Volume 22 Number 1

The Textbook on Scar Management has over 550 pages and focuses on the complex management of wound healing and scarring. The author team consists of highly regarded specialists globally. The issue of scarring is examined from different perspectives: the pathophysiology of wound healing before and afterbirth, undisturbed healing, cellular  mechanisms of scar formation, epidemiology of scars and  their consequences, complex treatment and aesthetic  and psychological issues.

The monography is divided into 14 sections and 64 chapters. The first section is dedicated to the biology of scars and scar formation. The epidemiology of scars and their consequences including the psychological and aesthetic aspects are described in the second section. The third section is focused on the most common scarring issues related to the development of the keloid and hypertrophic scarring. International Scar Classifications are filed under section four. Basic scar types and classes are defined here and supplemented by Japan Scar Workshop (JSW) scar scale for assessing the keloids and hypertrophic scars including other objective assessment tools and techniques in detail. This section is followed by a description of the most important scar symptoms in section five: pruritus and pain, erythema and thickness, pigmentation disorders and scar contractures. This information is supplemented by description of pharmacological and non-pharmacological ways of managing these symptoms. Scar symptoms are supplemented by presentation of different scar assessment scales in the sixth section.

The first six sections are more related to theory, whereas the succeeding parts of the book introduce the clinical assessment of scars and provide widening options of modern technologies. The next chapters on scar treatment comprise conventional and progressive ways of the topical therapy. They include new minimal-invasive technologies for treatment of scars like intralesional cryosurgery, topical application of corticosteroids, low-dose 5-fluorouracil or laser treatment. Local flaps, scar resurfacing, skin substitutes and fat tissue injections are important invasive techniques but also for scar contracture release.

Regarding pathophysiology, it is important to distinguish between defective scars, which may result from poor surgical techniques, and pathological scars, which are true evolutionary abnormalities of cutaneous scarring. Thus, the book rightly focuses its attention on hypertrophic scars and keloids, which are typical examples of pathological scarring.

Burn trauma is one of the most frequent causes of pathological scarring. Therefore, the publication describes in detail the main features of burn injury healing, together with scarring items and their clinical implications. Hypertrophic scars and scar-related contractures are a dominant type of pathological scar formation after burns; hence, the book underscores the importance of burns and burn scars, as they can cause severe aesthetic and functional problems to patients. As the authors emphasise, for complex perception of the scarring issue, it is important to focus not only on the epidemiology and diagnostics but also on the psychological consequences and ethical considerations.

As an example of the need for specific approaches to the treatment of different conditions, the textbook mentions scarring in cleft patients, where the authors discuss the various options to reduce scarring, such as perioperative botulinum toxin injections, sutureless skin closure techniques, silicone application and postoperative laser therapy.

Section VIII of the reviewed publication deals with evidence-based treatment options for immature scars, such as ideal wound closure methods, silicone gel, onion extract, botulinum toxin, laser techniques, compression therapy, manual massages and other conservative strategies in scar management. Minimal-invasive technologies play an important role in the treatment of hypertrophic scars and keloids. They involve intralesional cryosurgery, topical application and intralesional injections of corticosteroids, intralesional injections of low-dose of 5-fluorouracil, pulsed-dye laser, Yttrium Aluminium Granate (YAG) laser, fractional laser or medical needling. All the methods and application techniques are introduced very deftly and are described in detail the publication, together with tips and tricks to achieve the best results along with nicely documented representative case reports.

Invasive techniques for scar management are covered in Section X. The reader can find information about local flaps for contracture release, scar resurfacing, skin substitutes, fat injections and facial scar reconstructions in this section. The section concludes with detailed photo-documentation of healing tissues.

Some areas of scar management need specific approaches. The authors of the publication highlight the importance of particular actions by patients throughout their lifespan for particular kinds of scarring; for example, for specific anatomical locations or for specific skin colours. Such regimens tend to reduce scarring potential of the healing skin and reduce the symptoms and consequences of pathological scarring.

Burn injury and scarring have big impacts on patient social interactions and can lead to serious psychological problems; both these issues are discussed in Section XII. It is followed by a section on medical make-up treatment. Emerging technologies in scar management outline the new options for future development and challenges. Their use has not yet been supported by robust evidence, but the existing experience is promising. The textbook does not omit laser-assisted delivery of therapeutic agents, allogenic cells and human dermal substitutes including bio-printing of skin. They are followed by an introduction to new drugs for scar treatment, tissue remodelling technologies, vacuum massage of scars, shock wave therapy and new topical delivery systems, such as tapes and plasters for corticosteroids in scar management.

The final part of the textbook offers commented clinical cases highlighting the practical targeting of this scar management publication.

The publication brings considerable amount of clinical information in conjunction with evidence-based knowledge and its implications for clinical practice. The readers will definitely appreciate the concluding sections and take-home message boxes at the end of each chapter summing up the most important information. The publication offers future perspectives, further reading or lists of supplementary literature at the end of each chapter.

The only drawbacks of this textbook are connected with the broad constitution of the author team and large number of chapters written by different authors as, in some cases, they result in the repetition of certain redundant information.

We can summarise that the monograph is a modern textbook on scar management that provides evidence-based knowledge and emphasises the practical use of the presented information. It will be of interest to teachers, students, and clinicians working on various aspects of wound healing. We are quite confident it will be highly useful for all involved in the medical specialisation of wound healing and scar management.

Author(s)

Luc Téot, Thomas A. Mustoe
Esther Middelkoop, Gerd G. Gauglitz · Springer 2020

By:

Jan Stryja,
MUDr., Ph.D., Senior vascular surgeon, Outpatient Wound Management Clinic, Salvatella Ltd., Trinec, The Czech Republic
Cardiovascular Centre of Agel Hospital, Trinec - Podlesi, The Czech Republic