Iterative technology, precise thinking
The development and application of interdisciplinary technology, and the in-depth study of traditional technology).
We have been talking about the stalk of information ** for a long time, but after all, this is an era of rapid technological progress, and all kinds of information brought by technology have also bombarded doctors!
Wake up! Wake up!
New technologies are constantly being proposed, but they need to be used wisely and continuously validated; Don't be too anxious to draw a line with old technology, and be in a hurry to be different!
Academics need to be precipitated; The spirit of science should not be mixed with too much utilitarianism; Rediscovering the classics is actually a bit sad.
For the first program of scarring, there has been no stagnation; Technology is constantly iterating, and it is becoming more and more scientific from the two perspectives of holistic and precise.
old silicone preparations, topical application of glucocorticoids, physical protocols of pressure **, chemical peels of organic and inorganic acids; Later, onion extract preparations and photoelectric technology were later put back to basics, and some external preparations of traditional Chinese medicine and avoiding light had a good cost performance, and standardized local hygiene habits had also been put in as a supplement to the overall program, and the trend of joint application had become more and more clear.
Silicone preparationsIt is a milestone that scars can't get around. The application of silicone can protect the water loss of the stratum corneum from a microscopic perspective, and then stabilize the local tissue water content, which is the key to the "soil and water conservation", a stable environment can reduce the degree of inflammation, and the latter is an important cause of capillary hyperplasia, and silicone, as a small molecule of organic matter, continuously released low-molecular-weight silicon polymer, can change the chemical structure of scar tissue, one aspect is to change the retention ratio of collagen fibrillin, which can avoid excessive proliferation of collagen. alteration of microscopic extracellular matrix structure; When the water is maintained, the inflammatory capillary hyperplasia will also stabilize quickly, and the stabilization of capillaries is also an important plan for the progress of hypertrophic scar control.
Onion extractIt is the latest scar prevention and ** drug of choice. The active ingredient has anti-inflammatory, antipruritic, collagen-softening, inhibiting fibroblast proliferation, promoting wound healing, and promoting epithelialization. Modern medical studies have shown that onions contain the trace element selenium. Selenium is an antioxidant, its special role is to make the human body produce a large amount of glutathione, the physiological role of glutathione is to transport oxygen for cell respiration, the increase of selenium content in the human body, the incidence of cancer will be greatly reduced.
GlucocorticoidsThe use of a very traditional program has taken on a very important task in the specialist diagnosis and treatment of arthritis and ** disease, and its front-line role in scar prevention ** is certain. Glucocorticoids** pathological scarring have been used since 1960, and the mechanism of action of hormone** pathological scarring may be by inhibiting the proliferation of fibroblasts in pathological scars, inhibiting collagen synthesis, increasing collagenase production, and decreasing levels of collagenase inhibitors. A variety of hormones can be used**, such as hydrocortisone hydrochloride, methylprednisolone, dexamethasone, etc., the most commonly used is triamcinolone acetonide (10-40 mg ml), intrascarial injection alone or in combination with lidocaine. Some scholars have pointed out that after local injection of triamcinolone acetonide** during surgical resection, repeated injections at intervals of 2 to 5 weeks and continuous injection for 4 to 6 months have good efficacy. (Lilac Garden Material).
5-FU (5-fluorouracil).As an antineoplastic drug, it has application scenarios in keloids with tumor properties. Low concentrations of 5-fu can reduce scar blood vascularization, so that the effect of glucocorticoids is locked locally, improve local efficacy and reduce systemic blood circulation
Stress**Its mechanism of action is the intervention of MMP (metalloenzyme) expression. Reduction of hemodynamic levels at the scar site inhibits collagen synthesis by downregulating metalloproteinase-28 (MMP-28) and increasing the expression of prostaglandin E2 (PGE2), which activates collagenase. Pressure** has now become the standard and preferred method for hypertrophic scars after burns. (Lilac Garden Material).
