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Clinical Outcomes Following the Early Application of Multimodal Scar Programs for Facial Incisional Wounds

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  • Non-Surgical Aesthetic
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Abstract

Background

Even though scars are major issues for patients who undergo facial lacerations, programs for their prevention and early management are not well established. The purpose of this study was to evaluate the clinical outcomes of prophylactic scar assessments and early scar interventions in patients with lacerations.

Patients and Methods

A total of 116 patients underwent suture line and scar prevention treatment in the emergency room from 2014 to 2015. In the retrospective study, 46 patients who met all the criteria were included in the study. They were assigned to one of the following two scar prevention programs: the standard scar program for prevention, which included ta**, silicone sheets, and ointments, and the multimodality scar program for treatment, which included triamcinolone, botulinum toxins, or CO2 fractional lasers. The patterns of early scar program were investigated for the standard scar prevention program and the multimodality scar management program, and we evaluated the scar assessment scores of the patients at 3 and 6 months.

Results

Scar scores for the patients who received multimodality scar management showed statistically significant improvements in Patient Scar Assessment (PSA) scales, Stony Brook Scar Evaluation Scales (SBSES), Vancouver Scar Scale (VSS) scores, and Visual Analog Scar (VAS) scales (the p values were 0.008, 0.007, 0.017, and 0.01, respectively).

Conclusion

The multimodality scar program is more effective for scar prevention than the standard scar program.

Level of Evidence IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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References

  1. Fearmonti RM, Bond JE, Erdmann D, Levin LS, Pizzo SV, Levinson H (2011) The modified patient and observer scar assessment scale: a novel approach to defining pathologic and nonpathologic scarring. Plast Reconstr Surg 127:242–247

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Al-Attar A, Mess S, Thomassen JM, Kauffman CL, Davison SP (2006) Keloid pathogenesis and treatment. Plast Reconstr Surg 117:286–300

    Article  CAS  PubMed  Google Scholar 

  3. McDonald WS, Deitch EA (1987) Hypertrophic skin grafts in burned patients: a prospective analysis of variables. J Trauma 27:147–150

    Article  CAS  PubMed  Google Scholar 

  4. Singer AJ, Arora B, Dagum A, Valentine S, Hollander JE (2007) Development and validation of a novel scar evaluation scale. Plast Reconstr Surg 120:1892–1897

    Article  CAS  PubMed  Google Scholar 

  5. Louis TA, Lavori PW, Bailar JC 3rd, Polansky M (1984) Crossover and self-controlled designs in clinical research. New Engl J Med. 310:24–31

    Article  CAS  PubMed  Google Scholar 

  6. Burd A, Huang L (2005) Hypertrophic response and keloid diathesis: Two very different forms of scar. Plast Reconstr Surg 116:150e-e157

    Article  PubMed  CAS  Google Scholar 

  7. Bush JA, McGrouther DA, Young VL et al (2011) Recommendations on clinical proof of efficacy for potential scar prevention and reduction therapies. Wound Repair Regen 19(Suppl 1):s32–s37

    Article  PubMed  Google Scholar 

  8. Mustoe TA, Cooter RD, Gold MH et al (2002) International clinical recommendations on scar management. Plast Reconstr Surg 110:560–571

    Article  PubMed  Google Scholar 

  9. Gold MH, McGuire M, Mustoe TA et al (2014) Updated international clinical recommendations on scar management: Part 2–algorithms for scar prevention and treatment. Dermatol Surg 40:825–831

    CAS  PubMed  Google Scholar 

  10. Soltani AM, Francis CS, Motamed A et al (2012) Hypertrophic scarring in cleft lip repair: a comparison of incidence among ethnic groups. Clin Epidemiol. 4:187–191

    PubMed  PubMed Central  Google Scholar 

  11. van de Kar AL, Corion LU, Smeulders MJ, Draaijers LJ, van der Horst CM, van Zuijlen PP (2005) Reliable and feasible evaluation of linear scars by the patient and observer scar assessment scale. Plast Reconstr Surg 116:514–22

