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Zhang J, Tan K, Tang Y, Xiao X, Yang F, Chen J. SF method for removing small skin melanocytic nevus. Front Surg 2024; 11:1451660. [PMID: 39183777 PMCID: PMC11341494 DOI: 10.3389/fsurg.2024.1451660] [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: 06/19/2024] [Accepted: 07/25/2024] [Indexed: 08/27/2024] Open
Abstract
Background The most prevalent benign skin tumor is a melanocytic nevus, which can potentially turn cancerous and frequently impair a patient's appearance. Objective To find a standardized surgical procedure for the removal of tiny skin pigmented nevis and to look into the effectiveness of the SF technique for doing so. Methods A retrospective study was conducted on 723 patients with small-sized pigmented nevi between June 2022 and June 2023. The nevi were removed using the SF method, and the patients' overall health and the duration of the procedure were recorded. Three months following the procedure, the patients completed a questionnaire to assess the effectiveness, recurrence, complications, and degree of satisfaction with the surgical outcome. Results Compared with the normal method, SF method had shorter operation time, higher effective rate, no recurrence and other postoperative complications after 6 months, less scar hyperplasia, and good evaluation satisfaction of all patients. No patient was rated as average or poor. No recurrence. Conclusion The standardized surgical approaches for the small-size excision of melanocytic nevuses may be easily mastered by primary practitioners using the SF method, making it a valuable tool for practical use.
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Affiliation(s)
- Jianfei Zhang
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Kaixi Tan
- Department of Burns and Plastic Surgery, The Affiliated Nanhua Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Yujun Tang
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Xia Xiao
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Feng Yang
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Jie Chen
- Department of Burns and Plastic Surgery, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
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Park SH, Lee CM, Hur H, Min JS, Ryu SW, Son YG, Chae HD, Jeong O, Jung MR, Choi CI, Song KY, Lee HH, Kim HG, Jee YS, Hwang SH, Lee MS, Kim KH, Seo SH, Jeong IH, Son MW, Kim CH, Yoo MW, Oh SJ, Kim JG, Hwang SH, Choi SI, Yang KS, Huang H, Park S. Totally laparoscopic versus laparoscopy-assisted distal gastrectomy: the KLASS-07: a randomized controlled trial. Int J Surg 2024; 110:4810-4820. [PMID: 38716987 PMCID: PMC11325945 DOI: 10.1097/js9.0000000000001543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 04/15/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUNDS Strong evidence is lacking as no confirmatory randomized controlled trials (RCTs) have compared the efficacy of totally laparoscopic distal gastrectomy (TLDG) with laparoscopy-assisted distal gastrectomy (LADG). The authors performed an RCT to confirm if TLDG is different from LADG. METHODS The KLASS-07 trial is a multi-centre, open-label, parallel-group, phase III, RCT of 442 patients with clinical stage I gastric cancer. Patients were enroled from 21 cancer care centres in South Korea between January 2018 and September 2020 and randomized to undergo TLDG or LADG using blocked randomization with a 1:1 allocation ratio, stratified by the participating investigators. Patients were treated through R0 resections by TLDG or LADG as the full analysis set of the KLASS-07 trial. The primary endpoint was morbidity within postoperative day 30, and the secondary endpoint was quality of life (QoL) for 1 year. This trial is registered at ClinicalTrials.gov (NCT03393182). RESULTS Four hundred forty-two patients were randomized (222 to TLDG, 220 to LADG), and 422 patients were included in the pure analysis (213 and 209, respectively). The overall complication rate did not differ between the two groups (TLDG vs. LADG: 12.2% vs. 17.2%). However, TLDG provided less postoperative ileus and pulmonary complications than LADG (0.9% vs. 5.7%, P= 0.006; and 0.5% vs. 4.3%, P= 0.035, respectively). The QoL was better after TLDG than after LADG regarding emotional functioning at 6 months, pain at 3 months, anxiety at 3 and 6 months, and body image at 3 and 6 months (all P< 0.05). However, these QoL differences were resolved at 1 year. CONCLUSIONS The KLASS-07 trial confirmed that TLDG is not different from LADG in terms of postoperative complications but has the advantages to reduce ileus and pulmonary complications. TLDG can be a good option to offer better QoL in terms of pain, body image, emotion, and anxiety at 3-6 months.
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Affiliation(s)
- Shin-Hoo Park
- Department of Surgery, Korea University College of Medicine
- Division of Foregut Surgery, Korea University Anam Hospital
- Department of Surgery, Uijeongbu Eulji Medical Centre, Eulji University College of Medicine
| | - Chang-Min Lee
- Department of Surgery, Korea University College of Medicine
- Department of Surgery, Korea University Ansan Hospital, Ansan
| | - Hoon Hur
- Department of Surgery, Ajou University School of Medicine, Suwon
| | - Jae-Seok Min
- Department of Surgery, Korea University College of Medicine
- Department of Surgery, Uijeongbu Eulji Medical Centre, Eulji University College of Medicine
- Department of Surgery, Dongnam Institute of Radiological and Medical Sciences, Cancer Centre
| | - Seung Wan Ryu
- Department of Surgery, Keimyung University Dongsan Medical Centre
| | - Young-Gil Son
- Department of Surgery, Keimyung University Dongsan Medical Centre
| | - Hyun Dong Chae
- Department of Surgery, Catholic University of Daegu School of Medicine, Daegu
| | - Oh Jeong
- Department of Surgery, Chonnam National University Medical School, Jeollanam-do
| | - Mi Ran Jung
- Department of Surgery, Chonnam National University Medical School, Jeollanam-do
| | - Chang In Choi
- Department of Surgery, Pusan National University School of Medicine, Pusan
| | | | | | - Ho Goon Kim
- Department of Surgery, Chonnam National University Medical School, Gwangju
| | - Ye Seob Jee
- Department of Surgery, Dankook University College of Medicine, Cheonan
| | - Sun-Hwi Hwang
- Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan
| | - Moon-Soo Lee
- Department of Surgery, Eulji University Hospital, Daejeon
| | - Kwang Hee Kim
- Department of Surgery, Busan Paik Hospital, Inje University, Gimhae
| | - Sang Hyuk Seo
- Department of Surgery, Busan Paik Hospital, Inje University, Gimhae
| | - In Ho Jeong
- Department of Surgery, Jeju National University School of Medicine, Jeju
| | - Myoung Won Son
- Department of Surgery, Soonchunhyang University Hospital Cheonan, Cheonan, Korea
| | | | - Moon-Won Yoo
- Department of Surgery, Asan Medical Centre, University of Ulsan College of Medicine
| | - Sung Jin Oh
- Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan
| | - Jeong Goo Kim
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Seong Ho Hwang
- Department of Surgery, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul
| | - Sung Il Choi
- Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul
| | - Kyung Sook Yang
- Department of Biostatistics, Korea University College of Medicine
| | - Hua Huang
- Department of Gastric Surgery, Fudan University Shanghai Cancer Centre
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sungsoo Park
- Department of Surgery, Korea University College of Medicine
- Department of Surgery, Uijeongbu Eulji Medical Centre, Eulji University College of Medicine
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3
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Jiang Y, Qiao X, Li T, Wen J, Luo H. Comparison of ultrasonic diagnosis of cesarean scar defects at different timepoints following cesarean section. Quant Imaging Med Surg 2024; 14:5490-5498. [PMID: 39144005 PMCID: PMC11320551 DOI: 10.21037/qims-24-531] [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: 03/16/2024] [Accepted: 07/08/2024] [Indexed: 08/16/2024]
Abstract
Background Cesarean scar defect (CSD) is a potential complication following cesarean section (CS), which has significant clinical implications, and is usually clinically diagnosed by ultrasound. However, the optimal timing for ultrasound diagnosis of CSD after CS has not been well established. This study aimed to evaluate the appropriate time for the diagnosis of CSD after CS by ultrasonography. Methods The prospective study involved 120 women who delivered by elective CS with single birth and term birth from January 2021 to June 2022. Sample enrollment was consecutive in the study. Each woman underwent 3 ultrasound examinations for CSD diagnosis at 6 weeks, 6 months, and 12 months postpartum according to a modified Delphi method. The ultrasound indicators about the incision situation were recorded and statistically analyzed. Paired 4-fold table chi-square test was used to evaluate the consistency between the 3 diagnoses. The diagnostic sensitivity and specificity were calculated using a 4-cell table. According to whether the diagnosis was consistent to that at 6 or 12 months, the 120 cases at week 6 were separated into a consistent group and inconsistent group for statistical evaluation of the ultrasound indicators. Additionally, the menstrual duration of the included women was also recorded to analyze the correlation to ultrasound indicators of CSD at 6 months postpartum using the Person correlation coefficient. Results The included 120 women were divided into normal (3-7 days, n=52) and prolonged menstrual period (>7 days, n=68) groups. The 2 groups had no statistical differences in age, body mass index (BMI), gestational week of delivery, assisted reproduction rates, or postpartum complications. Among the 120 women, 100, 66, and 61 women were diagnosed as CSD at 6 weeks, 6 months, and 12 months postpartum, respectively. The results indicated that the diagnostic results of 6 weeks were inconsistent with those of 6 or 12 months postpartum, but the last 2 diagnostic results were consistent. The diagnostic sensitivity of 6 months was 100% and the specificity was 91.53% [95% confidence interval (CI): 85.84-95.26%]. Further, significant differences were found in depth of the defect, and the thickness (T) and ratio of residual muscle between the inconsistent group and the consistent group at 6 weeks. The patients could be considered self-recovered from CSD at 6 months when the defect depth was equal to or less than 4.04±0.82 mm at 6 weeks after CS. Additionally, in the CSD group at 6 months, the length (r=0.828, P<0.001), depth (r=0.784, P<0.001), width (r=0.787, P<0.001) of the defect, the T (r=0.831, P<0.001) and ratio of residual muscle (r=0.821, P<0.001) were strongly correlated with menstrual duration. Conclusions CSD evaluation at week 6 after CS may cause misdiagnosis or overdiagnosis. The diagnosis of CSD was suggested to be made following 6 months or longer postpartum.
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Affiliation(s)
- Yu Jiang
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xiaoyong Qiao
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- Department of Reproductive Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Tao Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
- Department of Obstetrics, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Juan Wen
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Hong Luo
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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4
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Sun Y, Zhou S, Zhou G. Safety and cosmesis of gasless endoscopic thyroidectomy: a retrospective study. Updates Surg 2024:10.1007/s13304-024-01938-9. [PMID: 39017820 DOI: 10.1007/s13304-024-01938-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 07/03/2024] [Indexed: 07/18/2024]
Abstract
Despite growing interest in gasless endoscopic unilateral thyroid lobectomy via the axillary approach, there are a lack of sufficient data on its safety and cosmetic outcomes. This retrospective study analysed the clinical outcomes and postoperative complications of 161 patients who underwent this surgery for thyroid cancer and nodules, with particular attention given to complications and patient satisfaction with cosmetic outcomes. All 161 patients (143 females, 18 males) successfully underwent the operation without conversion to open surgery. Temporary vocal cord paralysis occurred in five patients, with no other serious complications observed. The cosmetic outcomes were generally good, with no recurrences or tumour implantations observed during follow-up. For carefully selected patients, gasless endoscopic unilateral thyroid lobectomy via the axillary approach is not only safe but also provides excellent cosmetic results.
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Affiliation(s)
- Yizhou Sun
- Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, Yancheng, China
- The First People's Hospital of Yancheng, Yancheng, China
| | - Shengyi Zhou
- School of Medicine, Xiamen University, Xiamen, China
| | - Guangjun Zhou
- Yancheng First Hospital, Affiliated Hospital of Nanjing University Medical School, Yancheng, China.
- The First People's Hospital of Yancheng, Yancheng, China.
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5
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Nagle M, Conroy Broderick H, Vedel C, Destrade M, Fop M, Ní Annaidh A. A Gaussian process approach for rapid evaluation of skin tension. Acta Biomater 2024; 182:54-66. [PMID: 38750916 DOI: 10.1016/j.actbio.2024.05.025] [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: 02/15/2024] [Revised: 04/17/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
Skin tension plays a pivotal role in clinical settings, it affects scarring, wound healing and skin necrosis. Despite its importance, there is no widely accepted method for assessing in vivo skin tension or its natural pre-stretch. This study aims to utilise modern machine learning (ML) methods to develop a model that uses non-invasive measurements of surface wave speed to predict clinically useful skin properties such as stress and natural pre-stretch. A large dataset consisting of simulated wave propagation experiments was created using a simplified two-dimensional finite element (FE) model. Using this dataset, a sensitivity analysis was performed, highlighting the effect of the material parameters and material model on the Rayleigh and supersonic shear wave speeds. Then, a Gaussian process regression model was trained to solve the ill-posed inverse problem of predicting stress and pre-stretch of skin using measurements of surface wave speed. This model had good predictive performance (R2 = 0.9570) and it was possible to interpolate simplified parametric equations to calculate the stress and pre-stretch. To demonstrate that wave speed measurements could be obtained cheaply and easily, a simple experiment was devised to obtain wave speed measurements from synthetic skin at different values of pre-stretch. These experimental wave speeds agree well with the FE simulations, and a model trained solely on the FE data provided accurate predictions of synthetic skin stiffness. Both the simulated and experimental results provide further evidence that elastic wave measurements coupled with ML models are a viable non-invasive method to determine in vivo skin tension. STATEMENT OF SIGNIFICANCE: To prevent unfavourable patient outcomes from reconstructive surgery, it is necessary to determine relevant subject-specific skin properties. For example, during a skin graft, it is necessary to estimate the pre-stretch of the skin to account for shrinkage upon excision. Existing methods are invasive or rely on the experience of the clinician. Our work aims to present an innovative framework to non-invasively determine in vivo material properties using the speed of a surface wave travelling through the skin. Our findings have implications for the planning of surgical procedures and provides further motivation for the use of elastic wave measurements to determine in vivo material properties.
