to feel pain at the fingertip and complained of severe electric radiating pain when the radial and ulnar ends of the finger were touched. We treated painful neuromas formed on both palmar digital nerve stumps using a reverse pedicle island flap containing subcutaneous nerves, which were connected to the nerve stumps after removal of the neuromas of the finger. This maneuver relieved the finger pain completely.Removal of finger digital nerve neuromas, connecting the nerve stumps to the subcutaneous nerves included in a skin island flap and, covering the neurorrhaphy sites with the flap may have reduced the chance of the recurrence of neuromas and resulted in restoration of considerable function of the hand. Keywords: Digit tip amputation, Painful neuromas, Neurovascular island flap, Scar tissue

The incidence of adjacent level disease, in patients who have undergone a previous open posterior pedicle screw and rod instrumented fusion, is reported to be as high as 30% at 5-year follow-up. Due to the traditional revision open posterior surgery used to manage these patients being fraught with complications, several studies have compared this to newer MIS interbody fusion techniques. While the PLIF and TLIF inter-body fusion procedures have shown promising results, nerve root tethering by scar tissue limits the amount of retraction that can be safely performed, and as such may limit access to the disc space of the adjacent level. The ALIF is an anterior alternative, however several studies note it to be characterized by a high complication rate. As such the XLIF has been evaluated as an alternative to the ALIF, PLIF, and TLIF procedures and, despite several advantages, several papers note it to have its own specific set of complications despite the mandatory utilization of intra-operative electromyographic neurophysiological monitoring. As such an attending spinal surgeon, when managing a patient with adjacent level disease, must have a through understanding of the pros and cons of each possible surgical technique that could be used to manage the adjacent level. We present a series of three patients, all of which had previously undergone an open posterior instrumented lumbar fusion, and now presented to our unit with adjacent level disease. Two patients were successfully managed with a minimally invasive XLIF procedure augmented by open posterior decompression and extension of the instrumented fusion, and one patient was successfully managed by a minimally invasive stand-alone XLIF procedure without additional open posterior surgery. Our case series serves to highlight the specific and valuable role of the MIS XLIF procedure, specifically in the context of patients presenting with adjacent level disease.

Fibrosis is the accumulation of extracellular matrix components that make up scar tissue and is a common result of chronic tissue injury. Fibrotic diseases are responsible for a large burden of human illness, and the development of new methods to image fibrosis and fibrogenesis is a large unmet clinical need. This chapter provides an overview of molecular probes for fibrosis imaging by magnetic resonance imaging positron emission tomography and single-photon emission computed tomography. It starts by introducing the molecular processes involved in the development of fibrosis and identifying corresponding imaging targets. It then describes the application of the targeting molecular probes to image fibrotic processes in different organs or diseases. At the end of the chapter, the role of molecular imaging in answering unmet challenges in fibrosis and the next steps needed to translate molecular imaging into human fibrotic diseases are discussed.

Nerve deterioration, scar tissue growth, and the loss of interaction with nerves and body cells are the major nerve injury issues. Regeneration of nerve tissue at the sites of the injury remains a significant concern. There are different kinds of approaches based on nanomaterials that have been developed to mitigate nerve injury and to facilitate the growth of neural cells. In this chapter, carbon nanotubes are reviewed for their neurofunctional abilities. Owing to the optimal physicochemical properties, a wide variety of composites built on carbon nanotubes have been developed for different neural applications. An updated carbon nanotube surface has demonstrated neurite outgrowth enhancement, increased biocompatibility, neuronal production, and neurite/axonal elongation. Enhanced control of CNT activity is acquired to improve biocompatibility and tackle toxicity. That will encourage the incorporation of CNTs into neural functions.

