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Meade MH, Narayanan R, Buchan L, Bridges T, Opara OA, Brush PL, Lee Y, Glover A, Takagi-Stewart J, Ducaji E, Kurd MF, Canseco JA, Hilibrand AS, Vaccaro AR, Schroeder GD, Kepler CK. Physical and Psychological Impact of Scar Cosmesis After Cervical Spine Fusion Surgery. World Neurosurg 2024; 189:e1077-e1082. [PMID: 39032633 DOI: 10.1016/j.wneu.2024.07.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 07/09/2024] [Accepted: 07/10/2024] [Indexed: 07/23/2024]
Abstract
INTRODUCTION Patients' and surgeons' perceptions of cutaneous scarring can vary, causing unpleasant physical and psychological outcomes. This study aims to bridge the current scientific literature gap and understand the impact of patient-perceived scar cosmesis after anterior and posterior cervical spine surgery. METHODS Retrospective review of patients ≥18 years old who underwent anterior or posterior cervical spine surgery from 2017 to 2022 at a large, urban academic group. To select patients with adequate time for surgical scar maturation, only patients who were greater than 6 months postsurgery were included. The Scar Questionaire Survey (SCAR-Q) survey, a surgical scar assessment tool, was administered to patients to assess patient perceptions of scar symptomatology, appearance, and psychosocial impact. Scores range from 0 to 100, with 100 as the best outcome. An additional 5-item Likert scale question was administered to assess overall surgical satisfaction. RESULTS All 854 respondents who completed the survey were stratified into 2 groups "Unsatisfied vs. Satisfied." Patients who were "unsatisfied" with their surgery had the lowest outcome scores for SCAR-Q appearance, symptom, and psychosocial scores than those who were "Satisfied" (P < 0.001). Females had significantly "higher/more favorable" responses for SCAR-Q Appearance (77.5 vs. 82.8 P < 0.001) and Psychosocial (87.4 vs. 94.3 P < 0.001) scores compared to males. Regression analysis performed for each component score showed that increases in all 3 component scores were significant in patients in the satisfied group. CONCLUSIONS Our study demonstrates that cervical spine surgery patients unsatisfied with their surgical outcome have lower scar-related scores, highlighting the impact of cosmetic closure and appearance.
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Affiliation(s)
- Matthew H Meade
- Orthopaedic Surgery Department, Jefferson Health New Jersey, Stratford, New Jersey, USA
| | - Rajkishen Narayanan
- Orthopaedic Surgery Department, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
| | - Levi Buchan
- Orthopaedic Surgery Department, Jefferson Health New Jersey, Stratford, New Jersey, USA
| | - Tiffany Bridges
- Orthopaedic Surgery Department, Jefferson Health New Jersey, Stratford, New Jersey, USA
| | - Olivia A Opara
- Orthopaedic Surgery Department, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Parker L Brush
- Orthopaedic Surgery Department, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yunsoo Lee
- Orthopaedic Surgery Department, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Abbey Glover
- Orthopaedic Surgery Department, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Julian Takagi-Stewart
- Orthopaedic Surgery Department, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emily Ducaji
- Orthopaedic Surgery Department, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark F Kurd
- Orthopaedic Surgery Department, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A Canseco
- Orthopaedic Surgery Department, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S Hilibrand
- Orthopaedic Surgery Department, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R Vaccaro
- Orthopaedic Surgery Department, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D Schroeder
- Orthopaedic Surgery Department, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K Kepler
- Orthopaedic Surgery Department, Rothman Orthopedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Twisy HO. Subcision with platelet-rich plasma and microneedling versus subcision with saline and micro-needling in posttraumatic scars. Arch Dermatol Res 2024; 316:537. [PMID: 39158761 DOI: 10.1007/s00403-024-03226-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/27/2024] [Accepted: 07/06/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND In treating post-traumatic scars, this study compared the safety and effectiveness of combined subcision with saline and microneedling versus combined subcision with platelet-rich plasma and microneedling. Combined subcision with saline and microneedling or combined subcision with platelet-rich plasma and microneedling were used to treat 36 consecutive individuals with post-traumatic scarring. The Modified Manchester score was used to assess texture change, pigmentation, and surface distortion changes. Each change was given a score between 1 and 4. A lower score (range: 3-12) indicates a better result. The mean of the three individual scores was determined. For best outcomes, each patient needed four treatment sessions for each scar, with a one-month follow-up period following the final treatment. The three variables in group B had mean scores of 1.4 ± 0.5, 2 ± 0.8, and 2.2 ± 0.9, respectively, for texture change, pigmentation, and surface distortion. With a mean score of 1.4 ± 0.5, texture change had the best response out of the three variables we evaluated. The investigator determined that the mean improvement score for patients in group B's overall appearance was 5.61 ± 1.19. The study has shown that the combination of subcision with platelet-rich plasma, and microneedling appears to be a promising treatment for posttraumatic scars due to its low risk and high efficacy. Our findings suggest that this is a safe method for treating posttraumatic scars, with few side effects and a low chance of recurrence. IRB LOCAL APPROVAL NUMBER 04-2023-300279. CLINICAL TRIAL REGISTRY NCT06135480.
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Affiliation(s)
- Howida Omar Twisy
- Lecturer of Dermatology, Venereology and Andrology Department, Faculty of Medicine, Assiut University Hospitals, Assiut, 71515, Egypt.
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Imren C, IJsselstijn H, Vermeulen MJ, Wijnen RHM, Rietman AB, Keyzer-Dekker CMG. Scar Perception in School-aged Children After Major Surgery in Infancy. J Pediatr Surg 2024:161659. [PMID: 39179500 DOI: 10.1016/j.jpedsurg.2024.07.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/04/2024] [Accepted: 07/27/2024] [Indexed: 08/26/2024]
Abstract
BACKGROUND The long-term effects of childhood surgery scars on health status, quality of life (QoL), self-esteem, and body image remain uncertain. This study explores these effects in school-aged children. METHODS We conducted a retrospective cohort study involving 454 children (58% boys; 8-17 years) who had undergone surgical correction of anatomical anomalies or neonatal ECMO. Data included patient-reported scar perception and scar-related embarrassment, along with psychological assessment via questionnaires. RESULTS About 34% of children rated their scars as 'nice-looking', 49% as 'indifferent', and 12% as 'rather ugly'. Most children (91%) never experienced scar-related embarrassment, while frequent embarrassment was reported by 3%. Surgical scar correction was desired by 6% of the 8-year-olds and 19% of the 17-year-olds. Scar perception did not significantly affect health status or QoL. However, negative scar perception was associated with lower self-esteem in girls and a more negative body image in boys. Girls were more likely to report negative scar perception (OR: 1.54, 95%-CI: 1.06-2.24) and scar-related embarrassment (OR: 4.29, 95%-CI: 1.77-10.44). CONCLUSION Children who underwent surgery in the neonatal period and subsequently grew up with scars resulting thereof, mostly perceive them either indifferently or positively, with minimal effect on health status and QoL. Nonetheless, some children, particularly girls, experienced negative perceptions of their scars, although scar-related embarrassment was rare. We recommend integrating scar assessment into routine follow-up at ages 12 and 17, and offering appropriate and timely guidance and support to children at risk for negative effects of scars. LEVEL OF EVIDENCE III.
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Affiliation(s)
- C Imren
- Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015 CD Rotterdam, the Netherlands
| | - H IJsselstijn
- Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015 CD Rotterdam, the Netherlands
| | - M J Vermeulen
- Department of Neonatal and Paediatric Intensive Care, Division of Neonatology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015 CD Rotterdam, the Netherlands
| | - R H M Wijnen
- Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015 CD Rotterdam, the Netherlands
| | - A B Rietman
- Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015 CD Rotterdam, the Netherlands; Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015 CD Rotterdam, the Netherlands
| | - C M G Keyzer-Dekker
- Department of Paediatric Surgery, Erasmus University Medical Center - Sophia Children's Hospital, Wytemaweg 80, 3015 CD Rotterdam, the Netherlands.
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Lee IA, Kim M, Kim JK, Lee CR, Kang SW, Jeong JJ, Nam KH, Chung WY. Minimally Invasive Open Bilateral Total Thyroidectomy Using Unilateral Neck Incision in Thyroid Cancer: Preliminary Surgical and Quality of Life Outcomes. Yonsei Med J 2024; 65:448-455. [PMID: 39048320 PMCID: PMC11284307 DOI: 10.3349/ymj.2023.0457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/23/2024] [Accepted: 02/01/2024] [Indexed: 07/27/2024] Open
Abstract
PURPOSE Thyroid cancer incidence has increased in recent decades, and thyroid surgery is continuously evolving in response to demands for postoperative comfort and cosmesis. This study aimed to introduce a new surgical method for minimally invasive open bilateral total thyroidectomy (MI-BTT) using a unilateral 2.5-3.0 cm neck incision. Furthermore, we reported the surgical outcomes and postoperative quality of life (QoL) using a validated Korean translated Dermatology Life Quality Index (DLQI) questionnaire. MATERIALS AND METHODS We retrospectively evaluated 41 Asian patients who underwent MI-BTT for low-risk papillary thyroid cancer by a single surgeon from March 2019 to December 2021. RESULTS A total of 4 male and 37 female patients were included. The mean age and body mass index were 46.2±10.1 years and 23.3±3.3 kg/m², respectively. The average tumor size was 1.1±0.6 cm, and 36 patients (87.8%) had bilateral cancer. Twenty-three (56.1%) patients had occult central lymph node (CLN) metastasis in the final pathologic report, with the mean number of dissected CLNs being 7.2±6.5. Gross capsular extension was found in 6 patients (14.6%). Moreover, 28 patients (68.3%) received additional treatment after surgery with low or high doses of radioactive iodine. The average serum-stimulated thyroglobulin value identified during treatment was 1.57±2.30 ng/mL. The mean operation time was 78.0±13.9 minutes, and postoperative complications included transient hypocalcemia (36.6%), transient hoarseness (24.4%), and seroma (2.4%). The mean total DLQI score was 2.73±0.78, indicating a small effect on QoL. CONCLUSION MI-BTT is a novel, safe, and feasible technique to improve patient satisfaction for surgical scars and QoL.
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Affiliation(s)
- In A Lee
- Department of Thyroid Breast Surgery, Gimpo Woori Hospital, Gimpo, Korea
| | - Minji Kim
- Department of Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Jin Kyong Kim
- Department of Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Cho Rok Lee
- Department of Surgery, Yongin Severance Hospital, Yongin, Korea
| | - Sang-Wook Kang
- Department of Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Jong Ju Jeong
- Department of Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Kee-Hyun Nam
- Department of Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
| | - Woong Youn Chung
- Department of Surgery, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
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Poelchow F, Codde J, Kendell R, Edgar DW, Wood FM. A randomised investigation of film-forming silicone gel in superficial partial thickness face and neck burn patients: Indication of improved early scar pigmentation outcomes. Burns 2024; 50:1605-1613. [PMID: 38614897 DOI: 10.1016/j.burns.2024.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 03/18/2024] [Accepted: 03/18/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Burns to the face and neck are a source of considerable distress and a challenge to manage with dressings. Further, these often superficial injuries pose a risk of scarring and altered pigmentation. Silicone gels have emerged as a potential solution to the challenges of conservative management for face and neck burn injuries. The aims of this study were to explore the effect of topical silicone compared to routine treatment of conservatively managed burns to the face and neck. METHODS This single-blind, randomised, controlled trial compared topical silicone film-forming dressing to standard of care for superficial partial thickness burns to the face and neck. Time to healing was the primary outcome and secondary outcomes included: 1) scar assessments (modified Vancouver Scar Scale, Dermalab Combo and Patient and Observer Scar Assessment Scale) at six weeks and three months; and 2) pain intensity scale at wound review appointments. RESULTS Of the 55 participants in the face/neck study, 34 were male and 21 were female. Median age was 36 years (range from 25 to 47 years). The median time to healing for the silicone group was 9 days (CI 7.6 -10.4) and the control group was 7 days (CI 5.3- 8.7), p = 0.056. Analysis demonstrated significantly reduced pigmentation at six weeks in mVSS scores for the silicone group (Md = 0, IQR = 0) compared to the control group (Md = 0, IQR = 0 - 3), p = 0.043. We found no evidence of differences in reported pain between the groups (Silicone - Md = 1.15, IQR 0.3 - 4.5 vs control group - Md = 1.5, IQR 0.6 - 3.8, z = -0.63, p = 0.53). No other differences were observed, and no adverse events were associated with the topical silicone in the study whereas an infection and a reaction were experienced in the control group. CONCLUSION Film-forming silicone gel had comparable effects to standard of care emollient on wound healing of superficial partial thickness burns of the face and neck. Silicone treated wounds were associated with a significant improvement in scar pigmentation outcome at six weeks post-burn.
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Affiliation(s)
- Fiona Poelchow
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Jim Codde
- The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Rosemary Kendell
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia; Armadale Kalamunda Group Health Service, Safety and Quality Unit, East Metropolitan Health Service, Mt Nasura, Western Australia, Australia; Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia
| | - Fiona M Wood
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Fiona Wood Foundation, Perth, Western Australia, Australia; Burn Injury Research Unit, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, Australia.
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Kyriazidis I, Demiri E, Foroglou P. Familial Spontaneous Keloids: Examining Thoracic Manifestations in Two Brothers. Cureus 2024; 16:e64163. [PMID: 39119435 PMCID: PMC11309079 DOI: 10.7759/cureus.64163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2024] [Indexed: 08/10/2024] Open
Abstract
Keloids are complex fibroproliferative disorders with diverse clinical presentations. Spontaneous keloids (SKs) represent a rare subtype that emerges without any known preceding traumatic event. This report presents a case of familial spontaneous keloids appearing on the thoracic region in two brothers with no prior history of trauma or keloid occurrence in other family members. The lesions exhibited progressive growth over several years but responded to cycles of triamcinolone treatment. This case underscores an unusual spontaneous occurrence of keloids in the thoracic region of two siblings, highlighting the potential genetic predisposition in the aetiology of these lesions. Additionally, this instance reinforces the concept that keloids can develop spontaneously without any apparent trauma in the affected area.
