Contura International A/S announced that 5-year clinical data for its soft volume filler Aquamid(R) was presented at the annual meeting for the American Society of Aesthetic Plastic Surgery (ASAPS) in San Diego. Aquamid(R) is used to rejuvenate or contour the face, either by restoring lost volume or by adding extra volume where needed. Contura is currently conducting a multicenter, comparative clinical trial of Aquamid(R) in the United States.

The 5-year study presented at the ASAPS meeting is a multicenter, prospective study of safety and long-term aesthetic results of Aquamid(R) injections for facial soft tissue augmentation and facial contouring. A total of 116 patients attended the clinics for follow-up five years after their first Aquamid(R) injection. The aesthetic outcome of injections with the Aquamid(R) hydrogel showed that 96% of the 116 patients evaluated after five years had “very good” or “good” aesthetic results according to the physician investigators and 92% of the patients were “very satisfied” or “satisfied”. The safety data in the trial showed that injection of Aquamid(R) over a period of 5 years was safe with few and no unexpected adverse events. The 5-year results are consistent with the data from the 1-year, 2-year and 3- to 4-year follow-up visits.

“We are excited that our European 5-year clinical data demonstrates the long-term efficacy and safety of Aquamid(R). Aquamid(R) is well positioned to meet the global consumer needs for long-lasting aesthetic treatments to restore facial volume. In 2008 we expect to complete the 12-month follow-up in our US clinical trial and look forward to submitting the data to the FDA for review,” said Michael Peytz, Chief Executive Officer.

Produced using Contura’s patented hydrogel technology, Aquamid(R) is composed of 97.5% sterile water and 2.5% cross-linked polyacrylamide. The Aquamid(R) hydrogel is homogeneous: it contains no microparticles; hence its filling effect is due solely to the injected volume. Unlike particle-based fillers, the hydrogel does not rely on an intended foreign body reaction to achieve the desired augmentation. Therefore, the filling effect is immediate and predictable. Moreover, the hydrogel does not cause tissue hardening or fibrosis. No skin test is needed before treatment.

The hydrogel integrates completely into the tissue and does not migrate from the injection site. It stays soft, feels like a natural part of the tissue and follows tissue movements. Because the hydrogel does not degrade over time, it provides augmentation that lasts for years.

Aquamid(R) is available in 40 countries worldwide and is under clinical investigation in the United States. Aquamid is being studied in a double-blind, randomized, multi-center, 2-arm parallel study involving 315 patients in 13 centers comparing the effectiveness of Aquamid(R) and Restylane(R) for the aesthetic treatment of facial wrinkles/folds. Data from this trial will support a PMA application with the FDA.

About Aquamid(R)

Aquamid(R) is a soft volume filler that gives a natural look and feel. Produced using Contura’s patented hydrogel technology, Aquamid(R) is composed of 97.5% sterile water and 2.5% cross-linked polyacrylamide. Aquamid(R) was approved in Europe in 2001 and is available in 40 countries worldwide. Over 300,000 Aquamid(R) injections have been performed to date. It is currently under clinical investigation in the U.S. for the aesthetic treatment of facial wrinkles/folds. Aquamid(R) is not approved for sale in the United States.

About Contura

Contura is a medical technology company based in Denmark that develops and commercializes soft tissue fillers. Contura’s products — Aquamid(R) for facial contouring and Bulkamid(R) for the treatment of female urinary incontinence — are manufactured using the company’s patented polyacrylamide hydrogel technology. Aquamid(R) is sold through a network of local distributors in 40 countries. Ethicon Inc., a Johnson & Johnson company, holds the exclusive worldwide distribution rights for Bulkamid and has started to sell the product in Europe. Clinical trials evaluating Aquamid(R) and Bulkamid(R) are ongoing in the United States. Data from these trials will be used to support PMA applications for these products. Contura’s products are developed, manufactured and tested in Denmark in compliance with the European regulatory requirements for medical devices.

Contura
http://www.contura.com

At the moment in Canada a General Practitioner can advertise himself/herself as a cosmetic surgeon, even though he/she is not a certified surgeon - two new rules changes have been approved by the College of Physicians and Surgeons of Ontario (CPSO) which stop this. The new rule changes will make it much more likely that a patient who wants cosmetic surgery with a trained professional will be able to do so.

A growing number of health care professionals in Canada, especially family doctors, have been calling themselves cosmetic ’surgeons’ and carrying out such procedures as liposuctions and breast enlargements, even though they have had no surgical training.