We present a case of an intra-orbital, subperiosteal organizing hematoma (pseudocyst) which was referred to our clinic with a misdiagnosis of an orbital epidermoid cyst. This confounding lesion caused a great deal of debate following a magnetic resonance imaging (MRI) scan. It was only after surgery and investigating that the patient remembered an incident with orbital trauma nearly 2-years prior. We used existing literature to hypothesise that this lesion has a spectrum of presentations readily reported, but poorly presented. Histo-pathologically it seems feasible that this lesion progresses from an acute intra-orbital subperiosteal haemorrhage, to an organizing hematoma with associated scar tissue (pseudocyst) which would eventually develop into a chronic hematic (blood) cyst.

Oesophago-gastric ulcers (OGU) are a production and welfare problem in pigs. Stomach condition was scored for 22 551 pigs in 228 batches over a 7-month period at an abattoir in Italy processing heavy pigs for ham production. Mild or severe ulceration was observed in 20.7% of pigs, of which 13% had scar tissue. Variation between batches was high (0% to 36% prevalence of severe ulcers) and showed a significant effect of farm of origin (P

In revision surgery for a recurrent pyriform sinus fistula (PSF), complete resection of the fistula via a transcervical approach is difficult because of the surrounding scar tissue that results from previous surgery and infections. We successfully performed transoral endoscopic radical resection of the fistula for a recurrent PSF in two patients. Approaching the fistula from the orifice is reasonable and radical resection of the fistula is a reliable procedure in revision surgery. Transoral endoscopic resection is a feasible surgical option for a recurrent PSF. Keywords: Endoscopic surgery, Pyriform sinus fistula, Recurrence, Revision surgery, Transoral surgery

A patient with neurogenic thoracic outlet syndrome was initially treated with scalenectomy, first rib resection, and wrapping of the brachial plexus (BP) with amnion membrane (AM) to prevent postoperative adhesions. Twelve months later, at reoperation for recurrent symptoms, the AM was observed to be intact. The BP had no scar tissue around it. Recurrence was due to scarring around the nerve roots superior to the portion of the plexus that had been wrapped with AM. It was concluded that the AM had successfully protected the portion of the BP that had been wrapped. Longer term studies are in progress.

Surgical exposure of the glenoid after previous coracoid process transfer is technically challenging as a result of distorted anatomy, obliterated soft-tissue planes, and adhesive scar tissue, which poses additional risk to adjacent neurovascular structures. The purpose of this article is to present a technique for glenoid exposure following coracoid transfer that involves tenotomy of the conjoint tendon to minimize the risk for neurovascular injury while leaving the well-healed coracoid bone graft in place.

Chronic rhinosinusitis, particularly in the setting of nasal polyposis, is unfortunately associated with significant need for revision surgery following initial functional endoscopic sinus surgery and failed medical management. Goals of these revision procedures include removal of recurrent inflammatory disease, scar tissue, and residual bony lamellae, such that the final postsurgical anatomy reflects comprehensive opening of the sinonasal tract, including completion of a contiguous sphenoethmoid cavity. The present chapter illustrates methodology to surgically revise, or complete, functional endoscopic sinus surgery addressing the ethmoid and sphenoid sinuses. This will be discussed in the context of preoperative planning, necessary instrumentation, specific procedural steps, and postoperative management.

Reconstruction of bodily deformities due to burns is exceptionally difficult. The difficulty arises largely from a lack of understanding of the pathomechanism underlying scar tissue formation. Also, technical limitations in replacing body parts further fuel the psychological frustrations of reconstructive surgeons. The use of a musculocutaneous flap and/or fasciocutaneous flap, particularly as modified to follow the principles of z-plasty or three-quarter z-plasty, has been found to be effective in restoring functions lost because of scarring and scar contracture. It is conceivable that refinements in microsurgical tissue transfer techniques, together with advances in tissue engineering and facial transplantation, will render the task of reconstructing burn deformities much easier.

