Current concepts related to hypertrophic scarring in burn injuries.
Current concepts related to hypertrophic scarring in burn injuries.
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DOI：
10.1111/wrr.12432
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发表时间：
2016-05
期刊：
影响因子：
--
通讯作者：
Widgerow AD
中科院分区：
文献类型：
--
作者：
Chiang RS;Borovikova AA;King K;Banyard DA;Lalezari S;Toranto JD;Paydar KZ;Wirth GA;Evans GR;Widgerow AD
烧伤后的疤痕及其伴随的美学和功能后遗症仍然是主要的挑战。增生性瘢痕(HTS)对患者的生活质量有很大影响，主要表现为受损部位的外观、疼痛、瘙痒，甚至丧失功能。对烧伤疤痕演变过程中发生的分子事件的识别增加了我们的知识；然而，这些信息尚未转化为有效的治疗方式。虽然许多导致过度瘢痕形成的病理生理途径已经被识别，但烧伤疤痕形成中的某些细微差别开始被认识到。这些因素包括神经源性炎症、机械转导和烧伤创面液与真皮深层脂肪组织的独特相互作用，所有这些都可能影响瘢痕形成的结果。愈合的疤痕、瘙痒和疼痛的紧张都会诱导信号通路，最终导致胶原形成增加和肌成纤维细胞表型改变。暴露在真皮深层的脂肪穹隆与HTS增加有关，这可能是基于脂肪干细胞和深度烧伤渗出物相互作用的改变。这些与干细胞-细胞因子相互作用、机械转导和神经源性炎症相关的病理生理模式可以为可能的治疗干预提供新的探索途径。
Scarring following burn injury and its accompanying aesthetic and functional sequelae still pose major challenges. Hypertrophic scarring (HTS) can greatly impact patients’ quality of life related to appearance, pain, pruritus and even loss of function of the injured body region. The identification of molecular events occurring in the evolution of the burn scar has increased our knowledge; however, this information has not yet translated into effective treatment modalities. Although many of the pathophysiologic pathways that bring about exaggerated scarring have been identified, certain nuances in burn scar formation are starting to be recognized. These include the effects of neurogenic inflammation, mechanotransduction, and the unique interactions of burn wound fluid with fat tissue in the deeper dermal layers, all of which may influence scarring outcome. Tension on the healing scar, pruritus, and pain all induce signaling pathways that ultimately result in increased collagen formation and myofibroblast phenotypic changes. Exposure of the fat domes in the deep dermis is associated with increased HTS, possibly on the basis of altered interaction of adipose-derived stem cells and the deep burn exudate. These pathophysiologic patterns related to stem cell-cytokine interactions, mechanotransduction, and neurogenic inflammation can provide new avenues of exploration for possible therapeutic interventions.
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