Intralesional pentoxifylline as an adjuvant treatment for perioral post-burn hypertrophic scars

Pentoxifylline (PTF), a methylxanthine derivative, has therapeutic use as an antifibrotic agent. In vitro, PTF inhibits the production of collagen and reduces the proliferation of fibroblasts in hypertrophic scars. This study aimed to evaluate changes in the elasticity of hypertrophic scars in the peribuccal area in burned patients, who presented with mouth-opening limitation. Eighteen patients were divided into two groups. The case group (n = 10) was treated with PTF 1 mg ml⁻¹, while in the control group (n = 8) no treatment was performed. Measurements of mouth opening (lip-to-lip and tooth-to-tooth distances in mm) were taken, before and after five therapeutic sessions with pentoxifylline with weekly intervals. The variations of these measures (Δ%) were calculated and submitted to statistical analyses. There was a significant improvement in the opening of the mouth, in vermilion distance (V = 3.20 mm) as much as the dental distance (DD = 4.19 mm) in the treated group, than in the control group. It was noted that pentoxifylline increases the elasticity of hypertrophic scars in the perioral area.     

Functional analysis of T lymphocytes infiltrating the dermis and epidermis of post-burn hypertrophic scar tissues

The cytokine profile of T cell clones (TCC) from the dermis and epidermis of burn patients with hypertrophic scars (HS) in active (AHS) and remission phases (RHS) was determined in this study. We found that AHS tissues are heavily infiltrated by Type 0-Type 1 polarized CD3+ lymphocytes producing high IFN-gamma and low IL-4 levels. Analysis of their surface marker phenotype showed that the high IFN-gamma production was shared equally between the CD4+ TCRalpha/beta and CD8+ TCRalpha/beta clones. The profile of TCC from RHS tissues revealed pronounced infiltration of Type 0-Type 1 polarized lymphocytes with an even more evident Type 1 profile. However, the levels of IFN-gamma produced by RHS-derived TCC were 4-6 times lower than those produced by AHS-derived TCC. These data show that high levels of IFN-gamma produced by Type 0-Type 1 lymphocytes infiltrating HS are a feature of AHS, whereas reduction of this ability to produce high levels of IFN-gamma, though without a shift towards a Type 0-Type 2 phenotype through an increase in IL-4, is characteristic of RHS.     

The effect of burn rehabilitation massage therapy on hypertrophic scar after burn: A randomized controlled trial

ObjectiveTo evaluate the effect of burn rehabilitation massage therapy on hypertrophic scar after burn.MethodOne hundred and forty-six burn patients with hypertrophic scar(s) were randomly divided into an experimental group and a control group. All patients received standard rehabilitation therapy for hypertrophic scars and 76 patients (massage group) additionally received burn scar rehabilitation massage therapy. Both before and after the treatment, we determined the scores of visual analog scale (VAS) and itching scale and assessed the scar characteristics of thickness, melanin, erythema, transepidermal water loss (TEWL), sebum, and elasticity by using ultrasonography, Mexameter^®, Tewameter^®, Sebumeter^®, and Cutometer^®, respectively.ResultsThe scores of both VAS and itching scale decreased significantly in both groups, indicating a significant intragroup difference. With regard to the scar characteristics, the massage group showed a significant decrease after treatment in scar thickness, melanin, erythema, TEWL and a significant intergroup difference. In terms of scar elasticity, a significant intergroup difference was noted in immediate distension and gross skin elasticity, while the massage group significant improvement in skin distensibility, immediate distension, immediate retraction, and delayed distension.ConclusionOur results suggest that burn rehabilitation massage therapy is effective in improving pain, pruritus, and scar characteristics in hypertrophic scars after burn.     

