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Lasers in Medical Science Mar 2022Various clinical trials have explored whether the pulsed dye laser (PDL) method is safe to treat scars, especially surgical scars. However, comprehensive evidence... (Meta-Analysis)
Meta-Analysis
Various clinical trials have explored whether the pulsed dye laser (PDL) method is safe to treat scars, especially surgical scars. However, comprehensive evidence confirming the exact outcomes of PDL for treating surgical scars is lacking. The efficacy and safety of PDL in the treatment of surgical scars were determined through a review of several studies. The PubMed, Embase, Cochrane Library, and Web of Science databases were searched, and the main clinical outcomes were Vancouver Scar Scale (VSS) scores in terms of pigmentation, vascularity, pliability, and height. Review Manager 5.4 software was used for statistical analyses of the data; we chose a standardized mean difference (SMZ) to present the results with 95% confidence interval (CI). Overall, seven randomized controlled trials were used for this meta-analysis, all of these papers used 585 nm or 595 nm PDL with 7 mm or 10 mm spot size and a fluence of 3.5 to 10 J/cm for treating surgical scars; besides, the pulse duration ranged from 450 μs to 10 ms. We found that PDL significantly resulted in decreased VSS scores (P = 0.02) in four aspects: pigmentation (P = 0.0002), vascularity (P < 0.00001), pliability (P = 0.0002), and height (P = 0.0002). Moreover, scar improvement was similar when using 585 nm and 595 nm PDL in terms of pigmentation (P = 0.76), vascularity (P = 0.34), pliability (P = 0.64), and height (P = 0.57). Furthermore, our review indicated that PDL has no obvious adverse effects for most people, except transitory erythema and purpura. The meta-analysis showed that both 585 nm and 595 nm PDL therapy can effectively reduce the VSS score, suggesting that PDL can be a safe and effective method for the treatment of surgical scars.
Topics: Cicatrix; Erythema; Humans; Lasers, Dye; Low-Level Light Therapy; Treatment Outcome
PubMed: 34351564
DOI: 10.1007/s10103-021-03385-z -
Cureus Dec 2023Keloids, benign fibrous growths resulting from atypical skin responses to injuries, present a complex challenge in dermatology. These lesions, characterized by excessive... (Review)
Review
Keloids, benign fibrous growths resulting from atypical skin responses to injuries, present a complex challenge in dermatology. These lesions, characterized by excessive collagen production, often lead to physical discomfort and psychological distress. While various treatment methods exist, the lack of a universally effective modality underscores the need for a systematic evaluation of current approaches. This systematic review aims to comprehensively analyze the current available treatment modalities used for the management of keloids in the pediatric population in terms of their effectiveness, safety, and quality of life outcomes. The review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted on PubMed and Google Scholar databases to identify relevant studies published in English. The review specifically focused on randomized controlled trials involving patients under 18 diagnosed with keloids, assessing different treatment modalities, and reporting validated measures of treatment efficacy, safety outcomes, and quality of life. The risk of bias was assessed using Cochrane's Risk of Bias Tool for randomized studies to ensure the methodological quality of the included trials. Four studies met the inclusion criteria, collectively involving 196 pediatric patients. Treatment interventions included glucocorticosteroid and fusidic acid cream with silicone gel patches, botulinum toxin type A injections, and Scarban silicone gel sheets. Patient-reported outcomes exhibited varying degrees of improvement in scar size, vascularity, and pliability. Complications, such as rash and wound infection, were reported in some cases. Based on our review of the selected studies and due to the incompletely understood pathogenesis of keloids, there is an ongoing lack of universally effective treatment modality for the management of keloids resulting in their persistently high recurrence rate.
PubMed: 38205454
DOI: 10.7759/cureus.50290 -
Dental Materials : Official Publication... Mar 2017To evaluate a range of mechanical parameters of composite resins and compare the data to the frequency of fractures and wear in clinical studies. (Review)
Review
OBJECTIVE
To evaluate a range of mechanical parameters of composite resins and compare the data to the frequency of fractures and wear in clinical studies.
