Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：English   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

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Language：Japanese   Publisher：(一社)日本皮膚悪性腫瘍学会  

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Language：Japanese   Publisher：(一社)日本皮膚悪性腫瘍学会  

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Language：English   Publishing type：Research paper (scientific journal)  

UNLABELLED: Lumbar sympathetic nerve block (LSNB) improves blood flow in the lower limbs and relieves pain involving the sympathetic afferents. This study examines the use of LSNB, but there are no reports of its use for the purpose of wound healing. Therefore, the authors planned the following study. METHODS: An ischemic limb ulcer was created on both lower limbs using a rat model (N = 18). The rats were divided into three groups, namely, A, B, and C. Group A received LSNB on one side (N = 6). Group B was sprayed with basic fibroblast growth factor preparation (trafermin/fiblast) on one side (N = 6). Group C was used as a control (N = 6). Lower limb temperature and the ulcer area were measured over time in each group. Furthermore, the correlation between the ulcer temperature and the ulcer area reduction rate was analyzed. RESULTS: Group A had higher skin temperature on the LSNB-treated side than on the nontreated side (P = 0.0022 < 0.05). Regarding the correlation between the average temperature and the ulcer area reduction rate, the correlation coefficient was as high as 0.691 in group A. CONCLUSIONS: In the LSNB group, the skin temperature increased and the ulcer area decreased significantly. Conventionally, LSNB has been used for pain relief purposes, although the authors consider that it will be useful in the treatment of ischemic ulcers and that it is a potential treatment option for future chronic limb ischemia/chronic limb-threatening ischemia cases.

DOI： 10.1097/GOX.0000000000005010

PubMed

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Dermatofibroma is a common benign skin lesion with a contested etiology: some believe it is a neoplasm while others propose minor injuries initiate it. Many dermatofibroma variants have been described, including keloidal dermatofibroma, which is unusual by bearing keloidal collagen. Keloidal dermatofibroma was first described in 1998 and only 15 cases have been reported. Since keloids are driven by skin injuries, the existence of keloidal dermatofibroma has been suggested to support the injury hypothesis of dermatofibroma etiology. To better understand keloidal dermatofibroma characteristics and gain clues regarding dermatofibroma etiology, consecutive keloidal dermatofibroma cases (n = 52) and dermatofibroma without keloidal collagen (n = 2077) that were histopathologically diagnosed in 2016-2019 were identified from the records of a Japanese dermatopathology laboratory and compared in terms of demographic, clinical, and histopathological characteristics by univariate analyses. Compared to other dermatofibromas, keloidal dermatofibromas occurred more frequently on the forearm and hand (P < 0.0001 and 0.0019), especially the wrist dorsum, and in the superficial skin layer (P < 0.0001). Keloidal dermatofibromas also demonstrated more cellularity and hemorrhage (both P < 0.0001). Correlation analyses between keloidal collagen amount and keloidal dermatofibroma size (a proxy of time-since-onset) did not support the notion that keloidal collagen deposition and keloidal dermatofibroma formation are triggered simultaneously. Recent injury, as indicated by fresh hemorrhage, was equally common in putatively older and younger keloidal dermatofibromas. Thus, keloidal collagen in keloidal dermatofibromas could be due to injury to preexisting dermatofibromas, which suggests that the keloidal dermatofibroma entity does not prove the injury hypothesis. Commonalities between keloids and keloidal dermatofibromas suggest a link between genetics, provocative events that induce myofibroblast differentiation, and keloidal collagen production.

DOI： 10.1111/1346-8138.16638

PubMed

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Language：Japanese   Publisher：日本皮膚病理組織学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

症例は53歳男性で、40歳ごろから歩行時や起床時、脱水時に両下腿の痛みを自覚することがあったが、休息等により自然軽快していた。その後、転職したことにより片道1時間、徒歩と電車での通勤となり、転職3日目に痛みが生じ始め、4日目には間欠性の跛行となった。5日目には痛みは強く持続性となり、その翌日、欠勤のうえ当院受診となった。造影CT所見より下腿前区画コンパートメント症候群を疑い治療を開始した。入院6日目にデブリードマンを施行し、左側は前脛骨筋、長趾伸筋が完全壊死し、右側は前脛骨筋、長趾伸筋、長母趾伸筋が完全壊死していた。入院10日目に左側は一部縫縮、右側は完全縫縮を行い、左側は死腔と潰瘍を認めたため局所陰圧閉鎖療法を併用し、入院18日目に同側大腿部より分層植皮術を施行し治癒した。リハビリテーションの施行と装具の装着により、入院25日で退院となった。発症前と同様の通勤を再開したが、退院後6ヵ月の時点で症状の再燃はない。

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/GOX.0000000000004847

PubMed

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Language：Japanese   Publisher：Japan Society for Surgical Wound Care  

DOI： 10.11310/jsswc.14.67

CiNii Research

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：English   Publishing type：Research paper (scientific journal)  

UNLABELLED: No standards for the assessment of axillary odor intensity and the effects of therapy for osmidrosis have been established. This study presents an objective method for assessing odor severity in patients with osmidrosis and investigates the volatile odorants and skin flora. METHODS: The odor intensity was measured pre- and postoperatively using an industrial odor sensor in 79 patients with osmidrosis. Cultures of the axillary skin were obtained during skin flap surgery. Volatile odorants of the patients were assessed using an odor-sensor gas chromatograph mass spectrometer, and samples collected from clothing worn by the patients before and after surgery. The skin pH of the axilla was measured before and after surgery. The locations of odorants and bacteria in the skin were observed using electron microscopy. RESULTS: The mean patient age was 28.8 years, and the male-to-female ratio was 4:3. The odor significantly decreased from 52.6 preoperatively to 20.5 postoperatively (P < 0.001). The bacterial flora on the skin included mostly Staphylococcus. Multiple causative substances (volatile proteins) were identified on gas chromatography. The mean preoperative axillary skin pH was 6.21, which was significantly different than that of patients without osmidrosis (5.92; P < 0.01). CONCLUSIONS: An odor sensor accurately assesses odor intensity in patients with osmidrosis. The neutralization of axillary pH may promote the production of odorants by creating the optimal pH for bacterial growth. Odor sensor and pH values can be used pre- and postoperatively as objective assessment measurements for patients with osmidrosis.

DOI： 10.1097/GOX.0000000000004622

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Language：Japanese   Publisher：(一社)日本熱傷学会  

糖尿病を有する患者の足部低温熱傷潰瘍に対し腰部交感神経節ブロック(lumbar sympathetic nerve block:以下LSNB)を行うことで上皮化が得られた症例を経験した.LSNBは下肢の血流改善効果・交感神経求心路に関与する痛みの緩和効果などがあり,本症例においても糖尿病性神経障害の緩和目的に施行したが,施行後より難治性であった創部の良好な収縮を得た.直接的には下肢の血流改善効果が影響し,間接的には糖尿病性神経障害が緩和したことで十分な創処置が可能になったことが潰瘍の改善に寄与したと考えられた.LSNBは難治性となりやすい糖尿病性足部熱傷潰瘍において,新しい治療の選択肢となりえる.(著者抄録)

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UNLABELLED: Keloids are red' invasive scars that are driven by chronic inflammation in the reticular dermis. The role of blood vessels in keloid behavior remains poorly understood. In the present study with 32 keloid patients, we examined the hemodynamics of keloid tissue, the anatomy of the blood vessels feeding and draining the keloids, and the vascular histology of keloids. METHODS: Ten patients with large anterior chest keloids underwent near-infrared spectroscopy, which measured regional saturation of oxygen and total hemoglobin index in the keloid and surrounding skin. Another 10 patients with large chest keloids and three healthy volunteers underwent multidetector-low computed tomography. The extirpated chest keloids of 12 patients were subjected to histology with optical, CD31 immunohistochemical, and electron microscopy. RESULTS: All keloids had a low regional saturation of oxygen and a high total hemoglobin index, which is indicative of blood congestion. Multidetector-low computed tomography revealed dilation of the arteries and veins that were respectively feeding and draining the keloid leading edge. Hematoxylin-eosin staining and CD31 immunohistochemisty revealed considerable neovascularization in the keloid leading edge but not in the center. Electron microscopy showed that the lumens of many vessels in the keloid center appeared to be occluded or narrowed. CONCLUSIONS: Keloids seem to be congested because of increased neovascularization and arterial inflow at the leading edge and blocked outflow due to vascular destruction in the center. The surrounding veins seem to expand in response to this congested state. Methods that improve the blood circulation in keloids may be effective therapies.

DOI： 10.1097/GOX.0000000000004374

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Language：Japanese   Publisher：日本医科大学医学会  

69歳男性。右上口唇部の腫瘤を主訴とした。初診時、上口唇に32mmの淡紅色で辺縁やや不整な隆起性病変が認められた。また、MRIでは上口唇部皮膚から口輪筋に浸潤する35mm大のT1T2ともに低信号を呈する腫瘤が認められた。治療にあたって、腫瘍の拡大切除は患者QOLを著しく低下させると考え、辺縁切除と皮弁再建を行い、術後は放射線治療を併用することになった。その結果、最終病理診断は原発性皮膚未分化びまん性大細胞型リンパ腫であった。術後3年経過現在、腫瘍の再発はなく、整容的・機能的にも満足のいく結果が得られている。

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J04260&link_issn=&doc_id=20220307420017&doc_link_id=%2Fcw1nimed%2F2022%2F001801%2F019%2F0109-0113%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fcw1nimed%2F2022%2F001801%2F019%2F0109-0113%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

症例は4歳女児で、禿髪を主訴とした。頭頂部脂腺母斑の疑いで紹介受診し、頭頂部に1cm大の禿髪と隆起性皮膚局面を認め、頭部単純X線で頭頂骨の骨欠損が疑われたため、腫瘍の切除を計画した。禿髪部周囲の毛根がやや密であり、術中頭蓋骨方向に連続する瘢痕様の索状組織を認めたため、脳神経外科医に確認後、索状物を頭蓋側で結紮して腫瘤を一塊に摘出した。また、頭部単純CTでは頭頂骨矢状縫合付近に小孔を認め、頭蓋骨欠損に連続する脳瘤を考えたが、病理組織学的所見は高分化なアストロサイトと膠原線維のみで構成された組織で脈絡叢は確認されず、免疫組織学的所見でglial fibrillary acidic protein、S-100蛋白が陽性、髄膜のマーカー(EMA)が陰性より、異所性脳組織と診断した。小児の頭部正中に生じた皮膚腫瘤は脳瘤や異所性脳組織を鑑別に挙げる必要がある。

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Language：Japanese   Publisher：(一社)日本形成外科学会  

71歳女性。3年前に左上眼瞼、左右頬部に軽度硬結を伴う隆起性小病変が出現し、同部が急激に増大したため当科へ受診となった。初診時、左頬部に16mm、左上眼瞼に6mm、右頬部に3mm大の結節性病変が認められ、左頬部・上眼瞼部腫瘤の組織生検で皮膚粘液癌とされた。以後、治療として左頬部と左上眼瞼部の腫瘍切除術を行い、初回手術14日後に左頬部の皮膚欠損部をcheek rotation flapで、また左上眼瞼部皮膚欠損部をhatchet flapで創閉鎖し、右頬部の皮膚腫瘍を切除・単純縫縮した。目下、術後9ヵ月経過で転移・再発所見なく、良好に経過している。

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Language：English   Publishing type：Research paper (scientific journal)  

In 2006, we established a scar/keloid-specialized unit in the Department of Plastic, Reconstructive, and Aesthetic Surgery at Nippon Medical School (NMS) in Tokyo, Japan. In the ensuing 15 years, we treated approximately 2,000 new scar/keloid patients annually. This extensive experience has greatly improved the efficacy of the treatments we offer. Therefore, we discuss here the latest NMS protocol for preventing and treating keloids and hypertrophic scars. While this protocol was optimized for Japanese patients, our experience with a growing body of non-Japanese patients suggests that it is also effective in other ethnicities. The extensive evidence-based experience underlying the NMS protocol suggests that it may be suitable as the foundation of a standard international prevention/treatment algorithm for pathological scars.

DOI： 10.1272/jnms.JNMS.2021_88-106

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Language：English  

Cryptotia is a congenital auricular deformity. Common methods of surgical reconstruction involve creating an auricular temporal groove using local flaps and/or a skin graft. However, it can be difficult to determine which method is most suited to the unique 3-dimensional (3D) structure of each cryptotic ear. Here, we showed that creating 3D ear models of a cryptotic ear with a 3D camera and printer and using these models to simulate surgery with two different flap methods (cat's-ear and square) allowed selection of a reconstruction method that led to good outcomes after the actual surgery. The patient was a 7-year-old girl with left cryptotia. A 3D camera was used to acquire 3D data for the ear. After structural analysis, a home 3D printer was used to print the data into 3D ear models using an elastic material. These models exhibited good plasticity. After subjecting the models to simulated cat's-ear and square flap surgeries, the cat's-ear flap method was considered to better reproduce the healthy side of the ear compared with the square flap method for this particular case. Ear morphology during and after the actual surgery closely resembled the model-ear morphology during and after the simulated cat's-ear flap surgery. We successfully created a full-scale 3D model with good plasticity using a 3D camera and 3D printer. This allowed easy, noninvasive preoperative evaluation and identification of the most suitable operation for the specific case, facilitating easier, more successful surgery.

DOI： 10.1097/GOX.0000000000003194

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: A universally accepted therapeutic strategy for umbilical keloids has not been determined. Our team has had considerable success with combination therapy composed of surgical excision followed by postoperative radiotherapy and steroid plaster/injection. METHODS: All consecutive patients with umbilical keloids that developed from endoscopic surgical scars and underwent minimal-margin keloid excision followed by umbilicoplasty with a flap if needed, tension-reduction suturing, and postoperative radiotherapy in 2013-2017 in the keloid/scar-specialized clinic at the Department of Plastic, Reconstructive and Aesthetic Surgery of Nippon Medical School. The postsurgical radiotherapy regimen was 15 Gy administered in 2 fractions over 2 consecutive days. Radiotherapy was followed by tension-reducing wound self-management with silicone tape or, if needed, steroid plaster. The primary study focus was keloid recurrence during the 24-month follow-up period. Recurrence was defined as the growth of stiff red lesions in even small areas of the scar that was refractory to 2-6 months of steroid-plaster therapy. RESULTS: The case series consisted of 34 patients with 34 lesions. Three lesions (8.8%) recurred. One recurrence was successfully treated by concomitant steroid plaster/injection. The other 2 cases were resistant to steroid injection and underwent reoperation without radiotherapy followed by 6 months of steroid-plaster therapy. None of the 3 cases recurred within 2 years of steroid plaster/injection completion or reoperation. CONCLUSION: Umbilical keloids can be successfully treated by customized treatment plans that involve appropriate surgical modalities (including umbilicoplasty, if required), postoperative radiotherapy (15 Gy/2 fractions/2 days), and wound/scar self-management with silicone tape and steroid plaster.