    Article  PubMed  CAS  Google Scholar 

  12. Baryza MJ, Baryza GA (1995) The Vancouver scar scale: an administration tool and its interrater reliability. J Burn Care Rehabil 16:535–538

    Article  CAS  PubMed  Google Scholar 

  13. Truong PT, Lee JC, Soer B, Gaul CA, Olivotto IA (2007) Reliability and validity testing of the patient and observer scar assessment scale in evaluating linear scars after breast cancer surgery. Plast Reconstr Surg 119:487–494

    Article  CAS  PubMed  Google Scholar 

  14. Vercelli S, Ferriero G, Sartorio F, Cisari C, Bravini E (2015) Clinimetric properties and clinical utility in rehabilitation of postsurgical scar rating scales: a systematic review. Int J Rehabil Res 38:279–286

    Article  PubMed  Google Scholar 

  15. Lee RH, Gamble WB, Robertson B, Manson PN (1999) The MCFONTZL classification system for soft-tissue injuries to the face. Plast Reconstr Surg 103:1150–1157

    Article  CAS  PubMed  Google Scholar 

  16. Muneuchi G, Suzuki S, Onodera M, Ito O, Hata Y, Igawa HH (2006) Long-term outcome of intralesional injection of triamcinolone acetonide for the treatment of keloid scars in Asian patients. Scand J Plast Recons 40:111–116

    Article  Google Scholar 

  17. Makboul M, Makboul R, Abdelhafez AH, Hassan SS, Youssif SM (2014) Evaluation of the effect of fractional CO2 laser on histopathological picture and TGF-β1 expression in hypertrophic scar. J Cosmet Dermatol-US 13:169–179

    Article  Google Scholar 

  18. El-Zawahry BM, Sobhi RM, Bassiouny DA, Tabak SA (2015) Ablative CO2 fractional resurfacing in treatment of thermal burn scars: an open-label controlled clinical and histopathological study. J Cosmet Dermatol-US 14:324–331

    Article  Google Scholar 

  19. Draaijers LJ, Tempelman FR, Botman YA et al (2004) The patient and observer scar assessment scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 113:1960–5

    Article  PubMed  Google Scholar 

  20. Sullivan T, Smith J, Kermode J, McIver E, Courtemanche DJ (1990) Rating the burn scar. J Burn Care Rehabil 11:256–260

    Article  CAS  PubMed  Google Scholar 

  21. Duncan JA, Bond JS, Mason T et al (2006) Visual analogue scale scoring and ranking: a suitable and sensitive method for assessing scar quality? Plast Reconstr Surg 118:909–918

    Article  CAS  PubMed  Google Scholar 

  22. Shrout PE, Fleiss JL (1979) Intraclass correlations: Uses in assessing rater reliability. Psychol Bull 86:420–428

    Article  CAS  PubMed  Google Scholar 

  23. O'Brien L, Pandit A (2006) Silicone gel sheeting for preventing and treating hypertrophic and keloid scars. Cochrane Database Syst Rev 2006:CD003826

  24. Atkinson JA, McKenna KT, Barnett AG, McGrath DJ, Rudd M (2005) A randomized, controlled trial to determine the efficacy of paper tape in preventing hypertrophic scar formation in surgical incisions that traverse Langer’s skin tension lines. Plast Reconstr Surg 116:1648–56

    Article  CAS  PubMed  Google Scholar 

  25. Kim S, Choi TH, Liu W, Ogawa R, Suh JS, Mustoe TA (2013) Update on scar management: guidelines for treating Asian patients. Plast Reconstr Surg 132:1580–1589