瘢痕硬度测定计的研制及临床应用

为了达到无创伤、客观、定量测定瘢痕硬度的目的,设计制造出瘢痕硬度测定计,并用以测定了50例病人增生性瘢痕治疗前、治疗后1、2、3个月瘢痕的硬度以及相邻正常皮肤的硬度。研究结果表明:本硬度测定计重复性好,精密度达到质控标准;所测定的硬度值在瘢痕和正常皮肤有极显著差异,作为判断瘢痕特征指标有特异性;瘢痕硬度在治疗后3个月<2个月<1个月<治疗前,说明用于监测瘢痕疗效和成熟度具有临床实用价值。     

瘢痕硬度测定计的研制及临床应用

为了达到无创伤、客观、定量测定瘢痕硬度的目的，设计制造出瘢痕硬度测定计，并用以测定了５０例病人增生性瘢痕治疗前、治疗后１、２、３个月瘢痕的硬度以及相邻正常皮肤的硬度。研究结果表明：本硬度测定计重复性好，精密度达到质控标准；所测定的硬度值在瘢痕和正常皮肤有极显著差异，作为判断瘢痕特征指标有特异性；瘢痕硬度在治疗后３个月＜２个月＜１个月＜治疗前，说明用于监测瘢痕疗效和成熟度具有临床实用价值。     

Laser in the treatment of hypertrophic burn scars

This prospective study looked at the outcome of laser (light amplification by stimulated emission of radiation) treatment for hypertrophic scarring. Dermatrade mark K laser (a set of combined lasers erbium:yttrium aluminium garnet/carbon dioxide, qualified as a class IV laser) was used. Between 21 June 2000 and 19 November 2002, at the Siemianowice Burn Center, Poland, 592 interventions, using laser, were performed on N= 327 patients (220 women and 107 men, aged between 3 and 80 years). The majority of cases [N= 223 (68.9%)] were patients with post-burn hypertrophic scars, and 104 cases (31.8%) had various types of hypertrophic scars. Evaluation took place using an adapted Vancouver Scar Scale and digital photographs as well as the patient's opinion. It was noted that after laser treatment, satisfactory results were achieved in 72% of cases. The scars had become less red (192/327 scored no redness at the end of the study versus 92/327 upon initial), less raised (272/327 scored a flat scar versus 72/327 upon initial) and demonstrated an improved viscoelasticity (192/327 scored a soft skin versus 62/327 upon initial). Laser treatment did not improve contractures in post-burn hypertrophic scars. Results were not confirmed using objective measurement tools, as these were not available to us.     

The recovery of post-burn hypertrophic scar in a monitored pressure therapy intervention programme and the timing of intervention

Introduction

Pressure therapy used to be considered as the mainstay non-invasive treatment of hypertrophic scar. However, the maturation process of hypertrophic scar during pressure therapy process has seldom be reported. Moreover, although early application of pressure therapy after burn injuries is reco6mmended, minimal evidence exists to support it. This study aimed to examine the maturation trajectory of post-burn hypertrophic scars in a 6-month monitored pressure therapy intervention programme and investigate the difference in the trajectory between patients receiving early intervention and patients receiving late intervention.

局部应用卡托普利凝胶对兔耳增生性瘢痕作用的实验研究

目的观察局部应用卡托普利对兔耳增生性瘢痕的作用。方法将12只日本大耳白兔随机分为:卡托普利组(3只);空白对照组(3只);瘢痕组(3只);正常兔耳对照组(3只)。前3组每只耳朵建立5个兔耳瘢痕,总计90个增生性瘢痕。卡托普利组于术后21天开始局部应用10mg/ml卡托普利羧甲基纤维素胶,28天取材,进行大体观察,组织学检测。结果卡托普利组兔耳增生性瘢痕的瘢痕增生指数、表皮厚度指数较瘢痕对照组分别减少了34.1%、41.5%,真皮内的胶原含量为瘢痕对照组的68.8%(P<0.05)。结论局部应用ACE抑制剂卡托普利能改善兔耳增生性瘢痕的增生。     

