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Although postoperative scarring may be considered a cosmetic concern, it can greatly impact a patient's quality of life. This extends beyond psychosocial burden influenced by hypertrophic scars and keloids, as patients also experience discomfort and pain. This systematic review evaluates the efficacy of silicone gel (SG)-based products in preventing postoperative abnormal scar formation. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a PubMed search was performed to find randomized, controlled trials investigating the effect of SG-based products on postoperative wound healing. The search yielded 359 publications, but only 30 studies published between 1991-2022 were found to fit the inclusion criteria. Outcomes were extracted from the literature and subsequent quality and risk of bias assessments were performed. Most studies indicated improvement of at least one quality of the scar with the use of SG-based products. The greatest potential variable increasing bias was an inadequate control group. Studies also suffered from small sample sizes, use of unvalidated scar assessment scales, lack of double-blinding, and short follow-up periods. Overall, SG-based products demonstrated potential in preventing abnormal scar formation during postoperative healing, but further studies are required to validate the results of current literature.

Risk factors for the formation of facial scars include skin type, ethnicity, scar location, and certain medical conditions that contribute to poor or delayed healing. Risk of scar can be reduced with appropriate surgical planning, including proper placement and design of incisions, meticulous skin closure, aseptic technique, and wound care to improve healing. Common pathologic scars include hypertrophic scars and keloid scars, each of which has unique approaches to surgical revision and medical treatment due to their respective risks of recurrence. Topical scar therapies, medical therapies, and surgical revision techniques for improvement in final scar appearance are discussed., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: As we all know, the numbers of aesthetic surgery are increasing around the world. After the surgery, the scar would be a problematic issue for both the surgeons and the patients. Silicone has proven to be effective for keloids, hypertrophic scars, and prevention of scar formation in many literatures for a long time. In terms of scar prevention, silicone has been used in the form of silicone sheets in early times, which is later improved to be the form of silicone gel with the advantage of easier usage. Although silicone gel has improved greatly in the aspect of appearance and convenience of the silicone sheets, there are still some disadvantages of the gel form. Therefore, the LeniScar silicone stick (AnsCare) is invented., Objective: This article aimed to compare the results of scar treatment and prevention of the AnsCare LeniScar Silicone Stick versus the traditional silicone gel (Dermatix Ultra)., Methods: This study was a prospective, nonblinded, randomized clinical study. There were a total of 68 patients from September 2018 to January 2020. Patients were divided into 2 groups with AnsCare (n = 43) and Dermatix (n = 25), who both were required to schedule regular outpatient clinic follow-up, and photographs were taken before use, 1, 2, and 3 months later after the usage for the record. The physician assessed the scar condition by the Vancouver Scar Scale (VSS). The scores of the VSS were further analyzed and compared., Results: The overall P value of total score of VSS was 0.635, which indicates that there is no significant difference in using AnsCare LeniScar Silicone Stick versus Dermatix Ultra silicone gel in terms of scar prevention and treatment. Individual items of VSS such as pliability, height, vascularity, and pigmentation all show no significant statistical difference in the 2 treatment products, with P = 0.980, 0.778, 0.528, and 0.366, respectively., Conclusion: Traditional Dermatix Ultra silicone gel has been effective in the treatment of scar formation. AnsCare LeniScar Silicone Stick is statistically not different from the Dermatix Ultra silicone gel when comparing the treatment results of scar prevention. Furthermore, the AnsCare LeniScar Silicone Stick has the advantages of being time-saving with no need to wait for it to dry and application of precise amount to precise location, preventing waste or overuse., Competing Interests: Conflicts of interest and sources of funding: The research was funded by BenQ Materials Corp, Taipei, Taiwan., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

In most surgeries, the primary aim, for both surgeons and patients, is the success of the operation being undertaken. A secondary aim is for optimal wound healing with minimal scar formation. The normal wound-healing process involves four distinct but overlapping stages: haemostasis, inflammation, proliferation and remodelling. In some patients, the cellular process involved in the proliferation and remodelling stages can be deranged, resulting in the formation of hypertrophic or keloid scars, a phenomenon more frequently seen in skin of colour. The first report of excessive scarring is thought to be the Smith papyrus about 1700 BC. In the 20th century, both Mancini and Quaife (in 1962) and Peacock et al. (in 1970) classified excessive scarring into hypertrophic and keloid scar formation. Clinicians can minimize the risk of these pathological scars developing by using good preoperative, perioperative/intraoperative and postoperative surgical practices. This paper reviews the wound-healing processes in association with good surgical principles and practice, discusses how implementing these principles in practice helps in this prevention and management of pathological surgical scars such as hypertrophic scars and keloid scars. and offers a practical step-by-step clinical guide that can be used by any clinician., (© 2022 British Association of Dermatologists.)

Inflammation plays an active role during the wound healing process. There is a direct association between the extent of injury as well as inflammation and the amount of subsequent cutaneous scarring. Evidence to date demonstrates that high levels of inflammation are associated with excessive dermal scarring and formation of abnormal pathological scars such as keloids and hypertrophic scars. In view of the multiple important cell types being involved in the inflammatory process and their influence on the extent of scar formation, many scar therapies should aim to target these cells in order to control inflammation and by association help improve scar outcome. However, most current treatment strategies for the management of a newly formed skin scar often adopt a watch-and-wait approach prior to commencing targeted anti-inflammatory therapy. Moreover, most of these therapies have been evaluated in the remodelling phase of wound healing and the evaluation of anti-inflammatory treatments at earlier stages of healing have not been fully explored and remain limited. Taken together, in order to minimise the risk of developing a poor scar outcome, it is clear that adopting an early intervention prior to skin injury would be optimal, however, the concept of pre-emptively priming the skin prior to injury has not yet been thoroughly evaluated. Therefore, the aim of this review was to evaluate the available literature regarding scar therapies that aim to target inflammation which are commenced prior to when a scar is formed or immediately after injury, with a particular focus on the role of pre-emptive priming of skin prior to injury in order to control inflammation for the prevention of poor scarring outcome., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ud-Din and Bayat.)