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Affiliation(s)
- Ioannis Kyriazidis
- Department of Plastic and Reconstructive Surgery, General Hospital Papageorgiou, Thessaloniki, GRC
| | - Efterpi Demiri
- Department of Plastic and Reconstructive Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
- Department of Plastic and Reconstructive Surgery, General Hospital Papageorgiou, Thessaloniki, GRC
| | - Pericles Foroglou
- Department of Plastic and Reconstructive Surgery, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, GRC
- Department of Plastic and Reconstructive Surgery, General Hospital Papageorgiou, Thessaloniki, GRC
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Fefferman ML, Zheng C, Varsanik AM, Vigneswaran Y. Hidden Port Site Incisions for Robotic Foregut and Hepatopancreatobiliary Operations: A Cosmetically Superior Approach. J Am Coll Surg 2024; 239:e1-e6. [PMID: 38634560 DOI: 10.1097/xcs.0000000000001093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Affiliation(s)
- Marie L Fefferman
- From the Department of Surgery, The University of Chicago, Chicago, IL
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Verzella AN, Laspro M, Diaz A, Cassidy MF, Park J, Schechter J, Alcon A, Shetye PR, Staffenberg DA, Flores RL. Comparison of the Effects of Postoperative Arm Restraints and Mittens on Cleft Lip Scar Quality after Primary Repair. J Clin Med 2024; 13:3619. [PMID: 38999195 PMCID: PMC11242569 DOI: 10.3390/jcm13133619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
Introduction: Postoperative management following primary cleft lip repair varies across institutions, cleft care teams, and individual surgeons. Postoperative precautions employed after cleft lip repair include dietary restrictions, pacifier limitations, and immobilization, with arm restraints long being used. Yet, restraint distress has led to the exploration of other forms of immobilization. Thus, this study aims to assess cleft lip scar quality and complication rates after postoperative immobilization with arm restraints versus hand mittens. Methods: A retrospective review of patients with unilateral cleft who underwent primary repair with the senior surgeon was done. Data on demographics, surgical characteristics, and immobilization utilized were gathered. A survey with pictures of postoperative scars were sent to laypeople who assessed scar quality with Modified Scar-Rating Scale scores for surface appearance, height, and color of the scar tissue. Statistical analysis was carried out for significance. Results: Twenty-eight patients with a unilateral cleft underwent arm restraints after primary lip repair, and twenty-seven utilized mittens. In total, 42 medical students completed the scar assessment. Photographs were taken an average of 23.9 (±5.8) and 28.2 (±11.9) months postoperatively in the restraint and mitten groups, respectively (p = 0.239). There were no statistically significant differences in scores between scar surface, height, color, or overall scar appearance. Complication rates were also similar between groups. Conclusions: Arm restraints appear to have no additional benefit relative to scar quality, as compared to mittens. Considering the arm restraints' burden of care, mittens should be considered as a measure to protect the lip after primary repair.
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Affiliation(s)
- Alexandra N Verzella
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Matteo Laspro
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Allison Diaz
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Michael F Cassidy
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Jenn Park
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Jill Schechter
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Andre Alcon
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Pradip R Shetye
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - David A Staffenberg
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Roberto L Flores
- Hansjörg Wyss Department of Plastic Surgery, New York University Grossman School of Medicine, New York, NY 10016, USA
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Sciegienka S, Slijepcevic A, Lipsey K, Spataro E, Chen C. Time to Mohs Reconstruction: A Systematic Review Comparing Complication Rates between Immediate and Delayed Repair. Facial Plast Surg 2024; 40:370-377. [PMID: 37336502 DOI: 10.1055/a-2112-7073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Several known factors affect outcomes of Mohs facial defect reconstruction; however, the effect of repair timing on outcomes is ill-defined. The aim of this study was to determine postoperative complication rates between immediate and delayed repair of Mohs facial defects. Preferred Reporting Items of Systematic Reviews and Meta-Analyses guidelines were used. Articles were selected using PICO format-population: Mohs facial defect patients, intervention: defect repair, comparator: immediate (<24 hours), or delayed (>24 hours) repair, outcome: complication rate. PubMed/Medline (1946-2020), EMBASE (1947-2020), Scopus (1823-2020), Web of Science (1900-2020), Cochrane Library, and Clinicaltrials.gov were searched. Two independent reviewers screened abstracts; those in English with human subjects reporting repair timing and complication rates were included. Search criteria yielded 6,649 abstracts; 233 qualified for review. Data were gathered from six studies; they alone contained comparative data meeting inclusion criteria. While many well-written studies were encountered, reported results varied widely. A statistically sound meta-analysis could not be completed due to large heterogeneity between studies, biasing the analysis towards the largest weighted study. Clinically important differences may exist between immediate and delayed Mohs reconstruction, but small study numbers, large heterogeneity, and lack of standardized outcome measures limit definitive conclusions. More studies are needed to perform appropriate meta-analyses, including studies using standardized methods of reporting Mohs outcome data.
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Affiliation(s)
- Sebastian Sciegienka
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, St Louis, Missouri
| | - Allison Slijepcevic
- Department of Otolaryngology-Head and Neck Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Kim Lipsey
- Bernard Becker Medical Library, Washington University in St. Louis, St Louis, Missouri
| | - Emily Spataro
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St Louis, Missouri
| | - Collin Chen
- Department of Otolaryngology-Head and Neck Surgery, Division of Facial Plastic and Reconstructive Surgery, Saint Louis University School of Medicine, St Louis, Missouri
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Kučinskaitė A, Stundys D, Gervickaitė S, Tarutytė G, Grigaitienė J, Tutkuvienė J, Jančorienė L. Aesthetic Evaluation of Facial Scars in Patients Undergoing Surgery for Basal Cell Carcinoma: A Prospective Longitudinal Pilot Study and Validation of POSAS 2.0 in the Lithuanian Language. Cancers (Basel) 2024; 16:2091. [PMID: 38893210 PMCID: PMC11171257 DOI: 10.3390/cancers16112091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Facial basal cell carcinoma (BCC) surgery enhances the quality of life (QoL) but leaves patients with inferior QoL, presumably caused by scarring, emphasizing the need to understand post-surgery aesthetic satisfaction. This study aimed to validate the Lithuanian version of the Patient and Observer Scar Assessment Scale (POSAS) 2.0 and utilise it to identify scar evaluation differences and correlations among POSAS scores and specific aesthetic facial regions, age, gender, surgery types, and short- and long-term QoL. Employing a prospective longitudinal design, 100 patients with facial scars after surgical BCC removal were enrolled. The validation phase confirmed the translated POSAS 2.0 psychometric properties, while the pilot phase used statistical analyses to compare scores among demographic and clinical groups and evaluate correlations between scar assessment and QoL. The findings indicate that the translated Lithuanian version of POSAS 2.0 exhibits good psychometric properties, revealing insights into aesthetic satisfaction with post-surgical facial scars and their impact on QoL. The Lithuanian version of the POSAS 2.0 was established as a valid instrument for measuring post-surgical linear scars. QoL with scar assessment statistically significantly correlates, 6 months after surgery, with worse scores, particularly notable among women, younger patients, and those with tumours in the cheek region.
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Affiliation(s)
| | - Domantas Stundys
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (J.G.); (L.J.)
| | - Simona Gervickaitė
- Department of Anatomy, Histology and Anthropology, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (S.G.); (J.T.)
| | - Gabrielė Tarutytė
- Department of Research and Innovation, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
- Institute of Applied Mathematics, Faculty of Mathematics and Informatics, Vilnius University, 03225 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Jūratė Grigaitienė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (J.G.); (L.J.)
| | - Janina Tutkuvienė
- Department of Anatomy, Histology and Anthropology, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (S.G.); (J.T.)
| | - Ligita Jančorienė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (J.G.); (L.J.)
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11
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Shen WC, Cheng HT, Jan YK, Liau BY, Hsieh CW, Bau JG, Tai CC, Lung CW. Effect of negative pressure therapy on the treatment response to scar thickness and viscoelasticity. Front Bioeng Biotechnol 2024; 12:1353418. [PMID: 38712331 PMCID: PMC11070486 DOI: 10.3389/fbioe.2024.1353418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/12/2024] [Indexed: 05/08/2024] Open
Abstract
Patients with scars face a grave threat to their mental and physical health. Negative pressure has been used for scar therapy in medical care and provides a microenvironment conducive to scar healing while stimulating cell regeneration. Negative pressure may disrupt scar tissue regeneration when the pressure is too high or too low, so finding a suitable negative pressure is important. We hypothesized that different negative pressure magnitudes would affect scar tissue properties differently. This research aimed to provide practical recommendations for scar therapy. This study used three negative pressures (-105 mmHg, -125 mmHg, and -145 mmHg) to compare scar material properties. We measured scar tissue thickness and viscoelasticity with a motor-driven ultrasound indentation system. According to the results of this study, scar thickness is most effectively reduced at a negative pressure of -105 mmHg. In comparison, scar viscoelasticity continuously increases at a negative pressure of -125 mmHg. Negative pressure therapy can be recommended to scar care clinics based on the results of this study.
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Affiliation(s)
- Wei-Cheng Shen
- Department of Creative Product Design, Asia University, Taichung, Taiwan
| | - Hsu-Tang Cheng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Asia University Hospital, Asia University College of Medical and Health Science, Taichung, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
| | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Ben-Yi Liau
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan
| | - Chang-Wei Hsieh
- Department of Electrical Engineering, National Dong Hwa University, Hualien, Taiwan
| | - Jian-Guo Bau
- Department of Agricultural Technology, National Formosa University, Yunlin, Taiwan
| | - Chien-Cheng Tai
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chi-Wen Lung
- Department of Creative Product Design, Asia University, Taichung, Taiwan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
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12
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Rezzonico Jost T, Lozito A, Mangani D, Raimondi A, Klinger F, Morone D, Klinger M, Grassi F, Vinci V. CD304 + adipose tissue-derived mesenchymal stem cell abundance in autologous fat grafts highly correlates with improvement of localized pain syndromes. Pain 2024; 165:811-819. [PMID: 37943081 DOI: 10.1097/j.pain.0000000000003092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 09/06/2023] [Indexed: 11/10/2023]
Abstract
ABSTRACT Surgery, burns or surgery-free accident are leading causes of scars with altered tissue consistency, a reduced degree of motion and pain. Autologous fat grafting can dramatically improve tissue consistency and elasticity but less frequently results in the reduction of pain. Therefore, we analyzed different cell populations present within the adipose tissue to be engrafted and correlated them with the reduction of pain after surgery. Here, we identify a population of CD3 - CD4 - CD304 + cells present in grafted adipose tissue, whose abundance highly correlates with pain improvement shortly after surgery ( r2 = 0.7243****) as well as persistently over time (3 months later: r2 = 0.6277****, 1 year later: r2 = 0.5346***, and 4 years later: r2 = 0.5223***). These cells are characterized by the absence of the hematopoietic marker CD45, whereas they express CD90 and CD34, which characterize mesenchymal stem cells (MSCs); the concomitant presence of CD10 and CD73 in the plasma membrane supports a function of these cells in pain reduction. We deduce that the enrichment of this adipose tissue-derived MSC subset could enhance the therapeutic properties of adipose grafts and ameliorate localized pain syndromes.
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Affiliation(s)
- Tanja Rezzonico Jost
- Institute for Research in Biomedicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Alessia Lozito
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Davide Mangani
- Institute for Research in Biomedicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Andrea Raimondi
- Institute for Research in Biomedicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland
- Experimental Imaging Centre, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Klinger
- Department of Health Sciences, University of Milan, Ospedale San Paolo, Milan, Italy
| | - Diego Morone
- Institute for Research in Biomedicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Marco Klinger
- Plastic Surgery Unit, Department of Medical Biotechnology and Translational Medicine BIOMETRA, Humanitas Clinical and Research Hospital, Reconstructive and Aesthetic Plastic Surgery School, University of Milan, Rozzano, MI, Italy
| | - Fabio Grassi
- Institute for Research in Biomedicine, Faculty of Biomedical Sciences, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Valeriano Vinci
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
- Humanitas Clinical and Research Center-IRCCS, Rozzano, MI, Italy
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13
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Reiche E, Keller PR, Soares V, Schuster CR, Rahmayanti S, Mroueh J, Mroueh V, Billaud M, Hu S, Hoover-Watson H, Lian CG, Tan Y, Doloff JC, Newell-Fugate AE, Coon D. Androgenic steroids induce pathologic scarring in a preclinical porcine model via dysfunctional extracellular matrix deposition. FASEB J 2024; 38:e23561. [PMID: 38530321 DOI: 10.1096/fj.202302144rrr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/19/2024] [Accepted: 03/01/2024] [Indexed: 03/27/2024]
Abstract
Hypertrophic scarring is a major source of morbidity. Sex hormones are not classically considered modulators of scarring. However, based on increased frequency of hypertrophic scarring in patients on testosterone, we hypothesized that androgenic steroids induce abnormal scarring and developed a preclinical porcine model to explore these effects. Mini-swine underwent castration, received no testosterone (noT) or biweekly testosterone therapy (+T), and underwent excisional wounding. To create a delayed wound healing model, a subset of wounds were re-excised at 2 weeks. Scars from postoperative day 42 (POD42) and delayed wounds (POD28) were harvested 6 weeks after initial wounding for analysis via histology, bulk RNA-seq, and mechanical testing. Histologic analysis of scars from +T animals showed increased mean fibrosis area (16 mm2noT, 28 mm2+T; p = .007) and thickness (0.246 mm2noT, 0.406 mm2+T; p < .001) compared to noT. XX+T and XY+T scars had greater tensile burst strength (p = .024 and p = .013, respectively) compared to noT swine. Color deconvolution analysis revealed greater deposition of type I and type III collagen as well as increased collagen type I:III ratio in +T scars. Dermatopathologist histology scoring showed that +T exposure was associated with worse overall scarring (p < .05). Gene ontology analysis found that testosterone exposure was associated with upregulation of cellular metabolism and immune response gene sets, while testosterone upregulated pathways related to keratinization and laminin formation on pathway analysis. In conclusion, we developed a preclinical porcine model to study the effects of the sex hormone testosterone on scarring. Testosterone induces increased scar tissue deposition and appears to increase physical strength of scars via supraphysiologic deposition of collagen and other ECM factors. The increased burst strength seen in both XX and XY animals suggests that hormone administration has a strong influence on scar mechanical properties independent of chromosomal sex. Anti-androgen topical therapies may be a promising future area of research.