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Affiliation(s)
- Matt Nagle
- SFI Centre for Research Training in Foundations of Data Science, University College Dublin, Belfield, Dublin 4, Ireland; School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Hannah Conroy Broderick
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - Christelle Vedel
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland; EPF School of Engineering, Av. du Président Wilson, Cachan, France
| | - Michel Destrade
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland; School of Mathematical and Statistical Sciences, University of Galway, University Rd, Galway, Ireland
| | - Michael Fop
- School of Mathematics and Statistics, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Aisling Ní Annaidh
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland; Charles Institute of Dermatology, University College Dublin, Belfield, Dublin 4, Ireland.
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6
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Marangi GF, Gratteri M, Mirra C, Grosu FG, Rossi C, Cogliandro A, Segreto F, Versace D, Savani L, Persichetti P. Correlation Between General Satisfaction with the Breasts and Appearance of the Scars in Patients Undergoing Inverted T-Scar Reduction Mammaplasty: A Prospective PROMs-Based Study. Aesthetic Plast Surg 2024:10.1007/s00266-024-04162-3. [PMID: 38890160 DOI: 10.1007/s00266-024-04162-3] [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: 03/25/2024] [Accepted: 05/24/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Inverted-T scar reduction mammaplasty is still the most chosen technique for breast reduction even if scars are relevant. Sometimes, surgical scars may be esthetically unpleasant and may cause severe pain, tenderness, sleep disturbances, anxiety, and depression in these patients. This study aimed to assess any possible correlation between general satisfaction with the breast and appearance of the scars in patients who underwent inverted T-scar reduction mammaplasty. Secondary aim was to evaluate average variations of BREAST-Q and SCAR-Q at different postoperative times. MATERIALS AND METHODS 121 patients who underwent breast reduction using Pitanguy technique with inferiorly based dermo-adipose flap according to Ribeiro were enrolled in this prospective cross-sectional study. All patients filled the BREAST-Q REDUCTION and SCAR-Q questionnaires in paper form at 1, 6 and 12 months after surgery. BREAST-Q REDUCTION "Satisfaction with breast" scale was also administered preoperatively. Values were exported in Prism 9 for the statistical analysis. RESULTS Correlation index of Pearson between "Satisfaction with breast" and "Appearance of scar" was 0.09 at 1 month post-operative and - 0.07 and 0.21 at 6 and 12 months PO respectively. "Satisfaction with breast" mean value tends to rise over time. "Appearance of scar" mean value tends to decrease over time. CONCLUSION No correlation at different postoperative times between the general satisfaction with the breast and appearance of the scars was found. Data showed that satisfaction with the breast and appearance of the scars in patients who underwent inverted T-scar reduction mammaplasty tend to improve over time. LEVEL OF EVIDENCE IV 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)
- Giovanni Francesco Marangi
- From Department of Plastic, Reconstructive and Cosmetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, Italy
| | - Marco Gratteri
- From Department of Plastic, Reconstructive and Cosmetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, Italy
| | - Carlo Mirra
- From Department of Plastic, Reconstructive and Cosmetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, Italy.
| | - Felicia Geanina Grosu
- From Department of Plastic, Reconstructive and Cosmetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, Italy
| | - Caterina Rossi
- From Department of Plastic, Reconstructive and Cosmetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, Italy
| | - Annalisa Cogliandro
- From Department of Plastic, Reconstructive and Cosmetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, Italy
| | - Francesco Segreto
- From Department of Plastic, Reconstructive and Cosmetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, Italy
| | - Diletta Versace
- From Department of Plastic, Reconstructive and Cosmetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, Italy
| | - Luca Savani
- From Department of Plastic, Reconstructive and Cosmetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, Italy
| | - Paolo Persichetti
- From Department of Plastic, Reconstructive and Cosmetic Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo 200, Rome, Italy
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Patil IV, Sharma P, Salwan A, Khan KK, Pisulkar G. Successful Knee Replacement in a Patient With a History of Multiple Knee Surgeries: A Case Report. Cureus 2024; 16:e63355. [PMID: 39077289 PMCID: PMC11283917 DOI: 10.7759/cureus.63355] [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: 06/11/2024] [Accepted: 06/27/2024] [Indexed: 07/31/2024] Open
Abstract
This case report describes the successful total knee arthroplasty (TKA) in a 58-year-old female with a prior history of multiple knee surgeries. The patient had three prior surgical procedures. The first surgery of the patient was a partial knee replacement, the second surgery the patient underwent was an arthroscopic meniscectomy, and the third surgery was a high tibial osteotomy (HTO) that left her with an extensive amount of scar tissue and a change in physical structure. When scar tissue develops over or close to a joint, the surrounding tissues are pulled inward by this shrinking or contraction. A joint may experience restricted movement as a result of this tightness. Stretchy and excessively flexible joints are common in people with Ehlers-Danlos syndrome. This may become an issue if you need sutures for a wound because the skin is frequently not strong enough to support them. The patient already undergone three surgeries prior but still showed signs of severe pain, swelling, and stiffness in the knee which made the patient suffer more during rest position and also made it sometimes so difficult that it affected everyday tasks. In this situation when the patient consulted the doctors, the patient was suggested to undergo TKA. TKA is the method of orthopedic surgical technique that is most consistently successful and highly effective. Patients with end-stage degenerative knee osteoarthritis might expect reliable results from this surgery. The case demonstrates the preoperative planning, surgical methods, and postoperative care needed to successfully treat a complicated patient profile. Hospital protocols were followed, and the patient's surgery was done with proper care and hygiene.
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Affiliation(s)
- Ishiqua V Patil
- Hospital Administration, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Prerit Sharma
- Interventional Radiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ankur Salwan
- Orthopedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Khizar K Khan
- Orthopedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gajanan Pisulkar
- Orthopedic Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Zhang Y, Lei Z, Lin B, Lin Z, Dong Y, Ren P, Li X, Bian Y, Zhao C. Split-level folding, step-type tension-relieving suture technique, and the evaluation on scar minimization. J Cosmet Dermatol 2024; 23:2199-2208. [PMID: 38400620 DOI: 10.1111/jocd.16236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/21/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Prevailing tension-reducing suture methods have a spectrum of issues. This study presents a straightforward yet highly efficacious suture technique known as the Split-level Folding, Step-type Tension-relieving Suture technique, which could play a pivotal role in preempting incisional scarring. AIMS To introduce Split-level Folding, Step-type Tension-relieving Suture technique and assess its effect on scar minimization. METHODS A retrospective analysis of 64 patients who underwent treatment utilizing the proposed suturing methodology. Assessment parameters included the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS), scar width, complications, and all evaluated at 6- and 12-month postoperatively. RESULTS At 12-month follow-up, the POSAS and VSS scores in the normal suture group (32.58 ± 5.43, 3.58 ± 1.39) were considerably higher than the step-type suture group (29.75 ± 3.56, p = 0.0007; 2.78 ± 1.17, p = 0.0006). Moreover, the step-type suture group showcased a significantly narrower average incision scar width (1.62 ± 0.36) than the normal suture group (1.87 ± 0.42, p = 0.0004). This novel tension-relieving suture technique that effectively circumvents the occurrence of persistent localized eversion and other complications often associated with traditional tension-relieving sutures. CONCLUSIONS The Split-level Folding, Step-type Tension-relieving Suture technique emerges as a highly promising option for averting incisional scarring. This suture method works well for incisions on the chest, back, and extremities, resulting in significantly better long-term outcomes.
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Affiliation(s)
- Yuheng Zhang
- Department of Burn and Plastic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- Department of Orthopedics, Western Theater Air Force Hospital of PLA, Chengdu, China
| | - Zhanjun Lei
- Department of Burn and Plastic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Bin Lin
- Department of Burn and Plastic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Zhixiao Lin
- Department of Burn and Plastic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
- Department of Burn and Plastic Surgery, No. 923 Hospital of Joint Logistic Support Force of PLA, Nanning, China
| | - Yuchen Dong
- Department of Burn and Plastic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Pan Ren
- Department of Burn and Plastic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Xueyong Li
- Department of Burn and Plastic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Yongqian Bian
- Department of Burn and Plastic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
| | - Congying Zhao
- Department of Burn and Plastic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, China
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9
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Xu C, Zhang H, Yang C, Wang Y, Wang K, Wang R, Zhang W, Li C, Tian C, Han C, Li M, Liu X, Wang Y, Li Y, Zhang J, Li Y, Luo L, Shang Y, Zhang L, Chen Y, Shen K, Hu D. miR-125b-5p delivered by adipose-derived stem cell exosomes alleviates hypertrophic scarring by suppressing Smad2. BURNS & TRAUMA 2024; 12:tkad064. [PMID: 38765787 PMCID: PMC11102599 DOI: 10.1093/burnst/tkad064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 12/08/2023] [Accepted: 12/14/2023] [Indexed: 05/22/2024]
Abstract
Background Hypertrophic scarring is the most serious and unmet challenge following burn and trauma injury and often leads to pain, itching and even loss of function. However, the demand for ideal scar prevention and treatment is difficult to satisfy. We aimed to discover the effects and mechanisms of adipose-derived stem cell (ADSC) exosomes in hypertrophic scarring. Methods ADSC exosomes were isolated from the culture supernatant of ADSCs and identified by nanoparticle tracking analysis, transmission electron microscopy and western blotting. The effect of ADSC exosomes on wound healing and scar formation was detected by the wound model of BALB/c mice. We isolated myofibroblasts from hypertrophic scar tissue and detected the cell viability, proliferation and migration of myofibroblasts. In addition, collagen formation and fibrosis-related molecules were also detected. To further disclose the mechanism of ADSC exosomes on fibrosis in myofibroblasts, we detected the expression of Smad2 in hypertrophic scar tissue and normal skin and the regulatory mechanism of ADSC exosomes on Smad2. Injection of bleomycin was performed in male BALB/c mice to establish an in vivo fibrosis model while ADSC exosomes were administered to observe their protective effect. The tissue injury of mice was observed via hematoxylin and eosin and Masson staining and related testing. Results In this study, we found that ADSC exosomes could not only speed up wound healing and improve healing quality but also prevent scar formation. ADSC exosomes inhibited expression of fibrosis-related molecules such as α-smooth muscle actin, collagen I (COL1) and COL3 and inhibited the transdifferentiation of myofibroblasts. In addition, we verified that Smad2 is highly expressed in both hypertrophic scar tissue and hypertrophic fibroblasts, while ADSC exosomes downregulated the expression of Smad2 in hypertrophic fibroblasts. Further regulatory mechanism analysis revealed that microRNA-125b-5p (miR-125b-5p) is highly expressed in ADSC exosomes and binds to the 3' untranslated region of Smad2, thus inhibiting its expression. In vivo experiments also revealed that ADSC exosomes could alleviate bleomycin-induced skin fibrosis and downregulate the expression of Smad2. Conclusions We found that ADSC exosomes could alleviate hypertrophic scars via the suppression of Smad2 by the specific delivery of miR-125b-5p.
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Affiliation(s)
- Chaolei Xu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Hao Zhang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Chen Yang
- Department of Plastic Surgery, Burns and Cosmetology, The First Affiliated Hospital of Xi’an Medical University, Xi’an 710032, China
| | - Ying Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Kejia Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Rui Wang
- Department of Aerospace Medical Training, School of Aerospace Medicine, Fourth Military Medical University, Xi’an 710032, China
| | - Wei Zhang
- Department of Plastic Surgery, Burns and Cosmetology, The First Affiliated Hospital of Xi’an Medical University, Xi’an 710032, China
| | - Chao Li
- Department of Plastic Surgery, Burns and Cosmetology, The First Affiliated Hospital of Xi’an Medical University, Xi’an 710032, China
| | - Chenyang Tian
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Chao Han
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Mengyang Li
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Xu Liu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Yunwei Wang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Yan Li
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Jian Zhang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Yu Li
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Liang Luo
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Yage Shang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Lixia Zhang
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Yuxi Chen
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Kuo Shen
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, China
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10
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Wang M, Zhao J, Li J, Meng M, Zhu M. Insights into the role of adipose-derived stem cells and secretome: potential biology and clinical applications in hypertrophic scarring. Stem Cell Res Ther 2024; 15:137. [PMID: 38735979 PMCID: PMC11089711 DOI: 10.1186/s13287-024-03749-6] [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: 03/03/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024] Open
Abstract
Scar tissue is the inevitable result of repairing human skin after it has been subjected to external destructive stimuli. It leads to localized damage to the appearance of the skin, accompanied by symptoms such as itching and pain, which reduces the quality of life of the patient and causes serious medical burdens. With the continuous development of economy and society, there is an increasing demand for beauty. People are looking forward to a safer and more effective method to eliminate pathological scarring. In recent years, adipose-derived stem cells (ADSCs) have received increasing attention from researchers. It can effectively improve pathological scarring by mediating inflammation, regulating fibroblast proliferation and activation, and vascular reconstruction. This review focuses on the pathophysiological mechanisms of hypertrophic scarring, summarizing the therapeutic effects of in vitro, in vivo, and clinical studies on the therapeutic effects of ADSCs in the field of hypertrophic scarring prevention and treatment, the latest application techniques, such as cell-free therapies utilizing ADSCs, and discussing the advantages and limitations of ADSCs. Through this review, we hope to further understand the characterization of ADSC and clarify the effectiveness of its application in hypertrophic scarring treatment, so as to provide clinical guidance.
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Affiliation(s)
- Menglin Wang
- Department of Plastic Surgery, The First Affiliated Hospital, Dalian Medical University, No. 222, Zhongshan Road, Xigang District, Dalian, 116011, China
| | - Jianyu Zhao
- Department of Orthopaedics, The First Affiliated Hospital, Dalian Medical University, No. 222, Zhongshan Road, Xigang District, Dalian, 116011, China
| | - Jiacheng Li
- Department of Plastic Surgery, The Second Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Meng Meng
- Department of Orthopaedics, The First Affiliated Hospital, Dalian Medical University, No. 222, Zhongshan Road, Xigang District, Dalian, 116011, China.
| | - Mengru Zhu
- Department of Plastic Surgery, The First Affiliated Hospital, Dalian Medical University, No. 222, Zhongshan Road, Xigang District, Dalian, 116011, China.
