Conclusions Hypertrophic scars and keloids result from abnormal wound healing. strategies for hypertrophic scars and keloids are listed below and summarized in Table 1. Table 1 Current treatment strategies for hypertrophic scars and keloids. thead th align=”center” valign=”middle” style=”border-top:solid thin;border-bottom:solid thin” rowspan=”1″ colspan=”1″ Categories /th th align=”center” valign=”middle” style=”border-top:solid thin;border-bottom:solid thin” rowspan=”1″ colspan=”1″ Modalities /th th align=”center” valign=”middle” style=”border-top:solid thin;border-bottom:solid thin” rowspan=”1″ colspan=”1″ Suggested Mechanisms /th th align=”center” valign=”middle” style=”border-top:solid thin;border-bottom:solid thin” rowspan=”1″ colspan=”1″ Use /th /thead ProphylaxisTension-free closure-Reduce inflammation by reducing mechanotransduction-Debridement of inviable tissues, adequate hemostasis br / -Rapid tension free primary closureTaping or silicone sheeting-Reduce inflammation by reducing mechanotransduction: occlusion and hydration-Start 2 weeks after primary wound treatment br / -12 h a day for at least 2 monthsFlavonoids-Induction of MMPs br / -Inhibition of SMADs expression-Start 2 weeks after primary wound treatment br / -Generally twice daily for 4 to 6 6 monthsPressure therapy-Occlusion of blood vessels br / -Inducing apoptosis-Pressure of 15 to 40 mmHg br / -More than 23 h a day for at least Cefazolin Sodium 6 monthsTreatment (current)Corticosteroids-Reducing inflammation and proliferation br / -Vasoconstriction-Intralesional injection: triamcinolone 10 to 40 mg/mL Cefazolin Sodium br / -1 to 2 sessions a month (2 to 3 3 sessions, but can be extended) br / -Tapes/plasters, ointments are available br / -Combination is commonScar revision-Direct reduction of scar volume-At least 1 year after primary wound treatment br / -Combination is recommendedCryotherapy-Scar tissue necrosis-Deliver liquid nitrogen using spray, contact or intralesional needle cryoprobe br / -10 to 20 s freeze-thaw cycles br / -Combination is commonRadiotherapy-Anti-angiogenesis br / -Anti-inflammation-Adjuvant after scar revision br / -24C48 h after scar revision surgery br / -Total of 40 Gray or less, over several divided sessionsLaser therapy-Vaporize blood vessel br / -Anti-inflammation-585-nm pulsed dye laser: 6.0C7.5 J/cm2 (7 mm spot) or 4.5C5.5 J/cm2 (10 mm spot) br / -1064-nm Nd:YAG laser: 14 J/cm2 (5 mm spot) br / -2 to 6 sessions, every 3C4 weeks5-Fluorouracil-Anti-angiogenesis br / -Anti-inflammation-Intralesional injection: 50 mg/mL br / -Weekly for 12 weeks br / -Combination is Cefazolin Sodium commonTreatment (Emerging)MSC * therapy-Modulation of proinflammatory cell activity br / -Anti-fibrosis br / -Promote normal angiogenetic activity-Systemic injection br / -Local injection (at the wound) br / -Engineered Cefazolin Sodium MSC-seeded tissue scaffoldFat grafting-Deliver adipose-tissue derived MSCs-Fat injection or fat tissue grafting underneath or into the woundInterferon-Downregulating TGF-1 br / -Attenuates collagen synthesis and fibroblast proliferation-Intralesional injection: 1.5 106 IU, twice daily over 4 daysHuman recombinant TGF-3/TGF-1 or 2 neutralizing Cefazolin Sodium antibody-Adjust TGF-3: TGF-1 or 2 ratioNot available currentlyBotulinum toxin type A-Reduce muscle tension during wound healing br / -Arrest cell cycle in non-proliferative stage br / -Influence TGF-1 expression-Intralesional injection: 70~140 U, 1 or 3 months interval, 3 sessionsBleomycin-Decreasing collagen synthesis br / -Reduce lysyl-oxidase levels br / -Induce apoptosis-Intralesional injection: 1.5 IU/mL, 2 to 6 sessions at monthly interval Open in a separate window * MSC: mesenchymal stem cell; MMPs: matrix metalloproteinases; TGF: transforming growth factor. 6.1. Prevention 6.1.1. Tension-Free Primary ClosureRegardless of a patients tendency to exhibit bad scars (or not), (1) debridement of inviable or severely contaminated tissues, (2) adequate hemostasis to prevent hematoma, seroma or abscess formation and (3) rapid primary closure using tension-free techniques are wound care basics and are Rabbit polyclonal to RAD17 very important for minimizing the effects of bad scars. Wound epithelialization that is delayed beyond 10C14 days increases the risk of hypertrophic scars, and quick primary closure to induce rapid epithelialization is necessary to achieve good scarring [64]. The importance of tension-free closure techniques cannot be overstated. Wounds that are subject to tension tend to develop into bad scars [65]. The exact molecular mechanisms that govern how our skin responds to physical tension remain uncertain; however, several pathways that convert mechanical forces into biochemical responses have been investigated and reported. This process is called mechanotransduction [66]. Gurtner et al. reported on the fibrotic effects of mechanical tension and described the preventive effect of offloading wound tension on scar formation [67]. 6.1.2. Passive Mechanical StabilizationTo prevent wound stretching and consequential.