Combination of Medical Needling and ReCell? for Repigmentation of Hypopigmented Burn Scars

Abstract

The skin as biggest human organ plays a major role for temperature and water regulation, communication and representation. Moreover it essentially serves as a mechanical barrier and also protects from ultraviolet rays by producing melanin. By losing the physiological lattice pattern collagen and because of the absence or decreased amount of skin appendages, scar tissue frequently loses the aforesaid features of healthy skin. Thus, scars represent the replacement of healthy skin with poor tissue. They regularly remain rigid, dry and itching. Deeper second degree burns often cause death of melanocytes and can result in hypo-or depigmentation [1]. Additionally, scar tissue may provide a barrier to melanocyte migration and melanin transfer [2]. There are numerous methods to treat scar tissue. Beside classical surgical treatments like excision, w or z plasties, flaps or expanders, minimal invasive procedures like dermabrasio, Co²-Laser and deep peeling are highly demanded. The last treatments listed are ablative treatments. Using them on scar tissue with a lower amount of skin appendages and flat rete-pegs increases the risk of provoking new scaring [3]. Additionally, the skin becomes more vulnerable for ultraviolet rays and there is a raised risk for dyspigmentation [4,5]. Physical impairements like an increased photosensibility and thus a higher risk of sunburn [6] can also have an enormous impact on a patient's quality of life like cosmetic aspects. Bright, conspicuous scars are a frequent reminder of traumatic situations or life events and are therefore often associated with posttraumatic stress disorder and depressions [7]. There are several therapies available for repigmentation of hypopigmented scars, like split thickness skin grafts or autologues skin cell transplantation. They are usually combined with the ablative treatments named before and can lead to the known complications like new scaring or dyspigmentation [8]. An ideal scar treatment or wound bed preparation for repigmentation therapies would be a treatment, which does not harm the epidermis and which initiate physiological wound healing with formation of lattice pattern collagen and growth factors. Recent clinical and scientific researches have shown, that it is possible to achieve this ideal skin regeneration by medical needling. Initiating a clinical study in 2008, the outcome of 480 patients, who were treated by medical needling or "percutaneous collagen induction", was verified regarding satisfaction and cosmetic results [9]. Further, scientific research with histological and immunflourescence studies combined with RNA analyses were realized to quantify the effects of this therapy [10]. Currently there are ongoing studies to prove these results in vivo by using special measuring instruments. These instruments are used directly on the patients' skin and are able to determine different skin parameters. One of these instruments is the Mexameter® for capturing the amount of melanin in the skin (see below). (The results of different studies about percutaneous collagen induction are presented below [9,10]). Medical needling can be used as a minimal-invasive, non-ablative treatment for burn scars. By using a roller covered with 3mm long needles and rolling vertically, horizontally and diagonally over the scars, the physician induces multiple punctures right up to the Dermis (Figures 1 and 2). Abstract Burn scars remain a serious physical and psychological problem for the affected people. Clinical studies as well as basic scientific research have shown that medical needling can significantly increase the quality of burn scars with comparatively low risk and stress for the patient with regards to skin elasticity, moisture, erythema and transepidermal water loss. However, needling has no influence on repigmentation of large hypopigmented scars. The goal is to evaluate whether both established methods-needling improvement of scar quality) and ReCell® (repigmentation)-can be combined. So far, 20 patients with mean age of 35 years (7-61 years) with deep second and third degree burn scars have been treated. The average treated tissue surface was 8% (2-18% TBSA) and was focused on areas like face, neck, chest and arm. Percutaneous collagen induction or "medical needling" is performed using a roller covered with 3mm long needles. The roller is vertically, horizontally and diagonally rolled over the scar, inducing microtrauma. Then, ReCell® is applied, according to the known protocol. The patients have been followed 12 months postoperatively. Pigmentation changes are measured objectively, as well as with patient and observer ratings. Patient satisfaction/preference is also obtained. With this article we present first results of our ongoing study. Taken together, the pigmentation ratings and objective measures indicate improvement in all study participants. Medical needling in combination with ReCell ® shows promise for repigmentation of burn scars.