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11
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Alharbi Z, Khashab RM, Farran E, Bamatraf MS, Almaghrabi MT, Khamis SF, Ahmed KD. Knowledge and Practice of Scar Treatment Among Health Care Physicians in Saudi Arabia. Cureus 2024; 16:e60057. [PMID: 38854222 PMCID: PMC11162814 DOI: 10.7759/cureus.60057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Background The processes of wound healing and scar formation are complex phenomena that are determined by an intricate interplay of molecules and cells. A deviation from the anticipated trajectory of scarring can lead to the formation of hypertrophic scars and keloids. A wide range of therapeutic methodologies have been employed in the treatment of scars. This research paper seeks to enhance patient outcomes and the efficacy of scar repair as a whole by determining the knowledge of scar treatment and implementation in clinical practice in Saudi Arabia and thereby incorporating scientific findings into practical settings. Materials and methods This cross-sectional study, which included 237 participants, aimed to provide descriptive data on the knowledge and common practice of Saudi Arabian healthcare physicians with regard to scar prevention, treatment, and evaluation during the period from November 15, 2023, to December 11, 2023. Results In routine clinical practice, the most commonly employed subjective method for scar assessment is patient and observer scar assessment (162 (68.4%)) while the Modified Vancouver Scar Scale (91 (38.4%)) was commonly used for research purposes. However two-dimensional photography is the most frequently employed objective method in clinical practice (54 (22.8%)) and biomechanical properties (58 (24.5%)) for research purposes. Silicone scar therapy in the form of sheets or gel is the primary preventive measure in the prevention of keloids/hypertrophic scars across various patient populations. Corticosteroid injections and silicone are primary interventions within the initial 18-month period. Conclusion Although significant progress has been made in the field of scar management, standardization of procedures and increased adherence to evidence-based guidelines are still required.
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Affiliation(s)
- Ziyad Alharbi
- Clinical Sciences, Fakeeh College for Medical Sciences, Jeddah, SAU
- Plastic Surgery and Burn Unit, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
| | | | - Eyas Farran
- Medicine, Fakeeh College for Medical Sciences, Jeddah, SAU
| | | | - Maan T Almaghrabi
- Pediatric Plastic Surgery and Burns, King Abdulaziz Medical City, Riyadh, SAU
| | - Sherif F Khamis
- Plastic Surgery and Burn Unit, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
| | - Kausar D Ahmed
- Plastic Surgery and Burn Unit, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
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12
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Shen WC, Cheng HT, Jan YK, Liau BY, Hsieh CW, Bau JG, Tai CC, Lung CW. Effect of negative pressure therapy on the treatment response to scar thickness and viscoelasticity. Front Bioeng Biotechnol 2024; 12:1353418. [PMID: 38712331 PMCID: PMC11070486 DOI: 10.3389/fbioe.2024.1353418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 03/12/2024] [Indexed: 05/08/2024] Open
Abstract
Patients with scars face a grave threat to their mental and physical health. Negative pressure has been used for scar therapy in medical care and provides a microenvironment conducive to scar healing while stimulating cell regeneration. Negative pressure may disrupt scar tissue regeneration when the pressure is too high or too low, so finding a suitable negative pressure is important. We hypothesized that different negative pressure magnitudes would affect scar tissue properties differently. This research aimed to provide practical recommendations for scar therapy. This study used three negative pressures (-105 mmHg, -125 mmHg, and -145 mmHg) to compare scar material properties. We measured scar tissue thickness and viscoelasticity with a motor-driven ultrasound indentation system. According to the results of this study, scar thickness is most effectively reduced at a negative pressure of -105 mmHg. In comparison, scar viscoelasticity continuously increases at a negative pressure of -125 mmHg. Negative pressure therapy can be recommended to scar care clinics based on the results of this study.
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Affiliation(s)
- Wei-Cheng Shen
- Department of Creative Product Design, Asia University, Taichung, Taiwan
| | - Hsu-Tang Cheng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Asia University Hospital, Asia University College of Medical and Health Science, Taichung, Taiwan
- Department of Food Nutrition and Health Biotechnology, Asia University, Taichung, Taiwan
| | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Ben-Yi Liau
- Department of Automatic Control Engineering, Feng Chia University, Taichung, Taiwan
| | - Chang-Wei Hsieh
- Department of Electrical Engineering, National Dong Hwa University, Hualien, Taiwan
| | - Jian-Guo Bau
- Department of Agricultural Technology, National Formosa University, Yunlin, Taiwan
| | - Chien-Cheng Tai
- School of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chi-Wen Lung
- Department of Creative Product Design, Asia University, Taichung, Taiwan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States
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13
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Schuh A, Reischmann L, Hintschich CR. Effect of Compression Dressing After Upper Eyelid Blepharoplasty on Edema, Ecchymosis, Pain and Ocular Surface Irritation. Ophthalmic Plast Reconstr Surg 2024:00002341-990000000-00378. [PMID: 38624150 DOI: 10.1097/iop.0000000000002666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
PURPOSE To investigate the effect of a compression dressing (CD) on edema, ecchymosis, aesthetic outcome, pain, and ocular surface irritation after upper eyelid blepharoplasty. METHODS We conducted a case-control study. Bilateral blepharoplasty was performed on both upper eyelids at the same time in patients with dermatochalasis. One side was randomized for CD. Edema and ecchymosis were scored at a 4-point rating scale by a blinded observer 1 day (D1), 1 week (D7), and 8 weeks (D56) after surgery; the same for scar formation regarding redness and bulging at D7 and D56. Aesthetic outcome was evaluated by the patient and blinded observer using the global aesthetic improvement score at D1, D7, and D56. Postoperative pain was scored by the patients using a visual analogue scale (0 to 10) at D1. At D1 patients had to state which side they felt more comfortable. RESULTS Edema, scar formation and aesthetic outcome evaluated by the patient and blinded observer did not differ between the 2 sides on any of the survey days (p > 0.05). The median degree of ecchymosis was slightly higher on the lids without CD at D1 (1 [0-2] vs. 1.5 [0-2]; p = 0.495) and D7 (0 [0-2] vs. 0.5 [0-2]; p = 0.183), but not statistically significant. Postoperative pain was similar regardless to the use of CD (p = 0.925). The majority (55%) found the side without CD more comfortable. There was no case of corneal erosion and corneal staining was similar in both groups (p > 0.05). CONCLUSIONS Using a CD after blepharoplasty shows no advantages regarding postoperative edema, ecchymosis, scar formation, or aesthetic results in the early postoperative period. As most patients preferred the noncovered side, CD can be omitted after blepharoplasty without inferiority for the postoperative results. CLINICAL TRIAL REGISTRY NCT06111170.
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Affiliation(s)
- Anna Schuh
- Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
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14
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Gratteri M, Marangi GF, Mirra C, Arcari L, Romano FD, Cimmino A, Cogliandro A, Cagli B, Segreto F, Persichetti P. Impact of Incisional Access Site in Primary Breast Augmentation: Evaluation of Patient Satisfaction with SCAR-Q. Aesthetic Plast Surg 2024; 48:1565-1570. [PMID: 37495729 DOI: 10.1007/s00266-023-03502-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/30/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Scarring at the incision site represents one of the most impactful outcomes in breast augmentation surgery for both the patient and the surgeon. Few studies exist with the aim of assessing patient perception of scarring outcomes in primary breast augmentation. The aim of this study was to evaluate the impact on quality of life of scars by submitting the SCAR-Q in patients who underwent primary augmentation mammoplasty. METHODS The SCAR-Q was administered at one and at 6 months after surgery to 54 consecutive patients underwent primary breast augmentation with inferior hemi-periareolar or inframammary incision. A total of 50 patients were divided into two groups of 21 patients with inferior hemi-periareolar incision and 29 patients with inframammary fold incision, respectively. Statistical analysis was performed with Prism 9. RESULTS All mean values of the three SCAR-Q scales tend to decrease at the second administration meaning that the perception of the scar is better at time 6 from the patient perspective. In the "Psychosocial scale," lower values at both 1 month and 6 months for group 2 compared to group 1 were shown. Unpaired T tests with Welch's correction showed significance for delta values variations between the two groups with P values <0.0001. CONCLUSION Data show that patients undergoing primary breast augmentation have a scar that has no significant impact. Patients with inframammary fold scar have less psychosocial impact than those with inferior hemi-periareolar scar. There were no statistically significant differences in scar-related symptoms and scar appearance between scar along the inframammary groove and inferior hemi-periareolar scar. LEVEL OF EVIDENCE IV Case series study. 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)
- Marco Gratteri
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Giovanni Francesco Marangi
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Carlo Mirra
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy.
| | - Lucrezia Arcari
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Fara Desiree Romano
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Andrea Cimmino
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Annalisa Cogliandro
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Barbara Cagli
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Francesco Segreto
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
| | - Paolo Persichetti
- Department of Plastic, Reconstructive and Cosmetic Surgery, Campus Bio-Medico University Hospital, Via Alvaro del Portillo 200, Rome, Italy
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Hong N, Sheng B, Yu P. Early postoperative interventions in the prevention and management of thyroidectomy scars. Front Physiol 2024; 15:1341287. [PMID: 38523809 PMCID: PMC10958159 DOI: 10.3389/fphys.2024.1341287] [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: 11/20/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Thyroidectomy scars, located on the exposed site, can cause distress in patients. Owing to the cosmetic importance of thyroidectomy scars, many studies have been conducted on its prevention and treatment. Scar formation factors mainly include inflammatory cell infiltration, angiogenesis, fibroblast proliferation, secretion of cytokines such as transforming growth factor (TGF)-β1, and mechanical tension on the wound edges. Anti-scar methods including topical anti-scar agents, skin tension-bearing devices, and local injections of botulinum toxin, as well as lasers and phototherapies, that target these scar formation factors have been developed. However, current studies remain fragmented, and there is a lack of a comprehensive evaluation of the impacts of these anti-scar methods on treating thyroidectomy scars. Early intervention is a crucial but often neglected key to control hyperplastic thyroidectomy scars. Therefore, we review the currently adopted early postoperative strategies for thyroidectomy scar reduction, aiming to illustrate the mechanism of these anti-scar methods and provide flexible and comprehensive treatment selections for clinical physicians to deal with thyroidectomy scars.
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Affiliation(s)
- Nan Hong
- Department of Burn and Plastic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Department of Dermatology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Bin Sheng
- Department of Medical Cosmetology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Pan Yu
- Department of Burn and Plastic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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16
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Kono S, Kamei M. Transcanthal Canthopexy for Involutional Lower Eyelid Entropion Corrects Horizontal Laxity. J Ophthalmol 2024; 2024:4694296. [PMID: 38379662 PMCID: PMC10878753 DOI: 10.1155/2024/4694296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/18/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024] Open
Abstract
In this prospective observational study, we aimed to examine improvements in horizontal laxity after lower eyelid retractor advancement and transcanthal canthopexy for involutional lower eyelid entropion. The study included 19 sides in 15 patients with involutional entropion who underwent transcanthal canthopexy with the advancement of the lower eyelid retractor. Using the pinch test, the distance from the lowest part of the corneal limbus to the eyelid margin was measured using callipers. All measurements were performed preoperatively and at postoperative 3 and 6 months. Using the pinch test, the distance from the lowest part of the corneal limbus to the lower eyelid margin was significantly shortened during each postoperative follow-up period. None of the included cases experienced recurrence. Our results indicated that transcanthal canthopexy could preserve postoperative horizontal tightness.