METHODS
Based on a search of PubMed and SCOPUS, clinical studies on posterior composite restorations were investigated with regard to bias by two independent reviewers using Cochrane Collaboration's tool for assessing risk of bias in randomized trials. The target variables were chipping and/or fracture, loss of anatomical form (wear) and a combination of both (summary clinical index). These outcomes were modelled by time and material in a linear mixed effect model including random study and experiment effects. The laboratory data from one test institute were used: flexural strength, flexural modulus, compressive strength, and fracture toughness (all after 24-h storage in distilled water). For some materials flexural strength data after aging in water/saliva/ethanol were available. Besides calculating correlations between clinical and laboratory outcomes, we explored whether a model including a laboratory predictor dichotomized at a cut-off value better predicted a clinical outcome than a linear model.
RESULTS
A total of 74 clinical experiments from 45 studies were included involving 31 materials for which laboratory data were also available. A weak positive correlation between fracture toughness and clinical fractures was found (Spearman rho=0.34, p=0.11) in addition to a moderate and statistically significant correlation between flexural strength and clinical wear (Spearman rho=0.46, p=0.01). When excluding those studies with "high" risk of bias (n=18), the correlations were generally weaker with no statistically significant correlation. For aging in ethanol, a very strong correlation was found between flexural strength decrease and clinical index, but this finding was based on only 7 materials (Spearman rho=0.96, p=0.0001). Prediction was not consistently improved with cutoff values.
SIGNIFICANCE
Correlations between clinical and laboratory outcomes were moderately positive with few significant results, fracture toughness being correlated with clinical fractures and flexural strength with clinical wear. Whether artificial aging enhances the prognostic value needs further investigations.
Topics: Clinical Trials as Topic; Composite Resins; Compressive Strength; Dental Restoration Failure; Materials Testing; Pliability; Stress, Mechanical; Tooth Wear
PubMed: 27993372
DOI: 10.1016/j.dental.2016.11.013 -
Burns : Journal of the International... Feb 2018Scar massage is used in burn units globally to improve functional and cosmetic outcomes of hypertrophic scarring following a burn, however, the evidence to support this...
BACKGROUND
Scar massage is used in burn units globally to improve functional and cosmetic outcomes of hypertrophic scarring following a burn, however, the evidence to support this therapy is unknown.
OBJECTIVE
To review the literature and assess the efficacy of scar massage in hypertrophic burn scars.
METHODS
MEDLINE, PubMed, Embase, CINAHL and the Cochrane Library were searched using the key words "burn", "burn injury", "thermal injury" and "scar", "hypertrophic scar" and "massage", "manipulation", "soft tissue mobilisation", "soft tissue manipulation". The articles were scored by the assessors using the Physiotherapy Evidence Database (PEDro) scale and outcome measures on range of motion (ROM), cosmesis (vascularity, pliability, height), pain scores, pruritus, and psychological measures of depression and anxiety were extracted.
RESULTS
Eight publications were included in the review with 258 human participants and 15 animal subjects who received scar massage following a thermal injury resulting in hypertrophic scarring. Outcome measures that demonstrated that scar massage was effective included scar thickness as measured with ultrasonography (p=0.001; g=-0.512); depression (Centre for Epidemiologic Studies - Depression [CES-D]) (p=0.031; g=-0.555); pain as measured with Visual Analogue Scale (VAS) (p=0.000; g=-1.133) and scar characteristics including vascularity (p=0.000; g=-1.837), pliability (p=0.000; g=-1.270) and scar height (p=0.000; g=-2.054). Outcome measures that trended towards significance included a decrease in pruritus (p=0.095; g=-1.157).
CONCLUSIONS
It appears that there is preliminary evidence to suggest that scar massage may be effective to decrease scar height, vascularity, pliability, pain, pruritus and depression in hypertrophic burns scaring. This review reflects the poor quality of evidence and lack of consistent and valid scar assessment tools. Controlled, clinical trials are needed to develop evidence-based guidelines for scar massage in hypertrophic burns scarring.