The rule change does not ban doctors from carrying out the procedures. It just prohibits untrained or uncertified doctors (who are not surgeons) from promoting themselves as surgeons - they will not be allowed to use the word ’surgeon’ in their title.

Preston Zuliani, President, CPSO, said “There is actually no such term as cosmetic surgery. That is a term that has been made up.”

Before becoming law, the provincial government will have to approve the rule changes.

The changes will -

1. Prohibit doctors who are not formally certified as surgeons from advertising themselves as such.

2. Prohibit doctors from advertising themselves as practitioners of medical specializations if they have not been accredited for that (those) specialization(s).

In 2007 Krista Stryland, a real estate agent, died after having liposuction treatment with a GP (General Practitioner) who was not trained in liposuction. The tragic events hit the headlines in Canada.

The aim of the rule changes is to give Canadians better information so that they can then decide for themselves whether they would prefer to have cosmetic ’surgery’ with a surgeon or a doctor who is not a surgeon.

Policies - College of Physicians and Surgeons of Ontario

College of Physicians and Surgeons of Ontario

Written by - Christian Nordqvist
Copyright: Medical News Today

New ‘Miracle’ Skin Healing Cream Now Available to the Public

The wait is finally over as five of the UK’s leading plastic surgeons launch HEAL: a revolutionary new healing gel originally created to soothe and reduce inflammation of the skin following surgery (thereby shortening recovery times), but which has also proven to effectively treat everyday injuries such as sprains, sunburn, bruises and scars, making it the ideal medical product to have in the home for all the family to use. The innovative preparation, now available for purchase online, has been developed by The Firm, a specialist skincare group formed by some of the best-known names in plastic and cosmetic surgery including Peter Butler, Martin Kelly, Patrick Mallucci, Simon Withey and Norman Waterhouse of London Plastic Surgery Associates (LPSA). Together, they combine their specialist knowledge in skin anti-ageing, healing and nanotechnology to bring products to the public that actually work.

Each surgeon at The Firm has specific expertise in skin healing: Peter Butler carried out his experimental research on skin ageing and transplantation in the United States (Harvard). Martin Kelly has an MD in antioxidant skin therapy, Patrick Mallucci wrote a thesis on nanotechnology delivery systems and both Simon Withey and Norman Waterhouse have published widely on skin repair in plastic surgery. With a combined clinical experience of over fifty years in treating skin wounds after surgical procedures, they are well equipped to understand the healing process of the skin. In addition, The Firm drafted top French chemist Colette Haydon to perfect the formula in order to achieve the optimal effect, which offers a triple method of action: anti-inflammatory, bruise-solving and scar maturation.

According to Mr Butler, who leads the UK Facial Transplantation team and whose skincare research is internationally acclaimed;

“HEAL was created because no single product existed that combines all the elements of reducing bruising and inflammation as well as accelerating the healing process. This unique gel combines all of this and is completely different to any other ‘off the shelf’ products that claim to have healing effects on the skin, as they do not contain enough of the active ingredients needed to have an effect. The difference with HEAL is that the key ingredients are present in the right formulations to ensure they penetrate the skin’s surface and actually have a dramatic effect on the end result”.

Mr Mallucci added;”Over the last three years with the help and expertise of leading French chemist Colette Haydon we have developed HEAL which has a unique combination of active ingredients Arnica Montana and Madecassoside, for the first time ever packaged in a liposomal system, which delivers the agents to where they are needed most - to the deeper layers of the skin. The nanotechnology is designed to deliver the products of HEAL with maximum efficiency to the damaged area”.

HEAL combines a triple method of action which works to soothe the closed wound - using Arnica, Haloxyl and Glistin, to reduce heat sensation and discomfort; repair the damage - using Collaxyl protein fractions to promote cellular repair and optimise scar healing with Silicone. For the past two years The Firm have tested HEAL in their clinical practice, London Plastic Surgery Associates where every year hundreds of patients have undergone facelift, rhinoplasty and breast surgery. The feedback from their patients has been overwhelming, with:

- 94% of patients reporting that HEAL was very soothing to bruised areas
- 82% of patients reporting that HEAL reduced swelling after surgery
- 85% of patients reporting that HEAL highly effectively reduced post-surgery bruising
- 97% of patients would continue to use HEAL in the future and recommend the product to others

Fiona Kent, a 37-year-old Executive Personal Assistant - who had a Rhinoplasty and Chin Augmentation last year - says;

“I was amazed at how soothing and comforting the product felt on my tender skin after my operation and it reduced bruising within days. It smells divine and has a consistency that sinks into the skin. HEAL is truly amazing and is certainly a product that I will always have in the home.”