积雪草甙对烧伤增生性瘢痕作用的实验研究

目的 研究积雪草甙对体外培养的成纤维细胞的胶原蛋白合成的影响,以及对裸鼠增生性瘢痕动物模型的作用,以探讨积雪草甙治疗增生性瘢痕的机制。方法采用光镜、电镜研究用药前后成纤维细胞的形态学的变化,以^3H脯氨酸掺入等方法检测成纤维细胞胶原蛋白的合成,通过建立裸鼠增生性瘢痕动物模型,观察积雪草甙在体局部注射对增生性瘢痕的作用。结果 积雪草甙能明显影响成纤维细胞的超微结构,抑制胶原蛋白的合成,并呈量效关系;在裸鼠体内局部注射积雪草甙可抑制瘢痕增生,而且大剂量使用未发现药物毒性作用。结论 积雪草甙治疗瘢痕增生的机理与其抑制成纤维细胞增殖和胶原蛋白合成有关。     

增生性瘢痕中肥大细胞类胰蛋白酶的表达及定位

目的研究肥大细胞类胰蛋白酶(mast cell trphase,MCT)在增生性瘢痕形成过程中的表达及分布情况,探讨MCT在增生性瘢痕及正常皮肤中是否存在差别。方法采集未经任何治疗的临床诊断为增生性瘢痕及正常皮肤手术切除各20例。采用免疫组织化学方法对增生性瘢痕及正常皮肤中的MCT进行定位,反转录-聚合酶链式反应(RT-PCR)方法进行mRNA基因水平的半定量研究分析。结果MCT在增生性瘢痕中分布较正常皮肤明显增多(P<0.01),主要集中在各层血管周围及胶原纤维束之间,以真皮浅层分布较多;RT-PCR半定量结果显示,增生性瘢痕中MCTmRNA有高表达,而且明显高于正常皮肤,差异具统计学意义(P<0.01)。结论增生性瘢痕中MCT在分布及基因水平半定量表达均较正常皮肤明显增多,故有理由推论MCT在增生性瘢痕的形成过程中可能起重要作用。     

瘢痕疙瘩和增生性瘢痕表皮异常的实验研究

目的 探讨瘢痕疙瘩和增生性瘢痕的表皮异常。方法 采用免疫组织化学方法,检测腱糖蛋白C(Tn-C),角蛋白16(CK-16)和增殖相关核抗原Ki-67蛋白在瘢痕疙瘩、增生性瘢痕和正常成人表皮中的表达。取正常成人皮肤组织RNA,构建正义、反义Tn-C mRNA探针,运用原位杂交技术,观测瘢痕疙瘩、增生性瘢痕和正常皮肤表皮中Tn-C mRNA的表达。结果 瘢痕疙瘩、增生性瘢痕表皮角质形成细胞增生明显高于正常皮肤。Tn-C mRNA在瘢痕疙瘩表皮的表达明显高于其在增生性瘢痕及正常皮肤表皮中的表达。CK-16,Ki-67蛋白在瘢痕疙瘩和增生性瘢痕表皮中表达增加。结论 瘢痕疙瘩和增生性瘢痕的表皮存在增生分化异常,尤以瘢痕疙瘩更为明显。     

A protocol for the treatment of hypertrophic scars and keloids

Hypertrophic scars and keloids still present problems in both white and pigmented skin. A treatment protocol is proposed: Hypertrophic scars are primarily treated with intralesional injections of corticosteroids or with compression therapy. Surgical scar revision is only secondarily indicated. Recurrent and resistant hypertrophic scars are surgically excised and postoperatively irradiated (twice with 400-cGy 7-MeV electron irradiation).Presented at the VIII Congress of the International Society of Aesthetic Plastic Surgery, Madrid, Spain, 16 September 1985     