For drugs**, evidence-based medicineSummarize the order of size of the scar** effect as follows:
Effect sizes --- hormones, bleomycin, -fluorouracil, mitomycin, verapamil, and collagenase;
Effective --- hormones, bleomycin, fluorouracil, mitomycin, verapamil and collagenase.
Among them, the OR value of collagenase** effect is less than 1, indicating that the drug is not only ineffective for scarring, but also may be harmful, while the OR value range of -fluorouracil contains 1, and its ** effect also needs to be further confirmed, and the effect of other drugs such as bleomycin and mitomycin and verapamil can only be used for clinical reference due to the small amount of literature.
Optoelectronic technology is a relatively recent technical means. Techniques and methods that use photophysical effects (such as thermal, mechanical, and electromagnetic) and photobiological effects (such as photochemistry and photobiomodulation) generated between energy sources and tissues for medical diagnosis and development. The commonly used photoelectric technologies for scar ** mainly include excitation, photonics, radio frequency (micro-plasma) and other technologies. The two "milestone" theories in the history of laser medicine development proposed by Rox Anderson, namely selective photothermal interaction and fractional photothermal interaction, have laid the foundation for the application of laser technology in the world, and are also the key working principles to guide the application of optoelectronic technology in scars.
Clinically recommended are "variable pulse width doubling neodymium-yttrium-aluminum garnet (YAG) laser": 532nm, 1064nm (long pulse width): the use of hemoglobin to selectively absorb the energy released by a specific wavelength of laser, resulting in damage and destruction of blood vessels. Laser directly acting on the scar tissue: fractional laser, forming a tiny three-dimensional heat-damaged muscle micro-area, with a diameter of 500um, which can stimulate the injured area to complete healing through regeneration rather than repair, and can avoid scarring caused by heat injury.
The expression of TGF- varies at different times after scarring, and because fractional laser can produce micro-damage, the up-regulation of TGF- expression in the short term after ** is conducive to wound repair. In the later stage, the expression of TGF-1 was down-regulated and TGF-3 was up-regulated, which was conducive to inhibiting scar hyperplasia. In addition, the initial and final up-regulation of HSP expression in the scar after fractional laser surgery was not consistent with the change of TGF- expression, and the up-regulation of Mir-18A and Mir-19A expression inhibited TGF- expression, suggesting that the regulatory mechanism of TGF- after fractional laser surgery is complex.
To sum up, with the continuous deepening of scar research, the continuous maturation of new concepts and technologies will undoubtedly bring new hope to the development of scars, and the guidance and suggestions for scar prevention and treatment will also be updated. In view of the fact that consensus is an academic guidance document, evidence-based is an important basis, and the best program with a rich evidence-based basis is the main body of recommendation. In addition, as a treasure of traditional Chinese culture, traditional Chinese medicine has a large number of case data and a long history in clinical application, and it is expected that there will be more corresponding studies in the future to verify the efficacy and safety.
Walking with scars, a long-term strategic vision
I've written a lot, and it's almost time to put my pen down.
We deal with the relationship with scars with a confrontational thinking, however, the aforementioned personal history of pathological scars and familial pathological scars indicate that the individual will face the problem of scarring throughout his life, a lifetime of self-tearing, inner panic is like a shadow, being chased madly and silently, and ending in the grave, is this the relationship you want? Saddled with a lifetime of enmity?
As with many chronic diseases, the accompaniment of pathological scarring seems inevitable from a certain point in time, can we let go of hostility? In the face of the inevitable lifelong enemy, with a confrontational thinking that is different from modern medicine, understand this "enemy" of oneself, know its pathology, and understand its nature; know how to prevent and how to avoid; Set warning points for its progress and malignancy, walk through mountains, cross rivers, and carry it all the way.
Since the goal is poetry and distance, do you want to let go of the reluctance between the present and the "scar"? It's just a trace of life, whose life is perfect?! Doesn't an imperfect life have the meaning of pursuing perfection?