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Research Article|Articles in Press

The effect of Centella Asiatica cream on scar development in patients who underwent open carpal tunnel release surgery

  • Mustafa Balevi
    Correspondence
    Corresponding author. Neurosurgery expert. Department of Neurosurgery, Konya Numune State Hospital, Ferhuniye Mah. Hastane Cd. No:22 Selçuklu Konya /Turkey 42060, Telephone no. +90–3323252090, Fax: +903 3 22356786
    Affiliations
    Neurosurgery expert. Department of Neurosurgery, Konya Numune State Hospital, Konya, Turkey
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  • Ali Balevi
    Affiliations
    Department of Dermatology, Istanbul Medipol University, School of Medicine, Turkey
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Published:March 12, 2023DOI:https://doi.org/10.1016/j.jht.2022.11.001

      Abstract

      Aim

      To evaluate the efficacy of the Centella asiatica extract in a cream preparation for the prevention of scar tenderness formation in patients who underwent conventional open carpal tunnel release (CTR) surgery.

      Material and Methods

      A total of 280 patients with carpal tunnel syndrome who underwent CTR surgery were individually randomized into the intervention (n = 140) and control (n = 140) groups. In the intervention group, a petroleum cream mixture consisting of 1% Centella asiatica extract was applied to the patients’ wrist for 6 months after the sutures were removed. In the control group, no intervention was applied. The Vancouver Scar Scale (VSS), Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) functional score, and Visual Analog Scale (VAS) satisfaction scores were assessed preoperatively and postoperatively. Follow-up evaluations were scheduled at 1, 3 and 6 months after CTR surgery.

      Results

      The overall VSS score of the intervention group significantly improved at 3-6 months (-1.260, p = .040). At 6 months after surgery, the mean QuickDASH functional score was 18.54 (range 0.00-63.64, SD 17.4) in the intervention group and 28.70 ± 12 (range: 2.27-40.91) in the control group (p < .04). At 6 months after surgery, the mean VAS satisfaction score was 1.46 ± 1.95 (range: 0-4) in the intervention group and 2.48 ± 1.02 (range: 0-4) in the control group (p < .03).

      Conclusion

      The Centella asiatica cream applied to the wrist after CTR surgery was found to be beneficial in preventing scar tenderness in the thenar and hypothenar regions of the hand.

      Keywords

      Abbreviations:

      CTS (carpal tunnel syndrome), CTR (carpal tunnel release), VSS (Vancouver Scar Scale), QuickDASH (Quick Disabilities of Arm Shoulder and Hand functional score), VAS (Visual Analogue Scale)
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      References