Background: Silicone products, either as a sheet or in fluid form, are universally considered as the first line therapy in the prevention and treatment of hypertrophic scars and keloids. However, the study results have been questioned by different authors and there has never been a large systematic synopsis published on the efficacy of fluid silicone gels. This systematic review aims to elucidate the available evidence of the results obtained by fluid silicone gels and present a complete and comprehensive overview of the available literature as well as a meta-analysis of the pooled data., Methods: A systematic search for articles concerning the use of silicone gel in the treatment and prevention of scars was performed on 3 different databases (Pubmed, Embase and Cochrane library) according to the PRISMA statement. Only RCT's were included. Qualitative assessment was done by 2 separate reviewers using the Cochrane risk of bias (RoB 2) assessment tool. Revman 5.4.1 software was used for meta-analysis., Results: The search yielded 507 articles. Two articles were identified through other sources. After deduplication and removal of ineligible records, 340 records were screened on title and abstract. Full text screening was done for 23 articles and ultimately 18 articles were included. A meta-analysis comparing fluid silicone gel to no treatment or placebo gels was conducted., Conclusion: Studies on the effects of liquid silicone gels on hypertrophic scars are numerous and this systematic review shows that the use of liquid silicone gels is associated with both a prophylactic and a curative effect on scars. However, a considerable amount of the available 'high evidence' trials are at a high risk for bias and it is uncertain whether or not the effects of silicone gels are comparable to silicone sheets and if the additional components present in many silicone gels are partially responsible for their scar improving capacity., (Copyright © 2022 Elsevier Ltd and ISBI. All rights reserved.)

Significance: This body of work gives a concise and comprehensive overview for the clinician and scientist on the latest treatment modalities for hypertrophic scars (HTS) and keloids in the pediatric population, as well as the most promising methods of prevention currently being investigated. This review will serve as a guide to the clinician for treatment selection and as an efficient tool for the scientist to achieve a comprehensive overview of the scientific literature to guide their future experiments aimed at pathologic scar prevention. Recent Advances: Current studies in the literature suggest carbon dioxide (CO 2 ) laser and E-light (bipolar radiofrequency, intense pulsed light, and cooling) are two of the most effective treatment modalities for HTS, while surgical excision+CO 2 laser+triamcinolone injection was one of the most successful treatments for keloids. In animal models, drug impregnated electrospun nanofiber dressings offer encouraging results for HTS prevention, while Kelulut honey showed promising results for keloid prevention. Critical Issues: Treatment outcome reproducibility is hindered by small cohorts of patients, inadequate-follow up, and variability in assessment tools. Prevention studies show multiple ways of achieving the same result, yet fall short of complete prevention. Furthermore, some studies that have purported full prevention have not been validated. Future Directions: To establish a standard of care, large clinical trials of the most successful modalities in small cohorts are needed. The key for prevention will be validation in animal models of the most successful methods, followed by translational and clinical studies.

Background: Recently, pulsed dye laser (PDL) combined with triamcinolone intralesional injection (TAILI) has been introduced for surgical scar prevention. However, little is known about this procedure's effectiveness in preventing hypertrophic scar following surgical scar removal., Objectives: This study aimed to evaluate the outcome of early intervention using PDL combined with TAILI after surgical removal of hypertrophic cesarean section (CS) scars., Methods: The medical records of 35 patients who underwent early intervention using PDL and TAILI after removal of hypertrophic CS scars were retrospectively reviewed. The scars' average Vancouver Scar Scale (VSS) scores before scar removal and 3 months after the final treatment were compared., Results: The patients received 4.23 treatments on average and were followed up for a mean period of 7.74 months. The mean final VSS was 3.11 ± 1.52 and was significantly lower than that of the previous VSS (9.29 ± 1.74, p = 0.000). VSS of the previous CS scar, and the presence or absence of keloid formation in other areas, was associated with treatment outcome (p = 0.003 and 0.008, respectively)., Conclusions: Early intervention using PDL combined with TAILI could prevent the recurrence or progression of hypertrophic CS scarring after surgical scar removal., (© 2021 Wiley Periodicals LLC.)

This study aimed to investigate the side effects of silicone gel sheet (Lady Care ® ) and evaluate its prophylactic efficacy in preventing abnormal scarring. Sixty women who underwent caesarean section were recruited from September 2016 to September 2017 in this prospective study. Lady Care ® was applied from the 2nd to the 6th postoperative months. Side effects of Lady Care ® were evaluated through medical examinations and questionnaires. A plastic surgeon diagnosed abnormal scarring. Pruritus was diagnosed in 25 (47.2%) patients; folliculitis, four (7.5%); dry skin, four (7.5%); contact dermatitis, three (5.7%); wound infection, two (3.8%); and epidermolysis, one (1.9%), albeit with mild severity. Following Lady Care ® application, no abnormal scarring and mild hypertrophic scarring was observed in 32 (64.0%) and 18 (36.0%) patients respectively. Of seven patients with pre-existing hypertrophic scars, only two showed hypertrophic scarring after Lady Care ® application. Our findings support the safety and prophylactic efficacy of Lady Care ® .Impact Statement What is already known on this subject? The incidence of abnormal scarring, i.e. keloid or hypertrophic scar formation after caesarean section (CS) is reported to be ∼41%. Abnormal or excessive scar formation can lead to functional limitations, pruritus, pain and cosmetic issues. Studies have also shown a prophylactic effect of the application of silicone materials against the development of hypertrophic and keloid scars, though prohibitive cost and lack of adhesiveness of such gel sheets are known factors limiting their usage. What the results of this study add? The new silicone gel sheet 'Lady Care ® ' has strong adhesive properties and is consequently not easily peeled off. Furthermore, it is easy to use and economically efficient. What the implications are of these findings for clinical practice and/or further research? This is the first clinical trial on the application of Lady Care ® silicone gel sheet for the prevention of CS scarring. Our findings support the safety and prophylactic efficacy of Lady Care ® .

Background: Hypertrophic scars and keloids are postsurgery problems. Some studies showed that onion extract and aloe vera might be beneficial for postoperative scars. However, few of the randomized clinical trials were investigated., Aims: To compare the efficacy of silicone gel containing onion extract and aloe vera (SGOA) to silicone gel sheets (SGS) to prevent postoperative hypertrophic scars and keloids., Methods: The prospective randomized assessor-blind controlled trial was conducted with 40 patients who had undergone surgery. The patients were divided into two groups: one treated with SGOA, the other with SGS. The patients were evaluated after 1, 2, and 3 months. The objective assessment was to determine the incidences of scarring, erythema, and melanin values using Mexameter, and pliability through Cutometer. The subjective assessment consisted of the patient and observer scar assessment scale (POSAS) and patient satisfaction., Results: After the 12-week follow-up, there was no statistically significant difference in the scarring incidence rate of both groups. There were no statistical differences in the POSAS score, erythema, and melanin value between both groups. Using objective assessment, pliability in the SGOA group was statistically significantly higher compared to the SGS group. Pain and itchiness significantly decreased in both groups. No adverse effects were reported in either group., Conclusion: Silicone gel containing onion extract and aloe vera is effective as SGS for postoperative scar prevention., (© 2021 The Authors. Journal of Cosmetic Dermatology published by Wiley Periodicals LLC.)

