\r\n\tEnvironmental Chemoinformatics aims to avoid animal testing, with respect of REACH (Registration, Evaluation, Authorisation, and restriction of Chemicals) regulations, using QSAR models to prioritize compounds by environmental hazard and risk assessment. \r\n\tOptimization of process parameters in various chemical process and operations can carried out by simulation programs (separation: simulation of a fractional distillation column; transport properties; penetration trough membranes; coatings; fermentative process, etc.).
",isbn:"978-1-83880-068-0",printIsbn:"978-1-83880-067-3",pdfIsbn:null,doi:null,price:0,priceEur:0,priceUsd:0,slug:null,numberOfPages:0,isOpenForSubmission:!1,hash:"3fed97d1719b8a321190c86985494a34",bookSignature:"Dr. Amalia Stefaniu",publishedDate:null,coverURL:"https://cdn.intechopen.com/books/images_new/9236.jpg",keywords:"Drug Design, Activity, Toxicity, Molecular Dynamic, Chemical Structure, SMILES, 3D Structure Generation, Chemometric Analysis, Chemical Databases, MedChem, Beilstein, Available Chemical Directory (ACD), Machine Learning Techniques, Chemical Fingerprints, Chemical Descriptors, Environmental Chemoinformatics, Risk Assessment, REACH Regulations, Chemical Parameters Optimizations, Phase Equilibria Calculation, Thermodinamic Model",numberOfDownloads:456,numberOfWosCitations:0,numberOfCrossrefCitations:1,numberOfDimensionsCitations:2,numberOfTotalCitations:3,isAvailableForWebshopOrdering:!0,dateEndFirstStepPublish:"August 28th 2019",dateEndSecondStepPublish:"September 18th 2019",dateEndThirdStepPublish:"November 17th 2019",dateEndFourthStepPublish:"February 5th 2020",dateEndFifthStepPublish:"April 5th 2020",remainingDaysToSecondStep:"3 months",secondStepPassed:!0,currentStepOfPublishingProcess:4,editedByType:null,kuFlag:!1,editors:[{id:"213696",title:"Dr.",name:"Amalia",middleName:null,surname:"Stefaniu",slug:"amalia-stefaniu",fullName:"Amalia Stefaniu",profilePictureURL:"https://mts.intechopen.com/storage/users/213696/images/system/213696.jpg",biography:"Dr. chem. eng. Amalia Stefaniu has a background in chemical engineering, acquiring her Bachelor’s degree at University POLITEHNICA of Bucharest, Faculty of Chemical Engineering (in French). \r\nShe completed her studies with Postgraduate Academic Advanced Studies, Drugs and Cosmetics specialization and with a masters degree in Biotechnologies and food safety at University of Agricultural Sciences and Veterinary Medicine Bucharest, Faculty of Biotechnologies. \r\n\r\nShe obtained her Ph.D. degree in Exact Sciences - Chemistry (2011) at University POLITEHNICA of Bucharest, Romania, Faculty of Applied Chemistry and Materials Science, Department of Inorganic Chemistry, Physical Chemistry and Electrochemistry.\r\n\r\nHer current position is Senior research scientist at National Institute for Chemical-Pharmaceutical Research and Development, Bucharest, Laboratory of molecular design and molecular docking. 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Venkateswarlu",coverURL:"https://cdn.intechopen.com/books/images_new/371.jpg",editedByType:"Edited by",editors:[{id:"58592",title:"Dr.",name:"Arun",surname:"Shanker",slug:"arun-shanker",fullName:"Arun Shanker"}],productType:{id:"1",chapterContentType:"chapter",authoredCaption:"Edited by"}}]},chapter:{item:{type:"chapter",id:"64050",title:"Recycling of Polymeric Composite Materials",doi:"10.5772/intechopen.81281",slug:"recycling-of-polymeric-composite-materials",body:'\n
\n
1. Introduction
\n
In the last decades have revealed significant changes in the world in terms of the use of materials in various fields, mutations complained so special requirements of peak areas and increasingly diversified requirements related to the production of consumer goods and not least all environmental requirements.
\n
Composite materials are considered engineering materials that can replace non-ferrous or ferrous materials. Polymer composite materials have a large applicability in a different industries such as electrical engineering, electronics, building and civil engineering, rail, road and marine, aerospace technique and aeronautical, etc. [1, 2, 3, 4, 5, 6, 7, 8].
\n
Composite materials consist of reinforcement material (glass fiber, carbon fiber, Kevlar, etc.) and a matrix (polyester resin, epoxy resin, and so on). Fiber glass is the most used reinforcing materials. They have many characteristics: high tensile strength, high chemical resistance, low cost. To obtain low price or to give high properties to a composite material we can include in a structure auxiliary materials, like: coupling agents, catalysts, pigments, accelerators and so on [9].
\n
The storage of waste composite materials and the recovery of these, it’s an important problem that we have nowadays. In Figure 1, it can be seen composite parts out of use and composite waste resulted from different production processes that occupy considerable spaces for storage. In time the accumulation of such materials can create serious problems to the manufacturing companies.
\n
Figure 1.
Composite materials waste stored.
\n
Because the interest to find solutions for recovering or recycling is very low, the accumulation in time of composite materials waste is very significant. We can obtain a material rich in glass fiber by grinding the composite materials waste. Thus, it’s obtaining a very valuable reinforcement that can be embedded in other materials or can be used for obtaining reinforced composite materials. A solution for recycling such composite materials has been to grind these materials, Figure 2 and create new composite products.
\n
Figure 2.
Ground glass fiber.
\n
The recovery and recycling of polymeric composite materials has experienced an important concern in the last years. Researches dedicated to technologies for recycling composite materials were initiated and carried out by different authors, [10, 11, 12, 13].
\n
Mixtures of concrete with sand and fiberglass waste are known [14, 15, 16]. Waste composites can be used for concrete reinforcement or for a variety of construction materials. However, these materials from the known technical solutions point of view have higher density, lower mechanical properties, and the external factors like: UV radiation, moisture, sunlight, influence the degradation of these.
\n
A chemical recycling of glass fiber reinforced epoxy resin has been proposed by Dang et al. [17]. PET reinforced with glass fiber was recycled by Giraldi et al. [18], while Bartl et al. [19] study the fibers recycling obtained from tires. Vilaseca et al. [20] treat in their research recycled Kraft fibers (recycled softwood fibers) that coming from old sacs, used as reinforcement for the preparation of polypropylene composites. Composite materials obtained from wood fibers were analyzed by Nemes et al. [21] and Augier et al. [22].
\n
Hugo et al. [23] were investigated recycled polymers with a range of different fillers, and developed applications that use waste thermoplastic polymer.
\n
In order to make the ornamental plates used in the field of construction, a number of manufacturing processes are known which use sand mixtures with different binders: plaster, whitewash or cement [24, 25]. The obtained material as a dry mix or mortar is poured and pressed into a mold. After reinforcement of the material, the plate is extracted from the mold, after which time is left for stabilization, and then it can be used.
\n
For the same purpose, for the production of alternative materials it is known the manufacturing process of reinforced mortars used in construction [26, 27]. These mortars include besides sand, whitewash, cement, gypsum and various reinforcement materials, such as: hemp fiber, glass fiber, etc.
\n
The disadvantages of these processes are the high time of plates obtaining and their reduced mechanical characteristics. Other disadvantages of the plates obtained by these processes are the high density of the material and the degradation in time under the influence of external factors: humidity, sun, UV radiation.
\n
Reinforced materials and manufacturing procedures have a significant influence on the quality, productivity and competitiveness of composite structures. The interface between matrix-reinforced materials plays an essential part in the mechanical behavior and fabrication of composite materials.
\n
\n
\n
2. Recycling of composite materials
\n
The recycling of materials organic macromolecular surgery is more complicated than with traditional materials (glass, paper, metal), because there is an impressive variety of polymers, which in most cases are not compatible with each other, in the event of a global recycling [28, 29, 30].