To evaluate the appearance and distribution of intra-articular adhesions on direct MR arthrograms (MRA) in symptomatic patients after surgical hip dislocation (SHD) for the treatment of femoroacetabular impingement (FAI).All 18 patients (19 hips) who underwent arthroscopic debridement for treatment of symptomatic adhesions after open surgery of FAI between 2003 and 2012 and that had a complete set of pre- and postoperative direct MRA were evaluated. On radial PD-w images, pre- and postoperative osseous alpha angles were measured. Signal intensity and degree of obliteration of the peripheral compartment of the hip joint were assessed circumferentially at each 'half-hour' position and quantified with the adhesion alpha angle (measured between a line connecting the most proximal appearance of adhesions on the femoral neck with the femoral head center and the femoral neck axis). Linear regression analysis was performed between the site of correction and adhesions. As a control group, all patients (9; 9 hips) that underwent revision surgery during the same time period in which adhesions were not the primary cause for revision were evaluated.Femoral adhesions primarily (47%) appeared as intermediate, complete obliterations correlating with the site of offset correction (R = 0.883, p 0.001). Adhesion alpha angles were comparable to the pre-operative osseous alpha angles (21/24 positions, p 0.05) and were greater than the postoperative osseous alpha angles (11/24 positions, p 0.05). Most labral adhesions (83.2%) appeared as adjacent and correlated with the site of rim trimming (R = 0.777, p 0.001). In the control group, the most common reason for revision surgery was persisting cam deformity (67%). The radiographic findings were confirmed intra-operatively.Intra-articular adhesions most commonly appear at the site of primary offset correction. Recurrent impingement due to scar tissue may be quantified with the adhesion alpha angle. MRA of the hip are suitable to distinguish between postoperative adhesions and other known causes for persisting symptoms.

Normal knee range of motion varies slightly between individuals and measures approximately 0° to −5° of extension to 140° of flexion. A full arc of motion is required for normal gait and knee function. Loss of normal joint range of motion may occur after a traumatic knee injury and may contribute to increased pain, lower functional outcome scores, and decreased patient satisfaction. Although multiple factors may contribute to the development of motion loss, the occurrence of intra-articular scar tissue adhesions, or post-traumatic arthrofibrosis, may limit the patient's knee motion in the early postoperative period. Once motion loss has been identified, it can be a challenging complication to manage. Arthroscopic lysis of adhesions with manipulation under anesthesia is a reliable surgical technique that can improve range of motion in patients with knee stiffness due to post-traumatic arthrofibrosis.

Cellular responses occurring as cascades of inflammatory cells and tenocytes immigrating the wound site orchestrate the healing process in lacerated tendons and ligaments. Time-dependent concentrations of cytokines accompany this very well-balanced sequence of inflammation, remodelling, and maturation in the healing tissue. Extrinsic healing (cells migrating from synovium or tendon sheath towards the wound site) and intrinsic healing (cells primarily from endotenon and epitenon contribute to wound healing) lead to regeneration. However, unwanted scar-like tissue may be formed, associated with an insufficient resolution of inflammation and excessive remodelling. Scar tissue exhibits lower biomechanical properties and is prone to rerupture. Ways to promote scarless healing are discussed. In addition, gene expression and growth factor levels as a function of time after injury are presented.

Chronic distal tibiofibular syndesmosis disruption can be managed by endoscopic arthrodesis of the syndesmosis. This is performed through the proximal anterolateral and posterolateral portals. The scar tissue and bone block are resected to facilitate the subsequent reduction of the syndesmosis. The reduction of the syndesmosis can be guided either arthroscopically or endoscopically. The tibial and fibular surfaces of the tibiofibular overlap can be microfractured to facilitate subsequent fusion.

Urethral dilations represent the oldest method for treating urethral strictures. The procedure implies recalibration of the urethral lumen, ideally maintaining integrity of the mucosa and, implicitly, reducing the risk of scar tissue formation. Although the method is very cheap and rapid, it presents the disadvantage of very high recurrence rates, but also of inducing urethral lesions (from urethral abrasions to false passages). Moreover, the method keeps the patient dependent on the urologist, with a significant impact on quality of life.