DOI： 10.1097/GOX.0000000000003181

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Language：English   Publishing type：Research paper (scientific journal)  

Hypertrophic scars (HSs) and keloids are histologically characterized by excessive extracellular matrix (ECM) deposition. ECM deposition depends on the balance between matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteases (TIMPs). TIMP-1 has been linked to ECM degradation and is therefore a promising therapeutic strategy. In this study, we generated super carbonate apatite (sCA) nanoparticle-encapsulated TIMP-1 small interfering RNA (siRNA) (siTIMP1) preparations and examined the effect of local injections on mouse HSs and on ex vivo-cultured keloids. The sCA-siTIMP1 injections significantly reduced scar formation, scar cross-sectional areas, collagen densities, and collagen types I and III levels in the lesions. None of the mice died or exhibited abnormal endpoints. Apatite accumulation was not detected in the other organs. In an ex vivo keloid tissue culture system, sCA-siTIMP1 injections reduced the thickness and complexity of collagen bundles. Our results showed that topical sCA-siTIMP1 injections during mechanical stress-induced HS development reduced scar size. When keloids were injected three times with sCA-siTIMP1 during 6 days, keloidal collagen levels decreased substantially. Accordingly, sCA-siRNA delivery may be an effective approach for keloid treatment, and further investigations are needed to enable its practical use.

DOI： 10.1016/j.omtn.2020.08.005

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BACKGROUND: The 1,064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser (Cutera, Inc., Brisbane, CA) and steroid tape (fludroxycortide tape) have been used to treat keloids and hypertrophic scars. OBJECTIVE: To evaluate the efficacy of contact-mode 1,064-nm Nd:YAG laser therapy and steroid tape for hypertrophic cesarean-section scars versus conservative therapy (steroid tape only). MATERIALS AND METHODS: A medical record review identified 40 consecutive Japanese patients who had hypertrophic scars (total Japan Scar Workshop Scar Scale [JSS] 2015 evaluation scores of 9 to 12) for more than 1 year after a vertical cesarean section and who were treated at our scar-specialist clinic from July 2015 to December 2017. All 40 patients continued treatment until the total JSS score dropped below 3. Recurrence was defined as a ≥1-point increase in the total JSW score 6 months after achieving a total JSS score <3. RESULTS: The patients had a mean age of 34.2 years. The test (n = 25) and control (n = 15) groups took on average 16.9 and 24.3 months to achieve a total JSS score <3, respectively (p < .01). In the following 6 months, none of the scars recurred. CONCLUSION: Nd:YAG laser treatment effectively decreased the total treatment time of hypertrophic cesarean-section scars. An algorithm for treating mild and severe hypertrophic cesarean-section scars is proposed.

DOI： 10.1097/DSS.0000000000002235

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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BACKGROUND: Severe keloids are currently treated with surgical resection followed by radiation. Radiotherapy is essential for preventing recurrences. Fascia tensile reduction suturing may also prevent recurrence. We asked whether superficial fascia tensile reduction with or without deep fascia tensile reduction reduced skin mechanical tension and yielded good outcomes. METHODS: Geometric modeling on 3-dimensional anatomic shapes assessed the effect of superficial fascia tensile reduction with or without deep fascia tensile reduction on skin tension. A retrospective cohort study was performed on patients with severe anterior-chest keloids with Japan Scar Workshop-scar scale classification score ≥ 16 who underwent resection plus fascia tensile reduction plus radiotherapy between 2011 and 2016 and were followed for >18 months. Patient characteristics and 18-month postoperative outcomes were examined. Postoperative outcome was defined as rates of keloid disappearance, improvement, and obvious recurrence. RESULTS: Maximal mechanical forces placed on the dermis by dermal sutures, dermal sutures plus superficial fascia tensile reduction, and dermal sutures plus superficial fascia tensile reduction plus deep fascia tensile reduction were 4,700, 573, and 697 Pa, respectively. Adding deep fascia tensile reduction to superficial fascia tensile reduction decreased the force on the superficial fascia. Of 77 cohort patients, 27 and 50 underwent superficial fascia tensile reduction and superficial fascia tensile reduction plus deep fascia tensile reduction, respectively. Superficial fascia tensile reduction plus deep fascia tensile reduction patients underwent complete excision more often (60.0% vs 37.0%, P = .046). The groups did not differ in 18-month surgical outcome, including recurrence rate (P = .670). CONCLUSION: Our 2003 study showed that in anterior-chest keloids, resection plus non-fascial suturing plus radiotherapy led to a 43.1% recurrence. Thus, fascia tensile reduction suturing helps reduce anterior-chest keloid recurrence to ∼5.2%. Superficial fascia tensile reduction plus deep fascia tensile reduction is suitable for relatively large keloids that require total resection. Deep fascia tensile reduction may facilitate superficial fascia tensile reduction but may only be useful when it is technically difficult to achieve reduction with superficial fascia tensile reduction alone.

DOI： 10.1016/j.surg.2019.07.028

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Wound healing is a complex biological process, and imbalances of various substances in the wound environment may prolong healing and lead to excessive scarring. Keloid is abnormal proliferation of scar tissue beyond the original wound margins with excessive deposition of extracellular matrix (ECM) and chronic inflammation. Despite numerous previous research efforts, the pathogenesis of keloid remains unknown. Vascular endothelial cells (VECs) are a major type of inductive cell in inflammation and fibrosis. Despite several studies on vascular morphology in keloid formation, there has been no functional analysis of the role of VECs. In the present study, we isolated living VECs from keloid tissues and investigated gene expression patterns using microarray analysis. We obtained 5 keloid tissue samples and 6 normal skin samples from patients without keloid. Immediately after excision, tissue samples were gently minced and living cells were isolated. Magnetic-activated cell sorting of VECs was performed by negative selection of fibroblasts and CD45+ cells and by positive selection of CD31+cells. After RNA extraction, gene expression analysis was performed to compare VECs isolated from keloid tissue (KVECs) with VECs from normal skin (NVECs). After cell isolation, the percentage of CD31+ cells as measured by flow cytometry ranged from 81.8%-98.6%. Principal component analysis was used to identify distinct molecular phenotypes in KVECs versus NVECs and these were divided into two subgroups. In total, 15 genes were upregulated, and 3 genes were downregulated in KVECs compared with NVECs using the t-test (< 0.05). Quantitative RT-PCR and immunohistochemistry showed 16-fold and 11-fold overexpression of SERPINA3 and LAMC2, respectively. SERPINA3 encodes the serine protease inhibitor, α1-antichymotripsin. Laminin γ2-Chain (LAMC2) is a subunit of laminin-5 that induces retraction of vascular endothelial cells and enhances vascular permeability. This is the first report of VEC isolation and gene expression analysis in keloid tissue. Our data suggest that SERPINA3 and LAMC2 upregulation in KVECs may contribute to the development of fibrosis and prolonged inflammation in keloid. Further functional investigation of these genes will help clarify the mechanisms of abnormal scar tissue proliferation.

DOI： 10.3389/fcell.2020.00658

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Language：Japanese   Publisher：(一社)日本形成外科学会  

先天性耳介変形の正確な形態把握と矯正器具作製を目的として、3Dカメラ・プリンタを用いて耳介3Dモデルを作製した。今回、この耳介3Dモデルの有用性について代表症例を供覧するとともに、文献的考察を含めて報告した。当院で治療を行った先天性耳介変形13名のうち7名11耳に対し3Dモデルを用いた矯正療法を行い、6例で手術療法を選択した。3Dカメラ撮影により非侵襲的に耳介の3Dモデルを構築することが可能であった。一般的に用いられることが多い硬性プラスチック素材ではなく弾性フィラメントで出力を行うことで3Dモデルは用手的に変形可能であり、実際の耳介に近い矯正が可能であった。モデルを理想的な形態に変形させ、熱可塑性樹脂や鋼線とカテーテルなどにより矯正器具を作製した。折れ耳の3Dモデルで舟状窩の再現が困難な症例があるが(耳輪と対耳輪上脚が接着し窪みの再現が困難である場合)おおよその矯正後耳介を再現してから矯正器具を作製することで器具を修正する必要はなかった。

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UNLABELLED: Therapies for upper arm keloids include surgical excision followed by postoperative radiotherapy, silicone tape stabilization, and steroid plaster. However, a universally accepted therapeutic strategy for upper-arm keloids is lacking. METHODS: All consecutive patients with single upper-arm keloids who underwent keloid excision followed by tension-reducing suturing, multiple z-plasties, and postoperative radiotherapy in 2013-2016 in the keloid/scar specialist clinic at the Department of Plastic, Reconstructive and Aesthetic Surgery of Nippon Medical School, were included in this case series study. Only keloids that arose from the small injury produced during Bacillus Calmette-Guérin vaccination were selected. The postsurgical radiotherapy regimen was 18 Gy administered in 3 fractions over 3 days. Radiotherapy was followed by tension-reducing wound self-management with silicone tape and, if needed, steroid plaster. The primary study objective was keloid recurrence during the 24-month follow-up period. Recurrence was defined as the growth of stiff red lesions in even small areas of the scar that was refractory to at least 2 months of steroid plaster therapy. RESULTS: In total, 38 patients with 38 lesions were enrolled. Two lesions (5.3%) recurred. Both recurrences were successfully treated by concomitant steroid plaster and steroid injection. The recurrence patients were significantly more likely than the nonrecurrence patients to have multiple keloids. The 2 groups did not differ in terms of original keloid size. CONCLUSIONS: Upper-arm keloids can be successfully treated by customized plans that involve appropriate surgical modalities (including multiple z-plasties), postoperative radiotherapy (18 Gy/3 fractions/3 d), and postoperative wound/scar self-management with silicone tape and steroid plaster.

DOI： 10.1097/GOX.0000000000002496

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BACKGROUND: Fibroproliferative disorders result in excessive scar formation, are associated with high morbidity, and cost billions of dollars every year. Of these, keloid disease presents a particularly challenging clinical problem because the cutaneous scars progress beyond the original site of injury. Altered mechanotransduction has been implicated in keloid development, but the mechanisms governing scar progression into the surrounding tissue remain unknown. The role of mechanotransduction in keloids is further complicated by the differential mechanical properties of keloids and the surrounding skin. METHODS: The authors used human mechanical testing, finite element modeling, and immunohistologic analyses of human specimens to clarify the complex interplay of mechanical stress, strain, and stiffness in keloid scar progression. RESULTS: Changes in human position (i.e., standing, sitting, and supine) are correlated to dynamic changes in local stress/strain distribution, particularly in regions with a predilection for keloids. Keloids are composed of stiff tissue, which displays a fibrotic phenotype with relatively low proliferation. In contrast, the soft skin surrounding keloids is exposed to high mechanical strain that correlates with increased expression of the caveolin-1/rho signaling via rho kinase mechanotransduction pathway and elevated inflammation and proliferation, which may lead to keloid progression. CONCLUSIONS: The authors conclude that changes in human position are strongly correlated with mechanical loading of the predilection sites, which leads to increased mechanical strain in the peripheral tissue surrounding keloids. Furthermore, increased mechanical strain in the peripheral tissue, which is the site of keloid progression, was correlated with aberrant expression of caveolin-1/ROCK signaling pathway. These findings suggest a novel mechanism for keloid progression.

DOI： 10.1097/PRS.0000000000005717

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BACKGROUND: The therapies for anterior chest wall keloids include surgical excision, postoperative radiotherapy, silicone taping stabilization, and steroid plaster. However, to date, there is no universally accepted combination treatment strategy for anterior chest wall keloids. METHODS: All consecutive patients with single or multiple anterior chest wall keloids who underwent keloid excision, tension-reducing suturing, z-plasty, and postoperative radiotherapy in 2013-2016 in Nippon Medical School were included in this case series study. Only keloids that arose from small injuries such as folliculitis or acne were selected. The surgery was followed by tension-reducing self-management of the wounds with silicone tape and steroid plaster. The postsurgical radiotherapy modality was 18 Gy administered in 3 fractions over 3 days. The primary study outcome was keloid recurrence during the 24-month follow-up period. Recurrence was defined as the development of stiff and red lesions in even a small part of the scar that did not respond to 6 months of steroid plaster therapy. RESULTS: In total, 141 patients with 141 lesions were enrolled. Of the 141 lesions, 15 (10.6%) recurred. All recurrences were successfully treated by steroid plaster and steroid injection. The recurrence patients did not differ from the nonrecurrence patients in terms of the size of the original keloid or gender distribution. CONCLUSIONS: Anterior chest wall keloids can be successfully treated by customized plans that involve appropriate surgical modalities (including z-plasty) followed by postoperative radiotherapy (18 Gy in 3 fractions over 3 days) and scar self-management with silicone tape and steroid plaster.

DOI： 10.1097/GOX.0000000000002177

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Keloids can be treated in a number of ways, including by surgery. Multiple studies now show that while surgical monotherapy associates with extremely high rates of recurrence (50%-80%), postoperative radiotherapy can significantly reduce these recurrence rates. Ongoing improvements in radiation technology have further increased the safety and efficacy of this combination protocol. Of the various radiotherapies that have been used in this setting, electron beam (β-ray) irradiation is currently the best due to its excellent dose distribution and safety. The maximal biologically effective dose (BED) for keloids is 30 Gy (using an estimated α / β ratio of 10); increasing the dose has no further benefits and elevates side effects. Over the last two decades, we have modified and then fine-tuned our radiotherapy protocol for keloid excision wounds. Thus, our early protocol was used for all body sites and consisted of 15 Gy/3 fr/3 days. We then customised the radiotherapy protocol so that body sites that are highly prone to recurrence (e.g. the anterior chest) receive higher doses while low recurrence sites like the earlobe receive a much smaller dose. More recently, we tweaked this body site-customised protocol so that fewer fractions are employed. Therefore, we currently apply 18 Gy/3 fr/3 days to high-recurrence sites, 8 Gy/1 fr/1 day to earlobes and 15 Gy/2 fr/2 days to other body sites. These radiotherapy protocol changes were accompanied by the evolution of body site-customised surgical approaches. As a result of these developments, our overall keloid recurrence rate is now below 10%.

DOI： 10.1177/2059513119891113

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Pseudomyogenic hemangioendothelioma (PMHE) is a new entity. It is an intermediate soft tissue tumor clinically and/or histopathologically mimicking some other high-grade malignant tumors and some inflammatory diseases. We report a case of PMHE on the left plantar surface of a 28-year-old woman. Histopathological examination of the resected specimen revealed spindle and epithelioid cells with plump and atypical nuclei proliferated in the dermis and subcutaneous fat tissue with marked fibroplasia. Both spindle and epithelioid cells had abundant eosinophilic cytoplasm. Neoplastic cells were diffusely positive for AE1/AE3, CK7, vimentin, CD31, FLI-1, ERG, and INI-1. From those findings, we made the diagnosis of PMHE. We describe the main points of differentiation between PMHE and diseases that have similar clinical and/or histopathological findings, including cellular dermatofibroma, spindle cell squamous cell carcinoma, epithelioid sarcoma, epithelioid hemangioendothelioma, epithelioid angiosarcoma, nodular or proliferative fasciitis, and granulomatous fibrosing granulation tissue due to a ruptured epidermal cyst.

