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Meretsky CR, Polychronis A, Schiuma AT. A Comparative Analysis of the Advances in Scar Reduction: Techniques, Technologies, and Efficacy in Plastic Surgery. Cureus 2024; 16:e66806. [PMID: 39268283 PMCID: PMC11392586 DOI: 10.7759/cureus.66806] [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: 08/13/2024] [Indexed: 09/15/2024] Open
Abstract
The study provides a comprehensive analysis of the latest methodologies and treatments aimed at improving scar management. Scar formation results from the replacement of normal skin with fibroblasts, leading to a structured unidirectional collagen bundle, as opposed to the collagen sheet matrix found in healthy skin. This review categorizes scars into hypertrophic scars and keloids, each with distinct pathophysiological characteristics. It highlights the importance of consistent scar assessment using scales such as the Vancouver Scar Scale and the Patient and Observer Scar Assessment Scale, emphasizing the need for standardized evaluation methods. The study systematically reviews various scar management techniques, ranging from traditional surgical methods to innovative treatments. Conventional approaches such as pressure garments and silicone gel sheeting are explored, noting their roles in maintaining hydration and occlusion. The efficacy of intralesional corticosteroid injections and laser therapies is discussed, with particular attention given to their combined use for optimal outcomes. The review also covers advanced techniques such as microneedling, platelet-rich plasma therapy, and stem cell-based treatments, detailing their mechanisms and potential benefits in scar remodelling. Additionally, the study underscores the emerging role of botulinum toxin A in both preventive and corrective scar treatments, offering promising results in reducing movement-induced scar exaggeration. The systematic review includes a thorough examination of existing literature, clinical trials, and meta-analyses to evaluate the effectiveness of these interventions. It concludes by calling for further research to refine these techniques and enhance their application in clinical practice, aiming to achieve better aesthetic and functional outcomes for patients with scars.
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Affiliation(s)
| | - Andreas Polychronis
- General Surgery, St. George's University School of Medicine, Great River, USA
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2
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Nilforoushzadeh MA, Heidari A, Ghane Y, Heidari N, Azizi H, Fakhim T, Shahverdi M, Rafiee S, Lotfi Z, Najar Nobari N. The Endo-lift Laser (Intralesional 1470 nm Diode Laser) for Dermatological Aesthetic Conditions: A Systematic Review. Aesthetic Plast Surg 2024:10.1007/s00266-024-04082-2. [PMID: 38886198 DOI: 10.1007/s00266-024-04082-2] [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: 12/21/2023] [Accepted: 04/09/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND The prominence of minimally invasive aesthetic approaches has become increasingly pivotal. The endo-lift laser method is an intralesional 1470 nm diode laser connected to a fiber that serves both therapeutic and aesthetic properties. We sought to evaluate the efficacy and safety of the endo-lift laser method for dermatological aesthetic applications. METHODS PubMed, Ovid-Embase, and Web of Science were systematically searched up to November 5th, 2023. A citation search was also performed. The National Institute of Health (NIH) Quality Assessment Tool was used to evaluate the quality of the studies. RESULTS Out of 339 articles, twenty-three relevant studies were included in the current review. Applying the endo-lift laser method for rejuvenation, including face and neck lifting, enhancing skin laxity, and disappearing wrinkles, folds, and lines, demonstrated favorable efficacy and safety profile. Moreover, most studies have shown that the endo-lift laser method is promising in eliminating the adipose tissue in the jowl, abdomen, thighs, and arms. The endo-lift laser technique was also efficacious in nose remodeling and blepharoplastic procedures, including treating eyelid and eyebrow ptosis, eye bag, eyebrow position, and eyelid laxity. Patients who suffer from several diseases, such as hidradenitis suppurativa, progressive lipodystrophy, acne vulgaris, scars, and keloids, benefit from procedural treatment with the endo-lift laser technique. Across all studies, the adverse events were mild and self-limiting. Investigating the endo-lift laser method in all aesthetic and therapeutic indications resulted in high patient satisfaction rates. CONCLUSION The endo-lift laser technique has therapeutic effects and is recommended for various dermatological aesthetic indications. Further clinical studies with control groups and larger sample sizes are needed to acquire more reliable evidence. LEVELS OF EVIDENCE III AND 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)
- Mohammad Ali Nilforoushzadeh
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Mirdamad, Nelson Mandela St. 1518963113, Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Heidari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Mirdamad, Nelson Mandela St. 1518963113, Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Yekta Ghane
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Mirdamad, Nelson Mandela St. 1518963113, Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazila Heidari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Mirdamad, Nelson Mandela St. 1518963113, Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Hanieh Azizi
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Mirdamad, Nelson Mandela St. 1518963113, Tehran, Iran
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Tannaz Fakhim
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Mirdamad, Nelson Mandela St. 1518963113, Tehran, Iran
| | - Mohammadhasan Shahverdi
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Mirdamad, Nelson Mandela St. 1518963113, Tehran, Iran
| | - Shohreh Rafiee
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Mirdamad, Nelson Mandela St. 1518963113, Tehran, Iran
| | - Zahra Lotfi
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Mirdamad, Nelson Mandela St. 1518963113, Tehran, Iran
| | - Niloufar Najar Nobari
- Skin Repair Research Center, Shahid Beheshti University of Medical Sciences, Ahmadi Alley, Mirdamad, Nelson Mandela St. 1518963113, Tehran, Iran.