Due to the general acellularity of tendon tissue, the regenerative capacity of tendon tissue is limited. As a result, current treatments for tendon injuries and tears often leave healed tendons with scar tissue that possesses compromised mechanical properties and has high risks of subsequent injuries and tears. Tissue engineering has emerged as a method to enhance tendon healing and regeneration through the use of tissue engineering scaffolds, cells, and other biological factors. This chapter provides an overview of tissue engineering as it pertains to tendon tissue and the current strategies and challenges relevant to the field.

The current trend of peripheral nerve tissue engineering is the design of advanced nerve guidance channels (NGCs) acting as physical guidance for regeneration of nerves across lesions. NGCs should present multifunctional properties aiming to direct the sprouting of axons from the proximal nerve end, to concentrate growth factors secreted by the injured nerve ends, and to reduce the ingrowth of scar tissue into the injury site. A critical aspect in the design of NGCs is conferring them the ability to provide topographic, chemotactic and haptotactic cues that lead to functional nerve regeneration thus increasing the axon growth rate and avoiding or minimizing end-organ (e.g. muscle) atrophy. The present work reviews the recent state of the art in NGCs engineering and defines the external guide and internal fillers structural and compositional requirements that should be satisfied to improve nerve regeneration, especially in the case of large gaps (>2 cm). Techniques for NGCs fabrication were described highlighting the innovative approaches direct to enhance the regeneration of axon stumps compared to current clinical treatments. Furthermore, the possibility to apply stem cells as internal cues to the NGCs was discussed focusing on scaffold properties necessary to ensure cell survival. Finally, the optimized features for NGCs design were summarized showing as multifunctional cues are needed to produce NGCs having improved results in clinics.

Painful postoperative neuroma is psychologically and physically debilitating. Neuromas result from uncontrolled regeneration of axons into surrounding scar tissue. The incidence of painful neuroma formation ranges from 1-30%. The most important step in preventing neuroma formation is to be cognizant of surrounding peripheral nerves during the initial surgical dissection. While it is not ideal to injure a nerve, it is far more problematic to injure a nerve and not recognize the injury. A variety of techniques, such as primary nerve repair, nerve grafting, and transposition of the transected nerve ending into muscle or bone, exist to prevent neuroma formation. When patients present for evaluation of a painful neuroma, a thorough history and physical is paramount. Conservative treatment of painful neuromas should be tried prior to surgical treatment. Despite the myriad surgical treatments available, none prove to be the definitive procedure in postoperative painful neuroma treatment.

Bone marrow stimulation techniques for the treatment of articular cartilage defects such as microfracture so far have solely reproduced mechanically inferior fibrous cartilage tissue, which might result in unsatisfactory clinical results at midterm follow-up. A recent study has shown an improvement in repair tissue quality by enhancing microfracture with a chitosan-based biomaterial (BST-CarGel; Piramal, Laval, Quebec, Canada). BST-CarGel so far has only been applied by arthrotomy, which might lead to increased scar tissue formation and thus compromise recovery time and clinical outcome. We describe a surgical technique for an arthroscopic treatment of cartilage defects of the knee with microfracture in combination with BST-CarGel to benefit from improved repair tissue quality and to reduce arthrotomy-related morbidity.

This chapter discusses the pathological changes in tuberculosis. Tubercle bacilli are omnipresent, but while they can be in contact with tissue cells, it does not necessarily mean that there is a state of tuberculosis. Normal carbohydrate catabolism confers a degree of natural immunity on the tissues against the Tubercle bacillus . Bronchitis of tuberculous origin can be mild in type, or it can be acute with little or nothing to distinguish it from that arising from other causes, except that the constitutional disturbances can be more prominent. In tuberculosis, the infective agent is not uncommonly destroyed in a few days, debris is removed, and scar tissue replaces the tubercle. This is the natural or spontaneous cure of tuberculosis. While spread of tuberculosis can be checked, the result is the formation of a tumour-like mass, sometimes referred to as a tuberculoma.