DOI： 10.1272/jnms.JNMS.2019_86-209

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There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases. This is particularly true for clinicians who deal with Asian and African patients because these ethnicities are highly prone to these diseases. By contrast, Caucasians are less likely to develop keloids and hypertrophic scars, and if they do, the scars tend not to be severe. This ethnic disparity also means that countries vary in terms of their differential diagnostic algorithms. The lack of clear treatment guidelines also means that primary care physicians are currently applying a hotchpotch of treatments, with uneven outcomes. To overcome these issues, the Japan Scar Workshop (JSW) has created a tool that allows clinicians to objectively diagnose and distinguish between keloids, hypertrophic scars, and mature scars. This tool is called the JSW Scar Scale (JSS) and it involves scoring the risk factors of the individual patients and the affected areas. The tool is simple and easy to use. As a result, even physicians who are not accustomed to keloids and hypertrophic scars can easily diagnose them and judge their severity. The JSW has also established a committee that, in cooperation with outside experts in various fields, has prepared a Consensus Document on keloid and hypertrophic scar treatment guidelines. These guidelines are simple and will allow even inexperienced clinicians to choose the most appropriate treatment strategy. The Consensus Document is provided in this article. It describes (1) the diagnostic algorithm for pathological scars and how to differentiate them from clinically similar benign and malignant tumors, (2) the general treatment algorithms for keloids and hypertrophic scars at different medical facilities, (3) the rationale behind each treatment for keloids and hypertrophic scars, and (4) the body site-specific treatment protocols for these scars. We believe that this Consensus Document will be helpful for physicians from all over the world who treat keloids and hypertrophic scars.

DOI： 10.1186/s41038-019-0175-y

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Sclerotic fibromas of the skin (SFSs) have a very characteristic histology but the clinical signs are non-specific. Consequently, it is extremely difficult to make a diagnosis of SFS on the basis of the clinical findings only. We report here two cases of SFS arising on the right scapular region and the right lower leg, respectively. Both cases were clinically similar to keloids. Skin surgeons should remember that SFSs are an important differential diagnosis from keloids.

DOI： 10.1272/jnms.JNMS.2018_85-45

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Keloids grow and do not regress. They are characterised histologically by hyalinised keloidal collagen (HKC). HKC amounts vary, and the mechanism by which they form is unclear. To clarify how HKCs form and whether their formation associates with specific clinical features, we studied the histological findings of earlobe keloids and compared them with respective clinical features. A total of 50 earlobe keloids from 43 patients were used for histological analysis of keloid size (mm2 ), HKC area (mm2 ) and HKC area ratio (%). As a result, keloid durations ranged from 3 months to >13 years. Early-stage keloids exhibited little HKC and a tendency for the HKCs to locate in perivascular regions. In later-stage keloids, the HKCs were extremely interconnected and formed a thick bitten donut-shaped region. HKC area ratios correlated positively with keloid duration (r2 = 0·58, P<0·05). HKC area ratios and keloid durations did not correlate with keloid sizes. These patterns of HKC formation and growth may explain why local therapies, which effectively remove fibroblasts and accumulated collagen but not HKCs, are ineffective in older keloids. Keloids should be promptly treated after diagnosis, and older keloids with extensive HKCs may require surgical excision followed by radiotherapy.

DOI： 10.1111/iwj.12763

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Language：English  

Keloids are caused by excessive scar formation that leads to scar growth beyond the initial scar boundaries. Keloid formation and progression is promoted by mechanical stress such as skin stretch force. Consequently, keloids rarely occur in paralyzed areas and areas with little skin tension, such as the periauricular region. Therefore, periauricular incision is commonly performed for face lifts. We report a rare case of keloids that arose from face-lift scars in a patient with bilateral facial nerve paralysis. A 51-year-old Japanese man presented with abnormal proliferative skin masses in bilateral periauricular scars. Seventeen years before, he had a cerebral infarction that resulted in permanent bilateral facial nerve paralysis. Three years before presentation, the patient underwent face-lift surgery with periauricular incisions. We diagnosed multiple keloids. We removed the masses surgically, closed the wounds with sutures in the superficial musculoaponeurotic system layer to reduce tension on the wound edges, reconstructed the earlobes with local skin flaps, and provided 2 consecutive days of radiotherapy. The wounds/scars were managed with steroid plasters and injections. Histology confirmed that the lesions were keloids. Ten months after surgery, the lesions did not exhibit marked regrowth. The keloids appeared to be caused by the patient's helmet, worn during his 3-hour daily motorcycle rides, which placed repeated tension on the periauricular area. This rare case illustrates how physical force contributes to auricular and periauricular keloid development and progression. It also shows that when performing surgery with periauricular incisions, care should be taken to eliminate wound/scar stretching.

DOI： 10.1097/GOX.0000000000001417

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Language：Japanese   Publisher：(一社)日本形成外科学会  

目的:2012年に日本医科大学付属病院で多剤耐性アシネトバクター(以下MDRA)の院内伝播があり、MDRA陽性患者には当科で局所陰圧閉鎖療法を行った症例も含まれていた。局所陰圧閉鎖療法と汚染・感染との関連性と感染対策について考察した。対象と方法:MDRA陽性となった患者のなかで、当科がV.A.C.ATS治療システム(以下V.A.C.)を用いた局所陰圧閉鎖療法を行った患者を調査した。結果:当院のMDRA陽性患者25名のうち5名が当科で局所陰圧閉鎖療法を行っていた。その5名はすべて同一病棟の入院患者であった。当院のMDRA陽性患者はすべて保菌のみで、感染症で難渋した症例はなかった。環境培養検査でV.A.C.の内部フィルター部からはMDRAが検出されず、V.A.C.そのものがMDRAを媒介したことは否定的であった。考察:患者が移動する際に外すチューブのコネクターやチューブ表面からMDRAが伝播する可能性も考えられた。MDRAは接触感染により伝播しやすく、注意が必要である。(著者抄録)

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BACKGROUND: The commonly used flap models have drawbacks that limit their usefulness. In the random skin flap model, flap necrosis is caused by both arterial and venous insufficiency. In the axial skin flap model, flap viability is easily affected by the pedicle blood flow and can result in complete necrosis. This study aimed to establish a new rat skin flap model that has a consistent flap survival rate and in which venous congestion and arterial ischemia can be readily distinguished macroscopically. METHODS: Rats underwent reverse U-shaped bipedicled superficial epigastric artery flap elevation. The right superficial epigastric vessels formed the pedicle. In the control rats (n = 3), the left superficial epigastric vessels were left intact. In the ischemia group (n = 10), the left superficial epigastric artery was ligated. In the congestion group (n = 10), the left superficial epigastric vein was ligated. The flap was returned to the original site and sutured. The surrounding neovascularization was blocked by polyurethane film. Flap survival rates were evaluated on postoperative day 3. RESULTS: The flaps in the ischemia and congestion groups were noticeably pale and violet, respectively. Flap necrosis was noted in the contralateral distal zone only. It started on postoperative day 2 in the ischemia and congestion groups. The mean flap survival rates of the control, ischemia, and congestion groups were 100 percent, 61.8 percent (range, 56.9 to 67.1 percent), and 42.3 percent (35.7 to 48.7 percent), respectively (all p < 0.001). CONCLUSIONS: The flap facilitated discrimination of the effects of ischemia and congestion. This new rat skin flap model is simple and easy to construct, and has a consistent flap survival rate.

DOI： 10.1097/PRS.0000000000002900

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Language：Japanese  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：CHURCHILL LIVINGSTONE  

Keloids and hypertrophic scars are fibroproliferative disorders (FPDs) of the skin that result from abnormal healing of injured or irritated skin. They can be called pathological or inflammatory scars. Common causes are trauma, burn, surgery, vaccination, skin piercing, folliculitis, acne, and herpes zoster infection. The pathogenesis of these scars clearly involves local conditions such as delayed wound healing, wound depth, and the tension of the skin around the scars. Scar severity is also shaped by interactions between these local factors and genetic and systemic factors such as hypertension and sex hormones. Notably, to evaluate scar severity, the Japan Scar Workshop (JSW) has established the JSW Scar Scale. Our studies show that tension on the skin around the wound results in prolonged and/or repeated bouts of inflammation in the reticular layer of the dermis and that this inflammation generates abnormal numbers of blood vessels (as well as collagen and nerve fibers) in the dermal reticular layer. We hypothesize that local factors, such as the mechanobiology of the dermis and blood vessels, along with genetic and systemic factors promote pathological scar development by inducing endothelial dysfunction (i.e., vascular hyperpermeability) during the inflammatory stage of wound healing. The continued presence of these factors prolongs the influx of inflammatory cells and factors, thereby leading to fibroblast dysfunction.Evidence for this hypothesis includes the fact that all effective treatments of keloids, namely, radiotherapy, compression therapy, steroid administration, and long-pulsed Nd:YAG laser therapy, act, at least partly, by suppressing blood vessels.At present, keloids are classified as strongly inflammatory scars, while hypertrophic scars are considered to be mildly inflammatory scars. However, we propose that keloids and hypertrophic scars are simply manifestations of the same skin FPD and differ only in the degree of endothelial dysfunction and therefore inflammation. We therefore suggest that these pathological scars should be classified on the basis of the factor that causes the endothelial dysfunction. Thus, primary scars are caused by congenital endothelial dysfunction (e.g., a mutation prevents endothelial gaps from closing smoothly) while secondary scars are caused by endothelial dysfunction that results from aging, arterial sclerosis, and/or repeated/very strong local mechanical forces. We expect that primary keloids develop at younger ages and tend to become severe, while secondary keloids are seen in all ages and can vary in clinical severity.Thus, abnormal blood vessel regulation may underlie keloid and hypertrophic scar pathogenesis, which suggests that inhibiting abnormal angiogenesis and vascular hyperpermeability may be an important therapeutic approach. (C) 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

DOI： 10.1016/j.mehy.2016.09.024

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: It is difficult to completely resect huge anterior chest wall keloids and then close the wound directly. We report here our retrospective analysis of our case series of patients with such keloids who underwent reconstruction with internal mammary artery perforator (IMAP) pedicled propeller flaps and then received postoperative high-dose-rate superficial brachytherapy.Methods: All consecutive patients with large/severe keloids on the anterior chest wall who underwent keloid resection followed by reconstruction with IMAP-pedicled propeller flaps and then high-dose-rate superficial brachytherapy in our academic hospital were identified. All cases were followed for >18 months. Donor site position, perforator pedicle, flap size, angle of flap rotation, complications, and recurrence were documented.Results: There were nine men and one woman. The average age was 37.9 years. The average follow-up duration was 28.7 months. The largest flap was 16 x 4 cm. The dominant perforators of the internal mammary artery were located in the sixth (n = 2), seventh (n = 5), eighth (n = 1), and ninth (n = 2) intercostal spaces. Twelve months after surgery, patients reported marked relief from keloid-associated pain and itching, except in two patients who underwent partial keloid resection; their remaining keloids were still troublesome but after conservative therapies, including steroid ointments/plasters, the keloids gradually ameliorated. Eighteen months after surgery, there was no keloid recurrence or new development of keloids on the donor site.Conclusions: IMAP-pedicled propeller flaps transfer skin tension from the anterior chest wall to the abdomen. Our series suggests that this approach combined with radiation therapy can control keloid recurrence.

DOI： 10.1097/GOX.0000000000001049

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Language：English   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

Keloids and hypertrophic scars are fibroproliferative disorders of the skin that are caused by abnormal healing of injured or irritated skin. It is possible that they are both manifestations of the same fibroproliferative skin disorder and just differ in terms of the intensity and duration of inflammation. These features may in turn be influenced by genetic, systemic, and local risk factors. Genetic factors may include single nucleotide polymorphisms, while systemic factors may include hypertension, pregnancy, hormones, and cytokines. The most important local factor is tension on the scar. Over the past 10 years, our understanding of the pathogenesis of keloids and hypertrophic scars has improved markedly. As a result, these previously intractable scars are now regarded as being treatable. There are many therapeutic options, including surgery, radiation, corticosteroids, 5-fluorouracil, cryotherapy, laser therapy, anti allergy agents, anti-inflammatory agents, bleaching creams and make-up therapies. However, at present, we believe that the following combination of three therapies most reliably achieves a complete cure: surgery, followed by radiation and the use of steroid tape/plaster.

DOI： 10.1272/jnms.83.46

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BACKGROUND: Keloids are characterized by the formation of excessive scar tissue that extends beyond the area of the initial wound. Keloid redness is due to angiogenesis and chronic inflammation and is an important indicator of the severity of the lesion and the effectiveness of treatment. METHODS: The color of 33 untreated keloids from 30 patients was measured with a narrow-band reflectance colorimeter. The erythema and melanin levels in the keloids (Ek and Mk, respectively) were recorded with control data obtained from the flexor aspect of the forearm (Ec and Mc, respectively). The keloid color was also evaluated subjectively. RESULTS: The Ek or Mk values did not vary significantly according to symptom intensity, scar region, patient age, and patient sex. Younger patients (<40 years) and female patients had significantly higher Ek/Ec ratios than did older patients and male patients, respectively. Subjective keloid redness evaluations distinguished keloids with high Ek/Ec ratios from keloids with low Ek/Ec ratios (P<0.0001) but could not distinguish keloids with high Ek from keloids with low Ek. CONCLUSIONS: Subjective evaluations of keloids in Japanese subjects reflected Ek/Ec ratios, which were strongly affected by variation in background skin color. The subjective assessment of the color of keloids or other skin disorders should be performed with caution in Asian populations.

DOI： 10.1272/jnms.83.142

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Keloids are defined as a kind of dermal fibroproliferative disorder resulting from the accumulation of collagen. In the remodeling of extracellular matrix, the balance between matrix metalloproteinases (MMPs) and the tissue inhibitors of metalloproteinases (TIMPs) is as critical as the proper production of extracellular matrix. We investigate the role of TIMPs and MMPs in the pathogenesis of keloids and examine the therapeutic potential of TIMP-2. METHODS: The expression of TIMPs and MMPs in most inflamed parts of cultured keloid fibroblasts (KFs) and peripheral normal skin fibroblasts (PNFs) in the same individuals and the reactivity of KFs to cyclic mechanical stretch were analyzed by quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay (n = 7). To evaluate the effect of treating KFs with TIMP-2, collagen synthesis was investigated by quantitative real-time polymerase chain reaction and enzyme-linked immunosorbent assay, and microscopic analysis was used to examine the treatment effects of TIMP-2 on ex vivo cultures of keloid tissue (n = 6). RESULTS: TIMP-2 was downregulated in cultured KFs compared with PNFs in the same individuals, and the reduction in TIMP-2 was exacerbated by cyclic mechanical stretch. Administration of TIMP-2 (200 or 300 ng/mL) significantly suppressed expression of Col1A2 and Col3A1 mRNA and collagen type I protein in KFs. TIMP-2 also significantly reduced the skin dermal and collagen bundle thickness in ex vivo cultures of keloid tissue. CONCLUSION: These results indicated that downregulation of TIMP-2 in KFs is a crucial event in the pathogenesis of keloids, and the TIMP-2 would be a promising candidate for the treatment of keloids.

