Several physicians at Lucile Packard Children's Hospital are working on novel methods for minimizing scarring in children. There's good reason for their efforts. Children with prominent scars struggle with school performance, socialization and self-esteem, research has shown.
"Stealth" surgeries, pioneered by the Packard Children's pediatric general surgery team, circumvent the problem by hiding tiny laparoscopic incisions in unobtrusive locations, such as behind the hairline, in the armpits, or tucked into the belly button. (Shameless plug: The lead story in the next issue of Stanford Medicine magazine, which I'm writing, will explain how surgeon Sanjeev Dutta, MD, performs big operations through these small, well-concealed incisions. The issue publishes in mid-February.)
And I recently interviewed another Packard surgeon-scientist who is pursuing an even more ambitious approach for the future. Craniofacial and plastic surgeon Peter Lorenz, MD, hopes to one day do his job without leaving any scars at all. That's why his lab is studying how fetal skin repairs itself. The lab's 2008 discovery of Dot cells, key players in the fetal ability to heal without scarring, sparked excitement for the future of scarless surgery.
"Dot cells are like soldiers for stem cells," Lorenz explained. Unlike stem cells, they don't become new tissue in a test tube; instead they home in on a wound and help manufacture healthy new skin. Fetal mice have lots of Dot cells, whereas juvenile and adult mice have only a few. The same pattern holds for humans.
Lorenz hopes to one day be able to infuse Dot cells into children having skin surgery to prevent scars from forming. His research has already shown the strategy works in mice. "Dot cells know how to go to the wound site without any coaching," he said. And the cells don't appear to trigger immune rejection when swapped between animals.
"In theory, our plan would be to culture Dot cells and have a supply available for use where you don't have to worry about the donor," Lorenz said. "We could inject the cells into patients with skin problems to enable scarless skin repair. The possibilities are really exciting."