    Article  CAS  PubMed  Google Scholar 

  26. Kim SH, Lee SJ, Lee JW, Jeong HS, Suh IS (2019) Clinical trial to evaluate the efficacy of botulinum toxin type A injection for reducing scars in patients with forehead laceration: a double-blinded, randomized controlled study. Medicine (Baltimore) 98:e16952

    Article  CAS  Google Scholar 

  27. Jeong HS, Lee BH, Sung HM et al (2015) Effect of botulinum toxin type A on differentiation of fibroblasts derived from scar tissue. Plast Reconstr Surg 136:171e-e178

    Article  CAS  PubMed  Google Scholar 

  28. Hu L, Zou Y, Chang SJ et al (2018) Effects of botulinum toxin on improving facial surgical scars: a prospective, split-scar, double-blind, randomized controlled trial. Plast Reconstr Surg 141:646–650

    Article  CAS  PubMed  Google Scholar 

  29. Capon A, Iarmarcovai G, Gonnelli D, Degardin N, Magalon G, Mordon S (2010) Scar prevention using laser-assisted skin healing (LASH) in plastic surgery. Aesthet Plast Surg 34:438–446

    Article  Google Scholar 

  30. Nouri K, Jimenez GP, Harrison-Balestra C, Elgart GW (2003) 585-nm pulsed dye laser in the treatment of surgical scars starting on the suture removal day. Dermatol Surg 29:65–73

    PubMed  Google Scholar 

  31. Rosen DJ, Patel MK, Freeman K, Weiss PR (2007) A primary protocol for the management of ear keloids: results of excision combined with intraoperative and postoperative steroid injections. Plast Reconstr Surg 120:1395–1400

    Article  CAS  PubMed  Google Scholar 

  32. Fanous A, Bezdjian A, Caglar D et al (2019) Treatment of keloid scars with botulinum toxin type A versus triamcinolone in an athymic nude mouse model. Plast Reconstr Surg 143:760–767

    Article  CAS  PubMed  Google Scholar 

  33. Phillips TJ, Fung E, Rigby MH et al (2019) The use of botulinum toxin type A in the healing of thyroidectomy wounds: a randomized, prospective, placebo-controlled study. Plast Reconstr Surg 143:375e-e381

    Article  CAS  PubMed  Google Scholar 

  34. Thomas JR, Somenek M (2012) Scar revision review. Arch Facial Plast S 14:162–174

    Article  Google Scholar 

  35. Garg S, Dahiya N, Gupta S (2014) Surgical scar revision: an overview. J Cutan Aesthet Surg 7:3–13

    Article  PubMed  PubMed Central  Google Scholar 

  36. Anderson RR, Donelan MB, Hivnor C et al (2014) Laser treatment of traumatic scars with an emphasis on ablative fractional laser resurfacing: consensus report. JAMA Dermatol 150:187–193

    Article  PubMed  Google Scholar 

  37. Niwa AB, Mello AP, Torezan LA, Osório N (2009) Fractional photothermolysis for the treatment of hypertrophic scars: clinical experience of eight cases. Dermatol Surg 35:773–7

    Article  CAS  PubMed  Google Scholar 

  38. Arora P, Sarkar R, Garg VK, Arya L (2012) Lasers for treatment of melasma and post-inflammatory hyperpigmentation. J Cutan Aesthet Surg 5:93–103

    Article  PubMed  PubMed Central  Google Scholar 

  39. Taniguchi Y, Muraoka M, Harada T, Ito N (2003) Pulsed dye laser treatment for linear scars with concave and erythematous appearance. Aesthet Plast Surg 27:205–208

    Article  Google Scholar 

  40. Alster TS, Nanni CA (1998) Pulsed dye laser treatment of hypertrophic burn scars. Plast Reconstr Surg 102:2190–2195

    Article  CAS  PubMed  Google Scholar 

  41. Panchaprateep R, Munavalli G (2015) Low-fluence 585 nm Q-switched Nd:YAG laser: a novel laser treatment for post-acne erythema. Laser Surg Med 47:148–155