- Skin and Stem Cell Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Vrinceanu D, Dumitru M, Marinescu A, Dorobat B, Palade OD, Manole F, Muresian H, Popa-Cherecheanu M, Ciornei CM. New Insights into Cervicofacial Vascular Anomalies. J Clin Med 2024; 13:3515. [PMID: 38930043 PMCID: PMC11205235 DOI: 10.3390/jcm13123515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/10/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Congenital cervicofacial vascular anomalies are extremely rare and present many difficulties in diagnosis and treatment requiring a multidisciplinary approach. Firstly, there is little consensus on this subject among head and neck specialists. There are two main types of vascular anomalies: vascular tumors and vascular malformations. Vascular malformations are also divided into malformations with slow blood flow (veins, lymphatics, capillaries or combined) and malformations with a fast blood flow (arteriovenous malformations and fistula). Vascular tumors like hemangiomas are known for their spontaneous involution with aging, while vascular malformations grow in dimensions with age. It is very important to choose the correct differential diagnosis between cervicofacial hemangiomas and vascular malformations for proper therapy management. Anamnesis and clinical exams help in raising suspicions about the real nature of a cervico-vascular anomaly. Furthermore, imaging brings in-depth details of the anomaly, ranging from ultrasound and contrast CT to MRI scanning and minimally invasive angiography. Angiography with selective embolization is rarely a curative procedure for arteriovenous malformations, being more suitable as a preliminary step before attempted surgical removal. Surgery is clearly necessary when there are aesthetic and functional deficits. Slow-flow vascular malformations present a reduced morbidity, and in cases without involution, the surgical ablation is reserved for the cases with aesthetic dysfunctions or psychological trauma. Lymphatic malformations must undergo surgical ablation when they are associated with mass effects and compression of great vessels or aerial viscera. The prognosis after surgical removal is good, with a low rate of recurrence or morbidity. Fast-flow vascular malformations require a combined approach, with embolization and excision in the next 48 h for safety reasons. Removal may be followed by reconstructive surgery depending on the location and dimensions of the malformation, with a possible secondary recovery of the normal microscopic vessels. Some of the masses may hinder the normal airflow and swallowing. Pathology is the gold standard for confirming the clinical and imaging diagnosis.
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Affiliation(s)
- Daniela Vrinceanu
- ENT Department, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania
| | - Mihai Dumitru
- ENT Department, Carol Davila University of Medicine and Pharmacy, 050472 Bucharest, Romania
| | - Andreea Marinescu
- Radiology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Bogdan Dorobat
- Radiology Department, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Octavian Dragos Palade
- Surgical Department, Faculty of Medicine, University of Medicine and Pharmacy "Grigore T. Popa", 700115 Iasi, Romania
| | - Felicia Manole
- ENT Department, Faculty of Medicine, University of Oradea, 410073 Oradea, Romania
| | - Horia Muresian
- Vascular Surgery Department, Bucharest University Emergency Hospital, 050098 Bucharest, Romania
| | - Matei Popa-Cherecheanu
- Department of Cardiovascular Surgery, Carol Davila University of Medicine and Pharmacy, 011356 Bucharest, Romania
| | - Cătălina Mariana Ciornei
- Department of Physiology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
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Magalhães R, Louro M, Forny D, Sá Á, Franco D. Congenital midline cervical cleft: Management of a case series and literature review. J Plast Reconstr Aesthet Surg 2024; 93:117-126. [PMID: 38688177 DOI: 10.1016/j.bjps.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 02/02/2024] [Accepted: 04/05/2024] [Indexed: 05/02/2024]
Abstract
Congenital midline cervical cleft is a rare anomaly classified as a malformation of the branchial arches and represents less than 2% of congenital cervical malformations. Its clinical presentation involves cervical midline deformities: cephalic nodular lesion, linear groove with atrophic surface, and/or caudal sinus. Other midline alterations of variable complexity may also be present. Early treatment allows for avoiding long-term complications. Based on our experience in four clinical cases, a performed literature search on the topic in the last twenty years, and subsequent discussion of the employed surgical approaches, we included 150 reported cases in our review. Correct diagnosis and early treatment with complete removal of the fibrous midline band is paramount to avoid patient complaints until adolescence or adulthood.
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Affiliation(s)
- Raquel Magalhães
- Plastic Surgeon of Brazilian Society of Plastic Surgery, Brazil.
| | - Marcos Louro
- Plastic Surgery Residency Program, Clementino Fraga Filho University Hospital (HUCFF), Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Danielle Forny
- Department of Pediatric Surgery, Martagão Gesteira Pediatric Institute (IPPMG), Federal UFRJ, Brazil
| | - Álvaro Sá
- Plastic Surgeon of Brazilian Society of Plastic Surgery, Brazil
| | - Diogo Franco
- Department of Surgery - Plastic Surgery Section, Clementino Fraga Filho University Hospital (HUCFF), Federal UFRJ, Rio de Janeiro, Brazil
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Sangha MS, Deroide F, Meys R. Wound healing, scarring and management. Clin Exp Dermatol 2024; 49:325-336. [PMID: 38001053 DOI: 10.1093/ced/llad410] [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: 02/02/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023]
Abstract
Understanding wound healing is imperative for the dermatological physician to optimize surgical outcomes. Poor healing may result in negative functional, cosmetic and psychological sequelae. This review briefly outlines the physiology of wound healing, with a view to improving the management of wounds and scars, and minimizing the long-term scarring complications.
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Affiliation(s)
| | - Florence Deroide
- Department of Dermatology, Royal Free London NHS Foundation Trust, London, UK
| | - Rhonda Meys
- Department of Dermatology, Royal Free London NHS Foundation Trust, London, UK
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6
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Lin J, Wang X. Effects of botulinum toxin type A in the prevention and treatment of facial hypertrophic scars: A meta-analysis. Int Wound J 2024; 21:e14796. [PMID: 38494191 PMCID: PMC10944687 DOI: 10.1111/iwj.14796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/04/2024] [Indexed: 03/19/2024] Open
Abstract
A meta-analysis was conducted to comprehensively evaluate the prophylactic and therapeutic efficacy of botulinum toxin type A (BTX-A) in the treatment of facial hypertrophic scars. Computerised searches were performed in databases, from their inception to November 2023, including Embase, Google Scholar, Cochrane Library, Wanfang, PubMed and China National Knowledge Infrastructure databases, focusing on randomised controlled trials (RCTs) that investigated the use of BTX-A for treating facial hypertrophic scars. Two researchers independently screened the literature, extracted data and conducted quality assessments. Stata 17.0 software was employed for data analysis. Seventeen RCTs were ultimately included, involving 1605 patients who underwent facial cosmetic surgery. The analysis revealed that compared with conventional treatments, BTX-A significantly reduced visual analogue scale (VAS) scores (standardized mean difference [SMD]: -3.50, 95% confidence interval [CI]: -5.16 to -1.84, p < 0.001) and Vancouver scar scale (VSS) scores (SMD: -2.86, 95% CI: -4.03 to -1.68, p < 0.001), and narrowed scar width (SMD: -1.80, 95% CI: -2.48 to -1.13, p < 0.001), while also enhancing the overall effectiveness of the treatment. This study indicates that BTX-A is an effective modality in the prophylaxis and treatment of facial hypertrophic scars, significantly alleviating scar-related pain and preventing scar widening, and is thus worthy of broader clinical application.