Wound management has traditionally involved controlling the underlying cause and allowing the body to heal the wound naturally, or utilizing skin grafts to replace lost tissue. The emergence of regenerative medicine coupled with an increased understanding of the cellular and biochemical factors involved in wound repair have provided new therapeutic options which aim to alter the wound microenvironment from one that promotes inflammation and scar tissue formation to one that facilitates rapid regeneration with minimal scarring. In this chapter we will review the wound repair process and the influence of the wound microenvironment on the healing process. We will also discuss regenerative medicine strategies that target and manipulate the microenvironment to enhance healing.

This chapter explores the current views on the role of hyaluronic (HA) acid in wound healing and scarring (the intrinsic role) and then focuses at medical developments of hyaluronic acid that have been used or are proposed to either reduce or eliminate scar development in healing wounds or to reduce the degree of matrix disorganization, a key attribute of scar tissue, in the established scar (the extrinsic role). HA has a considerable affinity for water. In the tissues, this property is of considerable significance during periods of change, e.g., in embryonic development and during the inflammatory response to tissue injury when HA levels are elevated. It is thought that focal HA release can weaken cell anchorage to the extracellular matrix and thereby aid proliferation and migration. In addition to physicochemical properties, HA has the ability to bind to cells and extracellular matrix components in a specific manner which allows the modulation of the biological properties and functions of cells and tissues.

When the epithelial cell layer covering two adjacent tissues is removed accidentally or intentionally during surgical procedures, the underlying connective tissue will grow together during the wound- healing process. Similarly, when two connective tissue surfaces not covered by endothelium but separated by elastoviscous fluid containing high molecular weight hyaluronan are wounded by trauma or during surgical procedures, they can grow together during the healing process. Such adhesion between two tissue surfaces may interfere with function and the excessive new connective tissue formed (scar tissue) may exert pressure on adjacent nerves, causing chronic pain. This paper describes the use of new formulations of dry films containing only hylan. In animal models, this film prevented adhesion formation between two tissue surfaces denuded from their mesothelial or epithelial cell cover. The most important property of this film after it is hydrated by tissue fluids was that it still adhered to the tissue surface, ensuring its stay in place. Thus, it functions as a barrier material, separating the healing tissues. The films do not cause inflammation or foreign body reaction and they do not interfere with the healing of adjacent tissues. These films successfully prevented adhesions between tissue surfaces in liver and cecal abrasion models in rat and uterine horn abrasion models in rabbits. Such films can also be used as delivery vehicles for various drugs, influencing them by combining their physical barrier effect with regulation effects on the healing process.

Publisher Summary This chapter discusses injuries related to the skin and wound healing. The process of healing of a skin wound in mammals is a combination of epidermal regeneration and wound contraction. Epidermal continuity is re-established initially by a process of sliding out of the cells at the periphery of the wound, accompanied by brisk cell regeneration. The damaged dermal and deeper elements of the wound are replaced by scar tissue, which is initially laid down in a random and disorganized way to bridge the wound gap but has poor breaking strength. This is reorganized over a period of several months to produce a stronger mature scar with considerably greater breaking strength. Healing is a rapid and vigorous process in children and the incidence of hypertrophic scarring is certainly higher than in the elderly who often heal slowly but with remarkably little visible scars. The repair of wounds is an active metabolic process which utilizes energy. Wound healing is faster and results in a mature, stable scar much earlier in tissues which are well-perfused such as the face when compared to regions such as the pretibial skin.

THE clinical importance of the mechanical response of skin to load imposed is discussed by Gibson (1965) in a contribution to this Symposium. The results presented here cover the load-deformation characteristics of human skin assessed on detached samples and in situ with particular reference to the differences obtaining with age and orientation. Comparisons of mechanical characteristics are given of collagen fibre, scar tissue, “normal” skin and a particular type of adhesive bonded fibrous material, the last named being the latest example of a search for an artificial “model” of human skin. Analysis of the results appears to indicate that at the “biological” stress levels likely to be encountered in clinical practice it is histological structure rather than the mechanical properties of collagen that controls overall skin behaviour.