\n
For the recycling of polymeric materials there are several solutions:
The separation of the constituents of mixtures in order to recycling of each individual component;
The direct transformation of the mixture without prior sorting, in order to reduce the volume of waste.
\n
From the view point of recycling, waste can be classified as:
Manufacturing waste (10% of total waste) mainly formed of a single material. Because they are not contaminated (or less purified) with other materials, recycling is easier. Typically, these wastes are reintroduced into production lines.
Waste easily separable. They consist of 1–2 or more polymers (mix macroscopic scale) otherwise contaminated materials (fillers). These materials are, at least theoretically separable.
Microscopic mixtures or intimately connected (soldered, interpenetration). This is the case most difficult to treat because the separation of constituents is difficult or even impossible, requiring complicated operations. In this category fits very well with organic matrix composites. The most representative example is the waste from the automotive industry. In this case, the blend will find materials (resins) thermoplastic, polymer mix, fibers, fillers and multilayer composite materials.
Materials of the recycling, currently applies in particular to the first two categories mentioned.
\n
The recycling after separation of mixtures is a much more interesting because you have to drive theoretically product with performance very close to the base polymeric materials. In practice, the properties of recycled materials approaching initial properties of the base material, unless methods are very effective waste sorting and waste have undergone significant degradation during operation.
\n
Sorting of waste is done according to the basic polymeric material. The sequence of operations mainly comprises the following steps:
\n
Shredding. At this stage, the materials must be recovered shrinks size to be easily transported and handled.
\n
Separation of metals is well-established methods, obviating the mixture all existing metal fragments (e.g. electromagnetic methods).
Shredding and/or spraying. This stage is complementary to the first mentioned. At this stage takes place and the washing waste. Choppers additional step is required for further processing easier.
Washing and drying is intended to remove all impurities. In general washing is done with water and detergent, but depending on the nature of impurities at this stage can put complex problems. Flushing is required followed by spin drying to remove water.
Separation using air or hydro cyclones and disposal are conventional methods for separating materials based on the difference in density. The process stream is brought into contact with a stream of air (water) in a cyclone. With these separation methods do not obtain high degrees of purity. Moreover, this mineral phase (mineral fillers) often change the apparent density of the polymer, making it difficult to separate.
\n
By materializing the proposed project creates prerequisites for achieving scientific and technological results, competitive at European level in order to increase the visibility of Romanian research, especially to subsequently transfer the results in socio-economic practice.
\n
The resolving of proposed assignment will lead to the development of science-based knowledge of the manufacturing processes of parts of polymeric composite materials reinforced with biodegradable waste. The aim is to achieve a topic fundamental research, advanced to develop methods and technologies for recycling polymer composite materials and develop new recipes using biodegradable waste. It thus aims to improve the quality, productivity and competitiveness of industrial products. This is possible by using a multidisciplinary approach to research that brings together knowledge of chemistry, mathematics, physics, rheology and technological engineering.
\n
\n
\n
3. Proposed new composite material and manufacturing method for ornamental synthetic plates
\n
Both composite materials and waste composite materials resulting from production processes occupy important storage areas with an impact on the environment.
\n
It shows the utilization of the glass fiber waste obtained by grinding the waste resulting from the manufacturing technological process of composite materials or removing them from their use and incorporating them in a product with applications in the field of industrial constructions, offering superior mechanical characteristics to the existing similar products.
\n
\n
3.1. The matrix
\n
The mold, for obtaining the ornamental synthetic plates, is made of two separate modules, one of silicone rubber and one of fiber reinforced composite material. In Figure 3 are presented the steps of mold forming.
\n
Figure 3.
Steps of mold forming.
\n
Achieving the active part of the silicone rubber mold eliminates the need for additional separation planes, and the mold stiffness is ensured by reinforcing it with a fiber reinforced composite material. The use of matrix mold from the silicone elastomer eliminates additional separation planes reducing the cost of the mold.
\n
The manufacturing process of the matrix, involves the following phases:
The process of ornamental synthetic plates manufacturing consists in a mixing, in a recipient, of calcium carbonate with the polyester matrix 5 minutes, casting these materials into a modular mold made from silicone and reinforced by a fiber-reinforced composite material and maintaining at room temperature for 20 minutes until the matrix gel point has been reached, mixing in another recipient for 10 minutes of waste glass fiber ground with a polyester matrix and 0–0.3 mm sand, and molding it in the die over the initial molded material, holding molds in the die approx. 2 hours at 60°C, resulting an ornamental plate that is released from the mold after composite material polymerization. The material together with the unpolymerised matrix is deposited in a modular mold.
\n
The sand was used as a low-cost reinforcement material in the form of particles with transparent aspect. The morphological analysis of the sand is shown in Figure 4.
\n
Figure 4.
Sand grains.
\n
The manufacturing process of synthetic decorative plates involves the following phases:
preparing the mold and applying the first layer release agent,
preparing the first mixture consisting of 60% polyester matrix and 40% Calcium Carbonate CaCO3, mixed approx. 5 minutes in a recipient,
casting the first mixture so that it will cover more than 1–3 mm the height of the mold asperities and the maintenance until reaching the gel point, at room temperature,
preparing the consolidation mixture consisting of 30% sand of the 0–0.3 mm sort range, 30% grinded glass fiber waste and 40% polyester matrix and mixing it for 20 minutes,
casting the consolidation mixture over the first mixture until the mold filling and leveling the upper part,
transferring the mold with the composite mixture in a polymerization heat and maintaining in the mold at a temperature of 60°C, about 2 hours, until the composite material polymerization,
mold release and obtaining the ornamental synthetic plates.
\n
The composite material consists in obtaining a synthetic material composed of two component mixtures, Figure 5:
the first mixture, which forms the surface layer that copy the mold and render the appearance of the synthetic plate, Figure 6, consist of 60% polyester matrix and 40% Calcium Carbonate CaCO3, mixed approx. 5 minutes, casted and maintained until the gel point was reached;
the second mixture, of consolidation, consist of 40% polyester matrix, 30% sand of the 0–0.3 mm sort range, 30% grinded glass fiber waste, casted over the first mixture and maintaining in the mold until the polymerization, resulting a synthetic composite material reinforced with glass fiber having superior mechanical properties to similar materials used in construction.
\n
Figure 5.
The synthetic material consisting of two component mixtures.
\n
Figure 6.
The ornamental synthetic plate.
\n
The percentages mentioned above represent the percentage of the total volume of the constituent materials.
\n
The obtained material is a compact material with resistance at external agents, the process being easy to achieve. The composite material provides superior mechanical characteristics to traditional materials and can be used in other applications in the construction field such as reinforcing structures.
\n
The following advantages are obtained:
composite material waste utilization, thus solving the significant problem of glass fiber waste;
enlarge the range of materials used in construction;
making a composite material having superior mechanical characteristics and low density with respect to traditional materials;
getting some plates with good look, imitating the natural stone, which can be colored in large quantity in the production process and can be easily mounted on facades and buildings;
the technological simplicity of the process does not require substantial investment;
the use of matrix mold from the silicone elastomer eliminates additional separation planes reducing the cost of the mold;
increasing the mechanical characteristics when using these materials at low temperatures.
\n
\n
\n
3.3. Mechanical tests
\n
For mechanical tests, from the obtained material was done cubic specimens with 50 × 50 × 50 mm dimensions, according to EN 12320-3 standard.
\n
The obtaining process of the composite plates that include in the structure glass fiber waste was hand lay-up. The mechanical properties of composite plates were determined to perform the experimental test at compressive load.
\n
Table 1 shows data following the compressive stress of cubic specimens, the constituent composite material remains bonded through filaments of reinforcement material.
\n
\n
\n
\n
\n
\n
\n\n
\n
No.
\n
Force [KN]
\n
Average force [KN]
\n
Average compressive breaking strength [MPa]
\n
Density [Kg/m3]
\n
\n\n\n
\n
1.