DOI： 10.1097/GOX.0000000000000503

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: Treatments for keloids on the cartilaginous part of the auricle (i.e., the upper part of the ear excluding the earlobe) include surgical excision, cryosurgery, postoperative radiation therapy, steroid injection, taping stabilization, and pressure therapy. However, to date, there is no universally accepted treatment strategy for auricle keloids.Methods: In this retrospective cohort study, the 63 primary auricle keloids in all 57 patients who underwent surgery from 2006 to 2012 were included. Mild scars such as hypertrophic scars were excluded. All 63 scars were treated with surgery, namely, total excision or intralesional excision (core excision method), and postoperative adjuvant radiation therapy and self-managed scar stabilization with surgical tape. The postsurgical radiation therapy consisted of 15 Gy administered in three fractions over 3 days. The recurrence rates associated with the two surgical methods over 18 months of follow-up were recorded.Results: Of the 57 patients, 91.2 percent were women. Of the 63 lesions, 95.2 percent and 4.8 percent were caused by piercing and trauma, respectively. All were primary keloids. Before 2009, all lesions (n = 37) were treated by total excision. After 2009, all lesions (n = 26) were treated by core excision. These methods were associated with recurrence rates of 8.1 percent and 0 percent, respectively, although this difference did not achieve statistical significance (p > 0.05). The overall recurrence rate was 4.8 percent. Complications such as wound dehiscence and pigmentation during the 18-month follow-up period were not observed.Conclusion: Auricle keloids can be treated by customized plans consisting of appropriate surgical modalities, postoperative radiotherapy, and self-management.

DOI： 10.1097/PRS.0000000000000962

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY-BLACKWELL  

This study assessed whether hypertension, a circulating factor, influences local keloid severity. This retrospective cross-sectional study involved 304 consecutive patients (13-78 years old) with keloids who were surgically treated in our hospital between January 2011 and August 2013. Their blood pressure (BP), age and gender, and the size and number of their keloids before surgery were recorded. Ordinal logistic regression analyses showed that BP associated significantly with both keloid size and number (all p&lt;0.0001). Age also associated with keloid size (p&lt;0.0001). However, a Goodness-of-fit chi-square test showed that the prevalence of hypertension was not higher among keloid patients than in the general Japanese population. This study provides epidemiological evidence for the possibility that primary hypertension may aggravate keloids. We propose that the skin, along with the heart and liver, is a target organ of hypertension. The observations of this study, which require validation with large-scale prospective interventional trials, suggest that keloid patients should be screened for hypertension and that antihypertensive treatments may be of prophylactic and therapeutic value for skin fibrosis.

DOI： 10.1111/wrr.12277

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The present retrospective cohort study was performed to determine the efficacy of contact-mode 1064 nm neodymium-yttrium-aluminum-garnet (Nd:YAG) laser laser for keloids and hypertrophic scars. The indication and limitations of this modality are discussed. METHODS: The cohort consisted of 102 consecutive Japanese patients (23 males and 79 females) with keloids and hypertrophic scars for more than 1 year. They were treated every 3-4 weeks for 1 year with a long-pulsed 1064 nm Nd:YAG laser (Cutera, Brisbane, Calif.) in contact mode. Thirty-eight patients had hypertrophic scars and 64 had keloids. The scars were evaluated before the treatment commenced and 1 month after the last session by using the Japan Scar Workshop Scar Scale 2011. Recurrence was assessed at 6 months after the termination of treatment. RESULTS: The average total Japan Scar Workshop score of the keloid and hypertrophic scar region groups dropped significantly after 1 year of treatment compared with before treatment (all P < 0.05). None of the hypertrophic scars or keloids deteriorated. However, 3 of the 34 anterior chest keloids (8.8%) did not respond. The following recurrence rates were observed 6 months after stopping laser treatment: 1 of the abdomen hypertrophic scars (4%), 18 of the anterior chest keloids (52.9%), 5 of the upper arm keloids (35.7%), and 4 of the scapula keloids (25%). CONCLUSIONS: Hypertrophic scars responded significantly better to 1064 nm Nd:YAG laser treatment than keloids. However, keloid recurrence occurred when there was remaining redness and induration, even if only a small part of the scar was affected.

DOI： 10.1097/GOX.0000000000000231

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY  

Hypertrophic scars (HSs) and keloids are commonly seen as two different diseases by both clinicians and pathologists. However, as supported by histological evidence showing they share increased numbers of fibroblasts and accumulate collagen products, HS and keloid might be different forms of the same pathological entity, rather than separate conditions. To test this hypothesis, keloids from patients who underwent scar excisions (n = 20) in Nippon Medical School from 2005 to 2010 were examined histologically. The proportion and distribution of cellular and matrix collagen components were evaluated at the centre and periphery of each sample. In keloid samples, coexistence of hyalinised collagen, which is the most important pathognomonic characteristic of a keloid and dermal nodules that are considered to be characteristic of HS, was found. Moreover, hyalinised fibres appeared to initiate from the corner of the dermal nodules. Key features of inflammation such as microvessels, fibroblasts and inflammatory cells all decreased gradually from the periphery to the centre of keloids, indicative of reduced inflammation in the centre. Thus, we hypothesise that HS and keloid can be considered as successive stages of the same fibroproliferative skin disorder, with differing degrees of inflammation that might be affected by genetic predisposition.

DOI： 10.1111/j.1742-481X.2012.01118.x

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：English   Publisher：NATURE PUBLISHING GROUP  

DOI： 10.1038/jid.2014.144

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Language：English   Publisher：NATURE PUBLISHING GROUP  

DOI： 10.1038/jid.2014.71

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Keloids are defined as overgrowths of scar tissue resulting from abnormal wound healing. They are characterized by excessive dermal deposition of thick, hyalinized collagen bundles resulting from an imbalance between the production and degradation of extracellular matrix (ECM) components. Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) are two important regulators of ECM degradation and remodeling. To evaluate the role played by knockdown of TIMPs in keloid formation, we transduced human keloid-derived fibroblasts (KFs) with small interfering RNAs targeting TIMP-1 or -2 (siTIMP-1 or siTIMP-2) using a lentiviral vector and assessed the biological effects. We found that MMP-1/TIMP-1 and MMP-1/TIMP-2 complexes were suppressed and that MMP-2 activity was upregulated in KFs expressing siTIMP-1 or siTIMP-2. In addition, increased degradation of collagen type I was observed in the supernatant of KFs expressing siTIMP-1, but not siTIMP-2, with the suppression of cell viability and induction of apoptosis. These results suggest that targeting TIMP-1 using small interfering RNA has significant therapeutic potential as an approach to treating keloids through degradation of their thick collagen bundles.

DOI： 10.1038/jid.2013.396

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：ELSEVIER SCI LTD  

Pathological scars are fibroproliferative skin disorders that are characterised by the accumulation of fibroblasts and collagens. It is increasingly understood that their development and progression may be related to local skin mechanics, such as stretching. The present study evaluated the morphological and functional effects of cellular stretch on normal human dermal fibroblasts and explored the mechanotransduction mechanisms that may be involved. When fibroblasts were subjected to 24 h of cyclic axial stretching (10 cycles min(-1)), they migrated faster and for a longer distance than unstretched cells. The increased migration resulted in the cells reorienting themselves perpendicular to the direction of stretching. This was associated with reduced cellular apoptosis and unchanged proliferation. Stretching did not increase collagen synthesis but did elevate collagen degradation. These biological effects appeared to be mediated by the integrin and Wnt mechanotransduction pathways, which transmitted the mechanical stimulus via cell-substrate interactions, cell-cell junctions and indirect cell-cell communications. A better understanding of such fibroblast mechanoresponses in vitro will help the development of novel interventions that can prevent, reduce or even reverse pathological scar formation and/or progression in vivo. (C) 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.bjps.2013.08.002

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: Treatments for earlobe keloids include surgical excision, postoperative radiotherapy, steroid injection, taping stabilization, and pressure therapy. However, to date, there is no universally accepted treatment strategy for earlobe keloid therapy.Methods: A total of 174 lesions in 145 patients who attended the keloid/scar specialist clinic at the Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, between 2006 and 2011 were included and were classified as having primary keloids or recurring keloids. Mild scars, such as hypertrophic scars, were excluded from this study. Appropriate surgical approaches, postoperative adjuvant therapies, such as radiotherapy, and postsurgical self-management were applied. The postsurgical radiotherapy modalities were 15 Gy administered in three fractions over 3 days and 10 Gy administered in two fractions over 2 days. Recurrence during the following 18-month follow-up period was recorded.Results: Of the 174 lesions, 85.6 percent were primary keloids and 14.4 percent were recurrent keloids. Their recurrence rates were 4.7 percent and 0 percent, respectively. The overall recurrence rate was 4.0 percent. Complications during the 18-month follow-up period were not observed. The groups treated with 15-Gy and 10-Gy postsurgical radiotherapy did not differ significantly in terms of recurrence rate (p > 0.05).Conclusions: Earlobe keloids can be treated by customized plans that involve appropriate surgical modalities, postoperative radiotherapy, and self-management. Postsurgical radiotherapy with 10 Gy of radiotherapy administered in two fractions over 2 days can be used successfully to treat earlobe keloids.CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

DOI： 10.1097/PRS.0b013e3182a4c35e

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Lippincott Williams and Wilkins  

The development of cutaneous pathological scars, namely, hypertrophic scars (HSs) and keloids, involves complex pathways, and the exact mechanisms by which they are initiated, evolved, and regulated remain to be fully elucidated. The generally held concepts that keloids and HSs represent "aberrant wound healing" or that they are "characterized by hyalinized collagen bundles" have done little to promote their accurate clinicopathological classification or to stimulate research into the specific causes of these scars and effective preventative therapies. To overcome this barrier, we review here the most recent findings regarding the pathology and pathogenesis of keloids and HSs. The aberrations of HSs and keloids in terms of the inflammation, proliferation, and remodeling phases of the wound healing process are described. In particular, the significant roles that the extracellular matrix and the epidermal and dermal layers of skin play in scar pathogenesis are examined. Finally, the current hypotheses of pathological scar etiology that should be tested by basic and clinical investigators are detailed. Therapies that have been found to be effective are described, including several that evolved directly from the aforementioned etiology hypotheses. A better understanding of pathological scar etiology and manifestations will improve the clinical and histopathological classification and treatment of these important lesions.

DOI： 10.1097/GOX.0b013e31829c4597

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：English   Publisher：SPRINGER  

Mechanotransduction is the process by which physical forces are sensed and converted into biochemical signals that then result in cellular responses. The discovery and development of various molecular pathways involved in this process have revolutionized the fundamental and clinical understanding regarding the formation and progression of cutaneous scars. The aim of this review is to report the recent advances in scar mechanosignaling research. The mechanosignaling pathways that participate in the formation and growth of cutaneous scars can be divided into those whose role in mechanoresponsiveness has been proven (the TGF-beta/Smad, integrin, and calcium ion pathways) and those who have a possible but as yet unproven role (such as MAPK and G protein, Wnt/beta-catenin, TNF-alpha/NF-kappa B, and interleukins). During scar development, these cellular mechanosignaling pathways interact actively with the extracellular matrix. They also crosstalk extensively with the hypoxia, inflammation, and angiogenesis pathways. The elucidation of scar mechanosignaling pathways provides a new platform for understanding scar development. This better understanding will facilitate research into this promising field and may help to promote the development of pharmacological interventions that could ultimately prevent, reduce, or even reverse scar formation or progression.

DOI： 10.1007/s00403-012-1278-5

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：WILEY  

Keloids tend to occur on highly mobile sites with high tension. This study was designed to determine whether body surface areas exposed to large strain during normal activities correlate with areas that show high rates of keloid generation after wounding. Eight adult Japanese volunteers were enrolled to study the skin stretching/contraction rates of nine different body sites. Skin stretching/contraction was measured by marking eight points on each region and measuring the change in location of the marked points after typical movements. The distribution of 1,500 keloids on 483 Japanese patients was mapped. The parietal region and anterior lower leg were associated with the least stretching/contraction, while the suprapubic region had the highest stretching/contraction rate. With regard to keloid distribution, there were 733 on the anterior chest region (48.9%) and 403 on the scapular regions (26.9%). No keloids were reported on the scalp or anterior lower leg. Because these sites are rarely subjected to skin stretching/contraction, it appears that mechanical force is an important trigger that drives keloid generation even in patients who are genetically predisposed to keloids. Thus, mechanotransduction studies are useful for developing clinical approaches that reduce the skin tension around wounds or scars for the prevention and treatment of not only keloids but also hypertrophic scars.

DOI： 10.1111/j.1524-475X.2012.00766.x

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Pathological cutaneous scars such as keloids and hypertrophic scars (HSs) are characterized by a diffuse redness that is caused by the overgrowth of capillary vessels due to chronic inflammation. Our group has been using long-pulsed, 1064-nm Nd:YAG laser in noncontact mode with low fluence and a submillisecond pulse duration to treat keloids and hypertrophic scars since 2006 with satisfactory results. The present study examined the efficacy of this approach in 22 Japanese patients with keloids (n = 16) or hypertrophic scars (n = 6) who were treated every 3 to 4 weeks. Treatment settings were as follows: 5 mm spot size diameter; 14 J/cm(2) energy density; 300 μs exposure time per pulse; and 10 Hz repetition rate. The responses of the pathological scars to the treatment were assessed by measuring their erythema, hypertrophy, hardness, itching, and pain or tenderness. Moreover, skin samples from 3 volunteer patients were subjected to histological evaluation and 5 patients underwent thermography during therapy. The average total scar assessment score dropped from 9.86 to 6.34. Hematoxylin and eosin staining and Elastica Masson-Goldner staining showed that laser treatment structurally changed the tissue collagen. This influence reached a depth of 0.5 to 1 mm. Electron microscopy revealed plasma protein leakage, proteoglycan particles, and a change in the collagen fiber fascicles. Further analyses revealed that noncontact mode Nd:YAG laser treatment is highly effective for keloids and hypertrophic scars regardless of patient age, the origin and multiplicity of scarring, the location of the scar(s), or the tension on the scar.

