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(American Journal of Pathology. 1999;155:1671-1679.)
© 1999 American Society for Investigative Pathology

Regular Articles

Mechanical Forces Induce Scar Remodeling

Study in Non-Pressure-Treated versusPressure-Treated Hypertrophic Scars

Andréa Monte Alto Costa*{dagger}, Simone Peyrol{ddagger}, Luís Cristóvão Pôrto{dagger}, Jean-Pierre Comparin§, Jean-Louis Foyatier§ and Alexis Desmoulière*¶

From the Institut de Biologie et Chimie des Protéines,*
Centre National de la Recherche Scientifique, Lyon, France; the Departamento de Histologia e Embriologia,{dagger}
Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; the Service Commun de Microscopie Électronique,{ddagger}
Faculté de Médecine Laënnec, Lyon, France; the Centre des Brûlés,§
Chirurgie Réparatrice, Centre Hospitalier St. Joseph et St. Luc, Lyon, France; and the Groupe de Recherches pour l’Etude du Foie,
Institut National de la Santé et de la Recherche Médicale, Université Victor Segalen, Bordeaux, France

Reparative process of second and third degree burns usually results in hypertrophic scar formation that can be treated by pressure. Although this method is efficient, its mechanisms of action are not known. In this work, we have studied the histological organization of hypertrophic scars submitted to pressure. Skin biopsies were performed 2 to 7 months after the onset of treatment in two adjacent regions of the scar, non-pressure- or pressure-treated and analyzed by immunohistochemistry and transmission electron microscopy for extracellular matrix organization and cellular morphology. In non-pressure-treated regions, fibrillin deposits did not present the classical candelabra-like pattern under epidermis and were reduced in dermis; in pressure-treated regions the amount was increased compared to non-pressure-treated regions but the organization was still disturbed. In non-pressure-treated regions, elastin was present in patch deposits; in pressure-treated regions elastin formed fibers, smaller than in normal dermis. Tenascin was present in the whole dermis in non-pressure-treated regions, whereas in pressure-treated regions it was observed only under epidermis and around vessels, as in normal skin. {alpha}-Smooth muscle actin-expressing myofibroblasts were absent in normal skin, present in large amounts in non-pressure-treated regions, and almost absent in pressure-treated regions. The disturbed ultrastructural organization of dermal-epidermal junction observed in non-pressure-treated regions disappeared after pressure therapy; typical features of apoptosis in fibroblastic cells and morphological aspects of collagen degradation were observed in pressure-treated regions. Our results show that, in hypertrophic scars, pressure therapy restores in part the extracellular matrix organization observed in normal scar and induces the disappearance of {alpha}-smooth muscle actin-expressing myofibroblasts, probably by apoptosis. We suggest that the pressure acts by accelerating the remission phase of the postburn reparative process.




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