Tissue ablation (laser resurfacing, dermabrasion) or chemical peelings are the methods of choice for the treatment of sun-aged, wrinkled skin or for the treatment of annoying scars (e.g. pregnancy marks or burn scars). However, ablative surgical procedures or peelings are ablative or "abrasive" procedures that injure the epidermis and can damage the skin's basement membrane. The wound healing cascade is induced by the resulting superficial wound. An exudation (inflammation) phase, granulation (proliferation) and epithelialization phase are passed through in succession, but also overlapping. The inflammation induced by tissue ablation stimulates certain skin cells (fibroblasts) to produce scar collagen instead of normal skin (collagen-elastin matrix). The resulting scar in the dermis leads to skin tightening or scar smoothing. Histologically, however, the regenerated epidermis is thinner and the connecting layer between the epidermis and dermis is flattened. The skin becomes more susceptible to UV rays and there is a higher risk of pigment shifts, especially in darker skin types. However, the biggest disadvantage is the risk of new scarring.
The ideal therapy for any type of wrinkles or scars should therefore increase the skin's self-renewal through regenerating messenger substances without significantly damaging the skin. Recently, the Laboratory for Experimental Plastic Surgery at Hannover Medical School demonstrated that percutaneous collagen induction therapy or microneedling brings us closer to this ideal.

Indications:

• Wrinkles
• Sun-damaged skin
• Stretch marks
• Scars
• Burn scars

Technique

The natural inflammatory reaction in the skin is induced by a roller with 3 mm long needles. During the operation, the plastic surgeon moves the instrument under controlled pressure vertically, horizontally and diagonally over the skin of the area to be treated. The pinpricks create thousands of micro-wounds in the dermis and stimulate skin cells (fibroblasts) to produce collagen. Medical needling can be used on all areas of the body and on all skin types. The procedure can be performed either under local anesthesia or under short anesthesia.

Procedure after the operation

Immediately after percutaneous collagen induction, the treated area is swollen and discolored like a bruise. The bleeding stops spontaneously after a few minutes. The skin secretes wound fluid via the puncture channels within the first few hours. Moist compresses should be applied to the skin during this time to prevent crust formation. Approximately one hour after the operation, the skin is cleaned with an antiseptic washing lotion. Tea tree oil wash gel has proven effective here. To maximize collagen production and initiate the release of growth factors, we recommend local vitamin A and vitamin C therapy. The procedure is extremely painless for the patient. After about a week, the swelling is barely visible.

Advantages/disadvantages

One advantage of medical needling is that after only the epidermis and the basement membrane are punctured, the patient's wound is closed again after just a few hours. This minimizes the risk of infection and significantly shortens the healing phase. As a result, the procedure can often be performed on an outpatient basis. This is particularly advantageous for patients who associate traumatic experiences of their burns with hospitalization. Last but not least, the socio-economic aspects such as low treatment costs are also achieved. Compared to the other procedures mentioned above, the so-called convalescence of the patient is extremely low. Laboratory tests have shown that a tissue substance (TGF β 3) is released immediately after the operation, which leads to scar-free healing of the skin. Since the cells anchored on the basement membrane, which are responsible for the pigmentation of the skin (melanocytes), are not damaged, there is no risk of a postoperative pigment shift. Minimizing the risk of scar re-triggering is therefore one of the most important clinical benefits achieved. After medical needling, certain endogenous growth factors are released in the first few months after the operation, which lead to regeneration of the epidermis and dermis. The disadvantages are that the operations can only be performed under anesthesia and that there is considerable swelling in the first four to seven days after the procedure.
After appropriate assessment by the statutory health insurance companies, the costs of medical needling for the treatment of burn scars can be covered.