    Article  Google Scholar 

  42. Bowes LE, Nouri K, Berman B et al (2002) Treatment of pigmented hypertrophic scars with the 585 nm pulsed dye laser and the 532 nm frequency-doubled Nd:YAG laser in the Q-switched and variable pulse modes: a comparative study. Dermatol Surg 28:714–719

    PubMed  Google Scholar 

  43. Lee SJ, Lee JW, Kim SH, Suh IS, Jeong HS (2019) Comparison of the scar prevention effect between a carbon dioxide fractional laser and a continuous ablative carbon dioxide laser with a 595-nm Nd:YAG Laser. Aesthet Plast Surg 43:213–220

    Article  Google Scholar 

  44. Gassner HG, Sherris DA, Otley CC (2000) Treatment of facial wounds with botulinum toxin A improves cosmetic outcome in primates. Plast Reconstr Surg 105:1948–53

    Article  CAS  PubMed  Google Scholar 

  45. Gassner HG, Sherris DA (2003) Chemoimmobilization: improving predictability in the treatment of facial scars. Plast Reconstr Surg 112:1464–1466

    Article  PubMed  Google Scholar 

  46. Gassner HG, Brissett AE, Otley CC et al (2006) Botulinum toxin to improve facial wound healing: a prospective, blinded, placebo-controlled study. Mayo Clin Proc 81:1023–1028

    Article  CAS  PubMed  Google Scholar 

  47. Chang CS, Wallace CG, Hsiao YC, Chang CJ, Chen PK (2014) Botulinum toxin to improve results in cleft lip repair. Plast Reconstr Surg 134:511–516

    Article  CAS  PubMed  Google Scholar 

  48. Wang Y, Wang J, Zhang J, Hu C, Zhu F (2019) Effectiveness and safety of botulinum toxin type A injection for scar prevention: a systematic review and meta-analysis. Aesthetic Plast Surg 43:1241–1249

    Article  PubMed  Google Scholar 

  49. Roh TS, Jung BK, Yun I, Lew DH, Kim YS (2017) Effect of botulinum toxin A on vasoconstriction and sympathetic neurotransmitters in a murine random pattern skin flap model. Wound Repair Regen 25:75–85

    Article  PubMed  Google Scholar 

  50. **ao Z, Zhang M, Liu Y, Ren L (2011) Botulinum toxin type a inhibits connective tissue growth factor expression in fibroblasts derived from hypertrophic scar. Aesthetic Plast Surg 35:802–807

    Article  PubMed  Google Scholar 

  51. Lee SH, Min HJ, Kim YW, Cheon YW (2018) The efficacy and safety of early postoperative botulinum toxin A injection for facial scars. Aesthet Plast Surg 42(2):530–537

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea

    Joong Min Suh

  2. Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea

    Seong Hoon Park, Jun Won Lee, Seong Joo Lee & In Suck Suh

  3. Department of Plastic and Reconstructive Surgery, Hangang Sacred Heart Hospital, School of Medicine, Hallym University, Seoul, Korea

    Jong Wook Lee

  4. Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea

    Hii Sun Jeong

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Correspondence to Hii Sun Jeong.

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Human and Animal Rights

All research involving human participants was approved by the institutional review board of a single facility (IRB No. 2016-04-49), and all clinical investigations followed the Declaration of Helsinki principles.

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Informed consent was obtained from all participants.

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Presented at: The Korean Society of Aesthetic Plastic Surgery in Seoul, March 28–29, 2015, and the Korean Society of Plastic Surgery in Seoul, November 17–20, 2016.

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Suh, J.M., Park, S.H., Lee, J.W. et al. Clinical Outcomes Following the Early Application of Multimodal Scar Programs for Facial Incisional Wounds. Aesth Plast Surg 45, 1772–1782 (2021). https://doi.org/10.1007/s00266-021-02330-3

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