Eur J Plast Surg (2001) 24:186 DOI 10.1007/s002380100280 INVITED COMMENTAR Y Luigi Donati The influence of different occlusive plates on the erythema of hypertrophic burn scars, by E. van den Kerckhove et al. Published online: 31 July 2001 © Springer-Verlag 2001 The excellent review on pressure treatment for burn In the same way, growth factors, angiogenic and scars confirms and proves that silicone compression antiangiogenic factors, cytokines, antireactional or continues to play a central role in treating such scars. immunomodulating drugs should be studied with the The pressure works even though not all the related precise target of controlling surgical fibroplasia or scars pathophysiologic mechanisms are understood. However, and erythema or reaction. the problem is far from being resolved satisfactorily. What we expect might provide positive results in the The results for individual patients still remain largely near future are the indirect effect of certain scaffolds unpredictable even when the most accurate protocols employed by tissue engineering. For instance, in conjunc- are used and patient compliance is assured. This is tion with other researchers, we have been using esters of disappointing and upsetting because cortisone and silicone hyaluronic acid to grow and reapply autologous fibro- pressure have been the latest and primary treatments for blasts, keratinocytes and chondrocytes. These esters have more than 10 years. shown an ability to regulate the new tissues. Actually, The large number of publications examining the basic with certain chemical modifications, they seem capable biology of wound healing offer new perspectives both of promoting cell growth or avoiding abdominal or on myofibroblast kinetics, cellular apoptosis, collagen tendinous adhesions. Together with compressive action. maturation and degradation, contact inhibition, genetic This also seems interesting because those molecules determinants, etc. The clinical applications, however, are reproduce a fetal atmosphere.Embryonic tissue is known neither clear nor rewarding. The promising results that to contain, among other components, hyaluronic acid in Gabbiani, Montandon and others, including our team, a quantity that greatly exceeds the content of the healing have obtained using interferons need to be reevaluated in tissue of a mature adult. multicenter and controlled trials because of thevariable To overcome the difficulties of coordinating so many responses of various patients. different concepts there is an urgent need to set up In our opinion, the control of fibroplasia, which up to common studies so that different scholars might share now has been carried out essentially in the fields of liver the same objective. There is also probably the need to cirrhosis, lung fibrosis, or rheumatic diseases should be encourage the interest of large drug and biotechnology reapplied or extended to other fibroplastic conditions, companies in pursuing this research subject. It might such as scars, adhesions, and microreactions to sutures, also be necessary to establish multicenter and multina- nets and biomaterials (i.e., silicone). An investigation of tional controlled trials. the possible role of infection and bacterial activity In Italy, we are presently trying to bring together (sliming, chronic subclinical infections, etc.) should be different research teams — represented by clinical and included. veterinary surgeons and biomaterialists and tissue engi- neering experts — who will work in close collaboration to study fetal surgery extensively. These teams will refer their work to major biotechnology and basic research This commentary refers to the article at http://dx.doi.org/ laboratories. Including experts on antireactional drugs. 10.1007/s002380100279 Understanding, promoting and controlling systems L. Donati ( ) ✉ that enhance and regulate tissue regeneration and differ- Institute of Plastic Surgery, University of Milan, entiation in vivo and in vitro are also ways to improve Via Morandi 30, 20097 San Donato Milanese, Italy the treatment of scars and fibroplasia and therefore the e-mail: firstname.lastname@example.org Fax: +39-02-5560-7302 final surgical results.
European Journal of Plastic Surgery – Springer Journals
Published: Aug 1, 2001
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