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Affiliation(s)
- Jin Lin
- Department of DermatologyThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
| | - Xiao Wang
- Department of GeriatricsThe First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)HangzhouChina
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7
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de Souza LG, Gold MH, Steiner D, Silva MR, Viana de Oliveira G. A simple drug-delivery microneedling technique modality successfully improves linear atrophic scars. J Cosmet Dermatol 2024; 23:857-861. [PMID: 38071614 DOI: 10.1111/jocd.16061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/21/2023] [Indexed: 02/24/2024]
Abstract
BACKGROUND Atrophic scars are white, dermal depressions, caused by the destruction of collagen fibers and decrease in epidermal cells, following inflammation after different types of trauma. They lead to significant physical, aesthetic and psychological barriers and their treatment remain a therapeutic challenge for dermatologists. Microneedling has been shown to improve scars by stimulating angiogenesis and neocolagenesis and the combination of anti-fibrotic drugs could potentialize the results. METHODS We present 8 cases of patients with linear scars, successfully treated with two sessions of a new Microneedling technique, using a tattoo machine, associated with drug delivery of 5-FU. RESULTS A marked improvement in scar pigmentation and texture were noted by patients and doctors, 6 months following the sessions of MMP and drug delivery with 5-FU, in different body sites. We also showed that the assessment scores of at least one of the professionals with those of the patient had significant correlations with each other, which shows consistency between the qualitative assessment instruments. We also showed that the cause of the injury can influence joint assessment scores (physicians plus patient) or those exclusive to professionals trained for the assessments, generating evidence that the cause of the injury can influence the treatment outcome itself. CONCLUSIONS We present an inexpensive and promising approach that can be easily done as an in-office procedure. Larger, multicenter studies are needed to validate this technique among the first line therapies for acne scar treatment.
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Affiliation(s)
| | | | - Denise Steiner
- Mogi das Cruzes University (UMC), Mogi das Cruzes, Brazil
| | - Marcio Roberto Silva
- Embrapa Gado de leite e pós-graduação em saúde coletiva (UFJF), Juiz de Fora, Brazil
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8
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Tuset L, López-Cano M, Fortuny G, López JM, Herrero J, Puigjaner D. A virtual simulation approach to assess the effect of trocar-site placement and scar characteristics on the abdominal wall biomechanics. Sci Rep 2024; 14:3583. [PMID: 38351278 PMCID: PMC10864383 DOI: 10.1038/s41598-024-54119-4] [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: 05/15/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024] Open
Abstract
Analyses of registries and medical imaging suggest that laparoscopic surgery may be penalized with a high incidence of trocar-site hernias (TSH). In addition to trocar diameter, the location of the surgical wound (SW) may affect TSH incidence. The intra-abdominal pressure (IAP) exerted on the abdominal wall (AW) might also influence the appearance of TSH. In the present study, we used finite element (FE) simulations to predict the influence of trocar location and SW characteristics (stiffness) on the mechanical behavior of the AW subject to an IAP. Two models of laparoscopy patterns on the AW, with trocars in the 5-12 mm range, were generated. FE simulations for IAP values within the 4 kPa-20 kPa range were carried out using the Code Aster open-source software. Different stiffness levels of the SW tissue were considered. We found that midline-located surgical wounds barely deformed, even though they moved outwards along with the regular LA tissue. Laterally located SWs hardly changed their location but they experienced significant variations in their volume and shape. The amount of deformation of lateral SWs was found to strongly depend on their stiffness. Trocar incisions placed in a LA with non-diastatic dimensions do not compromise its mechanical integrity. The more lateral the trocars are placed, the greater is their deformation, regardless of their size. Thus, to prevent TSH it might be advisable to close lateral trocars with a suture, or even use a prosthetic reinforcement depending on the patient's risk factors (e.g., obesity).
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Affiliation(s)
- Lluís Tuset
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Av. Països Catalans 26, Tarragona, Catalunya, Spain
| | - Manuel López-Cano
- Abdominal Wall Surgery Unit, Department of General Surgery, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Gerard Fortuny
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Av. Països Catalans 26, Tarragona, Catalunya, Spain
| | - Josep M López
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Av. Països Catalans 26, Tarragona, Catalunya, Spain
| | - Joan Herrero
- Departament d'Enginyeria Química, Universitat Rovira i Virgili, Av. Països Catalans 26, Tarragona, Catalunya, Spain
| | - Dolors Puigjaner
- Departament d'Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Av. Països Catalans 26, Tarragona, Catalunya, Spain.