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Affiliation(s)
- Shinjiro Kono
- Department of Ophthalmology, Aichi Medical University Hospital, Nagakute, Japan
| | - Motohiro Kamei
- Department of Ophthalmology, Aichi Medical University Hospital, Nagakute, Japan
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17
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Gill HS, O-Wern L, Tiwari P, Gill GKS, Goh C, Hung J, Lee JT, Lim TC, Lim J, Yap YL, Nallathamby V. Postoperative Scar Management Protocol for Asian Patients. Aesthetic Plast Surg 2024; 48:461-471. [PMID: 37943348 DOI: 10.1007/s00266-023-03696-2] [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: 07/24/2023] [Accepted: 09/12/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Postoperative scar formation remains a morbidity for patients even with the advent of minimally invasive techniques. Furthermore, the significant difference between the Asian and Caucasian skin results in poorer postoperative scar outcomes in Asians, supporting the need for an evidence-based scar management protocol. METHODS Following a literature review of the PubMed and the Cochrane databases over the past 10 years, we constructed a novel postoperative scar management protocol for the Asian skin, utilized in a Singaporean tertiary healthcare institution. RESULTS We describe a timeline-based scar protocol from the point of skin closure to a minimum of 1 year of follow-up. We support the use of intraoperative botulinum toxin for selected high-risk individuals upon skin closure with a follow-up regimen in the postoperative setting. For recalcitrant keloids, we have described a multimodal therapy comprising elements of intralesional steroids, botulinum toxin, lasers, surgery, and radiotherapy. CONCLUSIONS A consolidated postoperative scar management protocol provides the necessary guidance for improved scar outcomes in the Asian skin. There is inherent potential in expanding the protocol to include post-traumatic and burn wounds or support other skin types including the Caucasian skin. NO LEVEL ASSIGNED This journal requires that authors assign a level of evidence to each submission to which Evidence-Based Medicine rankings are applicable. This excludes Review Articles, Book Reviews, and manuscripts that concern Basic Science, Animal Studies, Cadaver Studies, and Experimental Studies. 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)
- Hargaven Singh Gill
- Department of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Low O-Wern
- Department of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Priya Tiwari
- Department of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore.
| | - Gurveer Kaven Singh Gill
- Department of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Chance Goh
- Department of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Janet Hung
- Department of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Jing Tzer Lee
- Department of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Thiam Chye Lim
- Department of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Jane Lim
- Department of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Yan Lin Yap
- Department of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
| | - Vigneswaran Nallathamby
- Department of Plastic, Reconstructive and Aesthetic Surgery, National University Hospital (NUH), 5 Lower Kent Ridge Road, Singapore, 119074, Singapore
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18
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Schuh A, Reischmann L, Hintschich CR. Compression Dressing versus Noncompressive Transparent Eye Shield after Ptosis Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5548. [PMID: 38264444 PMCID: PMC10805438 DOI: 10.1097/gox.0000000000005548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/27/2023] [Indexed: 01/25/2024]
Abstract
Background We aimed to investigate the effect of compression dressing on edema, ecchymosis, pain, and ocular surface irritation after ptosis surgery. Methods After ptosis correction [anterior levator reinsertion (and resection) (ALR), if necessary additional blepharoplasty], the eye was randomized for compression dressing or transparent eye shield. Edema and ecchymosis were scored on a four-point rating scale by a blinded observer 1 day (D1), 1 week (D7), and 8 weeks (D56) after surgery; the same was done for scar formation regarding redness and bulging at D7 and D56. Aesthetic outcome was ranked by patient and blinded observer using the Global Aesthetic Improvement Score at D1, D7, and D56. Postoperative pain was scored using a visual analogue scale (0 to 10) at D1. Impairment after surgery by dressing or eye shield was evaluated at D1. Results Ecchymosis, edema, scar formation, and aesthetic outcome ranked by the patient and blinded observer did not differ between the groups with compression dressing and eye shield at any day of follow-up (P > 0.05). Postoperative pain and impairment were the same in both groups (P > 0.05). One case of corneal erosion occurred in the group with compression dressing at D1 (P = 0.342). At D7, corneal staining was increased in the group without compression dressing (P = 0.930). Conclusions Compression dressing after ALR does not reduce ecchymosis, edema, or postoperative pain and has no effect on early scar formation or aesthetic results. To prevent corneal erosion caused by the dressing, it can be omitted after ALR without inferiority for the early postoperative results.
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Affiliation(s)
- Anna Schuh
- From the Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Lilian Reischmann
- From the Department of Ophthalmology, Ludwig-Maximilians-University Munich, Munich, Germany
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Mirza HH, Ahmed F, Rahber M, Rana ZA. Post-operative Scar Comparison With Supraorbital Eyebrow and Upper Blepharoplasty Approach in the Management of Zygomaticomaxillary Complex Fractures. Craniomaxillofac Trauma Reconstr 2023; 16:268-274. [PMID: 38047146 PMCID: PMC10693260 DOI: 10.1177/19433875221124406] [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: 12/05/2023] Open
Abstract
Study Design A prospective randomized comparative study was conducted to evaluate the postsurgical scar with Supraorbital Eyebrow (SE) Approach and Upper Blepharoplasty (UB) Approach used for open reduction and internal fixation (ORIF) of zygomaticomaxillary complex (ZMC) fractures. Objective To evaluate and compare the post-operative scar using Vancouver Scar Scale (VSS) following ORIF of ZMC fractures with SE and UB approaches. Methods In this study, 88 patients with ZMC fractures requiring ORIF and meeting the inclusion criteria were recruited between 2019 and 2020. Patients were randomly divided into SE and UB group, 44 patients in each. Clinical and radiological assessment was done preoperatively and post-operative scar evaluation was carried out at different intervals over a period of 6 months using VSS. A blinded observer rated the scar. Results The results showed that after 6 months of surgery, all the 44 (100%) patients in UB group had a mild scar (VSS score 1-5), while in the SE group 34 (77.3%) patients had a mild scar (VSS score 1-5) and 10 (22.7%) had a moderate scar (VSS score 6-10). The difference between the 2 groups was statistically significant (P-value = .001). Conclusions The UB approach has been established to be superior to SE approach in terms of post-operative scar as the results were statistically significant. This study can be used to advocate more frequent use of UB approach as compared to the previously popular SE approach for the management of ZMC fractures.
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Affiliation(s)
- Hamza H. Mirza
- Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Faheem Ahmed
- Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Murtaza Rahber
- Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Zahoor A. Rana
- Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
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20
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Liu H, Lin MH, Jiang LL, Chang SS, Chen W, Nie KY, Huang GT, Qi F, Zhou XF, Chen JD, Deng CL, Wei ZR. A Modified Suture Technique to Improve Scar Appearance in Wounds Under High Tension. Ann Plast Surg 2023; 91:763-770. [PMID: 37962184 DOI: 10.1097/sap.0000000000003693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
ABSTRACT The purpose of this study was to introduce a modified suture technique and to compare its effects on skin scar formation with 2 traditional suture methods: simple interrupted suture (SIS) and vertical mattress suture (VMS). Three groups of healthy adult female Sprague-Dawley rats were selected (6 replicates in each group), and the full-thickness skin of 5 cm × 0.2 cm was cut off on the back of the rats after anesthesia. The wounds were then sutured using 1 of the 3 methods for each group: SIS, VMS, and a newly introduced modified vertical mattress suture (M-VMS) technique with the needle reinsertion at the exit point. A traction device was installed on the back of the rats to achieve high tension wounds. The tensile distance was increased by 1 mm every day for 20 days. After 20 days of healing, the hematoxylin-eosin staining method was used for observation of scar morphology. The collagen production rate was measured by Masson staining, and the type I collagen and type III collagen were detected by the immunofluorescence method. Immunohistochemical staining was used to detect the expression of myofibroblast marker α-smooth muscle actin, and real-time quantitative polymerase chain reaction and Western blot techniques were used to detect the expressions of transforming growth factors TGFβ1, TGFβ2, and TGFβ3 to understand the mechanisms of scar formation. Results showed that the quantity and density of collagen fibers were both lower in the M-VMS group than in the other 2 groups. Immunofluorescence results showed that type I collagen was significantly lower, whereas type III collagen was significantly higher in the M-VMS group than in the other 2 groups. The expressions of α-smooth muscle actin and TGFβ1 both were lower in the M-VMS group than in the other 2 groups. The expression of TGFβ2 and TGFβ3 had no obvious difference among the 3 groups. For wounds under high tension, compared with SIS and VMS methods, the M-VMS technique we proposed can reduce scar formation due to the reduction of collagen formation, myofibroblast expression, and TGFβ1 expression.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Xiao-Fan Zhou
- Department of Plastic Surgery, The Third People's Hospital of Guizhou, Guizhou, PR China
| | - Jian-Da Chen
- Department of Plastic Surgery, The Third People's Hospital of Guizhou, Guizhou, PR China
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21
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Pandit P, Murkey SP, Agarwal A, Jaiswal A, Agrawal S. Understanding Fibroadenoma of the Breast: A Comprehensive Review of Pre-operative and Post-operative Clinicopathological Correlations. Cureus 2023; 15:e51329. [PMID: 38288219 PMCID: PMC10823311 DOI: 10.7759/cureus.51329] [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: 11/23/2023] [Accepted: 12/30/2023] [Indexed: 01/31/2024] Open
Abstract
Fibroadenomas of the breast are common benign lesions that predominantly affect young women. This review provides a comprehensive overview of fibroadenoma management, encompassing their definition, clinical presentation, diagnostic tools, surgical management, clinicopathological correlations, treatment outcomes, complications, and emerging research. Fibroadenomas typically present as palpable breast lumps, often with no associated nipple discharge, and their diagnosis relies on a combination of clinical examination, breast imaging, and pathological confirmation. Surgical interventions, including excisional biopsy and lumpectomy, offer symptom relief and favorable long-term outcomes. Minimally invasive techniques and ongoing research into genomics and molecular aspects hold promise for the future of fibroadenoma management. Multidisciplinary collaboration among healthcare providers is paramount, ensuring accurate diagnosis, personalized treatment decisions, and holistic patient care. As research advances, the management of fibroadenomas is poised to evolve, providing improved diagnostic accuracy, minimally invasive treatments, and enhanced patient outcomes.
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Affiliation(s)
- Pranam Pandit
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Siddhant P Murkey
- Medicine and Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Akash Agarwal
- Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Arpita Jaiswal
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Suyash Agrawal
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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22
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Lackmann F, Rohwedder T, Maron A, Stegen L, Brunnberg M, Brunnberg L, Burger M, Böttcher P. Quantification of skin wound tension using a newly designed wound tensiometer. TIERARZTLICHE PRAXIS. AUSGABE K, KLEINTIERE/HEIMTIERE 2023; 51:386-393. [PMID: 38056476 PMCID: PMC10699892 DOI: 10.1055/a-2150-0587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 07/17/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To (i) quantitatively measure wound tension in experimental skin wounds using a newly developed wound tensiometer and (ii) establish reference values for primary skin wound closure in medium- and large-breed dogs. STUDY DESIGN Experimental cadaveric study. ANIMAL POPULATION Nineteen dogs of medium to large breeds (BW 20 to 40 kg). METHODS Elliptical skin wounds of different sizes were created on the chest and abdomen. The wounds were gradually enlarged. Experienced surgeons (ECVS diplomates or professors of small animal surgery) and inexperienced surgeons (1st year after graduation) independently assessed wound tension through manual manipulation and determined whether the wound could be closed without tension-relieving measures. In addition, wound tension was objectively quantified using a newly developed wound tensiometer. RESULTS The upper threshold for wound tension at which direct appositional wound closure was recommended by the experienced surgeons was 5.4 N, and the median minimal tension without recommendations for closure was 6.0 N. The data also demonstrate that wound tension and wound size do not necessarily correlate, and inexperienced surgeons need to develop a feel for wound tension. CONCLUSION The intraoperative use of the wound tensiometer, in combination with established cut-off values, might facilitate decision-making regarding primary wound closure. CLINICAL RELEVANCE The findings of this study provide evidence for the applicability of a wound tensiometer in guiding inexperienced surgeons in their choice of the skin wound closure method.
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Affiliation(s)
- Felix Lackmann
- Small Animal Clinic, Freie Universität Berlin, Berlin,
Germany
| | | | | | | | | | - Leo Brunnberg
- Small Animal Clinic, Freie Universität Berlin, Berlin,
Germany
| | | | - Peter Böttcher
- Small Animal Clinic, Freie Universität Berlin, Berlin,
Germany
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23
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Qi W, Xiao X, Tong J, Guo N. Progress in the clinical treatment of keloids. Front Med (Lausanne) 2023; 10:1284109. [PMID: 38046417 PMCID: PMC10690427 DOI: 10.3389/fmed.2023.1284109] [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: 08/30/2023] [Accepted: 11/03/2023] [Indexed: 12/05/2023] Open
Abstract
Keloid is a pathological scar that is higher than the skin surface following skin damage. Its lesion range often extends beyond the original damage boundary and does not naturally subside over time. Its pathogenesis is very complex, currently the main causes include fibroblast excessive proliferation, collagen and extracellular matrix (Extracellular matrix, ECM) excessive deposition, excessive angiogenesis, and so on. The traditional treatment method primarily involves surgical intervention, but it is associated with a high recurrence rate post-surgery. Consequently, many treatment methods are derived according to the different clinical characteristics of keloid. This paper will review the therapeutic progress in recent years from surgical treatment, physiotherapy, drug therapy, and biological therapy, with the goal of offering valuable insights for the clinical treatment of keloids.
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Affiliation(s)
| | | | - Jing Tong
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nengqiang Guo
- Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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24
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Hyakutake Y, Shibahara I, Toyoda M, Shigeeda R, Handa H, Saruta W, Sato S, Hide T, Kumabe T. Frontotemporal craniotomy with skin incision along the superior temporal line outside the hairline in bald male patients with temporal gliomas. Neurosurg Rev 2023; 46:296. [PMID: 37950043 DOI: 10.1007/s10143-023-02212-z] [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: 08/10/2023] [Revised: 10/16/2023] [Accepted: 11/05/2023] [Indexed: 11/12/2023]
Abstract
A head skin incision is inevitable in neurosurgical procedures and is usually concealed within the hairline. Androgenetic alopecia (AGA) is a progressive hair loss disorder or baldness highly prevalent in men. Therefore, if bald male patients require neurosurgical procedures, skin incisions cannot be concealed, but this subject is yet to be discussed in the literature. This study presents a frontotemporal craniotomy using a skin incision along the superior temporal line, ignoring the hairline in bald male patients. Thirty-three patients with temporal gliomas underwent surgical removal between 2015 and 2022. They were divided into three groups: bald male patients with skin incisions not concealed in the hairline (minimum group, n = 13), bald and non-bald male patients with skin incisions concealed in the hairline (male group, n = 11), and female patients with skin incisions concealed in the hairline (female group, n = 9). In the minimum group, patients had no complaints regarding the incision scar. Cosmetic outcome was excellent, and no cases showed surgical site infection or peripheral facial nerve palsy. Compared with the male and female groups, the minimum group had the shortest skin incision length; however, the craniotomy size and extent of resection were similar. Skin incision for frontotemporal craniotomy cannot be hidden in bald male patients, and the preferred location for the incision is unknown. The skin incision along the superior temporal line is a cosmetically favorable, feasible, and safe procedure.
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Affiliation(s)
- Yuri Hyakutake
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Ichiyo Shibahara
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Mariko Toyoda
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Ryota Shigeeda
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Hajime Handa
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Wakiko Saruta
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Sumito Sato
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Takuichiro Hide
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Toshihiro Kumabe
- Department of Neurosurgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-Ku, Sagamihara, Kanagawa, 252-0374, Japan
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25
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Davis M, Hom D. Current and Future Developments in Wound Healing. Facial Plast Surg 2023; 39:477-488. [PMID: 37308128 PMCID: PMC11121504 DOI: 10.1055/s-0043-1769936] [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] [Indexed: 06/14/2023] Open
Abstract
Poor wound healing on the face and neck can lead to significant morbidity and dissatisfaction in facial plastic surgery. With current advances in wound healing management and commercially available biologic and tissue-engineered products, there are several options available to optimize acute wound healing and treat delayed or chronic wounds. This article summarizes some of the key principals and recent developments in wound healing research in addition to potential future advancements in the field of soft tissue wound healing.