In 2006, we established a scar/keloid-specialized unit in the Department of Plastic, Reconstructive, and Aesthetic Surgery at Nippon Medical School (NMS) in Tokyo, Japan. In the ensuing 15 years, we treated approximately 2,000 new scar/keloid patients annually. This extensive experience has greatly improved the efficacy of the treatments we offer. Therefore, we discuss here the latest NMS protocol for preventing and treating keloids and hypertrophic scars. While this protocol was optimized for Japanese patients, our experience with a growing body of non-Japanese patients suggests that it is also effective in other ethnicities. The extensive evidence-based experience underlying the NMS protocol suggests that it may be suitable as the foundation of a standard international prevention/treatment algorithm for pathological scars.

Background: Hypertrophic scars and keloids, which are abnormalities of fibrosis, often occur in surgical wounds; however, their exact cause and preventive measures are unknown. The administration of dipeptidyl peptidase-4 inhibitors to humans is expected to suppress fibrosis in wounds and minimize hypertrophic scar and keloid formation., Methods: This study aimed to verify the suppressive effect of dipeptidyl peptidase-4 inhibitors on the formation of hypertrophic scars or keloids using real world data from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. It is a retrospective cohort study, and data were extracted from the National Database between April of 2013 and March of 2015. Patients who underwent median sternotomy were included in the study based on their claimed surgical codes. Subjects who were prescribed dipeptidyl peptidase-4 inhibitors constituted the treatment group; subjects who were not prescribed or administered dipeptidyl peptidase-4 inhibitors during that period constituted the nontreatment group., Results: Subjects included 5430 patients throughout Japan (3509 men and 1921 women). Of the 446 subjects who were treated with dipeptidyl peptidase-4 inhibitors within 1 year before the procedure, fewer than 10 (<2 percent) developed either hypertrophic scars or keloids. Of the 4984 subjects who were not treated, 152 (3.05 percent) were at significantly lower risk for hypertrophic scars and keloids (p = 0.04). A logistic regression analysis was performed to adjust for confounding factors, with history of hypertrophic scar formation as the explained variable., Conclusion: This study revealed that dipeptidyl peptidase-4 inhibitors suppress the onset of hypertrophic scars or keloids after surgery in humans., Clinical Question/level of Evidence: Therapeutic, III.

Background: Hypochlorous acid (HOCl), a naturally occurring molecule produced by the immune system, is highly active against bacterial, viral, and fungal microorganisms. Moreover, HOCl is active against biofilm and increases oxygenation of the wound site to improve healing. Natural HOCl is unstable; through technology, it can be stabilized into an effective topical antiseptic agent., Aim: This paper focuses on the use of topical stabilized HOCl in wound and scar management for pre-, peri-, and postprocedures-including its ability to reduce the occurrence hypertrophic scars and keloids. The role of the product in other skin conditions is beyond the scope of this article., Methods: A panel comprising clinicians with experience in cosmetic and surgical procedures met late 2018 to discuss literature search results and their own current clinical experience regarding topical stabilized HOCl. The panel of key opinion leaders in dermatology and plastic surgery defined key insights and consensus statements on the direction of use for the product., Results: Topical stabilized HOCl provides an optimal wound healing environment and, when combined with silicone, may be ideal for reducing scarring. Additionally, in contrast to chlorhexidine, HOCl, used as an antiseptic skin preparation, raises no concerns of ocular- or ototoxicity., Conclusions: For wound care and scar management, topical stabilized HOCl conveys powerful microbicidal and antibiofilm properties, in addition to potency as a topical wound healing agent. It may offer physicians an alternative to other less desirable wound care measures., (© 2020 Wiley Periodicals, Inc.)

Wound healing is a complex physiological process that repairs a skin lesion and produces fibrous tissue. In some cases, this process can lead to hypertrophic scars (HS) or keloid scars (KS), for which the pathophysiology remains poorly understood. Previous studies have reported the presence of oncostatin M (OSM) during the wound healing process; however, the role of OSM in pathological scarring remains to be precisely elucidated. This study aims to analyse the presence and involvement of OSM in the pathological scarring process. It was conducted with 18 patients, including 9 patients with hypertrophic scarring and 9 patients with keloid scarring. Histological tissue analysis of HS and KS showed minor differences in the organization of the extracellular matrix, the inflammatory infiltrate and the keratinocyte phenotype. Transcriptomic analysis showed increased expression levels of fibronectin, collagen I, TGFβ1, β-defensin-2 and S100A7 in both pathological samples. OSM expression levels were greater in HS than in KS and control skin. In vitro, OSM inhibited TGFβ1-induced secretion of components of the extracellular matrix by normal and pathological fibroblasts. Overall, we suggest that OSM is involved in pathological wound healing processes by inhibiting the evolution of HS towards KS by controlling the fibrotic effect of TGFβ1.

Botulinum Toxin Type A is a potent neurotoxin that is produced by a gram-positive bacteria clostridium botulinum. Its utilization in the treatment of various medical condition has expanded over the years in both medical and esthetic uses. It is being preferred by most physicians due to its efficacy and lack of side effects. It can be used as monotherapy or combined therapy. The aim of this review study was to show the role and mechanism of action of Botulinum toxin type A in the treatment and prevention of hypertrophic scars and keloids. The clear mechanisms underlying hypertrophic scars and keloids are still not clearly understood; however, the mechanism of action of Botulinum toxin type A has been shown to include action on wound tension, action on collagen, and action on fibroblasts. Different randomized controlled trials, double-blind, and placebo-controlled studies have been conducted to investigate its use in treatment and prevention of hypertrophic scars and keloids, and it still is one of the active areas of research in Dermatology and related fields. Method: In March 2018, we performed a literature search in PubMed for clinical studies, clinical trials, case reports, controlled trials, randomized controlled trials, and systemic reviews. The search terms we used were "BOTULINUM TOXIN" AND "HYPERTROPHIC SCARS" OR "KELOIDS" (from 1980). The search resulted in 1000 articles, out of these 35 articles met our inclusion exclusion criteria. Our inclusion criteria included relevant original articles relevant, critical systemic reviews, and crucial referenced articles, exclusion criteria included duplicates and articles not published in English language. We have reviewed these papers to show the role and mechanism of action of Botulinum toxin type A in the treatment and prevention of hypertrophic scars and keloids., (© 2018 Wiley Periodicals, Inc.)