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Khushalani A, Thakurani S, Garg P. Outcome Analysis of Two-Stage Paramedian Forehead Flap for Nasal Defects Reconstruction in Local Population: Experience of 3 Years at Our Center. Indian J Otolaryngol Head Neck Surg 2024; 76:559-566. [PMID: 38440631 PMCID: PMC10908939 DOI: 10.1007/s12070-023-04212-3] [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: 08/05/2023] [Accepted: 08/30/2023] [Indexed: 03/06/2024] Open
Abstract
The nose is a key aesthetic element of face. Nasal defect reconstruction by forehead flap has been done since ancient times. The aim of this study is to review our experience of the outcomes of two- stage paramedian forehead flap in nasal defects of various aetiologies in the local population. This prospective study was done from January 2020 to December 2022 in the Department of Plastic and Reconstructive Surgery at SMS Medical College and Hospital. A total of 29 patients were included in this study who were candidates for a forehead flap for nose reconstruction due to any aetiology. After informed and written consent, two- stage paramedian forehead flap was done and patients were followed up to 6 months for analysis of outcomes. 29 participants were included in the study. Age range was 18-72 years (mean age 38.5 ± 16.78). 21 (72.4%) were male and 8 (27.6%) were female.23 (79.3%) patients had multiple subunit involvement, 4 (13.8%) patients had single subunit defect and 2 (6.9%) had total nasal defect. Most common aetiology was trauma (58.7%). Early complications including flap and donor site healing related complications were present in 8 (27.5%) patients. Delayed complications were grouped into cosmetic and functional complications and were seen in 22 (75.8%) patients. Cosmetic dissatisfaction was high with the two- stage paramedian forehead flap. Forehead flap is an established gold standard reconstructive option for nasal defects. In a two stage paramedian forehead flap, flap and donor site related issues are minor but cosmetic dissatisfaction is high. With some additional stages, satisfaction among patients increases significantly.
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Affiliation(s)
- Asha Khushalani
- Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital, Jaipur, Rajasthan India
| | - Sangeeta Thakurani
- Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital, Jaipur, Rajasthan India
| | - Paheli Garg
- Department of Plastic, Reconstructive and Burns Surgery, SMS Hospital, Jaipur, Rajasthan India
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10
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Zhang B, He Z, Zhao H, Gao H, Zhang Z, Gao Z, Ke K. Evaluating the efficacy of recombinant human growth factors in scar remodelling for patients with facial soft tissue injuries. Int Wound J 2024; 21:e14649. [PMID: 38272796 PMCID: PMC10789918 DOI: 10.1111/iwj.14649] [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: 11/16/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Facial soft tissue injuries, often resulting in scarring, pose a challenge in reconstructive and aesthetic surgery due to the need for functional and aesthetic restoration. This study evaluates the efficacy of recombinant human growth factors (rhGFs) in scar remodelling for such injuries. A retrospective evaluation was conducted from January 2020 to January 2023, involving 100 patients with facial soft tissue injuries. Participants were divided equally into a control group, receiving standard cosmetic surgical repair, and an observation group, treated with rhGFs supplemented cosmetic surgery. The study assessed scar characteristics (pigmentation, pliability, vascularity, height), hospital stay duration, tissue healing time, complication rates and patient satisfaction. The observation group demonstrated significant improvements in all scar characteristics, with notably better pigmentation, pliability, vascularity and height compared with the control group. The rhGF treatment also resulted in reduced hospital stay duration and faster tissue healing. Notably, the total complication rate was significantly lower in the observation group (10%) compared with the control group (34%). Additionally, patient satisfaction levels were higher in the observation group, with 98% combined satisfaction compared with 76% in the control group. The application of rhGFs in treating facial soft tissue injuries significantly enhances scar remodelling, expedites healing, reduces complications and improves patient satisfaction. These findings establish rhGFs as a valuable tool in the management of facial soft tissue injuries, highlighting their potential in improving both functional and aesthetic outcomes.
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Affiliation(s)
- Baiyu Zhang
- The First Department of UrologyThe First Affiliated Hospital of Kunming Medical UniversityKunmingChina
- Yunnan Province Clinical Research Center for Chronic Kidney DiseaseKunmingChina
| | - Zonghai He
- The First Department of UrologyThe First Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Hui Zhao
- The First Department of UrologyThe First Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Hongbin Gao
- The First Department of UrologyThe First Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Zhiying Zhang
- The First Department of UrologyThe First Affiliated Hospital of Kunming Medical UniversityKunmingChina
| | - Zhenhua Gao
- The First Department of UrologyThe First Affiliated Hospital of Kunming Medical UniversityKunmingChina
- Yunnan Province Clinical Research Center for Chronic Kidney DiseaseKunmingChina
| | - Kunbin Ke
- The First Department of UrologyThe First Affiliated Hospital of Kunming Medical UniversityKunmingChina
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11
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Dany M, Walker J, Miller CJ, Giordano CN. An Institutional Experience of a Tertiary Referral Center in Surgically Managing Patients With Gorlin Syndrome. Dermatol Surg 2023; 49:1077-1084. [PMID: 37910540 DOI: 10.1097/dss.0000000000003990] [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: 11/03/2023]
Abstract
BACKGROUND The lifetime risk for basal carcinoma (BCC) is 90% in patients with Gorlin syndrome, also known as basal cell nevus syndrome. Compared with non-Gorlin patients, Gorlin patients often develop BCCs at a younger age and in greater numbers up to 500 BCCs in a lifetime. OBJECTIVE To review the options available for Gorlin patients and highlight existing knowledge gaps where future studies are indicated to optimize the care of this unique population. METHODS We review the current literature on managing patients with Gorlin syndrome from the lens of a dermatologic surgeon. RESULTS Although Mohs surgery is still the gold standard for large and aggressive BCCs, other less-invasive approaches may be considered for smaller, more numerous lesions. As dermatologic surgeons, we must be open to the full spectrum of surgical and nonsurgical options to individualize treatment and optimize patients' quality of life. Without maintaining a balance between optimal cure rate and volume management, Gorlin patients become at risk for surgical burn out and loss to follow-up. CONCLUSION Gorlin patients undergo numerous surgeries especially on the central face which can lead to disfigurement and reduce the quality of life. Identifying gaps in the current literature, continuing ongoing research, and eventually establishing appropriate guidelines that help to guide the formation of an individualized treatment plan is crucial in developing a balance between conservative and complex treatments for this population.