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

著者等は巨大なケロイドに対して皮弁を用いた再建術を行っており、特に、血管茎を軸に回転させて移動するプロペラ皮弁を好んで用いてきた。今回、切除後一期的縫縮が不可能なケロイドに対してプロペラ皮弁を使用し術後1年以上経過観察しえた13例の成績を報告した。手術部位は胸部が10例、肩が1例、恥骨上部が2例で、皮弁は部位別にそれぞれ内胸動脈穿通枝茎プロペラ皮弁、胸背動静脈茎プロペラ皮弁、浅腸骨回旋動静脈プロペラ皮弁を使用した。皮弁の挙上方法は、血管茎を同定した後、少なくとも浅筋膜を含むように挙上し、皮弁内の浅筋膜や深筋膜を移植床の筋膜と縫合することで皮弁の皮膚にかかる張力を軽減させる工夫を行った。皮弁採取部位に対しては、筋膜レベルで確実に減張縫合を行い、真皮縫合は最小限とした。術後は20Gy/4分割/4日間の密封小線源による高線量率表在照射を皮弁採取部と移植床縫合部双方に行い、抜糸後はサージカルテープによるテーピング固定を行った。手術成績は全例で皮弁の完全生着が得られ、ケロイドの再発は1例も認めていない。

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：MEDICAL ASSOC NIPPON MEDICAL SCH  

We use evidence-based algorithms to treat abnormal scarring, including keloids and hypertrophic scars (HSs). This involves a multimodal approach that employs traditional methods such as surgical removal, postoperative radiotherapy, corticosteroid injection, laser, and silicone gel sheets. As a result, the rate of abnormal scarring recurrence has decreased dramatically over the past 10 years. However, several problems remain to be solved. First, despite the optimization of a radiotherapy protocol, over 10% of cases who are treated with surgery and postoperative radiotherapy still recur in our facility. Second, the treatment options for cases with huge keloids are very limited. To address these problems, we performed basic research on the mechanisms that drive the formation of keloids and HSs. Extrapolation of these research observations to the clinic has led to the development of two treatment strategies that have reduced the rate of abnormal scar recurrence further and provided a means to remove large scars.Our finite element analysis of the mechanical force distribution around keloids revealed high skin tension at the keloid edges and lower tension in the keloid center. Moreover, when a sophisticated servo-controlled device was used to stretch wounded murine dorsal skin, it was observed that the stretched samples exhibited upregulated epidermal proliferation and angiogenesis, which are also observed in keloids and HSs. Real-time RT-PCR also revealed that growth factors and neuropeptides are more strongly expressed in cyclically stretched skin than in statically stretched skin. These findings support the well-established notion that mechanical forces on the skin strongly influence the cellular behavior that leads to scarring.These observations led us to focus on the importance of reducing skin tension when keloids/HSs are surgically removed to prevent their recurrence. Clinical trials revealed that subcutaneous/fascial tensile reduction sutures, which apply minimal tension on the dermis, are more effective in reducing recurrence than the three-layered sutures used by plastic surgeons. Moreover, we have found that by using skin flaps (e.g., perforator flaps and propeller flaps), which release tension on the wound, in combination with postoperative radiotherapy, huge keloids can be successfully treated. (J Nippon Med Sch 2011; 78: 68-76)

DOI： 10.1272/jnms.78.68

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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DOI： 10.1097/PRS.0b013e3181df7073

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: The physiopathogenesis of proliferative scarring in human skin is not well understood. Furthermore, knowledge of the precise mechanisms of action for physical treatment modalities is limited Compression garments, occlusive/adhesive skin taping, and silicone gel sheets are applied to form an occlusion on the scar surface, reduce tension, and/or increase pressure on the scar itself. The mechanisms by which the external or superficial actions of these treatments cause remission of a protruding scar may be related to mechanoreceptor (nociceptor and cellular mechanoreceptor) responses.Methods: Basic research studies about mechanoreceptor-related (nociceptors and cellular mechanoreceptors, separately) events are reviewed and discussed based on proliferative scarring background. Scar management related studies were corrected from the standpoint of mechanotransduction mechanisms. The methodologic quality of the clinical trials and basic studies was evaluated and reviewed.Results: it was suggested that many of the physical scar management methods, including compression therapy, silicone therapy, adhesive tape, and occlusive dressing therapy, are related to mechanotransduction mechanisms.Conclusions: A unifying perspective of basic research findings and clinical observations may be obtained by considering the mechanoreceptor-related events in scar management. Moreover, a precise understanding of the roles that cellular mechanoreceptors and mechanosensitive nociceptors play in proliferative scarring may lead to the development of innovative treatment strategies and new pharmacologic therapies targeting cellular mechanoreceptors and mechanosensitive nociceptors in fibroproliferative diseases. (Plast. Reconstr. Surg. 126. 426, 2010.)

DOI： 10.1097/PRS.0b013e3181df715d

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Language：Japanese   Publisher：(株)全日本病院出版会  

鼻翼部の瘢痕拘縮や変形に対する治療として、局所皮弁術や有茎皮弁移植術が広く行われているが、鼻翼の変形が顔面の広範囲熱傷に伴うケースでは、鼻部の近傍や顔面の中に適切な皮弁を作製し得ない場合がある。そのような症例では、鼻翼部の瘢痕拘縮を解除した後に全層植皮での再建を余儀なくされるが、術後しばしば植皮部の再拘縮に悩まされる。再拘縮を軽減するためには、移植される真皮部分をより厚くし、皮弁の厚さに近づけることが必要と考えられる。この目的のために著者等は、当該患者3例に対し、全層植皮に先立って皮膚欠損部に自家真皮移植を行い、その後(2〜3週後)二期的に全層植皮(overlay)を行うことを試み、植皮部の再拘縮を軽減することができたので報告した。

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Keloids grow and spread not only vertically but also horizontally, although hypertrophic scars do not grow beyond the boundaries of the original injury. Clinically, we have encountered keloids with regular and irregular (untypical) shapes. As the characteristics of the irregular growth patterns of keloids have not been studied yet, we analyzed the irregular growth of keloids both visually and pathologically.
A total of 220 keloid specimens, each from a different patient, were surgically removed and used in this study. Through visual analysis, the preoperative shapes of these 220 keloids were classified into those with a regular shape (R group) and those with an irregular shape (IR group). Moreover, we distinguished between cases that had received keloidectomy previously and those that had not. We also determined whether the keloids were recurrent keloids or not, In both the R and I R groups, keloid specimens were studied histologically to examine for infection.
In the R group, there were 156 cases (70.9%; 55 males and 101 females with a mean age of 33.68 years). Three patients (1.9%) had infection and 2 patients (1.3%) had undergone keloidectomy previously. In the IR group, there were 64 cases (29. 1%; 24 males and 40 females with a mean age of 45.27 years). Thirty patients (46.9%) had infection and 24 patients (37.5%) had undergone keloidectomy previously. Statistically, the rates of infection and keloidectomy were significantly different between the R group and the IR group.
Severe infection or operative history may be the cause of irregularly shaped keloids. Thus, in the absence of significant infection or a surgical history, the shape of keloids may be determined uniquely by skin tension.

DOI： 10.1097/SAP.0b013e31819967ed

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Language：English   Publishing type：Part of collection (book)   Publisher：Springer Berlin Heidelberg  

Hypertrophic scars (HSs) occur within weeks after burns, rapidly increase in size for 3-6 months, and then, after a static phase, begin to regress. The full maturation process may take up to 2-5 years. In the treatment of post-burn HSs, indication of treatment methods should be decided based on whether scar contracture is associated with HSs (Figs. 11.1 and 11.2)[1], because, surgery should be selected for HSs cases with scar contracture, to avoid functional dysfunction. Releasing scar contractures improves joint function, and even if it is partial releasing of contractures, it accelerates maturation of surrounding immature scars and HSs (Fig. 11.1 (A)). However, small and linear HSs with mild scar contractures can be treated with complete surgical resection radically (Fig. 11.1 (B)) or with non-surgical multi-modal therapy (Fig. 11.1 (C)). Intractable recurring HSs can be treated according to the algorithms of keloid treatment [1], among which the combination of surgery and adjuvant therapy (e.g. radiation or corticosteroid injection) is the treatment of choice (Fig. 11.1 (D)). After these treatments, long-term follow-up and conservative therapies are needed for complete functional and cosmetic recovery (Figs. 11.1 (E)). © 2010 Springer-Verlag Berlin Heidelberg.

DOI： 10.1007/978-3-642-05070-1_11

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Publishing type：Research paper (scientific journal)  

We presented the propeller flap method in 1991. In that paper the propeller flap was rotated almost 90 degrees to cover raw surfaces after scar incisions. Recently this method has been developed to recon-struct tissue defects by almost 180 degree rotation. This procedure is now considered to be another use of perforator flaps. However, the definition and classification of this flap are still confusing. Thus, here we present our consideration of this method and our expectations for its further development. 1. Definition of the propeller flap methods Every skin island flap has the possibility of being a propeller flap. However, advancement flaps, transposition flaps and rotation flaps without the need for harvesting as island flaps should be excluded. Consequently, a skin island flap with axial rotation is our definition of the propeller flap method. 2. Classification of the propeller flap methods This classification was organized by pedicle types as follows: 1) Subcutaneous tissue pedicled propeller (SPP) flap 2) Perforator pedicled propeller (PPP) flap 3) Muscle pedicled propeller (MPP) flap 4) Supercharging propeller flap SPP flaps should be used for wound coverage or scar contracture reconstruction with a small rotation. Flaps are vascularized from the subcutaneous pedicle made in the central portion or the acentric portion of flaps, and we generally do not need to identify perforators including those in the subcutaneous tissue pedicles. The degree of rotational freedom of the PPP flap is the largest among the propeller flaps, thus this type can be used for various kinds of reconstructions. MPP flaps are useful for the reconstruction using muscles such as pressure ulcer reconstruction. The supercharging propeller flap will be useful for creating a longer or larger hemi-wing of the flap. 3. Clinical results and discussion Our propeller flap cases with over 90° rotation which was performed between 2006 and 2008 number 10 cases in PPP, 2 cases in MPP and 3 cases in PPP. One flap of SPP showed distal necrosis but the other flaps survived completely. A representative 4 cases were shown. In conclusion, when over 90° rotation is required, care should be exerted with the PPP in preoperative design to avoid distal necrosis.

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: Mechanical forces modulate wound healing and scar formation through mechanotransduction. In response to mechanical stimulation, neuropeptides are released from peripheral terminals of primary afferent sensory neurons, influencing skin and immune cell functions and increasing vascular permeability, causing neurogenic inflammation.
Methods: A computer-controlled device was used to stretch murine skin. C57B16 mice (n = 26) were assigned to a cyclical square-wave tensile stimulation for 4 hours or continuous stimulation for 4 hours. Stretched skin was analyzed for expression of the neuropeptides, substance P and calcitonin gene-related peptide, their receptors (NK1R and calcitonin gene-related peptide receptor component protein), and growth factors (nerve growth factor, transforming growth factor beta 1, vascular endothelial growth factor, and epidermal growth factor) using immunohistochemistry and real-time reverse-transcriptase polymerase chain reaction.
Results: Cyclical stimulation resulted in a significant increase in expression of neuropeptides and growth factors, whereas the corresponding peptide receptors were down-regulated. Transcription of neuropeptide mRNA was elevated in stretched skin, which proves that neuropeptides are released from not only peripheral terminals of nerve fibers but also resident skin cells.
Conclusions: The authors' results suggest that skin stretching may alter cell physiology by stimulating neuropeptide expression, and that cyclical mechanical force may be more effectively stimulating mechanosensitive nociceptors or mechanoreceptors (mechanosensors) on cells. (Plast. Reconstr. Surg. 124: 102, 2009.)

DOI： 10.1097/PRS.0b013e3181a81542

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Previous articles suggested the presence of various kinds of malignant tumors that resemble keloid or hypertrophic scar, including dermatofibrosarcoma protuberans, trichilemmal carcinoma, and keloidal basal cell carcinoma. Thus, we studied our cases that were diagnosed with diseases other than keloid or hypertrophic scar. From April 2003 to March 2007, we examined 378 patients self diagnosed with keloid or hypertrophic scar.We detected 4 other diseases (1.06%) in the group of patients. All tumors were benign: apocrine cystadenoma, adult-onset juvenile xanthogranuloma, mixed tumor, and chronic folliculitis. Our study led us to the conclusion that differential or exclusive diagnosis of diseases similar to keloid and hypertrophic scar is important. We found the following considerations important in the examination of keloid or hypertrophic scar: (1) biopsy should be conducted in anomalous cases because malignant disease may be the original or secondary problem, (2) steroid injection should be performed only after careful consideration because malignancy or infections may be present, (3) careful differential diagnosis is particularly challenging in African-Americans because skin and tumor color are often similar, and (4) the presence of bacterial or fungal infection should be investigated.

DOI： 10.1097/SAP.0b013e31817e9d67

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/PRS.0b013e318194d290

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/SAP.0b013e3181855172

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本形成外科学会  

われわれはケロイドの治療において、手術を選択した症例に対しては、再発予防目的で電子線による術後放射線治療を行っている。2002年以前は、主として15Gy/3分割/3日間の照射を行ってきたが、2003年以降は、部位別に、前胸部、肩-肩甲部、恥骨上部には20Gy/4分割/4日間、耳垂部には10Gy/2分割/2日間、耳介軟骨部やその他の部位には15Gy/3分割/3日間としている。最低18ヵ月以上経過観察されている症例のうち、2002年以前に治療された235部位と、2003年以降に治療された317部位を抽出し、結果を比較検討した。15Gyから20Gyに変えた3部位のうち、前胸部と肩-肩甲部では統計学的有意差をもって再発率が低下した。耳垂は15Gyと10Gyで結果に差は認められなかった。20Gy照射は、ケロイドの高再発率部位には適切であると考えられたが、色素沈着が遷延する傾向があった。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: Keloids grow and spread horizontally, like malignant tumors, for reasons that remain unknown. Yet, stretching tension is clearly associated with keloid generation, as keloids tend to occur on high tension sites such as the anterior chest and scapular region. Thus, we analyzed the relationship between keloid growth patterns and stretching tension using a visualized finite element study.
Materials and Methods: Keloids, normal skin, and fat structures were reproduced using DISCUS software. The contours were transferred to ADINA analytical software to rebuild and mesh volumes.
Results: (1) High tension was observed at the edges, and not in the entire region, of stretched keloids. (2) Keloid centers were regions of low tension, which helps to explain the healing that generally occurs in the central regions of keloids. (3) Expansion of a keloid occurred in the direction in which it was pulled. (4) The "crab's claw"-shaped invasion occur-red in response to increased stretching tension. (5) Skin stiffness in the circumference of a keloid was associated with greatly increased tension. (6) Fat hardness and thickness did not influence the amount of tension. (7) Adhesion with subcutaneous hard tissue greatly increased the tension in the keloid.
Conclusion: These stretching results have advanced understanding of keloid formation under various conditions. Our results suggest that stretching tension is an important condition associated with keloid growth.

DOI： 10.1097/SAP.0b013e3181238dd7

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Language：Japanese   Publisher：(株)全日本病院出版会  

過去4年間にケロイド・肥厚性瘢痕を主訴に受診し、実際にはケロイド・肥厚性瘢痕ではないと考えられた患者、および鑑別診断に苦慮した症例を抽出し、検討した。受診した患者総数は378例中、4例が他の疾患であると考えられた。病理診断によりアポクリン腺腫、混合性腫瘍、成人発症型若年性黄色肉芽腫、慢性毛のう炎であった。また、ケロイドに母斑を合併した症例、病理診断と臨床診断が不一致であった症例もあった。

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：KARGER  

We have previously demonstrated that pluripotent stem cells can be obtained from green fluorescence protein (GFP) transgenic mouse adipose tissue. In this study, we sought to determine whether adipose tissue regeneration can be induced in vivo using adipose-derived stromal cells (ASCs) from GFP mice. ASCs were isolated from inguinal fat pads of GFP mice, as described in our previous publication. After incubation in two passages in the control medium, the cells were incubated in the induction medium to induce adipogenesis. Induced ASCs were merged with fibrin glue, and the mixture was injected subcutaneously into the dorsum of athymic mice. Finally, specimens were harvested and analyzed morphologically and histologically. The regenerated tissue was macroscopically semitransparent and soft with slight angiogenesis. Fluorescence microscopy revealed that the specimens strongly emitted green fluorescence, suggesting that the transplanted ASCs had contributed to adipogenesis. Both hematoxylin and eosin and oil red O staining revealed that cells containing small lipid droplets had been regenerated histologically. These findings suggest that ASCs could contribute to adipose tissue regeneration in vivo. ASCs may be an ideal source for adipose tissue regeneration, which may in turn play an important role in augmentation surgery in surgically treated cancer or trauma patients. Copyright (c) 2007 S. Karger AG, Basel.

