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Minic J, Vigato E, Shoham Y, Lavagnolo U, Governa M. Selective enzymatic debridement and modified Meek technique in the treatment of extensive burns: Preliminary observations. Health Sci Rep 2024; 7:e1829. [PMID: 39040879 PMCID: PMC11260873 DOI: 10.1002/hsr2.1829] [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: 05/15/2023] [Revised: 10/31/2023] [Accepted: 01/03/2024] [Indexed: 07/24/2024] Open
Abstract
Background Selective bromelain-based enzymatic debridement (BED) has emerged as a valid alternative for the treatment of extensive burns, with Total Body Surface Area (TBSA) > 20%. Autologous skin grafting represents the procedure of choice but the scarcity of donor sites remains the main reconstructive challenge. The modified Meek micro-grafting technique may represent a valid strategy to optimize the final outcome. Methods A single-cohort retrospective analysis was performed, involving nine burn patients (TBSA > 20%) who underwent both BED and subsequently modified Meek technique. Demographic and clinical data (mechanism of injury, surgical treatment, complications, necessity of re-grafting, further surgery and esthetic outcome) were collected. Results All patients had large burns of mixed and deep dermal thickness (first, second, and third degree). All burns were enzymatically debrided postadmission and covered by the modified Meek technique. Local infection due to poor general conditions was the main complication for all patients. All but two patients survived. The selectiveness of the enzymatic debridement and dermal preservation seemed to improve the quality of scars resulting from micro-grafting. Evaluations performed at 12 ± 2 months postburn showed superior scar quality compared to areas treated with traditional (sheet/mesh) grafts. Conclusion Combined BED and Meek techniques may provide an effective synergic combination for the treatment of extensive burns.
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Affiliation(s)
| | | | - Yaron Shoham
- Burn Unit, Soroka University Medical Center, Faculty of Health SciencesBen‐Gurion University of the NegevBeer ShebaIsrael
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Bagheri M, von Kohout M, Fuchs PC, Seyhan H, Stromps JP, Lefering R, Opländer C, Schiefer JL. How to evaluate scar colour after burn injuries - A clinical comparison of the Mexameter® and the subjective scar assessment (POSAS/VSS). Burns 2024; 50:691-701. [PMID: 38097444 DOI: 10.1016/j.burns.2023.11.010] [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: 03/20/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Scarring after burn injuries remains one of the major challenges in burn medicine and is the subject of current research. Accurate and high-quality assessment of scars is needed to enable exact outcome evaluation of different treatments. Our aim was to evaluate the most common subjective scar evaluation scores-the POSAS (Patient and Observer Scar Assessment Scale) and VSS (Vancouver Scar Scale)-in comparison with the objective device Mexameter® for colour evaluation. METHODS A prospective monocentre study was performed, which included 120 examined scar areas of 60 patients with third degree burns who had received skin grafts between 1975 and 2018 with a total burned surface area (TBSA) > 2%. Two different scar areas in comparison with one healthy skin area concerning 'colour', 'pigmentation', and 'vascularization' were evaluated by the Mexameter® MX 18, the OSAS, and the VSS by the same examiner, as well as the PSAS by the patient. RESULTS The mean TBSA of the 60 patients was 24.3%. In the OSAS, 61% of the scars were evaluated as 'hyper-', 19% as 'hypo-', and 19% as 'mix-pigmented'. Furthermore, 65% of the scars were estimated as highly vascularized. In the Mexameter®, the melanin index values of the scar areas compared to the healthy skin areas showed a small difference of 12 (p < 0.05). The mean difference of erythema between the scar and the healthy skin areas was 84 (p < 0.001). For the Mexameter®, moderate correlations were found when comparing 'erythema' with the OSAS category 'vascularization' (r = 0.33, p < 0.05) and 'melanin' with the OSAS parameter 'pigmentation' (r = 0.28, p < 0.05). When comparing the Mexameter® measurements to the OSAS questionnaire, 27% of the scars were wrongly evaluated as 'hyperpigmented' by the observer and 21% as 'hypervascularized', while showing low measurements in the device. Additionally, a novel Mexameter® ordinal scare scale was calculated. CONCLUSION In this study, we were able to show on a relatively large patient population that with the Mexameter®, the subjectivity of the scar colour assessment by examiner/patient can be overcome, but precise differentiation can still be ensured with subjective evaluation tools. We further introduced a novel Mexameter® Scar Scale. It is necessary to further investigate the vast range of objective devices and develop scar panels for with an incorporation of objective and subjective devices to further improve reliability with reduced bias in terms of scar assessment.
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Affiliation(s)
- M Bagheri
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany.
| | - M von Kohout
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - P C Fuchs
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - H Seyhan
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - J P Stromps
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, Cologne, Germany
| | - C Opländer
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, Cologne, Germany
| | - J L Schiefer
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
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3
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Bandopadhyay A, Kapoor A, Kundu K, Jagtap M, Chattopadhyay D. Translation and validation of Hindi version of patient scar assessment scale in patients with postburn facial scar. J Cutan Aesthet Surg 2024; 17:55-59. [PMID: 38736860 PMCID: PMC11086925 DOI: 10.4103/jcas.jcas_11_22] [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] [Indexed: 05/14/2024] Open
Abstract
Background Patient scar assessment scale (PSAS) is a reliable and standard tool for assessment of scars by the observer and the patient. Till now the scale has not been translated to Hindi. The objective of the study was to translate and validate the PSAS to Hindi. Materials and Methods We did forward and backward translation of the English PSAS together with its validation. In total, 64 patients with postburn facial scars were included. The validation committee consisted of 6 bilingual members. Results The PSAS-Hindi showed good internal consistency with Cronbach's α of 0.86. Test-retest reliability showed good correlation with intra class coefficient being 0.94 (95% confidence interval: 0.83-0.97). Conclusion The PSAS was successfully translated to Hindi, and cross-cultural adaptation was made.
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Affiliation(s)
- Arkapal Bandopadhyay
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Akshay Kapoor
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kaustav Kundu
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Manish Jagtap
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Debarati Chattopadhyay
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Carrière ME, Tyack Z, Westerman MJ, Pleat J, Pijpe A, van Zuijlen PPM, de Vet HCW, Mokkink LB. From qualitative data to a measurement instrument: A clarification and elaboration of choices made in the development of the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0. Burns 2023; 49:1541-1556. [PMID: 36914442 DOI: 10.1016/j.burns.2023.02.009] [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: 09/27/2022] [Revised: 02/05/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To clarify and elaborate on the choices that were made in the development of the Patient Scale of the Patient and Observer Scar Assessment Scale 3.0 (POSAS 3.0), based upon the rich information obtained from patients during focus groups and pilot tests. METHODS The discussions described in this paper are a reflection of the focus group study and pilot tests that were conducted in order to develop the Patient Scale of the POSAS3.0. The focus groups took place in the Netherlands and Australia and included 45 participants. Pilot tests were performed with 15 participants in Australia, the Netherlands, and the United Kingdom. RESULTS We discussed the selection, wording and merging of 17 included items. Additionally, the reason for exclusion of 23 characteristics are given. CONCLUSION Based upon the unique and rich material of patient input obtained, two versions of the Patient Scale of the POSAS3.0 were developed: the Generic version, and the Linear scar version. The discussions and decisions taken during the development are informative for a good understanding of the POSAS 3.0 and are indispensable as a background for future translations and cross-cultural adaptations.
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Affiliation(s)
- M E Carrière
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Burn center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, the Netherlands; Association of Dutch Burn centers, Beverwijk, the Netherlands.
| | - Z Tyack
- Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - M J Westerman
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Division of Life Science, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - J Pleat
- Department of Plastic and Reconstructive Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - A Pijpe
- Burn center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, the Netherlands; Association of Dutch Burn centers, Beverwijk, the Netherlands
| | - P P M van Zuijlen
- Burn center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, the Netherlands; Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - H C W de Vet
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - L B Mokkink
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands
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5
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Garg SP, Williams T, Taritsa IC, Wan R, Goel C, Harris R, Huffman K, Galiano RD. Evaluating skin colour diversity in the validation of scar assessment tools. Wound Repair Regen 2023; 31:731-737. [PMID: 37768279 DOI: 10.1111/wrr.13120] [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: 06/20/2023] [Revised: 08/23/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Across scar studies, there is a lack of dark-skinned individuals, who have a predisposition for keloid formation, altered pigmentation and poorer quality of life (QOL). There is a need for patients of colour to be included in scar scale development and validation. In this study, we evaluate the racial diversity of patients included in the validation of scar assessment scales. A systematic review was conducted for articles reporting on the validation of a scar assessment tool. Racial, ethnic and Fitzpatrick skin type (FST) data were extracted. Fifteen scar scale validation studies were included. Nine of the studies did not mention FST, race or ethnicity of the patients. Two of the studies that reported FST or race information only included White patients or included no FST V/VI patients: mapping assessment of scars (MAPS) and University of North Carolina '4P'. Only four studies included non-White patients or dark-skinned patients in the validation of their scar scale: the modified Vancouver Scar Scale (VSS), modified Patient and Observer Scar Assessment Scale (POSAS), acne QOL and SCAR-Q scales. The patients included in the modified VSS validation were 7% and 13% FST V/VI, 14% African in the modified POSAS and 4.5% FST V/VI in the SCAR-Q. We highlight the severe lack of diversity in scar scale validation, with only 4 out of 15 studies including dark-skinned patients. Given the susceptibility of darker-skinned individuals to have poorer scarring outcomes, it is critical to include patients of colour in the very assessment tools that determine their scar prognosis. Inclusion of patients of colour in scar scale development will improve scar assessment and clinical decision-making.
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Affiliation(s)
- Stuti P Garg
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tokoya Williams
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Iulianna C Taritsa
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rou Wan
- Division of Plastic & Reconstructive Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Chirag Goel
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Raiven Harris
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kristin Huffman
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert D Galiano
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Lassig AAD, Lindgren BR, Wilson AC, Joseph AM, Davison M, Yueh B. InCISE: Instrument for Comprehensive Incisional and Surgical Evaluation. Laryngoscope 2023; 133:2166-2173. [PMID: 36226730 PMCID: PMC10097828 DOI: 10.1002/lary.30439] [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: 06/08/2022] [Revised: 08/22/2022] [Accepted: 09/27/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The evaluation of healing after head and neck surgery is currently qualitative and non-standardized, limiting the quality of surgical healing assessments in clinical and research settings. We sought to develop an objective, standardized wound assessment score, and hypothesize that a reliable instrument can be developed to evaluate head and neck surgical wounds. METHODS A prospective cohort study was conducted in a tertiary-care, academic head and neck surgery practice. Patients undergoing head and neck surgery were enrolled. A digital photograph protocol was developed for evaluating healing surgical wounds. A panel of experts developed and refined a wound healing score and established reliability, reproducibility, internal consistency, and validity of the score. RESULTS InCISE: Instrument for comprehensive incisional and surgical evaluation was created. The utility of our wound healing score was assessed using classical test theory. We performed the major steps of establishing reliability in head and neck surgeons: (1) internal consistency (Cronbach's α = 0.81), (2) inter-observer reliability (intra-class correlation = 0.76), and (3) intra-rater reliability (intra-class correlation = 0.87), and content validity (through focus groups). Our composite measure was found to have strong internal consistency, inter-rater reliability, and intra-rater reliability. Preliminary work suggests criterion validity via associations with physical health related quality of life (SF-12). CONCLUSION A wound healing score for head and neck surgery, InCISE, has been developed and is reliable, reproducible, and consistent. Although content validity is present and criterion validity is suggested, work continues to establish validity in this instrument to allow for expanded clinical and research use. LEVEL OF EVIDENCE NA Laryngoscope, 133:2166-2173, 2023.
