Every year, surgical interventions, traumatic wounds, and burn injuries lead to over 80 million scars. These scars often lead to compromised skin function and can result in devastating disfigurement, permanent functional loss, psychosocial problems, and growth retardation. Today, a wide variety of nonsurgical scar management options exist, with only few of them being substantiated by evidence. The working mechanisms of physical anti-scarring modalities remained unclear for many years. Recent evidence underpinned the important role of mechanical forces in scar remodeling, especially the balance between matrix stiffness and cytoskeleton pre-stress. This perspective article aims to translate research findings at the cellular and molecular levels into working mechanisms of physical anti-scarring interventions. Mechanomodulation of scars applied with the right amplitude, frequency, and duration induces ECM remodeling and restores the ‘tensile’ homeostasis. Depending on the scar characteristics, specific (combinations of) non-invasive physical scar treatments are possible. Future studies should be aimed at investigating the dose-dependent effects of physical scar management to define proper guidelines for these interventions.

Fibrosis is characterized by scarring and hardening of tissues and organs. It can affect every organ system, and so could result in organ failure due to the accumulation of extracellular matrix proteins. Previous studies suggest that mechanical forces (such as shockwave therapy, SWT) initiate a process of mechanotransduction and thus could regulate fibrosis. Nevertheless, it is largely unexamined which pathways are exactly involved in the application of SWT and can regulate fibrosis. The present article seeks to elucidate the underlying effect of SWT on fibrosis. Evidence shows that SWT activates macrophage activity, fibroblast activity, collagen amount and orientation and apoptosis, which ultimately lead to an adaptation of inflammation, proliferation, angiogenesis and apoptosis. The included articles reveal that other proteins and pathways can be activated depending on the energy levels and frequency of SWT. These findings demonstrate that SWT has beneficial effects on fibrosis by influencing the proteins and pathways. Based on these data, which highlights the underlying mechanisms, we can make preliminary conclusions about the treatment modalities of SWT in scar formation, such as the energy levels and frequencies that are necessary to prevent or treat fibrotic tissue.

‘Systematic review on working mechanisms of signaling pathways in fibrosis during shockwave therapy’. Lot Demuynck1, Karsten Knobloch3, Eric Van |

Background: Two-component cohesive compression systems are available for compression therapy. Objectives: To assess the sub-bandage pressure and stiffness of the two-component compression systems, Coban and CoFlex, and to investigate how an additional partial compression layer after two hours and the experience of the therapist impact these outcomes. Methods: The study examined 19 patients whose lower limbs were bandaged by either a trainee or an experienced physical therapist. Sub-bandage pressures were measured using PicoPress® sensors placed 10 cm and 25 cm proximal to the medial malleolus. Additionally, the Static Stiffness Index (SSI) and Dynamic Stiffness Index (DSI) were calculated. Results: The addition of a partial compression layer on the ventral side of the leg significantly increased sub-bandage pressure and DSI. SSI effects were significant at 10 cm, but not at 25 cm height. Coban generated significantly higher pressures than CoFlex, while the level of experience of the therapist showed no significant influence. Conclusions: The addition of a partial compression layer effectively increases sub-bandage pressure, with Coban exerting higher pressure than CoFlex. However, the level of experience of the therapist does not significantly influence the compression outcomes.