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Burn injuries in the United States account for over one million hospital admissions per year, with treatment estimated at four billion dollars. Of severe burn patients, 30–90% will develop hypertrophic scars (HSc). In this study, we evaluate the impact of an elastomeric, randomly-oriented biostable polyurethane (PU) scaffold on HSc-related outcomes. In vitro , fibroblast-seeded PU scaffolds contracted significantly less and demonstrated fewer αSMA + myofibroblasts compared to fibroblast-seeded collagen lattices. In a murine HSc model, collagen coated PU (ccPU) scaffolds significantly reduced HSc contraction as compared to untreated control wounds and wounds treated with the clinical standard of care. Our data suggest that electrospun ccPU scaffolds meet the requirements to reduce HSc contraction including reduction of in vitro HSc related outcomes, diminished scar stiffness, and reduced scar contraction. While clinical dogma suggests treating severe burn patients with rapidly biodegrading skin equivalents, our data suggest that a more long-term scaffold may possess merit in reducing HSc. Statement of Significance In severe burns treated with skin grafting, between 30% and 90% of patients develop hypertrophic scars (HSc). There are no therapies to prevent HSc, and treatments are marginally effective. This work is the first example we are aware of which studies the impact of a permanent electrospun elastomer on HSc contraction in a murine model that mimics the human condition. Collagen coated polyurethane scaffolds decrease αSMA+ myofibroblast formation in vitro , prevent stiffening of scar tissue, and mitigate HSc contraction. Unlike current standards of care, electrospun, polyurethane scaffolds do not lose architecture over time. We propose that the future bioengineering strategy of mitigating HSc contraction should consider a long-term elastomeric matrix which persists within the wound bed throughout the remodeling phase of repair. [ABSTRACT FROM AUTHOR]

Plastic surgery continues to be one of the most competitive programs into which medical students attempt to match. The reasons for this include the complexity and diversity of cases, the opportunity to interact with multiple specialties, patient and surgeon satisfaction, and the potential for higher compensation compared with other specialties. The disparity between the relatively small number of plastic surgery residency positions and the large number of highly competitive candidates has created challenges for both the applicant and the residency program director. This challenge is even greater for international medical graduates because of traditional preconceived notions about the quality of the applicants. The authors sought to determine existing beliefs about international medical graduates among plastic surgeons.