The effect of pressure therapy intervention on the maturation of hypertrophic scars : a longitudinal histopathological and clinical study

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The effect of pressure therapy intervention on the maturation of hypertrophic scars : a longitudinal histopathological and clinical study

 

Author: Feng, Beibei
Title: The effect of pressure therapy intervention on the maturation of hypertrophic scars : a longitudinal histopathological and clinical study
Degree: M.Phil.
Year: 2012
Subject: Hypertrophic scars -- Care.
Pressure suits -- Therapeutic use.
Hong Kong Polytechnic University -- Dissertations
Department: Dept. of Rehabilitation Sciences
Pages: xvi, 161 leaves : ill. ; 30 cm.
Language: English
InnoPac Record: http://library.polyu.edu.hk/record=b2522698
URI: http://theses.lib.polyu.edu.hk/handle/200/6595
Abstract: Pressure therapy, usually prescribed as pressure garments, has been widely applied for the management of hypertrophic scars since the 1970's. Despite its wide application by clinicians, the effect of pressure therapy on scar controlling has still not been well recognized by researchers from previous literature evidence. There is a lack of a standardized method to prescribe pressure therapy and to monitor the pressure range. It certainly has an impact on the adherence of patients in putting on the pressure garments and also on the efficacy of this treatment. What is more, the theory underlying pressure therapy remains unknown up till now. The aims of the study were two-fold: Firstly, phase I of the study was to validate a standardized regime in prescription and monitoring of pressure therapy; secondly, the main part of the study (phase II) aimed to investigate the role of a valid protocol of pressure therapy on control of hypertrophic scar through histopathological perspective in line with the clinical characteristics. Results of the study could serve to provide further scientific evidence to this popular treatment on hypertrophic scars. In phase I of the study, a newly developed system for prescribing pressure therapy, the Smart Pressure Monitored Suits (SPMS), was compared with the conventional pressure garments (CG) in local hospital settings in terms of their ability to maintain sufficient interface pressure and the garment properties. SPMS showed a better performance in the sustainability of pressure than the conventional garment. Garment users rated a higher score for SPMS than that of CG in terms of the overall grading of garment comfort properties. This newly developed prescription method using the SPMS was found to provide more efficient therapeutic pressure treatment.
Phase II of the study, the main study of this thesis, was set out to investigate the underlying mechanism of pressure therapy on the maturation of hypertrophic scars. Six patients with 10 hypertrophic scars were recruited in the study. A 3-month standardized pressure treatment was prescribed to the participants. Both clinical and histopathological assessments of hypertrophic scar tissues were conducted prior to the pressure intervention, at 1-month and 3-month post pressure treatment. Clinically, the overall grading of scar thickness and redness were significantly improved after pressure intervention. Histological staining revealed an obvious reduction in dermal cellularity of scar tissues after 3 months of pressure treatment, while the arrangement of the collagen fibers was changed from the nodular form to a more wave-like pattern after pressure therapy. There was a significant reduction of myofibroblasts population after the 3-month pressure intervention. The intensity of alpha-smooth muscle actin (α-SMA) expression was also decreased significantly as early as 1 month after treatment. The apoptotic index in the scar dermis was found to increase after 3 months' pressure treatment. In addition, a suppressed keratinocytes proliferation in scar epidermis was also demonstrated after pressure treatment. In conclusion, pressure therapy was proven to exert some effects on the histopathological changes which may be related to the maturation of hypertrophic scars. It was found that pressure therapy could induce apoptosis of the myofibroblasts and inhibit the keratinocytes proliferation. It was suggested that pressure therapy intervention could affect the process of scar maturation through a combined pathway involving both the epidermal and dermal layers. Further research should be warranted in this direction for a deeper understanding of the mechanism of pressure therapy intervention on hypertrophic scarring.

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