Purpose: We aimed to explore the molecular mechanism of pathologic skin scar and novel target for scar prevention., Materials and Methods: Microarray data derived from keloid and hypertrophic scar were downloaded from ArrayExpress database. The common differentially expressed genes (DEGs) in keloid and hypertrophic scar samples were investigated by function and pathway analysis. The protein-protein interaction (PPI) network was constructed and the modules were screened., Results: There were a total of 485 DEGs related with skin scar, including 247 up-regulated genes and 238 down-regulated genes. The up-regulated genes were closely related with Rho protein signal transduction, cytoskeleton organization, and Ras protein signal transduction related biological process. The down-regulated genes were enriched in sterol metabolic process, fatty acid metabolic process, and steroid metabolic process. PPI network was constructed with 680 protein pairs and modules 1 and 2 were screened out. Fos proto-oncogene (FOS) and early growth response 1 (EGR1) were significant transcriptional factors in the two modules., Conclusions: FOS and EGR1 may be potential targets for skin scar prevention.

Hypertrophic scars and keloids are fibroproliferative disorders that may arise after any deep cutaneous injury caused by trauma, burns, surgery, etc. Hypertrophic scars and keloids are cosmetically problematic, and in combination with functional problems such as contractures and subjective symptoms including pruritus, these significantly affect patients' quality of life. There have been many studies on hypertrophic scars and keloids; but the mechanisms underlying scar formation have not yet been well established, and prophylactic and treatment strategies remain unsatisfactory. In this review, the authors introduce and summarize classical concepts surrounding wound healing and review recent understandings of the biology, prevention and treatment strategies for hypertrophic scars and keloids., Competing Interests: The authors declare no conflict of interest.

Background: Keloids and hypertrophic scars are characterized by excessive proliferation of fibroblasts; abnormal accumulation of extracellular matrix; and clinical findings of raised, red, itchy, and painful lesions. There are few sufficient interventions for keloids, and the development of new therapeutic agents is urgently needed. Several studies suggest that a therapeutic possibility is β-adrenergic receptor blocker treatment., Methods: In this single-center case-control study, patients who had undergone cardiac device implantation 7 to 23 months earlier were identified. The implantation incision scars of the patients were deemed to be normal or abnormal depending on their redness. The cases (abnormal scars) and controls (normal scars) were compared in terms of their β-blocker use rates., Results: Of the 45 eligible patients, 12 and 33 patients were cases and controls, respectively. The cases tended to be less likely to have taken blockers than the controls (25 percent versus 45.5 percent). This difference became significant when the patients whose scars were diagnosed 7 or 8 months after implantation were excluded from the analysis: the age-adjusted odds ratios of the patients who were diagnosed 8 to 23 and 9 to 23 months after implantation were 0.10 (95 percent CI, 0.00 to 0.83; p = 0.0309) and 0.11 (95 percent CI, 0.00 to 0.98; p = 0.047), respectively., Conclusions: β-Blockers may be an effective alternative modality for preventing and treating keloids and hypertrophic scars. Large-scale multicenter prospective studies that use histology to diagnose scars and diagnose the postoperative scars at the most suitable period are needed to confirm the effectiveness of blockers for abnormal scars., Clinical Question/level of Evidence: Therapeutic, III.

Background: Keloids and hypertrophic scars are fibroproliferative disorders of dermal tissue after skin injury. Many clinical control studies have reported evidence that silicone gel is effective in preventing and alleviating hypertrophic scarring. Whether silicone gel sheeting prevents hypertrophic scars or keloids requires clear evidence of its clinical effectiveness., Objective: This review investigated the effectiveness of silicone gel and silicone gel sheeting for the prevention of hypertrophic or keloid scarring in patients with newly healed wounds., Methods: The authors searched the MEDLINE, EMBASE, CINAHL, and CENTRAL databases (January 1, 1990 to September 24, 2014) for any randomized or quasi-randomized controlled trials or controlled clinical trials comparing silicone gel sheeting or silicone gel with a control group for prevention of hypertrophic scars or keloids. All collected trials were assessed for methodological quality, control group and treatment group, and number of participants developing hypertrophic scars and keloids. The authors calculated risk ratios (RR) from each trial for the development of abnormal scarring and combined these using random-effects model meta-analysis. Between-study heterogeneity was calculated by using the I2 statistic., Results: Ten trials in 9 studies were pooled (random effect; I² = 88%). There was a significant difference between the silicone gel sheeting group and the placebo group (RR 0.70; 95% confidence interval, 0.49-0.99; P = .04) in preventing the risk of hypertrophic scars., Conclusion: There was statistical significance in the effectiveness of silicone gel and silicone gel sheeting on the prevention of keloids or hypertrophic scars, especially in skin lesion wounds. However, most of the trials evaluating silicone gel sheeting or silicone gel as a prevention of hypertrophic scars and keloids had poor quality with high or uncertain risk of biases either in study design or in conduct.

Keloids scars are a dysregulated response to cutaneous wound healing and can be associated with substantial physical and psychological distress. Unfortunately, they occur when surgical excision is performed. While the pathogenesis of keloids continues to be investigated, numerous treatment options exist. But there is still no ideal treatment. Their management needs association of treatment and long-term follow-up to observe and manage recurrence. In this second part, we propose a strategy for management of keloids scars., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: Silicone gel sheeting has been introduced to prevent scarring, but objective evidence for its usefulness in scar healing is limited. Therefore, the authors' objective was to examine the effectiveness of silicone gel sheeting by randomly applying it to only unilateral scars from a bilateral hallux valgus surgery with symmetrical closure., Design: In a prospective randomized, blinded, intraindividual comparison study, the silicone gel sheeting was applied to 1 foot of a hallux valgus incision scar (an experiment group) for 12 weeks upon removal of the stitches, whereas the symmetrical scar from the other foot was left untreated (a control group). The scars were evaluated at 4 and 12 weeks after the silicon sheet application. The Vancouver Scar Scale was used to measure the vascularity, pigmentation, pliability, height, and length of the scars. Adverse effects were also evaluated, and they included pain, itchiness, rash, erythema, and skin softening., Results: At weeks 4 and 12, the experiment group scored significantly better on the Vancouver Scar Scale in all items, except length (P < .05 for all except the length of scar), compared with the control group. In all items, adverse effects of the experiment group were significantly lower than those of the control group at week 12, suggesting that direct attachment of the silicone sheet does not cause adverse effects (P < .05)., Conclusions: To the authors' knowledge, this is one of the first models to minimize bias related to scar evaluation by using symmetrical scars. The early silicone sheet application did show a significant improvement in prevention of postoperative scarring.