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Affiliation(s)
- Erik Reiche
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patrick R Keller
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Vance Soares
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Calvin R Schuster
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Siti Rahmayanti
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Jessica Mroueh
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Vanessa Mroueh
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Marie Billaud
- Division of Thoracic and Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Sophia Hu
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Hunter Hoover-Watson
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Christine G Lian
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yu Tan
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
| | - Joshua C Doloff
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Annie E Newell-Fugate
- Department of Veterinary Physiology and Pharmacology, Texas A&M University, College Station, Texas, USA
| | - Devin Coon
- Division of Plastic Surgery, Brigham and Women's Hospital - Harvard Medical School, Boston, Massachusetts, USA
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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14
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Eberlin KR, Amis BP, Berkbigler TP, Dy CJ, Fischer MD, Gluck JL, Kaplan FTD, McDonald TJ, Miller LE, Palmer A, Perry PE, Walker ME, Watt JF. Final 1-Year Results of the TUTOR Randomized Trial Comparing Carpal Tunnel Release with Ultrasound Guidance to Mini-open Technique. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5665. [PMID: 38440365 PMCID: PMC10911521 DOI: 10.1097/gox.0000000000005665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Accepted: 01/25/2024] [Indexed: 03/06/2024]
Abstract
Background Studies comparing carpal tunnel release with ultrasound guidance (CTR-US) to mini-open CTR (mOCTR) are limited. This randomized trial compared the efficacy and safety of these techniques. Methods In this multicenter randomized trial, patients were randomized (2:1) to unilateral CTR-US or mOCTR. Outcomes included Boston Carpal Tunnel Questionnaire Symptom Severity Scale (BCTQ-SSS) and Functional Status Scale (BCTQ-FSS), numeric pain scale (0-10), EuroQoL-5 Dimension 5-Level (EQ-5D-5L), scar outcomes, and complications over 1 year. Results Patients received CTR-US (n = 94) via wrist incision (mean 6 mm) or mOCTR (n = 28) via palmar incision (mean 22 mm). Comparing CTR-US with mOCTR, the mean changes in BCTQ-SSS (-1.8 versus -1.8; P = 0.96), BCTQ-FSS (-1.0 versus -1.0; P = 0.75), numeric pain scale (-3.9 versus -3.8; P = 0.74), and EQ-5D-5L (0.13 versus 0.12; P = 0.79) over 1 year were comparable between groups. Freedom from scar sensitivity or pain favored CTR-US (95% versus 74%; P = 0.005). Complications occurred in 2.1% versus 3.6% of patients (P = 0.55), all within 3 weeks postprocedure. There was one revision surgery in the CTR-US group, and no revisions for persistent or recurrent symptoms in either group. Conclusions CTR-US and mOCTR demonstrated similar improvement in carpal tunnel syndrome symptoms and quality of life with comparable low complication rates over 1 year of follow-up. CTR-US was performed with a smaller incision and associated with less scar discomfort.
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15
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Li S, Wang Y, Chen Y, Zhang H, Shen K, Guan H. PTEN hinders the formation of scars by regulating the levels of proteins in the extracellular matrix and promoting the apoptosis of dermal fibroblasts through Bcl-xL. Arch Biochem Biophys 2024; 753:109912. [PMID: 38325773 DOI: 10.1016/j.abb.2024.109912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 02/09/2024]
Abstract
Hypertrophic scar (HS) is a dermatological condition characterized by an excessive accumulation of proteins in the extracellular matrix (ECM) and an elevated cell count. The development of HS is thought to be linked to the disruption of dermal fibroblast proliferation and apoptosis. The processes of cell proliferation and apoptosis are notably influenced by PTEN. However, the precise mechanisms by which PTEN regulates hypertrophic scar fibroblasts (HSFs) and its overall role in scar formation are still not fully understood. The objective of this study was to investigate the influence of PTEN on hypertrophic scars(HS) and its function in the regulation of scar formation, with the aim of identifying a pivotal molecular target for scar treatment. Our results demonstrate that the overexpression of PTEN (AdPTEN) significantly suppressed the expression of type I collagen (Col I), type III collagen (Col III), and alpha smooth muscle actin (α-SMA) in HSFs. Furthermore, it was observed that the introduction of AdPTEN resulted in the suppression of Bcl-xL expression, which consequently led to an increase in the apoptosis of HSFs. Similarly, in the inhibition of collagens expression and subsequent increase in HSF apoptosis were also observed upon silencing Bcl-xL (sibcl-xL). Additionally, the in vitro model demonstrated that both AdPTEN and sibcl-xL were effective in reducing the contraction of FPCL. The findings of our study provide validation for the role of PTEN in inhibiting the development of hypertrophic scars (HS) by modulating the expression of extracellular matrix (ECM) proteins and promoting apoptosis in hypertrophic scar fibroblasts (HSFs) via Bcl-xL. These results indicate that PTEN and Bcl-xL may hold promise as potential molecular targets for therapeutic interventions aimed at managing hypertrophic scars.
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Affiliation(s)
- Shaohui Li
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, 127 West Chang-le Road, Xi'an, 710032, China
| | - Yunwei Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, 127 West Chang-le Road, Xi'an, 710032, China
| | - Yang Chen
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, 127 West Chang-le Road, Xi'an, 710032, China
| | - Hao Zhang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, 127 West Chang-le Road, Xi'an, 710032, China
| | - Kuo Shen
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, 127 West Chang-le Road, Xi'an, 710032, China
| | - Hao Guan
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Air Force Medical University, 127 West Chang-le Road, Xi'an, 710032, China.
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16
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Chen J, Fang J, Liu J, Lu T, Zheng X, Wang S. Patient-reported oral function and psychological well-being outcomes of papillary thyroid cancer patients (PTC) after surgery: a cross-sectional study. Surg Endosc 2024; 38:813-820. [PMID: 38062180 DOI: 10.1007/s00464-023-10603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/14/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND This study was performed to evaluate the differences in oral function and psychological well-being between patients with PTC after the gasless transoral endoscopic thyroidectomy vestibular approach (gasless-TOETVA) and patients with PTC after open surgery. METHODS PTC patients who underwent radical surgery from May 2021 to August 2022 were included in this study. Postoperative data on oral function and psychological well-being, including the Oral Health Impact profile-14 (OHIP-14) and State-Trait Anxiety Inventory Form Y, were collected and analyzed. RESULTS 212 patients were included in the analysis. Among them, 102 patients who received gasless-TOETVA were assigned to the gasless-TOETVA group, while the remaining 110 patients who underwent open surgery were categorized as the open group. Although the OHIP-14 score in the gasless-TOETVA group was higher than that of the open group from 6 months to 1 year after surgery (p = 0.012), the difference in OHIP-14 scores between the two groups disappeared 1 year after surgery (p = 0.155). There were no differences between the gasless-TOETVA group and the open group in state-anxiety scores. However, the gasless-TOETVA group had significantly lower trait-anxiety scores than the open group at all follow-up time periods. Furthermore, within the gasless-TOETVA group, patients who were more than 1 year post-surgery showed significantly increased trait-anxiety scores compared to those of patients who were less than 1 year post-surgery (Δ = 3.4; p = 0.032). In contrast, the open group showed a decreasing trend in trait-anxiety scores, but there was no statistically significant difference between patients who had surgery less than 1 year ago and those who had surgery more than 1 year ago (Δ = - 2.2; p = 0.094). CONCLUSION Gasless TOETVA had a temporary impact on oral function, but it did not alleviate the state of anxiety. Furthermore, we observed a significant increase in trait-anxiety scores among PTC patients who underwent gasless-TOETVA after 1 year.
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Affiliation(s)
- Jiaolong Chen
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China
| | - Jing Fang
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China
| | - Jianjun Liu
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China
| | - Tianya Lu
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China
- Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China
| | - Xucai Zheng
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
- Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China.
| | - Shengying Wang
- Department of Head and Neck Surgery, West District of The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
- Department of Head and Neck Surgery, Anhui Provincial Cancer Hospital, Hefei, China.
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17
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Chen A, Ray P, Rogers H, Bialowas C, Butala P, Chen M, Daveluy SD, Davidson C, Faringer P, Guarda H, Kantor J, Kaweski S, Lawrence N, Lickstein D, Lomax J, Parra S, Retson N, Suryadevara A, Smith R, Tollefson TT, Wisco OJ. Evidence-Based Performance Measures for Reconstruction after Skin Cancer Resection: A Multidisciplinary Performance Measure Set. Plast Reconstr Surg 2024; 153:424e-441e. [PMID: 38266139 DOI: 10.1097/prs.0000000000010916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND The American Society of Plastic Surgeons commissioned the multidisciplinary Performance Measure Development Work Group on Reconstruction after Skin Cancer Resection to identify and draft quality measures for the care of patients undergoing skin cancer reconstruction. Included stakeholders were the American Academy of Otolaryngology-Head and Neck Surgery, the American Academy of Facial Plastic and Reconstructive Surgery, the American Academy of Dermatology, the American Society of Dermatologic Surgery, the American College of Mohs Surgery, the American Society for Mohs Surgery, and a patient representative. METHODS Two outcome measures and five process measures were identified. The outcome measures included the following: (1) patient satisfaction with information provided by their surgeon before their facial procedure, and (2) postprocedural urgent care or emergency room use. The process measures focus on antibiotic stewardship, anticoagulation continuation and/or coordination of care, opioid avoidance, and verification of clear margins. RESULTS All measures in this report were approved by the American Society of Plastic Surgeons Quality and Performance Measures Work Group and Executive Committee, and the stakeholder societies. CONCLUSION The work group recommends the use of these measures for quality initiatives, Continuing Medical Education, Continuous Certification, Qualified Clinical Data Registry reporting, and national quality reporting programs.
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Affiliation(s)
| | - Peter Ray
- East Hills Professional Center and Marshall University Joan C. Edwards School of Medicine
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18
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Kassotis AS, Grimes J, Samie FH, Lewin JM, Levenson JA, Glass LRD. Risk factors for developing depressive symptoms in the immediate postoperative period after Mohs micrographic surgery. Orbit 2024; 43:22-27. [PMID: 36847522 DOI: 10.1080/01676830.2023.2179639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
PURPOSE Mohs micrographic surgery (MMS) is a highly efficacious, tissue sparing method of skin cancer removal. Nevertheless, in the months to years after MMS, psychosocial distress has been described. The present study addressed the immediate period after MMS and assessed the frequency and risk factors for development of depressive symptoms. METHODS Subjects undergoing MMS at two physician practices (JL, FS) were included in this prospective cohort study. Preoperatively, a standardized depression screening, the Patient Health Questionnaire-8 (PHQ-8), was administered. After MMS, the PHQ-8 was readministered at weeks 1, 2, 4, 6, and 12. Average PHQ-8 score by week and change from baseline PHQ-8 score were the primary outcomes. RESULTS Sixty-three subjects were included of which 49 (78%) had a facial site. Twenty-two subjects (35%) had some increase in score during the 12-week follow-up period, of which 18 had a facial site. The oldest subjects (83-99 years, n = 14) had significantly higher PHQ-8 scores at week 4 (p < 0.01) and week 6 (p = 0.02) than all other age groups. There were no differences in scores between location groups. CONCLUSIONS One-third of subjects had some increase in score during the follow-up period. Those in the oldest age cohort were at highest risk of increased score. In contrast to prior literature, those with facial sites were not at higher risk. This difference may be explained by increased masking during the ongoing COVID-19 pandemic. Ultimately, consideration of patients' psychologic status in the immediate postoperative period after MMS, particularly in the elderly population, may enhance perceived patient outcomes.
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Affiliation(s)
- Alexis S Kassotis
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Joseph Grimes
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
| | - Faramarz H Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, NY, USA
| | - Jesse M Lewin
- The Kimberly and Eric J. Waldman Department of Dermatology, Ichan School of Medicine at Mt. Sinai, New York, NY, USA
| | - Jon A Levenson
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA
| | - Lora R Dagi Glass
- Department of Ophthalmology, Columbia University Irving Medical Center, New York, NY, USA
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19
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De Henau M, van Kuijk SM, Colla C, Van den Kerckhove E, Van der Hulst RR, Piatkowski A. Pressure Masks for Facial Scar Treatment after Oncological Reconstruction: Long-Term Patient Satisfaction and Quality of Life. Facial Plast Surg 2024; 40:36-45. [PMID: 36787790 PMCID: PMC10774008 DOI: 10.1055/a-2035-4468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
INTRODUCTION With increasing incidence of facial skin cancer, more patients undergo facial reconstruction following Mohs micrographic surgery (MMS). Aesthetically unpleasing, thickened facial flaps, and disturbing scars can be treated with a pressure mask with inner silicone lining to help improve functional and aesthetic outcomes. However, data on long-term patient satisfaction and quality of life (QoL) following this treatment are lacking. METHODS We aimed to assess long-term satisfaction and QoL of patients who underwent local flap reconstruction following MMS. Patients treated between January 2012 and October 2020 were invited to answer FACE-Q and SCAR-Q questionnaires. Demographic data, skin cancer type and location, type of reconstruction, postoperative complications, duration of pressure mask therapy, daily compliance, and additional scar treatment were collected to explore possible predictors. RESULTS Of 92 eligible patients, 50 responded. Eighteen respondents were male (36%) and 32 were female (64%). Mean duration of pressure mask therapy was 10.20 ± 4.61 months. Patients were 61.14 ± 32.91 months after completion of pressure mask therapy upon participation. Patients whose reconstruction consisted of multiple flaps had significantly worse outcomes in social function (p = 0.012), scar appearance (p = 0.045), and scar symptoms (p = 0.008). A trend of increasing time since therapy completion predicting better outcomes was observed for all scales, and it was a significant predictor for better scar appearance (p = 0.001) and less scar symptoms (p = 0.001). CONCLUSION Pressure mask treatment for facial flaps and scars following MMS results in good long-term patient satisfaction and QoL. Multiple local flaps, reflecting a larger skin defect postexcision, is a predictor for worse outcomes in social function, scar appearance, and symptoms. Increasing time is associated with increasing satisfaction, which reflects satisfactory and stable long-term effects of treatment, possibly combined with more acceptance of the result over time.