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Affiliation(s)
- Amy Anne D. Lassig
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, University of Minnesota, Minneapolis, MN USA
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, Hennepin Healthcare Research Institute / Hennepin County Medical Center, Minneapolis, MN USA
| | - Bruce R. Lindgren
- Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN USA
| | - Anna C. Wilson
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, University of Minnesota, Minneapolis, MN USA
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, Hennepin Healthcare Research Institute / Hennepin County Medical Center, Minneapolis, MN USA
| | - Anne M. Joseph
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN USA
| | - Mark Davison
- Department of Education, University of Minnesota, Minneapolis, MN USA
| | - Bevan Yueh
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, University of Minnesota, Minneapolis, MN USA
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7
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Carrière ME, Mokkink LB, Tyack Z, Westerman MJ, Pijpe A, Pleat J, van de Kar AL, Brown J, de Vet HCW, van Zuijlen PPM. Development of the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0: a qualitative study. Qual Life Res 2023; 32:583-592. [PMID: 36355319 PMCID: PMC9911488 DOI: 10.1007/s11136-022-03244-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE The Patient and Observer Scar Assessment Scale (POSAS) is widely used for measurements of scar quality. This encompasses visual, tactile and sensory characteristics of the scar. The Patient Scale of previous POSAS versions was lacking input from patients. Therefore, the aim of this study was to develop the POSAS3.0, Patient Scale with involvement of adults patients with all scar types, complying with the highest clinimetric standards. METHODS From February 2018 to April 2019, a series of six focus group interviews were performed in the Netherlands and Australia to identify scar quality characteristics that adults with scars consider to be important. All focus groups were transcribed, anonymized and analysed using a thematic analysis. Relevant characteristics were formulated into items, resulting in a Dutch and English version of the Patient Scale. These drafts were pilot tested in Australia, the Netherlands and the United Kingdom, and refined accordingly. RESULTS A total of 21 relevant scar quality characteristics were identified during the focus groups. Two distinct versions of the POSAS3.0, Patient Scale were developed. The Generic version contains 16 items and can be used for all scar types, except linear scars. The Linear Scar version of the Patient Scale contains the same 16 items, with an extra item referring to the widening of scar margins. All included items are rated on a verbal rating scale with five response options. CONCLUSION Two versions of the POSAS3.0 Patient Scale were developed. Further field tests are being performed to establish the measurement properties and scoring algorithm of the scales.
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Affiliation(s)
- M. E. Carrière
- grid.16872.3a0000 0004 0435 165XDepartment of Epidemiology and Data Science, Amsterdam UMC (location VUmc), Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.415746.50000 0004 0465 7034Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, The Netherlands ,grid.418147.f0000 0004 9238 8347Association of Dutch Burn Centers, Beverwijk, The Netherlands
| | - L. B. Mokkink
- grid.16872.3a0000 0004 0435 165XDepartment of Epidemiology and Data Science, Amsterdam UMC (location VUmc), Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Z. Tyack
- grid.1003.20000 0000 9320 7537Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - M. J. Westerman
- grid.16872.3a0000 0004 0435 165XDepartment of Epidemiology and Data Science, Amsterdam UMC (location VUmc), Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Division of Life Science, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - A. Pijpe
- grid.415746.50000 0004 0465 7034Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - J. Pleat
- grid.418484.50000 0004 0380 7221Department of Plastic and Reconstructive Surgery, North Bristol NHS Trust, Bristol, UK
| | - A. L. van de Kar
- grid.440209.b0000 0004 0501 8269Department of Plastic, Reconstructive en Handsurgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - J. Brown
- grid.416100.20000 0001 0688 4634Burn Center, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - H. C. W. de Vet
- grid.16872.3a0000 0004 0435 165XDepartment of Epidemiology and Data Science, Amsterdam UMC (location VUmc), Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - P. P. M. van Zuijlen
- grid.415746.50000 0004 0465 7034Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, The Netherlands ,Pediatric Surgical Centre, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
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Vafeiadou A, Bowling NC, Hammond C, Banissy MJ. Assessing individual differences in attitudes towards touch in treatment settings: Introducing the touch & health scale. Health Psychol Open 2022; 9:20551029221137008. [DOI: 10.1177/20551029221137008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Individuals commonly receive touch in treatment settings, but there is limited research on how they perceive it. The current project sought to address this gap by: 1) developing the Touch & Health Scale (THS) - a novel instrument to measure attitudes to touch in treatment settings 2) assessing inter-individual differences in THS scores, and 3) examining the association between individuals’ THS scores and wellbeing. Data of a large U.K. adults sample ( N > 12,000) were used. THS showed Cronbach’s α between 0.636 and 0.816 and significant correlations ( p < 0.001) with day-to-day attitudes to touch. THS scores differed as a function of extraversion and avoidant attachment style. Participants with more positive attitudes to touch in treatment settings showed greater wellbeing. Overall, the study highlights the importance of a personalised approach to touch in treatment settings and provides a new scale that may act as a screening tool for this purpose.
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Affiliation(s)
| | | | | | - Michael J Banissy
- Department of Psychology, Goldsmiths, University of London, London, UK
- School of Psychological Science, University of Bristol, Bristol, UK
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9
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Chuangsuwanich A, Kongkunnavat N, Kamanamool M, Maipeng G, Kamanamool N, Tonaree W. Extracorporeal Shock Wave Therapy for Hypertrophic Scars. Arch Plast Surg 2022; 49:554-560. [PMID: 35919551 PMCID: PMC9340180 DOI: 10.1055/s-0042-1751027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background
Hypertrophic scars cause aesthetic concerns and negatively affect the quality of life. A gold standard treatment for hypertrophic scars has not been established due to various responses of modalities. Extracorporeal shock wave therapy (ESWT) is a noninvasive and affects scar remodeling by fibroblast regulation. This study investigated the effectiveness of ESWT for hypertrophic scars.
Methods
Twenty-nine patients were enrolled. All patients underwent ESWT once a week for 6 consecutive weeks. Their scars were assessed using the Patient and Observer Scar Assessment Scale (POSAS), erythema index, melanin index, and scar pliability before treatment and again 4 weeks after treatment completion.
Results
Thirty-four hypertrophic scars in this study had persisted for between 6 months and 30 years. Most scars developed after surgical incision (55.88%). The chest and upper extremities were the predominant areas of occurrence (35.29% each). Most of the POSAS subscales and total scores were significantly improved 4 weeks after treatment (
p
< 0.05). Furthermore, the pain, itching, and pigmentation subscale were improved. The pliability, melanin index, and erythema index were also improved, but without significance. The patients were satisfied with the results and symptoms alleviation, although subjective score changes were insignificant. No serious adverse events were found. The patients reported pruritus in 62.5% and good pain tolerance in 37.5%. Subgroup analyses found no differences in scar etiologies or properties at different parts of the body.
Conclusion
The ESWT is a modality for hypertrophic scar treatment with promising results. Most of POSAS subscales were significantly improved.
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Affiliation(s)
- Apirag Chuangsuwanich
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Natthapong Kongkunnavat
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Malika Kamanamool
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Gulradar Maipeng
- Perioperative Nurse Division, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nanticha Kamanamool
- Department of Preventive and Social Medicine, Faculty of Medicine Srinakharinwirot University, Ongkharak, Thailand
| | - Warangkana Tonaree
- Division of Plastic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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10
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Morandi EM, Pinggera D, Kerschbaumer J, Rauchenwald T, Winkelmann S, Thomé C, Pierer G, Wolfram D. Correction of temporal hollowing after pterional craniotomy by autologous fat grafting. A single-center experience. World Neurosurg 2022; 164:e784-e791. [PMID: 35597536 DOI: 10.1016/j.wneu.2022.05.049] [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: 03/30/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Aesthetic complications following neurosurgical procedures impact patient quality of life and self-perception. Postoperative temporal hollowing is frequently seen after temporal craniotomy, resulting mainly from atrophy of the temporal muscle. Autologous fat grafting is a tailorable method to correct such approach-related sequelae. We herein present our clinical patient series and discuss pearls and pitfalls of this method. METHODS In this retrospective single-center study, correction of postoperative temporal hollowing using autologous fat grafting was performed in 16 patients. Temporal tissue thickness ratio was measured using magnetic resonance tomography images to visualize the graft. Patients, plastic surgeons and neurosurgeons evaluated the results independently using the herein presented scale. RESULTS The mean interval between the neurosurgical procedure and fat grafting was 62 months. A mean volume of 11.5 ml autologous fat was injected in an average of 2.5 sessions after initial rigotomy. Temporal tissue thickness was significantly augmented at a mean of 2.2 years after the operation (mean 0.71 ± 0.25, range 0.43-1.1; p=0.0214) as compared to the preoperative finding (mean 0.48 ± 0.1, range 0.32-0.6). Patients were more satisfied with the results than were surgeons, reflecting the significant impact of the deformity on patient self-esteem. CONCLUSIONS Autologous fat grafting is a valuable method for correcting postoperative temporal hollowing that provides stable results, high patient and surgeon satisfaction and can be tailored to the patient's individual needs. It should not be considered a merely aesthetic operation, but an important rehabilitation step towards restoring the patient's quality of life.