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Affiliation(s)
- Mohammed Dany
- Division of Dermatologic Surgery, Deprtment of Dermatology, Virginia Commonwealth University, Richmond, Virginia
| | - Joanna Walker
- Division of Dermatologic Surgery, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christopher J Miller
- Division of Dermatologic Surgery, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene N Giordano
- Division of Dermatologic Surgery, Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
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12
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Gelidan AG. Hybrid double-dermal flap technique for vest-over-pants-closure correction of depressed abdominal scars. Int Wound J 2023; 20:3185-3190. [PMID: 37231983 PMCID: PMC10502272 DOI: 10.1111/iwj.14197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/30/2023] [Accepted: 04/05/2023] [Indexed: 05/27/2023] Open
Abstract
Surgical procedures performed during neonatal period or childhood that result in vertical midline, transverse left upper quadrant, or central upper abdominal scars create significant psychological concerns in adulthood. Various surgical techniques correct depressed scars, including scar revision, Z- or W-plasty flaps, sub-incision tunnelling, fat grafting, and autologous or alloplastic dermal grafting. This article describes a novel technique for repairing depressed abdominal scars using hybrid double-dermal flaps. We included patients with psychosocial concerns who underwent abdominal scar revision because of wedding plans. Hybrid local de-epithelised dermal flaps were used to correct the depression of the abdominal scar. Superior and inferior skin flaps, medial and lateral to the depressed scar, were de-epithelised for 2 to 3 cm and sutured using the vest-over-pants technique with 2/0 nylon permanent sutures. Six female patients who want to marry were included in this study. Depressed abdominal scars were successfully fixed using hybrid double-dermal flaps, either from the superior-inferior aspect for transverse scars or from the medial-lateral aspect for vertical scars. No postoperative complications were noted, and the patients were satisfied with the outcomes. De-epithelialised double-dermal flaps in the vest-over-pants technique are an effective and valuable surgical technique for correcting depressed scars.
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Affiliation(s)
- Adnan G. Gelidan
- Division of Plastic Surgery, Department of Surgery, College of MedicineKing Saud UniversityRiyadhSaudi Arabia
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13
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Goslawski A, Tranchito E, Rabbani CC. Insights on in-office scar revision and resurfacing procedures. World J Otorhinolaryngol Head Neck Surg 2023; 9:249-256. [PMID: 37780675 PMCID: PMC10541167 DOI: 10.1002/wjo2.122] [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: 05/05/2023] [Revised: 06/08/2023] [Accepted: 06/28/2023] [Indexed: 10/03/2023] Open
Abstract
Objective Many facial plastic surgery procedures can be performed in an office-based setting, ranging from simple chemical peels to reconstructive surgeries to assist with scar revision. The aim of this review is to summarize the current state of facial plastics in-office surgical procedures, including scar revision, dermabrasion, lasers, and chemical peels. Methods A literature review was conducted with the PubMed search engine with the following keywords: facial plastics, scar revision, dermabrasion, lasers, chemical peels, face, office, and outpatient. The literature was surveyed for relevance, with a focus on realistically which procedures were performed in a facial plastics surgery outpatient clinic. These were then used to compile a review of the current state of this field. Results and Conclusions There are various scar revision procedures that can be performed in the office setting, including z-plasty, w-plasty, and geometric broken line closure techniques, as well as various nonmedical treatment options to improve the appearance of a scar. Dermabrasion can also be performed to assist with elevated scars. Various lasers are available to enhance cell turnover in the field of facial rejuvenation, scarring, and sun damage. Chemical peels are also available to assist with facial rejuvenation. With the appropriate counseling of the patient and medical staff, these can be safely performed in the office.
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Affiliation(s)
- Amanda Goslawski
- Department of Otolaryngology—Head & Neck SurgeryUniversity Hospitals Cleveland Medical CenterClevelandOhioUSA
- Case Western Reserve University School of MedicineClevelandOhioUSA
| | - Eve Tranchito
- Department of Otolaryngology—Head & Neck SurgeryUniversity Hospitals Cleveland Medical CenterClevelandOhioUSA
- Case Western Reserve University School of MedicineClevelandOhioUSA
| | - Cyrus C. Rabbani
- Department of Otolaryngology—Head & Neck SurgeryUniversity Hospitals Cleveland Medical CenterClevelandOhioUSA
- Case Western Reserve University School of MedicineClevelandOhioUSA
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14
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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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15
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Kwon H, Lee S, Kim J, Song SH. Efficacy and safety of stromal vascular fraction on scar revision surgery: a prospective study. J DERMATOL TREAT 2023; 34:2171260. [PMID: 36661928 DOI: 10.1080/09546634.2023.2171260] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Cell-based therapies are popular in the field of reconstructive surgery. The stromal vascular fraction (SVF), comprised of mature adipocytes or blood, reportedly has a regenerative effect; however the mechanism remains unclear. This study aimed to prove the viability and effectiveness of using SVF in scar treatment. METHODS This prospective double-blind study involved 20 patients who visited an outpatient clinic for 2 years, from July 2016 to July 2018, and underwent scar revision for traumatic or surgical scars. After scar revision surgery performed by a single surgeon, patient scars were divided into experimental and control sides. The subcutaneous layer of the experimental and control sides were injected with 0.1 mL/cm of SVF and normal saline, respectively. Each side was evaluated using the Patient and Observer Scar Assessment Scale (POSAS) before and six months after the surgery. RESULTS Of the 20 patients who underwent scar revision surgery and SVF treatment, 4 dropped out for personal reasons. In 11 of 12 POSAS items, the experimental side showed significant improvements compared to the control side. CONCLUSIONS Although more research is needed, autologous SVF is a valuable source of regenerative medicine that can be swiftly and inexpensively prepared from human fat tissue.