\n
185.8
\n
189.96
\n
78.27
\n
1380
\n
\n
\n
2.
\n
191.2
\n
\n
\n
3.
\n
193.2
\n
\n
\n
4.
\n
187.3
\n
\n
\n
5.
\n
192.3
\n
\n\n
Table 1.
Compressive tests results.
\n
The composite plates provide higher mechanical properties, lower costs and reduce waste materials in the environment.
\n
The experimental data shows that the new materials have good mechanical properties and they can be successfully used in the dimensioning and verification process of composite structures resistance.
\n
\n
\n
3.4. Microscopy study
\n
The microstructure of fracture samples from waste glass fibers/sand/polyester matrix composites was analyzed using a metallographic microscope type Optika XDS-3 MET [31, 32].
\n
The sand grains contain in the structure over 90% silica (SiO2). The glass fibers are made from silica sand, which melts at 1720°C.
\n
The monofilaments of non-impregnated glass fiber have a smooth and glossy surface, specific to the glass. These were analyzed using the optical microscopy, Figure 7. To have a good adhesion at the interface between matrix and fibers, the surface of glass fibers is treated with silane. In Figure 8 it’s show the impregnated glass fiber monofilaments with resin.
\n
Figure 7.
Non-impregnated glass fiber monofilaments.
\n
Figure 8.
Impregnated glass fiber monofilaments with resin.
\n
Figure 9 shows the adhesion between matrix and glass fiber monofilaments. Figure 10 illustrates that sand grains and glass fiber monofilaments are well impregnated with resin according to the morphological analysis of the fracture area. It can be observed a good compatibility between resin, filaments and sand, and a good impregnation of the matrix.
\n
Figure 9.
Waste glass fiber monofilaments impregnated with resin.
\n
Figure 10.
The fracture zone of waste fiber glass/sand/polyester resin plate.
\n
According to the Figure 11, it can be observe the achieved connection between polyester matrix, glass fibers and sand, because of the particles of sand and polyester resin that were well glued on the glass monofilaments. Thus, a composite material with low density and high mechanical properties has obtained. These types of materials allow one reuse of glass fiber waste. Using these types of materials at low temperatures increases their mechanical characteristics.
\n
Figure 11.
Sand and glass monofilaments in polyester resin.
\n
\n
\n
\n
4. Energy dispersive x-ray analysis
\n
With the help of the energy dispersive x-ray spectroscopy (EDX) was performed the elemental analysis of the polyester resin and waste fiber glass. The weight fraction ratio is composed on the total weight of the chemical substances analyzed. The predominance of silicon and aluminum can be observed in the Figure 12, after the elemental EDX analysis was done of the waste glass fiber [32]. Also, small amounts of carbon, oxygen, sodium, magnesium and calcium are detected. The obtained data are expressed in two ways, both atomic percent (At.%) and weight percent (Wt.%). The atomic and the weight percentages of the fiber glass elements are: C with 30.96At.%, 17.67Wt.%; O with 24.12At.%, 18.34Wt.%; Na with 0.34At.%, 0.37Wt.%; Mg with 0.38At.%, 0.43Wt.%; Al with 14.43At.%, 18.50Wt.%; Si with 21.12At.%, 28.19Wt% and Ca with 8.66At.%, 16.50Wt.%. In Table 2 are presented the elements on the surface of a waste glass fiber.
\n
Figure 12.
EDX analysis of the chemical constituents from the glass fiber.
\n
\n
\n
\n
\n\n
\n
Element
\n
At.%
\n
Wt.%
\n
\n\n\n
\n
Si
\n
21.12
\n
28.19
\n
\n
\n
Al
\n
14.43
\n
18.50
\n
\n
\n
Ca
\n
08.66
\n
16.50
\n
\n
\n
O
\n
24.12
\n
18.34
\n
\n
\n
C
\n
30.96
\n
17.67
\n
\n
\n
Mg
\n
00.38
\n
00.43
\n
\n
\n
Na
\n
00.34
\n
00.37
\n
\n\n
Table 2.
EDX analysis of the glass fiber.
\n
The EDX analysis of the matrix polymer is presented in Figure 13, [32]. The predominance of carbon, silicon and oxygen is obviously in this case study. Also, small amount of sodium, aluminum and calcium are detected. The atomic and the weight percentages of the polyester matrix elements are: C with 74.80At.%, 62.18Wt.%; O with 15.97At.%, 17.69Wt.%; Na with 0.29At.%, 0.47Wt.%; Al with 1.28At.%, 2.39Wt.%; Si with 4.78At.%, 9.30Wt.% and Ca with 2.87At.%, 7.98Wt.%.
\n
Figure 13.
EDX analysis of the matrix polymer.
\n
In the table above, Table 3, are presented the elemental quantitative analyses that give us the polyester matrix elements on the surface.
\n
\n
\n
\n
\n\n
\n
Element
\n
At.%
\n
Wt.%
\n
\n\n\n
\n
C
\n
74.80
\n
62.18
\n
\n
\n
Si
\n
04.78
\n
9.30
\n
\n
\n
O
\n
15.97
\n
17.69
\n
\n
\n
Ca
\n
02.87
\n
7.98
\n
\n
\n
Al
\n
01.28
\n
2.39
\n
\n
\n
Na
\n
00.29
\n
0.47
\n
\n\n
Table 3.
EDX analysis of the matrix.
\n
\n
\n
5. Conclusions
\n
The storage of waste composite materials and the recovery of these, it’s an important problem that we have nowadays. Composite parts out of use and composite waste resulted from different production processes occupy considerable spaces for storage. The manufacturing companies can be affected by serious problems, because of the accumulation in time of these types of materials.
\n
A solution for recycling these composite materials has been to grind these materials and create new composite products.
\n
A new composite material obtained from recovered materials, with a complete recovery of glass fibers waste is described in this study.
\n
The composite material for obtaining the ornamental synthetic plates consist of a mixture that forms the surface layer, that copy the mold and render the appearance of the synthetic plate, consist of 60% polyester matrix and 40% Calcium Carbonate CaCO3 and a consolidation mixture consist of 40% polyester matrix, 30% sand of the 0–0.3 mm sort range, 30% grinded glass fiber waste, casted over the first mixture and maintaining in the mold until the polymerization.
\n
The experimental properties obtained indicate a very good mechanical behavior of the new composite materials. The compressive tests indicate a high value, superior of traditional materials, like concrete.
\n
The fracture area of the samples from glass fibers waste/polyester resin/sand composites was microscopically analyzed. A good compatibility between resin, filaments and sand, and a good impregnation of the matrix was obtained.
\n
The new composite material contained grinded glass fiber waste, polyester matrix and sand all mixed together. After polymerization of the resin we obtain a composite material with superior mechanical properties. This material can be used in different applications, like: strengthening composite parts (ornamental garden stones, ornamental composites plates, garden furniture, additive materials and so on), polyester reinforced concrete.
\n
\n
Acknowledgments
\n
This paper was supported by the project AMATUC HORIZONT 2020, contract nr. GA 691787, “Boosting the scientific excellence and innovation capacity in Additive Manufacturing of the TUC-N (AMaTUC)”, 2016-2018, project director: Nicolae Balc.
