Scar Formation and Regenerative Treatments with PRP and Shockwave
Scar formation is a natural component of the healing process after tissue injury. It is characterized by the body’s attempt to repair the damaged skin of the underlying tissue. While scars are generally functional, they can result in aesthetic concerns and functional impairment.
Following tissue injury, a complex series of cellular and molecular events take place. These are designed to restore the tissue integrity following the damage. The formation of scars involves interactions between various cell types and signaling molecules. These complex interactions can result in different types of scars including hypertrophic scars and keloids. The types of scars dictate the various treatment options to remove them and regain the normal tissue appearance and function. In the past, therapy options have been limited, with surgical revision being the most effective. However, newer less invasive treatments are now available with significant aesthetic outcomes and normal functionality of the tissue.
Mechanism of Scar Formation
Scar formation, also known as fibrosis, occurs in several stages after the initial tissue injury. They are hemostasis, inflammation, proliferation and remodeling. These stages are driven by a variety of cells and molecular signals, including growth factors, cytokines and extracellular matrix components.
Hemostasis and Inflammation
The initial response to a tissue injury is hemostasis where blood vessels constrict to restrict bleeding and platelets adhere to the wound, then activate and aggregate.
The inflammatory phase then follows which involves the activation and recruitment of neutrophils and macrophages. These cells remove debris and pathogens from the wound site while secreting pro-inflammatory cytokines that facilitate the next phase of the healing cascade. This phase can last for a few days.
Proliferation
The proliferation phase can last from a few days to weeks depending on the type of wound and the size. Fibroblastic activity is the main activity in this phase. Fibroblasts migrate to the wound site where they secrete collagen and extracellular matrix components. These extracellular components provide structural support for the wound and facilitate the formation of new tissue. Simultaneously, with the action of the fibroblasts, endothelial cells stimulate angiogenesis (formation of new blood vessels) and keratinocytes proliferate to repithelialize the wound.
Remodeling
The remodeling phase can last from months to years and is characterized by the maturation of the scar tissue. Type 111 collagen, initially deposited during the proliferative phase is replaced by stronger type 1 collagen. This matures the scar formation. However, it is within this phase that excessive collagen deposition results in abnormal scar formation such as hypertrophic scars and keloid formation.
Types of Scars and Their Characteristics
Hypertrophic scars are red, raised and thickened scars that develop within the boundaries of the original wound. These scars result from the overproduction of collagen during the proliferation phase of healing. Hypertrophic scars have the potential to improve over time as collagen remodeling continues during the late phases of healing.
Keloids are a severe form of scar formation characterized by the overgrowth of collagen beyond the original wound boundary. Unlike hypertrophic scars that have the potential to improve, keloids have the opposite potential. Keloids can continue to grow sometimes becoming larger than the original wound. Keloids are more common in darker skinned individuals with Fitzpatrick type 4 skin color. They can also have a genetic predisposition. The excessive collagen production in keloids results from dysregulated fibroblastic activity coupled with extracellular matrix remodeling abnormalities.
Treatment of Scars: Traditional and Regenerative Options
Treatment of scars aims to improve the aesthetic appearance and the functionality of the tissues. Several treatment approaches have been used to reach this goal.
- Surgical revision has been the primary treatment modality for years. However, surgical revision can cause further scarring.
- Laser Therapy
- Corticosteroid injections
- Platelet Rich Plasma Injections
- Shockwave therapy
Platelet Rich Plasma Therapy for Scar Reduction
Platelet Rich Plasma treatment is an autologous blood derived concentrate that is rich in growth factors, cytokines and bioactive proteins. The PRP is introduced by injection into the scar site. The growth factors in the PRP such as platelet derived growth factor, transforming growth factor beta and vascular endothelial growth factor can promote and regulate collagen synthesis, enhance tissue regeneration and reduce inflammation. Platelet Rich Plasma stimulates fibroblastic activity and keratinocytes leading to a more organized collagen deposition and rapid healing.
Shockwave Therapy for Fibrosis and Keloids
Shockwave therapy, also called extracorporeal shock wave therapy, has emerged as the newest treatment for scar reduction. It uses high energy acoustic waves to stimulate healing and reduce fibrosis. The shockwaves increase blood flow, enhance collagen deposition and improve the quality and quantity of the extracellular matrix. Studies have proven shockwave therapy reduces fibrosis and scar thickness while increasing elasticity of the tissue. In cases of severe scarring and keloid formation, shockwaves can reduce the pain associated with these lesions.
Study: PRP for Scar Treatment – Systematic Review and Meta-Analysis
Platelet Rich Plasma in the Treatment of Scars, to Suggest of Not to Suggest?
Tissue Eng Regen Med 2022 Oct;16(10):875-899
Purpose: Review the randomized clinical trials that examine the efficacy of Platelet Rich Plasma, alone or in combination with other methods, for the management of atrophic or hypertrophic /keloidal scars.
