Background: In large burn injuries, wound resurfacing is often performed using split thickness or full thickness skin grafts. Various different approaches have developed over the years, including the use of dermal regenerative matrices (DRMs). These are skin substitutes that are made from bovine collagen and shark chondroitin-6-sulfate. Once applied to the wound, they take around 2-3 weeks to ‘integrate’, and a thin split skin graft is then applied.
Whilst DRMs have gained support for producing good functional and esthetic results, they are also thought to have disadvantages such as increased infection risk, need for 2 procedures, and cost. This study was a literature review looking into DRMs.

Findings: Analysis of 72 articles showed advantages for function and scarring. A 13% complication rate was found (including infection, graft loss & contracture).

Conclusions: Overall, DRMs seem to give some advantages in major burn reconstruction, and the authors feel that the benefits outweigh the risks, although they do say that essential data was lacking in many studies.

Authors: K.E.Hicks et al
Journal: Journal of Plastic, Reconstructive & Aesthetic Surgery, 2019; 72: 1741-51

Background: Scars following burn injuries can be problematic, potentially leading to life-changing cosmetic effects and loss of function. Various techniques have been employed to try and limited these effects or help improve scars and contractures, including carbon dioxide laser. The CO2 laser could lead to unwanted side-effects including infection & pigmentation changes though, leading to an increasing use of the fractionated CO2 laser. This delivers micro ‘drill holes’ in the skin, leaving undamaged columns of tissue between them. This allows for reduced risks and faster healing times.
This prospective study was conducted to look at the effects of ablative fractionated CO2 laser on burn-related scarring.

Findings: 19 patients completed the trial. All scars showed improvement, with statistically significant improvement in pain and itch following fractionated CO2 laser, as well as an increase in medium-sized collagen fibres. Early intervention seemed to yield better results than on older scars.

Conclusions: From this study, ablative fractionated CO2 laser appears to help the pain and itch in burn scars, and increases medium collagen fibers. Early intervention seems better than waiting until the scars mature further.

Authors: H.Douglas et al
Journal: Journal of Plastic, Reconstructive & Aesthetic Surgery, 2019; 72: 863-870

Background: A number of surgical and non-surgical techniques have been used in treating axillary osmidrosis, with variable success. This article looks at 480 patients that underwent hydrosurgery (Versajet) under local anaesthetic as out-patients. The article describes the subcutaneous dissection of teh axillae, with the Versajet being used to ablate the apocrine glands.

Findings: The authors report 99.6% patient satisfaction, 2.7% complications, and 2 recurrences.

Conclusions: The authors found this to be a reliable technique with good outcomes.

Authors: M.Wu, W-H.Wu
Journal: Annals of Plastic Surgery, 2019; 83: 137-141

Background: Keloid scar treatment is often challenging, and a number of various treatments have been tried in a bid to resolve these disfiguring and occasionally disabling scars; Intralesional triamcinolone has been used as first-line treatment for many years, but up to 50% of keloids may be steroid resistant and up to 50% recur, with subcutaneous atrophy and telangiectasia being associated complications.

A newer potential treatment has emerged with 5-fluorouracil (5-FU), an antineoplastic agent that is usually known as a topical treatment for lesions. It is thought that 5-FU in keloids may selectively block collagen synthesis by keloid fibroblasts.

This study was conducted to compare triamcinolone to 5-FU in keloid scars, where the authors define keloid scars as ‘a scar growing outside the boundaries of the original wound without signs of resolution over 3 years’. A total of 43 patients with 50 keloid scars were recruited for intralesional injections of either agent.

Findings: Mean number of injections were 2.4 for both triamcinolone (TAC), and for 5-FU. Remission at 6 months was 60% for TAC and 46% for 5-FU, which was not statistically significant. Skin atrophy was 44% for TAC, and 8% for 5-FU, and telangiectasia was 50% for TAC and 21% for 5-FU; both these differences were statistically significant.

Conclusions: Both TAC and 5-FU seem similar in effectiveness for keloid scar treatment, although 5-FU seems to have fewer side effects. Both treatments have a fairly high non-response rate; these patients went on to have further treatment such as surgery, radiotherapy, pressure garments and silicone gel sheeting.

Authors: K.E.Hietanen et al

Journal: Journal of Plastic, Reconstructive & Aesthetic Surgery, 2019; 72: 4-11

Background: Keloid scars are notoriously difficult to treat, with high recurrence rates. The authors performed a literature search to assess effectiveness of adjuvant treatments after surgery.

Findings: 14 studies, including 996 patients, were assessed.

Conclusions: The authors conclude that ‘excision + radiation’ had less recurrences than ‘excision only’ or ‘excision + 1 adjuvant drug’, but other comparisons of groups were not statistically significantly different.

Authors: C.Siotos et al
Journal: Annals of Plastic Surgery, 2019; 83: 154-162