Purpose of Review: Abnormal scarring remains a poorly understood but functional and aesthetic consequence of surgical and traumatic wounds. The purpose of this review is to describe the current state of the science behind the prevention and management of these scars., Recent Findings: A recent update in the International Clinical Recommendations on Scar Management provides a wealth of information on new and revised treatments for hypertrophic scars and keloids. Silicone-based products continue to be the premier option for prevention and initial treatment of hypertrophic and keloid scars. There is growing evidence demonstrating the efficacy of intralesional corticosteroids and 5-fluorouracil. Laser therapy remains a second-line treatment option, with low-level evidence supporting the use of pulse dye lasers and ablative fractional lasers., Summary: Although there remains no 'gold standard' for the prevention and treatment of hypertrophic scars and keloids, silicone gel products and microporous paper tape present the best conservative options. A stepwise algorithm for the treatment of hypertrophic scars or keloids based on the characteristics and responsiveness of the scar presents the best management strategy. Combination therapy (including steroid injections, 5-fluorouracil, and pulse dye laser) proves to be the strongest option for the nonsurgical management of severe hypertrophic scars and keloids.

Keloids and hypertrophic scars are fibroproliferative disorders of the skin that are caused by abnormal healing of injured or irritated skin. It is possible that they are both manifestations of the same fibroproliferative skin disorder and just differ in terms of the intensity and duration of inflammation. These features may in turn be influenced by genetic, systemic, and local risk factors. Genetic factors may include single nucleotide polymorphisms, while systemic factors may include hypertension, pregnancy, hormones, and cytokines. The most important local factor is tension on the scar. Over the past 10 years, our understanding of the pathogenesis of keloids and hypertrophic scars has improved markedly. As a result, these previously intractable scars are now regarded as being treatable. There are many therapeutic options, including surgery, radiation, corticosteroids, 5-fluorouracil, cryotherapy, laser therapy, anti-allergy agents, anti-inflammatory agents, bleaching creams and make-up therapies. However, at present, we believe that the following combination of three therapies most reliably achieves a complete cure: surgery, followed by radiation and the use of steroid tape/plaster.

Background: The treatment and prevention of hypertrophic scars and keloids represents a special challenge particularly in plastic surgery. Given their simple, non-invasive and painless application, topical preparations are an attractive therapeutic option. On the part of the patients, the efficacy in prevention of and therapy for hypertrophic scars and keloids of these topical preparations is regularly questioned. The clarification of this issue is subject of this review., Material and Methods: A systematic literature research on the databases Medline, Medline Plus, Oldmedline and Cochrane Library was conducted. All randomised controlled trials, meta-analyses, systematic reviews, case series and case studies from the German and English literature, dealing with topical preparations approved in the German speaking area, were included., Results: In this research, 14 topical preparations were identified. However, there is limited data regarding their efficacy as compared to each other, to other treatment options or untreated controls. Only for 6 topical preparations studies with high evidence level exist. Contractubex showed best results in the prevention of pathological scars., Conclusion: Even though Contractubex shows preventive effects and can be recommended based on current data, further studies are needed to strengthen the body of evidence and to prove the therapeutic efficacy of topical preparations in general., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Skin injuries and the consequent loss of tissue integrity triggers a sequence of cellular and biochemical events that lead to a healed wound. Any failure during this rather sophisticated process may result in pathological scarring., Methods: To evaluate the efficacy of topical verapamil as a modulator of the healing process, a group of five observers (plastic surgeon, dermatologist, physiotherapist, biologist, and layman) analyzed pictures of 120 patients 3 months after abdominoplasty (60 patients) and mammoplasty (60 patients). Half of each group of patients used the topical verapamil scar modulator. Pictures were rated using the Stony Brook Scale., Results: According to the classification established by us, the scars in patients who used topical verapamil scar modulator showed better results than those who did not (p < 0.05). Patients treated with verapamil presented good-quality scarring (80 % of mammoplasty scars and 75.2 % abdominoplasty scars), while patients who did not use healing modulators showed 48 and 51.2 % satisfaction for mammoplasty and abdominoplasty scars, respectively. No adverse reactions were observed or reported after the use of topical verapamil., Conclusions: This is the first clinical trial that reports the use of topical verapamil as a modulator in the healing process in the postoperative period. Based on clinical results and on the high level of reliability and statistical significance, we concluded that verapamil at a concentration of 50 µM is an excellent choice as a scar modulator; its use avoids the development of keloids and hypertrophic scars after plastic surgery.

Background: Numerous modalities have been used to treat keloids and hypertrophic scars; however, optimal treatment has not yet been established. Therefore, prevention is the mainstay. Recently, silicone gel and tretinoin cream have been shown to be useful for the prevention of hypertrophic scars and keloids. However, there has been no comparative study of the two topical agents thus far., Objective: To determine and compare the effectiveness of silicone gel and tretinoin cream for the prevention of hypertrophic scars and keloids resulting from postoperative wounds and for scar improvement., Method: This study included 26 patients with 44 different wounds. The postoperative wounds were divided into two treatment groups and one control group. The patients in the first and second treatment group applied silicone gel and tretinoin cream, respectively, twice a day on their wounds after their stitches were removed. In contrast, the control group patients did not apply anything. We used the Modified Vancouver Scar Scale to quantitatively examine the effectiveness of silicone gel and tretinoin cream just after stitches removal, and at 4, 8, 12 and 24 weeks after removal of the stitches., Results: The silicone gel and tretinoin cream effectively prevented hypertrophic scars and keloids and improved scar effects in the two treatment groups compared with those in the control group. However, no significant difference was noted between the two treatment groups., Conclusion: To prevent hypertrophic scars and keloids and improve scars after surgery, application of a silicone gel or a tretinoin cream to the wounds is needed., (© 2013 European Academy of Dermatology and Venereology.)

No universally accepted standard for evaluation, prevention, and treatment of scars, hypertrophic scars, and keloids exists. Following development of a questionnaire, we performed a closed Web-based survey among burn centers. Server-based data collection was performed over 4 weeks and closed thereafter. The poll revealed emerging new treatment schemes, but the majority of participants adhered to evaluation (Patient and Observer Scar Assessment Scale, Matching Assessment of Scars and Photographs, Vancouver Scar Scale, two-dimensional photography) and prevention (silicone gel sheets and compression garments) strategies that were in line with the currently available recommendations from the literature. We noted a low penetration for the use of objective evaluation tools in our poll and detected differences in surgical approaches to keloids. Based on the results of our survey and the power of currently available clinical recommendations, we expect future guidelines to gain more evidence-based power, especially when more high-quality clinical trials with objective evaluation support, clearly defined disease entities, and therapeutic outcome factors have become available., (© 2014 by the Wound Healing Society.)