Conclusion: Platelet Rich Plasma appears to be safe and effective treatment for various types of atrophic scars. In addition, when added to microneedling, it seems to considerably add to the efficacy of the treatment and reduce the side effects.
Study: Regenerative Medicine for Hypertrophic Scars and Keloids
A Systematic Review of the Efficacy, Safety and Satisfaction of Regenerative Medicine Treatments
Int Wound 2024 Apr;21(4):e14557 PMID 38126221
Purpose: The primary objective of this study is to examine the efficacy of various regenerative medicine approaches such as platelet rich plasma, cell therapy, exosomes and stem cells in the process of healing hypertrophic scars and keloids.
Conclusion: In all eight reviewed studies, the effectiveness of regenerative medicine in treating hypertrophic scars and keloids has been proven. Out of these studies, five focused on platelet rich plasma. In conclusion, regenerative medicine is an effective method with minimal side effects for the treatment of hypertrophic scars and keloids.
Study: Shockwave Therapy’s Effect on Fibrosis Signaling Pathways
Explore how PRP and shockwave therapy help reduce hypertrophic scars and keloids. Learn the mechanisms behind scar healing and modern treatment options.
Int J Mol Sci 2024 Oct 31;25(21):11729 PMID 39519292
Purpose: The present article seeks to elucidate the underlying effect of shockwave therapy on fibrosis.
Discussion: Evidence shows that shockwave therapy activates macrophage activity, fibroblast activity, collagen amount and orientation and apoptosis which ultimately lead to the adaption of inflammation, proliferation, angiogenesis and apoptosis.
Conclusion: Based on the data which highlights the underlying mechanisms, we can make preliminary conclusions about the treatment of shockwave therapy in scar formation such as the energy levels that are necessary to prevent of treat fibrotic scar tissue.
Study: Shockwave Effects on Keratinocytes in Hypertrophic Scars
Effect of Extracorporeal Shock Wave Therapy on Keratinocytes Derived from Human Hypertrophic Scars
Sci Rep 2021 Aug 27;11(1):17296 PMID 34453089
Purpose: Hypertrophic scars represent a common complication in burn patients. In addition to cosmetic defects, they may cause serious sensory abnormalities such as pain and itching, severe dysfunction depending on the site and emotional disorders such as anxiety and depression.
Discussion: Keratinocytes were derived from hypertrophic scar tissue were cultured and compared to those from normal tissue. Scar derived keratinocytes were treated with extracorporeal shock waves. The shock waves altered the molecular pattern of proliferation, activation, differentiation and apoptosis as wells as the proliferation/differentiation activators.
Conclusion: In summary, we show that extracorporeal shock wave therapy regulates the proliferation and differentiation of keratinocytes derived from hypertrophic scar to maintain normal epidermal integrity.
Juventix Regenerative Medical: PRP Kits and Shockwave Devices
Juventix Regenerative Medical is an industry leader in the regenerative medical field. Our Platelet Rich Plasma Kits are FDA cleared and designed for safety, sterility and effectiveness. Our kits are scientifically manufactured to provide a platelet concentrate, devoid of red blood cells with a minimum number of leukocytes that are critical for the regenerative process.
Juventix Regenerative Medical offers a patented LED Activator to activate the platelets and begin the regenerative process. The activation is a critical step in the release of the growth factors, cytokines and bioactive proteins from the granules that are contained on the platelets and is accomplished with LED light. This negates the use of chemical additives such as Calcium Chloride, Thrombin or Collagen. This mode of activation by LED light provides sustained growth factor release versus older methods of activation while adhering to the minimal manipulation standards of the FDA.
This activation should always be accomplished after the gentle swirl of the centrifuged product to maximize the number of captured platelets.
Juventix Regenerative Medical is proud to be a distributer of the PhysioPRO Shock Wave System. This clinical grade radial shock wave device induces intracellular and extracellular reactions to assist in the repair and regeneration of tissues. The waves activate cellular pathways that drive the healing process. Shock wave treatment stimulates angiogenesis and neogenesis. These metabolic processes form new blood vessels to better oxygenate the scar tissue for the repair to occur. Treatments with the PhysioPRO can also mobilize mesenchymal stem cells to migrate to the area for enhanced cellular regeneration.
Juventix Regenerative Medical has a vast array of products, devices and services tailored for the medical and regenerative professional. Platelet Rich Plasma Kits and the Physio Pro are two of the many devices that offer the latest treatments in scar reduction.
With our premier line of products and support from our experienced staff, Juventix Regenerative Medical is poised to aid any professional in enhancing clinical outcomes, while increasing patient satisfaction.
RESTORE, REVIVE, REGENERATE – JUVENTIX REGENERATIVE MEDICAL
Regenerative Regards,
Dr. Robert McGrath
