Surgical scars

In the deepest protocol, after abrasion and application of the ETCA solution, the post-peel mask cream is applied under occlusion. This is the protocol used to treat stretch marks and surgical scars, when the skin needs tightening. 

Treating surgical scars and acne scars is never easy. A scar is the tip of a fibrotic iceberg buried deep under the skin effective treatment is therefore by definition a deep treatment. 

We saw in Chapter 30 that it can improve the appearance of stabilized surgical scars on the face. Phenol should not be used to treat recent postoperative wounds that have not yet stabilized, however, as there is a significant risk of necrosis. 

In the experience of the authors, desmin may be detected as well, although others have disagreed on that point.224 The ultrastructural and biochemical attributes of myofi-broblastic contractile elements are essentially identical to those of smooth muscle cells. Notably, the peculiar intra-cytoplasmic inclusions that are present in DF correspond to aggregates of immunoreactive actin filaments.222-229 Fibrosarcoma of the skin has been reported in association with burn scars, surgical scars, smallpox vaccinations, and other injection sites.221 This exceedingly uncommon neoplasm is composed exclusively of fibroblastic elements and stains only for vimentin, to the exclusion of the other specialized mesenchymal... 

The skin should be inspected for any signs of trauma or surgical scars. Skin lesions should be noted. The erythema test and skin drag test can be performed as possible indicators of somatic dysfunction. 

Observation of the chest wall will reveal any asymmetry of its structures. One should note the typical barrel chest of chronic pulmonary diseases. Retraction of the intercostal muscles or use of the accessory muscles of respiration [scalenes, sternocleldomastolds] can Indicate the severity of respiratory difficulty, especially In status asth-matlcus. The rate of respiration and the degree to which the patient uses abdominal versus thoracic breathing should be noted. The physician should Inspect for any signs of trauma to the thoracic cage, as well as any surgical scars. 

Patients exhibit their history on their skin (Fig. 15.9). Unlike other organs, this one is accessible. 1 ask them if they have been burned and look where they were burned. 1 ask them if they have had a brown spot after a bum or a light spot (Fig. 15.10). Look for surgical scars, ask about previous experience with bums (i.e., with curling irons] and whether the patient has had any procedures before. 

Treatment of acne scars must be individually tailored to address the specific findings. The patient has to understand that the scar revision process may require more that one surgical session. Punch excisions or elevations have to be performed 4-6 weeks before the peel, while subcision can be performed at the same session with the peel. 

Kadunc BV, Trindade de Almeida AR (2003) Surgical treatment of facial acne scars based on morphologic classification a Brazilian experience. Dermatol Surg 29 1200-1209... 

Kurtin A (1953) Corrective surgical planing of skin new technique for treatment of acne scars and other skin defects. AMA Arch Derm Syphilol 68 389-397... 

Malherbe WD, Davies DS (1971) Surgical treatment of acne scarring, by a dermatome. Plast Reconstr Surg 47 122-126... 

Fig. 5. (a) Schematic of the scaffold design showing the inner and outer scaffolds, (b and c) Inner scaffolds seeded with NSCs. (Scale bars 200 pm and 50 tm, respectively.) The outer section of the scaffold was created by means of a solid-liquid phase separation technique that produced long, axially oriented pores for axonal guidance as well as radial pores to allow fluid transport and inhibit the ingrowth of scar tissue (d scale bar, 100 pm), (e) Schematic of surgical insertion of the implant into the spinal cord. [Reproduced with permission from Teng et al. (2002).]... 

Transepicardial injection of stem cells has been performed during open surgical revascularization procedures to deliver the cells to infarct border zones or areas of infarcted or scarred myocardium. Because a sternotomy is required, this approach is highly invasive and associated with surgical complications. However, in the setting of a planned open... 

The presence of an implant almost always energizes the body s immune system, which sends out white hlood cells to destroy the "foreign invader" (the implant). Even if a hiocompatihle material is used for the implant, inflammation caused hy the surgical procedure used in its insertion may also cause an immune response. Although the immune system s macrophages are generally unable to eliminate the implant itself, they may cause scar tissue to form around the implant. The scar tissue often prevents the restoration of normal tissue at the site of the implant, which can prompt an early failure of the implant itself. 

Fig. 13.1 Phosphorylated c-Ski expression in cytosolic fraction of cells in post-MI rat heart. In post-MI rat hearts with chronic large myocardial infarction, phosphorylated c-Ski expression was noted in the cytosol of cells populating the infarct scar (predominantly myofibroblasts) and the remnant heart (mixed cytosolic fraction from myocytes and nonmyocytes). Hearts were sampled at different times after surgical ligation of coronary artery occlusion and Western analysis was carried out to assess phosphorylated c-Ski expression. Trends in -fold protein expression (target band intensity corrected for loading) are shown in curves.

Invasive as described in Section 3.5.2, either a minor or a major surgical procedure is required to initiate therapy. This requires the appropriate surgical personnel, and may be traumatic, time-consuming, cause some scar formation at the site of implantation and, in a very small portion of patients, may result in surgery-related complications. The patient may also feel uncomfortable wearing the device. 

Roughly a hundred years earlier Sir Joseph Lister suffered exposure to exactly the same total amount of phenol with no blisters and no scarring at all. Sir Joseph conducted surgical operations under a fine spray of a very dilute solution of phenol. The speed of a reaction in solution depends on the concentration of the solution. Thankfully there are better ways of ensuring hygiene in operating theatres now as phenol is nasty stuff. 

Hyaluronic acid succinylate, (II), was prepared by Rivarossa [2] by reacting succinic anhydride with sodium hyaluronate and the material used in either venous and arterial vascular anastomoses. This included creating a physical hemostatic barrier to prevent scar tissue formation or to prevent post surgical adherence of the vessels to the surrounding tissues. Laredo [3] prepared... 

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