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Improving Cutaneous Scar Formation by Controlling the Mechanical Environment

2011; Lippincott Williams & Wilkins; Volume: 254; Issue: 2 Linguagem: Inglês

10.1097/sla.0b013e318220b159

1528-1140

Geoffrey C. Gurtner, Reinhold H. Dauskardt, Victor W. Wong, Kirit A. Bhatt, Kenneth S. Wu, Ivan N. Vial, Karine Padois, Joshua M. Korman, Michael T. Longaker,

Burn Injury Management and Outcomes

In Brief Objective: To test the hypothesis that the mechanical environment of cutaneous wounds can control scar formation. Background: Mechanical forces have been recognized to modulate myriad biologic processes, but the role of physical force in scar formation remains unclear. Furthermore, the therapeutic benefits of offloading cutaneous wounds with a device have not been rigorously tested. Methods: A mechanomodulating polymer device was utilized to manipulate the mechanical environment of closed cutaneous wounds in red Duroc swine. After 8 weeks, wounds subjected to different mechanical stress states underwent immunohistochemical analysis for fibrotic markers. In a phase I clinical study, 9 human patients undergoing elective abdominal surgery were treated postoperatively with a stress-shielding polymer on one side whereas the other side was treated as standard of care. Professional photographs were taken between 8 and 12 months postsurgery and evaluated using a visual analog scale by lay and professional panels. This study is registered with ClinicalTrials.gov, number NCT00766727. Results: Stress shielding of swine incisions reduced histologic scar area by 6- and 9-fold compared to control and elevated stress states, respectively (P < 0.01 for both) and dramatically decreased the histologic expression of profibrotic markers. Closure of high-tension wounds induced human-like scar formation in the red Duroc, a phenotype effectively mitigated with stress shielding of wounds. In the study on humans, stress shielding of abdominal incisions significantly improved scar appearance (P = 0.004) compared with within-patient controls. Conclusions: These results indicate that mechanical manipulation of the wound environment with a dynamic stress-shielding polymer device can significantly reduce scar formation. Scar formation was effectively controlled with a dynamic polymer device by manipulating the mechanical environment of wounds in red Duroc swine for eight weeks and in human post-surgical incisions for over eight months. Device approaches to mechanically offload human wounds can significantly reduce cutaneous scar formation following injury.