6-O-羧甲基壳聚糖对兔耳增生性瘢痕的作用

目的 通过建立兔耳腹侧增生性瘢痕的模型,探讨6-O-羧甲基壳聚糖（carboxyl methyl chitosan,6-O-CM-CH）局部注射对瘢痕的作用.方法 新西兰大白兔12只,在兔耳腹侧制备直径约1 cm、深达软骨膜的圆形瘢痕123个,随机将新西兰大白兔分为A、B、C3组,每组4只.分别于术后第30天、第40天瘢痕组织内注射药物,于术后第35天、第45天取瘢痕样本,分析成纤维细胞密度、羟脯氨酸含量和瘢痕增生指数.A组为治疗组,瘢痕内注射6-O-CM-CH（500μg/ml）;B组为对照组1,注射曲安奈德（10 mg/ml）;C组为对照组2,注射生理盐水.结果 A组与C组相比,瘢痕组织HE染色和胶原染色均可见胶原成纤维细胞密度降低（P＜0.05）,羟脯氨酸含量降低（P＜0.05）,瘢痕增生指数降低（P＜0.05）,两组间差异有统计学意义;A组与B组相比较,成纤维细胞密度、羟脯氨酸含量、瘢痕增生指数差异均无统计学意义（P＞0.05）.结论 6-O-CM-CH局部注射对兔耳增生性瘢痕的抑制作用与曲安奈德相近,局部注射能够抑制兔耳增生性瘢痕.     

增生性瘢痕中纤维连接蛋白和层粘连蛋白的分布

取临床病人的增生性瘢痕和相邻的正常皮肤作组织切片，分别行纤维连接蛋白（ｆｉｂｒｏｎｅｃｔｉｏｎ，ＦＮ）免疫组织化学染色和层粘连蛋白（ｌａｍｉｎｉｎ，ＬＮ）免疫组织化学染色。结果发现：①增生性瘢痕中，基底膜ＦＮ呈弱阳性；真皮全层由浅及深ＦＮ呈弱阳性－强阳性－弱阳性分布；中层含有大量ＦＮ阳性的成纤维细胞；部分瘢痕最深层ＦＮ分布呈“树根”状突入皮下组织内。提示增生性瘢痕增生最旺盛的部位在中层。真皮ＦＮ阳性与否和强弱是判断瘢痕增生程度的一种指标。②增生性瘢痕中基底膜ＬＮ呈阳性；真皮内分布有密度不均、疏松紊乱、呈条索状或丛状的ＬＮ阳性结构。增生性瘢痕真皮内ＬＮ的存在可能是瘢痕长期增生的另一个原因。     

增殖细胞核抗原在增生性瘢痕组织中的表达与分布

目的　研究增殖细胞核抗原 (PCNA)在增生性瘢痕组织中的表达水平和分布特点 ,探讨该组织中细胞增殖的特征。方法　利用PCNA单克隆抗体 ,对 12例增生性瘢痕、8例成熟瘢痕及其配对的正常皮肤 ( 2 0例 )进行免疫组织化学染色 (SABC法 )。结果　在增生性瘢痕组织中 ,PCNA标记率 ( 4 5 4± 12 3 )明显高于正常皮肤 ( 13 5± 4 1)和成熟瘢痕 ( 17 4± 6 2 ) ,差异有非常显著意义(P <0 0 1) ;而后两者间差异无显著意义。其中表皮角朊细胞和真皮成纤维细胞的细胞核内可见阳性颗粒。结论　增生性瘢痕组织中表皮角朊细胞和真皮成纤维细胞均增殖活跃 ,两者与细胞外基质过度沉积均有密切关系 ;PCNA是判断细胞增殖状态的良好指标 ,是诊断增生性瘢痕的客观依据     

硫喷妥钠麻醉对小鼠T淋巴细胞亚群的影响

目的 观察静脉麻醉药硫喷妥钠对小鼠T淋巴细胞亚群的影响。方法 T淋巴细胞亚群的测定应用单克隆抗体直接免疫荧光技术由流式细胞仪测定。结果 硫喷妥钠麻醉后20小时小鼠外周血中CD4T淋巴细胞、CD4／CD8比值均显著下降。同时测定血中白细胞总数，实验组与对照组比较统计学差异无显著意义。结论 硫喷妥钠麻醉引起小鼠细胞免疫功能抑制。     