\n
\n',keywords:"waste, composite materials, glass fibers, polymer matrix, recycled materials",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/64050.pdf",chapterXML:"https://mts.intechopen.com/source/xml/64050.xml",downloadPdfUrl:"/chapter/pdf-download/64050",previewPdfUrl:"/chapter/pdf-preview/64050",totalDownloads:545,totalViews:320,totalCrossrefCites:2,totalDimensionsCites:2,hasAltmetrics:0,dateSubmitted:"February 27th 2018",dateReviewed:"September 3rd 2018",datePrePublished:"November 5th 2018",datePublished:"November 21st 2018",readingETA:"0",abstract:"This chapter treats studies about the methods and technologies used to recycle the polymeric composite materials and develop new recipes using waste of polymer composite materials resulted from recycling. Composite materials obtained from recycling are presented, with a complete recovery of waste glass fibers. Also, the mechanical properties for new structures of polymeric composite materials, containing additional materials were presented. These were obtained from the recycling of composite waste. A morphology analysis of fracture area of composites samples was done. At present, the polymeric composite materials present a great scientific and technical interest, which justify both the development of research in this field, and the expansion of production of such materials. The author treats aspects regarding a current problem due to the large number of polymeric composite materials waste, and reduced of environmental impact. This field is representing one of the top viable research directions.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/64050",risUrl:"/chapter/ris/64050",book:{slug:"product-lifecycle-management-terminology-and-applications"},signatures:"Emilia Sabău",authors:[{id:"248080",title:"Dr.Ing.",name:"Emilia",middleName:null,surname:"Sabau",fullName:"Emilia Sabau",slug:"emilia-sabau",email:"emilia.sabau@tcm.utcluj.ro",position:null,institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Recycling of composite materials",level:"1"},{id:"sec_3",title:"3. Proposed new composite material and manufacturing method for ornamental synthetic plates",level:"1"},{id:"sec_3_2",title:"3.1. The matrix",level:"2"},{id:"sec_4_2",title:"3.2. The material",level:"2"},{id:"sec_5_2",title:"3.3. Mechanical tests",level:"2"},{id:"sec_6_2",title:"3.4. Microscopy study",level:"2"},{id:"sec_8",title:"4. Energy dispersive x-ray analysis",level:"1"},{id:"sec_9",title:"5. Conclusions",level:"1"},{id:"sec_10",title:"Acknowledgments",level:"1"}],chapterReferences:[{id:"B1",body:'Barbero EJ. Introduction to Composite Materials Design. USA: West Virginia University; 1998. 336 p. ISBN 97e8-1-4200-7915-9\n'},{id:"B2",body:'Gay D. Matériaux Composites. 4th ed. Paris: Hezrmes; 1997. 640 p. ISBN2-86601-586-X\n'},{id:"B3",body:'Berthelot JM. Matériaux Composites. Comportement mécanique et analyse des structures. Paris: Editions TEC&DOC; 1999. 620 p. ISBN 2-7430-0349-9\n'},{id:"B4",body:'Ch D. Structures composites. Calcul des plaques et des poutres multicouches. Paris: Hermes; 2000. 352 p. ISBN 2-7462-0114-3\n'},{id:"B5",body:'Jones RM. Mechanics of Composite Materials. 2nd ed. Philadelphia: Taylor and Francis; 1999. 519 p. ISBN 1-56032-712-X\n'},{id:"B6",body:'Kollar LP, Springer GS. Mechanics of Composite Structures. Cambridge: Cambridge University Press; 2003. 480 p. ISBN 978-0-511-05703-8\n'},{id:"B7",body:'Vasiliev VV, Morozov EV. Mechanics and Analysis of Composite Materials. London: Elsevier Science; 2001. 41e2 p. ISBN 0-08-042702-2\n'},{id:"B8",body:'Cobzaru P. Materiale compozite (Composite materials). Bucureşti: Didactică şi Pedagogică; 2004. ISBN 973-30-1445-1\n'},{id:"B9",body:'Nemeş O, Lachaud F, Piquet R, Soporan VF, Tătaru O. The waste rubber used to improve the properties of composite materials. Studia UBB Chemia;2008, 53(3):25-30. ISSN: 1224-7154. WOS:000263940900002\n'},{id:"B10",body:'Pickering SJ. Recycling technologies for thermoset composite materials-current status. Composites Part A Applied Science and Manufacturing. 2006;37:1206-1215. DOI: 10.1016/j.compositesa.2005.05.030\n'},{id:"B11",body:'Turner TA, Pickering SJ, Warrior NA. Development of recycled carbon fibre moulding compounds – Preparation of waste composites. Composites: Part B. 2011;42:517-525. DOI: 10.1016/j.compositesb.2010.11.010\n'},{id:"B12",body:'Bernasconi A, Rossin D, Armanni C. Analysis of the effect of mechanical recycling upon tensile strength of a short glass fibre reinforced polyamide 6,6. Journal of Engineering Fracture Mechanics. 2007;74(4):627-641. DOI: 10.1016/j.engfracmech.2006.10.002\n'},{id:"B13",body:'Pickering SJ, Kelly RM, Kennerley JR, Rudd CD, Fenwick NJ. A fluidised-bed process for the recovery of glass fibres from scrap thermoset composites. Composites Science and Technology. 2000;60(4):509-523. DOI: 10.1016/S0266-3538(99)00154-2\n'},{id:"B14",body:'Sebaibi N, Benzerzour M, Abriak NE, Binetruy C. Mechanical properties of concrete-reinforced fibre sand powders with crushed thermoset composites: The influence of fibre/matrix interaction. Construction and Building Materials. 2012;29:332-338. ISSN 0950-0618\n'},{id:"B15",body:'Park SB, Lee BC, Kim JH. Studies on mechanical properties of concrete containing waste glass aggregate. Cement and Concrete Research. 2004;34:2181-2189\n'},{id:"B16",body:'Tam VWY, Gao XF, Tam CM, Ng KM. Physio-chemical reactions in recycle aggregate concrete. Journal of Hazardous Materials. 2009;163:823-828. DOI: 10.1016/j.jhazmat.2008.07.031\n'},{id:"B17",body:'Dang WR, Kubouchi M, Sembokuya H, Tsuda K. Chemical recycling of glass fiber reinforced epoxy resin cured with amine using nitric acid. Polymer. 2005;46(6):1905-1912. DOI: 10.1016/j.polymer.2004.12.035\n'},{id:"B18",body:'Giraldi ALF de M, Bartoli JR, Velasco JI, Mei LHI. Glass fibre recycled poly(ethylene terephthalate) composites: Mechanical and thermal properties. Polymer Testing. 2005;24:507-512. DOI: 10.1016/j.polymertesting.2004.11.011\n'},{id:"B19",body:'Bartl A, Hackl A, Mihalyi B, Wistuba M, Marini I. Recycling of fibre materials. Institution of chemical engineers. Trans IChemE: Part B. Process Safety and Environmental Protection. 2005;83(B4):351-358. DOI: 10.1205/psep.04392\n'},{id:"B20",body:'Vilaseca F, Mendez JA, Lopez JP, Vallejos ME, Barbera L, Pelach MA, et al. Recovered and recycled Kraft fibers as reinforcement of PP composites. Chemical Engineering Journal. 2008;138:586-595. DOI: 10.1016/j.cej.2007.07.066\n'},{id:"B21",body:'Nemes O, Chiper AM, Rus AR, Soporan VF, Tataru O, Bere P. New composite materials plates from vegetal fibres. Studia UBB Chemia. 2010;54. Sp.Iss. SI. 101-108 p. ISSN: 1224-7154. WOS:000208359300011\n'},{id:"B22",body:'Augier L, Sperone G, Vaca-Garcia C, Borredon ME. Influence of the wood fibre filler on the internal recycling of poly(vinyl chloride)-based composites. Polymer Degradation and Stability. 2007;92:1169-1176. DOI: 10.1016/j.polymdegradstab. 2007.04.010\n'},{id:"B23",body:'Hugo AM, Scelsi L, Hodzic A, Jones FR, Dwyer-Joyce R. Development of recycled polymer composites for structural applications. Plastics, Rubber and Composites. 2011;40(6-7):323-317. DOI: 10.1179/1743289810Y.0000000008\n'},{id:"B24",body:'La PR. Sculpture—Méthodes et matériaux nouveaux. Paris: Dessain et Tolra; 2001. 64 p. ISBN 2-04-720032-6\n'},{id:"B25",body:'Le PR. Moulage. Paris: Dessain et Tolra; 2001. 158 p. ISBN 2-04-021842-4\n'},{id:"B26",body:'Mohanu I, Georgescu M, Mohanu D, Manolache L, Draganoaia C. Physical-mechanical and aesthetic characteristics of some mortars based on lime-limestone-volcanic tuff. Romanian Journal of Materials. 2011;41(4):332-345. ISSN: 1583-3186. WOS:000298204200005\n'},{id:"B27",body:'Rapisca P. Materiale de construcții (Building Materials). Bucuresti: Matrixrom; 2006. 480 p. ISBN 973-755-067-6\n'},{id:"B28",body:'Thomas C, Lombillo I, Polanco JA, Villegas L, Setien J, Biezma MV. Polymeric and cementitious mortars for the reconstruction of natural stone structures exposed to marine environments. Composites Part B Engineering. 2010;41:663-672. DOI: 10.1016/j.compositesb.2010.08.007\n'},{id:"B29",body:'Popescu V, Horovitz O, Damian L. Compozite cu matrice organic (Organic Matrix Composites). Cluj-Napoca: UTPRES; 2001. 327 p. ISBN 973-9471-97-8\n'},{id:"B30",body:'Bere P. Materiale compozite polimerice (Polymeric composite materials). Cluj-Napoca: U.T.Press; 2012. 252 p. ISBN 978-973-662-723-1\n'},{id:"B31",body:'Sabău E, Bâlc N, Bere P. Mechanical behavior of new composite materials reinforced by waste glass fibre. Advanced Engineering Forum. Switzerland: Trans Tech Publications; 2013;(8-9):309-316. DOI: 10.4028/www.scientific.net/AEF.8-9.309\n'},{id:"B32",body:'Sabău E, Bâlc N, Bere P, Nemes O. New materials from waste glass fibre. Studia Universitatis Babes-Bolyai Seria Chemia. 2012;LVII(4):201-208. ISSN 1224-7154. WOS: 000318593300020\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Emilia Sabău",address:"emilia.sabau@tcm.utcluj.ro",affiliation:'