Most cutaneous wounds heal with scar formation. Ideally, an inconspicuous normotrophic scar is formed, but an abnormal scar (hypertrophic scar or keloid) can also develop. A major challenge to scientists and physicians is to prevent adverse scar formation after severe trauma (e.g. burn injury) and understand why some individuals will form adverse scars even after relatively minor injury. Currently, many different models exist to study scar formation, ranging from simple monolayer cell culture to 3D tissue-engineered models even to humanized mouse models. Currently, these high-/medium-throughput test models avoid the main questions referring to why an adverse scar forms instead of a normotrophic scar and what causes a hypertrophic scar to form rather than a keloid scar and also, how is the genetic predisposition of the individual and the immune system involved. This information is essential if we are to identify new drug targets and develop optimal strategies in the future to prevent adverse scar formation. This viewpoint review summarizes the progress on in vitro and animal scar models, stresses the limitations in the current models and identifies the future challenges if scar-free healing is to be achieved in the future., (© 2014 The Authors. Experimental Dermatology. Published by John Wiley & Sons Ltd.)

Background: The management of hypertrophic scars and keloids remains a therapeutic challenge. Treatment regimens are currently based on clinical experience rather than substantiated evidence. Laser therapy is an emerging minimally invasive treatment that has recently gained attention., Methods: A meta-analysis was conducted to evaluate the effectiveness of various laser therapies. The pooled response rate, pooled standardized mean difference of Vancouver Scar Scale scores, scar height, erythema, and pliability were reported., Results: Twenty-eight well-designed clinical trials with 919 patients were included in the meta-analysis. The overall response rate for laser therapy was 71 percent for scar prevention, 68 percent for hypertrophic scar treatment, and 72 percent for keloid treatment. The 585/595-nm pulsed-dye laser and 532-nm laser subgroups yielded the best responses among all laser systems. The pooled estimates of hypertrophic scar studies also showed that laser therapy reduced total Vancouver Scar Scale scores, scar height, and scar erythema of hypertrophic scars. Regression analyses of pulsed-dye laser therapy suggested that the optimal treatment interval is 5 to 6 weeks. In addition, the therapeutic effect of pulsed-dye laser therapy is better on patients with lower Fitzpatrick skin type scores., Conclusions: This study presents the first meta-analysis to confirm the efficacy and safety of laser therapy in hypertrophic scar management. The level of evidence for laser therapy as a keloid treatment is low. Further research is required to determine the mechanism of action for different laser systems and to examine the efficacy in quantifiable parameters, such as scar erythema, scar texture, degrees of symptom relief, recurrence rates, and adverse effects.

Background: New topical treatments studied in adults have been published to be potentially effective in the treatment of hypertrophic scar and keloids. There is still no study in Thai children., Objective: To study the efficacy of 10% onion extract in silicone derivative gel for the prevention of hypertrophic scar and keloid in median sternotomy wound from open heart surgery in pediatric patients., Material and Method: Thirty-nine pediatric patients who had median sternotomy were recruited in this prospective randomized, double-blinded, placebo-controlled split-scar experimental study. The wound in each patient was divided into upper and lower parts, and the treatment with, either onion extract gel or placebo was randomly applied by block randomization onto each part of the wound twice daily after the seventh day postoperatively for six months. The incidence of scars, serial photographs of the wound, Vancouver Scar Scale (VSS), and adverse effect were assessed at each visit., Results: Thirty patients with the mean age of 4.3 years completed the 6-month study period. Six patients (20%) in onion extract gel group had no scar compared to one patient (3.3%) in placebo group (p = 0.04). Of the 27 patients with hypertrophic scar nine were from onion extract gel group and 18 from the placebo group (p = 0.02). Keloid was not statistically significant diferent in both groups (p = 0.29). VSS was not statistically significant different in all visits. One case had a pustule on the part of the onion extract in silicone derivative application at the sixth month., Conclusion: Onion extract in silicone derivative gel can significantly decreased the incidence of hypertrophic scar from median sternotomy wound in pediatric patients. Keloid did not show statistically significant differences in both groups.

Background: Keloid and hypertrophic scars are common and are caused by a proliferation of dermal tissue following skin injury. They cause functional and psychological problems for patients, and their management can be difficult. The use of silicone gel sheeting to prevent and treat hypertrophic scarring is still relatively new and started in 1981 with treatment of burn scars., Objectives: To determine the effectiveness of silicone gel sheeting for:(1) prevention of hypertrophic or keloid scarring in people with newly healed wounds (e.g. post surgery);(2) treatment of established scarring in people with existing keloid or hypertrophic scars., Search Methods: In May 2013 we searched the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL for this second update., Selection Criteria: Any randomised or quasi-randomised controlled trials, or controlled clinical trials, comparing silicone gel sheeting for prevention or treatment of hypertrophic or keloid scars with any other non surgical treatment, no treatment or placebo., Data Collection and Analysis: We assessed all relevant trials for methodological quality. Three review authors extracted data independently using a standardised form and cross-checked the results. We assessed all trials meeting the selection criteria for methodological quality., Main Results: We included 20 trials involving 873 people, ranging in age from 1.5 to 81 years. The trials compared adhesive silicone gel sheeting with no treatment; non silicone dressing; other silicone products; laser therapy; triamcinolone acetonide injection; topical onion extract and pressure therapy. In the prevention studies, when compared with a no treatment option, whilst silicone gel sheeting reduced the incidence of hypertrophic scarring in people prone to scarring (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.21 to 0.98) these studies were highly susceptible to bias. In treatment studies, silicone gel sheeting produced a statistically significant reduction in scar thickness (mean difference (MD) -2.00, 95% CI -2.14 to -1.85) and colour amelioration (RR 3.49, 95% CI 1.97 to 6.15) but again these studies were highly susceptible to bias., Authors' Conclusions: There is weak evidence of a benefit of silicone gel sheeting as a prevention for abnormal scarring in high-risk individuals but the poor quality of research means a great deal of uncertainty prevails. Trials evaluating silicone gel sheeting as a treatment for hypertrophic and keloid scarring showed improvements in scar thickness and scar colour but are of poor quality and highly susceptible to bias.