HEAL is available online at http://www.healgel.com and costs ￡28 for a 30 ml jar.

About The Firm

The Firm is a specialist group developing a new brand of skincare, created by founding Partners of thriving practice London Plastic Surgery Associates (http://www.lpsa.co.uk). The Firm draw on their expertise and worldwide acclaimed research to bring to the public skin healing solutions that work. All surgeons are members of the British Association of Aesthetic Plastic Surgeons (BAAPS) and BAPRAS (British Association of Plastic, Reconstructive and Aesthetic Surgeons). The Firm is based at 30 Devonshire Street, telephone 0207 908 3777.

London Plastic Surgery Associates

Consultant Plastic Surgeon and international laser expert David Gault spoke out against the Department of Health’s proposal to deregulate laser and Intense Pulsed Light (IPL) devices for ‘cosmetic’ treatments. Mr Gault who helped develop the first hair-removing laser over 18 years ago and acts as an expert witness in medico-legal cases of ‘botched’ laser and IPL treatments is particularly concerned that these measures will lead to permanent complications in patients.

David Gault, a member of the British Association of Aesthetic Plastic Surgeons said;

“Just because a laser is used for cosmetic purposes, it does not mean that it is any less dangerous. There have been an increasing number of cases where their incorrect use has resulted in patients ending up ’spotted’ like a leopard with either circular patches of brown or black pigmentation or white patches of depigmentation”.

If administered by untrained hands, these treatments can result in skin blisters, burns, sores and pigment scarring. Clinical expertise is required to analyse and choose the best treatment for different colours of hair in depilation. Misdiagnosis of a pre-cancerous pigmented lesion as “cosmetic” can mean that the early signs are missed and the opportunity to cure is lost.

David Gault, who is based at the Cadogan Clinic in London (http://www.cadoganclinic.com) continued;

“I would be very concerned about untrained attempts to treat port wine stains and pigment spots and any treatment at all on children”.

Many patients are treated inappropriately with either the wrong laser, or with the right laser but the wrong settings. GP’s, who are often not consulted when a patient chooses to have laser treatments, are later forced to get involved when complications result from an inexperienced practitioner.

Mr Gault added;

“It seems entirely inappropriate that the Government should seek to deregulate this type of treatment when within the last year I have seen more cases of complications following laser and IPL treatments than ever before, and if any changes in regulation should be proposed at all, they should be to control their use more stringently - not less”.

To ensure optimum results David Gault also recommends staying out of the sun for several weeks both before and after treatments.

David Gault has gained international acceptance for the many new techniques and devices he has developed. As a leading authority on laser treatments for both children and adults, David Gault uses lasers at the Lister Hospital, Chelsea and the new Plasma Skin Regeneration device at the Portland Hospital, London.

British Association of Aesthetic Plastic Surgeons

A teenager from South Florida, USA, died last Saturday during an operation to correct asymmetrical breasts and an inverted areola.

Two hours into what was supposed to be a routine operation at a plastic surgery facility in Boca Raton, 18-year old Stephanie Kuleba was rushed to Delray Medical Center.

According to a report in ABC News, doctors believe Kuleba had a fatal reaction to anesthesia known as malignant hyperthermia, where increased heart rate and metabolism cause the body temperature to rise as high as 112 degrees F (44.4 degrees C).

Family attorney Roberto Stanziale told the Associated Press that it was too early to tell if any legal action would be taken.

He said there was no indication something like this was going to happen. Kuleba died about 24 hours after the surgery.

Kuleba was captain of her varsity cheerleading team at West Boca High School where she was well liked. She was hoping to become a doctor and had been accepted to study medicine at the University of Florida.

The surgeon who carried out the procedure, board certified plastic surgeon Stephen Schuster said in a statement that he was devastated by the loss and felt for the family, reported ABC News.

The state allows doctors to carry out such procedures at their own premises instead of a hospital if they comply with certain regulations, such as having advanced training in life saving, and special emergency equipment and drugs.

They must also use an an anesthesiologist or specially trained nurse, according to a report in the South Florida Sun Sentinel.