DOI： 10.1159/000110805

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：CHURCHILL LIVINGSTONE  

The mechanisms of fibroproliferation disease (FPD) of the skin, such as keloids and hypertrophic scars, are still unknown. Since mechanical stress appears to be an important factor for FPD generation, we have studied the intervening factors that connect mechanical stress with keloid and scar formation. Hence, we introduce our "neurogenic inflammation hypothesis" in this paper. Our hypothesis is as follows. Mechanical stress, including skin stretching, stimulates mechanosensitive nociceptors on sensory fibers in the skin. Stimulated fibers release neuropeptides, including SP and CGRP, and these peptides bind to the receptors SP-NK1R and CGRP-CGRP1R on various cells in the skin. Moreover, histamine release is upregutated by mast cells. Consequently, activated endothelial cells and vascular smooth muscle cells induce vasodilation and permeabilization of vessels. Cytokine production, including TGF beta and NGF, is also stimulated by various cells. The neurogenic inflammation and upregulation of TGF beta would activate fibroblasts through various signals. Interestingly, overexpressed NGF may induce the hyper-release of neuropeptides from sensory fibers, resulting in the accumulation of neuropeptides even in the absence of mechanical stress, once the malignant cycle has started. Moreover, individual differences in FPD generation may be based on differences in reactivity towards neuropeptides, NGF, and other neurotrophins. Hence, neuropeptide antagonists may be effective against FPD. While further experimental studies and clinical confirmation are needed, our hypothesis may provide new insights into the etiology and pathology of FPD of the skin, such as keloids and hypertrophic scars. (c) 2008 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.mehy.2008.01.032

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

Background: Before 2002, keloids and intractable hypertrophic scars were treated at our facility with postoperative irradiation of 15 Gy (the traditional protocol). Analysis of the therapeutic outcomes of patients treated with this protocol showed that the recurrence rates of keloids and intractable hypertrophic scars in the anterior chest wall, as well as the scapular and suprapubic regions, were statistically higher than at other sites, while the recurrence rates in earlobes were lower. Thus, we customized doses for various sites. This report describes our trial of postoperative radiation therapy.Methods: Between January 2002 and September 200.4, 109 patients with 121 keloid and intractable hypertrophic scar sites were treated with surgical excision following the new protocol: electron-beam irradiation at total doses of 10, 15, or 20 Gy, depending on the site. The recurrence rates and toxicities were historically followed in 218 patients with 249 keloid and intractable hypertrophic, scar sites treated with the old protocol of surgical removal followed by irradiation at 15 Gy (without variation by site). The minimal follow-up time was 18 months. Statistical analysis was performed using Fisher exact probability test.Results: Total. recurrence rates were 29.3% before 2002 and 14.0% after 2003. The recurrence rate in the anterior chest wall was statistically reduced. Outcomes of earlobe did not differ between irradiation with 15 Gy or 10 Gy.Conclusions: Keloids and intractable hypertrophic scars should be treated with dose protocols customized by site. Our results suggest that keloid and intractable hypertrophic scar sites with a high risk of recurrence should be treated with 20 Gy in 4 fractions over 4 days and that earlobe should be treated with 10 Gy in 2 fractions over 2 days.

DOI： 10.1097/SAP.0b013e3180423b32

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Language：English   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/SAP.0b013e3180a032f3

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Language：Japanese   Publisher：(一社)日本頭蓋顎顔面外科学会  

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

The authors have reconstructed neck scar contractures with "super-thin flaps" (subdermal vascular network [SVN] flaps) since 1994 and have used the circumflex scapular artery and veins (CSAV) and dorsal intercostal perforators (DICPs) to augment the blood flow in the distal portion of the flaps. These free microvascular augmentations enlarge the flap survival area. In this report, the authors describe a severe neck scar contracture reconstructed with a ninth DICP augmented "super-thin flap." The patient was a 51-year-old woman with severe flame bums on 44% of her total body surface area, resulting from a cooking accident. After emergency skin grafting, the patient had a severe scar contracture and intractable ulcer of the anterior neck. CSAV and a ninth DICP augmented occipito-cervico-dorsal (OCD) "super-thin flap" transfer were used to reconstruct the anterior neck. The flap size was 28 X 15 cm, and it survived completely. The cervico-mental angle was, clear and esthetically pleasing, and not only the aesthetic results but also the functional results were excellent.

DOI： 10.1097/01.SAP.0000070640.49193.96

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：克誠堂出版(株)  

当院では耳ケロイドに対し基本的に外科的切除+術後放射線治療の組み合わせを第一選択としており、外来受診、手術、放射線治療(1〜2日)、抜糸の最低4〜5日間の通院で治療が可能である。外科的切除では耳垂には楔状切除、耳介にはくり抜き法を基本とし、症例に応じてZ形成術や皮弁作成術を追加しており、術後はケロイドの再発予防を目的として十分な圧迫固定を行い、基本的には術後3日以内に放射線治療を開始している。また、術後は1〜1ヵ月半毎に6ヵ月〜数年間の経過観察を行い、術後創部の硬さを認める症例には早期よりステロイド治療を開始している。現時点で再発率の上昇はなく、放射線治療に伴う有害事象も認めていない。

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姿勢変換に伴う皮膚の伸展変化率やその特徴、持続時間などをケロイドの好発部位との関係性において検討した。ヒトの基本3姿勢(座位、立位、臥位)に着目し、健常者10人の姿勢変化による皮膚の伸展の変化をケロイドの好発部位(前胸部、肩甲部、後肩部、下顎部)、低発生部位(上腕部、大腿外側)、無発生部位(前脛骨部、前額部)の3群に分けて調査した。ケロイド好発部位は体位変換によって、およそ20〜30%にも上る伸展刺激が加わっていることが判明した。また、低発生部位には10%程度の伸展刺激が加わっており、無発生部位に関してはおよそ5%にも満たない程度の伸展刺激しか加わっていないことが判明した。ケロイド好発部位においては、およそ20〜30%の最大の伸展変化を起こした姿勢変化の際、2関節以上の影響を受けて直交する2軸で正負の一致した強い伸展変化が起こっていることが示唆された。

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症例は72歳女性で、67歳時に左大腿部の皮膚腫瘍を自覚して近医を受診し、粉瘤と診断され摘出された。70歳時に再発したため他院で再度摘出した。その後、創部の発赤と隆起を認め、72歳時に当科紹介となった。左大腿部に表面が発赤した約5cmの腫瘤を認め、発赤部より外側にも皮下硬結を触知した。腫瘤正中には白色化した線状瘢痕を認めた。硬結部分をくりぬくようにして切除生検を行い、病理所見でatypical intradermal smooth muscle neoplasmと診断され、拡大切除の方針となった。残存している発赤部より側方マージンは1cm、深部マージンは深筋膜上で切除した。病理所見で腫瘍細胞が残存していないことを確認し、同側大腿前面より採皮し分層植皮術で再建した。術後6ヵ月の現在、腫瘍の再発は認めていない。

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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Language：Japanese   Publisher：(一社)日本乳癌学会  

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2週間の間に瘢痕・ケロイド治療の専門外来を受診した209名を対象に、アンケートを実施した。不安やいらだち、日常生活の制限、人目が気になる頻度、外観の不快感(赤さや出っ張り)、痛み、痒み、引きつれ感(拘縮感)、症状で睡眠中に目が覚める頻度について調査した。治療前と現在のVAS値を比較し、すべての項目で有意に改善した。痛み・痒み・引きつれ感・睡眠障害といった症状は、比較的改善が得られやすいが、より精神的な不安や人目の気になり方、不快感といった感情は改善が得られにくいことが示唆された。手術した81例と、手術しなかった134例において、人目が気になる頻度や外観の不快感などが手術によってより改善する傾向があることが示された。手術を行わなかった保存的治療症例において、すべての項目がステロイドテープにより改善する傾向が示された。痛みや引きつれ感、また睡眠障害、不安やいらだちといった症状が、ステロイドの注射で改善する傾向を認めた。治療期間が長くなるほど、各項目で改善度が上昇したが、3年以上経過している症例では、逆に改善度が減少している傾向が判明した。

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Language：Japanese   Publisher：(株)全日本病院出版会  

ケロイド・肥厚性瘢痕は創にかかる張力が、発症・悪化の一因である。強い力がかかる関節をまたぐような創では肥厚性瘢痕・瘢痕拘縮を生じやすく、ケロイドは張力がかかる方向に増大する。ケロイド・肥厚性瘢痕を予防・治療するためには、創にできるだけ張力をかけない縫合技術、すなわち減張縫合が必要となる。しかし、ケロイド・肥厚性瘢痕は真皮の網状層から発生するため、強い緊張がかかる部位(ケロイドの好発部位や関節部)では真皮縫合ではなく、皮下の強固な組織、たとえば深筋膜や狭義の浅筋膜(脂肪組織中に認められる線維性の組織)に糸をかけて、真皮にかかる力を減張する必要がある。理想的には、真皮縫合を開始する前に、創縁同士が自然に密着する状態をつくることが望ましい。さらに拘縮ライン・張力の方向に一致する長い創や、張力の方向と直交する方向に縫えない創においては、適宜Z形成術を行い、創を分断させるとよい。(著者抄録)

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Language：Japanese   Publisher：日本医科大学医学会  

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ケロイド・肥厚性瘢痕に対する副腎皮質ホルモンテープ剤(ステロイドテープ)の有用性について、フルドロキシコルチド製剤(ドレニゾンテープ)とデプロドンプロピオン酸エステル製剤(エクラープラスター)で比較検討した。成人では、前胸部12例、肩甲部8例、上腕3例、腹部5例、膝2例で、全症例がドレニゾンテープを使用していた。ケロイド・肥厚性瘢痕の隆起・赤さがほぼ成熟瘢痕となった症例は、前胸部1例、肩甲部1例、上腕1例、腹部1例、膝2例であった。残りの24例はエクラープラスターに切り替えたが、エクラープラスターで隆起・赤さがほぼ成熟瘢痕となった症例は、前胸部7例、肩甲部4例、上腕2症、腹部4例であった。小児では、頸部2例、前胸部3例、肩甲部3例、腹部-恥骨上部5例、上腕2例、膝12例、足関節部3例で全症例がドレニゾンテープを使用し、ケロイド・肥厚性瘢痕の隆起・赤さがほぼ成熟瘢痕となった症例は、頸部2例、肩甲部3例、腹部-恥骨上部3例、上腕1例、膝12例、足関節部3例であった。ドレニゾンテープで軽快しなかった症例はエクラープラスターに変更した。これらの6例は現在も治療中であるが、全例軽快傾向にある。

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Language：Japanese   Publisher：(株)全日本病院出版会  

ケロイド内血管について検討した。全例ざ瘡から発生した前胸部ケロイドで、男性3例(35〜56歳)であった。それぞれのケロイドにおいて、辺縁部・発赤部・中心部の3部位を血流撮影装置にて検体採取直後に直接観察した。血管長の変化の比率を、伸展時の血管長/安静時の血管長としたものを、それぞれ比較し、辺縁部は1.84、発赤部は1.22、中心部は1.08で、ケロイドの活動性が高い部位ほど、血管が直接引き伸ばされているのが明らかとなった。流体解析のソフトウェアを使用し、血管径が変化した時のずり応力の変化を確認した。左側から血流が流れるシミュレーションを構成し、左側の血管径を5とした場合、5対5・4・3・2・1と流出する右側の血管径を変化させた場合の流速を調べた。血管径の変化を起こすことにより、「引き伸ばされた部分」・「径が変化していない部分」の両方に、流速(=ずり応力>)の上昇を認めた。

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Language：Japanese   Publisher：医歯薬出版(株)  

メカノバイオロジーは、張力やせん断応力、静水圧や浸透圧といった物理的刺激が、細胞、組織、臓器あるいは生体にどのような影響を与えるかを解析する生物物理学の研究領域である。メカノバイオロジーが基礎となる医学研究はメカノメディシンである。さらに著者らは、形成外科、美容医療、創傷治療に携わる形成外科医としてメカノメディシンを実際の臨床現場で考え、物理的刺激をコントロールする医療"メカノセラピー"を実践してきた。皮膚・皮膚付属器・皮下組織はつねに内部および外部から物理的刺激を感受し、その機能・構造を維持している。さらに、形成外科・皮膚外科・再建外科手術、あるいは美容医療・抗加齢医療においてもメカノセラピーが臨床現場で用いられている。創傷治癒の促進、瘢痕形成の抑制などにも物理的刺激のコントロールは重要であり、さらにケロイド、肥厚性瘢痕、Recklinghausen病、Ehlers-Danlos症候群、Marfan症候群といった皮膚疾患においても、その発生機序や症状に物理的刺激の関与を考え、メカノセラピーを実践して治療にあたる必要があると考えられた。(著者抄録)

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当科を受診した前胸部ケロイド患者5例(男3例、女2例、平均45.8歳)を対象に発赤部・萎縮部・正常皮膚の3部位の検体を採取し、電子顕微鏡を用いて血管構造を観察した。その結果、全例において、ケロイド発赤部に特徴的な所見として、1)血管内皮細胞の構造の乱れ、2)リンパ球の血管周囲への浸潤、3)血管周囲の浮腫が認められた。また、一部の血管内皮細胞には細胞質内の空胞形成がみられた。一方、正常皮膚・萎縮部にはそれら3つの特徴を備えた部分はみられなかった。

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当科で行っているケロイド切除と縫合法(1:皮下の脂肪層を付けてケロイド全摘、2:筋と深筋膜の間を剥離、3:深筋膜、浅筋膜を寄せて、創縁が密着した状態をつくり、真皮と表面を縫合する)について、どの程度張力を解除する効果があるか調べた。前胸部のケロイドを切除・縫合した10例を対象に、術中に創部にかかる張力をデジタルフォースゲージを用いて計測した。ケロイド全摘後、大胸筋の深筋膜縫合前、浅筋膜縫合前、真皮縫合前にそれぞれ3回ずつ計測した。その結果、深筋膜縫合で約9割、浅筋膜の縫合で約1割の張力を解除しており、真皮縫合にはほとんど力が生じていないことが示された。

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

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Language：Japanese   Publisher：日本医科大学医学会  

J-GLOBAL

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Language：Japanese   Publisher：日本医科大学医学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

有限要素法による縫合法の最適化について検討した。図形作成ソフト:DISCUSを使用して、断面像の輪郭像を作製し、非線形の汎用構造解析プログラムであるADINAを用い4-Noded Iso-Parametric要素で分割した。それぞれの硬さの条件を、正常皮膚(20kPa)、脂肪(15kPa)、筋膜(30kPa)とした。真皮縫合において真皮部分にかかる応力は4700Paで、筋膜縫合を併用した場合は697Paに低下した。真皮にかかる応力は、浅筋膜縫合のみ573Pa、浅筋膜・深筋膜両方を縫合した場合697Paで、両者に大きな違いは認めなかった。ただ、浅筋膜縫合だけであると、浅筋膜に非常に強い応力がかかることを認めた。