Technical University of Cluj-Napoca, Romania
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\n
1. Introduction
\n
While keloids and hypertrophic scars have some tumor-like properties, they are actually inflammatory conditions that drive the excessive proliferation of dermal fibroblasts and the aberrant accumulation of dermal matrix [1]. These fibroproliferative disorders of the skin are caused by abnormal healing of injured or irritated skin. Common causes of injury and irritation are trauma, burn, surgery, vaccination, skin piercing, acne, and herpes zoster. The risk of developing keloids and hypertrophic scars is particularly high if the wound is deep enough to damage the reticular layer of the dermis and if various genetic, systemic, and/or local risk factors that prolong the inflammatory stage of wound healing are present. The protracted inflammation accelerates angiogenesis and induces the excessive accumulation of collagen. As a result, red and elevated scars that have an unappealing appearance arise. These scars also associate with intermittent pain, persistent itching, and a sensation of contraction. Moreover, if the wounds are located on the joints or mobile regions, including the neck, the resulting scars can develop into scar contractures. Thus, the primary end-points of treatments for keloids and hypertrophic scars should be functional improvement and relief from pain and itch. Another important goal is the esthetic improvement.
\n
\n
\n
2. Causes of keloids and hypertrophic scars
\n
A number of genetic, systemic, and local factors that influence the characteristics and quantity of keloids and hypertrophic scars have been identified [2]. The genetic causes of pathological scar development include single nucleotide polymorphisms [3, 4]. Moreover, our study showed that one of these polymorphisms associates significantly with clinically severe keloids [4]. It has been suggested that keloids are more influenced by genetic background than hypertrophic scars. This notion remains to be tested. To test it, it will be necessary to have a critical biomarker that reliably distinguishes keloids from hypertrophic scars. One possibility is keloidal collagen: it seems that this histological feature is only present in lesions that bear other classical hallmarks of keloids, including growth over the edges of the original wound. However, identification of other, nonpathology, biomarkers would be highly useful for addressing questions about the differences between keloids and hypertrophic scars in terms of their etiology, growth characteristics, and treatment responses.
\n
In terms of systemic factors, adolescence and pregnancy appear to associate with a higher risk of developing pathological scars [5, 6]. Our recent study also showed that hypertension associates with the development of severe keloids [7, 8]. I believe that while these factors are not primary causes of keloid and hypertrophic scars, they do worsen the inflammation in the scar tissue, thereby accelerating and increasing angiogenesis and matrix production.
\n
Of the many factors that contribute to pathological scar development is local mechanical forces, I believe that they play a particularly important role [9, 10, 11]. Keloids commonly adopt distinct site-specific shapes, namely, the typical butterfly, crab’s claw, and dumbbell shapes on the shoulder, anterior chest, and upper arm, respectively. These shapes reflect the region-specific distribution of skin tension that then tugs repetitively or constantly on the wounds/scars. Moreover, keloids are rare on the upper eyelid. This reflects the fact that eyelid skin is always relaxed regardless of whether the eyes are open or closed. An exception may be earlobe keloids: the contribution of mechanical factors to the development of these keloids may be minor. Instead, the most likely local cause of these keloids is the repeated attaching and detaching of the piercing, which repeatedly injures the skin and heightens the risk of infection. Both the skin tension and repeated injury/infection trigger inflammation and the downstream fibroproliferative events. In summary, while skin tension itself may not be a primary cause of keloids and hypertrophic scars, it is likely to be an important local risk factor that worsens and prolongs the inflammation that drives the formation and/or progression of these fibroproliferative scars.
\n
\n
\n
3. Standard treatment of keloids and hypertrophic scars
\n
These findings have markedly improved our understanding of the pathogenesis of keloids and hypertrophic scars, which in turn has promoted the development of highly effective treatments for these once-intractable scars. At present, I believe that the most reliable approach is a combination of three therapies, namely, surgery, followed by radiation, and prolonged daily use of steroid tape/plaster. The addition of radiation and steroid tape/plaster to surgery reflects the point made above, namely, that keloids and hypertrophic scars are inflammatory disorders, and not tumors. Consequently, anti-inflammatory treatments are most effective for these lesions. Indeed, as will be described below, steroid tapes/plasters/injections on their own work well to reduce the volume of accumulated collagen in keloids and hypertrophic scars, thereby causing their mass to shrink. However, steroid treatments take a long time to achieve mass reduction. Consequently, with large lesions, they are best performed after surgery that rapidly removes the lesion mass. Radiation on its own also has mass-reducing effects because it appears to suppress angiogenesis, and therefore dampens the influx of inflammatory cells and factors into the scar. These anti-inflammatory properties of steroid and radiation mean that their application after mass-reducing surgery (which by itself provokes inflammatory responses) will prevent the recurrence of excised keloids and hypertrophic scars.
\n
Below, we will describe each of the three modalities separately. Thereafter, we will describe the three modalities when used in our combination therapeutic protocol.
\n
\n
3.1. Surgery
\n
Since surgical treatment itself induces inflammation, surgery alone associates with high rates of keloid and hypertrophic scar recurrence. Worse, the recurrent scars are often much bigger than the original lesions. Thus, unless the scar is a minor hypertrophic scar, the decision to surgically remove a pathological scar should be made very carefully and postoperative radiation therapy should always be performed. However, if keloids and hypertrophic scars have infected areas, such as inclusion cysts, these should be removed surgically. Another key indication for surgery is keloids and hypertrophic scars that result in scar contracture of the joints or mobile areas such as the neck. In this case, the contractures should be released by a combination of subcutaneous/fascial tensile reduction sutures, z-plasties, and regional/local flap transfer.
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The main objective of surgery for keloids and hypertrophic scars is not only mass reduction, but it is also to reduce the mechanical tension on the scar or the wound that is left after surgical removal of the scar. This is due to the important role of mechanical tension in the development and progression of keloids and hypertrophic scars. This is reflected by the fact that the most effective surgical method for releasing scar contractures is to use a regional or local flap, especially skin-pedicled local flaps: these flaps are particularly useful because they expand naturally after surgery and are therefore not prone to postsurgical contractures [12]. In contrast, skin grafts do not expand, which means that skin grafting tends to generate secondary contractures that result in circular pathological scars around the grafted skin.
