Authors:
Gurtner, Geoffrey C. MD; Dauskardt, Reinhold H. PhD; Wong, Victor W. MD; Bhatt, Kirit A. MD; Wu, Kenneth PhD; Vial, Ivan N. BA; Padois, Karine PhD; Korman, Joshua M. MD; Longaker, Michael T. MD, MBA
Summary:
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.
Source:
Annals of Surgery; Vol. 254, Issue 2, 217-225 (08/11)