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Language：Japanese   Publisher：(一社)日本形成外科学会  

ケロイドの重症化にはさまざまな増悪因子が指摘されているが、われわれは高血圧との関連性に着目したため報告する。2011年1月から2012年10月まで当院で外科的加療を施行したケロイド症例について、ケロイドの個数、ケロイドの面積、男女比における高血圧の合併率を統計学的に比較検討した。症例は200症例。13歳から73歳まで(平均年齢32.99歳)であり、男性70例、女性130例であった。ケロイドの面積における高血圧合併率では有意差を認め(p<0.01)、ケロイドの個数、男女比における高血圧合併率に有意な差はなかった。この関連性の機序として、高血圧が直接的にケロイド内の毛細血管や血管内皮細胞に影響を与えている可能性や、サイトカインなどの液性因子を介して間接的に影響を与えている可能性、また高血圧とケロイドが共通の遺伝因子をもつ可能性などが考えられた。(著者抄録)

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Language：Japanese   Publisher：(株)全日本病院出版会  

皮膚線維腫と肥厚性瘢痕・ケロイドとの関連性について検討した。術後の病理診断が皮膚線維腫の24例を対象とした。3例は別の部位に皮膚線維腫とケロイドを有した。病理所見では、線維芽細胞や肥満細胞、マクロファージが真皮内で限局して増殖し、膠原線維の増殖も確認した。一部では硝子化した膠原線維も確認した。炎症細胞浸潤は少なからず観察し、真皮の限局した炎症性変化を確認した。ケロイドや肥厚性瘢痕の検体と比較し、硝子化した膠原線維の量は少なく、線維芽細胞の数は多い傾向を認めた。細胞は検体の中央に位置し、びまん性に細胞が分布している肥厚性瘢痕や周囲に多いケロイドと異なる所見が得られた。

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Language：Japanese   Publisher：(一社)日本形成外科学会  

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Language：Japanese  

J-GLOBAL

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J05739&link_issn=&doc_id=20140704430002&doc_link_id=10.11310%2Fjsswc.5.56&url=https%3A%2F%2Fdoi.org%2F10.11310%2Fjsswc.5.56&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese  

J-GLOBAL

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J05739&link_issn=&doc_id=20141027320001&doc_link_id=10.11310%2Fjsswc.5.102&url=https%3A%2F%2Fdoi.org%2F10.11310%2Fjsswc.5.102&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

ケロイドの重症化と高血圧との関連性について検討した。外科的加療を施行したケロイド症例100例について、後向き調査を行った。ケロイドの個数と高血圧合併の関連性の検討では、ケロイドの個数3個以上では、3個未満と比較して、高血圧の合併率が有意に高かった。ケロイドの大きさと高血圧合併の関連性の検討では、ケロイドの大きさ10cm2以上では、10cm2未満と比較して、高血圧の合併率が有意に高かった。さらにケロイドの大きさが40cm2以下では、それ未満と比べて、ケロイドの合併率が有意に高かった。高血圧を合併したケロイド患者の男女差は有意差を認めなかった。しかし、30歳以上の高血圧を合併したケロイド患者数は、30未満と比較して有意に多かった。

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Language：Japanese   Publisher：(株)全日本病院出版会  

耳垂ケロイド・肥厚性瘢痕症例の治療法について検討した。耳垂ケロイド・肥厚性瘢痕114例140部位を、肥厚性瘢痕、初発ケロイド、再発ケロイドの3つに分類した。ケロイドに対しては全例術後の電子線照射を行った。肥厚性瘢痕と思われる症例に対しては、手術のみを施行した。再発率は初発ケロイドが4.6%、再発ケロイドが0%、肥厚性瘢痕が25%であった。初発ケロイドは、全例耳垂の頬部側の皮膚が残存していたため、単純縫縮で耳垂の良好な形態を再建することが可能であった。再発したケロイドは、残存している正常皮膚が極めて少なく、再建するのに、V-Y皮弁術、Z形成術などを頬部に作成する必要があった。術後放射線治療を施行し、18ヵ月以上経過した時点での再発率は5%以下に抑えることができた。肥厚性瘢痕は、耳垂の表面と裏面からそれぞれ切開して腫瘤を核出する方法で、耳垂の形態を損なわず、腫瘤を摘出することが可能であった。

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Language：Japanese   Publisher：(株)全日本病院出版会  

瘢痕の発赤の原因である過剰増生している血管を標的として1064nmのロングパルスNd:YAGレーザーの接触照射の効果と適応について検討した。Nd:YAGレーザーの接触照射のみを施行し、12ヵ月以上経過観察できた30例を対象とした。各部位別(18点満点)では、施術前後の平均点の変化が、顔面6.3→0.7、頸部4.0→1.0、前胸部8.5→4.7、上肢5.0→3.1、下腹部7.0→3.7、下肢4.0→3.0であった。各項目毎(3点満点)では硬結1.77→0.8、隆起1.9→1.0、発赤2.0→1.O3、周囲発赤浸潤0.87→0.5、自発痛・圧痛0.4→0.13、そう痒0.4→0.13であった。Nd:YAG治療を開始した患者においては、Nd:YAGレーザーの効果が期待できると判断した患者を施術者が選択しているものの、概ね良好な結果を得ることができた。

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Language：Japanese   Publisher：(株)全日本病院出版会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

インピーダンス法を用いた皮膚バリア機能測定器を用い、ケロイドの皮膚バリア機能を計測し、ケロイドの皮膚バリア機能、また表皮の形態学的変化などについて検討した。手術目的で入院したケロイド10例を対象とした。上腕、背部、胸部、下顎部のすべてのケロイドで、ばらつきはあるものの、20前後〜60前後と高値を認めた。それに対し、ケロイドでは分布に幅があるものの、全例で健常部よりも高値となった。ケロイドでも部位による値の差異は認めなかった。光学顕微鏡においてはケロイドでは表層が著明に重層化し、真皮深層部分での膠原線維の増生が目立っていた。しかし、バリア機能測定値が高値となるような、表層レベルの明らかな変化は認めなかった。電子顕微鏡で形態学的変化を解析したところ、真皮深層の膠原線維の増加があるだけではなく表皮細胞間の間隙の増大を認めた。また、表皮のメラニン顆粒が真皮に脱顆粒している現象を認めた。

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

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Language：Japanese   Publisher：日本臨床皮膚外科学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：日本シミュレーション外科学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

ケロイド外来を受診中の患者7例の組織を用いて解析を行った。方法は、ケロイド組織と隣接健常皮膚組織から全RNAを抽出し、cRNAにCy3ラベリングおよびCy5ラベリングを行い、ヒト全ゲノムマイクロアレイチップへハイブリダイゼーションした。そしてスキャナーで遺伝子発現の網羅的解析を行い、ケロイド組織と健常皮膚での発現の違いを調べた。さらに公共データベースを用い、シグナル伝達経路のバイオインフォマティクス解析を行った。遺伝子発現解析の結果、534遺伝子が全てのサンプルにおいて4倍以上の発現を示し、109遺伝子が全てのサンプルにおいて4倍以上の発現低下を示した。これらをバイオインフォマティクス解析した結果、線維性コラーゲン生成、軟骨形成、神経再生、上皮再生に関与するシグナル伝達系の活性化と、脂質代謝に関与するシグナル伝達系の活性低下が認められた。

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Language：Japanese   Publisher：(株)全日本病院出版会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

ケロイド・肥厚性瘢痕に対して手術治療を選択した場合、術後再発予防目的の瘢痕ケアにシリコーンジェルシートやサージカルテープが広く用いられているが、サージカルテープは皮膚の糜爛を生じることがある。著者らは、メンリッケヘルス社製のソフトシリコーンテープ「メピタック」を用いており、良好な結果が得られているので報告した。メピタックは固定が強固でありながらテープ交換時の疼痛・皮膚損傷が少なく、皮膚が脆弱・敏感な患者や、テープを同じ部位に継続して使用する場合に適していた。代表例として、サージカルテープで皮膚糜爛を生じたためメピタックに変更した1例を提示した。

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Language：Japanese   Publisher：(一社)日本形成外科学会  

メカノバイオロジー(mechanobiology:機械生物学)とは、張力やせん断応力、静水圧や浸透圧といった物理的刺激(機械的刺激、力学的刺激)が、生体にどのような影響を与えるかを研究する学問である。常に物理的刺激が加わっている筋や骨格を扱う整形外科、血圧や血流を扱う血液循環器内科などでは比較的なじみのある研究分野であるが、皮膚や軟部組織を扱う形成外科ではまだ一般的ではない。しかし、皮膚こそ常に物理的刺激を受けている組織であり、創傷治癒や組織再建、再生医療を行う形成外科医はメカノバイオロジーを理解しておく必要がある。物理的刺激は細胞の生命活動において最も大切な刺激である可能性が示唆されており、組織から細胞、細胞膜から核内へ、さまざまな構造を通じて感受され、物理化学的信号に変換されながら細胞内シグナル伝達系路に影響を与えることが分かってきた。創傷治癒や組織再建、再生医療、さらには美容医療、抗加齢医療を考えるうえで、メカノバイオロジーの理解は必須であると考えられた。(著者抄録)

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Language：Japanese  

J-GLOBAL

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Language：Japanese   Publisher：日本医科大学医学会  

J-GLOBAL

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Language：Japanese   Publisher：日本医科大学医学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

耳ケロイドは、発生部位が耳介軟骨部か耳垂部かによって治療後の再発率が異なることが示されている。そこで著者等は、それぞれの部位に適した治療法を確立するために検討を行ってきた。2002年以前の治療方法は両部位ともケロイドの単純切除術+一期的縫縮術と術後15Gy/3分割/3日間の電子線照射を行っており、耳垂部ケロイドの再発率は5.7%(2/35例)と概ね良好であったが、耳介軟骨部ケロイドの再発率は38.5%(5/13例)と高かった。このため2003年から治療方法を変更した。具体的には、耳介軟骨部のケロイドに対しては、皮膚に生じた張力を減弱させる目的で、腫瘤は全てを切除するのではなく、内部の瘢痕組織を主に切除して皮膚を残す「くり抜き法」を施行するようにした。術後の電子線照射は従来どおり15Gy/3分割/3日間とし、再発率は10%(2/20例)に低下した。耳垂部のケロイドに対しては、単純切除術と6-0 Prolineによる縫合を行った後10Gy/2分割/2日間の電子線照射を行うようにし、再発率は6.7%(8/120例)となった。

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Language：Japanese   Publisher：(株)全日本病院出版会  

瘢痕周囲皮膚の応力分布と、シリコーンジェルシートを貼付したときの力学的変化について、パソコン用の非線形汎用構造解析プログラム「ADINA」を用いて解析した。方法は、4-Noded Iso-Parametric要素で分割し、それぞれのヤング率をケロイド(25kPa)・正常皮膚(20kPa)・脂肪(15kPa)・シリコーンジェルシート(20kPa)と設定し、ポアソン比を0.49とした。解析の結果、瘢痕周囲皮膚の応力分布については、瘢痕に伸展刺激を加えたさい瘢痕辺縁に放射線状に応力の集中が認められた。シリコーンジェルシートを貼付したときには、瘢痕辺縁の応力集中がシリコーンジェルシートの辺縁に移動し、これに伴い、瘢痕に対する直接の応力が軽減された。これらの結果から、シリコーンジェルシートの貼付は、瘢痕の辺縁に生じた張力を減弱させる効果もあることが示唆された。

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Language：Japanese   Publisher：(株)全日本病院出版会  

1988〜2008年に当院を受診したケロイド例の中から、微細な原因(特発性・尋常性ざ瘡・小外傷)で発生したいわゆる真性ケロイドのみ(362例1034部位)を抽出し、好発部位の分布図を作成した。方法は、臨床画像の長径と短径の中心点にプロットをおき、臨床写真と同様な角度に調整した3D画像上に発生部位をプロットした。好発部位を領域別にみると、顔面では下顎角部を中心に多く発生している。肩関節部では三角筋の起始部〜停止部に発生しており、三角筋起始部より近位には発生していない。下肢では大腿前面に僅かに発生を認めるのみで、下腿には発生していない。背部では三角筋起始部と僧帽筋に囲まれた部分に多く発生しており、背部正中と三角筋起始部の間の中枢側半分には発生していない。躯幹では前胸部(特に胸骨部上半分)に多く発生しており、腹部では臍部と恥骨上部の間の下半分に発生している。

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Language：Japanese   Publisher：(株)全日本病院出版会  

著者等はケロイド・肥厚性瘢痕に対し、プローベを病変部から2〜3cm離して照射を行う非接触ロングパルスNd:YAGレーザー照射を施行している。すなわち、1064nm Nd:YAGレーザー(キュテラ社製)の非接触モードで治療を行っている。今回、本法を施行したケロイド16例と肥厚性瘢痕6例の成績を報告した。照射条件は5mmスポットでエネルギーを14J/cm2に設定し、1例あたり平均14セッションの治療を行った。治療成績の評価方法は、「紅斑」「肥厚」「硬結」「そう痒」「疼痛」の5項目についてそれぞれ0〜3点の4段階評価を行い、その合計点を治療前後で比較し。結果、治療前の平均点は9.86点で、治療後は6.34に低下(改善)した。本レーザーの有用性を色素レーザーと比較するためハーフサイドテストを行い、照射部の組織学的差異について検討した結果、本レーザーの非接触照射を行った瘢痕の血管に変化は認めなかったのに対し、色素レーザー照射を行った瘢痕には血管の有意な減少を認めた。

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Language：English   Publisher：(一社)日本外科学会  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL  

Web of Science

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：WILEY-BLACKWELL PUBLISHING, INC  

Web of Science

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Language：Japanese   Publisher：日本医科大学医学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本創傷外科学会  

シリコーンジェルシートは,肥厚性瘢痕やケロイドに対して世界中で広く使われている。しかし,作用機序や適切な使用方法に関していまだ不明な点が多いため,本論文ではシリコーンジェルシートの既存の文献を網羅し,臨床応用や作用機序に関して考察した。その結果,作用機序として外部からの刺激の保護や瘢痕周囲にかかる皮膚張力の分散などが示唆され,また,材質はシリコーンに限らず,ほかのものでもよい可能性が示された。かつ理想的なジェルシートとは,(1)表面の保湿を行いつつ適度に水分をシートより蒸散するもの,(2)皮膚に対して接触性皮膚炎を起こさず接着し,外部の刺激からクッションの役割を果たす軟らかさをもったもの,(3)正常皮膚と比較して同様の厚さ・硬さ,厚く軟らかい,もしくは薄く硬いものである可能性が示唆された。(著者抄録)

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Language：Japanese   Publisher：(株)全日本病院出版会  

くり抜き法の手術手技について解説し、本法を施行した12例の成績を報告した。12例の術後観察期間は12〜21ヵ月で、再発したものは1例もなかった。一般に耳介の手術は再発率が高いといわれているが、くり抜き法は整容的に優れているだけでなく再発率も低いことが示された。巨大なケロイドほどその有用性は高く、治療に難渋する症例に対して推奨される方法と考えられた。

