“Scarless world or scar-less world”: expedition on new perspectives on management of post-burn hypertrophic scar

Hypertrophic scar has always been the top priority of post-burn intervention. Specialists from multiple disciplines have dedicated enormous efforts expanding the knowledge in understanding the etiology of hypertrophic scar formation and establishing the scientific evidence of effective management of hypertrophic scar. The devotion and pursuit of these scientists and clinicians has been especially meaningful for the population in Asia since it has been well proven that hypertrophic scar was endemic to the Asian population comparing to the Caucasians. Besides early intervention, functional outcomes and longterm quality of life for people with extensive burn injuries have been investigated by different researchers and further substantiate the importance of long-term continuum of rehabilitation programs [1, 2]. In Asian countries such as China, management of hypertrophic scar is mainly confined to surgical removal of scar causing contracture, deformities, and/or disfigurement. Early and active scar management is rarely practiced soon after surgical implementation. Thus, functional outcomes are expected to be poor. In the past two decades, burn specialists have begun to realize the importance of functional outcome of patients with massive burns in China [3]. New evidence regarding the quality of life of patients with extensive burn injuries identified a poorer quality of life with prolonged physical and psychological problems. Fortunately, there is a positive trend of gradual improvements noted but slow [2]. As the socio-economic boost of the society and the advancement in the quality and standards of medical care, the ultimate goal of postburn management has been shifting from survival to functional recovery, since both the patient and the health care professional gradually strive for a better quality of life with social re-integration. The thorough understanding of etiological and molecular basis of hypertrophic scar formation has been considered as the foundation of effective prevention and management of hypertrophic scar. In this special issue, Zhu, Ding, and Tredget [4] conducted comprehensive review on the molecular basis of hypertrophic scars, highlighting the roles of cytokines, growth factors, and macrophages via chemokine pathways. In Tan et al.’s recent article [5], novel technology of isobaric tags for relative and absolute quantitation (iTRAQ) was applied in order to advance our exploration on the various mechanisms and cellular signaling pass ways of hypertrophic scar formation. The comprehensive investigation identified multiple up-regulated and downregulated proteins, which might serve as indicators for future management strategies. Along with the advocacy of evidence-based medicine, international burn society has gradually recognized the importance of research evidence in guiding clinical practice. Several international guidelines have been published in recent years based on extensive literature reviews. Despite the limited research design and inadequacy of clinical data available, consensus in several areas on scar management was finalized and new intervention strategies could be explored [6, 7]. Interestingly, despite the relatively adequacy of the literature supporting the effectiveness of silicone gel and emergence of all the alternative interventions, a survey of burn centers across North America and Australia suggested that the most common intervention are still splinting, postoperative ambulation, conditioning, scar massage, and use of compression garments [8]. In accordance with the International Society for Burn Injuries, the first Guidelines for Burn Rehabilitation in China has been published by the Chinese Burn Association, Chinese Association of Burn Surgeons, and The Correspondence: [email protected] Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China