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Affiliation(s)
- Evi M Morandi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Daniel Pinggera
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Johannes Kerschbaumer
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
| | - Tina Rauchenwald
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Selina Winkelmann
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Claudius Thomé
- Department of Neurosurgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Gerhard Pierer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
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11
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Hong JS, Yoo SJ, Shin HK. A new technique of suturing using adhesive skin closure for uncooperative patients. Int Wound J 2022; 19:1821-1828. [PMID: 35293122 PMCID: PMC9615285 DOI: 10.1111/iwj.13787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 02/25/2022] [Accepted: 03/05/2022] [Indexed: 11/26/2022] Open
Abstract
Open wounds are usually closed with suture. However, young patients often do not cooperate and prevent proper suture placement. Young patients are often terrified of mild pain and wholly uncooperative, which is why we introduce this timesaving, less painful, more aesthetic technique of placing and removing stitches. 104 patients with facial lacerations aged 5 to 15 years were treated at a single center from May 2019 to March 2021. Patients were randomly assigned equally to a simple interrupted suture group (the SI group) or a continuous locking with Steri‐Strip group (the CS group). Suture times, times for stitch removal, pain scores at stitch removal and mature scar scores were evaluated. Suture and stitch removal times were significantly shorter, and pain scores at stitch removal and observer scar assessment scale scores were lower in the CS group. Patient scar assessment scale score was non‐significantly lower in the SI group. This study shows that the novel continuous locking with the Steri‐Strip technique is easier and quicker to perform, causes less pain when removing stitches, provides better aesthetic results than the simple interrupted suture technique and suggests the continuous locking with Steri‐Strip technique would be very useful for uncooperative young patients.
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Affiliation(s)
- Joon-Shik Hong
- Department of Plastic and Reconstructive Surgery, College of Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Seok-Ju Yoo
- Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju, Republic of Korea
| | - Hea-Kyeong Shin
- Department of Plastic and Reconstructive Surgery, College of Medicine, Dongguk University, Gyeongju, Republic of Korea
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12
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Ud-Din S, Bayat A. Noninvasive Objective Tools for Quantitative Assessment of Skin Scarring. Adv Wound Care (New Rochelle) 2022; 11:132-149. [PMID: 33966482 DOI: 10.1089/wound.2020.1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Significance: Many treatments are utilized in the management of skin scarring; however, difficulties arise due to the high rates of recurrence and the identification of treatment efficacy in each patient, in particular, in the case of raised dermal scarring. Therefore, evaluation of treatments and the provision of objective scar assessment pre-therapy and post-therapy is of paramount importance to identify changes in scar characteristics using noninvasive devices. Recent Advances: There have been a number of emerging noninvasive objective quantitative devices, which assess specific scar parameters such as pliability, volume, color, perfusion, and depth. These can include three-dimensional imaging, optical coherence tomography, in vivo confocal microscopy, full-field laser perfusion imaging, and spectrophotometric intracutaneous analysis. Critical Issues: Clinical assessment and grading scales are most commonly used to assess scarring; however, there is a need for more objective quantitative measures to monitor their maturation and response to therapy. Currently, there is no consensus as to which objective measuring device is most optimal when assessing skin scarring. There is a need for a predictor tool that allows early implementation of treatment and addresses diagnosis, therapy, and prognosis. Future Directions: Validation of noninvasive objective scar assessment tools is essential as well as further development of technologies. There are currently more modalities that assess physical scar characteristics and only few that measure the physiological parameters. Therefore, the development of a technology that quantifies the metabolic and cellular activity in skin scars is necessary to allow for bespoke strategies for each patient.
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Affiliation(s)
- Sara Ud-Din
- Plastic and Reconstructive Surgery Research, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, England, United Kingdom
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research, NIHR Manchester Biomedical Research Centre, University of Manchester, Manchester, England, United Kingdom
- MRC-SA Wound Healing Unit, Division of Dermatology, University of Cape Town, Cape Town, South Africa
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13
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Chen HH, Huang TC, Hsu YC, Chen HC. Prospective clinical trial comparing barbed dermal suture and interrupted suture closure of the anterolateral thigh flap donor site in a Taiwanese population based on the Vancouver scar scale and the patient and observer scar assessment scale. J Plast Reconstr Aesthet Surg 2021; 74:3196-3211. [PMID: 34247963 DOI: 10.1016/j.bjps.2021.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 04/05/2021] [Accepted: 06/22/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Hsin-Han Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Tsung-Chun Huang
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan.
| | | | - Hung-Chi Chen
- Department of Plastic and Reconstructive Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
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14
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Choo AMH, Ong YS, Issa F. Scar Assessment Tools: How Do They Compare? Front Surg 2021; 8:643098. [PMID: 34250003 PMCID: PMC8260845 DOI: 10.3389/fsurg.2021.643098] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Healing after dermal injury is a complex but imperfect process that results in a wide range of visible scars. The degree of disfigurement is not the sole determinant of a scar's effect on patient well-being, with a number of other factors being critical to outcome. These include cosmetic appearance, symptoms such as itch and pain, functional loss, psychological or social problems, and quality of life. An accurate assessment of these domains can help clinicians measure outcomes, develop, and evaluate treatment strategies. A PubMed literature search was performed up to 31st March 2020. Ten objective scar measurements, four Clinician-Reported Outcome Measures (CROMs), six Patient-Reported Outcome Measures (PROMs), and one combined measure were evaluated for their reliability, clinical relevance, responsiveness to clinical change, and feasibility. Many quantitative tools were limited in their clinical relevance and feasibility, whereas few qualitative CROMs and PROMs have undergone rigorous assessment. This review examines currently available assessment tools, focusing primarily on subjective scar measurements (CROMs, PROMs), and offers a perspective on future directions in the field.
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Affiliation(s)
| | - Yee Siang Ong
- Department of Plastics, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Fadi Issa
- Department of Plastic Surgery and Burns, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom.,Medical Sciences Division, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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15
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Berenguer B, García T, Lorca-García C, San-Basilio M. Aesthetic forehead reduction in female patients: Surgical details and analysis of outcome. J Plast Reconstr Aesthet Surg 2021; 75:407-414. [PMID: 34305024 DOI: 10.1016/j.bjps.2021.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 01/04/2021] [Accepted: 06/02/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Primary aesthetic hairline lowering, also known as forehead reduction, is a relatively unexplored procedure, and the perceived satisfaction with outcome has not been previously discussed in scientific literature. The objectives of this study were to review the surgical technique and to analyze outcome assessing objective reduction, improvement of facial balance, patient satisfaction, and complications. PATIENTS AND METHODS This was a prospective cohort study of patients seeking aesthetic forehead reduction since 2010. Inclusion criteria were as follows: women with a high but stable hairline. We excluded smokers, those seeking combined surgery, and those who had history of scalp surgery or hair loss. All patients were operated following the same protocol. Forehead reduction was measured comparing the pre- and postoperative distance from the glabella to the trichion. Improvement in facial balance was assessed comparing the pre- and postoperative quotient between the upper and middle thirds of the face. The forehead FACE-Q tool and the Vancouver Scar Scale were used to assess patient satisfaction. All complications were registered with a minimum follow-up of 6 months. RESULTS Twenty-six women aged 16 to 56 years were included. The average reduction was 2.03 cm. The facial balance quotient improved from 1:1.44 preoperatively to 1:1.05 postoperatively (p < 0.01). Both the forehead FACE-Q and the Vancouver Scar Scale showed significantly positive results. Complications included transient scalp numbness in 23 subjects, small areas of scar widening in 3 patients, and minor seroma in 1 patient. CONCLUSION With meticulous execution, aesthetic forehead reduction in female patients is effective and safe, resulting in high patient satisfaction. The FACE-Q is owned by the Memorial Sloan Kettering Cancer Center (MSKCC) and was used with permission for this research.
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Affiliation(s)
| | - Teresa García
- Unit of Plastic Surgery, Hospital la Luz, Madrid, Spain
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16
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Falkner F, Thomas B, Mayer S, Haug V, Harhaus L, Nagel S, Kneser U, Bigdeli AK. The impact of closed incisional negative pressure therapy on anterior lateral thigh flap donor site healing and scarring: A retrospective case-control study. J Plast Reconstr Aesthet Surg 2021; 75:152-159. [PMID: 34274247 DOI: 10.1016/j.bjps.2021.05.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 03/21/2021] [Accepted: 05/27/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The objective of this study was to investigate whether closed incisional negative pressure therapy (cINPT) is suitable to improve anterior lateral thigh (ALT) flap donor site healing and scarring. METHODS We identified 271 ALT free flaps of widths between 7 and 9 cm and primary donor site closure performed between January 2012 to December 2019. Patients were divided into cases of cINPT versus controls without cINPT as part of this retrospective case-control review. We compared the incidences of postoperative donor site complications (wound dehiscence, infection, seroma, hematoma) and the degree of scarring severity using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scales (POSAS). RESULTS A total of 106 ALT donor sites received cINPT (39%), whereas the remaining 165 donor sites received conventional dressings (61%). The distribution of gender, age, body mass index, comorbidities, and mean flap sizes were comparable between both groups. The occurrence of surgical wound dehiscence was significantly lower in the cINPT group (2.8%), when compared to controls (9.0%) (p = 0.04). Furthermore, the mean length of postoperative hospital stay was significantly shorter in the cINPT group (19 ± 8 days versus 21 ± 11 days; p = 0.03). CINPT was associated with a more favorable donor site scar quality when assessed by VSS (p = 0.03) and POSAS (p = 0.002). CONCLUSION The use of cINPT was associated with significantly less ALT donor site complications and superior scar quality accelerating patients' postoperative recovery.
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Affiliation(s)
- Florian Falkner
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Benjamin Thomas
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Simon Mayer
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Valentin Haug
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Leila Harhaus
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Sarah Nagel
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany
| | - Amir K Bigdeli
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwig-Guttmann-Strasse 13, 67071 Ludwigshafen, Germany; Hand and Plastic Surgery, University of Heidelberg, Heidelberg, Germany.
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17
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Price K, Moiemen N, Nice L, Mathers J. Patient experience of scar assessment and the use of scar assessment tools during burns rehabilitation: a qualitative study. BURNS & TRAUMA 2021; 9:tkab005. [PMID: 34212058 PMCID: PMC8240530 DOI: 10.1093/burnst/tkab005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/27/2020] [Indexed: 02/03/2023]
Abstract
Background Scar assessment plays a key role during burns aftercare, to monitor scar remodelling and patients’ psychosocial well-being. To aid assessment, subjective scar assessment scales are available that use health-care professionals’ and patients’ opinions to score scar characteristics. The subjective scales are more widely used in clinical practice over objective scar measures. To date, there is no research that considers patients’ views on scar assessment and the role of subjective and objective assessment tools. Therefore, the aim of this qualitative study was to explore patients’ perspectives on scar assessment and the utility of scar assessment tools during burns rehabilitation. Methods Semi-structured interviews were conducted with 10 adult burn patients who were being reviewed in clinic for scarring. Participants were recruited via their clinical care team and research nurses at the Queen Elizabeth Hospital, Birmingham, UK. Topics covered during interview included patient experience of scar assessment, the use of scar assessment tools and discussion surrounding important factors to be addressed when assessing scars. A thematic analysis using the Framework Method was conducted. Results Participants identified key subthemes that contribute towards the overarching theme of patient-centred scar assessment. These are: patient-led care; continuity in care; learning how to self-manage scarring; and psychological assessment. Links were demonstrated between these subthemes and the remaining themes that describe scar assessment strategies, indicating their potential patient-centred contributions. The subjective opinions of clinicians were found to be valued above the use of subjective or objective scar assessment tools. Scar assessment scales were perceived to be a beneficial method for self-reflection in relation to psychosocial functioning. However, minimal feedback and review of completed assessment scales led to uncertainty regarding their purpose. Patients perceived objective tools to be of primary use for health-care professionals, though the measures may aid patients’ understanding of scar properties. Conclusions Scar assessment tools should be used to support, rather than replace, health-care professionals’ subjective judgements of scarring. Adapting the way in which clinicians introduce and use scar assessment tools, according to patient needs, can support a patient-centred approach to scar assessment.