Background: Keloids and hypertrophic scars (HSc) affect 4.5-16% of the population. Thus far, the different approaches of keloid treatment are not very efficient, with a 50% relapse rate and many ongoing researches are looking for simple, safe and more efficient therapeutic methods. Tacrolimus is an immunomodulator that could be useful in treating keloid., Objectives: The objective of this study is to evaluate the effectiveness of Tacrolimus in inhibiting HSc formation on rabbits' ears model and to check optical skin spectroscopy in tissue characterization., Methods: Our study was carried out on 20 New-Zealand female white rabbits. HSc were obtained by wounding rabbits' ear. These wounds were treated with intradermal injections of tacrolimus (0.2-0.5 mg/cm(2)) or a vehicule. The assessment of treatment efficacy was performed by clinical examinations, histological assay and skin spectrometry., Results: Tacrolimus did not induce general or local side-effects. The scar elevation index in treated subjects was half less than that of the untreated ones. Furthermore, dermal thickness and inflammatory cellular density were both significantly smaller for treated scars than for the control ones. In vivo optical skin spectroscopy can characterize hypertrophic and normal skin with high sensibility and specificity., Conclusion: Intradermal injection of tacrolimus at 0.5 mg/cm(2) is an efficient way to prevent HSc in our experiment model and its tolerance is correct. Optical spectroscopy could be a good non-invasive tool to evaluate HSc treatment. These promising results might be proposed for patients suffering from keloid., (© 2011 John Wiley & Sons A/S.)

Hypertrophic scars and keloids form due to aberrations in the physiologic wound healing cascade characterized by greater and more sustained ECM deposition. Both entities are frequently associated with pain, pruritus and contractures, and are thus significantly affecting the patient's quality of life. Genetic susceptibility, specific anatomic locations, prolonged inflammation and delayed epithelialization significantly contribute to excessive scar formation. However, despite intensive scientific work in this field the complex mechanisms underlying the processes of scarring and wound contraction remain poorly understood and most therapeutic approaches are clinically unsatisfactory. Nevertheless, based on a rising number of clinical studies next to well-known therapeutic concepts including cryotherapy and intralesional triamcinolone, recent techniques extend the spectrum for treating excessive scars. Nonetheless, prevention of pathologic scarring is undoubtedly more effective than to later attempts to treat it.

Background: The physiopathogenesis of proliferative scarring in human skin is not well understood. Furthermore, knowledge of the precise mechanisms of action for physical treatment modalities is limited. Compression garments, occlusive/adhesive skin taping, and silicone gel sheets are applied to form an occlusion on the scar surface, reduce tension, and/or increase pressure on the scar itself. The mechanisms by which the external or superficial actions of these treatments cause remission of a protruding scar may be related to mechanoreceptor (nociceptor and cellular mechanoreceptor) responses., Methods: Basic research studies about mechanoreceptor-related (nociceptors and cellular mechanoreceptors, separately) events are reviewed and discussed based on proliferative scarring background. Scar management-related studies were corrected from the standpoint of mechanotransduction mechanisms. The methodologic quality of the clinical trials and basic studies was evaluated and reviewed., Results: It was suggested that many of the physical scar management methods, including compression therapy, silicone therapy, adhesive tape, and occlusive dressing therapy, are related to mechanotransduction mechanisms., Conclusions: A unifying perspective of basic research findings and clinical observations may be obtained by considering the mechanoreceptor-related events in scar management. Moreover, a precise understanding of the roles that cellular mechanoreceptors and mechanosensitive nociceptors play in proliferative scarring may lead to the development of innovative treatment strategies and new pharmacologic therapies targeting cellular mechanoreceptors and mechanosensitive nociceptors in fibroproliferative diseases.

Background and Objectives: Hypertrophic and keloid scars result from alterations in the wound healing process. Treating abnormal scars remains an important challenge. The aim of this case series was to investigate the effectiveness of near infrared (NIR) light emitting diode (LED) treatment as a prophylactic method to alter the wound healing process in order to avoid or attenuate the formation of hypertrophic scars or keloids., Study Design/patients and Methods: Three patients (age 27-57) of phototypes I-III with hypertrophic scars or keloids due to acne or surgery participated in this case series. Following scar revision by surgery or CO(2) laser ablation on bilateral areas, one scar was treated daily by the patient at home with non-thermal, non-ablative NIR LED (805 nm at 30 mW/cm(2)) for 30 days. Efficacy assessments, conducted up to a year post-treatment, included the Vancouver Scar scale (VSS), clinical global assessment of digital photographs, and quantitative profilometry analysis using PRIMOS. Safety was documented by adverse effects monitoring., Results: Significant improvements on the NIR-treated versus the control scar were seen in all efficacy measures. No significant treatment-related adverse effects were reported., Conclusion: Possible mechanisms involved are inhibition of TGF-beta I expression. Further studies in larger group of patients are needed to evaluate this promising technique., ((c) 2010 Wiley-Liss, Inc.)

Background: Previous reports on the treatment of hypertrophic scars and keloids have not described clear algorithms for multimodal therapies. This article presents an evidence-based review of previous articles and proposes algorithms for the treatment and prevention of hypertrophic scars and keloids., Methods: The methodologic quality of the clinical trials was evaluated, and the baseline characteristics of the patients and the interventions that were applied and their outcomes were extracted., Results: Important factors that promote hypertrophic scar/keloid development include mechanical forces on the wound, wound infection, and foreign body reactions. For keloids, the treatment method that should be used depends on whether scar contractures (especially joint contractures) are present and whether the keloids are small and single, or large and multiple. Small and single keloids can be treated radically by surgery with adjuvant therapy (which includes radiation or corticosteroid injections) or by nonsurgical monotherapy (which includes corticosteroid injections, cryotherapy, laser, and antitumor/immunosuppressive agents such as 5-fluorouracil). Large and multiple keloids are difficult to treat radically and are currently only treatable by multimodal therapies that aim to relieve symptoms. After a sequence of treatments, long-term follow-up is recommended. Conservative therapies, which include gel sheeting, taping fixation, compression therapy, external and internal agents, and makeup (camouflage) therapy, should be administered on a case-by-case basis., Conclusions: The increase in the number of randomized controlled trials over the past decade has greatly improved scar management, although these studies suffer from various limitations. The hypertrophic scar/keloid treatment algorithms that are currently available are likely to be significantly improved by future high-quality clinical trials.

The potential of various biological agents to reduce or prevent excessive scar formation has now been evaluated in numerous in-vitro studies, experimental animal models and preliminary clinical trials, in some cases with particularly promising results. Perhaps prominent among this group of biological agents, and, to some degree, possibly representing marketed compounds already being used 'off label' to manage excessive scarring, are the tumor necrosis factor alpha antagonist etanercept, and immune-response modifiers such as IFNalpha2b and imiquimod. Additional assessment of these novel agents is now justified with a view to reducing or preventing hypertrophic scars, keloid scars and the recurrence of post-excision keloid lesions.

Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. Combination of therapies is the mainstay of current burn scar management, including surgical reconstruction, pressure therapy, silicon gels and sheets, and temporary garments. Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children.