        • Latinovic R
        • Gulliford MC
        • Hughes RA.
        Incidence of common compressive neuropathies in primary care.
        J Neurol Neurosurg Psychiatry. 2006; 77: 2635
        • Shapiro S.
        Microsurgical carpal tunnel release.
        Neurosurgery. 1995; 37: 66-70
        • Karthik K
        • Nanda R
        • Stothard J.
        Recurrent carpal tunnel syndrome–analysis of the impact of patient personality in altering functional outcome following vascularised hypothenar fat pad flap surgery.
        J Hand Microsurg. 2012; 4: 1-6
        • Ruch DS
        • Seal CN
        • Bliss MS
        • et al.
        Carpal tunnel release: efficacy and recurrence rate after a limited incision release.
        J South Orthop Assoc Fall. 2002; 11: 144-147
        • Okutsu I
        • Hamanaka I
        • Yoshida A.
        Retrospective analysis of five-year and longer clinical and electrophysiological results of the world's first endoscopic management for carpal tunnel syndrome.
        Hand Surg. 2013; 18: 317-323
        • Hallock GG
        • Lutz DA.
        Prospective comparison of minimal incision “open” and two- portal endoscopic carpal tunnel release.
        Plast Reconstr Surg. 1995; 96: 941-947
        • Karamanos E
        • Jillian B Q
        • Person D.
        Endoscopic carpal tunnel release.
        Orthop Clin North Am. 2020; 51: 361-368
        • Housley SB
        • Vakharia K
        • Winograd EK
        • et al.
        A endoscopic carpal tunnel release.
        World Neurosurg. 2020; 139: 548
        • Gaba S
        • Bhogesha S
        • Singh O.
        Limited incision carpal tunnel release.
        Indian J Orthop. 2017; 51: 192-198
        • Kern BC
        • Brock M
        • Rudolph KH
        • et al.
        The recurrent carpal tunnel syndrome.
        Zentralbl Neurochir. 1993; 54: 80-83
        • Kim PT
        • Lee HJ
        • Kim TG
        Jeon IH. Current for carpal tunnel syndrome. approaches.
        Clin Orthop Surg. 2014; 6: 253-257
        • Louis DS
        • Greene TL
        • Noellert RC.
        Complications of carpal tunnel surgery.
        J Neurosurg. 1985; 62: 352-356
        • Phalen G.
        The carpal tunnel syndrome. Clinical evaluation of 598 hands.
        Clin Orthop. 1972; 83: 29-40
        • Wade RG
        • Wormald JC
        • Figus A.
        Absorbable versus non-absorbable sutures for skin closure after carpal tunnel decompression surgery.
        Cochrane Database Syst Rev. 2018; 2 (Feb 1)CD011757
        • Menovsky T
        • Bartels RH
        • Lindert EL
        • et al.
        Skin closure in carpal tunnel surgery: a prospective comparative study between nylon, polyglactin 910 and stainless steel sutures.
        Hand Surg. 2004; 1: 35-38
        • Dosani A
        • Khan SK
        • Gray S
        • et al.
        Clinical outcome and cost comparison of carpal tunnel wound closure with monocryl and ethilon: a prospective study.
        Hand Surg. 2013; 2: 189-192
        • Boya H
        • Ozcan O
        • Oztekin H.H
        Long-term complications of open carpal tunnel release.
        Muscle & Nerve. 2008; 38: 1443-1446
        • Zhang J
        • Li Y
        • Bai X
        • et al.
        Recent advances in hypertrophic scar.
        Histol Histopathol. 2018; 33: 27-39
        • Wang ZC
        • Zhao WY
        • Cao Y
        • et al.
        The roles of inflammation in keloid and hypertrophic scars.
        Front Immunol. 2020; 11 (Dec 4)603187
        • Ogawa R
        • Dohi T
        • Tosa M
        • et al.
        The latest strategy for keloid and hypertrophic scar prevention and treatment: the Nippon medical school (NMS) protocol.
        J Nippon Med Sch. 2021; 88 (Mar 11): 2-9
        • Ye Q
        • Wang SJ
        • Chen JY
        • et al.
        Medicinal plants for the treatment of hypertrophic scars.
        Evid Based Complement Alternat Med. 2015; 1: 15
        • Bahramsoltani R
        • Farzaei M
        • Rahimi R.
        Medicinal plants and their natural components as future drugs for the treatment of burn wounds: an integrative review.
        Arch Dermatol Res. 2014; 306: 601-617
        • Van den Helder C
        • Joris HJ.
        Sense and nonsense of scar creams and gels.
        Aesthetic Plast Surg. 1994; 18: 307-313