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Affiliation(s)
- Melissa De Henau
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- GROW School of Oncology and Reproduction, Maastricht University, the Netherlands
| | - Sander M.J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, the Netherlands
| | - Carlo Colla
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eric Van den Kerckhove
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Rehabilitation Sciences, Faber, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
- Department of Physical Medicine and Rehabilitation and Burns Center, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Rene R.W.J. Van der Hulst
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Andrzej Piatkowski
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Plastic Surgery, VieCuri Medical Centrum, Venlo, the Netherlands
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20
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van de Warenburg MS, Munk EFL, Davies A, McBride CA, Edgar DW, Vehmeijer-Heeman MLAW, Young AE. Working Towards Holistic Scar Assessment and Improved Shared Decision Making in Global Burn Care. J Burn Care Res 2024; 45:112-119. [PMID: 37310702 PMCID: PMC10768758 DOI: 10.1093/jbcr/irad089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Indexed: 06/14/2023]
Abstract
Cutaneous burn scars impact various aspects of life. Scar treatment is mainly evaluated on scar characteristics. Consensus is needed on which other outcomes to capture, ensuring they are relevant to patients, clinicians, and researchers. The aim of this study was to identify, discuss and analyze outcomes related to cutaneous burn scarring, incorporating the voice of patients and views of healthcare professionals. For this, a Delphi process consisting of two survey rounds and a consensus meeting was initiated. Burn scar-related outcomes were identified from an existing comprehensive list of 100 outcomes by an international panel of patients, healthcare professionals and researchers. Fifty-nine outcomes were identified from the Delphi process as related to scarring (≥60% votes). Outcomes less impactful in relation to scar outcomes included psychosocial issues, sense of normality, understanding of treatment, costs and systemic issues. To represent a holistic assessment of outcomes related to cutaneous burn scarring, this Delphi process established a battery of outcomes currently included in scar quality assessment tools, and an expanded set of less frequently considered outcomes. Future work in this area must include the patient voice from developing countries. This is essential to identify globally applicable outcomes related to scarring.
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Affiliation(s)
- Milly S van de Warenburg
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Elleke F L Munk
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Anna Davies
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Craig A McBride
- Centre for Children’s Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
| | - Dale W Edgar
- State Adult Burn Unit, Fiona Stanley Hospital, Murdoch, Australia
- Burn Injury Research Node, The Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia
- Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia
| | - Mariëlle L A W Vehmeijer-Heeman
- Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Amber E Young
- Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, UK
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21
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Poddighe D, Ferriero G, Corna S, Bravini E, Sartorio F, Vercelli S. Effects of soft tissue mobilisation on subacute adherent linear scars: a single-group intervention study. J Wound Care 2024; 33:43-50. [PMID: 38197283 DOI: 10.12968/jowc.2024.33.1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Scar adherence due to a pathological healing process can cause physical and psychological disturbance. Soft tissue mobilisation (STM) techniques are widely used to treat and prevent scar adherence, but little is known on their effects. We aimed to analyse the effect of STM in patients with subacute post-surgical scar adhesions affecting the extremities. METHOD A single-group quasi-experimental study was conducted on consecutive patients undergoing post-surgery limb rehabilitation. Patients with a baseline Adhesion Severity (AS) index of <0.5 at the worst scar point, as measured by the Adheremeter, were eligible. All patients who completed a minimum of five manual treatment sessions were included. The primary outcome was the AS index and the secondary outcome was the Italian version of the Patient and Observer Scar Assessment Scales (POSAS-I). RESULTS A cohort of 19 patients underwent an average of eight STM sessions over a period of one month. The AS index value increased from a median of 0.12 at baseline (interquartile range (IQR): 0.05-0.25) to 0.41 post-treatment (IQR: 0.26-0.63; median change: 0.24; IQR: 0.16-0.40; p<0.001). A large effect size was observed for both AS and Observer Scar Assessment Scale (OSAS-I) (Cohen r=0.6), with a large probability of superiority (PS) (87% and 86%, respectively). A moderate effect was observed for the Patient Scar Assessment Scale (PSAS-I) (Cohen=0.4; PS=71%). Pre-post treatment changes exceeded the minimal detectable changes for the AS and OSAS-I in 68% of subjects, and for PSAS-I in 21% of subjects. CONCLUSION STM manual techniques may produce a large effect on the mobility of adherent subacute post-surgical scars.
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Affiliation(s)
- Diego Poddighe
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, B-3000 Leuven, Belgium
| | - Giorgio Ferriero
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri, Institute of Tradate, IRCCS, Tradate (VA), Italy
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Stefano Corna
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri, Institute of Veruno, IRCCS, Gattico-Veruno (NO), Italy
| | | | - Francesco Sartorio
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri, Institute of Veruno, IRCCS, Gattico-Veruno (NO), Italy
- Department of Scientific Research, Campus LUdeS Lugano (CH), Off-Campus Semmelweis University of Budapest, Hungary
| | - Stefano Vercelli
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri, Institute of Veruno, IRCCS, Gattico-Veruno (NO), Italy
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
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Kennedy DL, Hettiaratchy S, Alexander CM. Clinical evaluation of post-surgical scar hyperaesthesia: a longitudinal observational pilot study. Scars Burn Heal 2024; 10:20595131241230742. [PMID: 38450365 PMCID: PMC10916468 DOI: 10.1177/20595131241230742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024] Open
Abstract
Introduction The mechanisms underlying persistent scar pain are not fully elucidated and evidence for the clinical evaluation of scar pain is limited. This pilot observational study investigated participation data and sought to identify objective clinical scar evaluation measures for future trials. Methods With ethical approval and consent, adults undergoing planned hand surgery were enrolled from one NHS hospital. At 1- and 4-months post-surgery scar thermal and mechanical pain thresholds were evaluated with quantitative sensory testing; peri-scar inflammation with infrared thermometry and pliability with durometry. Participation data were analysed with descriptive statistics; the association of clinical measures with patient reported scar pain was analysed. Results Twenty-one participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No adverse events or dropouts resulted from clinical scar evaluation. Seventy percent of participants reported undertaking topical, nonprescription scar treatment independently. Neuropathic Pain Symptom Inventory (NPSI) scores were dispersed across the score range, capturing variability in participant-reported scar symptoms. Scar morphology, pliability and inflammation were not associated with scar pain. Differences between scar and contralateral skin in thermal and mechanical pain sensitivity were identified. Conclusion People with acute hand scars participate in clinical research and independently initiate scar treatment. Clinical testing of acute post-surgical hand scars is well tolerated. The NPSI demonstrates utility for exploring scar pain symptoms and may support the elucidation of mechanisms of persistent scar pain. Clinical tests of thermal and mechanical and sensitivity are promising candidate clinical measures of scar pain for future trials. Lay Summary Background: it is unknown why some scars remain painful long-term. We do not know if scar flexibility, inflammation or sensitivity to temperature or pressure relate to scar pain. We investigated if patients would enrol in scar research, if scar testing was tolerated and if clinical tests are useful for future scar studies. Study conduct: with ethical approval and consent, adult hand surgery patients were enrolled from one NHS hospital. Scar pain, inflammation and response to thermal, sharp and pressure tests were assessed at 1- and 4-months after surgery. Statistically, we analysed study participation, tolerance for clinical scar tests and if the scar tests related to scar pain. Findings: 21 participants (22% eligible patients) enrolled before study closure due to the COVID-19 pandemic; 13 completed follow up. No participants were injured due to scar testing. 70% of participants reported treating their scar independently. Neuropathic Pain Symptom Inventory (NPSI) allows participants to give a broad range of answers about their scar symptoms. Scores for clinical tests of scar flexibility and inflammation did not relate to participant-reported scar pain. Scars were more sensitive to tests of pin prick and cold than unaffected skin. What we learned: people with new hand scars participate in research and independently initiate scar treatment. Clinical testing of post-surgical hand scars is well tolerated. The NPSI is useful for exploring scar pain symptoms and may help us to learn about persistent scar pain. Pinprick and cold clinical tests may be useful objective pain tests for future scar research.
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Affiliation(s)
- Donna L. Kennedy
- Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Human Performance Group, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Shehan Hettiaratchy
- Plastic and Reconstructive Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Caroline M. Alexander
- Therapy Department, Imperial College Healthcare NHS Trust, London, UK
- Human Performance Group, Department of Surgery and Cancer, Imperial College London, London, UK
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Chul Lee D, Hyung Lee H, Hoon Koh S, Soo Kim J, Young Roh S, Jin Lee K. Donor-Site Morbidity Analysis of Thenar and Hypothenar Flap. Arch Plast Surg 2024; 51:94-101. [PMID: 38425867 PMCID: PMC10901602 DOI: 10.1055/a-2168-4771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 09/01/2023] [Indexed: 03/02/2024] Open
Abstract
Background For the small glabrous skin defect, Thenar and Hypothenar skin are useful donors and they have been used as a free flap. Because of similar skin characteristics, both flaps have same indications. We will conduct comparative study for the donor morbidity of the Free thenar flap and Hypothenar free flap. Methods From January 2011 to December 2021, demographic data, characteristics of each flap, and complications using retrospective chart review were obtained. Donor outcomes of the patient, who had been followed up for more than 6 months, were measured using photographic analysis and physical examination. General pain was assessed by Numeric Rating Scale (NRS) score, neuropathic pain was assessed by Douleur Neuropathique 4 Questions (DN4) score, scar appearance was assessed by modified Vancouver Scar Scale (mVSS), and patient satisfaction was assessed on a 3-point scale. Statistical analysis was performed on the outcomes. Results Out of the 39 survey respondents, 17 patients received Free thenar flaps, and 22 patients received Hypothenar free flaps. Thenar group had higher NRS, DN4, and mVSS ( p < 0.05). The average scores for the Thenar and Hypothenar groups were 1.35 and 0.27 for NRS, 2.41 and 0.55 for DN4, and 3.12 and 1.59 for mVSS, respectively. Despite the Hypothenar group showing greater satisfaction on the 3-point scale (1.82) compared with the Thenar group (1.47), the difference was not significant ( p = 0.085). Linear regression analysis indicated that flap width did not have a notable impact on the outcome measures, and multiple linear regression analysis revealed no significant interaction between flap width and each of the outcome measures. Conclusion Despite the limited number of participants, higher donor morbidity in general pain, neuropathic pain, and scar formation was noted in the Thenar free flap compared with the Hypothenar free flap. However, no difference in overall patient satisfaction was found between the two groups.
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Affiliation(s)
- Dong Chul Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Ho Hyung Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Sung Hoon Koh
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Jin Soo Kim
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Si Young Roh
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
| | - Kyung Jin Lee
- Department of Plastic and Reconstructive Surgery, Gwangmyeong Sungae General Hospital, Gwangmyeong, Republic of Korea
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Wu J, Zou J, Yang Q, Wang H, Tian H, Chen L, Ji Z, Zheng D, Li Z, Xie Y. The effects of scar in psychological disorder: A bibliometric analysis from 2003 to 2022. Int Wound J 2024; 21:e14373. [PMID: 37675814 PMCID: PMC10784201 DOI: 10.1111/iwj.14373] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
Scars are fibrous tissues that replace normal tissue during the wound healing process. Scarring can lead to low self-esteem, social impairment, depression, anxiety, and other psychiatric and psychological distress, necessitating a comprehensive understanding of the latest perspectives, topical research, and directions in scarring-mental health. This is a biblioshiny and VOSviewer based bibliometric analysis study. All data were obtained from the Web of Science, and a total of 664 articles from 2003 to 2022 met the criteria. The last 7 years have been a period of rapid growth in the field, with 2022 having the highest number of articles. The United States is the core country with the highest production and citation rate. The most cited literature was written in 2003 by Van Loey NE et al. Van Loey NE is the most prolific and influential author in this field. The top five popular keywords include "quality of life", "depression", "management", "anxiety", and "prevalence". The paper concludes that the current focus of scholars in the field is on the treatment of scars and that multidisciplinary treatment of such patients is worth exploring. These findings provide relevant researchers with the current state of research and possible future directions in this field.
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Affiliation(s)
- Jinyao Wu
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
- Department of Thyroid, Breast and Hernia Surgery, General SurgeryThe Second Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Juan Zou
- Department of Thyroid, Breast and Hernia Surgery, General SurgeryThe Second Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Qiuping Yang
- Department of Thyroid, Breast and Hernia Surgery, General SurgeryThe Second Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Haiting Wang
- Department of Thyroid, Breast and Hernia Surgery, General SurgeryThe Second Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Huiting Tian
- Department of Thyroid, Breast and Hernia Surgery, General SurgeryThe Second Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Lingzhi Chen
- Department of Thyroid, Breast and Hernia Surgery, General SurgeryThe Second Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Zeqi Ji
- Department of Thyroid, Breast and Hernia Surgery, General SurgeryThe Second Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Daitian Zheng
- Department of Thyroid, Breast and Hernia Surgery, General SurgeryThe Second Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Zhiyang Li
- Department of Thyroid, Breast and Hernia Surgery, General SurgeryThe Second Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Yanna Xie
- Department of Respiratory and Critical Care MedicineThe First Affiliated Hospital of Shantou University Medical CollegeShantouChina
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Henry S, Mapula S, Grevious M, Foster KN, Phelan H, Shupp J, Chan R, Harrington D, Mashruwala N, Brown DA, Mir H, Singer G, Cordova A, Rae L, Chin T, Castanon L, Bell D, Hughes W, Molnar JA. Maximizing wound coverage in full-thickness skin defects: A randomized-controlled trial of autologous skin cell suspension and widely meshed autograft versus standard autografting. J Trauma Acute Care Surg 2024; 96:85-93. [PMID: 38098145 DOI: 10.1097/ta.0000000000004120] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
BACKGROUND Traumatic insults, infection, and surgical procedures can leave skin defects that are not amenable to primary closure. Split-thickness skin grafting (STSG) is frequently used to achieve closure of these wounds. Although effective, STSG can be associated with donor site morbidity, compounding the burden of illness in patients undergoing soft tissue reconstruction procedures. With an expansion ratio of 1:80, autologous skin cell suspension (ASCS) has been demonstrated to significantly decrease donor skin requirements compared with traditional STSG in burn injuries. We hypothesized that the clinical performance of ASCS would be similar for soft tissue reconstruction of nonburn wounds. METHODS A multicenter, within-patient, evaluator-blinded, randomized-controlled trial was conducted of 65 patients with acute, nonthermal, full-thickness skin defects requiring autografting. For each patient, two treatment areas were randomly assigned to concurrently receive a predefined standard-of-care meshed STSG (control) or ASCS + more widely meshed STSG (ASCS+STSG). Coprimary endpoints were noninferiority of ASCS+STSG for complete treatment area closure by Week 8, and superiority for relative reduction in donor skin area. RESULTS At 8 weeks, complete closure was observed for 58% of control areas compared with 65% of ASCS+STSG areas (p = 0.005), establishing noninferiority of ASCS+STSG. On average, 27.4% less donor skin was required with ASCS+ STSG, establishing superiority over control (p < 0.001). Clinical healing (≥95% reepithelialization) was achieved in 87% and 85% of Control and ASCS+STSG areas, respectively, at 8 weeks. The treatment approaches had similar long-term scarring outcomes and safety profiles, with no unanticipated events and no serious ASCS device-related events. CONCLUSION ASCS+STSG represents a clinically effective and safe solution to reduce the amount of skin required to achieve definitive closure of full-thickness defects without compromising healing, scarring, or safety outcomes. This can lead to reduced donor site morbidity and potentially decreased cost associated with patient care.Clincaltrials.gov identifier: NCT04091672. LEVEL OF EVIDENCE Therapeutic/Care Management; Level I.