Topics: Burns; Cicatrix, Hypertrophic; Depression; Humans; Massage; Pruritus; Quality of Life
PubMed: 28669442
DOI: 10.1016/j.burns.2017.05.006 -
Advances in Skin & Wound Care Apr 2020Keloids and hypertrophic scars often result after skin trauma. Currently, intralesional triamcinolone acetonide (TAC) is the criterion standard in nonsurgical management...
BACKGROUND
Keloids and hypertrophic scars often result after skin trauma. Currently, intralesional triamcinolone acetonide (TAC) is the criterion standard in nonsurgical management of keloids and hypertrophic scars. Intralesional verapamil may be an effective alternative modality, but it has been insufficiently studied. Accordingly, the study authors conducted a systematic review and meta-analysis of randomized controlled trials to compare the efficacy and safety of the two drugs.
METHODS
The study authors systematically searched the MEDLINE, EMBASE, Cochrane Library, and China National Knowledge Infrastructure databases for relevant trials published in any language through September 2018.
RESULTS
According to the four studies included in this review, TAC improved scar pliability and vascularity more than verapamil after 3 weeks (P < .05). For scar height and scar pigmentation, no statistical difference was observed between the treatments (P > .05). The difference in effects on symptoms was not statistically significant (P = .89). For pain and telangiectasia, no statistical difference was observed (P > .05). Verapamil resulted in fewer cases of skin atrophy (P < .05).
CONCLUSIONS
It appears that TAC is more effective than verapamil for improving scar pliability and vascularity in keloids and hypertrophic scars after 3 weeks of treatment. However, verapamil has fewer adverse drug reactions than TAC, which allows for a longer treatment period and the possibility that it might be effective for patients who cannot receive TAC.
Topics: Calcium Channel Blockers; Cicatrix, Hypertrophic; Glucocorticoids; Humans; Injections, Intralesional; Keloid; Treatment Outcome; Triamcinolone Acetonide; Verapamil
PubMed: 32195728
DOI: 10.1097/01.ASW.0000655476.10403.d6 -
Aesthetic Plastic Surgery Oct 2022Autologous fat transfer (AFT) has been introduced as a potential treatment option for scar-tissue and its related symptoms. However, the scientific evidence for its... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND AIM
Autologous fat transfer (AFT) has been introduced as a potential treatment option for scar-tissue and its related symptoms. However, the scientific evidence for its effectiveness remains unclear. This meta-analysis aims to evaluate the available evidence regarding the effectiveness of autologous fat transfer for the treatment of scar-tissue and its related conditions.
METHODS
PubMed/Medline database was queried from its inception till the end of November 2021. All the relevant studies assessing the effect of autologous fat transfer in the treatment of scar-related conditions were pooled in using a random-effects model.
RESULTS
9 studies (n=179) were included in the meta-analysis. Pooled analysis demonstrates significant improvement in all subscales of the POSAS patient score with most prominent in color 2.4 points (95% CI 1.78-3.041), stiffness 2.9 points (95% CI 2.33-3.45), irregularity 2.2 points (95% CI 1.093-3.297) and thickness 1.8 points (95% CI 0.804-2.719), respectively. Pain and itch improved relatively lesser, 1.3 points (95% CI 0.958-1.674) and 0.6 points (95% CI 0.169-1.215), respectively. The POSAS observer scale showed a relatively lower improvement with the least in vascularity 0.5 points (95% CI 0.098-0.96), pigmentation 0.8 points (95% CI 0.391-1.276) and surface area 0.8 points (95% CI 0.34-1.25). Thickness improved by 1.4 points (95% CI 0.582-2.3), relief 1.0 points (95% CI 0.461-1.545) and pliability 1.5 points (95% CI 1.039-2.036).