        • Bylka W
        • Znajdek-Awiżeń P
        • Studzińska-Sroka E
        • et al.
        Centella asiatica in dermatology: an overview.
        Phytother Res. 2014; 28: 1117-1124
        • Bylka W
        • Znajdek-Awizeń P
        • Studzińska-Sroka E
        • et al.
        Centella asiatica in cosmetology.
        Postepy Dermatol Alergol. 2013; 30: 46-49
        • Jenwitheesuk K
        • Rojsanga P
        • Chowchuen B
        • et al.
        A prospective randomized, controlled, double-blind trial of the efficacy using centella cream for scar improvement.
        Evid Based Complement Alternat Med. 2018; 179525624
        • Somboonwong J
        • Kankaisre M
        • Tantisira B
        • et al.
        Wound healing activities of different extracts of Centella asiatica in incision and burn wound models: an experimental animal study.
        BMC Complement Altern Med. 2012; 12: 103
        • Sunilkumar Parameshwaraiah S
        • Shivakumar HG.
        Evaluation of topical formulations of aqueous extract of Centella asiatica on open wounds in rats.
        Indian J Exp Biol. 1998; 36: 569-572
        • Peters S
        • Page MJ
        • Coppieters MW
        • et al.
        Rehabilitation following carpal tunnel release.
        Cochrane Database Syst Rev. 2016; 2 (Feb 17)CD004158
        • Mary JO
        • Baryza MS
        • Gregory A
        • et al.
        The vancouver scar scale: an administration tool and its interrater reliability.
        J Burn Care Rehabil. 1995; 16: 535-538
        • Lazaridou A
        • Elbaridi N
        • Edwards RR
        • et al.
        Chapter 5 - Pain Assessment, Essentials of Pain Medicine (Fourth Edition).
        2018: 39-46.e1
        • Angst F
        • Schwyzer HK
        • Aeschlimann A
        • et al.
        Measures of adult shoulder function: Disabilities of the arm, shoulder, and hand questionnaire (DASH) and its short version (QuickDASH), Shoulder pain and disability index (SPADI), American shoulder and elbow surgeons (ASES) society standardized shoulder assessment form, constant (Murley) score (CS), simple shoulder test (SST), Oxford shoulder score (OSS), Shoulder disability questionnaire (SDQ), and Western ontario shoulder instability index (WOSI).
        Arthritis Care Res (Hoboken). 2011; 63 (Nov): S174-S188
        • Calotta NA
        • Lopez J
        • Deune EG.
        Improved surgical outcomes with endoscopic carpal tunnel release in patients with severe median neuropathy.
        Hand (N Y). 2017; 12: 252-257
        • Schmidt W
        • Gruber AA
        • Hammer R.
        Results of different incisions in treatment of carpal tunnel syndrome.
        Handchir Mikrochir Plast Chir. 2000; 32: 67-69
        • Jugovac I
        • Burgic N
        • Micovic V
        • et al.
        Carpal tunnel release by limited palmar incision versus.
        Hand Surg. 2004; 9: 35-38
        • Cseuz KA
        • Thomas JE
        • Lambert EH
        • et al.
        Long-term results of operation for carpal tunnel syndrome.
        Mayo Clin Proc. 1966; 41: 232-241
        • Malhotra R
        • Kiran EK
        • Dua A
        • et al.
        Endoscopic versus open carpal tunnel release: a short-term comparative study.
        J Orthop. 2007; 41: 57-61
        • Robert A
        • Weber MD
        • Malcolm J
        • et al.
        Clinical outcomes of carpal tunnel release in patients 65 and older.
        Hand Surgery. 2005; 30: 75-80
        • Hwang Peter Y K
        • Ho Chi Long
        Minimally invasive carpal tunnel decompression using the KnifeLight.
        Neurosurgery. 2007; 60: 162-169
        • Thoma A
        • Veltri K
        • Haines T
        • et al.
        A meta-analysis of randomized controlled trials comparing endoscopic and open carpal tunnel decompression.
        Plast Reconstr Surg. 2004; 114: 1137-1146
        • Somboonwong j
        • Kankaisre M
        • Tantisira B
        • Tantisira MH
        Wound healing activities of different extracts of Centella asiatica in incision and burn wound models: an experimental animal study.
        MC Complement Altern Med. 2012; 12: 103
        • Gohil KJ
        • Patel JA
        • Gajjar AK.
        Pharmacological review on Centella asiatica: a potential herbal cure-all.
        Indian. J Pharm Sci. 2010; 72: 546-556