title: The Relationship between Proliferative Scars and Endothelial Function in Surgically Revascularized Patients.
abstract: BACKGROUND
  Proliferative scars are benign fibrotic proliferations which demonstrate abnormal wound healing in response to skin injuries. As postulated in the "response to injury hypothesis", atherosclerosis is also triggered by an endothelial injury. Keloid and atherosclerotic processes have many pathophysiological and cytological features in common.
  
  
  OBJECTIVE
  In this study, we investigated the relationship between proliferative scars and endothelial function in surgically revascularized patients. We aimed to test the hypothesis that atherosclerosis is a wound healing abnormality.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Consecutive patients who were admitted to the cardiology outpatient clinic with a history of coronary artery bypass grafting operation were evaluated. Thirty-three patients with proliferative scars at the median sternotomy site formed the keloid group, and 36 age- and sex-matched patients with no proliferative scar at the median sternotomy site formed the control group. Endothelial function was evaluated by flow-mediated vasodilatation of the brachial artery via ultrasonograhic examination.
  
  
  RESULTS
  There is no signicant difference according to the demographic data, biochemical parameters, clinical parameters and number of grafts between keloid and control groups. Endothelial-dependent vasodila-tory response was lower in the keloid group than the control group (9.30±3.5 and 18.68±8.2, respectively; p=0.001).
  
  
  CONCLUSIONS
  This study showed that endothalial dysfunction, which is strongly correlated with atherosclerosis, was more prominent in patients with proliferative scars. As proliferative scars and atherosclerosis have many features in common, we might conclude that atherosclerosis is a wound healing abnormality.
authors.affiliation: Department of Cardiology, Karadeniz Hospital, Trabzon, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Ziyrek
authors.affiliation: Department of Cardiology, Kanuni Training and Research Hospital, Trabzon, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Şahin
authors.affiliation: Department of Cardiology, Karadeniz Hospital, Trabzon, Turkey.
authors.forename: Zeydin
authors.initials: Z
authors.lastname: Acar
authors.affiliation: Department of Cardiovascular Surgery, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Şen
keywords: Endothelium; cicatrix; keloid; wound healing