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Affiliation(s)
- Kate Price
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Naiem Moiemen
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laura Nice
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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18
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Nair VV, Singh O, Ranjan P, Chawla S, Unnikrishnan A. Randomised Control Clinical Trial of Topical Silicone Gel in Post-Lower Segment Caesarean Section Closure scar in Primigravida. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02420-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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19
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Mayfield CK, Thomas I, Shauly O, Gould DJ, Seruya M. Validating Grading of Aesthetic Outcomes of Web Space Reconstruction for Finger Syndactyly: Crowdsourcing Public Perceptions Using Amazon Mechanical Turk. Aesthet Surg J Open Forum 2021; 3:ojaa046. [PMID: 33791667 PMCID: PMC7760566 DOI: 10.1093/asjof/ojaa046] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND It has recently been attempted in the literature to analyze the aesthetic outcomes of syndactyly web space reconstruction utilizing dorsal pentagonal advancement flaps and dorsal rectangular flaps with skin grafting. The study utilized a categorical grading system for evaluating the aesthetic outcomes of reconstruction to be used in conjunction with a visual analog scale (VAS), which has yet to be validated in the assessment of aesthetic outcomes following web space reconstruction. OBJECTIVES To utilize crowdsourced public perceptions to validate the grading of aesthetic outcomes in web space reconstruction for finger syndactyly. METHODS A prospective study was conducted of random volunteers recruited through an internet crowdsourcing service to gain responses for a survey to analyze patient opinions toward the aesthetic outcomes of web space reconstruction. Outcomes were graded based on descriptions of the appearance, color, matte, and distortion of the reconstruction. RESULTS The excellent dorsal flap demonstrated a mean VAS score of 6.66 (95% confidence interval [CI] = 6.45-6.87), and the very good, good, and poor dorsal flaps had mean VAS scores of 5.94 (95% CI = 5.73-6.15), 4.98 (95% CI = 4.77-5.19), and 3.55 (95% CI = 3.31-3.79), respectively. The odds ratio for receiving an excellent rating was 4.21 (95% CI = 3.04-5.82) for excellent dorsal flap with P < 0.0001. CONCLUSIONS This study confirms and validates the assessment of aesthetic outcomes of web space reconstruction by the Yuan Grading Scale. This evidence may guide future practice such that recommendations can be made to align with the aesthetic preferences of the patient.
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Affiliation(s)
- Cory K Mayfield
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ian Thomas
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Orr Shauly
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel J Gould
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mitchel Seruya
- Department of Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Moon SJ, Byun IH, Chang JS, Song SY, Lee WJ, Lee DW. A prospective comparative study of radiotherapy effect upon scar quality. J Plast Reconstr Aesthet Surg 2020; 74:1801-1806. [PMID: 33358674 DOI: 10.1016/j.bjps.2020.11.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 07/07/2020] [Accepted: 11/22/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The effect of radiation on uncomplicated postoperative scars is unclear. This study aimed to analyze irradiated and non-irradiated scars in patients with unilateral breast cancer, who underwent oncoplastic breast reduction surgery and radiation therapy (RT), to identify how postoperative scar changes with radiation. METHODS Twenty breast scars in 10 patients were analyzed after unilateral breast-conserving surgery, oncoplastic breast reduction, and RT. Scars were assessed using the Vancouver scar scale (VSS) by two independent blinded observers and three-dimensional scar analysis camera. Paired t-test between irradiated and non-irradiated scars in each patient and correlation of scar score differences with potential contributing factors were analyzed. RESULTS The VSS was significantly lower for the irradiated scar than that for the non-irradiated contralateral scar (1.40 vs. 4.05, p = 0.001), although time interval from the last radiation to scar assessment had a negative correlation with paired differences of VSS (Spearman's correlation coefficient: -0.637, p = 0.048). Compared with the non-irradiated scar, the irradiated scar showed a significantly high level of hemoglobin (1.04 vs. 1.26, p = 0.017) and melanin (0.55 vs. 0.63, p = 0.03). CONCLUSIONS Postoperative scars with radiation showed better results in objective and subjective assessments than scars without radiation. These findings suggest that radiation has a positive effect on general scar maturation.
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Affiliation(s)
- Seung Jin Moon
- Department of Plastic & Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, South Korea
| | - Il Hwan Byun
- Department of Plastic & Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, South Korea
| | - Jee Suk Chang
- Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Yong Song
- Department of Plastic & Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, South Korea
| | - Won Jai Lee
- Department of Plastic & Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, South Korea
| | - Dong Won Lee
- Department of Plastic & Reconstructive Surgery, Institute for Human Tissue Restoration, Yonsei University College of Medicine, 50-1 Yonsei-Ro, Seodaemun-Gu, Seoul 03722, South Korea.
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Treatment of hypertrophic scars and keloids using an intralesional 1470 nm bare-fibre diode laser: a novel efficient minimally-invasive technique. Sci Rep 2020; 10:21694. [PMID: 33303965 PMCID: PMC7728807 DOI: 10.1038/s41598-020-78738-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 11/26/2020] [Indexed: 12/20/2022] Open
Abstract
Hypertrophic and keloid scars result from abnormal wound healing and can have a variable response to a number of available treatment modalities. The evolution of laser treatments in recent years has shown a wide range of clinical applications including their use in the treatment of scars. We investigated the effectiveness of a 1470 nm diode laser using an intralesional optical fibre delivery device in the treatment of hypertrophic and keloid scars. We evaluated its safety and efficacy as a novel and minimally invasive treatment alternative for scar modulation and volume reduction. A prospective cohort study was performed involving 21 patients with hypertrophic scars (HS) (n = 9) and keloids (n = 12) resulting from various aetiology. Patients were treated with one to three treatment sessions. Comprehensive evaluations were performed using the Vancouver Scar Scale, Doppler ultrasound, Cutometer, Mexameter and PeriCam PSI. Scar thickness was reduced by an average of 0.308 ± 0.138 cm (p < 0.001). In particular the two subgroups showed a significant 27.7% and 28.2% reduction in scar thickness of HS and Keloids, respectively. Scar firmness showed a significant improvement of 1.2% (p < 0.05) for HS, though for keloids this was 0.4% (p = 0.26). Keloids had a significant reduction in pigmentation at 21.3%. Blood perfusion had a significant reduction of 29.6% in HS and 22.7% in Keloids. Overall VSS total score improvement of 42% in the HS and at 37.9% in the Keloid subgroup. No adverse events such as hypo/hyperpigmentation, skin infection, or recurrence were reported. This study shows that the intralesional 1470 nm bare-fibre diode laser significantly improved hypertrophic and keloid scars based on both subjective and objective analyses and supports this type of laser therapy as a safe and effective minimally-invasive treatment option.
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22
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Zhang N, Yu X, Zhao J, Yu J, Shi K, Liu T. Fractional CO 2 laser therapy for cesarean scar under the guidance of multiple evaluation methods: A retrospective study. J Cosmet Dermatol 2020; 20:2119-2124. [PMID: 33185305 DOI: 10.1111/jocd.13840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 10/23/2020] [Accepted: 11/03/2020] [Indexed: 11/28/2022]
Abstract
AIMS To introduce the treatment experience of fractional CO2 laser for cesarean scar under the guidance of multiple evaluation methods. METHODS Cesarean scar patients receiving fractional CO2 laser therapy between January 2016 and January 2020 were retrospectively analyzed in this study. The demographic characteristics and treatment protocols, the Vancouver Scar Scale (VSS), the University of North Carolina "4P" Scar Scale (UNC4P), and the Antera3D score of all the enrolled patients were recorded. RESULTS Altogether, 79 cesarean scar patients were involved in this study, with the average age of 28.1 years, the average scar age and length of 26.5 (range, 24-30) months and 8.5 (range, 7-11) cm, respectively. Significant improvements were observed in VSS (t = 16.75, P < .05), UNC4P (t = 15.63, P < .05), and Antera3D score (color:t = 13.19, P < .05; texture: t = 13.12, P < .05; melanin: t = 3.89, P < .05; hemoglobin: t = 2.28, P < .05). No long-term complication was reported during the follow-up visits. CONCLUSIONS Fractional CO2 laser therapy is an effective treatment for cesarean scar. The multiple evaluation methods, including the combined application of VSS, UNC4P, and Antera3D score, can be potentially used for guiding treatment protocols and evaluating efficacy. Meanwhile, rhGM-CSF hydrogel provides another choice for laser wound management.