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Affiliation(s)
- Sharon Henry
- From the University of Maryland Medical Center (S.H.), Baltimore, Maryland; John Peter Smith Health Network (S.M.), Fort Worth, Texas; Cook County Health (M.G.), Chicago, Illinois; Arizona Burn Center Valleywise Health (K.N.F.), Phoenix, Arizona; University Medical Center New Orleans (H.P.), New Orleans, Louisiana; MedStar Washington Hospital Center, Washington (J.S.), District Columbia; Metis Foundation (R.C.), San Antonio, Texas; Rhode Island Hospital (D.H.), Providence, Rhode Island; Carle Foundation Hospital (N.M.), Urbana, Illinois; Duke University Medical Center (D.A.B.), Durham, North Carolina; Kendall Regional Medical Center (H.M.), Miami, Florida; Lundquist Institute (G.S.), Torrance, California; Ohio State University Wexner Medical Center (A.C.), Columbus, Ohio; Temple University (L.R.), Philadelphia, Pennsylvania; University of California Irvine (T.C.), Irvine, California; University of Arizona (L.C.), Tucson, Arizona; University of Rochester (D.B.), Rochester, New York; Thomas Jefferson University Hospital (W.H.), Philadelphia, Pennsylvania; and Wake Forest Baptist Medical Center (J.A.M.), Winston-Salem, North Carolina
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Ten Kate CA, Koese HJH, Hop MJ, Rietman AB, Wijnen RMH, Vermeulen MJ, Keyzer-Dekker CMG. Psychometric Performance of the Stony Brook Scar Evaluation Scale and SCAR-Q Questionnaire in Dutch Children after Pediatric Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 21:57. [PMID: 38248522 PMCID: PMC10815752 DOI: 10.3390/ijerph21010057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/23/2024]
Abstract
Introduction: The growing population of survivors following pediatric surgery emphasizes the importance of long-term follow-up. The impact of surgical scars on daily life can be evaluated through patient-reported outcome measurements. The Stony Brook Scar Evaluation Scale (SBSES) and SCAR-Q questionnaire are two interesting instruments for this purpose. We evaluated their psychometric performance in Dutch children after pediatric surgery. Methods: After English-Dutch translation, we evaluated-following the COSMIN guidelines-the feasibility, reliability (internal and external), and validity (construct, criterion, and convergent) of the SBSES and SCAR-Q in Dutch patients < 18 years old with surgical scars. Results: Three independent observers completed the SB for 100 children (58% boys, median age 7.3 (IQR 2.5-12.1) years) in whom surgery had been performed a median of 2.8 (0.5-7.9) years ago. Forty-six of these children (61% boys, median age 12.1 (9.3-16.2) years) completed the SCAR-Q. Feasibility and internal reliability (Cronbach's alpha > 0.7) was good for both instruments. For the SB, external reliability was poor to moderate (interobserver variability: ICC 0.46-0.56; intraobserver variability: ICC 0.74). For the SCAR-Q, external reliability was good (test-retest agreement: ICC 0.79-0.93). Validity tests (construct, criterion, and convergent) showed poor to moderate results for both instruments. Conclusions: The Dutch-translated SBSES and SCAR-Q showed good feasibility and internal reliability. External reliability and validity were likely affected by differences in conceptual content between the questionnaires. Combining them would provide insight in the impact of scars on patients. Implementation of these instruments in longitudinal follow-up programs could provide new insights into the long-term psychological outcome after pediatric surgery.
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Affiliation(s)
- Chantal A. Ten Kate
- Department of Pediatric Surgery and Intensive Care Children, Erasmus MC Sophia Children’s Hospital, Wytemaweg 80, 3015 CD Rotterdam, The Netherlands; (C.A.T.K.); (H.J.H.K.); (A.B.R.); (R.M.H.W.)
| | - Hilde J. H. Koese
- Department of Pediatric Surgery and Intensive Care Children, Erasmus MC Sophia Children’s Hospital, Wytemaweg 80, 3015 CD Rotterdam, The Netherlands; (C.A.T.K.); (H.J.H.K.); (A.B.R.); (R.M.H.W.)
| | - M. Jenda Hop
- Department of Plastic and Reconstructive Surgery, Erasmus University Medical Center, 3015 CD Rotterdam, The Netherlands;
| | - André B. Rietman
- Department of Pediatric Surgery and Intensive Care Children, Erasmus MC Sophia Children’s Hospital, Wytemaweg 80, 3015 CD Rotterdam, The Netherlands; (C.A.T.K.); (H.J.H.K.); (A.B.R.); (R.M.H.W.)
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, 3015 CD Rotterdam, The Netherlands
| | - René M. H. Wijnen
- Department of Pediatric Surgery and Intensive Care Children, Erasmus MC Sophia Children’s Hospital, Wytemaweg 80, 3015 CD Rotterdam, The Netherlands; (C.A.T.K.); (H.J.H.K.); (A.B.R.); (R.M.H.W.)
| | - Marijn J. Vermeulen
- Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children’s Hospital, 3015 CD Rotterdam, The Netherlands;
| | - Claudia M. G. Keyzer-Dekker
- Department of Pediatric Surgery and Intensive Care Children, Erasmus MC Sophia Children’s Hospital, Wytemaweg 80, 3015 CD Rotterdam, The Netherlands; (C.A.T.K.); (H.J.H.K.); (A.B.R.); (R.M.H.W.)
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Mashbari H, Hamdi S, Darraj H, Awaf M, Zaalah S, Hakami F, Hakami KM, Alhazmi E, Al khairat L, Hakami SA, Aburasain A, Hakami IAI, Arishi AA. Knowledge, attitude and practices towards surgical wound care and healing among the public in the Jazan Region, Saudi Arabia. Medicine (Baltimore) 2023; 102:e36776. [PMID: 38134059 PMCID: PMC10735108 DOI: 10.1097/md.0000000000036776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023] Open
Abstract
The purpose of this research was to evaluate how much the people in the Jazan region know about the care and healing of surgical wounds. Proper care of surgical wounds is very important to achieve the best treatment outcomes and to avoid negative consequences. However, factors like obesity, diabetes, and certain medications can impair wound healing, with surgical site infections being a major problem in the healthcare system. Therefore, this study aimed to determine public awareness and perceptions of surgical wound care to help improve education and raise awareness of the importance of proper wound care for better results. We run an observational cross-sectional study among adults above 18 years in the Jazan region. An online self-administered questionnaire was used in the collection of data. Simple random sampling was the used technique and 384 participants were calculated. The study used Statistical Package for the Social Sciences (SPSS) for data analysis and employed descriptive statistics, independent t test, Analysis of Variance (ANOVA), Pearson's correlation, and multivariate logistic regression to identify factors associated with knowledge of surgical site infection and wound care. This study analyzed 599 participants' knowledge, attitude, and practice about surgical site infection and wound management. While participants had a strong general understanding of surgical wounds, only 17% had a high degree of knowledge about surgical site infection and wound management. Medical students had the highest degree of knowledge, and being a medical student was the only significant predictor of having a high level of knowledge about surgical site infection (SSI) and wound care. The study emphasizes the necessity of enhanced patient education and investment in medical education quality. The participants in this study had high overall knowledge regarding surgical wounds but lacked particular knowledge concerning surgical site infection and wound management. Medical education was discovered to be a strong predictor of having a high level of knowledge about surgical site infection and wound management. Healthcare professionals should take the lead in giving accurate and reliable information regarding wound care techniques to patients, and legislators should invest in enhancing medical education quality.
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Affiliation(s)
- Hassan Mashbari
- Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Sulaiman Hamdi
- Jazan University, Faculty of Medicine, Jazan, Saudi Arabia
| | - Hussam Darraj
- Jazan University, Faculty of Medicine, Jazan, Saudi Arabia
| | - Mohammed Awaf
- Jazan University, Faculty of Medicine, Jazan, Saudi Arabia
| | - Shaden Zaalah
- Jazan University, Faculty of Medicine, Jazan, Saudi Arabia
| | - Faisal Hakami
- Jazan University, Faculty of Medicine, Jazan, Saudi Arabia
| | | | - Essam Alhazmi
- Jazan University, Faculty of Medicine, Jazan, Saudi Arabia
| | | | | | | | | | - Abdulaziz A. Arishi
- Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
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Jacobs J, Kattapuram M, Rundle CW, Kaplan SJ, Dreyfuss I, Suggs A. The impact on quality-of-life following treatment of surgical facial scars with laser-based therapy: a scoping review. Arch Dermatol Res 2023; 316:47. [PMID: 38103110 DOI: 10.1007/s00403-023-02779-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 09/19/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023]
Abstract
Post-surgical scarring impacts quality of life (QOL) and is a significant source of morbidity. Existing treatments targeted at improving the appearance and morbidity of scarring include laser-based therapies. Although lasers are frequently used to improve scar appearance, the effects on QOL are unclear. A scoping review was conducted to assess the impact of laser-based therapy for patients with surgical facial scarring on QOL. Throughout literature review was conducted with the guidance of a medical librarian. Relevant articles underwent two rounds of screening by two, independent reviewers. Data were extracted from each article and later analyzed. Of the four articles analyzed, laser-based therapies were demonstrated as effective in improving QOL for patients with facial scars resultant from surgical intervention. Laser-based therapy should be considered when treating facial scarring resultant from surgical intervention, as it has been shown to improve patient QOL. Standardization of QOL assessment and further studies expanding scar inclusion should be pursued given the paucity of information found through this review.
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Affiliation(s)
| | - Meera Kattapuram
- University of Michigan Medical School, Ann Arbor, MI, 48105, USA
| | | | - Samantha J Kaplan
- Duke University Medical Center Library and Archives, Duke University School of Medicine, 40 Duke Medicine Circle Clinic 3k, Durham, NC, 27710, USA
| | | | - Amanda Suggs
- Department of Dermatology, Duke University, Durham, NC, 27710, USA.
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Zhu P, Zhang H, Gu X, Ding Y, Qian M, Wang W, Shi G, Lee A. Quality of Life in Chinese Youth Following Open Thyroid Surgery: A Qualitative Study. Cancer Nurs 2023:00002820-990000000-00202. [PMID: 38100753 DOI: 10.1097/ncc.0000000000001314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
BACKGROUND Because of the increased incidence of thyroid cancer and good survival rates and with research into scarless techniques, it is increasingly important to understand the quality of life of thyroid cancer patients and identify areas for improvement. Therefore, it is necessary to explore the importance of neck appearance after thyroidectomy for thyroid cancer survivors in China. OBJECTIVE The purpose of this study was to investigate the effect of scarring after open thyroid surgery on the quality of life of young patients. METHODS A descriptive qualitative design was used. Data were collected using face-to-face semistructured interviews and analyzed using directed content analysis. RESULTS Five men and 19 women participated in the study. The following 3 broad themes and 9 subthemes emerged, which were (1) emotional functioning, including low self-esteem due to high visibility of scars, concerns and helplessness about scarring lesions, and feelings of isolation due to lack of support; (2) social functioning, including restricted choice of employment, avoidance of socializing with others, and reduced participation in social activities; and (3) information seeking, acceptance, and living with the scar, including bargaining, seeking professional help, and use of social media. CONCLUSIONS After open surgery for thyroid cancer, patients experience a variety of scarring features that affect their quality of life. Therefore, preoperative communication and long-term postoperative care should be emphasized in clinical practice and research. IMPLICATIONS FOR PRACTICE Understanding the experience of carrying scars after thyroid cancer surgery helps provide adequate information, expectation management, and informed decision-making.
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Affiliation(s)
- Pingting Zhu
- Author Affiliations: Department of Nursing, Yangzhou University, Yangzhou, Jiangsu, People's Republic of China (Mss Zhang, Gu, Ding, Qian, Wang, and Shi; Dr Zhu) and Manchester Metropolitan University, Manchester, England (Dr Lee)
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Kong J, Zhou C, Pan L, Li M, Zhang L. Micro-plasma radiofrequency and silicone gel dressings for treating early post-traumatic facial scars: A retrospective study. J Plast Reconstr Aesthet Surg 2023; 87:10-16. [PMID: 37804642 DOI: 10.1016/j.bjps.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Although different options are available for treating post-traumatic facial scars, they remain a therapeutic challenge. AIM To evaluate the safety and effectiveness of combined therapy using micro-plasma radiofrequency (MPRF) technology and silicone gel (SG) dressings for treating post-traumatic facial scars. METHODS This retrospective study was conducted at a single center. Patients with facial injuries in the outpatient and emergency units of the Department of Plastic Surgery at our hospital underwent debridement and cosmetic sutures performed by the same surgeon from October 2020 to October 2021. In the first arm, patients with facial injuries were treated with MPRF technology and SG, and in the second arm, they were treated with SG dressings alone. We observed the safety and effectiveness of these treatments in both arms. RESULTS A total of 32 patients with facial injuries were treated with MPRF technology and SG dressings (combined treatment group), and 28 patients were treated with SG dressings alone (SG group). After 6 months of treatment, the Vancouver Scar Scale scores of the combined treatment and SG groups were 1.38 ± 0.71 and 4.39 ± 0.50, respectively, and the difference was statistically significant (P < 0.01). After 6 months of treatment, the effectiveness rate in the combined treatment group was 93.8%, which was significantly higher than that in the SG group (67.9%), and the difference between the two groups was statistically significant (P < 0.05). No obvious adverse reactions occurred in the two arms. CONCLUSION Treating early post-traumatic facial scars with combined MPRF technology and SG is significantly better than treating them with SG alone; moreover, the combined therapy is safe and effective.
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Affiliation(s)
- Jiao Kong
- China-Japan Union Hospital of Jilin University, No. 126 of Xiantai Street, Changchun 130033, China
| | - Changcai Zhou
- China-Japan Union Hospital of Jilin University, No. 126 of Xiantai Street, Changchun 130033, China
| | - Lingfeng Pan
- China-Japan Union Hospital of Jilin University, No. 126 of Xiantai Street, Changchun 130033, China
| | - Mingxi Li
- China-Japan Union Hospital of Jilin University, No. 126 of Xiantai Street, Changchun 130033, China
| | - Lianbo Zhang
- China-Japan Union Hospital of Jilin University, No. 126 of Xiantai Street, Changchun 130033, China.
