Widgerow A D, Chait L A, Stals R, Stals P J
Aesthetic Plast Surg. 2000 May-Jun;24(3):227-34. doi: 10.1007/s002660010038.
As current aesthetic surgical techniques become more standardized and results more predictable, a fine scar may be the demarcating line between acceptable and unacceptable aesthetic results. With this in mind, a scar management program has been adopted based on the modalities of wound support, hydration, and hastened maturity, all factors gleaned from scientific evidence published over the past 25 years. Tension on a scar in one axis will result in a stretched scar, probably initiated by neutrophils and their neutral proteases [18,26]. Tension on a scar from many directions or intermittently will result in a hypertrophic scar, possibly initiated by lymphocytes but definitely related to a prolongation of the inflammatory process, with increased fibroblast activity and overabundant extracellular matrix secretion [24,26]. The common initiating factor is the tension on the scar, and the critical element needed to counteract this tension is scar support. Clinical experience has shown us that the most reliable way to support a scar is by using microporous tape. Hydration is a second beneficial influence on scar control and is the basis of the use of silicone sheeting and gel [7,29,36]. Alpha Centella cream has two main components. The first is an extract from the plant Bulbine frutescens. This increases hydration under the tape by leaving a layer of fatty vesicles of glycoprotein on the skin surface. This also has antibacterial properties. The second component is the principal terpenoids extracted from the Centella asiatica plant. These include asiatic acid, madecassic acid, and asiaticoside. Centella asiatica has been documented to aid wound healing in a large number of scientific reports [5,12,21,22,33,34,40]. The most beneficial effect appears to be the stimulation of maturation of the scar by the production of type I collagen [4,19] and the resulting decrease in the inflammatory reaction and myofibroblast production. Thus these components have been incorporated into the formulation of a scar management program. This publication reviews much of the available literature relating to scar management and describes the formulation and use of a scar management program based on this information.
随着当前美容外科技术变得更加标准化，手术效果更可预测，一道细微的瘢痕可能成为美学效果可接受与不可接受之间的分界线。考虑到这一点，我们采用了一项瘢痕管理方案，该方案基于伤口支撑、保湿以及加速成熟等方式，所有这些因素均来自过去25年发表的科学证据。瘢痕在一个轴向上受到张力会导致瘢痕拉伸，这可能由中性粒细胞及其中性蛋白酶引发[18,26]。瘢痕从多个方向或间歇性地受到张力会导致瘢痕增生，可能由淋巴细胞引发，但肯定与炎症过程的延长有关，同时成纤维细胞活性增加且细胞外基质分泌过多[24,26]。常见的引发因素是瘢痕上的张力，而抵消这种张力所需的关键要素是瘢痕支撑。临床经验告诉我们，支撑瘢痕最可靠的方法是使用微孔胶带。保湿是对瘢痕控制的第二个有益影响，也是使用硅胶片和凝胶的基础[7,29,36]。积雪草霜有两个主要成分。第一个是从植物黄花牛角提取的提取物。它通过在皮肤表面留下一层糖蛋白脂肪小泡来增加胶带下方的湿度。它还具有抗菌特性。第二个成分是从积雪草植物中提取的主要萜类化合物。这些包括积雪草苷、羟基积雪草苷和积雪草糖。大量科学报告已证明积雪草有助于伤口愈合[5,12,21,22,33,34,40]。最有益的作用似乎是通过产生I型胶原蛋白来刺激瘢痕成熟[4,19]，从而减少炎症反应和成肌纤维细胞的产生。因此，这些成分已被纳入瘢痕管理方案的配方中。本出版物回顾了许多与瘢痕管理相关的现有文献，并基于这些信息描述了瘢痕管理方案的配方和使用方法。