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Affiliation(s)
- Nan Zhang
- Department of Burn Surgery, Jilin University First Hospital, Changchun, China.,Department of Surgery, Jilin University Second Hospital, Changchun, China
| | - Xin Yu
- Department of Pediatrics, Jilin University First Hospital, Changchun, China
| | - Jingchun Zhao
- Department of Burn Surgery, Jilin University First Hospital, Changchun, China
| | - Jiaao Yu
- Department of Burn Surgery, Jilin University First Hospital, Changchun, China
| | - Kai Shi
- Department of Burn Surgery, Jilin University First Hospital, Changchun, China
| | - Tongjun Liu
- Department of Surgery, Jilin University Second Hospital, Changchun, China
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23
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Legemate CM, Ooms PJ, Trommel N, Goei H, Lucas Y, Middelkoop E, Baar ME, Vlies CH. Course of scar quality of donor sites following split skin graft harvesting: Comparison between patients and observers. Wound Repair Regen 2020; 28:696-703. [DOI: 10.1111/wrr.12840] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/28/2020] [Accepted: 06/01/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Catherine M. Legemate
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences Amsterdam UMC, Vrije Univeristeit Amsterdam Amsterdam the Netherlands
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
| | | | - Nicole Trommel
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
| | - Harold Goei
- Department of Surgery, Amsterdam Movement Sciences Amsterdam UMC, Vrije Univeristeit Amsterdam Amsterdam the Netherlands
| | - Ymke Lucas
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
| | - Esther Middelkoop
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam Movement Sciences Amsterdam UMC, Vrije Univeristeit Amsterdam Amsterdam the Netherlands
- Association of Dutch Burn Centres, Red Cross Hospital, Beverwijk the Netherlands
| | - Margriet E. Baar
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
- Department of Public Health, Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
| | - Cornelis H. Vlies
- Maasstad Hospital, Burn Center Rotterdam the Netherlands
- Department of Public Health, Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
- Trauma Research Unit, Department of Surgery, Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
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Baumann ME, DeBruler DM, Blackstone BN, Coffey RA, Boyce ST, Supp DM, Bailey JK, Powell HM. Direct comparison of reproducibility and reliability in quantitative assessments of burn scar properties. Burns 2020; 47:466-478. [PMID: 32839037 DOI: 10.1016/j.burns.2020.07.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/03/2020] [Accepted: 07/22/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Determining the efficacy of anti-scar technologies can be difficult as qualitative, subjective assessments are often utilized instead of systematic, objective measures. Perceptions regarding the reliability of instruments for quantitative measurements along with their high cost and increased data collection time may discourage their use, leading to use of scar scales which are relatively quick and low-cost. To directly evaluate the reliability of instruments for quantitative measurements of scar properties, instruments and two qualitative scales were compared by assessing a variety of cutaneous scars. METHODS Scar height and surface texture were evaluated using a 3D scanner and a mold/cast technique. Scar color was evaluated by using a spectroscopy-based tool, the Mexameter®, and digital photography with image analysis. Scar biomechanics were evaluated using the BTC-2000™, Dermal Torque Meter (DTM®), and ballistometer®. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) were used to qualitatively evaluate the same scar properties. Intraclass correlation coefficients (ICC) were used to determine inter- and intra-user reliability (poor, moderate, good, excellent) with all instruments and the kappa reliability statistic was used to asses inter-user reliability (poor, fair, moderate, good, very good) for VSS and POSAS. Time for measurement collection and after collection analysis was also recorded. RESULTS The Mexameter® was the most reliable method for evaluating erythema and pigmentation compared to digital photography and image processing, POSAS and VSS. Digital photography and analysis was more reliable than POSAS and VSS. Assessment of scar height was significantly more reliable when using a 3D scanner versus VSS and POSAS. The 3D scanner and mold-cast techniques also offered an additional benefit of providing an absolute value of scar height relative to the surrounding tissue. Intra-user reliability for all mechanical tests was moderate to good. Inter-user reliability was greater when using the BTC-2000™ and ballistometer® versus the DTM®. All quantitative measurements took less than 90 s for collection, with the exception of the mold/cast technique. CONCLUSION Non-invasive instruments allow scar properties to be quantitatively assessed with high sensitivity and as a function of time and/or treatment without the need for biopsy collection. Overall, the reliability of scar assessments was significantly improved when quantitative instruments were utilized versus scar scales. Quantitative assessment of color and biomechanics were swift, requiring less than 90 s per measurement while assessments of texture and height required additional analysis time after collection. With proper training of clinical staff and well-defined protocols for measurement collection, reliable, quantitative assessments of scar properties can be collected with little disruption to the clinical workflow.
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Affiliation(s)
- Molly E Baumann
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States
| | - Danielle M DeBruler
- Department of Materials Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Britani N Blackstone
- Department of Materials Science and Engineering, The Ohio State University, Columbus, OH, United States
| | - Rebecca A Coffey
- Department of Surgery and Division of Critical Care, Trauma and Burns, The Ohio State University, Columbus, OH, United States
| | - Steven T Boyce
- Research Department, Shriners Hospitals for Children, Cincinnati, OH, United States; Department of Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - Dorothy M Supp
- Research Department, Shriners Hospitals for Children, Cincinnati, OH, United States; Department of Surgery, University of Cincinnati, Cincinnati, OH, United States
| | - J Kevin Bailey
- Department of Surgery and Division of Critical Care, Trauma and Burns, The Ohio State University, Columbus, OH, United States; Department of Surgery, Wake Forest University College of Medicine, Winston-Salem, NC, United States
| | - Heather M Powell
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, United States; Department of Materials Science and Engineering, The Ohio State University, Columbus, OH, United States; Research Department, Shriners Hospitals for Children, Cincinnati, OH, United States.
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Balzarro M, Rubilotta E, Trabacchin N, Soldano A, Cerrato C, Migliorini F, Mancini V, Pastore AL, Carbone A, Cormio L, Carrieri G, Antonelli A. Early and Late Efficacy on Wound Healing of Silver Nanoparticle Gel in Males after Circumcision. J Clin Med 2020; 9:jcm9061822. [PMID: 32545258 PMCID: PMC7356923 DOI: 10.3390/jcm9061822] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 05/28/2020] [Accepted: 06/08/2020] [Indexed: 11/16/2022] Open
Abstract
We evaluate the early and late safety and efficacy of silver nanoparticle (AgNPs) in wound healing after circumcision. This multicenter prospective comparative non-randomized observational study compares wound dressing with AgNPs (group A) vs. gentamicin cream (group B). Follow-up included objective evaluation at 10 and 30 days by the Southampton Scoring System (SSS) and Stony Brook Scar Evaluation Scale (SBSES). We enrolled 392 males: 194 in group A, and 198 in group B. At 10 days follow-up, in group A, the SSS scale was grade 1 in 49.5% and grade 2 in the remaining; meanwhile, in group B, grade 1 was in 58%, grade 2 in 34.3%, and grade 4 in 7.6%. At 30 days follow-up, grade 1 healing was 97.4% and 98.4% in group A and B, respectively. At 10 days follow-up, the mean SBSES score was 3.58 and 3.69 in group A and B, respectively; while at 30 days follow-up, 4.81 and 4.76 in group A and B, respectively. Only in group B did 7.6% of males have antibiotic therapy due to pus discharge. No patients needed surgical wound revision. AgNPs led to a late but safer healing, they were non-inferior to the antibiotic cream wound dressing efficacy, and they avoided pus discharge and the need for oral antibiotics due to their polymer material.
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Affiliation(s)
- Matteo Balzarro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy; (E.R.); (N.T.); (A.S.); (C.C.); (F.M.); (A.A.)
- Correspondence:
| | - Emanuele Rubilotta
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy; (E.R.); (N.T.); (A.S.); (C.C.); (F.M.); (A.A.)
| | - Nicolò Trabacchin
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy; (E.R.); (N.T.); (A.S.); (C.C.); (F.M.); (A.A.)
| | - Antonio Soldano
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy; (E.R.); (N.T.); (A.S.); (C.C.); (F.M.); (A.A.)
| | - Clara Cerrato
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy; (E.R.); (N.T.); (A.S.); (C.C.); (F.M.); (A.A.)
| | - Filippo Migliorini
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy; (E.R.); (N.T.); (A.S.); (C.C.); (F.M.); (A.A.)
| | - Vito Mancini
- Department of Urology and Renal Transplantation, University of Foggia, 71122 Foggia, Italy; (V.M.); (L.C.); (G.C.)
| | - Antonio Luigi Pastore
- Department of Medic-Surgical Sciences and Biotechnologies Urology Unit, Sapienza University of Rome, 00185 Latina, Italy; (A.L.P.); (A.C.)
| | - Antonio Carbone
- Department of Medic-Surgical Sciences and Biotechnologies Urology Unit, Sapienza University of Rome, 00185 Latina, Italy; (A.L.P.); (A.C.)
| | - Luigi Cormio
- Department of Urology and Renal Transplantation, University of Foggia, 71122 Foggia, Italy; (V.M.); (L.C.); (G.C.)
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University of Foggia, 71122 Foggia, Italy; (V.M.); (L.C.); (G.C.)
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata di Verona, 37126 Verona, Italy; (E.R.); (N.T.); (A.S.); (C.C.); (F.M.); (A.A.)
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Felix C, Russell JO, Juman S, Medford S. Cervical scar satisfaction post conventional thyroidectomy. Gland Surg 2020; 8:723-728. [PMID: 32042680 DOI: 10.21037/gs.2019.11.17] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Thyroidectomy is a commonly performed procedure with large centres performing thousands of thyroid surgeries per year. The traditional Kocher mid-cervical incision has been the standard approach to thyroidectomy since the late 1870s with predictable results. The introduction of minimally invasive and remote access techniques seeks to reduce the morbidity of a mid-cervical scar incision. Methods Ninety-five [95] patients who underwent this approach over the thirty [30] months period from January 2015 to July 2017 were administered the validated Patient Scar Assessment Questionnaire and the collected data analysed. Results Forty-eight [48] patients, (50.5%) met inclusion criteria and provided responses with a mean time since surgery of 18.9 months. There is a high level of satisfaction with 91.7% of patients in the study having scores consistent with scar satisfaction after conventional thyroidectomy. While patients were satisfied with the appearance of their scars, a majority of patients (n=28, 58.3%) were at least slightly conscious of their incisions, with more than 10% of patients (n=5) reporting significant levels of self-consciousness. Patients of Mixed race were found to have slightly elevated scores on PSAQ compared with IndoTrinidadian and AfroTrinidadian races (P=0.002 and P=0.006). Conclusions Most patients were satisfied with their scar results in the years after thyroidectomy. Despite the high level of satisfaction, a majority of patients are self-conscious about the presence of a mid-cervical incision. Further research is needed to elucidate causes and the effects of this finding.
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Affiliation(s)
- Cherian Felix
- The University of the West Indies, Department of Otolaryngology, Head and Neck Surgery, St. Augustine, Trinidad
| | - Jonathon O Russell
- Johns Hopkins Medicine, Division of Head and Neck and Endocrine Surgery, Department of Otolaryngology, Head and Neck Surgery, Baltimore, MD, USA
| | - Solaiman Juman
- The University of the West Indies, Department of Otolaryngology, Head and Neck Surgery, St. Augustine, Trinidad
| | - Steve Medford
- Department of Otolaryngology, Head and Neck Surgery, San Fernando General Hospital, San Fernando, Trinidad
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Roy S, Buckingham ED. Comparison of W-Plasty and Straight-Line Trichophytic Closure on Aesthetic Outcomes of Occipital Hairline Scars in Rhytidectomy. JAMA FACIAL PLAST SU 2019; 20:14-18. [PMID: 28837737 DOI: 10.1001/jamafacial.2017.0644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Incision placement and design in rhytidectomy is critical for patient satisfaction. Objective To evaluate the aesthetic outcome of W-plasty vs traditional straight-line (SL) trichophytic closure techniques on posterior occipital hairline scars in rhytidectomy. Design, Setting, and Participants A retrospective cohort study was conducted at the Buckingham Center for Facial Plastic Surgery. Clinical history and operative reports were reviewed for 46 patients who underwent rhytidectomy (23 using W-plasty and 23 using SL technique) between June 1, 2014 and August 31, 2015. Blinded photographic analysis of 1-year postoperative photographs was performed. Interventions The posterior occipital hairline incision was primarily closed with either a W-plasty or SL trichophytic technique. Main Outcomes and Measures Standard photographs of the posterior occipital incision site obtained after the 1-year postoperative mark were reviewed and scored in a blinded fashion by 3 nonphysician medical staff members using a modified Manchester Scar Scale (MSS: from 0 [best possible outcome] to 24 [worst possible outcome]). Interrater reliability was assessed via Cronbach α testing. Results There were 23 patients in each group. The W-plasty and SL groups were similar in terms of age (mean [SD] age, 59.6 [6.3] years and 64.1 [7.3] years, respectively), sex (21 [91%] and 21 [91%] women, respectively), race-ethnicity, and absence of risk factors (smoking and diabetes) predisposing to poor wound healing (0 and 0 smoking/diabetes, respectively). Mean (SD) follow-up times for the W-plasty and SL groups were 388 (38.8) and 475 (100.1) days, respectively. No statistical difference was demonstrated in the mean aggregate MSS scores from all evaluators between the W-plasty group and the SL group (reviewer 1: 5.69 vs 5.86, P = .60; reviewer 2: 10.09 vs 9.56, P = .65; and reviewer 3: 5.30 vs 6.17, P = .08). Overall interrater reliability for the MSS scores was 0.56. Conclusion and Relevance Primary W-plasty and SL trichophytic closures in the posterior occipital hairline appear to yield highly acceptable and similar cosmetic outcomes under objective blinded evaluation. These techniques can be used with success to help minimize conspicuous scarring after rhytidectomy. Level of Evidence 3.