The aetiology of pathologic scarring is unknown today regarding the keloids. The authors have analyzed the literature and own experience retrospectively according to the evidence based treatments and prevention of the hypertrophic and keloid scars. The corticosteroids have been used intralesionally since the beginning of the 1960-ies. It was followed by the pressure garment therapy in order to treat the widespread burns scars in the early 1970-ies. The silicone gel sheeting is being used since the 1980-ies. The basic treatment of keloids changed, radiotherapy was combined with the above mentioned methods because of its high recurrence rate. Newer methods, cryosurgery as well as lasers were used to treat keloids. The number of effective topical agents was increased. The researchers have been looking for other, intralesionally usable medicine and genetic causes for more than ten years. The clinicians have had the standard protocols of the adjunct and alternative methods too. After having the standard and internationally accepted scar assessment system (Vancouver-scar scale and score), the controlled, randomized trials were practicable. The prospective evaluation of the efficacy of different protocols with adequate follow-up became performable. The comparison of different methods is difficult because of the lack of its standard outcome.

Aberrant wound healing results in unsightly scarring, hypertrophic scarring, and keloid formation, causing functional and cosmetic deformities, discomfort, psychological stress, and patient dissatisfaction. Scar prevention and management continue to be important issues for the facial plastic surgeon. This article presents an overview on the pathogenesis of a scar and of the different types of scars. Differences between keloids, hypertrophic scars and normal scars include distinct scar appearance, histologic morphology and cellular function in response to growth factors. Recent advances in our understanding of the wound healing process reveal possible causes for hypertrophic scars and keloids. This information might assist in the development of efficacious prevention and treatment for hypertrophic scar and keloid formation. This article also describes the strategies available for scar prevention. Recommendations focus on the management of hypertrophic scars and keloids.

Background: Keloid and hypertrophic scars are common and are caused by a proliferation of dermal tissue following skin injury. They cause functional and psychological problems for patients, and their management can be difficult. The use of silicon gel sheeting to prevent and treat hypertrophic scarring is still relatively new, and started in 1981 with treatment of burn scars., Objectives: To determine the effectiveness of silicon gel sheeting for: (1) prevention of hypertrophic or keloid scarring in people with newly healed wounds (e.g. post surgery); (2) treatment of established scarring in people with existing keloid or hypertrophic scars., Search Strategy: Trials were identified from searches of the Cochrane Wounds Group Specialised Register (searched September 2005), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2005); MEDLINE (1989 to June 2002); EMBASE (1988 to May 2002); CINAHL (1982 to May 2002) and reference lists of articles and relevant reviews. The major supplier of silicon gel sheeting (Smith and Nephew) was approached for details of unpublished, ongoing and recently published trials., Selection Criteria: Any randomised or quasi-randomised controlled trials, or controlled clinical trials comparing silicon gel sheeting for prevention or treatment of hypertrophic or keloid scars against no treatment, placebo, or any other treatment type except surgery., Data Collection and Analysis: All relevant trials were assessed for methodological quality. Data were extracted independently by both reviewers using a standardized form, and the results cross-checked. All trials, meeting the selection criteria were assessed for methodological quality., Main Results: Thirteen trials, involving 559 people, ranging in age from 2 to 81 years, were included in the review. The trials compared adhesive silicon gel sheeting with control; non-silicon gel sheeting; silicon gel plates with added Vitamin E; laser therapy; triamcinolone acetonide injection, and non-adhesive silicon gel sheeting. In the prevention studies, when compared with a no treatment option; whilst silicon gel sheeting reduced the incidence of hypertrophic scarring in people prone to scarring, (RR 0.46, 95% CI 0.21 to 0.98) these studies were highly susceptible to bias. Silicon gel sheeting produced a statistically significant improvement in scar elasticity, (RR 8.60, 95% CI 2.55 to 29.02), but again these studies were highly susceptible to bias., Authors' Conclusions: Trials evaluating silicon gel sheeting as a treatment for hypertrophic and keloid scarring are of poor quality and highly susceptible to bias. There is weak evidence of a benefit of silicon gel sheeting as a prevention for abnormal scarring in high risk individuals but the poor quality of research means a great deal of uncertainty prevails.

Purpose of Review: Aberrant wound healing results in unsightly scar, hypertrophic scar, and keloid formation, causing functional and cosmetic deformities, discomfort, psychological stress, and patient dissatisfaction. Scar prevention and management, both surgical and nonsurgical, continue to be important issues for the otolaryngologist., Recent Findings: Both animal and human models continue to point to the integral role of transforming growth factor-beta in aberrant healing. Multiple extracts have promising results as therapies for scarring and are widely marketed but need to be further investigated. Scar prevention advancements include refinements in surgical technique, nutritional supplementation, and optimal wound care. Steroid injections continue to play a major role in the regression of scars and keloids. Dermatography assists in the minimization of scar appearance. Dermatography, laser therapies, intralesional 5-fluorouracil, and adjuvant radiotherapy are emerging therapies. Topical vitamin E utility is revisited. New surgical scar revision techniques include modified excision techniques and skin grafting., Summary: Despite optimal efforts to avoid scar formation, aberrant wound healing may occur. The use of topical agents and intralesional steroid injections can minimize early scar formation. Strategies for prevention and management of keloids and hypertrophic scars continue to develop, as the basic science mechanisms underlying aberrant wound healing are elucidated.

Objective: To assess the ability of mitomycin C to prevent the recurrence of surgically excised keloid scars. Mitomycin C has been successfully used to prevent scar tissue formation at the site of subglottic stenosis in the field of pediatric otolaryngology. It appears that mitomycin C interferes with the ability of fibroblasts to produce a scar without causing changes in epithelialization., Design: We excised keloid scars from various sites in the head and neck and then applied mitomycin C to the resected bed prior to closure of the wound at a concentration of 0.4 mg/mL for 5 minutes. All patients had multiple keloids and acted as their own control. At 1 month after the procedure both wounds were started on a regimen of triamcinolone acetonide, 40 mg/mL injections, repeated every month for 6 months. At the end of the study, photos and measurements were again taken., Results: Fifteen patients (13 female and 2 male) ranging in age from 10 to 55 years enrolled in the study. No infections or nonhealing wounds were seen. There was no difference in postoperative pain. Eight patients completed the triamcinolone injections, 5 had fewer than 6 injections, and 2 patients had no steroid injections. Twelve patients completed follow-up and were evaluated for surgical complications and recurrence of the keloids at either site. Two patients had partial postoperative follow-up in person and then completed follow-up via telephone. One patient could not be found for follow-up. Four patients had recurrence of both excised lesions. Ten patients had no recurrence of their keloids at either site., Conclusion: Mitomycin C made no difference in the prevention of keloid recurrence after excision when topically applied.