\n
\n
\n
3.2. Radiation
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Interestingly, keloids respond very well to primary radiation therapy (i.e., radiation monotherapy). This reflects the fact that radiotherapy has a strong anti-inflammatory effect. Primary radiation therapy is suitable for older patients or patients with severe (huge) keloids (Figure 1). Since the total radiation dose in these cases is relatively high (e.g., 5 Gy administered once a week for 5 weeks by superficial brachytherapy), it is necessary to apply the radiation carefully to prevent secondary radiation carcinogenesis. However, the risks of primary radiation therapy should be weighed against its tremendous benefits; in particular, the fact that it immediately alleviates the subjective symptoms of keloids such as pain and itching. Moreover, over the following year, it causes the color and thickness of the scars to progressively normalize.
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Figure 1.
A patient with severe abdominal keloids was effectively treated by radiation monotherapy. (a) View before treatment. (b) 4 months post-treatment. (c) 9 months post-treatment. (d) 14 months post-treatment. (e) 18 months post-treatment. A 68-year-old female was treated with high-dose-rate superficial brachytherapy. A total of 25 Gy was administered in five fractions over 5 days (i.e., 5 Gy was delivered once a week for 5 weeks). After 4 months of treatment, both the subjective and objective symptoms had improved dramatically. The keloids became mature scars 18 months after the treatment.
\n
Radiation is also useful in the treatment of keloids and hypertrophic scars as a postsurgical modality [13, 14, 15, 16, 17, 18, 19, 20, 21]. As mentioned above, the main problem of surgery for pathological scars is recurrence. However, postsurgical radiation therapy can dramatically reduce these rates of recurrence. Use of the linear-quadratic model to calculate the biologically effective doses (BEDs) for various therapeutic radiation regimens after surgical excision of keloids showed that when the BED exceeds 30 Gy, the recurrence rate is less than 10%. Indeed, our review of the literature showed that to ensure maximum efficacy and safety, postoperative radiation for keloids in adults should involve the application of 10–20 Gy via daily fractions of 5 Gy.
\n
Currently, we propose that the maximum dose of postoperative radiation therapy for surgically excised keloids is a BED of 30 Gy. A BED of 30 Gy can be obtained in several ways: a single fraction dose of 13 Gy, two fractions of 8 Gy, three fractions of 6 Gy, or four fractions of 5 Gy. In addition, recommended site-dependent dose protocols for the treatment of keloids are as follows: 18 Gy in three fractions over 3 days for the anterior chest wall, shoulder-scapular region, and suprapubic region; 8 Gy in a fraction over a day for the ear lobe; and 15 Gy in two fractions over 2 days for other sites.
\n
It should be noted that the calculated BED of 30 Gy assumes that the α/β ratio for keloids is 10 (the α/β ratio is a measure of the radiosensitivity of a specific tissue). However, when Flickinger [21] investigated the α/β ratio of keloids, they found that it was as low as 2, which suggests that high doses with limited numbers of fractions is the best strategy to achieve low recurrence rates. At present, there is no widely accepted radiation regimen for keloid treatment. Further research on regimens that effectively prevent recurrence without elevating the risk of secondary carcinogenesis is welcome.
\n
\n
\n
3.3. Corticosteroid tapes/plasters
\n
Corticosteroid injections rapidly reduce the volume of a scar [22]. However, the downsides of corticosteroid injections include pain (caused by the injection itself) and difficulties associated with contraindications such as pregnancy, glaucoma, or Cushing’s disease. This problem can be overcome by using steroid tapes/plasters. Most pediatric and older patients can be treated by steroid tapes/plaster alone because they have much thinner skin, which means that the steroids are easily absorbed (Figure 2). Corticosteroid tape/plasters on their own or in combination with other therapies such as corticosteroid injection are also suitable for adults with minor keloids. Notably, postoperative application of corticosteroid tape/plasters significantly prevents the development of keloids and hypertrophic scars after surgery.
\n
Figure 2.
A child with a mild keloid was effectively treated with steroid tape alone. (a) View before treatment. (b) After 16 months of treatment. (c) After 26 months of treatment. This 9-year-old boy had a mild right scapular keloid and was treated by fludroxycortide tape (Drenison® tape). The tape was placed on the keloid 24 h a day and was changed daily. The inflammation resolved completely. After 26 months of treatment, both the subjective and objective symptoms of the patient had improved dramatically (the case was cited from the article: Ogawa R, Akaishi S, Kuribayashi S, Miyashita T. Keloids and Hypertrophic Scars Can Now Be Cured Completely: Recent Progress in Our Understanding of the Pathogenesis of Keloids and Hypertrophic Scars and the Most Promising Current Therapeutic Strategy. J Nippon Med Sch. 2016;83(2):46–53).
\n
Steroid tape/plasters should be changed every day. Important tips regarding the treatment of keloids and hypertrophic scars with steroid tapes/plasters are as follows. First, the patient should continue to use the tapes/plasters until the elevated mass becomes flat and soft. Second, once the mass has become flat and soft, steroid tape/plaster use should be stopped, even if the scar is still red. This reflects the fact that if the patient continues to use the tape just because the scar is still red, capillarectasia will occur. This is because the steroid treatment thins the supporting structure of the blood vessels.
\n
Steroid tape is available in the following three countries in slightly different preparations [22]. In the UK, the commercially available formulation comprises a fludroxycortide-impregnated tape (4 μg/cm2). In the USA, a preparation containing 4 μg/cm2 flurandrenolide (a medium-strength steroid) is available. In Japan, two steroid tape formulations are available, namely, a 4 μg/cm2 fludroxycortide tape (medium-strength) and a 20 μg/cm2 deprodone propionate tape (higher potency steroid). In our experience, deprodone propionate tape is the most effective tape for the treatment and prevention of keloids.
\n
\n
\n
\n
4. Combination treatment for severe keloids and hypertrophic scars
\n
If a patient has severe keloids with infected areas or scar contractures, surgery should be performed (Figure 3). If the keloids are too large to be removed in their entirety, the surgeon can resect the region of contracture or infection. The resulting defects can then be covered by a regional/local flap. Surgery should also be performed if the keloid growth causes significant deformity and the keloid does not respond to nonsurgical therapies. An example of severely deforming earlobe keloids is shown in Figure 4. Such keloids can be treated by the core excision method, where the fibrous reticular layer of the keloid (i.e., the core of the earlobe keloid) is extirpated and the epidermis and papillary layer of the dermis is preserved as a thin flap.
\n
Figure 3.
A patient with an upper limb keloid was effectively treated by surgery and postoperative radiotherapy. (a) Preoperative view. (b) Removal of the hand and wrist keloids and harvest of the flap. (c) Flap rotation. (d) The recipient site immediately after surgery. (e–i) 5 years after the operation. This 63-year-old female had hypertension together with severe keloids of an unknown origin (folliculitis was suspected) that covered her right elbow, wrist joint, and thumb and made it difficult for her to use her right hand. The contractures were released by surgery with a distally based radial forearm flap followed by adjuvant 4-MeV electron beam irradiation therapy (15 Gy/three fractions for 3 days) (the case was cited from the article: Ogawa R, Arima J, Ono S, Hyakusoku H. CASE REPORT Total Management of a Severe Case of Systemic Keloids Associated With High Blood Pressure (Hypertension): Clinical Symptoms of Keloids May Be Aggravated by Hypertension. Eplasty. 2013 Jun 3;13:e25).
\n
Figure 4.