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Affiliation(s)
- Sudeep Roy
- Buckingham Center for Facial Plastic Surgery, Austin, Texas
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Deng H, Li-Tsang CW. Measurement of vascularity in the scar: A systematic review. Burns 2019; 45:1253-1265. [DOI: 10.1016/j.burns.2018.10.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 06/28/2018] [Accepted: 10/31/2018] [Indexed: 01/24/2023]
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Kim SH, Lee SJ, Lee JW, Jeong HS, Suh IS. Clinical trial to evaluate the efficacy of botulinum toxin type A injection for reducing scars in patients with forehead laceration: A double-blinded, randomized controlled study. Medicine (Baltimore) 2019; 98:e16952. [PMID: 31441893 PMCID: PMC6716761 DOI: 10.1097/md.0000000000016952] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Botulinum toxin type A (BoNTA) is known to prevent fibroblast proliferation and expression of transforming growth factor beta 1 (TGF-β1). It also induces temporary muscle paralysis and decreases tension vectors. Fibroblasts induce scar contracture and hypertrophy by producing collagen fibers in wound healing processes. The aim of this study is to identify the effect of BoNTA on the scar formation. METHODS Forty-five patients with forehead laceration were enrolled in this study and randomized into 2 groups with or without injection of BoNTA. When the patients presented to the clinic to remove the stitches, BoNTA was injected to the BoNTA group with 24 patients and saline was injected to the control group with 21 patients. The BoNTA was injected on dermal layer with 5 IU/cm. After that, follow-up was done in 1, 3, and 6 months. The scars were analyzed with the patient and observer scar assessment scale, Stony Brook scar evaluation scales (SBSESs), and visual analog scale (VAS) and analyzed with independent T-test, along with clinical photographs, cutometer, and biopsies. RESULTS In all scar scales, the scores changed into favorable direction in both groups and the changes were larger in BoNTA group compared with the control group. On SBSES and VAS, better improvements on BoNTA group showed statistical significance. Skin biopsy showed less collagen deposition on dermal layer in BoNTA group. CONCLUSION Improvement of aesthetic, functional, and emotional aspect of the scar formation in the groups treated with BoNTA was illustrated. The application of BoNTA may be expanded to prevent hypertrophic scar after trauma, burns, or operations.
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Aesthetic Comparison of Two Different Types of Web-Space Reconstruction for Finger Syndactyly. Plast Reconstr Surg 2019; 142:963-971. [PMID: 29994847 DOI: 10.1097/prs.0000000000004798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Syndactyly reconstruction incorporates techniques of applying skin grafts or dorsal advancement flaps without the use of skin grafts. Comparative outcome studies of these two approaches are lacking. The authors' study compares the long-term aesthetic outcomes of these two flap techniques. METHODS Forty-five patients were included in the authors' study. The methods of reconstruction used were a dorsally based rectangular flap with skin graft from the groin and a dorsal pentagonal advancement flap without skin grafting. Eighteen independent raters completed a visual analogue scale and a unique classification scale to subjectively assess aesthetic outcomes. The authors used univariate analyses to determine which variables significantly influenced the outcome score. The authors then used multivariable regression models to compare the two flap types. RESULTS Dorsally based rectangular flaps with skin graft had statistically significantly better visual analogue scale scores and greater odds of receiving an "excellent" rating compared with dorsal pentagonal advancement flaps. CONCLUSIONS Despite the use of skin grafting, with its associated donor-site morbidity, dorsal rectangular flaps may offer better overall aesthetic outcomes for patients. Future comparative studies should incorporate functional and patient-reported outcomes to better assess the optimal reconstruction type. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Abstract
BACKGROUND Barbed sutures have become increasingly popular in the field of aesthetic plastic surgery, particularly in body contouring and breast operations, in which the use of barbed sutures may offer both time and cost savings. Scar aesthetics is an important outcome for both surgeons and patients in these procedures; however, there is a paucity of studies assessing the aesthetic outcome of barbed sutures with regard to scarring. METHODS A systematic review of the PubMed, EMBASE, and Cochrane databases was performed from the date of their inception through July of 2017 using the search terms "barbed suture" combined with "scar" or "wound." Studies were included if they were prospective, evaluator-blind, randomized, controlled trials; closed the dermal layer of incisions using barbed sutures; and included an evaluator-blind aesthetic assessment of scarring. RESULTS Six prospective, randomized, controlled trials met inclusion criteria. The cosmetic result of scars in 926 patients was evaluated after an average of 8.1 months. Five of the six controlled trials found the aesthetic results of wounds closed with barbed sutures to be equivalent to those closed with traditional sutures, and one study showed significantly superior aesthetic results with barbed sutures. Use of barbed sutures resulted in shorter operating times in four of the five studies that timed incision closure. Similar complication rates were observed in all evaluated studies. CONCLUSION Based on this systematic review, the majority of studies concluded that there were no differences in scarring aesthetics when dermal layers were closed using barbed sutures compared with traditional suturing techniques.
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Frew Q, Rennekampff HO, Dziewulski P, Moiemen N, Zahn T, Hartmann B. Betulin wound gel accelerated healing of superficial partial thickness burns: Results of a randomized, intra-individually controlled, phase III trial with 12-months follow-up. Burns 2018; 45:876-890. [PMID: 30559054 DOI: 10.1016/j.burns.2018.10.019] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 09/23/2018] [Accepted: 10/25/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Acceleration of wound healing promises advantages for patients and caregivers in reducing the burden of disease, avoiding complications such as wound infections, and improving the long-term outcome. However, medicines that can accelerate wound healing are lacking. The objective of this open, blindly evaluated, randomized, multicenter phase III study was to compare intra-individually the efficacy and tolerability of Oleogel-S10 with fatty gauze dressing versus Octenilin® wound gel with fatty gauze dressing in accelerating the healing of superficial partial thickness burn wounds. METHODS Acute superficial partial thickness burn wounds in adults caused by fire, heat burn or scalding were divided into 2 halves and randomly assigned to treatment with Oleogel-S10 or Octenilin® wound gel. Photos for observer-blinded analysis of wound healing were taken at each wound dressing change. Percentages of reepithelialization were assessed at defined intervals. Efficacy and tolerability were evaluated based on a 5-point Likert scale. RESULTS Of 61 patients that were enrolled, 57 received the allocated intervention and 48 completed treatment. The percentage of patients with earlier wound healing was significantly higher for Oleogel-S10 (85.7%, n=30) compared to Octenilin® wound gel (14.3%, n=5, p<0.0001). The mean intra-individual difference in time to wound closure was -1.0 day in favour of Oleogel-S10 (-1.4, -0.6; 95% CI, p<0.0001). Most investigators (87.0%) and patients (84.8%) evaluated the efficacy of Oleogel-S10 to be 'better' or 'much better' than that of Octenilin® wound gel. Long-term outcome 3 months and 12 months post injury was improved in some patients. CONCLUSIONS Oleogel-S10 (Episalvan) significantly accelerated the healing of superficial partial thickness burn wounds. It was safe and well tolerated.
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Affiliation(s)
- Quentin Frew
- St. Andrew's Centre for Plastic Surgery and Burns, Mid Essex Hospitals Trust, Broomfield Hospital, Chelmsford, UK
| | | | - Peter Dziewulski
- St. Andrew's Centre for Plastic Surgery and Burns, Mid Essex Hospitals Trust, Broomfield Hospital, Chelmsford, UK
| | - Naiem Moiemen
- Burns and Plastics, University Hospitals Birmingham NHS Foundation Trust Queen Elisabeth Hospital, Birmingham, UK
| | | | - Bernd Hartmann
- Burn Center with Plastic Surgery, Unfallkrankenhaus Berlin, Germany.
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Mather M, Hamilton D, Robalino S, Rousseau N. Going where other methods cannot: A systematic mapping review of 25 years of qualitative research in Otolaryngology. Clin Otolaryngol 2018; 43:1443-1453. [DOI: 10.1111/coa.13200] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 05/18/2018] [Accepted: 06/18/2018] [Indexed: 11/27/2022]
Affiliation(s)
- M.W. Mather
- Institute of Cellular Medicine; Newcastle University; Newcastle-upon-Tyne UK
- Freeman Hospital; Newcastle-upon-Tyne UK
| | - D. Hamilton
- Freeman Hospital; Newcastle-upon-Tyne UK
- Institute of Health & Society; Newcastle University; Newcastle-upon-Tyne UK
| | - S. Robalino
- Institute of Health & Society; Newcastle University; Newcastle-upon-Tyne UK
- Kaiser Permanente Research Affiliates Evidence-based Practice Center; Center for Health Research; Portland Oregon
| | - N. Rousseau
- Institute of Health & Society; Newcastle University; Newcastle-upon-Tyne UK
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Tanaydin V, Beugels J, Andriessen A, Sawor JH, van der Hulst RRWJ. Randomized Controlled Study Comparing Disposable Negative-Pressure Wound Therapy with Standard Care in Bilateral Breast Reduction Mammoplasty Evaluating Surgical Site Complications and Scar Quality. Aesthetic Plast Surg 2018; 42:927-935. [PMID: 29442143 PMCID: PMC6097780 DOI: 10.1007/s00266-018-1095-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/25/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Negative pressure wound therapy (NPWT) for postsurgical incision treatment has demonstrated benefits. A prospective randomized study was developed including 32 patients who underwent bilateral breast reduction mammoplasty. Patients served as their own control and received NPWT to one breast and fixation strips to the other breast. METHODS The primary outcome was the number of wound healing complications within 21 days when comparing NPWT treatment with fixation strips. The secondary outcome was aesthetic appearance and quality of scarring using questionnaires [visual analogue scale (VAS) and Patient and Observer Scar Assessment Scale (POSAS)] scored at day 42-, 90-, 180- and 365-day follow-up using additional scar measurement modalities, such as viscoelasticity. RESULTS For the 32 included patients, the number of wound complications was significantly lower (p < 0.004) for the NPWT treated sites compared to fixation strips. POSAS and VAS scores at 42 and 90 days revealed a significantly better quality of scarring in the NPWT treatment breasts than in fixation strips. At 180-day follow-up, there was a significant improvement in total VAS scores, as well as a comparable improvement in POSAS scores. No consistent significant improvement in scar quality was demonstrated with the assays that were used. CONCLUSIONS Our study showed less complications and a significant improvement in quality of scarring in favor of the NPWT-treated sites. The results indicate NPWT to be an attractive option for these patients. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- V Tanaydin
- Maastricht University Medical Center, Maastricht, The Netherlands.
