barcode printing in vb net Rejuvenation of Scars and Striae in VS .NET

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CHAPTER 11 Rejuvenation of Scars and Striae
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Meghan F Stier and Ranella J Hirsch
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reaching maturity at approximately 1 year3 They are the result of extreme collagen production and reduced collagen degradation during wound remodeling1 HS may follow acne, infections, burns, or piercings3,4
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KEY POINTS
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Wound healing process is highly ordered and complex Malfunctions may result in hypertrophic scars (HS), keloids, or striae Abnormal or conspicuous scars or striae may require medical treatment, and most serious malformations are also accompanied by psychological distress The rejuvenation of HS, keloids, and striae can not only heal the abnormal appearance of these scars but can ease the psychological burden of an unsightly wound as well Rejuvenation of HS yields the most dramatic improvements, while keloid and striae treatments have yet to provide such extensive bene ts
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Epidemiology
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HS affect 15% to 45% of the general population3 They present equally among males and females5 HS occur most often in areas where the skin is signi cantly anatomically stretched, such as the presternal area, upper back, and deltoid region, usually within the rst month post surgery or trauma6 HS and keloids tend to develop between the ages of 10 and 307
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Patient Selection and Preprocedure Evaluation
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HS, by de nition, are con ned to the original region of injury They are raised, erythematous, and may be painful or pruritic Fortunately, many HS gradually resolve; rst erythema decreases, followed by scar attening months to years later2 In some cases, scars can grow further and become permanent3 However, overall, HS are expected to have a good response to treatment2 Histologically, normal skin shows distinct collagen bundles that are oriented parallel to the epithelial surface In contrast, collagen bundles in HS are atter than those in normal skin, less distinct, and run in a wavy pattern4 These thin collagen bundles have unique nodules containing alpha smooth muscle actin expressing myo broblasts,4 as well as the presence of increased mast cells2 Although HS can resolve over time, they should be treated when they cause functional or cosmetic deformities, discomfort or pain, or psychological stress8
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HYPERTROPHIC SCARS De nition, Cellular Anatomy, and Etiology
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HS are de ned as raised, rm, erythematous scars that remain within the boundaries of the original injury1 The etiology of hypertrophic scarring is poorly understood as cutaneous wound healing is an extremely complex procedure that offers countless paths for deviation2 When normal wound healing occurs after injury, hemostasis begins at once, as platelets begin plugging vessels and brin polymerizes through the wound area2 Next is the in ammatory stage, with the arrival of neutrophils, macrophages, and synthesis lymphocytes to the wound region Synthesis events follow as cytokines from the injured tissues, platelets, and cellular migrants start the processes for angiogenesis and brogenesis In the remodeling phase, continuing over the next 6 to 12 months, tissue proliferation and reepithelialization begin, with matrix deposition and collagen synthesis The nal mature scar will have approximately 80% of the strength of the initial, uninjured tissue2 HS often appear within 6 to 8 weeks after reepithelialization of a wound, and continue to grow rapidly until
Techniques
Treatments for HS (Table 111) are many and include pressure garments, silicone gel sheeting, corticosteroid injections, 5- uorouracil (5-FU), interferon ( , , and ), bleomycin, radiotherapy, surgery, cryosurgery, and laser therapy8,20 Intralesional corticosteroid treatment is the current gold standard and is often used alone or in combination with pressure treatment or surgery Triamcinolone
TABLE 111 Author PDL Studies Alster et al (1993)
Hypertrophic Scars Treatment Studies # Patients 10 Treatment PDL: 585 nm, 60 70 J/cm2, 360 s Spot size not given Cooling Devices Not noted # Treatments 5 Results All treated scars improved Dilated vascular channels cleared and regular-sized dermal vessels replaced these Unexpected improvements in scar texture, height, and pliability Color, texture, height, hypertrophy, and erythema improved Younger scars improved more than older scars Facial scars improved more than body scars Maximum scar growth inhibition at 585 nm, minimal scar growth inhibition at 600 nm Fluences of 6 J/cm2 and 10 J/cm2 yielded best results with 585 nm 124(171 (72%) sites had minimal white scar with good pliability and no contour abnormalities Analyzing PDL as a preventative therapy for HS, researchers advocated more aggressive treatment Side Effects Not noted
Dierickx et al (1995)
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