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Affiliation(s)
- Morgan Davis
- Department of Otolaryngology, Head and Neck Surgery, University of California, San Diego, La Jolla, California
| | - David Hom
- Department of Otolaryngology, Head and Neck Surgery, University of California, San Diego, La Jolla, California
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26
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Ho MP, Hughes H, Fleming P. The Attitudes of Patients Toward Orthopaedic Post-surgical Scars. Cureus 2023; 15:e47975. [PMID: 38034173 PMCID: PMC10686239 DOI: 10.7759/cureus.47975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Background Post-surgical scars (PSS) are an expected consequence of surgery. Several factors have previously been associated with PSS satisfaction including patient age and time elapsed post-operative. Little data are available regarding patient attitudes toward orthopaedic PSS. Knowledge of patient attitudes and the various associated factors may allow physicians to administer peri-operative care to mitigate the potential negative effects of PSS. Our study aims to investigate the attitudes of patients toward their PSS using quantitative scar assessment scales and to identify factors associated with PSS satisfaction. Methods We conducted a retrospective study with a follow-up. We included all patients with orthopaedic PSS on their upper or lower limbs between two and 18 weeks postoperative attending Cork University Hospital, Ireland, between February and August 2022. Patients completed an initial baseline questionnaire and then a follow-up questionnaire six months post-operative. The Patient and Observer Scar Assessment Scale (POSAS) evaluated PSS satisfaction. The European Quality of Life 5 Domain (EQ-5D), alongside several Likert scales, evaluated the patient's quality of life (QoL). Results In total, 91 patients were included. The mean POSAS score was 28.41 (95% CI, 25.85-30.97). Younger patient age (p=0.045) and decreased time passed post-operatively (p=0.002) were associated with poorer PSS satisfaction. Patients reporting their PSS appearing worse than expected were more likely to agree that their QoL had been adversely affected by it (p=0.001). Conclusion Most patients were satisfied with their orthopaedic PSS. This study identified several factors associated with poor PSS satisfaction. Our finding, which associated patient scar expectations and QoL, is novel and has not been previously examined. Accordingly, peri-operative interventions, including scar expectation management, may be implemented to mitigate scar-related QoL impact.
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Affiliation(s)
- Martin P Ho
- Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Cork, IRL
| | - Hannah Hughes
- Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Cork, IRL
| | - Patrick Fleming
- Department of Trauma and Orthopaedic Surgery, Cork University Hospital, Cork, IRL
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27
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Ning Y, Liu Y, Zeng D, Zhou Y, Ma L, Dong S, Sheng J, Wu G, Tian W, Cai Y, Li C. Patterns of lymph node metastasis in level IIB and contralateral level VI for papillary thyroid carcinoma with pN1b and safety of low collar extended incision for neck dissection in level II. World J Surg Oncol 2023; 21:249. [PMID: 37592337 PMCID: PMC10433677 DOI: 10.1186/s12957-023-03075-w] [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: 11/14/2022] [Accepted: 06/14/2023] [Indexed: 08/19/2023] Open
Abstract
OBJECTIVE To explore relevant clinical factors of level IIB and contralateral level VI lymph node metastasis and evaluate the safety of low-collar extended incision (LCEI) for lymph node dissection in level II for papillary thyroid carcinoma (PTC) with pN1b. METHOD A retrospective analysis was performed on 218 patients with PTC with pN1b who were treated surgically in the Head and Neck Surgery Center of Sichuan Cancer Hospital from September 2021 to May 2022. Data on age, sex, body mass index (BMI), tumor location, maximum tumor diameter, multifocality, Braf gene, T staging, surgical incision style, and lymph node metastasis in each cervical subregion were collected. The chi-square test was used for comparative analysis of relevant factors. All statistical analyses were completed by SPSS 24 software. RESULT Each subgroup on sex, age, BMI, multifocality, tumor location, extrathyroidal extension, Braf gene, and lymphatic metastasis in level III, level IV, and level V had no significant difference in the positive rate of lymph node metastasis in level IIB (P > 0.05). In contrast, patients with bilateral lateral cervical lymphatic metastasis were more likely to have level IIB lymphatic metastasis than those with unilateral lateral cervical lymphatic metastasis, with a statistically significant difference (P = 0.000). In addition, lymph node metastasis in level IIA was significantly associated with lymph node metastasis in level IIB (P = 0.001). After multivariate analysis, lymph node metastasis in level IIA was independently associated with lymph node metastasis in level IIB (P = 0.010). The LCEI group had a similar lymphatic metastasis number and lymphatic metastasis rate in both level IIA and level IIB as the L-shaped incision group (P > 0.05). There were 86 patients with ipsilateral central lymphatic metastasis (78.2%). Patients with contralateral central lymphatic metastasis accounted for 56.4%. The contralateral central lymphatic metastasis rate was not correlated with age, BMI, multifocality, tumor invasion, or ipsilateral central lymphatic metastasis, and there was no significant difference (P > 0.05). The contralateral central lymphatic metastasis in males was slightly higher than that in females, and the difference was statistically significant (68.2% vs. 48.5%, P = 0.041). CONCLUSION Lymphatic metastasis in level IIA was an independent predictor of lymphatic metastasis in level IIB. When bilateral lateral cervical lymphatic metastasis or lymph node metastasis of level IIA is found, lymph node dissection in level IIB is strongly recommended. When unilateral lateral cervical lymphatic metastasis and lymphatic metastasis in level IIA are negative, lymph node dissection in level IIB may be performed as appropriate on the premise of no damage to the accessory nerve. LCEI is safe and effective for lymph node dissection in level II. When the tumor is located in the unilateral lobe, attention should be given to contralateral central lymph node dissection because of the high lymphatic metastasis rate.
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Affiliation(s)
- Yudong Ning
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, , Chengdu, China
| | - Yuebai Liu
- Department of Head and Neck Surgery, Education & Training, Sichuan Cancer Center, University of Electronic Science and Technology of China, Chengdu, China
| | - Dingfen Zeng
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, , Chengdu, China
| | - Yuqiu Zhou
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, , Chengdu, China
| | - Linjie Ma
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, , Chengdu, China
| | - Shuang Dong
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, , Chengdu, China
| | - Jianfeng Sheng
- Department of Thyroid, Head, Neck and Maxillofacial Surgery, The Third People's Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, China
| | - Gaosong Wu
- Department of Thyroid and Breast Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Wen Tian
- Department of General Surgery, Chinese PLA General Hospital, Beijing, China
| | - Yongcong Cai
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, , Chengdu, China.
| | - Chao Li
- Department of Head and Neck Surgery, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, University of Electronic Science and Technology of China, , Chengdu, China.
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Bueno A, Nevado-Sanchez E, Pardo-Hernández R, de la Fuente-Anuncibay R, González-Bernal JJ. Treatment and Improvement of Healing after Surgical Intervention. Healthcare (Basel) 2023; 11:2213. [PMID: 37570454 PMCID: PMC10418496 DOI: 10.3390/healthcare11152213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023] Open
Abstract
The development of abnormal scars has a great impact on people's well-being, and improving scarring outcomes after surgery is a field that currently lacks consensus. This review aims to identify newly researched approaches to improving the quality of surgical scars. A systematic search of PubMed, Scopus, Web of Science, and ScienceDirect was conducted between 13 May 2023 and 17 May 2023, in accordance with the recommendations of the PRISMA Statement. Study selection and analysis of methodological quality were performed in parts, independently and blindly, based on eligibility criteria. The 21 prospective, comparative, and randomized studies reviewed included 1057 subjects and studied approaches such as topical applications of creams with herbal extracts and silicone gels, growth factors, negative pressure dressings, oligonucleotides, intralesional injection of compounds such as botulinum toxin, skin closure techniques such as suturing and tissue adhesive, and laser treatments. There are recent research techniques that generate good results and are really promising to improve the results of surgical scars; however, the available evidence is extremely limited in some cases, and it is necessary to deepen its analysis to obtain reliable action protocols in each type of surgery.
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Affiliation(s)
- Andrea Bueno
- Health Center of Las Huelgas, 09001 Burgos, Spain;
| | - Endika Nevado-Sanchez
- Reconstructive and Aesthetic Plastic Surgery Service, University Hospital of Burgos, 09006 Burgos, Spain
- Propios Nevado Clinic, 09004 Burgos, Spain
| | - Rocío Pardo-Hernández
- Department of Health Sciences, University of Burgos, 09001 Burgos, Spain; (R.d.l.F.-A.); (J.J.G.-B.)
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29
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Qari S, Bader M, Farran E, Borrah R, Khamis S, Alharbi Z. Combined Synergetic Effect of Lipoconcentrate Fat Grafting, Nanofat Transfer, Platelet-Rich Plasma, Microneedling, and CO2 Fractional Laser for Plastic Regenerative and Esthetic Surgery and Cosmetic Care. Cureus 2023; 15:e44035. [PMID: 37746505 PMCID: PMC10517633 DOI: 10.7759/cureus.44035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
The advancements in skin care methods and products show the rising interest in cosmetics. Recent studies emphasize the regenerative potential of fat grafting, platelet-rich plasma (PRP), microneedling, and carbon dioxide (CO2) fractional laser techniques. Combining these strategies into a protocol is yet to be explored. In this article, we demonstrate different types of fat grafts and their versatility in treating different facial problems found in our patient. This study evaluated the synergistic effect of lipoconcentrate and nanofat grafting, PRP, microneedling, and CO2 fractional laser to provide esthetic and regenerative facial skin care. This case report was conducted in Dr. Soliman Fakeeh Hospital, Saudi Arabia. Our case involved a 53-year-old woman who had traumatic facial injuries due to a car accident years ago that buried asphalt particles in her facial scars, causing bluish skin discoloration. She suffered from multiple deep atrophic scars in several areas on the left side of her face, causing asymmetry. She was treated using lipoconcentrate and nanofat grafting, followed by three PRP with microneedling sessions and then a final CO2 fractional laser session. The evaluation was based on the physician's clinical assessment, image documentation, and patient satisfaction, which revealed significant improvement in skin appearance with respect to texture, color, symmetry, and overall health of the skin over a period of four months. The potentiality and efficacy of the combination therapy of lipoconcentrate, nanofat, PRP, microneedling, and CO2 fractional laser for skin rejuvenation and scar treatment showed promising results in this case report.
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Affiliation(s)
- Sarah Qari
- Plastic Surgery and Burn Unit, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
| | - Maryam Bader
- Plastic Surgery and Burn Unit, King Fahad General Hospital, Jeddah, SAU
| | - Eyas Farran
- College of Medicine, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Renad Borrah
- Plastic Surgery and Burn Unit, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
| | - Sherif Khamis
- Plastic Surgery and Burn Unit, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
- Clinical Sciences Department, Fakeeh College for Medical Sciences, Jeddah, SAU
| | - Ziyad Alharbi
- Plastic Surgery and Burn Unit, Dr. Soliman Fakeeh Hospital, Jeddah, SAU
- Clinical Sciences Department, Fakeeh College for Medical Sciences, Jeddah, SAU
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30
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Mazy D, Ma Z, Chung-Tze-Cheong C, Lamer S, Li J, Nault ML. Modification of the properties of a suture thread with a tough gel coating: A baseline ex-vivo study. J Orthop Res 2023; 41:1815-1820. [PMID: 36610018 DOI: 10.1002/jor.25514] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/23/2022] [Accepted: 01/04/2023] [Indexed: 01/09/2023]
Abstract
The mechanical properties of sutures are important for wound closure and meniscus repair. A tough gel coating technology has been developed to modify and functionalize sutures, but its effects on suture degradation remain unexplored. Our aim is to investigate how a tough gel coating mediates the properties of the suture. The Polyglactin910 (Vicryl) suture was chosen because it is widely used, strong, easy to handle, and degradable. This study compared six pristine Vicryl sutures and six coated Vicryl sutures at 0, 2, 4, and 6 weeks. All the sutures were soaked in phosphate-buffered saline (PBS), to mimic degradation in physiological conditions, and tensile strength was tested at each time point. The pH of the soaking mediums was measured weekly and compared at 4, 5, and 6 weeks. No significant difference (p = 0.059 and p = 0.576) was found between the absolute and normalized breaking force of coated and pristine Vicryl sutures at 0, 2, 4, and 6 weeks. After 4 weeks of immersion, the soaking medium became more acidic for both suture types. The decrease in pH was less significant for coated Vicryl sutures than for pristine ones (p < 0.001) at 4, 5, and 6 weeks of immersion. Although coating does not affect the strength of Vicryl sutures soaked in PBS, it can effectively act as a buffer to the acidic environment caused by suture degradation, which could help reduce inflammation. Hydrogel coating is a promising technology to modify suture characteristics.