| | - J Beugels
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - A Andriessen
- Andriessen Consultants, Malden, The Netherlands
- UMC St Radboud Nijmegen, Nijmegen, The Netherlands
| | - J H Sawor
- Maastricht University Medical Center, Maastricht, The Netherlands
- VieCuri Medical Center, Venlo, The Netherlands
| | - R R W J van der Hulst
- Maastricht University Medical Center, Maastricht, The Netherlands
- VieCuri Medical Center, Venlo, The Netherlands
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Cultural adaptation and validation of Patient and Observer Scar Assessment Scale for Turkish use. Burns 2018; 44:1352-1356. [PMID: 29580666 DOI: 10.1016/j.burns.2018.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 02/16/2018] [Accepted: 02/22/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND This study aimed to evaluate cross-cultural adaptation, validation, and reliability of Patient and Observer Scar Assessment Scale (POSAS) for its Turkish use. METHOD This study included 50 burn patients with hypertrophic scars who were aged 18-65 years (mean, 37.5±1.4years) and were admitted to Wound and Burn Treatment Center from February 2014 to April 2014. With regard to the cultural adaptation of POSAS from English to Turkish, the scale was translated by two people who worked in different health fields. POSAS was administered to the patients with a 1-week interval to evaluate the validity and reliability of the scale. Internal consistency of the scale was tested using the Cronbach alphamethod. RESULTS The Cronbach alpha value for the observer measurements was found to be 0.93 (excellent), and that for patient measurements was found to be 0.77 (good). Accordingly, the internal consistency of the scale was established. CONCLUSION The Turkish version of POSAS is a valid, reliable and culturally appropriate survey for evaluating hypertrophic scars. We believe that the Turkish version of POSAS will be an important clinical/scientific tool in the field of burn physiotherapy in Turkey, which will lead to new researches in this field.
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Clemons TD, Bradshaw M, Toshniwal P, Chaudhari N, Stevenson AW, Lynch J, Fear M, Wood FM, Iyer KS. Coherency image analysis to quantify collagen architecture: implications in scar assessment. RSC Adv 2018; 8:9661-9669. [PMID: 35540841 PMCID: PMC9078703 DOI: 10.1039/c7ra12693j] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 02/27/2018] [Indexed: 11/21/2022] Open
Abstract
A novel technique for the fast and robust quantification of collagen architecture following scarring.
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Affiliation(s)
- T. D. Clemons
- School of Molecular Sciences M313
- The University of Western Australia
- Crawley
- Australia
| | - M. Bradshaw
- School of Molecular Sciences M313
- The University of Western Australia
- Crawley
- Australia
| | - P. Toshniwal
- School of Molecular Sciences M313
- The University of Western Australia
- Crawley
- Australia
| | - N. Chaudhari
- School of Molecular Sciences M313
- The University of Western Australia
- Crawley
- Australia
| | - A. W. Stevenson
- Fiona Wood Foundation and Burn Injury Research Unit
- The University of Western Australia, M318
- Crawley
- Australia
| | - J. Lynch
- Fiona Wood Foundation and Burn Injury Research Unit
- The University of Western Australia, M318
- Crawley
- Australia
- Royal College of Surgeon's of Ireland
| | - M. W. Fear
- Fiona Wood Foundation and Burn Injury Research Unit
- The University of Western Australia, M318
- Crawley
- Australia
| | - F. M. Wood
- Fiona Wood Foundation and Burn Injury Research Unit
- The University of Western Australia, M318
- Crawley
- Australia
| | - K. Swaminathan Iyer
- School of Molecular Sciences M313
- The University of Western Australia
- Crawley
- Australia
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Busche MN, Thraen ACJ, Gohritz A, Rennekampff HO, Vogt PM. Burn Scar Evaluation Using the Cutometer® MPA 580 in Comparison to “Patient and Observer Scar Assessment Scale” and “Vancouver Scar Scale”. J Burn Care Res 2017; 39:516-526. [DOI: 10.1093/jbcr/irx009] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
- Marc Nicolai Busche
- Department of Plastic and Aesthetic Surgery, Burn Surgery, Klinikum Leverkusen, Germany
| | | | - Andreas Gohritz
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Switzerl
| | | | - Peter Maria Vogt
- Department of Plastic, Aesthetic, Hand, and Reconstructive Surgery, Hannover Medical School, Germany
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Delgove A, Weigert R, Casoli V. Evaluation of donor site morbidity after medial triceps brachii free flap for lower limb reconstruction. Arch Orthop Trauma Surg 2017; 137:1659-1666. [PMID: 28887648 DOI: 10.1007/s00402-017-2780-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The medial head of the triceps brachii muscle (MTB)-free flap is an attractive solution to cover small-to-medium defects of the lower limb. This muscular head has no well-identified function, suggesting minimal impact of its removal on elbow mobility. The aim of this study was to evaluate the safety and reliability of the harvest procedure and the functional and cosmetic morbidity of this donor site. MATERIALS AND METHODS Twenty-four consecutive MTB-free flaps were performed for reconstructive surgery of the lower limb between 2011 and 2015. Patients and their records were retrospectively examined. Functional results were evaluated by assessing elbow extension strength using a dynamometer and with a QuickDASH questionnaire. Cosmetic results were assessed using the POSAS observer and patient scales. RESULTS Twenty-four patients were followed up postoperatively for an average of 33.9 [min 12-max 59] months. No major complication (in particular, no ulnar or radial nerve injury) occurred during harvest. No patient complained of elbow pain or reduction in strength. Elbow extension was complete in all patients and the mean strength was calculated at 89 [61.1-112.5] % of the opposite arm. The POSAS scale scored an average 8.6 [7-21] for the observer and 10 [7-26] for the patient. Cosmetic results using the POSAS scale were satisfactory in all patients. CONCLUSIONS Objective evaluation of patients who underwent an MTB-free flap for limb reconstruction shows no impact of the harvesting procedure on elbow extension. Patient satisfaction with the donor site was high. From this retrospective study, it appears that this surgery is safe, aesthetically acceptable, and has minimal impact on donor site elbow function.
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Affiliation(s)
- A Delgove
- Plastic Surgery and Burns Unit, University Hospital of Bordeaux, FX Michelet Center, Place Amelie Raba Leon, 33076, Bordeaux, France.
| | - R Weigert
- Plastic Surgery and Burns Unit, University Hospital of Bordeaux, FX Michelet Center, Place Amelie Raba Leon, 33076, Bordeaux, France
| | - V Casoli
- Plastic Surgery and Burns Unit, University Hospital of Bordeaux, FX Michelet Center, Place Amelie Raba Leon, 33076, Bordeaux, France
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Transumbilical multi-port laparoscopic pyeloplasty versus transumbilical single-site laparoscopic pyeloplasty for ureteropelvic junction obstruction in children: A retrospectively comparative study. J Pediatr Urol 2017. [PMID: 28630020 DOI: 10.1016/j.jpurol.2017.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Laparoscopic pyeloplasty has achieved good cosmetic and functional outcomes. Both transumbilical single-site and transumbilical multi-port approaches are currently being used. No comparison of transumbilical single-site laparoscopic pyeloplasty (TSLP) and transumbilical multi-port laparoscopic pyeloplasty (TMLP) has been reported in the literature. OBJECTIVES We present a retrospective comparison study to evaluate clinical outcomes of TSLP and TMLP for children with ureteropelvic junction obstruction (UPJO). STUDY DESIGN A retrospective study was carried out comparing TSLP and TMLP performed by a single surgeon between July 2012 and June 2014. The patient data of the two groups (90 in each group) were evaluated. All patients underwent urine analysis, ultrasonography, magnetic resonance urography, and diuretic renogram using 99Tc-diethylene triamine pentaacetic acid scan preoperative and postoperative follow-up. Data were analyzed using the SPSS 20.0 software package. RESULTS DISCUSSION: To our knowledge, our series is the first report in the literature that compares the outcomes of TSLP and TMLP in children. Our study suggested that there were no significant differences in start of oral feeding, drain removal, hospital stay, postoperative renal pelvic anteroposterior diameter and differential renal function at 6 months, postoperative complications, and success rate between the two groups. It demonstrated that TMLP is as effective and safe as TSLP. Although the cosmetic result of the TSLP group is satisfactory, TMLP requires three 0.5-cm ports around the umbilicus and does not change the shape of the umbilicus. Hence, the cosmetic result of the TMLP group is better than that of the TSLP group. TSLP involves some technical challenges. However, TMLP facilitates the procedure and renders the operation easier. Our findings confirmed that the operative time of TMLP group is shorter than that in TSLP group, and also showed that TMLP is relatively easy to perform compared with TSLP. CONCLUSION TMLP is a feasible and safe operation for pediatric UPJO. TMLP is shorter in operative time and has a better cosmetic result than TSLP. We propose TMLP as a more viable treatment option for pediatric UPJO.
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Wormald JCR, Rodrigues JN. Outcome measurement in plastic surgery. J Plast Reconstr Aesthet Surg 2017; 71:283-289. [PMID: 29233505 DOI: 10.1016/j.bjps.2017.11.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/11/2017] [Accepted: 11/09/2017] [Indexed: 01/14/2023]
Abstract
Outcome measurement in plastic surgery is often surgeon-centred, and clinician-derived. Greater emphasis is being placed on patient-reported outcomes (PROs), in which the patients' perspective is measured directly from them. Numerous patient-reported outcome measures (PROMs) have been developed in a range of fields, with a number of good quality PROMs in plastic surgery. They can be deployed to support diagnosis, disease severity determination, referral pathways, treatment decision-making, post-operative care and in determining cost-effectiveness. In order to understand the impact of disease and health interventions, appropriate PROMs are a logical choice in plastic surgery, where many conditions involve detriment of function or cosmesis. PROMS can be classified as disease-specific, domain-specific, dimension-specific, population-specific and generic. Choosing the correct outcome and measure can be nebulous. The two most important considerations are: is it suitable for the intended purpose? And how valid is it? Measurement that combines being patient-centred and aligning with clinicians' understanding is achievable, and can be studied scientifically. Rational design of new PROMs and considered choice of measures is critical in clinical practice and research. There are a number of tools that can be employed to assess the quality of PROMs that are outlined in this overview. Clinicians should consider the quality of measures both in their own practice and when critically appraising evidence. This overview of outcome measurement in plastic surgery provides a tool set enabling plastic surgeons to understand, implement and analyse outcome measures across clinical and academic practice.
