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Liu et al. Inflatable pressure garment device

A B

Figure 4: A female patient with chest wall keloids that were treated with surgical excision, radiotherapy and conventional garment pressure
therapy. (A) Preoperative view; (B) 21 months after the operation, keloid recurrence was observed

A B

Figure 5: A female patient with chest wall keloid that were treated with surgical excision, skin graft, radiotherapy and conventional garment
pressure therapy. (A) Preoperative view; (B) keloid recurrence was observed 3 years after operation
DISCUSSION Rose and Deitch [12] reported that the most important
factor in determining the effectiveness of pressure
Pressure has been known to be a useful treatment therapy is the anatomical area treated. In general, the
method for scars since the 16th century. Garment clinical response is positively correlated with higher
[9]
pressure therapy is now widely used in the treatment of pressure generated. However, different pressures
[8]
hypertrophic scars and keloids. Possible mechanisms are generated by conventional pressure garments at
of its effect include hypoxia, biochemical changes different anatomical sites. Therefore, to achieve better
and cellular or collagenous influences. The effects pressure effectiveness, pressure garments, or the
[8]
of pressure have also been reported on the growth other pressure methods used, should be improved.
of human scar fibroblasts and on cellular proliferation
and apoptosis. [10,11] Pressure inhibits the proliferation of Anatomical concavity is the most important factor in
cells, especially fibroblasts; it also suppresses collagen the reduction of the pressure applied by garments.
production and accelerates apoptosis, inhibiting the Therefore, conventional garment pressure therapy is
growth of hypertrophic scars and keloids. seldom effective in the treatment of chest wall keloids,
and its usage is limited. We have previously observed
Appropriate pressure levels are required for garment many recurrences in patients with chest wall keloids
pressure treatment. Van den Kerckhove et al. [7] that were treated with conventional pressure therapy
compared the effects of 10 and 15 mmHg pressure [Figures 4 and 5]. Anatomical convexity increases the
garments. They observed that 15 mmHg of pressure garment pressure; therefore, methods that can convert
tends to accelerate scar maturation. Some authors an anatomical concavity to an anatomical convexity
have recommended the use of pressures between will also theoretically change the garment pressure.
20 and 40 mmHg, based on the theoretical 25 mmHg Our inflatable pressure garment device was designed
arterial capillary pressure level. Although no standard according to this hypothesis. The concave site on
[8]
pressure values have been established, some common the chest wall was converted into a convex shape
practices are accepted. One study recommended a by inserting the expander under the garment and
pressure above 15 mmHg. [8] inflating it. The convexity and pressure increase can

Plastic and Aesthetic Research ¦ Volume 4 ¦ June 16, 2017 95