21

Session I

Updates in scar care products

Updates in scar care products

문 정 환

단국대학교 의과대학 이비인후과과학교실

Contents

• Mechanism of wound healing

• Principles of scar care

• Scar management practical guidelines

• Scar care products• Silicone gel sheeting or gel• Other topical treatments • New products

Disclosure

• No conflict of interestUpdates in scar care products: For the Better Outcomes

Jeong Hwan Moon, MD, PhD

Department of Otolaryngology-Head and Neck Surgery, College of Medicine, Dankook University

Mechanism of wound healingHumphrey and Thomas, Operative Techniques in Otolaryngology2011

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Wound care basics & Laryngopharyngeal reconstruction

16th Head and Neck Workshop

Normal wound healing

Occlusive biological dressing

Widespread scars after prolonged healing

Principles of scar care

• Maintain moisture• Reduces transdermal water loss• Decreased abnormal epidermal differentiation (ex. Keloid)

• Occlusion• re- epithelialization ↑• collagen synthesis ↑• hypoxic environment→ angiogenesis

• Minimize tension• preventing excessive soft tissue formation

Scar management practical guidelines: Linear scar

Keloid

23

Session I

Updates in scar care products

Scar care products

Paper tape

• Micropore, Steri-Strips (3M) - latex-free hypoallergenic paper tapes

• often placed over incision lines postoperatively• Prevent stretching of the wound • reducing tension on wound edges minimizing shear forces• preventing excessive soft tissue formation (scar volume)• keeping the wound moist • analogous results compared with silicone sheets• recommend placement of paper tape for at least 6 weeks

postoperatively

Silicone gel sheeting or gel

• Mechanism : unclear• increase occlusion and hydration of wounds• decrease capillary activity, hyperemia, and collagen deposition

• Effective treatment for scars and keloids

메피폼 _ 흉터 관리를 위한 실리콘 겔시트

24

Wound care basics & Laryngopharyngeal reconstruction

16th Head and Neck Workshop

Silicone gel

Polyurethane dressing

Onion extract

• Allium cepa (onion extract) + Heparin + allantoin• Cepae extract: anti-inflammatory, bactericidal effect, reduce

swelling• Heparin: tissue structure loosening, anti-inflammatory effect, water

binding capacity• Allantoin: wound healing, keratolytic effect, tblood flow↑, moisturizer

Polyurethane dressing

• self-adherent, flexible, hydroactive pad• by creating a moist wound healing promote re-epithelialization and dermal extracellular matrix synthesis

• to prevent the formation of hypertrophic scars• reduces color, prominence, and hardness of mature hypertrophic

scars

Moist exposed burn ointment (MEBO)

• Contain• Six herbal extracts • □-sitosterol: anti-inflammatory effects• sesame oil

• increasing tissue moisture decreased vascular activity preventing vascular overgrowth preventing scar hypertrophy

Onion extract

25

Session I

Updates in scar care products

Scar prevention: topical therapies

Evidence for scar prevention and treatment

Selected products and features

Kerwin et al. International Journal of Dermatology 2014

Selected products and features

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Wound care basics & Laryngopharyngeal reconstruction

16th Head and Neck Workshop

New products

Prineo (Ethicon)

PracaSil (Professional Compounding Centers of America)

• Silicone based + pracaxi oil high amounts of fatty acids that are integral to the development of cellular membranes.

Prineo (Ethicon)

• Two-component system:• Flexible, self-adhesive polyester mesh tape, laid across incision• DERMABOND Topical Skin Adhesive (2-octylcyanoacrylate topical skin

adhesive), applied to mesh tape• Potential mechanisms for differences in outcomes versus other

wound closure modalities:• Antimicrobial protection• Strength equivalent to 3-0 suture, superior to 4-0 suture or staples• Optimal distribution of tension• Easier self-care (e.g., no need for dressing changes)• Ability to shower immediately after procedure• No suture or staple removal

Embrace (Neodyne Biosciences)

• Embrace Minimize Silicone Scar Sheets • by plastic surgeons • to soften, smooth, flatten and fade the color of existing scars• to stay in place up to 10 days, creating a long-lasting seal that

encourages faster healing

Summary• Goals of scar management

• Maintain moisture• Minimize tension

• Silicone gel sheeting • Strong evidence• supporting effectiveness in preventing and treating hypertrophic scars

• Other topical ointments(Onion extract, Vit. A, E, D, Mederma etc.)• Limited data• no adequate benefit ~ some benefit• Side effects – acute inflammatory reaction

• New products• Silicone based• Maintain moisture, Minimize tension