探讨硫酸软骨素酶在兔耳增生性瘢痕模型中的作用

目的应用兔耳模型探讨硫酸软骨素裂解酶在增生性瘢痕中的作用。方法将健康的日本大耳白兔12只,随机分成胶原酶治疗组(A组)、硫酸软骨素裂解酶与胶原酶混合治疗组(B组)、硫酸软骨素裂解酶治疗组(C组)、对照组(D组)。采用复合染色法观察组织形态学变化,并进行图像定量分析,羟脯氨酸含量测定。结果各治疗组酸性黏多糖染色变浅,数量减少,胶原纤维被破坏,排列稀疏。A、B、C、D组的羟脯氨酸含量,随着时间的变化其含量不一致(P<0.05),A、C组与B组比较在第28天差异有显著意义(P<0.05),B组与A组比较在第35天差异有显著意义(P<0.05),在用药两周后B组羟脯氨酸含量始终低于其他各组。结论硫酸软骨素裂解酶水解了硫酸软骨素,在去除了胶原纤维周围的酸性黏多糖后,促进了胶原的降解,提示可能为瘢痕的治疗提供新的途径。     

增生性瘢痕中肥大细胞的种类及分布

揭示瘢痕增生与肥大细胞的关系是本研究的目的。取临床病人的增生性瘢痕和相邻或相近部位的正常皮肤作电镜切片和特殊染色的光镜切片。光镜发现：瘢痕中肥大细胞主要分布在各层血管周围及胶原纤维束之间，其数量比正常皮肤中的多（Ｐ＜００１）；瘢痕中爱先蓝阳性肥大细胞的比值也比正常皮肤中的高（Ｐ＜００１）；增生性瘢痕中存在一定数量（１１２４％±０４５％）的粘膜肥大细胞。电镜发现：增生性瘢痕中存在一定量的较不成熟的肥大细胞和脱颗粒的肥大细胞；部分肥大细胞与成纤维细胞有胞膜接触。增生性瘢痕与肥大细胞有关     

探讨硫酸软骨素酶在兔耳增生性瘢痕模型中的作用

目的应用兔耳模型探讨硫酸软骨素裂解酶在增生性瘢痕中的作用。方法将健康的日本大耳白兔12只，随机分成胶原酶治疗组（A组）、硫酸软骨素裂解酶与胶原酶混合治疗组（B组）、硫酸软骨素裂解酶治疗组（C组）、对照组（D组）。采用复合染色法观察组织形态学变化，并进行图像定量分析。羟脯氨酸含量测定。结果各治疗组酸性黏多糖染色变浅，数量减少，胶原纤维被破坏，排列稀疏。A、B、C、D组的羟脯氨酸含量，随着时间的变化其含量不一致（P〈0．05），A、C组与B组比较在第28天差异有显著意义（P〈0．05），B组与A组比较在第35天差异有显著意义（P〈0．05），在用药两周后B组羟脯氨酸含量始终低于其他各组。结论硫酸软骨素裂解酶水解了硫酸软骨素，在去除了胶原纤维周围的酸性黏多糖后，促进了胶原的降解，提示可能为瘢痕的治疗提供新的途径。     

神经肽P物质对增生性瘢痕的作用与钙离子相关的研究

目的神经肽P物质可以促进人增生性瘢痕中肥大细胞组胺的释放,在此过程中对钙离子因素的作用进行定量分析,探讨增生性瘢痕中神经肽P物质与钙离子的相互作用及作用条件。方法2005年1月至2005年10月,将取自于西南医院整形美容外科烧伤患者的增生性瘢痕活体组织块切下后立即处理,修剪成0.5mm×0.5mm×0.5mm~1.0mm×1.0mm×1.0mm的组织块,测定作用后上清液中组胺含量,计算组胺释放率。结果在增生性瘢痕中,神经肽P物质对肥大细胞的作用受钙离子浓度影响,钙离子为5×10-3mol/L时,组胺释放率最高;乙二胺四乙酸去除钙离子后,组胺释放率最低;钙离子为1×10-3mol/L时,组胺释放有一低谷。结论神经肽P物质对肥大细胞的作用受钙离子浓度影响,研究神经肽P物质与增生性瘢痕的相互作用及作用条件,应用神经肽P物质及神经肽P物质受体拮抗剂阻断神经肽P物质对增生性瘢痕促增值与促瘙痒作用,有望成为治疗增生性瘢痕的新方法,并将在临床有广阔的应用前景。