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Affiliation(s)
- Justin C R Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK
| | - Jeremy N Rodrigues
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK.
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Scar satisfaction and body image in thyroidectomy patients: prospective study in a tertiary referral centre. The Journal of Laryngology & Otology 2017; 132:60-67. [DOI: 10.1017/s0022215117002158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground:This study is the first to evaluate scar satisfaction and body image in thyroidectomy patients using validated assessment tools.Methods:A total of 123 thyroidectomy patients were recruited over 8 months. Both patients and clinicians completed assessment tools that included: the Manchester Scar Scale (to measure scar perception), Dysmorphic Concern Questionnaire (to assess body image), Body Dysmorphic Concern Questionnaire (to screen for body dysmorphic disorder) and EQ-5D (to measure life quality). A separate image panel comprising experts and non-experts assessed 15 scar photographs. The results were analysed using non-parametric descriptive statistics.Results:Poor body image was associated with poor scar perception (ρ = 0.178,p= 0.05). Poor life quality correlated with poor scar perception (ρ = −0.292,p= 0.001). Scar length did not affect scar perception. Prevalence of body dysmorphic disorder among patients was found to be 8.94 per cent, which is higher than general population rates.Conclusion:Negative body image and life quality impact negatively upon scar perception.
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Liu X, Nelemans PJ, Frenk LD, Sengers H, Tuinder SM, Steijlen PM, Mosterd K, Kelleners-Smeets NW. Aesthetic outcome and complications of simple interrupted versus running subcuticular sutures in facial surgery: A randomized controlled trial. J Am Acad Dermatol 2017; 77:911-919. [DOI: 10.1016/j.jaad.2017.04.1128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 04/21/2017] [Accepted: 04/27/2017] [Indexed: 11/25/2022]
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Galukande M, Nakaggwa F, Busisa E, Sekavuga Bbaale D, Nagaddya T, Coutinho A. Long term post PrePex male circumcision outcomes in an urban population in Uganda: a cohort study. BMC Res Notes 2017; 10:522. [PMID: 29084559 PMCID: PMC5663120 DOI: 10.1186/s13104-017-2845-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/23/2017] [Indexed: 11/12/2022] Open
Abstract
Objective The objective of this study was to determine the long term adverse events profile at least a year after safe male circumcision. Results A cohort study, investigating patients who had undergone a non surgical circumcision procedure called Prepex. The study variables included scar appearance and sexual experiences. Clients were contacted for a phone interview and data were collected using a questionnaire, for some, a physical examination was done. We obtained ethical committee approval. Data from 304 out of a possible 625 men were analyzed, the rest was lost to follow up. The follow up period was 12–24 months. The mean age was 28 years. Up to 97% were satisfied with the penile scar appearance and the absence of pain. There was no keloids formation, though one developed a hypertrophic scar. Participants reported improved sexual intercourse enjoyment (post circumcision). Up to 17% resumed sexual intercourse before the 6-week long mandatory abstinence period. The average self-reported healing time was 4.7 weeks. There was a high level of scar appearance satisfaction, there was no keloids formation. There was a perceived improvement of sexual enjoyment after circumcision. Trial registration ClinicalTrials. Gov Identifier: NCT02245126 (Date of registration: September 19, 2014)
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Affiliation(s)
- M Galukande
- International Hospital Kampala, P.O. Box 8177, Kampala, Uganda.
| | - F Nakaggwa
- International Health Sciences University, Kampala, Uganda
| | - E Busisa
- International Hospital Kampala, P.O. Box 8177, Kampala, Uganda
| | - D Sekavuga Bbaale
- Infectious Disease Institute, Makerere University Kampala, Kampala, Uganda
| | - T Nagaddya
- International Health Sciences University, Kampala, Uganda
| | - A Coutinho
- Infectious Disease Institute, Makerere University Kampala, Kampala, Uganda
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Jones LL, Calvert M, Moiemen N, Deeks JJ, Bishop J, Kinghorn P, Mathers J. Outcomes important to burns patients during scar management and how they compare to the concepts captured in burn-specific patient reported outcome measures. Burns 2017; 43:1682-1692. [PMID: 29031889 DOI: 10.1016/j.burns.2017.09.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/21/2017] [Accepted: 09/15/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Pressure garment therapy (PGT) is an established treatment for the prevention and treatment of hypertrophic scarring; however, there is limited evidence for its effectiveness. Burn survivors often experience multiple issues many of which are not adequately captured in current PGT trial measures. To assess the effectiveness of PGT it is important to understand what outcomes matter to patients and to consider whether patient-reported outcome measures (PROMs) can be used to ascertain the effect of treatments on patients' health-related quality of life. This study aimed to (a) understand the priorities and perspectives of adult burns patients and the parents of burns patients who have experienced PGT via in-depth qualitative data, and (b) compare these with the concepts captured within burn-specific PROMs. METHODS We undertook 40 semi-structured interviews with adults and parents of paediatric and adolescent burns patients who had experienced PGT to explore their priorities and perspectives on scar management. Interviews were audio-recorded, transcribed and thematically analysed. The outcomes interpreted within the interview data were then mapped against the concepts captured within burn-specific PROMs currently in the literature. RESULTS Eight core outcome domains were identified as important to adult patients and parents: (1) scar characteristics and appearance, (2) movement and function, (3) scar sensation, (4) psychological distress, adjustments and a sense of normality, (5) body image and confidence, (6) engagement in activities, (7) impact on relationships, and (8) treatment burden. CONCLUSIONS The outcome domains presented reflect a complex holistic patient experience of scar management and treatments such as PGT. Some currently available PROMs do capture the concepts described here, although none assess psychological adjustments and attainment of a sense of normality following burn injury. The routine use of PROMs that represent patient experience and their relative contribution to trial outcome assessment versus clinical measures is now a matter for further research and debate.
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Affiliation(s)
- Laura L Jones
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Melanie Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Naiem Moiemen
- The Scar Free Foundation Centre for Burns Research, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Jonathan Bishop
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Philip Kinghorn
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham B15 2TT, UK.
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- Membership of the Pegasus Study Group is provided in the Acknowledgements
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Maruccia M, Fallico N, Cigna E, Ciudad P, Nicoli F, Trignano E, Nacchiero E, Giudice G, Ribuffo D, Chen H. Suprafascial versus traditional harvesting technique for free antero lateral thigh flap: A case‐control study to assess the best functional and aesthetic result in extremity reconstruction. Microsurgery 2017; 37:851-857. [DOI: 10.1002/micr.30248] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 08/01/2017] [Accepted: 09/05/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Michele Maruccia
- Department of Plastic and Reconstructive Surgery“Sapienza” University of Rome Italy
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung40447 Taiwan
- Department of Emergency and Organ Transplantation, Plastic and Reconstructive Surgery and Burns Unit“Aldo Moro” University of Bari Italy
| | - Nefer Fallico
- Department of Plastic and Reconstructive Surgery“Sapienza” University of Rome Italy
| | - Emanuele Cigna
- Department of Plastic and Reconstructive Surgery“Sapienza” University of Rome Italy
| | - Pedro Ciudad
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung40447 Taiwan
| | - Fabio Nicoli
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung40447 Taiwan
| | - Emilio Trignano
- Department of Plastic and Reconstructive SurgeryUniversity of SassariViale San Pietro 43b, Sassari 07100 Italy
| | - Eleonora Nacchiero
- Department of Emergency and Organ Transplantation, Plastic and Reconstructive Surgery and Burns Unit“Aldo Moro” University of Bari Italy
| | - Giuseppe Giudice
- Department of Emergency and Organ Transplantation, Plastic and Reconstructive Surgery and Burns Unit“Aldo Moro” University of Bari Italy
| | - Diego Ribuffo
- Department of Plastic and Reconstructive Surgery“Sapienza” University of Rome Italy
| | - Hung‐Chi Chen
- Department of Plastic and Reconstructive SurgeryChina Medical University HospitalTaichung40447 Taiwan
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Agabalyan NA, Su S, Sinha S, Gabriel V. Comparison between high-frequency ultrasonography and histological assessment reveals weak correlation for measurements of scar tissue thickness. Burns 2017; 43:531-538. [DOI: 10.1016/j.burns.2016.09.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 09/09/2016] [Accepted: 09/11/2016] [Indexed: 10/20/2022]
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Abstract
BACKGROUND The assessment of activity in keloids may be critical for defining their management. There is a lack of clinical scorings designed for the evaluation of keloids and biopsies may be contraindicated. OBJECTIVE To assess the sonographic activity of keloids in comparison with clinical scoring. MATERIALS AND METHODS A retrospective study of the clinical and color Doppler ultrasound (CDU) images of patients medically derived to CDU with the diagnosis of keloid was performed. Activity was evaluated clinically (modified Seattle Scar Scale) and CDU. Keloids were considered active when CDU detected vascularity within the lesion. Statistical analysis was performed (Wilcoxon-Mann-Whitney, Student t-test, and interobserver agreement). RESULTS Thirty-five patients with 42 keloids were evaluated. Color Doppler ultrasound provided the diameters, including depth, and vascularity. On CDU, 76% were active and 24% inactive. Clinically, Observer 1 found 55% and Observer 2 found 88% of active keloids. Interobserver agreement between clinical observers was moderate (k = 0.42). Subclinical fistulous tracts, involvement of the hypodermis, muscle, and calcifications were also found on CDU. CONCLUSION Color Doppler ultrasound can support the assessment of activity in keloids. Clinical evaluation alone can underestimate the activity in keloids. Relevant anatomical and subclinical features can be detected by CDU.
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Current and Emerging Options for Documenting Scars and Evaluating Therapeutic Progress. Dermatol Surg 2017; 43 Suppl 1:S25-S36. [DOI: 10.1097/dss.0000000000000698] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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50
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Kantor J. The SCAR (Scar Cosmesis Assessment and Rating) scale: development and validation of a new outcome measure for postoperative scar assessment. Br J Dermatol 2016; 175:1394-1396. [PMID: 27292082 DOI: 10.1111/bjd.14812] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Kantor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.,Florida Center for Dermatology, P.A., PO Box 3044, Saint Augustine, FL, 32085, U.S.A
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