Rei Ogawa

Background: NexoBrid^® (NXB), an enzymatic debridement agent approved in Japan in 2022, provides a less invasive alternative to surgical excision for burn treatment. However, its optimal therapeutic benefit depends on appropriate patient selection and proper application technique. Existing international consensus documents are not fully applicable to clinical practice in Japan because of differences in available devices and drugs. Therefore, a Japan-specific consensus document was developed by a panel of seven Japanese burn experts, including four plastic surgeons and three emergency physicians. Methods: A questionnaire-based survey was conducted using the Delphi method to achieve expert consensus. Consensus was defined as agreement by at least 80% of committee members for each statement. A total of 27 statements were evaluated over two rounds. Results: Consensus was achieved for 20 of 27 statements (74.1%) in the first round and for 21 of 27 statements (77.8%) in the second round. The finalised statements were organised into seven categories according to their attributes: indications, pain management, application timing, application technique, post-application wound care, skin grafting, and scarring/aesthetic outcomes. Conclusions: This consensus document integrates the opinions of plastic surgeons and emergency physicians in Japan, while also incorporating relevant international perspectives, to provide practical guidance on the use of NXB for burn treatment. It is intended to improve the quality of burn care by clarifying efficacy, safety, and precautions associated with NXB use. These recommendations should be updated as further clinical experience accumulates.

Summary: Reconstruction of nasal skin poses significant challenges due to its thickness, sebaceous nature, and high bacterial colonization. Full-thickness nasal skin grafting is extremely rare, as native nasal skin is not commonly used as a donor site. This report describes a unique case of successful reconstruction using avulsed native nasal skin following trauma. A healthy man in his 60s sustained a complete avulsion of the nasal skin after a fall. The avulsed skin, initially discarded, was retrieved and prepared as a graft. Thorough disinfection and aggressive thinning were performed to optimize graft take. The graft was secured using a tie-over dressing under local anesthesia in the emergency room. The graft achieved full survival without the need for secondary interventions. Mild postoperative erythema resolved completely after 6 months of topical diclofenac therapy. This case demonstrates that avulsed native nasal skin can be successfully repurposed for nasal reconstruction when carefully prepared. Key factors for success included meticulous thinning and rigorous disinfection to counter the sebaceous and microbial challenges of nasal skin. Further studies may be beneficial to define the limitations and optimal management strategies for nasal skin grafting.

Differentiating dermatofibrosarcoma protuberans (DFSP) from keloids presents significant clinical challenges, particularly when skin biopsies are contraindicated. This study introduces a novel, non-invasive diagnostic method leveraging the Japan Scar Workshop Scar Scale (JSS) combined with the cosine of the angle (cosθ) to distinguish between these conditions. In this case–control study, 43 cases were retrospectively analyzed using the new evaluation method, JSS × cosθ, designed specifically for this differential diagnosis. This method applies JSS in conjunction with cosθ to assess lesion characteristics non-invasively. The JSS × cosθ scores effectively differentiated between DFSP and keloids. Scores ≥16 were indicative of keloids, whereas scores <16 suggested DFSP, with these findings achieving statistical significance (p < 0.001). The JSS × cosθ scoring system provides a reliable and safe diagnostic tool for distinguishing DFSP from keloids, particularly in cases where biopsy is avoided due to the risk that stimulation of the reticular dermis may lead to the development, enlargement, or worsening of keloids. This method promises to significantly impact the specific management of DFSP and keloids.

Keloids are chronic fibroproliferative skin disorders with high recurrence rates and limited treatment options, yet reliable diagnostic biomarkers are lacking. Current classification systems rely heavily on clinical observation, underscoring the need for objective, noninvasive tools. In this exploratory study, serum-based ¹H nuclear magnetic resonance (NMR) measurement combined with short-time Fourier transform (STFT) for time-frequency analysis was performed, followed by principal component analysis (PCA), to investigate potential patient subgroups. Serum samples from 29 patients were analysed and PC1 scores suggested two potential patient subgroups. Retrospective analysis showed that these subgroups differed primarily in keloid aetiology: one group predominantly included cases arising from unclear or minimal causes (e.g., acne, folliculitis), whereas the other comprised cases following clear traumatic events (e.g., surgery). Although most clinical variables showed no significant differences, significant differences in aetiology and Japan Scar Workshop Scar Scale (JSS) scores support the biological relevance of this separation of subgroups. These findings suggest that the time-frequency features of NMR signals from serum samples capture systemic characteristics associated with keloid pathophysiology. If validated in larger cohorts, this approach may serve as a noninvasive adjunct to clinical assessment and lay the foundation for objective patient stratification and precision-guided treatment strategies.

