Hyaluronic Acid in Modern Cosmetic and Reconstructive Surgery - Hyaluronic Acid for Biomedical and Pharmaceutical Applications - page 140

fermentation or chemically synthesised and further crosslinked to
improve biocompatibility and mechanical properties.
7.2.1 Application of Hyaluronic Acid in Reconstructive
Surgery
Over the past two decades, HA has become the most extensively used
material in plastic surgery, ophthalmology and orthopaedics. The use
of HA in reconstructive surgery, as a dermal filler, dressing, or cream,
centres on the restoration of soft tissue defects, and the treatment of
wounds and burns. Typically, these defects are secondary to surgical
or physical trauma, especially in subtractive surgeries, such as tumour
removal. HA is used as a filler due to its ability not only to restore
the lost volume, but to also improve the quality of the skin, namely
its elasticity, plasticity and hydration.
HA dressing or cream is also frequently applied in the treatment
of chronic wounds and burns. Chronic wounds originate from
skin lesions that remain unresolved for more than 3 months [7].
The healing process involves several complex and dynamic changes,
such as: haemostasis, inflammation, proliferation and remodelling
of dermal tissue [8]. The participation of biological factors, such
as cytokines, chemokines, growth factors, components of the
extracellular space, proteases and cell receptors, is vital for the
normal healing process [9]. However, prolonging the healing process
and overexposure to proinflammatory cytokines can abrogate the
restoration of normal tissue, especially in the proliferative phase
where granulomatous tissue is formed by HA, fibronectin, collagen
and GAG. During healing, HA helps with tissue neovascularisation
and establishes the necessary microenvironment to promote migration
of fibroblasts, endothelial cells and keratinocytes and increase the
levels of growth factors [10].
Skin exposure to excessive heat, chemicals, radiation, electric current,
or even mechanical friction results in burns and skin lysis due to
damage to the underlying tissues. The severity of the burn depends