The Sentinel explained that Kuleba arrived at Schuster’s office for surgery at 8 am on the Friday, accompanied by her mother. One hour and 45 minutes later she was showing signs of malignant hyperthermia: her muscles became rigid and her metabolism increased.

A member of the American Society of Anesthesiologists and staff anesthesiologist at Cleveland Clinic in Weston, Dr Jeff Jacobs, told the paper that because malignant hyperthermia is a rare condition, and its symptoms are so general, it is not easy for the anesthesiologist to realize what it is straight away.

Kuleba was given dantrolene and an ambulance called via 911 rushed her to Delray Medical Center, where her symptoms deteriorated: her temperature rose to 108 degrees, her blood stopped clotting, and she started to bleed all over, said Malignant Hyperthermia Association president, Dr Henry Rosenberg, who told the Sentinel that Schuster and the anesthesiologist also called the Association hotline and spoke with an expert from the Mayo Clinic in Minnesota.

Speculating on what may have gone wrong, Rosenberg said Kuleba may not have received enough dantrolene, or her symptoms may have progressed too quickly.

A full-blown case of malignant hyperthermia would need “more than one pair of experienced hands”, an expert in emergency procedures told the Sentinel. Chairman of the University of Miami medical school, Dr David Lubarsky said that emergency procedures are “tricky and labor-intensive”. The patient has to be cooled quickly and the drug mixed precisely. Other drugs may also be necessary to act against some of the effects.

Meanwhile Kuleba’s parking space at her school in Boca Raton has been turned into a makeshift shrine where her high school friends have placed flowers and mementos and gather to mourn their loss.

click here for Malignant Hyperthermia Association (US).

Source: Sun Sentinel, South Florida, ABC News, Associated Press.

Written by: Catharine Paddock, PhD
Copyright: Medical News Today

Almost a quarter (2,626,700) of cosmetic plastic surgery procedures were performed on ethnic patients in 2007, up 13 percent from last year, including Hispanics, African Americans and Asian Americans, according to statistics released today by the American Society of Plastic Surgeons (ASPS).

Since 2007, cosmetic plastic surgery procedures increased in the following demographic categories: up 8 percent (1,011,000) in Hispanics, up 8 percent (847,800) in African Americans, and up 26 percent (767,800) in Asian Americans.

“A key take-away from this data is that the plastic surgery patient profile is changing,” said ASPS President Richard A. D’Amico, MD. “The majority of patients remain Caucasian women, but it is noteworthy that cosmetic plastic surgery procedures were performed on almost as many Hispanic patients as male patients.”

Increases in these demographic categories are considerably higher when compared to ASPS data from 2000. Cosmetic plastic surgery procedures increased 173 percent in Hispanics, 129 percent in African Americans, and 246 percent in Asian Americans.

The most commonly requested surgical procedures for ethnic patients are consistent with last year. African-American patients requested nose reshaping, liposuction and breast reduction; Asian-American patients requested nose reshaping, breast augmentation and eyelid surgery; Hispanic patients requested breast augmentation, nose reshaping and liposuction.

ASPS procedural statistics are collected through the first online national database for plastic surgery procedures, Tracking Operations and Outcomes for Plastic Surgeons (TOPS). This data, combined with the annual survey sent to American Board of Medical Specialties certified physicians most likely to perform plastic surgery, results in the most comprehensive census on plastic surgery procedures.

To view the entire 2007 National Clearinghouse of Plastic Surgery Report, visit the ASPS web site, http://www.plasticsurgery.org. Visitors can also find information on procedures and referrals to ASPS Member Surgeons.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

American Society of Plastic Surgeons

Plastic surgery procedures of the face and chest were popular among both women and men in 2007, increasing at similar rates for similar procedures, according to statistics released today by the American Society of Plastic Surgeons (ASPS).

Facelifts increased 14 percent for women and 16 percent for men from 2007. Breast augmentation for women increased 6 percent and pectoral implants for men increased 8 percent. Further, reconstructive breast reduction for women increased 2 percent, which is a significant difference from the 9 percent decrease reported last year. Male breast reduction increased 7 percent.

“It is not surprising that the highly visible focal points of the face and chest would interest both women and men seeking plastic surgery,” said ASPS President Richard A. D’Amico, MD. “However, while 91 percent of plastic surgery procedures are performed on women and 9 percent are performed on men, it is interesting to see the rate of increase is comparable in both.”