Keloids are chronic fibroproliferative skin disorders with high recurrence rates and limited treatment options, yet reliable diagnostic biomarkers are lacking. Current classification systems rely heavily on clinical observation, underscoring the need for objective, noninvasive tools. In this exploratory study, serum‐based ¹ H nuclear magnetic resonance (NMR) measurement combined with short‐time Fourier transform (STFT) for time‐frequency analysis was performed, followed by principal component analysis (PCA), to investigate potential patient subgroups. Serum samples from 29 patients were analysed and PC1 scores suggested two potential patient subgroups. Retrospective analysis showed that these subgroups differed primarily in keloid aetiology: one group predominantly included cases arising from unclear or minimal causes (e.g., acne, folliculitis), whereas the other comprised cases following clear traumatic events (e.g., surgery). Although most clinical variables showed no significant differences, significant differences in aetiology and Japan Scar Workshop Scar Scale (JSS) scores support the biological relevance of this separation of subgroups. These findings suggest that the time‐frequency features of NMR signals from serum samples capture systemic characteristics associated with keloid pathophysiology. If validated in larger cohorts, this approach may serve as a noninvasive adjunct to clinical assessment and lay the foundation for objective patient stratification and precision‐guided treatment strategies.

Background: Hypertrophic scars and keloids can develop from surgical incisions. These pathologic scars grow progressively due to chronic dermal inflammation, which is exacerbated by skin tension. Postsurgical wound tension can be mitigated by various surgical tactics. One underrecognized aspect is surgical incision orientation. Here, we discuss the principles underlying existing surgical incision line systems, including Langer and Pinkus lines, and propose a new system based on our observations of pathological scar growth. Methods: We review the biological mechanisms that drive pathological scar growth, describe existing surgical incision line systems and their limitations, and propose our “ideal surgical incision line” system. Results: Keloids grow in the direction of predominant skin-stretching tension. The main surgical incision line systems are those of Borges (relaxed skin tension lines caused by anatomical features), Kraissl (dynamic lines driven by muscle contraction), and Lemperle (striae distensae). Borges lines only consist of static lines; Kraissl lines are generally not accurate for dynamic wrinkles caused by multidirectional or multilayered muscle contraction; and not every patient bears striae distensae. Our experience with pathologic scars led us to develop an “ideal surgical incision” system for the face and entire body that incorporates static wrinkles, dynamic wrinkles caused by simple and multidirectional muscle contraction, and classical folds/creases/grooves. We also propose that when ideal lines cannot be used for practical reasons, Z-incisions and Z-plasties can mitigate skin tension. Conclusions: Our ideal surgical incision line system may help guide surgeons in their choice of surgical incision lines, thus reducing the risk of pathological scarring.

Chronic wounds pose a persistent clinical and economic burden, often failing to respond to standard care as a result of impaired angiogenesis, prolonged inflammation, and dysfunctional cellular activity. Emerging strategies in regenerative medicine offer new hope, particularly those focusing on stem cell therapy, growth factor modulation, and mechanical support. This narrative emphasizes the clinical applicability. We performed targeted searches of PubMed/MEDLINE and Embase using terms related to regenerative cell therapy, growth factor modulation, mechanical/physical strategies, adjuvant therapies, and platelet-derived products (PRP/PRF). We prioritized randomized/controlled studies, high-quality observational cohorts, meta-analyses, and consensus guidelines relevant to chronic wound healing, and we critically appraised heterogeneity and limitations. In particular, the latest innovations in chronic wound management, mesenchymal stem cells (MSCs), and adipose-derived stem cells (ASCs) have shown promise in promoting angiogenesis and modulating immune responses. Concurrently, the targeted delivery of cytokines such as vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF), and epidermal growth factor (EGF) is being optimized through advanced biomaterials to enhance healing microenvironments. Mechanical interventions, including negative pressure wound therapy (NPWT) and shock wave therapy, further support tissue repair and revascularization. Together, these approaches reflect a shift from symptomatic wound care to personalized, regenerative strategies. This review synthesizes preclinical and clinical data, explores translational challenges, and outlines future directions that integrate biology, bioengineering, and digital tools for optimized wound healing.