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Affiliation(s)
- Hyeokjae Kwon
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, South Korea.,Department of Plastic and Reconstructive Surgery, College of Medicine, Chungnam National University, Daejeon, South Korea
| | - Seokui Lee
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, South Korea
| | - Jiyoung Kim
- Healthcare Data Science Center, Konyang University Hospital, Daejeon, Korea
| | - Seung Han Song
- Department of Plastic and Reconstructive Surgery, Chungnam National University Hospital, Daejeon, South Korea.,Department of Plastic and Reconstructive Surgery, College of Medicine, Chungnam National University, Daejeon, South Korea
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16
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Maudet A, Le Bec J, Flament F, Mirassou L, Caron J, Negre C, Delaunay C, Balooch G, Jang E. Analysis of images supplied by Skincam® can record the changes of some scar features that occur over time. Comparisons with the assessments of dermatologist and patients' perception. J Cosmet Dermatol 2023; 22:1334-1343. [PMID: 36606386 DOI: 10.1111/jocd.15575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/12/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The objective of the study was to assess in vivo the validity of a new imaging device in quantifying the scarring process over time and to compare its data with the expertise of dermatologist and patients' self-appraisals. MATERIALS AND METHODS A total of 37 Korean women, aged 20-50 year, with closed scars of different types, were enrolled after a dermatological evaluation. All subjects applied daily a hydrating cream on their scars for 2 months. Images of scars at different times (Day 0, Day 28, and Day 56) were taken and further analyzed, yielding various parameters such as color, luminance, size, volume, and depth of each scar. A dermatologist visually graded, at each time point, the clinical aspect of the scar, and patients were asked to answer to some questions dealing with their self-examination of their scar. RESULTS The changes in some scar features that occurred during the application period were quantified and statistically differed from the D0 baseline value. Scars became of reduced size, lighter (Increased luminance), less red, less deep, and less voluminous. Some of these parameters (volume, lightness, smoothness, texture regularity) were statistically different at D28 whereas some others (area, depth, redness) showed significant changes at D56 . Dermatologist expertise and patients' assessments were in high agreement. CONCLUSION This methodological approach that uses a dedicated camera associated with image analysis, despite some inherent limits (size of the scar), appears as a valuable aid to surgeons in the management of scars, in the follow-up of a given procedure or treatment. Beyond scar management, this approach may be extended to other skin disorders such as acne.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Eunjoo Jang
- Jamsil Gowoonsesang dermatologic clinic, Seoul, South Korea
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17
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Huang C, Gold S, Radi R, Amos S, Yeung H. Managing Dermatologic Effects of Gender-Affirming Therapy in Transgender Adolescents. Adolesc Health Med Ther 2022; 13:93-106. [PMID: 36237602 PMCID: PMC9552673 DOI: 10.2147/ahmt.s344078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022] Open
Abstract
Transgender adolescents seek gender-affirming medical care to address gender identity and incongruence. Improved understanding of the dermatologic impact of gender-affirming medical care such as pubertal suppression, hormone therapy, and surgeries can enhance patient outcome. Pubertal suppression treats dysphoria associated with development of secondary sex characteristics, including androgen-driven acne. Gender-affirming hormone therapy influences acne and hair development in transgender adolescents. Dermatologists can help manage skin effects associated with chest binding and gender-affirming hormone therapy and surgery. Provision of patient-centered gender-affirming care in dermatologic and multidisciplinary settings is essential to improve skin and overall outcomes of gender-affirming therapy.
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Affiliation(s)
- Christina Huang
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Sarah Gold
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Rakan Radi
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Seth Amos
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Howa Yeung
- Department of Dermatology, Emory University School of Medicine, Atlanta, GA, USA
- Clinical Resource Hub, Veterans Affairs Southeast Network Veterans Integrated Service Network 7, Decatur, GA, USA
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18
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Khodaei B, Nasimi M, Nassireslami E, Seyedpour S, Rahmati J, Haddady Abianeh S, Motavalli Khiavi F. Efficacy of Topical Losartan in Management of Mammoplasty and Abdominoplasty Scars: A Randomized, Double-Blind Clinical Trial. Aesthetic Plast Surg 2022; 46:2580-2587. [PMID: 35614156 DOI: 10.1007/s00266-022-02935-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/02/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Annually, millions of people suffer from skin scars' psychological and physical disadvantages. Pathologic scars prevention is challenging and requires developing feasible and effective therapeutic strategies. Regarding promising results of losartan (an angiotensin 1 receptor inhibitor) on skin scar in preclinical studies, we aimed to assess the losartan ointment's impact on surgical scars in a clinical setting. MATERIAL AND METHOD Twenty-four patients with surgical wounds were enrolled from Razi hospital's plastic and reconstructive surgery department. The patients were trained to apply ointments 14-18 days post-surgery on the determined scar side, twice a day for 6 months. Two dermatologists independently evaluated scar formation at 3 and 6-month follow-ups using the Vancouver Scar Scale (VSS) score. RESULT Twenty-four female patients with cosmetic surgeries were included. The mean VSS score of losartan-treated sides was 7.1 ± 2.06 (at month 3) and 5.21 ± 1.71 (at month 6) that significantly were different from placebo-treated sides (9.77 ± 1.55 and 8.31 ± 1.88 at 3 and 6 months, respectively) (P value < 0.001 and < 0.001, respectively, for months 3 and 6). The subset analysis demonstrated a significant improvement in height (P value < 0.001 at 3 and 6 months), pliability (P value < 0.001 at 3 and 6 months), and vascularity (P value < 0.001 at 3 and 6 months) subsets at losartan compared to placebo-treated side. Losartan ointment was well tolerated with no complication. CONCLUSION Losartan ointment successfully improved scar formation in mammoplasty and abdominoplasty patients. The losartan preventive effect should be confirmed in future large-scale studies with long-term follow-ups. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Behzad Khodaei
- Medical Biotechnology Research Center, AJA University of Medical Sciences, Etemad zadeh Street, Fatemi-Gharbi Street, Tehran, Iran
| | - Maryam Nasimi
- Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Nassireslami
- Toxicology Research Center, AJA University of Medical Sciences, Tehran, Iran
- Department of Pharmacology and Toxicology, Faculty of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Simin Seyedpour
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Nanomedicine Research Association (NRA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Javad Rahmati
- Department of Plastic and Reconstructive Surgery, Imam Khomeini Hospital, Tehran University of Medical Sciences Tehran, Tehran, Iran
- Department of Plastic and Reconstructive Surgery, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahriar Haddady Abianeh
- Department of Plastic and Reconstructive Surgery, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Motavalli Khiavi
- Medical Biotechnology Research Center, AJA University of Medical Sciences, Etemad zadeh Street, Fatemi-Gharbi Street, Tehran, Iran.