CONCLUSION
Our findings demonstrate that autologous fat transfer (AFT) is a promising treatment for scar-related conditions as it provides beneficial results in the scar quality. Future research should focus on the long-term effects of AFT and high-level evidence studies such as, randomized controlled trials (RCTs) and cohort studies are required.
LEVEL OF EVIDENCE III
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 .
Topics: Humans; Cicatrix; Transplantation, Autologous; Cohort Studies; Treatment Outcome
PubMed: 35411408
DOI: 10.1007/s00266-022-02869-9 -
Journal of Plastic, Reconstructive &... Nov 2020Autologous fat transfer (AFT), also known as lipofilling, has been demonstrated to be more than just a filler. Through both mechanical dissection and local tissue...
BACKGROUND
Autologous fat transfer (AFT), also known as lipofilling, has been demonstrated to be more than just a filler. Through both mechanical dissection and local tissue remodelling mediated by stem cells, it is thought to improve scar quality, function and even pain. This paper aims to investigate the evidence regarding its safety and effectiveness for treating fibrosis and scar-related conditions.
METHODS
A literature search was performed in PubMed, Embase and the Cochrane Library to identify relevant studies. Extensive data extraction and standardization allowed conducting a meta-analysis.
RESULTS
Forty-five studies (3033 patients) provided sufficient data for meta-analysis. The AFT treatment resulted in significant increase in satisfaction scores of both patient and surgeon (p = 0.001). Furthermore, a significant overall scar improvement was also found in the evaluation using the Patient and Observer Scar Assessment Scale, with the most notable effect in the scar stiffness (p<0.001) and pliability (p = 0.004). In patients with severe pain, AFT resulted in a significant pain reduction of 3.7 points on the Visual Analogue Scale (p<0.001). Last, but not the least, the evidence suggests a significant recovery of radiotherapy-induced tissue damage (p = 0.003) and function (p = 0.012). On average, 1.4 procedures were required to achieve the desired result. Minor complications occurred in 4.8% of the procedures.
CONCLUSIONS
AFT is a promising treatment for fibrosis and scar-related conditions. Future research should focus on determining the long-term effects of AFT on fibrosis, pain and function. In addition, it would be crucial to quantify the mechanical and regenerative properties of fat as well as the effect of added supplements or stem cells.
Topics: Adipose Tissue; Cicatrix; Fibrosis; Humans; Outcome Assessment, Health Care; Radiotherapy; Plastic Surgery Procedures; Transplantation, Autologous
PubMed: 32948494
DOI: 10.1016/j.bjps.2020.08.023 -
Dermatologic Therapy Jul 2020The treatment of keloids and hypertrophic scars remains a challenge. Although triamcinolone acetonide (TAC) is one of the most common and effective treatments for... (Meta-Analysis)
Meta-Analysis
The treatment of keloids and hypertrophic scars remains a challenge. Although triamcinolone acetonide (TAC) is one of the most common and effective treatments for keloids and hypertrophic scars, TAC is not effective in some patients, and some may even experience adverse outcomes. Verapamil might be considered a safe alternative to TAC. The aim of this study was to compare the efficacy and safety of verapamil and TAC for the treatment of keloids and hypertrophic scars. Three databases (Medline, EMBASE, and CENTRAL database) were electronically searched from 1997 to December 2019. Article selection was limited to randomized controlled trials (RCTs) and controlled clinical trials (CCTs). Two authors independently assessed the selection of studies, risk of bias, and extracted the data. Mean differences (MDs) were computed for continuous variables, risk ratios (RRs) were computed for dichotomous variables, and 95% confidence intervals (CIs) were calculated for both assessments. Five RCTs were included, comprising a total of 215 patients (273 scars). Vancouver Scar Scale (VSS) parameters (such as height, vascularity, pliability, and pigmentation) were reported as the outcome measures and provided detailed values in four studies. No significant differences were observed between verapamil and TAC in the reduction of height (MD 0.57, 95% CI -0.94 to 2.08, P = .46), vascularity (MD 0.30, 95% CI -0.42 to 1.02, P = .41), pliability (MD 0.67, 95% CI -1.12 to 2.47, P = .46), and degree of pigmentation (MD 0.14, 95% CI -0.41 to 0.69, P = .61). Adverse outcomes were reported in four studies. The results showed that the incidence of telangiectasia and skin atrophy that used verapamil was significantly lower than that for TAC. Concerning the treatment of keloids and hypertrophic scars, even though verapamil was safer than TAC, TAC worked faster than verapamil. Furthermore, we did not find any clear evidence that verapamil was more or less effective than TAC. Considering the high degree of safety of verapamil, we suggest that verapamil might be used as an alternative treatment when TAC results in adverse outcomes.