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Greif T, Alsawas M, Reid AT, Liu V, Prokop L, Murad MH, Powers JG. Targeting the Angiotensin Pathway in the Treatment of Cutaneous Fibrosis: A Systematic Review. JID INNOVATIONS 2023; 3:100231. [PMID: 37840767 PMCID: PMC10568560 DOI: 10.1016/j.xjidi.2023.100231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 08/03/2023] [Accepted: 08/22/2023] [Indexed: 10/17/2023] Open
Abstract
Acting on the renin-angiotensin-aldosterone system, angiotensin-converting enzyme inhibitors (ACE-Is) and angiotensin receptor blockers (ARBs) are mechanisms of some of the most prescribed medications in the world. In addition to their routine use for the treatment of hypertension, such agents have gained attention for their influence on the angiotensin receptor pathway in fibrotic skin disorders, including scars and keloids. To evaluate the current level of evidence supporting the use of these agents, a systematic review related to ACE-Is/ARBs and cutaneous scarring was conducted. We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from database inception through January 26, 2022. Two independent reviewers identified eligible studies for inclusion and extracted data. Data were insufficient for meta-analysis and are presented narratively. Of 461 citations identified, seven studies were included (199 patients). The studies included two randomized clinical trials, one comparative observation study, and four case reports. All the included studies reported statistically significant improvement in cutaneous scarring in patients using ACE-Is/ARBs compared with that in those treated with placebo/control using various outcome measures such as scar size and scar scales. However, much of the literature on this subject to date is limited by study design.
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Affiliation(s)
- Trenton Greif
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Mouaz Alsawas
- Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander T. Reid
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Vincent Liu
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
- Department of Pathology, University of Iowa Hospitals & Clinics, Iowa City, Iowa, USA
| | - Larry Prokop
- Mayo Clinic Libraries, Mayo Clinic, Rochester, Minnesota, USA
| | - M. Hassan Murad
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer G. Powers
- Department of Dermatology, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
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Gelidan AG. Hybrid double-dermal flap technique for vest-over-pants-closure correction of depressed abdominal scars. Int Wound J 2023; 20:3185-3190. [PMID: 37231983 PMCID: PMC10502272 DOI: 10.1111/iwj.14197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 05/27/2023] Open
Abstract
Surgical procedures performed during neonatal period or childhood that result in vertical midline, transverse left upper quadrant, or central upper abdominal scars create significant psychological concerns in adulthood. Various surgical techniques correct depressed scars, including scar revision, Z- or W-plasty flaps, sub-incision tunnelling, fat grafting, and autologous or alloplastic dermal grafting. This article describes a novel technique for repairing depressed abdominal scars using hybrid double-dermal flaps. We included patients with psychosocial concerns who underwent abdominal scar revision because of wedding plans. Hybrid local de-epithelised dermal flaps were used to correct the depression of the abdominal scar. Superior and inferior skin flaps, medial and lateral to the depressed scar, were de-epithelised for 2 to 3 cm and sutured using the vest-over-pants technique with 2/0 nylon permanent sutures. Six female patients who want to marry were included in this study. Depressed abdominal scars were successfully fixed using hybrid double-dermal flaps, either from the superior-inferior aspect for transverse scars or from the medial-lateral aspect for vertical scars. No postoperative complications were noted, and the patients were satisfied with the outcomes. De-epithelialised double-dermal flaps in the vest-over-pants technique are an effective and valuable surgical technique for correcting depressed scars.
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Affiliation(s)
- Adnan G. Gelidan
- Division of Plastic Surgery, Department of Surgery, College of MedicineKing Saud UniversityRiyadhSaudi Arabia
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Choi S, Ham S, Lee YI, Kim J, Lee WJ, Lee JH. Silibinin Downregulates Types I and III Collagen Expression via Suppression of the mTOR Signaling Pathway. Int J Mol Sci 2023; 24:14386. [PMID: 37762688 PMCID: PMC10531945 DOI: 10.3390/ijms241814386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 09/29/2023] Open
Abstract
Keloid scars are fibro-proliferative conditions characterized by abnormal fibroblast proliferation and excessive extracellular matrix deposition. The mammalian target of the rapamycin (mTOR) pathway has emerged as a potential therapeutic target in keloid disease. Silibinin, a natural flavonoid isolated from the seeds and fruits of the milk thistle, is known to inhibit the mTOR signaling pathway in human cervical and hepatoma cancer cells. However, the mechanisms underlying this inhibitory effect are not fully understood. This in vitro study investigated the effects of silibinin on collagen expression in normal human dermal and keloid-derived fibroblasts. We evaluated the effects of silibinin on the expressions of collagen types I and III and assessed its effects on the suppression of the mTOR signaling pathway. Our findings confirmed elevated mTOR phosphorylation levels in keloid scars compared to normal tissue specimens. Silibinin treatment significantly reduced collagen I and III expressions in normal human dermal and keloid-derived fibroblasts. These effects were accompanied by the suppression of the mTOR signaling pathway. Our findings suggest the potential of silibinin as a promising therapeutic agent for preventing and treating keloid scars. Further studies are warranted to explore the clinical application of silibinin in scar management.
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Affiliation(s)
- Sooyeon Choi
- Department of Dermatology & Cutaneous Biology, Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.C.); (S.H.); (Y.I.L.)
| | - Seoyoon Ham
- Department of Dermatology & Cutaneous Biology, Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.C.); (S.H.); (Y.I.L.)
| | - Young In Lee
- Department of Dermatology & Cutaneous Biology, Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.C.); (S.H.); (Y.I.L.)
- Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Seoul 03722, Republic of Korea; (J.K.); (W.J.L.)
| | - Jihee Kim
- Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Seoul 03722, Republic of Korea; (J.K.); (W.J.L.)
- Department of Dermatology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin 16995, Republic of Korea
| | - Won Jai Lee
- Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Seoul 03722, Republic of Korea; (J.K.); (W.J.L.)
- Department of Plastic Surgery, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Ju Hee Lee
- Department of Dermatology & Cutaneous Biology, Research Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea; (S.C.); (S.H.); (Y.I.L.)
- Scar Laser and Plastic Surgery Center, Yonsei Cancer Hospital, Seoul 03722, Republic of Korea; (J.K.); (W.J.L.)
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Zheng H, Cheng X, Jin L, Shan S, Yang J, Zhou J. Recent advances in strategies to target the behavior of macrophages in wound healing. Biomed Pharmacother 2023; 165:115199. [PMID: 37517288 DOI: 10.1016/j.biopha.2023.115199] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
Chronic wounds and scar formation are widespread due to limited suitable remedies. The macrophage is a crucial regulator in wound healing, controlling the onset and termination of inflammation and regulating other processes related to wound healing. The current breakthroughs in developing new medications and drug delivery methods have enabled the accurate targeting of macrophages in oncology and rheumatic disease therapies through clinical trials. These successes have cleared the way to utilize drugs targeting macrophages in various disorders. This review thus summarizes macrophage involvement in normal and pathologic wound healing. It further details the targets available for macrophage intervention and therapeutic strategies for targeting the behavior of macrophages in tissue repair and regeneration.
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Affiliation(s)
- Hongkun Zheng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Xinwei Cheng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Lu Jin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China; School of Life Science and Technology, ShanghaiTech University, Shanghai, China
| | - Shengzhou Shan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Jun Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
| | - Jia Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China.
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Palackic A, Franco-Mesa C, Beck I, Nolte S, Tapking C, Panayi AC, Stolle A, Haug V, Hirche C, Kneser U, Hundeshagen G. The Impact of Facial Burns on Short- and Long-Term Quality of Life and Psychological Distress-A Prospective Matched Cohort Study. J Clin Med 2023; 12:5057. [PMID: 37568459 PMCID: PMC10419582 DOI: 10.3390/jcm12155057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Burn injuries are a major healthcare challenge worldwide, with up to 50% of all minor burns located on the head and neck. With this study, we sought to describe the effect of facial burns (FB) on health-related quality of life through a prospective and matched cohort study design. Patients completed the 36 Item Short Form (SF-36) and the Hospital Anxiety and Depression Scale (HADS). Results were analyzed based on the distribution of datasets. In total, 55 patients with FB and 55 age-and sex-matched candidates were recruited. The most common mechanism of thermal injury was burns from flames. The FB group scored lower in physical and psychological dimensions than the control group, both acutely and one year after injury. An analysis of each domain showed that subjects in the FB group trended toward improvements in their score after one-year post-burn in physical functioning (acute: 71.0 ± 29.2; one-year: 83.7 ± 23.9; p = 0.02) and bodily pain (acute: 58.5 ± 30.3; one-year: 77.9 ± 30.5; p = 0.01) domains. Additionally, the FB group had significanlyt higher scores for anxiety (FB: 4.8 ± 3.2; control: 2.5 ± 2.8; p = <0.002) and depression (FB: 3.9 ± 3.5; control: 2.1 ± 2.7; p = 0.01) compared to the control. In conclusion, facial burns are associated with physical and psychosocial deficits, as well as elevated levels of psychological distress.
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Affiliation(s)
- Alen Palackic
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Camila Franco-Mesa
- Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Inessa Beck
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
| | - Steffen Nolte
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
- Department of Otorhinolaryngology, Head and Neck Surgery, Armed Forces Hospital Ulm, 89081 Ulm, Germany
| | - Christian Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
| | - Adriana C. Panayi
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
| | - Annette Stolle
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
| | - Valentin Haug
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
| | - Christoph Hirche
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
- Department of Plastic, Hand and Reconstructive Microsurgery, Hand Trauma and Replantation Center (FESSH), BG Klinik Frankfurt am Main gGmbH, Academic Teaching Hospital of Goethe-University of Frankfurt, 60629 Frankfurt am Main, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
| | - Gabriel Hundeshagen
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen am Rhein, Germany; (A.P.); (I.B.); (S.N.); (C.T.); (A.C.P.); (A.S.); (V.H.); (C.H.); (U.K.)
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Garg SP, Weissman JP, Chwa ES, Galiano RD. Content Validity of a Novel Scar Assessment Tool Evaluating the Career and Sexual Well-being Impact of Scars. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5118. [PMID: 37448762 PMCID: PMC10337705 DOI: 10.1097/gox.0000000000005118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 05/30/2023] [Indexed: 07/15/2023]
Abstract
Currently, patient reported outcome scales used to assess scar impact focus solely on psychosocial well-being, symptoms, and appearance. There remains a need to develop a broadened measure of scar impact on patients, focusing on sexual and career aspects. This study investigates the content validity of the novel Career and Sexual Well-being (CS) Scar Impact Scale. Method The CS scale contains five questions and was developed from previous patient thematic analysis interviews describing scar impact, and covers self-conscious behavior, new partners, hiding of the scar, being hindered in the workplace, and concerns regarding unprofessional appearance. Cognitive interviews and established guidelines were used to ensure that the scale was comprehensive, reproducible, and easily understandable. Results In total, 86 patients completed cognitive interviews. Patients had a clear understanding of the questions and elicited their intent in the interviews. An estimated 86% of patients rated the CS scale coverage of scar impact on career and sexual health at a three or above out of four; 95% said the specific instructions were clear, and 92% stated it took them less than 4 minutes to complete the scale. After the first round of interviews, a question about "perception/self-consciousness in a professional environment" was added based on patient suggestions. Conclusions The CS scar scale demonstrated face validity, acceptability, and field-readiness through cognitive interviewing of patients at our institution. Sexual well-being and career performance are important yet often neglected themes with which scars should be assessed. Usage of these tools would serve to improve current scar scales.
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Affiliation(s)
- Stuti P. Garg
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Joshua P. Weissman
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Emily S. Chwa
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
| | - Robert D. Galiano
- From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine
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Mahajan S, Sawant NS, Mahajan S. Depression, body image and quality of life in acne scars. Ind Psychiatry J 2023; 32:282-287. [PMID: 38161457 PMCID: PMC10756596 DOI: 10.4103/ipj.ipj_201_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 01/03/2024] Open
Abstract
Background Acne scars commonly occur in almost 95% of adolescents having acne. Depression and the psychosocial impact of acne have been studied by previous researchers but there are few studies on acne scar patients. Objectives To study the prevalence of depression, body image, and quality of life in patients with acne scars and the correlation of depression with body image and quality of life. Material and Methods Around 81 patients above 18 years of age clinically diagnosed as having different grades of acne by a dermatologist were assessed for depression using Becks Depression Inventory, Body image concern inventory, and Dermatology Life Quality Index and included in the study after being informed consent. Results The mean duration of acne was 6.03 ± 2.9 years, and acne scar was 2.88 ± 1.2 years. Nearly 93% of our sample had an equal preponderance of Grade 1 and Grade 2 acne scars. 31 (38.27%) patients had clinical depression with a total mean BDI score of 16.8 ± 9.7. 15 (18.5%) and 7 (8.6%) patients had moderate and severe depression respectively. Only 5 (6.17%) patients reported significant body image disturbances. All patients reported a very large effect on the quality of life due to flaws in facial appearance leading to feelings of embarrassment and impairment in sexual activities. Depression was significantly associated with grade 1 and 2 scars, body image disturbances, and quality of life. Conclusions There is a high prevalence of depression in patients with acne scarring which needs to be detected and treated. Liaison with a psychiatrist would improve the outcome.