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Language：Japanese   Publisher：(株)全日本病院出版会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

これまで様々な皮膚切開線が提唱されてきたが、決定的な切開線は確定されておらず、その主な理由は切開の目的・条件が症例によって異なるためである。また、「静的状態」で調べた切開線と、「動的状態」で調べた切開線とでは違いが生じると考えられる。ケロイドは皮膚の張力がかかる方向に伸展していくことから、いわゆる真性ケロイドの発生・伸展を調べれば、日常生活での「動的状態」において皮膚のどの部分にどういった方向で張力がかかっているのかを調べることができると思われる。そこで著者等は、当院を受診したケロイド患者のうち微細な原因で発生したいわゆる真性ケロイド362例1034部位の臨床写真をもとに、全身のケロイド伸展方向の分析を行い、切開した創が肥厚しにくい皮膚切開線について検討した。具体的な方法は、ケロイドの全身分布図の各中心点からのベクトルを3次元人体シミュレーションソフト「Poser」に挿入し、ケロイド伸展方向の分析を行った。その結果を提示した。

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Language：Japanese   Publisher：(株)全日本病院出版会  

ケロイド発生部位の統計的検討を行った。方法は、1988〜2008年に当院を受診したケロイド患者のうち微細な原因で発生したいわゆる真性ケロイド362例1034部位の臨床写真を用い、3D画像作成ソフト「Poser7」にて臨床写真と同様な角度に調整した3D画像を作成し、各原因・性別ごとに発生部位をプロットした。その結果、下顎部領域では下顎角部を中心に多くの発生が認められた。上肢では上腕・前腕近傍に発生が認められ、肘関節部・前腕遠部には認められなかった。肩に関しては前面・後面にはほとんど認められず、上面に多く認められた。背部領域では肩甲部に発生が集中しており、胸腹部領域では前胸部に多くの発生が認められた。下肢では大腿にわずかに発生を認めるのみで、下腿には認められなかった。

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Language：Japanese   Publisher：(株)全日本病院出版会  

ケロイド切除後の縫合に起因するケロイドを起こさないための新たな縫合法を考案した。その手順は下記の通りで、これまでに施行した13例すべてで良好な結果が得られている。1)ケロイド周囲皮膚を切開し、脂肪組織内にあるsuperficial fasciaを同定する。2)そこに皮膚マーカーでラインを引く。3)superficial fasciaを切開して下の脂肪を除去し、deep fasciaを露出する。4)deep fasciaを2〜3cmほど大胸筋から剥離し、deep fasciaに2-0 PDSを水平マットレスでかけて縫合を行う。5)さらにsuperficial fasciaに4-0 PDSを水平マットレスでかけて2層目の縫合を行う。6)真皮縫合は5-0 PDSで粗に縫合し、表面を6-0か7-0ナイロンで縫合する。

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(一社)日本創傷外科学会  

ケロイドや肥厚性瘢痕には確実な治療法がないため統一された治療指針がなく、各施設が治療経験を基に独自に治療を行っている。世界的にはケロイドや肥厚性瘢痕の基礎研究が進み、臨床研究が増えつつある。これらの報告の中から質の高い臨床研究を抽出し、現時点における治療に対するエビデンスを検討した。その結果、診断ではバイオプシーも考慮すべきであること、予防では皮膚の炎症性疾患、外力などを極力排除すべきであること、治療では、手術、圧迫療法、放射線療法、凍結療法、ジェルシート、レーザー、ステロイド注射、5-フルオロウラシルなどの単独療法、併用療法が有用であることが示唆された。

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

肥厚性瘢痕・ケロイドに対してNd:YAGレーザーを使用する際には、どのような症例に効果があるのかをその作用機序とともに理解する必要がある。(著者抄録)

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Language：Japanese   Publisher：(株)全日本病院出版会  

肥厚性瘢痕・ケロイドに対してのレーザー治療はDye(色素)レーザーが一般的でありNd:YAGレーザーの使用に関しては文献も少なく一般的ではない。しかし、適応症例を選択し、集学的治療の一つとして用いることにより、著明な効果を認めることがある。したがって、Nd:YAGレーザーの効果を説明する一方で、具体的な使用方法について解説する。(著者抄録)

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

瘢痕でレーザー治療の対象は、「白い」瘢痕である「成熟瘢痕・萎縮性瘢痕」と「赤い」瘢痕である「ケロイド・肥厚性瘢痕」に大別される。「成熟瘢痕・萎縮性瘢痕」にはCO2(10600nm)、Er:YAG(2940nm)、YSSG(2790nm)laserなどのアブレーティブレーザー、long-pulsed Nd:YAG(1064、1320nm)などのノン・アブレーティブレーザーやフラクショナルレーザー(1410〜1540nm、2940nm、10600nm)を使用することが多い。また、「ケロイド・肥厚性瘢痕」には、dye laserやNd:YAG laserが適応となる。それぞれについて、効果の原理をよく理解し、治療の限界を知りつつ治療に望むことが重要である。(著者抄録)

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Language：Japanese   Publisher：(株)全日本病院出版会  

肥厚性瘢痕治療やケロイドの症状軽減に汎用されるシリコンジェルシート(SGS)の減張効果について有限要素法(FEM)を用いて検討した。その結果、SGSの厚さが正常皮膚と同じで硬さ半分としたモデルでは瘢痕両端の応力(張力)が最高値を示し、高応力部位は瘢痕と正常組織の境界から正常組織に広がるように認められた。しかし、SGSをのせたモデルでは瘢痕両端の応力は低下し、SGS辺縁の正常皮膚に起こる応力変化の上昇を認めた。SGSの硬さでは柔らかいほど瘢痕周囲応力変化の低減を認めず、硬さが正常皮膚とほぼ等しくなると瘢痕周囲応力変化は変わらないことが判明した。SGSの厚さでは正常皮膚の半分以下では瘢痕周囲応力の低減効果が減弱し、SGSが厚くなるのに比例しSGS辺縁の正常皮膚の応力変化は上昇した。以上より、SGSの効果は瘢痕の安静・減張であることがシミュレーションで示唆され、力学的に理想的なSGSの硬さは正常皮膚に近く、厚さは正常皮膚の0.5〜1.0倍と考えられた。

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Language：Japanese   Publisher：(株)全日本病院出版会  

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Language：Japanese   Publisher：日本医科大学医学会  

J-GLOBAL

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Language：Japanese   Publisher：日本医科大学医学会  

J-GLOBAL

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Language：English   Publishing type：Rapid communication, short report, research note, etc. (scientific journal)   Publisher：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/PRS.0b013e31817d632e

Web of Science

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Language：Japanese   Publisher：(一社)日本熱傷学会  

2000年に現地依頼を受けて以来、われわれはほぼ毎年ベトナム社会主義共和国の首都ハノイにあるベトナム国立熱傷研究所病院において全身の熱傷瘢痕拘縮に対する再建外科手術支援を行っている。これまでに実施した手術症例は6年間で19例であり、そのほとんどは熱傷瘢痕拘縮に対する皮弁移植術であった。手術はおもにわれわれが実施するが、一部現地形成外科医にも協力してもらっている。本活動は、開始当時はボランティア活動であったが、一昨年よりその功績が評価され、国家予算措置を受けるようになった。また本期間中に現地形成外科医1名を国費留学生として受け入れ、学位取得とともに指導者としての育成を行った。さらには昨年、本活動が著しい功績として認められ、ベトナム国厚生大臣顕彰を授与される名誉にも浴した。その一方で、当該施設はベトナム国内における唯一の熱傷センターであるがいまだ医療レベルは発展段階にあり、形成外科領域においても熱傷再建手術を要する熱傷後瘢痕拘縮患者が少なくない反面、いまだ再建手術に熟知した専門医の存在が少ない問題点も多く存在する。今後もこのような国際交流を通じて、人材の育成や医療レベルの発展に寄与することが必要と考えられた。(著者抄録)

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Language：Japanese   Publisher：(株)全日本病院出版会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

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Language：Japanese   Publisher：日本医科大学医学会  

J-GLOBAL

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Language：Japanese   Publisher：日本医科大学医学会  

J-GLOBAL

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Language：Japanese   Publisher：日本シミュレーション外科学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(一社)日本マイクロサージャリー学会  

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Language：Japanese   Publisher：(株)全日本病院出版会  

1988〜2005年に治療した耳部ケロイド患者135例・195部位中、耳垂ケロイドの形態が明瞭であるもしくはアンケートにより回答が得られた84例・100部位を対象に耳垂ケロイドの形態についてアンケート調査し、新しい知見を得た。貫通型ケロイドにおける後部径の前部径に対する割合と分布は、耳垂前面直径をA、後面直径をPとするとA>P3部位、A=P7部位、A<P90部位であった。アンケートによると後面ケロイドが大きくなる、ある程度後面が大きくなった後に前面が大きくなる、ケロイドが耳垂辺縁に浸潤し耳垂形態を侵食して下垂するといった経過を示しているのが明らかになった。今回の検討で耳垂ケロイドが後面より発生することが多い、就寝時等に耳垂皮膚が牽引されることにより、耳垂後面が高張力になるため、ピアス入れ替えによるピアスホールが損傷されるためといった可能性が推察された。

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Language：Japanese   Publisher：(株)全日本病院出版会  

未知環境下の複雑系の挙動を把握できる有限要素法を用いて、ケロイドの伸展形式について非線形構造解析を行った。その結果、ケロイド辺縁に高張力部位が存在すること、牽引される方向とケロイドの形態でケロイドの伸展形式を説明することが可能であること、ケロイド中心部分で低張力部位が存在し、中心治癒傾向の可能性があること、ケロイドがカニ爪状に伸展するのは有限要素法により説明可能であることが示唆された。しかしモデルが二次元であること、ケロイドをシミュレーションで完全には表現できないことから、今後臨床的・病理組織学的な実証が必要であると思われた。

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Language：Japanese   Publisher：(株)全日本病院出版会  

ケロイドモデルにシリコンシートをのせたシリコンシートモデルを作成し、非線形の汎用構造解析プログラムであるADINAを用いて様々な解析を行った。その結果、有限要素法ではシリコンジェルシート(SGS)の効果として減張効果の可能性があることがケロイドシリコンシート貼付モデルで示唆された。シリコンシートは柔らかくても効果を認め、硬いシートは表皮剥離を起こしやすいことが示唆された。シートが硬いほど表皮剥離が起きやすいという臨床経験と合致する所見で、シリコンシートの効果・表皮剥離の副作用の両方を加味した場合シリコンシートはやわらかいものが良いという可能性が示唆された。

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Language：Japanese   Publisher：日本医科大学医学会  

J-GLOBAL

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Language：Japanese   Publisher：(株)全日本病院出版会  

ケロイドに対し、1988〜2002年はケロイド切除術に加え、15Gy/3分割/3日間術後照射、2003年からは前胸部、肩甲部、恥骨上部には20Gy/4分割/4日間術後照射、耳垂部には10Gy/2分割/2日間術後照射、耳介部・その他の部位には15Gy/3分割/3日間術後照射を行った。18ヵ月以上経過観察されている症例中、2002年以前は249部位を、2003年以降は109部位を抽出し再発について統計学的に比較検討した。20Gy照射に変更した部位では再発率が減少し、また耳垂では10Gy照射に変更しても再発率は上昇しなかった。特に前胸部は統計学的有意差を認めて改善した。しかし、放射線照射直後の色素沈着が28.9%から42.2%とやや増加した。

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：日本医科大学医学会  

J-GLOBAL

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：(一社)日本美容外科学会  

ピアスや外傷を契機に耳部に発生したケロイドおよび肥厚性瘢痕は,形成外科・美容外科領域ではありふれた疾患である.耳垂および耳介のケロイドに対して電子線照射を含めた集学的治療を施行し,術後半年以上経過観察可能であった10〜30代女性のなかから50例を無作為に抽出して,原因や治療方法,再発率を検討した.原因は,耳垂ケロイド45例中40例がピアス,4例が原因不明,1例が外傷,耳介ケロイド5例中3例がピアス,2例が外傷であった.手術による摘出,術後電子線照射,トラニラストの内服,およびテーピングによる術後圧迫療法を施行した.50例中5例にトラニラスト内服による腹部違和感や膀胱炎様症状が生じ,中止した.その他電子線照射による色素沈着が2例に生じたが,一過性であり,術後6ヵ月の時点では消失した.45例の耳垂ケロイドのうち2例で手術痕部に再発を認めた.5例の耳介ケロイドでは3例で再発を認めた

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Language：Japanese   Publisher：(一社)日本美容外科学会  

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Language：Japanese   Publisher：日本医科大学医学会  

J-GLOBAL

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Language：Japanese   Publisher：日本医科大学医学会  

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Language：Japanese   Publisher：(一社)日本創傷治癒学会  

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Language：Japanese   Publisher：(株)臨床医薬研究協会  

ケロイドおよび肥厚性瘢痕症例でシリコン・ジェルシート「原沢」の改良製品を使用し,3ヵ月以上フォローアップ可能であった10例を対象に,その効果を検討した.症状の評価は5項目(掻痒,自発痛・圧痛,色調,隆起・肥厚の程度,有害事象)について,それぞれ5段階評価(無し0点,軽微1点,軽度2点,中等度3点,高度4点)を行った.有害事象を除く各々の項目について使用3ヵ月の時点で1段階の改善を認めた場合は+1点,2段階の改善ほ認めた場合は+2,というように点数を加算した.悪化した場合は-1点,-2点とし,変化なしは0点とした.よって使用3ヵ月の時点で,4項目の合計が-16点から16点の範囲で各症例について評価した.症状の改善度の平均値は1.6点(-2〜5点)であり,掻痒や自発痛といった自覚症状や,発赤の消退,隆起・肥厚といった他覚症状の改善を10例中6例に認めた.一方,全ての項目で不変であった症例は3症例であった.症状の悪化を訴えた症例は1例であった

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Language：Japanese   Publisher：(一社)日本熱傷学会  

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Language：Japanese   Publisher：克誠堂出版(株)  

近年若い年齢層を中心としたピアス式イヤリング(ピアス)の普及に伴い,耳部ケロイドの症例報告が見られる.良性疾患であるため軽快した患者は通院しなくなり,術後経過観察は難しい.そこで,患者が簡便に記入できるようにアンケート用紙を作成し,ケロイドの経過観察を詳細に行った.アンケートの結果から,耳垂の形態が再発率に大きく関与していることが示唆された

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Language：Japanese   Publisher：(株)臨床医薬研究協会  

ケロイドおよび肥厚性瘢痕摘出術後,抜糸を完了した時点から術後併用療法としてジェルシート「原沢」を使用し,3ヵ月以上フォローアップ可能であった10例を対象とし,新しく開発・発売されたシリコーン・ジェルシートの有効性と安全性について検討した.改善度の平均値は2.1点で,掻痒や自発痛といった自覚症状,発赤の消退,隆起・肥厚といった他覚症状の改善を10例中7例に認めた.すべての項目で不変であった症例は3例であった.悪化は1例にも認めなかった

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