Further, cosmetic minimally-invasive procedures for the face increased considerably for both women and men. Calcium hydroxylapatite (Radiesse™) increased 123 percent for women and 134 percent for men, laser skin resurfacing increased 32 percent for both women and men, polylactic acid (Sculptra™) increased 38 percent for both women and men, hyaluronic acid (Restylane®, Hylaform®, Hylaform Plus® and Juvederm™) increased 35 percent for women and 24 percent for men, and Botox® increased 14 percent for women and 4 percent for men.

“Increases in facelifts and cosmetic minimally-invasive facial procedures were also sizeable in the boomer age groups, which is anticipated,” said Dr. D’Amico. “As we age, the repositioning [lifting] and volume replacing [plumping] procedures supplement one another and we advise boomer-age patients do both to maintain their desired youthful appearance.”

ASPS procedural statistics are collected through the first online national database for plastic surgery procedures, Tracking Operations and Outcomes for Plastic Surgeons (TOPS). This data, combined with the annual survey sent to American Board of Medical Specialties certified physicians most likely to perform plastic surgery, results in the most comprehensive census on plastic surgery procedures.

To view the entire 2007 National Clearinghouse of Plastic Surgery Report, visit the ASPS web site, http://www.plasticsurgery.org. Visitors can also find information on procedures and referrals to ASPS Member Surgeons.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

American Society of Plastic Surgeons

Despite domestic concerns like inflation and a looming home lending crisis, average Americans continue to spend money on plastic surgery. According to the latest procedural statistics report from the American Society of Plastic Surgeons (ASPS), almost 12 million cosmetic plastic surgery procedures were performed in 2007 - a 7 percent increase from 2007 and a 59 percent increase from 2000. Also, 5.1 million reconstructive plastic surgery procedures were performed last year.

“The report tells me Americans are devoted to looking and feeling their best,” said Richard A. D’Amico, MD, ASPS president. “High demand continues for less invasive and relatively less expensive procedures, but there were also promising rebounds in some surgical procedures.”

Numbers of surgical cosmetic procedures remained unchanged from the previous year, with more than 1.8 million procedures performed in 2007. The top five surgical procedures were breast augmentation (348,000, up 6 percent), liposuction (302,000, unchanged), nose reshaping (285,000, down 7 percent), eyelid surgery (241,000, up 3 percent), and tummy tuck (148,000, up 1 percent).

Minimally-invasive cosmetic procedures rose by nine percent, to nearly 10 million procedures. With a hefty increase in demand, hyaluronic acid fillers (Restylane®, Hylaform®, Hylaform Plus®, and JuvedermTM) jumped from fifth most popular in 2007 to second most popular in 2007. The top five minimally-invasive procedures were Botox® (4.6 million, up 13 percent from 2007), hyaluronic acid fillers (1.1 million, up 35 percent), chemical peel (1 million, down 4 percent), laser hair removal (906,000, up 2 percent) and microdermabrasion (897,000, up 10 percent).

Reconstructive plastic surgery procedures decreased 2 percent in 2007. The top five reconstructive procedures were tumor removal (3.9 million, down 1 percent), laceration repair (286,000, down 9 percent), scar revision (150,000, down 9 percent), hand surgery (142,000, down 9 percent) and breast reduction (106,000, up 2 percent).

“We wish the number of reconstructive plastic surgery procedures was waning because fewer people are getting sick or injured,” said Dr. D’Amico. “Rather, we think it has to do with extenuating circumstances like insurers denying claims and stating medically necessary procedures are cosmetic.”

ASPS procedural statistics are collected through the first online national database for plastic surgery procedures, Tracking Operations and Outcomes for Plastic Surgeons (TOPS). This data, combined with the annual survey sent to American Board of Medical Specialties certified physicians most likely to perform plastic surgery, results in the most comprehensive census on plastic surgery procedures.

To view the entire 2007 National Clearinghouse of Plastic Surgery Report, visit the ASPS web site, http://www.plasticsurgery.org. Visitors can also find information on procedures and referrals to ASPS Member Surgeons.

The American Society of Plastic Surgeons is the largest organization of board-certified plastic surgeons in the world. Representing more than 6,700 physician members, the Society is recognized as a leading authority and information source on cosmetic and reconstructive plastic surgery. ASPS comprises more than 90 percent of all board-certified plastic surgeons in the United States. Founded in 1931, the Society represents physicians certified by The American Board of Plastic Surgery or The Royal College of Physicians and Surgeons of Canada.