A patient with bilateral ear keloids was effectively treated by surgery and postoperative radiotherapy. (a, b) Preoperative view of the left ear. (c) Design of the incision on the left ear. (d) Intraoperative view of the left ear. (e, f) The left ear immediately after surgery. (g) Preoperative view of the right ear. (h) Design of the incision on the right ear. (i) Intraoperative view (the right ear). (j, k) The right ear immediately after surgery. (l, m) The right ear 14 months after surgery. (n, o) The left ear 14 months after surgery. A 37-year-old Japanese woman with multiple keloids was diagnosed with multicentric type Castleman’s disease. She was treated with systemic administration of steroid for Castleman’s disease but the treatment did not improve her keloids. We removed both auricular keloids by using the core excision method. On postoperative days 1, 2, and 3, the patient received a total radiation dose of 15 Gy in three fractions over 3 days. The radiation was delivered by a 4 MeV electron beam. Histopathological examination of the resected tissues showed the absence of abnormal lymphocytes or plasma cell infiltration. Consequently, the auricular lesions were diagnosed definitively as keloids (the case was cited from the article: Quong WL, Kozai Y, Ogawa R. A Case of Keloids Complicated by Castleman’s Disease: Interleukin-6 as a Keloid Risk Factor. Plast Reconstr Surg Glob Open. 2017 May 16;5(5):e1336).
\n
While these surgical approaches on their own associate with a relatively high risk of recurrence, this risk can be significantly reduced by combining surgery with postoperative radiotherapy and prolonged corticosteroid tape/plaster application. Thus, after the operation, both the donor and recipient sites of the flap should be irradiated to prevent the new formation of keloids. Notably, when partial resection or core extirpation is followed by postoperative radiotherapy, any remaining keloids around the flap (which do not undergo radiotherapy) also improve (Figure 3). This reflects the fact that the flap releases tension, which in turn decreases the inflammation in the remnant keloids. The high risk of recurrence in these severe cases can be further reduced by the routine application of corticosteroid tape/plasters on the operated area that are changed daily. In general, we recommend patients to use tape/plasters for at least 6 months after the surgery and radiotherapy, or until the scar becomes soft. Long-term follow-up is necessary because if the scars start to stiffen again, corticosteroid tape/plasters should be re-applied. In general, it will take at least 2 years before combination therapy-treated keloids and hypertrophic scars mature. It is important to make clear to the patient before this therapy starts that the protocol has a long duration. Nevertheless, close monitoring and assiduous re-application of steroid tape/plasters have an excellent chance of converting postoperative keloid sites into mature scars.
\n
It should be noted that our combination therapy is not suitable for growing children and pregnant women. In our facility, we do not treat pediatric patients (<20 years of age) or pregnant women with radiation. Moreover, invasive treatments such as surgery are not performed during pregnancy. The primary choice of treatment for children and pregnant women with keloids and hypertrophic scars should be steroid tape/plaster on its own (Figure 5).
\n
Figure 5.
Algorithm for selecting keloid and hypertrophic scar treatment modalities. Particular care should be taken when selecting the treatment for growing children and pregnant women with keloids and hypertrophic scars. In our facility, pediatric patients (<20 years of age) and pregnant women are not treated with radiation. Invasive surgery in pregnant women is also avoided. In these cases, the primary treatment choice should be steroid tape/plaster together with stabilization/compression therapy that reduces the tension on the scar.
\n
\n\n',keywords:"keloid, hypertrophic scar, scar, scar contracture, fibroproliferative disorder, fibrosis, surgery, radiotherapy, corticosteroid, tape, plaster",chapterPDFUrl:"https://cdn.intechopen.com/pdfs/65397.pdf",chapterXML:"https://mts.intechopen.com/source/xml/65397.xml",downloadPdfUrl:"/chapter/pdf-download/65397",previewPdfUrl:"/chapter/pdf-preview/65397",totalDownloads:1389,totalViews:0,totalCrossrefCites:1,dateSubmitted:"September 5th 2018",dateReviewed:"January 6th 2019",datePrePublished:"February 8th 2019",datePublished:"September 11th 2019",readingETA:"0",abstract:"Keloids and hypertrophic scars are fibroproliferative disorders of the skin. Research over the last decade has markedly improved our understanding of the pathogenesis of these scars, in particular, the fact that both disorders are caused by prolonged inflammation that prevents the orderly healing of injured or irritated skin. This protracted inflammatory response is due to genetic, systemic, and local risk factors. Genetic factors include single nucleotide polymorphisms, while systemic factors include hypertension, pregnancy-related and other hormones, and aberrant cytokine levels. An important local factor is the mechanical force (tension) on the scar. These observations have greatly aided the development of therapies for these once-intractable scars. As a result, these scars are now regarded as being completely treatable. At present, we believe that the following combination of three therapies most reliably achieves a complete cure: surgery followed by radiation and the prolonged daily use of corticosteroid tape/plaster.",reviewType:"peer-reviewed",bibtexUrl:"/chapter/bibtex/65397",risUrl:"/chapter/ris/65397",signatures:"Rei Ogawa",book:{id:"7182",title:"Scars",subtitle:null,fullTitle:"Scars",slug:"scars",publishedDate:"September 11th 2019",bookSignature:"Anca Chiriac",coverURL:"https://cdn.intechopen.com/books/images_new/7182.jpg",licenceType:"CC BY 3.0",editedByType:"Edited by",editors:[{id:"193329",title:"Prof.",name:"Anca",middleName:null,surname:"Chiriac",slug:"anca-chiriac",fullName:"Anca Chiriac"}],productType:{id:"1",title:"Edited Volume",chapterContentType:"chapter",authoredCaption:"Edited by"}},authors:[{id:"45225",title:"Dr.",name:"Rei",middleName:null,surname:"Ogawa",fullName:"Rei Ogawa",slug:"rei-ogawa",email:"r.ogawa@nms.ac.jp",position:null,institution:null}],sections:[{id:"sec_1",title:"1. Introduction",level:"1"},{id:"sec_2",title:"2. Causes of keloids and hypertrophic scars",level:"1"},{id:"sec_3",title:"3. Standard treatment of keloids and hypertrophic scars",level:"1"},{id:"sec_3_2",title:"3.1. Surgery",level:"2"},{id:"sec_4_2",title:"3.2. Radiation",level:"2"},{id:"sec_5_2",title:"3.3. Corticosteroid tapes/plasters",level:"2"},{id:"sec_7",title:"4. Combination treatment for severe keloids and hypertrophic scars",level:"1"}],chapterReferences:[{id:"B1",body:'Ogawa R. Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. International Journal of Molecular Sciences. 2017;18(3):E606\n'},{id:"B2",body:'Huang C, Murphy GF, Akaishi S, Ogawa R. Keloids and hypertrophic scars: Update and future directions. Plastic and Reconstructive Surgery. Global Open. 2013;1(4):e25\n'},{id:"B3",body:'Nakashima M, Chung S, Takahashi A, Kamatani N, Kawaguchi T, Tsunoda T, et al. A genome-wide association study identifies four susceptibility loci for keloid in the Japanese population. Nature Genetics. 2010;42(9):768-771\n'},{id:"B4",body:'Ogawa R, Watanabe A, Than Naing B, Sasaki M, Fujita A, Akaishi S, et al. Associations between keloid severity and single-nucleotide polymorphisms: Importance of rs8032158 as a biomarker of keloid severity. The Journal of Investigative Dermatology. 2014;134(7):2041-2043\n'},{id:"B5",body:'Moustafa MF, Abdel-Fattah MA, Abdel-Fattah DC. Presumptive evidence of the effect of pregnancy estrogens on keloid growth. Case report. Plastic and Reconstructive Surgery. 1975;56(4):450-453\n'},{id:"B6",body:'Mendelsohn ME, Karas RH. Estrogen and the blood vessel wall. Current Opinion in Cardiology. 