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Affiliation(s)
- David Mazy
- Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada
- Department of Surgery, CHU Sainte-Justine, Montréal, Quebec, Canada
| | - Zhenwei Ma
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada
| | | | - Stephanie Lamer
- Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada
| | - Jianyu Li
- Department of Mechanical Engineering, McGill University, Montreal, Quebec, Canada
- Department of Biomedical Engineering, McGill University, Montréal, Quebec, Canada
| | - Marie-Lyne Nault
- Faculty of Medicine, University of Montreal, Montréal, Quebec, Canada
- Department of Surgery, CHU Sainte-Justine, Montréal, Quebec, Canada
- Department of Orthopedic Surgery, CIUSSS Hôpital du Sacré-Cœur de Montréal (HSCM), Montreal, Quebec, Canada
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Zhang W, Ling Y, Sun Y, Xiao F, Wang L. Extracellular Vesicles Derived from Mesenchymal Stem Cells Promote Wound Healing and Skin Regeneration by Modulating Multiple Cellular Changes: A Brief Review. Genes (Basel) 2023; 14:1516. [PMID: 37628568 PMCID: PMC10453884 DOI: 10.3390/genes14081516] [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: 06/12/2023] [Revised: 07/14/2023] [Accepted: 07/21/2023] [Indexed: 08/27/2023] Open
Abstract
Mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) are biologically active substances secreted by MSCs into the extracellular matrix that play an immunomodulatory role in skin damage repair. To investigate the mechanism of MSC-EVs in reducing inflammation, promoting angiogenesis, promoting the proliferation and migration of epithelial cells and fibroblasts, and extracellular matrix remodeling during wound healing, we focused on the effects of EVs on multiple cell types at various stages of skin injury. A literature review was conducted to explore related research on the influence of MSC-EVs on the types of cells involved in wound healing. MSC-EVs show a strong regulatory ability on immune cells involved in the regulation of inflammation, including macrophages, neutrophils, and T cells, and other cells involved in tissue proliferation and remodeling, such as fibroblasts, keratinocytes, and endothelial cells, during wound healing in in vitro and in vivo experiments, which substantially promoted the understanding of wound healing in the field of trauma medicine. MSC-EVs have potential applications in combating poor skin wound healing. Elucidating the mechanism of action of EVs in the wound-healing process would greatly advance the understanding of therapeutic wound healing.
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Affiliation(s)
- Weiyuan Zhang
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao 266000, China; (W.Z.); (Y.L.); (Y.S.)
| | - Yang Ling
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao 266000, China; (W.Z.); (Y.L.); (Y.S.)
| | - Yang Sun
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao 266000, China; (W.Z.); (Y.L.); (Y.S.)
| | - Fengjun Xiao
- Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Lisheng Wang
- Department of Special Medicine, School of Basic Medicine, Qingdao University, Qingdao 266000, China; (W.Z.); (Y.L.); (Y.S.)
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Min P, Zhang S, Sinaki DG, Yao P, Hu F, Wang X, Zhou D, Chai J, Zhang Y. Using Zhang's supertension-relieving suture technique with slowly-absorbable barbed sutures in the management of pathological scars: a multicenter retrospective study. BURNS & TRAUMA 2023; 11:tkad026. [PMID: 37334139 PMCID: PMC10271604 DOI: 10.1093/burnst/tkad026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/06/2023] [Accepted: 04/23/2023] [Indexed: 06/20/2023]
Abstract
Background An ideal tension-relieving suture should be efficient for >3 months to retrieve normal tensile strength. Most preexisting suturing techniques provided tension elimination followed by relapse and scar proliferation due to absorption and cut-through of the sutures. This study introduces a simple but effective suture technique developed by a senior author (ZYX) to solve this problem. Methods A total of 120 patients with pathological scar (PS) had intervention treatment with the proposed suturing strategy at three centers from January 2018 to January 2021. A slowly absorbable 2-0 barbed suture was used for subcutaneous tension relieving with a set-back from the wound edge and a horizontal interval between proposed inserting points of 1 cm. The Patient and Observer Scar Assessment Scale (POSAS), scar width, perfusion and eversion of the wound edge were evaluated at 3-, 6- and 12-month follow-up. The time needed to place the tension-relieving suture was recorded and relapse was monitored for 18 months postoperatively. Results In total, 76 trunks, 32 extremities and 12 cervical PS were included, with an average subcutaneous tension-relieving suture time of 5 min. The Patient and Observer Scar Assessment Scale (POSAS) score decreased from 84.70 ± 7.06 preoperatively to 28.83 ± 3.09, 26.14 ± 1.92 and 24.71 ± 2.00 at 3, 6 and 12 months postoperatively, respectively (p < 0.0001). The scar widths were 0.17 ± 0.08, 0.25 ± 0.09 and 0.33 ± 0.10 cm, respectively, with perfusion significantly decreased from 213.64 ± 14.97 to 112.23 ± 8.18 at 6 months (p < 0.0001). The wound edge flattened out during the first 3 months in most cases with only two scar relapses. Conclusions Zhang's suture technique provides a rapid and long-lasting tension-relieving effect with ideal scar appearances and lower relapse rates in the surgical management of PS.
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Affiliation(s)
| | | | - Dorsa Gholamali Sinaki
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, 639 ZhiZaoJu Road, Huangpu District, Shanghai, 200011, China
| | - Ping Yao
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, 168 Shangtang Road, Xiacheng District, Hangzhou, 310000, Zhejiang, China
| | - Fuhua Hu
- Department of Plastic Surgery, Hangzhou Plastic Surgery Hospital, 168 Shangtang Road, Xiacheng District, Hangzhou, 310000, Zhejiang, China
| | - Xin Wang
- Department of Plastic and Reconstructive Surgery, Ningbo Sixth Hospital, 1059 East Zhongshan Road, Yinzhou District, Ningbo, 315040, Zhejiang, China
| | - Danya Zhou
- Department of Plastic and Reconstructive Surgery, Ningbo Sixth Hospital, 1059 East Zhongshan Road, Yinzhou District, Ningbo, 315040, Zhejiang, China
| | - Jun Chai
- Correspondence. Jun Chai, ; Yixin Zhang,
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Obaidi N, Keenan C, Chan RK. Burn Scar Management and Reconstructive Surgery. Surg Clin North Am 2023; 103:515-527. [PMID: 37149387 DOI: 10.1016/j.suc.2023.01.012] [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: 05/08/2023]
Abstract
This chapter highlights the importance of a comprehensive burn scar treatment plan in approaching a burn survivor. General concepts of burn scar physiology and a practical system to describe burn scars based on cause, biology, and symptoms are presented. Common scar management modalities including nonsurgical, surgical, and adjuvant therapies are further discussed.
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Affiliation(s)
- Noor Obaidi
- The Metis Foundation, 84 NorthEast 410 Loop, STE 325, San Antonio, TX 78216, USA
| | - Corey Keenan
- The Metis Foundation, 84 NorthEast 410 Loop, STE 325, San Antonio, TX 78216, USA
| | - Rodney K Chan
- The Metis Foundation, 84 NorthEast 410 Loop, STE 325, San Antonio, TX 78216, USA; United States Army Institute of Surgical Research, Fort Sam Houston, TX, USA.
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Weisberger JS, Park JB, Cortes R, Pizzo D, Van Kouwenberg EA, Agag RL, Sinkin JC. Reconstruction of Acquired Defects of the External Genitalia: A 24-Patient, Single-Institution Experience. Ann Plast Surg 2023; 90:S578-S582. [PMID: 37399482 DOI: 10.1097/sap.0000000000003501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
PURPOSE Patients undergoing resection of the external genitalia are often faced with significant deformity and decreased quality of life. Plastic surgeons are tasked with the challenge of reconstructing these defects to minimize morbidity and increase patients' quality of life. The authors have set out to investigate the efficacy of local fasciocutaneous and pedicled perforator flaps in external genital reconstruction. METHODS A retrospective review was conducted of all patients undergoing reconstruction of acquired defects of the external genitalia from 2017 to 2021. In total, 24 patients met inclusion criteria for the study. Patients were allocated into 2 cohorts: patients with defects reconstructed using local fasciocutaneous flaps (FF) versus patients with defects reconstructed using pedicled islandized perforator flaps (PF). Comorbid conditions, ablative procedures, operative times, flap size, and complications were compared across all groups. Fisher exact test was used to analyze differences in comorbidities, while independent t tests were used to analyze age, body mass index, operative time, and flap size. Significance was set at P < 0.05. RESULTS Of the 24 patients included in the study, 6 underwent reconstruction with islandized PFs (either profunda artery perforator or anterolateral thigh), and 18 underwent reconstruction with FFs. The most common indication for reconstruction was vulvectomy for vulvar cancer, followed by radical debridement for infection, and lastly penectomy for penile cancer. The PF cohort had a significantly higher percentage of previously irradiated patients (50% vs 11.1%, P = 0.019). Although mean flap size was larger in the PF cohort, this difference did not reach statistical significance (176 vs 143.4 cm2, P = 0.5). Perforator flaps had significantly longer operative times when compared with FFs (237.33 vs 128.99 minutes, P = 0.003). Average length of stay was 6.88 days in FF and 5.33 days in PF (P = 0.624). Complication profile including flap necrosis, wound healing delays, and infection were similar between groups despite a significantly higher rate of prior radiation in the PF cohort. CONCLUSIONS Our data suggest that PFs such as profunda artery perforator and anterolateral thigh flaps are associated with longer operative times but may offer a suitable option for reconstruction of acquired defects of the external genital compared with local FFs, especially in the setting of prior radiation.
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Affiliation(s)
- Joseph S Weisberger
- From the Division of Plastic Surgery, Rutgers-New JerseyMedical School, Newark
| | - John B Park
- Division of Plastic Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Ricardo Cortes
- From the Division of Plastic Surgery, Rutgers-New JerseyMedical School, Newark
| | - Dane Pizzo
- Division of Plastic Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Emily A Van Kouwenberg
- Division of Plastic Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Richard L Agag
- Division of Plastic Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jeremy C Sinkin
- Division of Plastic Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ
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Nagle M, Price S, Trotta A, Destrade M, Fop M, Ní Annaidh A. Analysis of In Vivo Skin Anisotropy Using Elastic Wave Measurements and Bayesian Modelling. Ann Biomed Eng 2023:10.1007/s10439-023-03185-2. [PMID: 37022652 DOI: 10.1007/s10439-023-03185-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 03/13/2023] [Indexed: 04/07/2023]
Abstract
In vivo skin exhibits viscoelastic, hyper-elastic and non-linear characteristics. It is under a constant state of non-equibiaxial tension in its natural configuration and is reinforced with oriented collagen fibers, which gives rise to anisotropic behaviour. Understanding the complex mechanical behaviour of skin has relevance across many sectors including pharmaceuticals, cosmetics and surgery. However, there is a dearth of quality data characterizing the anisotropy of human skin in vivo. The data available in the literature is usually confined to limited population groups and/or limited angular resolution. Here, we used the speed of elastic waves travelling through the skin to obtain measurements from 78 volunteers ranging in age from 3 to 93 years old. Using a Bayesian framework allowed us to analyse the effect that age, gender and level of skin tension have on the skin anisotropy and stiffness. First, we propose a new measurement of anisotropy based on the eccentricity of angular data and conclude that it is a more robust measurement when compared to the classic "anisotropic ratio". Our analysis then concluded that in vivo skin anisotropy increases logarithmically with age, while the skin stiffness increases linearly along the direction of Langer Lines. We also concluded that the gender does not significantly affect the level of skin anisotropy, but it does affect the overall stiffness, with males having stiffer skin on average. Finally, we found that the level of skin tension significantly affects both the anisotropy and stiffness measurements employed here. This indicates that elastic wave measurements may have promising applications in the determination of in vivo skin tension. In contrast to earlier studies, these results represent a comprehensive assessment of the variation of skin anisotropy with age and gender using a sizeable dataset and robust modern statistical analysis. This data has implications for the planning of surgical procedures and questions the adoption of universal cosmetic surgery practices for very young or elderly patients.
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Affiliation(s)
- Matt Nagle
- SFI Centre for Research Training in Foundations of Data Science, University College Dublin, Belfield, Dublin 4, Ireland.
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Susan Price
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - Antonia Trotta
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
| | - Michel Destrade
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
- School of Mathematical and Statistical Sciences, University of Galway, Galway, Ireland
| | - Michael Fop
- School of Mathematics and Statistics, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Aisling Ní Annaidh
- School of Mechanical and Materials Engineering, University College Dublin, Belfield, Dublin 4, Ireland
- Charles Institute of Dermatology, University College Dublin, Belfield, Dublin 4, Ireland
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36
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Elouneg A, Chambert J, Lejeune A, Lucot Q, Jacquet E, Bordas SPA. Anisotropic mechanical characterization of human skin by in vivo multi-axial ring suction test. J Mech Behav Biomed Mater 2023; 141:105779. [PMID: 36940583 DOI: 10.1016/j.jmbbm.2023.105779] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 02/10/2023] [Accepted: 03/12/2023] [Indexed: 03/17/2023]
Abstract
Human skin is a soft tissue behaving as an anisotropic material. The anisotropy emerges from the alignment of collagen fibers in the dermis, which causes the skin to exhibit greater stiffness in a certain direction, known as Langer's line. The importance of determining this anisotropy axis lies in assisting surgeons in making incisions that do not produce undesirable scars. In this paper, we introduce an open-source numerical framework, MARSAC (Multi-Axial Ring Suction for Anisotropy Characterization: https://github.com/aflahelouneg/MARSAC), adapted to a commercial device CutiScan CS 100® that applies a suction load on an annular section, causing a multi-axial stretch in the central zone, where in-plane displacements are captured by a camera. The presented framework receives inputs from a video file and converts them into displacement fields through Digital Image Correlation (DIC) technique. From the latter and based on an analytical model, the method assesses the anisotropic material parameters of human skin: Langer's line ϕ, and the elastic moduli E1 and E2 along the principal axes, providing that the Poisson's ratio is fixed. The pipeline was applied to a public data repository, https://search-data.ubfc.fr/femto/FR-18008901306731-2021-08-25_In-vivo-skin-anisotropy-dataset-for-a-young-man.html, containing 30 test series performed on a forearm of a Caucasian subject. As a result, the identified parameter averages, ϕˆ=40.9±8.2∘ and the anisotropy ratio E1ˆ/E2ˆ=3.14±1.60, were in accordance with the literature. The intra-subject analysis showed a reliable assessment of ϕ and E2. As skin anisotropy varies from site to site and from subject to subject, the novelty of the method consists in (i) an optimal utilization of CutiScan CS 100® probe to measure the Langer's line accurately and rapidly on small areas with a minimum diameter of 14mm, (ii) validation of an analytical model based on deformation ellipticity.