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19
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Namgoong S, Lee KI, Han SK, Jeong SH, Dhong ES. Staged Excision Technique to Reduce Scar Length. J Plast Reconstr Aesthet Surg 2022; 75:2775-2783. [PMID: 35379584 DOI: 10.1016/j.bjps.2022.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 01/11/2022] [Accepted: 02/15/2022] [Indexed: 11/29/2022]
Abstract
Patients and surgeons are often disappointed with the scar length after conventional staged excision of large disfiguring skin lesions. We have developed an alternative approach to facilitate scar length reduction. We aimed to report the efficacy of our staged excision method, which includes a hexagonal-pattern excision, wide undermining, and purse-string suture. Sixty-five patients, each with one lesion, were included in the current study. The lesion length and width were recorded, and the scar area was calculated at each stage. The final scar length after performing the altered staged excision method was compared with that obtained after the conventional staged excision method, which was calculated using a theoretical scar model. Patient satisfaction was also evaluated. The mean longest axis length was 9.41 ± 3.83 cm preoperatively, 9.50 ± 3.92 cm after the first stage postoperatively, and 10.19 ± 3.98 cm after the final stage. The mean lesion width was 6.50 ± 3.48 cm preoperatively, 3.60 ± 1.77 cm after the first stage postoperatively, and 0.42 ± 0.31 cm after the final stage. The final scar length obtained using the altered procedure was much shorter than what would be obtained using conventional staged excision. The patient satisfaction score was 8.8 ± 1.1 out of a possible 10.0 rating. Staged excision with a hexagonal-pattern excision, wide undermining, and purse-string closure may improve aesthetic results.
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Affiliation(s)
- Sik Namgoong
- Department of Plastic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Kyu-Il Lee
- Department of Plastic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Seung-Kyu Han
- Department of Plastic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea.
| | - Seong-Ho Jeong
- Department of Plastic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Eun-Sang Dhong
- Department of Plastic Surgery, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
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20
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Difficult Conversations. Plast Reconstr Surg 2022; 150:237-241. [PMID: 35895519 DOI: 10.1097/prs.0000000000009087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Abstract
BACKGROUND Scars are a vexing sequela of surgery. Microneedling, also known as Minimally Invasive Percutaneous Collagen Induction (MIPCI), has demonstrated impressive improvements in chronic acne scars; however, no evidence exists for treating post-surgical scars during active wound healing. The purpose of this study was to demonstrate the utility and safe use of MIPCI in acute post-surgical scars. METHODS Twenty-five subjects who underwent surgery had scars treated with 3 treatments of MIPCI in the postoperative period. Scar assessment was measured by Vancouver Scar Scale (VSS), Patient & Observer Scar Assessment Scale (POSAS) and Global Aesthetic Improvement Scale (GAIS) after each of the 3 treatments and at final 2 month follow up. RESULTS Patients had positive improvement in VSS, POSAS and GAIS at 16-week post treatment initiation evaluation compared to initial measurement (p value<0.001). No statistically significant differences were noted when comparing the age of the patient, location of scars or Fitzpatrick Phototype Scales between patients. However, when comparing patients who began treatment early (week 6 to 7 post-op) to those who began treatment late (week 13 to 16 postop), there was a statistically significant difference in the POSAS group (p value <0.04). CONCLUSIONS Post-surgical scars treated with MIPCI in the maturation and remodeling phase had no adverse outcomes. Interestingly, our data shows treatment initiated early in the maturation phase (6-7 weeks post-op) while natural collagen formation was tapering off demonstrated improved aesthetic outcomes compared to treatments initiated late in the maturation phase (13-16wk post-op).
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22
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Self-reported health measures in burn survivors undergoing burn surgery following acute hospitalization: A burn model system national database investigation. Burns 2022; 49:688-700. [PMID: 35718573 DOI: 10.1016/j.burns.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/28/2022] [Accepted: 05/09/2022] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Health Related Quality of Life (HRQoL) surveys such as PROMIS-29 may facilitate shared decision-making regarding surgery after burn injury. We aimed to examine whether scar revision and contracture release surgery after index hospitalization was associated with differences in HRQoL. METHODS Patient and PROMIS-29 Profile v2.0 data were extracted from the Burn Model System (BMS) at 6-, 12-, and 24-months after burn. PROMIS-29 measures 7 health-related domains. Linear regression was performed to identify associations between independent burn patient variables (e.g. scar-related surgery) and PROMIS-29 scores. Socio-demographic and injury variables were analyzed using logistic regression to determine the likelihood of undergoing burn-related surgery. RESULTS Of 727 participants, 201 (27.6%) underwent ≥ 1 scar/contracture operation within 24 months of injury. Number of operations at index hospital admission and range of motion (ROM) deficit at discharge were correlated with an increased likelihood of undergoing subsequent scar/contracture surgery (p < 0.05). Participants undergoing scar/contracture surgery and those that were Medicaid insured reported significantly worse HRQoL for PROMIS domains: anxiety, depression, and fatigue (p < 0.05). CONCLUSIONS After adjusting for burn severity and available confounders, participants who underwent scar-related burn reconstructive surgery after index hospitalization reported overall worse Health-Related Quality of Life (HRQoL) in multiple domains.