American Society of Plastic Surgeons

Most patients have moderately severe pain resulting from their injuries one year after sustaining major trauma, according to a report in the March issue of Archives of Surgery, one of the JAMA/Archives journals.

“Pain is a natural accompaniment of acute injury to tissues and is expected in the setting of acute trauma,” according to background information in the article. Recent studies have shown that most patients with pelvic fractures and lower extremity injuries continue to experience chronic pain five to seven years after injury. Pain after injury can lead to disability, post-traumatic stress disorder and depression.

Frederick P. Rivara, M.D., M.P.H., of the University of Washington, Seattle, and colleagues analyzed information from 3,047 patients (age 18 to 84) who were admitted to the hospital and survived to one year after experiencing acute trauma. Pain 12 months after injury was measured on a 10-point scale. Personal, injury and treatment factors that may predict chronic pain in these patients were also noted.

“At 12 months after injury, 62.7 percent of patients reported injury-related pain. Most patients had pain in more than one body region, and the mean [average] severity of pain in the last month was 5.5 on a 10-point scale,” the authors write. The occurrence of pain one year after injury was most common in those age 35 to 44 and least common in those 75 to 84. “The most common painful areas were joints and extremities (44.3 percent), back (26.2 percent), head (11.5 percent), neck (6.9 percent), abdomen (4.4 percent), chest (3.8 percent) and face (2.8 percent).”

Most (59.3 percent) of those with injury-related pain had three or more painful areas one year after injury, while only 37.3 percent had a single painful area. Patients age 75 to 84 had the fewest number of injury-related painful areas, while those 35 to 44 had the most.

“The reported presence of pain varied with age and was more common in women and those who had untreated depression before injury,” the authors write. “Pain at three months was predictive of both the presence and higher severity of pain at 12 months. Lower pain severity was reported by patients with a college education and those with no previous functional limitations.”

“The findings of this study suggest that interventions to decrease chronic pain in trauma patients are needed,” the authors conclude. “The high prevalence of pain, its severity and its effect on functioning warrant such interventions. This may consist of interventions during the acute phase of hospitalization to aggressively treat early pain and better manage neuropathic pain.”

Arch Surg. 2008;143[3]:282-287.
http://archderm.ama-assn.org

Sex, age, burn site, number of surgical procedures and the type of skin graft are associated with abnormal scarring following burns, according to a report in the March/April 2008 issue of Archives of Facial Plastic Surgery, one of the JAMA/Archives journals.

The survival rate of patients with burns has dramatically increased over the past few decades, but healing burns almost always form scars, according to background information in the article. “Burn scars have a dramatic influence on a patient’s quality of life,” the authors write. “They have been associated with anxiety, social avoidance, depression, a disruption in activities of daily living, the onset of sleep disturbances and all of the consequent difficulties in returning to normal life after physical rehabilitation.”

Normal scars are characterized by minor alterations in skin properties, whereas disturbances in the wound healing process produce abnormal or pathologic scars. Ezio Nicola Gangemi, M.D., and colleagues at the University of Turin, Italy, analyzed the records of 703 patients treated at an outpatient burn clinic between 1994 and 2007. In addition to the sex, age, total burn surface, cause of the burn and wound healing time, they noted the prevalence and evolution of several types of pathologic scars: hypertrophic (enlarged) scars; contracted scars, which shorten the length of the tissue; and scars with both characteristics.

Of the 703 patients, 540 (77 percent) had pathologic scars, including 310 (44 percent) with hypertrophic scars, 34 (5 percent) with contractures and 196 (28 percent) with hypertrophic-contracted scars. Patients who were female, young, burned on the neck or arms, had multiple surgical procedures or received meshed skin grafts (sections of skin that have been mechanically cut and expanded, as opposed to sheet or solid grafts) all had a higher risk of pathologic scarring.

Questions remain regarding the clinical course of post-burn scarring, the authors note. “Our data seem to support the role of the immune system for a number of reasons,” they write. Females have a higher risk for both pathologic burn scarring and most immune-related diseases, including rheumatoid arthritis and lupus. In addition, younger patients with more active immune systems are also more likely to develop abnormal scars.

The results could improve physicians’ approach to post-burn scarring, the authors note. “Risk information may be easily integrated into routine clinical practice for early risk stratification, thus facilitating optimal medical prevention and helping physicians adopt follow-up timing and more aggressive or experimental therapies for subjects likely to be at high risk,” they write.

Arch Facial Plast Surg. 2008;10[2]:93-102.
http://archderm.ama-assn.org