Topics: Cicatrix, Hypertrophic; Humans; Injections, Intralesional; Keloid; Triamcinolone Acetonide; Verapamil
PubMed: 32400925
DOI: 10.1111/dth.13564 -
Journal of Plastic, Reconstructive &... Jan 2021Hypertrophic scarring and keloid can cause significant emotional and physical discomfort. Cosmetic appearance, functional limitations, pain and pruritus form a degree of...
BACKGROUND
Hypertrophic scarring and keloid can cause significant emotional and physical discomfort. Cosmetic appearance, functional limitations, pain and pruritus form a degree of impairment. While the etiology is not fully known, there is a wide array of treatment options, which include excision, radiation, cryotherapy, silicone gel sheeting, and intralesional injections. A relatively new modality is laser therapy. While results are promising, the number of different laser systems is substantial. This review evaluates the available evidence regarding outcomes on specific objective characteristics (i.e., erythema, pigmentation, height, and pliability) of the different laser systems.
METHODS
A systematic literature review was performed using MEDLINE, Cochrane Library, and EMBASE. Data on scar characteristics were extracted from scar scales Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS), and from objective measurement tools.
RESULTS
Heterogeneity was seen in a lot of aspects: maturity of scar, origin of scar, follow-up, and number of treatments. The fractional ablative lasers CO 10,600 nm and Er:YAG 2940 nm were found to produce the best results regarding erythema, height, and pliability, while the flash lamp-pumped pulsed dye laser (PDL) 585 nm scored slightly below that.
CONCLUSIONS
Laser systems, and specifically the fractional ablative lasers CO and Er:YAG, improved various characteristics of excessive scarring. An overview of preferred laser modality per scar characteristic is presented. Accounting for the methodological quality and the level of evidence of the data, future research in the form of randomized trials with comparable standardized scar scales is needed to confirm these results.
Topics: Cicatrix, Hypertrophic; Humans; Keloid; Laser Therapy
PubMed: 33645505
DOI: 10.1016/j.bjps.2020.08.108 -
Applied Ergonomics May 2017Safety boots are compulsory in many occupations to protect the feet of workers from undesirable external stimuli, particularly in harsh work environments. The unique... (Review)
Review
Safety boots are compulsory in many occupations to protect the feet of workers from undesirable external stimuli, particularly in harsh work environments. The unique environmental conditions and varying tasks performed in different occupations necessitate a variety of boot designs to match each worker's occupational safety and functional requirements. Unfortunately, safety boots are often designed more for occupational safety at the expense of functionality and comfort. In fact, there is a paucity of published research investigating the influence that specific variations in work boot design have on fundamental tasks common to many occupations, such as walking. This literature review aimed to collate and examine what is currently known about the influence of boot design on walking in order to identify gaps in the literature and develop evidence-based recommendations upon which to design future research studies investigating work boot design.
Topics: Ankle Joint; Biomechanical Phenomena; Equipment Design; Foot; Fractures, Stress; Gait; Hip Joint; Humans; Knee Joint; Metatarsal Bones; Muscle, Skeletal; Occupational Health; Personal Protective Equipment; Pliability; Shoes; Walking
PubMed: 28237020
DOI: 10.1016/j.apergo.2017.01.003