1994;9(5):619-626\n'},{id:"B7",body:'Arima J, Huang C, Rosner B, Akaishi S, Ogawa R. Hypertension: A systemic key to understanding local keloid severity. Wound Repair and Regeneration. 2015;23(2):213-221\n'},{id:"B8",body:'Huang C, Ogawa R. The link between hypertension and pathological scarring: Does hypertension cause or promote keloid and hypertrophic scar pathogenesis? Wound Repair and Regeneration. 2014;22(4):462-466\n'},{id:"B9",body:'Ogawa R, Okai K, Tokumura F, Mori K, Ohmori Y, Huang C, et al. The relationship between skin stretching/contraction and pathologic scarring: The important role of mechanical forces in keloid generation. Wound Repair and Regeneration. 2012;20(2):149-157\n'},{id:"B10",body:'Ogawa R, Akaishi S, Huang C, Dohi T, Aoki M, Omori Y, et al. Clinical applications of basic research that shows reducing skin tension could prevent and treat abnormal scarring: The importance of fascial/subcutaneous tensile reduction sutures and flap surgery for keloid and hypertrophic scar reconstruction. Journal of Nippon Medical School. 2011;78(2):68-76\n'},{id:"B11",body:'Akaishi S, Akimoto M, Ogawa R, Hyakusoku H. The relationship between keloid growth pattern and stretching tension: Visual analysis using the finite element method. Annals of Plastic Surgery. 2008;60(4):445-451\n'},{id:"B12",body:'Yoshino Y, Kubomura K, Ueda H, Tsuge T, Ogawa R. Extension of flaps associated with burn scar reconstruction: A key difference between island and skin-pedicled flaps. Burns. 2018;44(3):683-691\n'},{id:"B13",body:'Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids. Plastic and Reconstructive Surgery. 2010;125(2):557-568\n'},{id:"B14",body:'Norris JE. Superficial x-ray therapy in keloid management: A retrospective study of 24 cases and literature review. Plastic and Reconstructive Surgery. 1995;95(6):1051-1055\n'},{id:"B15",body:'Enhamre A, Hammar H. Treatment of keloids with excision and postoperative X-ray irradiation. Dermatologica. 1983;167(2):90-93\n'},{id:"B16",body:'Guix B, Henríquez I, Andrés A, Finestres F, Tello JI, Martínez A. Treatment of keloids by high-dose-rate brachytherapy: A seven-year study. International Journal of Radiation Oncology, Biology, Physics. 2001;50(1, 1):167-172\n'},{id:"B17",body:'Kuribayashi S, Miyashita T, Ozawa Y, Iwano M, Ogawa R, Akaishi S, et al. Post-keloidectomy irradiation using high-dose-rate superficial brachytherapy. Journal of Radiation Research. 2011;52(3):365-368\n'},{id:"B18",body:'Ogawa R, Miyashita T, Hyakusoku H, Akaishi S, Kuribayashi S, Tateno A. Postoperative radiation protocol for keloids and hypertrophic scars: Statistical analysis of 370 sites followed for over 18 months. Annals of Plastic Surgery. 2007;59(6):688-691\n'},{id:"B19",body:'Ogawa R, Mitsuhashi K, Hyakusoku H, Miyashita T. Postoperative electron-beam irradiation therapy for keloids and hypertrophic scars: Retrospective study of 147 cases followed for more than 18 months. Plastic and Reconstructive Surgery. 2003;111(2):547-553\n'},{id:"B20",body:'Lo TC, Seckel BR, Salzman FA, Wright KA. Single-dose electron beam irradiation in treatment and prevention of keloids and hypertrophic scars. Radiotherapy and Oncology. 1990;19(3):267-272\n'},{id:"B21",body:'Flickinger JC. A radiobiological analysis of multicenter data for postoperative keloid radiotherapy. International Journal of Radiation Oncology, Biology, Physics. 2011;79(4):1164-1170\n'},{id:"B22",body:'Goutos I, Ogawa R. Steroid tape: A promising adjunct to scar management. Scars, Burns & Healing. 2017;3:2059513117690937\n'}],footnotes:[],contributors:[{corresp:"yes",contributorFullName:"Rei Ogawa",address:"r.ogawa@nms.ac.jp",affiliation:'
Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School Hospital, Tokyo, Japan
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Afterward, he finished rheumatology training and remained at the Cleveland Clinic foundation for 37 years, retiring in April, 2011. Throughout the span of his career, Dr. Wilke was Chairman of the Medical Grand Rounds Committee and the Pharmacy and Therapeutics Committee. He was also head of Subspecialty Clinics from 1981-1995. Since 1990, he has been Associate Editor of the Cleveland Clinic Journal of Medicine. Outside activities included annual “Meet the Professor” meetings at the American College of Rheumatology from 1991-1993, and participation as a member of the United States Pharmacopeia General Committee from 1995-2000. Dr. Wilke is the author of 121 various publications, editor of Methotrexate Therapy in Rheumatic Disease: Marcel Dekker Inc, 1989, and authored The Cleveland Clinic Guide to Fibromyalgia: Kaplan Publishing, 2010.",institutionString:null,profilePictureURL:"https://mts.intechopen.com/storage/users/86580/images/1869_n.jpg",totalCites:0,totalChapterViews:"0",outsideEditionCount:0,totalAuthoredChapters:"2",totalEditedBooks:"2",personalWebsiteURL:null,twitterURL:null,linkedinURL:null,institution:null},booksEdited:[{type:"book",slug:"new-insights-into-fibromyalgia",title:"New Insights into Fibromyalgia",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/961.jpg",abstract:"Given the potential problems that can obscure any scientific enterprise, inconsistent results across studies are bound to occur. How are we to decide what is true? Let's turn to philosophy for a reasonable answer. The mathematician-philosopher Bertrand Russell approached a similar problem in his monograph The Problems of Philosophy (Russell B, 1912). He addressed the following question: How do we know that anything is \"real\"? Is the only reality subjective and simply in our minds, as Bishop Berkley challenged, or can we mostly believe the objective reality? His pragmatic answer: All possibilities may be true, but when the preponderance of evidence indicates that objective reality and knowledge are the most probable case, go with it. If the preponderance of all evidence about the clinical description of fibromyalgia and it's pathogenic mechanisms and treatment strategies indicate a highly probable interrelated hypothesis, go with it. The direction of the literature on the whole trumps the less likely tangents. At the same time, remember Bertrand Russell and his pragmatic answer, and keep an open mind.",editors:[{id:"86580",title:"Dr.",name:"William S.",surname:"Wilke",slug:"william-s.-wilke",fullName:"William S. Wilke"}],productType:{id:"1",title:"Edited Volume"}},{type:"book",slug:"discussions-of-unusual-topics-in-fibromyalgia",title:"Discussions of Unusual Topics in Fibromyalgia",subtitle:null,coverURL:"https://cdn.intechopen.com/books/images_new/5992.jpg",abstract:"This book is a compilation of chapters, of which two chapters review the treatment strategies for fibromyalgia syndrome (FMS), and one chapter describes the role of mitochondrial dysfunction and related pathology in the FMS pathogenesis and reviews the appropriate treatment moieties. This book chapter reviews the phenotypic changes that alter the diagnostic criteria and disease activity measures when FMS is comorbid in three potentially painful selected rheumatic diseases. The introductory preface takes the form of an editorial in which I challenge the concept that inflammation, measured as cytokine activity, plays a prominent role in the FMS pathogenesis. All of these chapters and the Preface are authoritative and accomplished discussions that provide novel perspectives on rarely addressed FMS topics.",editors:[{id:"86580",title:"Dr.",name:"William S.",surname:"Wilke",slug:"william-s.-wilke",fullName:"William S. Wilke"}],productType:{id:"1",title:"Edited Volume"}}],chaptersAuthored:[{title:"Introductory Chapter: A Challenge to the Concept that Inflammation Plays a Prominent Pathogenic Role in Fibromyalgia",slug:"introductory-chapter-a-challenge-to-the-concept-that-inflammation-plays-a-prominent-pathogenic-role-",abstract:null,signatures:"William S. Wilke",authors:[{id:"86580",title:"Dr.",name:"William S.",surname:"Wilke",fullName:"William S. 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