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Affiliation(s)
- A Elouneg
- Université de Franche-Comté, CNRS, institut FEMTO-ST, F-25000 Besançon, France; Institute of Computational Engineering and Sciences, Department of Engineering, Université du Luxembourg, Esch-sur-Alzette, Luxembourg
| | - J Chambert
- Université de Franche-Comté, CNRS, institut FEMTO-ST, F-25000 Besançon, France
| | - A Lejeune
- Université de Franche-Comté, CNRS, institut FEMTO-ST, F-25000 Besançon, France
| | - Q Lucot
- Université de Franche-Comté, CNRS, institut FEMTO-ST, F-25000 Besançon, France
| | - E Jacquet
- Université de Franche-Comté, CNRS, institut FEMTO-ST, F-25000 Besançon, France
| | - S P A Bordas
- Université de Franche-Comté, CNRS, institut FEMTO-ST, F-25000 Besançon, France; Institute of Computational Engineering and Sciences, Department of Engineering, Université du Luxembourg, Esch-sur-Alzette, Luxembourg.
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Postabdominoplasty Scar Improvement after a Single Session with an Automated 1210-nm Laser. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e4866. [PMID: 36910728 PMCID: PMC10005831 DOI: 10.1097/gox.0000000000004866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/24/2023] [Indexed: 03/12/2023]
Abstract
Abdominoplasty, one of the most commonly performed aesthetic procedures, aims at correcting excess abdominal skin and fat, but generates a long abdominal scar. The efficacy of an automated portative 1210-nm laser in improving the appearance of surgical scars has been previously demonstrated in a double-blind randomized controlled trial. The purpose of this work was to document the use of this laser in real-life practice. Methods Eighteen patients undergoing abdominoplasty and treated with the evaluated laser (UrgoTouch, Laboratoires Urgo; one single session immediately after the surgery) were included in this prospective, mono-center, observational study. Change in scar characteristics was assessed using the validated Observer Scar Assessment Scale, and the patients' and surgeon's satisfaction was rated using a four-point scale. Results The aesthetic outcome of the scars was very positive with a mean Observer Scar Assessment Scale score of 17.0 (SD 4.6) and 14.4 (SD 3.8) on the 6-60 point scale (60: the worst possible outcome) at 6 and 12 months, respectively. A high degree of satisfaction was also expressed by both surgeon and patients at 6 weeks, 6 months, and 12 months. No laser-related incident was reported during the study, including in patients with darker phototypes. Conclusions These findings seem to be consistent with previous clinical evidence on the use of this laser on fresh incisions. The high degree of satisfaction reported by both surgeon and patients seems to comfort the benefits of this procedure at short- and long-term and support the use of this laser in daily practice of plastic surgery.
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Dolivo DM, Sun LS, Rodrigues AE, Galiano RD, Mustoe TA, Hong SJ. Epidermal Potentiation of Dermal Fibrosis: Lessons from Occlusion and Mucosal Healing. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:510-519. [PMID: 36740181 DOI: 10.1016/j.ajpath.2023.01.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023]
Abstract
Fibrotic skin conditions, such as hypertrophic and keloid scars, frequently result from injury to the skin and as sequelae to surgical procedures. The development of skin fibrosis may lead to patient discomfort, limitation in range of motion, and cosmetic disfigurement. Despite the frequency of skin fibrosis, treatments that seek to address the root causes of fibrosis are lacking. Much research into fibrotic pathophysiology has focused on dermal pathology, but less research has been performed to understand aberrations in fibrotic epidermis, leading to an incomplete understanding of dermal fibrosis. The literature on occlusion, a treatment modality known to reduce dermal fibrosis, in part through accelerating wound healing and regulating aberrant epidermal inflammation that otherwise drives fibrosis in the dermis, is reviewed. There is a focus on epidermal-dermal crosstalk, which contributes to the development and maintenance of dermal fibrosis, an underemphasized interplay that may yield novel strategies for treatment if understood in more detail.
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Affiliation(s)
- David M Dolivo
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lauren S Sun
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Adrian E Rodrigues
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Robert D Galiano
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Thomas A Mustoe
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Seok Jong Hong
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Changes in Lacrimal Punctum Position and Tear Meniscus Height after Correction of Horizontal Laxity in Involutional Lower Eyelid Entropion. J Ophthalmol 2023; 2023:4113151. [PMID: 36703702 PMCID: PMC9873414 DOI: 10.1155/2023/4113151] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/31/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
Purpose To examine changes in the position of the lower eyelid punctum and tear meniscus height (TMH) after correction of horizontal laxity of the lower eyelid in involutional lower eyelid entropion. Methods This prospective, observational study included 42 sides of 36 patients with involutional entropion who underwent a lateral tarsal strip procedure or transcanthal canthopexy (+ lower eyelid retractor advancement). The horizontal distance from the medial margin of the lower lacrimal punctum to the medial canthus was measured using ImageJ software. TMH was measured using anterior segment optical coherence tomography. All measurements were performed preoperatively, at postoperative 3-month and at postoperative 6-month. Results The lower lacrimal punctum significantly shifted laterally at 3-month follow-up and slightly returned toward its original position at 6-month follow-up (Friedman's test, P < 0.001). Although the differences did not reach statistical significance, TMH in the lower eyelid increased at 3-month follow-up and then slightly decreased at 6-month follow-up (Friedman's test, P = 0.076). Conclusions The results of this study imply that lateral shift of the lower lacrimal punctum prevents effective drainage of tears accumulated in the lacrimal lake, resulting in increased TMH after correction of horizontal laxity of the lower eyelid in involutional entropion.
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40
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Prognostic Analysis of Skin Scar Loosening and Tissue-Expansive Autologous Skin Grafting in the Treatment of Skin Postburn Scars. J Craniofac Surg 2022:00001665-990000000-00509. [DOI: 10.1097/scs.0000000000009149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/11/2022] [Indexed: 12/23/2022] Open
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41
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Xu S, Yang Z, Guo Q, Zou W, Liu S, Gao Q, Wu M, An X, Han Y. Surgical Steps of Gasless Transaxillary Endoscopic Thyroidectomy: From A to Z. JOURNAL OF ONCOLOGY 2022; 2022:2037400. [PMID: 36536786 PMCID: PMC9759389 DOI: 10.1155/2022/2037400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 08/29/2023]
Abstract
In the past 30 years, the incidence of differentiated thyroid cancer (DTC) has been increasing rapidly and has become one of the most common malignant tumors in females. Currently, the main surgical treatment for DTC is standard open thyroidectomy (SOT) via a traditional Kocher mid-cervical incision, but postoperative neck scarring was associated with significantly worse health-related quality of life (HRQOL) scores. To offer better cosmesis, robotic/endoscopic thyroidectomy via cervical, axillary, anterior chest, breast, postauricular, or transoral approaches have been developed over the past 20 years. In general, gasless transaxillary endoscopic thyroidectomy (GTET) has advantages in terms of convenience, clarity of vision, and aesthetic incision. The current work aims to provide a step-by-step description of GTET, supported by a high-quality, pictorial guide.
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Affiliation(s)
- Shujian Xu
- Department of Thyroid Surgery, Binzhou Medical University Hospital, No. 661 Huangheer Road, Bincheng District, Binzhou 256603, China
| | - Zhenlin Yang
- Department of Thyroid Surgery, Binzhou Medical University Hospital, No. 661 Huangheer Road, Bincheng District, Binzhou 256603, China
| | - Qingqun Guo
- Department of Thyroid Surgery, Binzhou Medical University Hospital, No. 661 Huangheer Road, Bincheng District, Binzhou 256603, China
| | - Weiwei Zou
- Department of Thyroid Surgery, Binzhou Medical University Hospital, No. 661 Huangheer Road, Bincheng District, Binzhou 256603, China
| | - Song Liu
- Department of Thyroid Surgery, Binzhou Medical University Hospital, No. 661 Huangheer Road, Bincheng District, Binzhou 256603, China
| | - Qiang Gao
- Department of Thyroid Surgery, Binzhou Medical University Hospital, No. 661 Huangheer Road, Bincheng District, Binzhou 256603, China
| | - Mengmeng Wu
- Department of Thyroid Surgery, Binzhou Medical University Hospital, No. 661 Huangheer Road, Bincheng District, Binzhou 256603, China
| | - Xingguo An
- Department of Thyroid Surgery, Binzhou Medical University Hospital, No. 661 Huangheer Road, Bincheng District, Binzhou 256603, China
| | - Yong Han
- Department of Thyroid Surgery, Binzhou Medical University Hospital, No. 661 Huangheer Road, Bincheng District, Binzhou 256603, China
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Wan WD, Lu C, yuan YX, Hu JJ, Liang J, He CY, Huang YQ, Su T, Guo F, Jiang CH, Li N. Lateral approach is a more aesthetical option for radical resection of BSCC: assessment of its surgical, oncological, functional, and aesthetic outcomes. BMC Oral Health 2022; 22:464. [PMID: 36329463 PMCID: PMC9632109 DOI: 10.1186/s12903-022-02519-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022] Open
Abstract
Background The purpose of this study was to introduce a modified lateral approach for combined radical resection of buccal squamous cell carcinoma (BSCC) and evaluate its surgical, oncological, functional, and aesthetic outcomes in comparison with the conventional lower-lip splitting approach. Methods This single-center study retrospectively reviewed 80 patients with BSCC, of which 37 underwent the lateral approach and 43 underwent the conventional approach. Surgical, functional, oncological, and aesthetic evaluations, as well as follow-ups, were recorded and compared. Results Compared to the conventional approach group, the lateral approach group had a longer surgical time (P = 0.000), but there was no significant difference in other surgical and oncological parameters. Moreover, the scar in the head and neck had a significantly discreet appearance in the lateral approach group, whose satisfaction was better than those in the conventional approach group (P = 0.000). Other oral function parameters, postoperative mouth-opening, and 3-year survival rate were not significantly different between the two groups. Conclusion The lateral approach could provide superior aesthetic results while maintaining equal surgical, functional, and oncological outcomes compared to the conventional approach for radical resection of BSCC. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02519-1.
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Miyake S, Izaki T, Arashiro Y, Kobayashi S, Shibata Y, Shibata T, Yamamoto T. Excessively High Repair Tension Decreases Microvascular Blood Flow Within the Rotator Cuff. Am J Sports Med 2022; 50:3643-3648. [PMID: 36263917 DOI: 10.1177/03635465221125939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Repair tension and microvascular blood flow within the rotator cuff has a critical impact on tendon healing after rotator cuff repair. However, the relationship between repair tension and microvascular blood flow within the rotator cuff remains unclear. PURPOSE/HYPOTHESIS The purpose of this study was to determine how much tension adversely affects microvascular blood flow within the rotator cuff. The hypothesis was that as the repair tension increases, the microvascular blood flow within the rotator cuff decreases. STUDY DESIGN Controlled laboratory study. METHODS Repair tension and microvascular blood flow within the rotator cuff of 30 patients with full-thickness rotator cuff tears were simultaneously measured using a digital tension meter and a contact-type laser Doppler flowmeter, respectively. Microvascular blood flow was measured under 4 levels of tension (0, 10, 20, and 30 N) at 5 points on the rotator cuff. The obtained values were statistically analyzed by a linear mixed-effects model to clarify the effect of tension on microvascular blood flow within the rotator cuff. RESULTS There was no statistically significant difference in microvascular blood flow (mL/min/100 g) within the rotator cuff between 0 N (mean, 3.51; 95% CI, 3.0-4.0) and 10 N (mean, 3.74; 95% CI, 3.2-4.3) of tension (P = .716). However, there were statistically significant differences in microvascular blood flow within the rotator cuff between 0 and 20 N of tension (mean, 2.84; 95% CI, 2.3-3.4) (P = .002) and between 0 and 30 N of tension (mean, 2.45; 95% CI, 1.9-3.0) (P < .001). CONCLUSION/CLINICAL RELEVANCE Our findings indicate that tension of ≥10 N during rotator cuff repair significantly decreases the microvascular blood flow within the rotator cuff. These data will contribute to determining the optimal repair tension during rotator cuff repair.
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Affiliation(s)
- Satoshi Miyake
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Teruaki Izaki
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yasuhara Arashiro
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Shunsuke Kobayashi
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
| | - Yozo Shibata
- Department of Orthopedic Surgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Terufumi Shibata
- Department of Orthopedic Surgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Takuaki Yamamoto
- Department of Orthopedic Surgery, Fukuoka University Faculty of Medicine, Fukuoka, Japan
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Zhang J, Han P, Yuan H, Tang Y, Xiao X. Clinical application of absorbable collagen thread and cosmetic suture technique in emergency treatment of children's facial trauma. J Paediatr Child Health 2022; 58:2039-2043. [PMID: 35924762 DOI: 10.1111/jpc.16147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 07/19/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022]
Abstract
AIM To explore the effect of absorbable collagen thread and cosmetic suture technique on scar inhibition after emergency facial trauma in children, and to explore the application value of absorbable collagen thread in emergency facial trauma. METHODS Children who received emergency treatment of facial trauma in plastic surgery department from January 2021 to January 2022 were analysed retrospectively, and were divided into absorbable collagen thread group and non-absorbable nylon thread group. The general data, scar appearance and local symptoms of the two groups were analysed, and the scar appearance was scored by scar beauty rating scale and non-inferiority test was analysed statistically. RESULTS A total of 632 children with facial trauma were included in this study, including 458 patients with absorbable collagen thread and 174 patients with non-absorbable nylon thread. The SCAR score of the absorbable collagen thread group (3.03 ± 1.57) was similar to that of the non-absorbable nylon thread group (2.98 ± 2.39) (95% confidence interval), and the final scar outcome score was not statistically different (P > 0.05). All families of the patients were satisfied with the results of the procedure, 95% very satisfied. CONCLUSION The use of absorbable collagen thread and cosmetic suture technique to treat the wounds of children with facial emergency trauma, resulted in good wound healing, little scar expansion, low incidence of erythema and pigment abnormality, no obvious surgical trace, and no scar hypertrophy or atrophy. The overall impression was good, the pain of stitch removal was avoided for children's patients, and the satisfaction of family members was high. Cosmetic suture technique with absorbable sutures is worthy of clinical application.