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Affiliation(s)
- Sachin Mahajan
- Department of Psychiatry, Seth GSMC and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Neena S. Sawant
- Department of Psychiatry, Seth GSMC and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Sunanda Mahajan
- Department of Dermatology, Seth GSMC and KEM Hospital, Parel, Mumbai, Maharashtra, India
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Cironi KA, Issa PP, Albuck AL, McCarthy C, Rezvani L, Hussein M, Luo X, Shama M, Toraih E, Kandil E. Comparison of Medical Management versus Parathyroidectomy in Patients with Mild Primary Hyperparathyroidism: A Meta-Analysis. Cancers (Basel) 2023; 15:3085. [PMID: 37370696 DOI: 10.3390/cancers15123085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Parathyroidectomy is the definitive cure for patients with primary hyperparathyroidism (pHPT) and has an annual prevalence of 0.2-1% in the United States. Some patients with mild disease are medically managed effectively using calcium-lowering medications and drugs against complications such as osteoporosis; however, many maintain a persistently high calcium level that negatively impacts their skeletal, renal, and psychogenic systems over the long term. This meta-analysis aims to compare the outcomes of medical management versus parathyroidectomy in patients with mild pHPT. STUDY DESIGN This meta-analysis was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed, Embase, and Web of Science by two teams of investigators. Analysis was run using R packages. RESULTS A total of 12 publications including seven randomized control, two prospective, and three retrospective trials with a total of 1346 patients were included for analysis. The average follow-up for all patients was 41 ± 23.8 months. Demographics, pre-treatment calcium, PTH, and bone mineral density (BMD) were similar between the medical (N = 632) and surgical (N = 714) cohorts. Post-treatment calcium and PTH levels were significantly higher in the medical cohort (10.46 vs. 9.39, p < 0.01), (106.14 vs. 43.25, p = 0.001), respectively. Interestingly, the post-treatment PTH in the medical cohort increased when compared to pre-treatment (83.84 to 106.14). Patients in the medical cohort had lower BMD in lumbar (0.48 g/cm2; OR = 0.42, 95% CI = 0.21, 0.83), femoral (0.48; OR = 0.42, 95% CI = 0.29, 0.61), and hip (0.61; OR = 0.33, 95% CI = 0.13, 0.85). Incidences of fracture, nephrolithiasis, cardiovascular death, or overall mortality were not significantly different between the cohorts. CONCLUSIONS The present study is the most comprehensive meta-analysis on mild pHPT to date. Our findings reflect that parathyroidectomy is the superior option in the treatment of mild pHPT patients as opposed to medical management.
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Affiliation(s)
| | - Peter P Issa
- School of Medicine, Louisiana State University, New Orleans, LA 70112, USA
| | - Aaron L Albuck
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | | | - Leely Rezvani
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohammad Hussein
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Xinyi Luo
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Mohamed Shama
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
| | - Eman Toraih
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
- Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia 41511, Egypt
| | - Emad Kandil
- School of Medicine, Tulane University, New Orleans, LA 70112, USA
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Braizat O, Jafarian N, Al-Majid D, El-Debs M, Althalathini M. The Difference in Scar-Related Quality of Life in Open Versus Closed Septorhinoplasty. Cureus 2023; 15:e40541. [PMID: 37465790 PMCID: PMC10350346 DOI: 10.7759/cureus.40541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION The open and closed techniques are the main surgical techniques to perform septorhinoplasty. Although the open technique offers a better view of the pertinent anatomy and facilitates surgical access, it creates an external scar that could affect patients' satisfaction and quality of life (QoL). This study aims to compare the open and closed techniques using the SCAR-Q patient-reported outcome measure. METHODS In this retrospective study, we have included patients who had their nasal surgery one year ago, in the period between April 2020 and April 2021. The SCAR-Q assessment tool to study patients' satisfaction with appearance, symptoms, and psychological impact of open and closed septorhinoplasty techniques. RESULTS A total of 77 patients were included in this analysis. Of these, 39 (50.6%) patients underwent a closed septorhinoplasty, and 38 (49.4%) patients underwent an open approach. The mean (SD) age was 29.6 (8.1) years, and most patients were females (59.7%). The overall SCAR-Q questionnaire responses were very positive across all scales in our cohort, the median (IQR) scores were 91.0 (73.0-100.0) for the appearance scale, 89.0 (70.0-100.0) for the symptoms scale, and 100.0 (87.0-100.0) for the psychological impact scale. However, we have found no differences in SCAR-Q scores regarding appearance, symptoms, and psychological impact between open and closed septorhinoplasty. CONCLUSION We have found no significant differences in QoL between open and closed techniques of septorhinoplasty. Larger studies are needed to further validate this finding.
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Affiliation(s)
- Omar Braizat
- Department of Plastic and Reconstructive Surgery, Hamad Medical Corporation, Doha, QAT
| | - Nasrin Jafarian
- Department of Plastic and Reconstructive Surgery, Hamad Medical Corporation, Doha, QAT
| | - Dana Al-Majid
- Department of Plastic and Reconstructive Surgery, Hamad Medical Corporation, Doha, QAT
- Department of Head and Neck Surgery, McGill University, Quebec, CAN
| | - Mohammed El-Debs
- Department of Plastic and Reconstructive Surgery, Hamad Medical Corporation, Doha, QAT
| | - Mahmoud Althalathini
- Department of Plastic and Reconstructive Surgery, Hamad Medical Corporation, Doha, QAT
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Tan A, Castner NB, Slutsky JB. Mohs Surgeons Dominate Cutaneous Reconstructions in Cosmetically and Functionally Sensitive Sites: Medicare Trends From 2013 to 2019. Dermatol Surg 2023; 49:539-543. [PMID: 37000985 DOI: 10.1097/dss.0000000000003787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
Abstract
BACKGROUND Although dermatologists perform more cutaneous reconstructions than any other specialists for the Medicare population, the perception of dermatologists as surgeons may not be as fully recognized. Mohs surgeons are trained in complex reconstructions of cosmetically and functionally sensitive (CFS) sites, although the proportion they account for is unknown. OBJECTIVE To quantify the proportion of cutaneous reconstructions in CFS sites performed by Mohs surgeons compared with other specialists, and to identify trends from 2013 to 2019. METHODS A cross-sectional analysis was performed using the Medicare Public Use Files for 2013 to 2019. Data were stratified by physician specialty, with dermatologists further subdivided into Mohs surgeons and non-Mohs dermatologists. RESULTS Mohs surgeons performed 75.3% of all reconstructions in 2019, a significant increase from 2013 ( p < .0001). Mohs surgeons dominated nearly every type of CFS cutaneous reconstruction, with significant increases in proportion ( p < .0001) from 2013 to 2019 for every category except interpolation flaps. Complex repairs were the most commonly performed cutaneous reconstruction type. CONCLUSION Mohs surgeons perform far more cutaneous reconstructive surgeries in CFS sites than any other specialty for the Medicare population, with significant increases in their lead over the study period.
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Affiliation(s)
- Andrea Tan
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, New York
| | - Nicholas B Castner
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jordan B Slutsky
- Department of Dermatology, Stony Brook University Hospital, Stony Brook, New York
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Short WD, Rae M, Lu T, Padon B, Prajapati TJ, Faruk F, Olutoye OO, Yu L, Bollyky P, Keswani SG, Balaji S. Endogenous Interleukin-10 Contributes to Wound Healing and Regulates Tissue Repair. J Surg Res 2023; 285:26-34. [PMID: 36640607 PMCID: PMC9993344 DOI: 10.1016/j.jss.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 11/22/2022] [Accepted: 12/14/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Interleukin-10 (IL-10) is essential in fetal regenerative wound healing and likewise promotes a regenerative phenotype in adult dermal wounds. However, the role of endogenous IL-10 in postnatal dermal wound healing is not well-established. We sought to determine the function of endogenous IL-10 in murine full thickness excisional wounds that are splinted to prevent contracture and mimic human patterns of wound closure. METHODS Full-thickness excisional wounds were made in wildtype (WT) and IL-10-/- mice on a C57BL/6J background (F/M, 8 wk old). In a subset of wounds, contraction was prevented by splinting with silicone stents (stenting) and maintaining a moist wound microenvironment using a semiocclusive dressing. Wounds were examined for re-epithelialization, granulation tissue deposition, and inflammatory cell infiltrate at day 7 and fibrosis and scarring at day 30 postwounding. RESULTS We observed no difference in wound healing rate between WT and IL-10-/- mice in either the stented or unstented group. At day 7, unstented IL-10-/- wounds had a larger granulation tissue area and more inflammatory infiltrate than their WT counterparts. However, we did observe more F4/80+ cell infiltrate in stented IL-10-/- wounds at day 7. At day 30, stented wounds had increased scar area and epithelial thickness compared to unstented wounds. CONCLUSIONS These data suggest that endogenous IL-10 expression does not alter closure of full thickness excisional wounds when wound hydration and excessive contraction of murine skin are controlled. However, the loss of IL-10 leads to increased inflammatory cell infiltration and scarring. These new findings suggest that IL-10 contributes to the regulation of inflammation without compromising the healing response. These data combined with previous reports of increased rates of healing in IL-10-/- mice wounds not controlled for hydration and contraction suggest an important role for murine wound healing models used in research studies of molecular mechanisms that regulate healing.
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Affiliation(s)
- Walker D Short
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Meredith Rae
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas; Department of Pediatrics, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Thomas Lu
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas; Department of Pediatrics, McGovern Medical School, Houston, Texas
| | - Benjamin Padon
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Tanuj J Prajapati
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Fayiz Faruk
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Oluyinka O Olutoye
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Ling Yu
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Paul Bollyky
- Department of Medicine, Stanford University, Division of Infectious Diseases, Stanford, California
| | - Sundeep G Keswani
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas
| | - Swathi Balaji
- Laboratory for Regenerative Tissue Repair, Division of Pediatric Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas.
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Mekereș GM, Buhaș CL, Tudoran C, Csep AN, Tudoran M, Manole F, Iova CS, Pop NO, Voiţă IB, Domocoș D, Voiţă-Mekereş F. The practical utility of psychometric scales for the assessment of the impact of posttraumatic scars on mental health. Front Public Health 2023; 11:1103714. [PMID: 37089486 PMCID: PMC10113612 DOI: 10.3389/fpubh.2023.1103714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/02/2023] [Indexed: 04/09/2023] Open
Abstract
BackgroundScars are a natural consequence of the healing process, but with an impact on the psychological and social level for the individual, which can even lead to withdrawal and social stigmatization. We aimed to analyze the psychosocial impact determined by post-traumatic scars, using psychometric scales, to assess the effectiveness of the Mekereș’ Psychosocial Internalization Scale (MPIS), and to identify relevant predictors of traumatic and surgical scar internalization.MethodsOur cohort included 293 participants, 149 women and 144 men, aged 18–64 years who were screened for scar characteristics and completed a set of psychological scales. We compared the results obtained in two subgroups: 153 subjects with posttraumatic scars and 140 with surgical scars.ResultsRelevant predictors for posttraumatic scar internalization (R2 = 0.721) are adaptation time, age of the occurrence and subjective appraisal, while for the depression, and hopelessness relevant predictors are the subjective appraisal of the scars and the posttraumatic quality of life.ConclusionThe psychological and social reporting of the aftermath of trauma, that has been followed by scar-ring, is an indicator of how a person will react and could indicate the susceptibility to psycho-pathology.
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Affiliation(s)
| | | | - Cristina Tudoran
- Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara, Romania
- County Emergency Hospital “Pius Brinzeu”, Timisoara, Romania
- *Correspondence: Cristina Tudoran,
| | | | - Mariana Tudoran
- County Emergency Hospital “Pius Brinzeu”, Timisoara, Romania
| | - Felicia Manole
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | | | | | - Ioan Bogdan Voiţă
- Regional Institute of Gastroenterology and Hepatology “Prof. Octavian Fodor”, Cluj-Napoca, Romania
| | - Daniela Domocoș
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
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Kim HY, Im HY, Chang HK, Jeong HD, Park JH, Kim HI, Yi HS, Kim YS. Correlation between Collagen Type I/III Ratio and Scar Formation in Patients Undergoing Immediate Reconstruction with the Round Block Technique after Breast-Conserving Surgery. Biomedicines 2023; 11:biomedicines11041089. [PMID: 37189707 DOI: 10.3390/biomedicines11041089] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/26/2023] [Accepted: 03/27/2023] [Indexed: 04/07/2023] Open
Abstract
The aim of this study was to investigate the relationship between the collagen type I/III ratio and scarring in patients who underwent immediate reconstruction with the round block technique (RBT) after breast conservation surgery. Seventy-eight patients were included, and demographic and clinical characteristics were recorded. The collagen type I/III ratio was measured using immunofluorescence staining and digital imaging, and scarring was assessed using the Vancouver Scar Scale (VSS). The mean VSS scores were 1.92 ± 2.01 and 1.79 ± 1.89, as assessed by two independent plastic surgeons, with good reliability of the scores. A significant positive correlation was found between VSS and the collagen type I/III ratio (r = 0.552, p < 0.01), and a significant negative correlation was found between VSS and the collagen type III content (r = −0.326, p < 0.05). Multiple linear regression analysis showed that the collagen type I/III ratio had a significant positive effect on VSS (β = 0.415, p = 0.028), whereas the collagen type I and collagen type III content had no significant effect on VSS. These findings suggest that the collagen type I/III ratio is associated with scar development in patients undergoing RBT after breast conservation surgery. Further research is needed to develop a patient-specific scar prediction model based on genetic factors affecting the collagen type I/III ratio.
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Affiliation(s)
- Hyo-young Kim
- We Are the Plastic Surgery, 415, Haeun-daero, Haeundae-gu, Busan 48064, Republic of Korea
| | - Ho-young Im
- Department of Plastic and Reconstructive Surgery, College of Medicine, Kosin University, 262, Seo-gu, Busan 49267, Republic of Korea
| | - Hee-kyung Chang
- Department of Pathology, College of Medicine, Kosin University, 262, Seo-gu, Busan 49267, Republic of Korea
| | - Hwan-do Jeong
- Kosin Innovative Smart Healthcare Research Center, Kosin University Gospel Hospital, 262, Seo-gu, Busan 49267, Republic of Korea
| | - Jin-hyung Park
- Department of Plastic and Reconstructive Surgery, College of Medicine, Kosin University, 262, Seo-gu, Busan 49267, Republic of Korea
| | - Hong-il Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Kosin University, 262, Seo-gu, Busan 49267, Republic of Korea
| | - Hyung-suk Yi
- Department of Plastic and Reconstructive Surgery, College of Medicine, Kosin University, 262, Seo-gu, Busan 49267, Republic of Korea
| | - Yoon-soo Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Kosin University, 262, Seo-gu, Busan 49267, Republic of Korea
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Abdelhakim M, Dohi T, Ogawa R. Congress Report on the Second World Congress of Global Scar Society with Scar Academy and Japan Scar Workshop. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4921. [PMID: 37073255 PMCID: PMC10106224 DOI: 10.1097/gox.0000000000004921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/16/2023] [Indexed: 04/20/2023]
Abstract
Pathological scars (including keloids, hypertrophic scars, and scar contractures) are present with high severity among certain populations, particularly in Asians and Africans who are highly prone to develop scars. Understanding the patho-mechanism that underlies scarring, such as mechanosignaling, systemic, and genetic factors, as well as optimal surgical techniques and integrated noninvasive therapeutic methods can guide clinicians to develop treatment protocols that can overcome these issues. This report summarizes a congress at Pacifico Yokohama (Conference Center) on December 19, 2021 involving researchers and clinicians from diverse disciplines who convened to discuss current clinical, preclinical, and most recent research advances in understanding pathological scarring, keloid and hypertrophic scar management, and research progress in wound healing. Presenters described the advances in scar therapies, understanding scarring mechanisms, and scar prevention and assessments tools. Moreover, presenters addressed the challenges during the COVID-19 pandemic and using telemedicine in management of scar patients.
