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