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Affiliation(s)
- Jianfei Zhang
- Burn and Plastic Surgery Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Pengpeng Han
- Burn and Plastic Surgery Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Hui Yuan
- Burn and Plastic Surgery Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Yujun Tang
- Burn and Plastic Surgery Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Xia Xiao
- Burn and Plastic Surgery Department, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
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Xu Z, Zhou T, Wang Y, Zhu L, Tu J, Xu Z, Li L, Li Y. Integrated PPI- and WGCNA-retrieval of hub gene signatures for soft substrates inhibition of human fibroblasts proliferation and differentiation. Aging (Albany NY) 2022; 14:6957-6974. [PMID: 36057261 PMCID: PMC9512501 DOI: 10.18632/aging.204258] [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: 05/13/2022] [Accepted: 08/23/2022] [Indexed: 11/25/2022]
Abstract
Fibroblasts (FBs) are the most important functional cells in the process of wound repair, and their functions can be activated by different signals at the pathological site. Although wound repair is associated with microenvironmental stiffness, the effect of matrix stiffness on FBs remains elusive. In this study, TGF-β1 was used to mimic the fibrotic environment under pathological conditions. We found that the soft substrates made FBs slender compared with tissue culture plastic, and the main altered biological function was the inhibition of proliferation and differentiation ability. Through PPI and WGCNA analysis, 63 hub genes were found, including GADD45A, CDKN3, HIST2H3PS2, ACTB, etc., which may be the main targets of soft substrates affecting the proliferation and differentiation of FBs. Our findings not only provide a more detailed report on the effect of matrix stiffness on the function of human skin FBs, but also may provide new intervention ideas for improving scars and other diseases caused by excessive cell proliferation, with potential clinical application prospects.
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Affiliation(s)
- Ziran Xu
- The Key Laboratory of Pathobiology, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
| | - Tian Zhou
- The First Norman Bethune Clinical Medical College, Jilin University, Changchun 130021, China
| | - Yin Wang
- The Key Laboratory of Pathobiology, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
| | - Leijie Zhu
- The Third Norman Bethune Clinical Medical College, Jilin University, Changchun 130021, China
| | - Jihao Tu
- Department of Hand and Foot Surgery, The First Hospital of Jilin University, Changchun 130021, China
| | - Zhixiang Xu
- The Key Laboratory of Pathobiology, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
| | - Lisha Li
- The Key Laboratory of Pathobiology, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
| | - Yulin Li
- The Key Laboratory of Pathobiology, Ministry of Education, College of Basic Medical Sciences, Jilin University, Changchun 130021, China
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Allen BN, Wang Q, Filali Y, Worthington KS, Kacmarynski DSF. Full-Thickness Oral Mucoperiosteal Defects: Challenges and Opportunities. TISSUE ENGINEERING. PART B, REVIEWS 2022; 28:813-829. [PMID: 34409870 PMCID: PMC9469748 DOI: 10.1089/ten.teb.2021.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/10/2021] [Indexed: 11/12/2022]
Abstract
Regenerative engineering strategies for the oral mucoperiosteum, as may be needed following surgeries, such as cleft palate repair and tumor resection, are underdeveloped compared with those for maxillofacial bone. However, critical-size tissue defects left to heal by secondary intention can lead to complications, such as infection, fistula formation, scarring, and midface hypoplasia. This review describes current clinical practice for replacing mucoperiosteal tissue, including autografts and allografts. Potentially paradigm-shifting experimental regenerative engineering strategies for mucoperiosteal wound healing, such as hybrid grafts and engineered matrices, are also discussed. Throughout the review, the advantages and disadvantages of each replacement or regeneration strategy are outlined in the context of clinical outcomes, quality of life for the patient, availability of materials, and cost of care. Finally, future directions for research and development in the area of mucoperiosteum repair are proposed, with an emphasis on identifying globally available and affordable solutions for promoting mucoperiosteal regeneration. Impact statement Unassisted oral mucoperiosteal wound healing can lead to severe complications such as infection, fistulae, scarring, and developmental abnormalities. Thus, strategies for promoting wound healing must be considered when mucoperiosteal defects are incident to oral surgery, as in palatoplasty or tumor resection. Emerging mucoperiosteal tissue engineering strategies, described in this study, have the potential to overcome the limitations of current standard-of-care donor tissue grafts. For example, the use of engineered mucoperiosteal biomaterials could circumvent concerns about tissue availability and immunogenicity. Moreover, employment of tissue engineering strategies may improve the equity of oral wound care by increasing global affordability and accessibility of materials.
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Affiliation(s)
- Brittany N Allen
- Roy J. Carver Department of Biomedical Engineering, College of Engineering, The University of Iowa, Iowa City, Iowa, USA
| | - Qi Wang
- Roy J. Carver Department of Biomedical Engineering, College of Engineering, The University of Iowa, Iowa City, Iowa, USA
| | - Yassine Filali
- Roy J. Carver Department of Biomedical Engineering, College of Engineering, The University of Iowa, Iowa City, Iowa, USA
| | - Kristan S Worthington
- Roy J. Carver Department of Biomedical Engineering, College of Engineering, The University of Iowa, Iowa City, Iowa, USA
| | - Deborah S F Kacmarynski
- Department of Otolaryngology - Head and Neck Surgery, Carver College of Medicine, The University of Iowa, Iowa City, Iowa, USA
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Parikh UM, Mentz J, Collier I, Davis MJ, Abu-Ghname A, Colchado D, Short WD, King A, Buchanan EP, Balaji S. Strategies to Minimize Surgical Scarring: Translation of Lessons Learned from Bedside to Bench and Back. Adv Wound Care (New Rochelle) 2022; 11:311-329. [PMID: 34416825 DOI: 10.1089/wound.2021.0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Significance: An understanding of the physiology of wound healing and scarring is necessary to minimize surgical scar formation. By reducing tension across the healing wound, eliminating excess inflammation and infection, and encouraging perfusion to healing areas, surgeons can support healing and minimize scarring. Recent Advances: Preoperatively, newer techniques focused on incision placement to minimize tension, skin sterilization to minimize infection and inflammation, and control of comorbid factors to promote a healing process with minimal scarring are constantly evolving. Intraoperatively, measures like layered closure, undermining, and tissue expansion can be taken to relieve tension across the healing wound. Appropriate suture technique and selection should be considered, and finally, there are new surgical technologies available to reduce tension across the closure. Postoperatively, the healing process can be supported as proliferation and remodeling take place within the wound. A balance of moisture control, tension reduction, and infection prevention can be achieved with dressings, ointments, and silicone. Vitamins and corticosteroids can also affect the scarring process by modulating the cellular factors involved in healing. Critical Issues: Healing with no or minimal scarring is the ultimate goal of wound healing research. Understanding how mechanical tension, inflammation and infection, and perfusion and hypoxia impact profibrotic pathways allows for the development of therapies that can modulate cytokine response and the wound extracellular microenvironment to reduce fibrosis and scarring. Future Directions: New tension-off loading topical treatments, laser, and dermabrasion devices are under development, and small molecule therapeutics have demonstrated scarless wound healing in animal models, providing a promising new direction for future research aimed to minimize surgical scarring.
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Affiliation(s)
- Umang M. Parikh
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - James Mentz
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Ian Collier
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Matthew J. Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Daniel Colchado
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Walker D. Short
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Alice King
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Edward P. Buchanan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Swathi Balaji
- Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
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Lee HR, Lee DH, Seok SY, Park S, Cho JH, Hwang CJ, Lee CS. What Type of Incision for Anterior Cervical Spine Surgery Involving Long Segments Can Bring Better Cosmetic and Functional Outcomes? Neurospine 2022; 19:412-421. [PMID: 35577336 PMCID: PMC9260544 DOI: 10.14245/ns.2143260.630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/02/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Hyung Rae Lee
- Department of Orthopedic Surgery, Uijeongbu Eulji Medical Center, Uijeongbu, Korea
| | - Dong-Ho Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Corresponding Author Dong-Ho Lee Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea
| | - Sang Yun Seok
- Department of Orthopedic Surgery, Daejeon Eulji Medical Center, Daejeon, Korea
| | - Sehan Park
- Department of Orthopedic Surgery, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Jae Hwan Cho
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chang Ju Hwang
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Choon Sung Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Li T, Zhang Z, Chen W, Yu S, Sun B, Deng X, Ge J, Wei Z, Lei S, Li G. Comparison of quality of life and cosmetic result between open and transaxillary endoscopic thyroid lobectomy for papillary thyroid microcarcinoma survivors: A single-center prospective cohort study. Cancer Med 2022; 11:4146-4156. [PMID: 35470574 DOI: 10.1002/cam4.4766] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 04/05/2022] [Accepted: 04/11/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Transaxillary endoscopic thyroidectomy has been introduced to achieve better cosmetic outcomes. However, the benefits of this technology on the patients' health-related quality of life (HRQoL) remain unclear. We aimed to investigate whether transaxillary endoscopic lobectomy is comparable to conventional open lobectomy in terms of QOL and cosmetic results in order to provide more evidence for establishing appropriate clinical decisions. METHODS Between August 2019 and May 2020, transaxillary endoscopic lobectomy and conventional open lobectomy were performed in 73 and 99 patients with papillary thyroid microcarcinoma, respectively. HRQoL was assessed at 1, 3, 6, and 12 months after surgery using the Thyroid Cancer-Specific Quality of Life Questionnaire. The cosmetic outcomes were assessed 12 months after surgery using the Patient and Observer Scar Assessment Scale (POSAS). RESULTS No significant difference was observed in the surgical results between the two groups. However, the data showed that the average operative time and postoperative hospital stay of the transaxillary group were longer than those of the open group (p < 0.001). Both groups showed similar changes in the QOL scores over time. However, the transaxillary group had fewer complaints of the throat or oral problems at 1 month postoperatively than the open group (p < 0.001). During the follow-up, the cosmetic results of scars in the transaxillary group were significantly better than those in the open group (p < 0.05). Patients who underwent transaxillary endoscopic lobectomy had higher overall satisfaction with their scar appearance, determined using POSAS, at 12 months postoperatively. CONCLUSIONS The current findings suggest that transaxillary endoscopic lobectomy may offer better cosmetic and HRQoL outcomes.
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Affiliation(s)
- Tingting Li
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhicheng Zhang
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Weisheng Chen
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Shitong Yu
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Baihui Sun
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiangqian Deng
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Junna Ge
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhigang Wei
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Shangtong Lei
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
| | - Guoxin Li
- Department of General Surgery & Guangdong Provincial Key Laboratory of Precision Medicine for Gastrointestinal Tumor, Nanfang Hospital, The First School of Clinical Medicine, Southern Medical University, Guangzhou, Guangdong, China
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Eichler C, Üner J, Thangarajah F, Radosa J, Zinser M, Fischer LA, Puppe J, Warm M, Malter W, Lenz C. Platelet-rich plasma (PRP) in oncological patients: long-term oncological outcome analysis of the treatment of subcutaneous venous access device scars in 89 breast cancer patients. Arch Gynecol Obstet 2022; 306:1171-1176. [PMID: 35377044 PMCID: PMC9470624 DOI: 10.1007/s00404-022-06416-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/20/2022] [Indexed: 11/11/2022]
Abstract
Purpose Platelet-rich plasma (PRP) is widely used product, and meta-analyses showed this product to be beneficial when applied to a wound area. This study group has already demonstrated increased patient satisfaction and lower complication rates in breast cancer patients who received PRP after removal of their subcutaneous venous access device. This work is a follow-up analysis focusing on oncologic safety. Currently, there is no long-term data on the use of PRP products in cancer patients available yet. Methods Between the years 2012–2016, venous access device removal was supported with the application of Arthrex ACP® (Autologous Conditioned Plasma)—a PRP product to improve the wound-healing process. All surgeries were performed in the breast cancer center of the municipal hospital of Cologne, Holweide, Germany. 35 patients received an application of Arthrex ACP® after port removal compared to the control group of 54 patients. Endpoints were local recurrence-free, distant recurrence-free as well as overall survival. Results Median follow-up was 45 months. No (0) adverse events were shown for cancer recurrence within the subcutaneous venous access device scar area. Thus, there seems to be no local oncogenic potential of the PRP product. All other endpoints as well as any-cause death numerically favor PRP use. Conclusion PRP products such as Arthrex ACP® seem to be oncological inert when applied after removal of subcutaneous access devices. This is the first study providing long-term data about overall survival, distant recurrence-free and local recurrence-free survival after applying PRP in high-risk cancer patients.
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Affiliation(s)
- Christian Eichler
- Breast Cancer Center, St. Franziskus Hospital Muenster, Muenster, Germany.,Department of Gynecology and Obstetrics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Jens Üner
- Department of Radiology, Municipal Hospital Holweide, Cologne, Germany
| | - Fabinshy Thangarajah
- Department of Gynecology and Obstetrics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Julia Radosa
- Department of Gynecology and Obstetrics, Obstetrics and Reproductive Medicine, Saarland University Hospital, Homburg, Germany
| | - Max Zinser
- Department of Craniomaxillofacial and Plastic Surgery, University of Cologne, Cologne, Germany
| | | | - Julian Puppe
- Department of Gynecology and Obstetrics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Matthias Warm
- Breast Cancer Center, Municipal Hospital Holweide, Cologne, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Caroline Lenz
- Department of Gynecology and Obstetrics, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
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