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Affiliation(s)
- Mohamed Abdelhakim
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Teruyuki Dohi
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
| | - Rei Ogawa
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
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Kennedy DL, Chism-Balangue T, Furniss D. Reporting of scar outcomes in the hand and wrist; a state-of-the-art literature review. BMC Musculoskelet Disord 2023; 24:249. [PMID: 37004025 PMCID: PMC10064537 DOI: 10.1186/s12891-023-06296-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 03/07/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVES The aim of this literature review was to synthesise and report current practice in evaluation and reporting of scar outcomes in hand and wrist clinical research. METHODS A systematic search from inception to 2022 was conducted using three electronic databases. English language randomized controlled trials and observational cohort studies reporting standardised scar outcome measures and/or scar symptoms, appearance, impairment, function, or mental health outcomes in patients with hand and wrist scars were included. Two independent reviewers determined study eligibility and performed data extraction of a priori identified scar outcome domains. Data analysis included descriptive statistics and identification of discordance in taxonomy. RESULTS Fifty-nine studies were included. Elective surgery cohorts were the most frequently included clinical population (n = 28; 47%) followed by burns (n = 16; 27%). Six different standardised scar outcome measures were reported by 25% of studies however only 7% of studies utilised a patient-reported measure. Scar symptoms were the most frequently reported outcome domain (81%); but taxonomy was incongruous, constructs lacked working definitions required for generalisability and outcome measurement was variable and unreported. Nineteen different measures of scar appearance and structure were reported by 30 (51%) of studies however only nine (23%) were patient-reported. Seven different hand function PROMs were reported by 25 (43%) studies. Person-centred domains including scar acceptability (12%), mental health impact (5%), and social participation (4%) were rarely reported. CONCLUSIONS This review highlights that evaluation and reporting of hand and wrist scar outcomes is not standardised, assessment methods and measures are under-reported and there is discordance in taxonomy. Evaluation is not person-centred, rather it is dependent on clinician assessment. Domains including scar acceptability, mental health, and social participation are rarely addressed. A stakeholder consensus derived hand and wrist scar core outcome measurement set will promote standardisation and underpin improvements in clinical research quality, transparency, and rigour.
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Affiliation(s)
- Donna L Kennedy
- Therapy Department, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK.
- Pain Research, Department of Surgery and Cancer, Imperial College London, London, UK.
| | | | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Science, University of Oxford, Botnar Research Centre, Oxford, UK
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Mekeres GM, Buhaș CL, Csep AN, Beiușanu C, Andreescu G, Marian P, Cheregi CD, Fodor R, Manole F. The Importance of Psychometric and Physical Scales for the Evaluation of the Consequences of Scars-A Literature Review. Clin Pract 2023; 13:372-383. [PMID: 36961059 PMCID: PMC10037630 DOI: 10.3390/clinpract13020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Scars affect patients after trauma, burns, or surgical procedures and can generate both physical and psychosocial changes. The aesthetic damage represents the modification of a person's physical appearance, in its bodily integrity, causing numerous sufferings and determining social or economic consequences. The aim of this research is to evaluate the advantages and disadvantages offered by the available psychosocial and physical scar scales in assessing the physical, aesthetic, psychosocial, and juridical consequences of scars. This will aid to inform medical examiners about the most valued existing scales to allow them to select the most appropriate instrument to manage their patient. METHODS A broad search of relevant scientific studies on the psychosocial determinants of post-traumatic and surgical scars was conducted by using the following international database tools: PsycINFO, MedLine Social Science Index, Scopus, Web of Science, published from 1960 until 2022. RESULTS We analyzed 63 scientific studies to assess the advantages and limits of several psychometric and physical scar evaluation scales. CONCLUSIONS The researchers analyzed in this review highlight the advantages and limitation of existing instruments, evidencing the demand for future scar evaluation instruments and a scar-assessing algorithm that takes into account the physical, aesthetic, psychosocial, and legal consequences of scars.
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Affiliation(s)
- Gabriel Mihai Mekeres
- Doctoral School of Biomedical Sciences, University of Oradea, Faculty of Medicine and Pharmacy, 410087 Oradea, Romania
| | - Camelia Liana Buhaș
- Morphological Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
- Department of Legal Medicine, County Clinical Emergency Hospital of Oradea, 410169 Oradea, Romania
| | - Andrei Nicolae Csep
- Medical Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Corina Beiușanu
- Morphological Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Gineta Andreescu
- Morphological Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Paula Marian
- Medical Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Cornel Dragoș Cheregi
- Surgical Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Radu Fodor
- Doctoral School of Biomedical Sciences, University of Oradea, Faculty of Medicine and Pharmacy, 410087 Oradea, Romania
| | - Felicia Manole
- Surgical Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
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Leonardo TR, Chen L, Schrementi ME, Shi J, Marucha PT, Glass K, DiPietro LA. Transcriptional changes in human palate and skin healing. Wound Repair Regen 2023; 31:156-170. [PMID: 36571451 PMCID: PMC10006330 DOI: 10.1111/wrr.13068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/26/2022] [Accepted: 12/20/2022] [Indexed: 12/27/2022]
Abstract
Most human tissue injuries lead to the formation of a fibrous scar and result in the loss of functional tissue. One adult tissue that exhibits a more regenerative response to injury with minimal scarring is the oral mucosa. We generated a microarray gene expression dataset to examine the response to injury in human palate and skin excisional biopsies spanning the first 7 days after wounding. Differential expression analyses were performed in each tissue to identify genes overexpressed or underexpressed over time when compared to baseline unwounded tissue gene expression levels. To attribute biological processes of interest to these gene expression changes, gene set enrichment analysis was used to identify core gene sets that are enriched over the time-course of the wound healing process with respect to unwounded tissue. This analysis identified gene sets uniquely enriched in either palate or skin wounds and gene sets that are enriched in both tissues in at least one time point after injury. Finally, a cell type enrichment analysis was performed to better understand the cell type distribution in these tissues and how it changes over the time course of wound healing. This work provides a source of human wound gene expression data that includes two tissue types with distinct regenerative and scarring phenotypes.
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Affiliation(s)
- Trevor R Leonardo
- Department of Microbiology and Immunology, University of Illinois Chicago, Chicago, Illinois, USA
- Department of Periodontics, Center for Wound Healing and Tissue Regeneration, University of Illinois Chicago, Chicago, Illinois, USA
| | - Lin Chen
- Department of Periodontics, Center for Wound Healing and Tissue Regeneration, University of Illinois Chicago, Chicago, Illinois, USA
| | - Megan E Schrementi
- Department of Science and Health, DePaul University, Chicago, Illinois, USA
| | - Junhe Shi
- Department of Periodontics, Center for Wound Healing and Tissue Regeneration, University of Illinois Chicago, Chicago, Illinois, USA
- National Medical Products Administration Key Laboratory for Clinical Research and Evaluation of Traditional Chinese Medicine, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Phillip T Marucha
- Department of Periodontics, College of Dentistry, Oregon Health and Sciences University, Portland, Oregon, USA
| | - Kimberly Glass
- Channing Division of Network Medicine,Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
- Department of Biostatistics, Harvard Chan School of Public Health, Boston, Massachusetts, USA
| | - Luisa A DiPietro
- Department of Periodontics, Center for Wound Healing and Tissue Regeneration, University of Illinois Chicago, Chicago, Illinois, USA
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Amici JM, Taieb C, Le Floc'h C, Demessant A, Seité S, Cogrel O. The impact of visible scars on well-being and quality of life: An international epidemiological survey in adults. J Eur Acad Dermatol Venereol 2023; 37 Suppl 3:3-6. [PMID: 36635614 DOI: 10.1111/jdv.18856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/29/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Scars are visible marks from various causes, including surgery, skin injury, burning or dermatological disease, and may impact the quality of life. OBJECTIVE To assess the impact of scars on quality of life (QoL). MATERIAL AND METHODS Data about sociodemography, presence, origin, and symptoms of scars were collected using an Internet survey between April and May 2020. Overall, 11,100 individuals answered the survey. In total, 48.5% of the responders had at least one scar of less than 1 year of age. Scars were mainly reported on the abdomen and face. Globally, 28.9% of subjects with recent scars reported pain, 23.7% reported burning, 35.0% reported itching, and 44.1% reported redness. Subjects were most frequently bothered by the visibility of their scars and the presence of marks. Incidences were significantly higher than for those with older scars. The average DLQI score was 7.44; it decreased to 2.90 after 1 year. Subjects with scars aged less than 3 months had their QoL more frequently impacted (33.9%) than those with scars aged 12 months or more (10.2%). In subjects reporting skin discomfort, clinical symptoms significantly impacted body movement, choice of clothes, leisure activities, and sexual life more than in those reporting no skin discomfort. Moreover, subjects felt significantly more impacted in their daily lives due to their skin discomfort. When feeling bothered by the visibility of their scars, significantly more subjects were also impacted in their body movement, choice of clothes, leisure activities, and sexual life than those subjects who did not feel bothered. Moreover, significantly more subjects felt embarrassed. CONCLUSION Scars significantly impact the subjects' quality of life. This impact is even more important when caused by recent and visible scars, with a lower DLQI score in subjects with more aged than in those with recent scars.
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Affiliation(s)
- Jean Michel Amici
- Dermatology Department, CHU Bordeaux, Hôpital Saint-André, Bordeaux, France
| | - Charles Taieb
- European Market Maintenance Assessment, Fontenay-sous-Bois, France
| | | | | | - Sophie Seité
- La Roche-Posay Dermatological Laboratories, Levallois-Perret, France
| | - Olivier Cogrel
- Dermatology Department, CHU Bordeaux, Hôpital Saint-André, Bordeaux, France.,French Society of Dermatological Surgery, Paris, France
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Novel, Blended Polymeric Microspheres for the Controlled Release of Methotrexate: Characterization and In Vivo Antifibrotic Studies. Bioengineering (Basel) 2023; 10:bioengineering10030298. [PMID: 36978688 PMCID: PMC10045572 DOI: 10.3390/bioengineering10030298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 03/03/2023] Open
Abstract
Low dose methotrexate (MTX) is known to effectively decrease type I collagen production in dermal fibroblasts, while increasing the matrix metalloproteinase-1 (MMP-1) production in vitro. For in vivo use as an antifibrotic agent on wounds, a linear and extended controlled release formulation of MTX is required. The objective of this study was to optimize the fabrication of MTX-loaded polymeric microspheres with such properties, and to test the efficacy for the prevention of fibrosis in vivo. Poly lactic-co-glycolic acid (PLGA), Poly (L-lactic acid) (PLLA) and the diblock copolymer, methoxypolyethylene glycol-block-poly (D, L-lactide) (MePEG-b-PDLLA), were used to fabricate microspheres, which were then characterized in terms of size, drug encapsulation efficiency, and in vitro release profiles. The optimized formulation (PLGA with diblock copolymer) showed high drug encapsulation efficiency (>80%), low burst release (~10%) and a gradual release of MTX. The amphipathic diblock copolymer is known to render the microsphere surface more biocompatible. In vivo, these microspheres were effective in reducing fibrotic tissue which was confirmed by quantitative measurement of type I collagen and α-smooth muscle actin expression, demonstrating that MTX can be efficiently encapsulated in PLGA microspheres to provide a delayed, gradual release in wound beds to reduce fibrosis in vivo.
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Rijpma D, Pijpe A, Claes K, Hoeksema H, de Decker I, Verbelen J, van Zuijlen P, Monstrey S, Meij-de Vries A. Outcomes of Meek micrografting versus mesh grafting on deep dermal and full thickness (burn) wounds: Study protocol for an intra-patient randomized controlled trial. PLoS One 2023; 18:e0281347. [PMID: 36787292 PMCID: PMC9928116 DOI: 10.1371/journal.pone.0281347] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/16/2022] [Indexed: 02/15/2023] Open
Abstract
INTRODUCTION Autologous split thickness skin grafting is the standard-of-care for most deep dermal and full thickness skin defects. Historically, mesh grafting is used to expand skin grafts for smaller defects and other techniques such as Meek micrografting is used to enable expansion for larger skin defects. Yet, Meek micrografting is increasingly used for smaller skin defects as well. Both techniques are frequently used, especially in burn centers, but evidence on which one is preferable for relative smaller skin defects is lacking. Therefore, an intra-patient randomized controlled trial was designed to adequately compare multiple outcomes of the Meek micrografting and mesh grafting techniques. MATERIALS AND METHODS A multicenter intra-patient controlled randomized trial is being performed in two burn centers (the Netherlands and Belgium) to compare multiple outcomes of Meek micrografting and mesh grafting burns or skin defects. Study registration number (NL74274.029.20). Adult patients with a (burn) wound and an indication for surgical excision and skin grafting were screened for inclusion. In total 70 patients will be included and the primary outcome is scar quality twelve months post-surgery assessed by the Patient and Observer Scar Assessment Scale. Moreover, graft take, re-epithelialization, infection rate, donor site size and patients' preference are also measured within hospital admission, on 3 months and 12 months post-surgery. DISCUSSION This is the first randomized trial that is intra-patient controlled, which enables a proper comparison between both skin expansion techniques. The results of this study will contribute to the clarification of the indications of both techniques and ample attention is paid for the patients' opinion on the surgical treatment options.
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Affiliation(s)
- Danielle Rijpma
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, The Netherlands
- Association of Dutch Burn Centers, Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- * E-mail: (DR); (AMV)
| | - Anouk Pijpe
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, The Netherlands
- Association of Dutch Burn Centers, Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
| | - Karel Claes
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Henk Hoeksema
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Ignace de Decker
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Jozef Verbelen
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Paul van Zuijlen
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Plastic, Reconstructive and Hand Surgery, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Pediatric Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Stan Monstrey
- Department of Plastic Surgery, Ghent University Hospital, Ghent, Belgium
- Ghent Burn Center, Ghent University Hospital, Ghent, Belgium
| | - Annebeth Meij-de Vries
- Burn Center, Red Cross Hospital, Beverwijk, The Netherlands
- Department of Pediatric Surgery, Amsterdam UMC, Amsterdam, The Netherlands
- Department Surgery, Red Cross Hospital, Beverwijk, The Netherlands
- * E-mail: (DR); (AMV)
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