الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
A scar is a fibrous tissue replacement where a wound, burn, or sore has not healed completely and fibrous tissue has developed. Scarring is a mechanism by the body to repair itself after injury in a rapid manner. Atrophic scar is a common cosmetic problem. It occurs due to inadequate compensation of dermal collagen and diminished production of connective tissue which occurs during the healing process after tissue injury.
The disfigurement after atrophic scarring makes many patients asking for medical advice. A lot of different procedures can be used to treat atrophic scars such as: chemical peels, dermabrasion, punch grafting, and using filling materials for augmentation of depressed area.
Platelet-rich plasma (PRP) is an autologous solution of highly concentrated plasma prepared from the blood of the patient himself. Platelets play an important role in mediation of tissue repair via the release of many growth factors (GFs), such as transforming growth factor-β (TGF-β), platelet degradation growth factor (PDGF), insulin growth factor-1 (IGF-1), epidermal growth factor (EGF), fibroblast growth factor (FGF), and vascular endothelial growth factor (VEGF) from their α-granules. These factors regulate cell proliferation, migration, attachment, differentiation, and through binding to specific cell surface receptors they promote accumulation of extracellular matrix.
Several types of threads used in face lift and facial rejuvenation due to its effect on collagen stimulation and filling of face on long term.Poly-L- Lactic Acid threads are used in facial rejuvenation because they are absorptive, biodegradable and cause minimal immune reaction.The aim of this study was to evaluate the efficacy of Poly-L- Lactic Acid threads and platelet rich plasma in treatment of atrophic scar.
The current study was carried out on 24 patients complaining of atrophic scar. All were selected from the Outpatient Clinic of Dermatology and Venereology Department, Tanta University Hospital in the period between from February 2019 to February 2020.
The patients with atrophic scar were divided randomly into 3 groups
group A: 8 patients received subcision with PLLA threads insertion.
group B: 8patients received subcision with PLLA threads insertion and PRP injection. PRP injected for four sessions with one month interval.
group C: 8 patients received subcision with PRP injection for four sessions with one month interval.
All participants were subjected to:
1. An informed written consent.
2. Complete history taking
3. Thorough general examination to evaluate the overall condition of the subject and exclude any associated systemic disease.
4. Detailed dermatological examination to assess the atrophic scar and to exclude any other skin disease.
5. Scars were evaluated according to Modified Manchester Scar Scale (112).
6. Routine investigations to exclude anemia, bleeding disorders and other systemic chronic diseasesThe patients were informed about the nature of the procedures, number of sessions, and expected side effects of the procedures.
8. Digital photography: Digital colored photographs were taken before treatment and at the end of follow up period using 8 mega pixels Honor 6x digital camera (China). Photographic evaluation was done with the same equipment, lighting and location by 3 dermatologists.
9. Twelve skin biopsies were taken from four patients from each group before treatment and at the end of follow up period to assess clinical results and compare the results of techniques. The specimens were processed and semithin sections were stained with ordinary hematoxylin and eosin stains and trichrome stain.
The results of this study revealed the followings:
Regarding clinical data:
group A included 5 males and 3females. The age range was 16 to 55 years with mean±SD 30.88 ± 14.31. group B included 5 males and 3 females. The age range was 20.0 – 45.0 years with mean±SD 30.50 ± 9.70. group C included 7 males and 1female. The age range was 16.0 – 54.0 years with mean±SD 32.25 ± 12.91.
Regarding the duration of scar in group (A): it ranged from 24.0 to 360.0 months with a Mean ± SD 112.50 ± 109.22. In group (B): it ranged from 12.0 – 360.0 months with a Mean ± SD 87.0 ± 116.12. In group (C): it ranged from 24.0 – 420.0 months with a Mean ± SD 139.50 ± 158.54.
Regarding clinical evaluation:
Regarding the Modified Manchester scale: There was statistically significant reduction in the mean values at the end of follow upperiod in comparison to that before treatment in group (A) with P. value 0.002*, in group (B) with P. value <0.001*and in group (C) with P. value <0.001*.
Regarding the degree of improvement according to physician opinion after treatment: There was statistically significant improvement comparing between group A and group C with P. value p2=0.016*also There was statistically significant improvement comparing between group b and group C with P. value p3=0.012*.
Regarding patient satisfaction: There was statistically significant improvement comparing between group A and group C with P. value p2=0.047* also There was statistically significant improvement comparing between group b and group C with P. value p3=0.017*.
In group (A)There was significant negative correlation between duration of scar and the degree of clinical improvement (r -0.961*/ p value<0.001*), while in group (B)and group (C) There was no significant correlation between duration of scar and the degree of clinical improvement (r -0171/ p value 0.685), (r 0.410/ p value 0.314).
There was no statistically significant relation between the percentage of improvement and the site of the scar with P. value in group A p=0.320, in group B p=0.621and in group C p=0.766.Histopathological examination:
Revealed increase in collagen fibers and vascular spaces in the dermis with infiltration by inflammatory cells. After treatment changes were marked in group (B)moderate in group (A)and mild in group (C).
Regarding complications:
Pain during session was tolerable as we inject anesthesia before the procedure. All patients developed edema and ecchymosis immediately after the session which resolve in 5 to 7 days. There was no complication developed in our patients during the follow up period.