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23
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Napavichayanun S, Vasuratna A, Santibenchakul S, Cherdchom S, Aramwit P. Evaluating efficacy and safety of the topical silicone gel containing onion extract in the treatment of post-cesarean surgical scars. J Cosmet Dermatol 2021; 21:2908-2915. [PMID: 34658139 DOI: 10.1111/jocd.14524] [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: 07/19/2021] [Accepted: 09/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cesarean section scars are post-surgical problems in women. Many active ingredients have been found to diminish scar formation. Clinical investigations on the onion extract have gained more attention due to its properties, such as improvement of scar appearance and texture. However, published studies evaluating the usefulness of the onion extract in the treatment of scars are controversial. METHODS The three-month study period followed a prospective, randomized, and double-blinded design. Each enrolled subject's post-cesarean completely sealed wounds were divided into two halves along the closure axis. Each half was randomly assigned to the treatment with either silicone gel containing 5% onion extract or the silicone gel containing vitamin C. All subjects were respectively evaluated at the one, two, and three months of the treatment. RESULTS After the three-month follow-up, there was a statistically significant difference in scar improvement between before and after treatment. None of statistically significant difference in the Patient and Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS) scores and melanin value was found between silicone gel containing 5% onion extract and the control silicone gel. However, the improvement of scar erythema by treatment with the silicone gel containing 5% onion extract was significantly greater than in the control group. No adverse effects were reported in either group.
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Affiliation(s)
- Supamas Napavichayanun
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Bioactive Resources for Innovative Clinical Applications, Chulalongkorn University, Bangkok, Thailand
| | - Apichai Vasuratna
- Obstetrics and Gynecology Department, Division of Gynecologic Oncology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Somsook Santibenchakul
- Department of Obstetrics and Gynecology, Family Planning and Reproductive Health Unit, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand
| | - Sarocha Cherdchom
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Pornanong Aramwit
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand.,Center of Excellence in Bioactive Resources for Innovative Clinical Applications, Chulalongkorn University, Bangkok, Thailand.,The Academy of Science, The Royal Society of Thailand, Bangkok, Thailand
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24
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Psychosocial Impact of Coronal Access Scars in Craniosynostosis Procedures on Patients and Their Families. J Craniofac Surg 2021; 33:168-173. [PMID: 34560731 DOI: 10.1097/scs.0000000000008181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT The coronal incision is the mainstay for access in craniosynostosis surgery. Scarring is a common concern of parents whose children are offered an open procedure. To the author's knowledge, there are no previous studies looking at the psychosocial impact of scarring from coronal access incisions for craniosynostosis procedures. The author's study focused on patients undergoing procedures for nonsyndromic single-suture craniosynostosis.This study comprised 3 parts: worldwide survey regarding coronal access incisions for craniosynostosis surgery, questionnaire to determine the psychosocial impact of the scars on patients and their parents, and measurement of postoperative scars in craniosynostosis patients.Survey responses from 46 craniofacial centers worldwide revealed a zig-zag was the most commonly utilized incision. Seventy-two percent of survey responses reported problems with postoperative stretching of the scar; only 20% of centers reported formal data collection of whether families were affected by this.Psychology questionnaires revealed that the majority of patients and their parents were not bothered by the zig-zag coronal scars. Patient felt the scars were less noticeable than the parents. Parent perceptions improved with age and time postsurgery.Coronal access scars following craniosynostosis surgery appear to stretch more in the supra-auricular region compared with the midline.These findings are useful for the craniofacial multidisciplinary team to inform parents contemplating surgery and who may be concerned about the impact of the scar in the future.
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25
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Suh JM, Park SH, Lee JW, Lee SJ, Suh IS, Lee JW, Jeong HS. Clinical Outcomes Following the Early Application of Multimodal Scar Programs for Facial Incisional Wounds. Aesthetic Plast Surg 2021; 45:1772-1782. [PMID: 33973048 DOI: 10.1007/s00266-021-02330-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Even though scars are major issues for patients who undergo facial lacerations, programs for their prevention and early management are not well established. The purpose of this study was to evaluate the clinical outcomes of prophylactic scar assessments and early scar interventions in patients with lacerations. PATIENTS AND METHODS A total of 116 patients underwent suture line and scar prevention treatment in the emergency room from 2014 to 2015. In the retrospective study, 46 patients who met all the criteria were included in the study. They were assigned to one of the following two scar prevention programs: the standard scar program for prevention, which included taping, silicone sheets, and ointments, and the multimodality scar program for treatment, which included triamcinolone, botulinum toxins, or CO2 fractional lasers. The patterns of early scar program were investigated for the standard scar prevention program and the multimodality scar management program, and we evaluated the scar assessment scores of the patients at 3 and 6 months. RESULTS Scar scores for the patients who received multimodality scar management showed statistically significant improvements in Patient Scar Assessment (PSA) scales, Stony Brook Scar Evaluation Scales (SBSES), Vancouver Scar Scale (VSS) scores, and Visual Analog Scar (VAS) scales (the p values were 0.008, 0.007, 0.017, and 0.01, respectively). CONCLUSION The multimodality scar program is more effective for scar prevention than the standard scar program. 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)
- Joong Min Suh
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Seong Hoon Park
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jun Won Lee
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seong Joo Lee
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - In Suck Suh
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong Wook Lee
- Department of Plastic and Reconstructive Surgery, Hangang Sacred Heart Hospital, School of Medicine, Hallym University, Seoul, Korea
| | - Hii Sun Jeong
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Skochdopole A, Dibbs RP, Sarrami SM, Dempsey RF. Scar Revisions. Semin Plast Surg 2021; 35:130-138. [PMID: 34121948 DOI: 10.1055/s-0041-1727291] [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: 10/21/2022]
Abstract
Scars pose a complex challenge to the reconstructive surgeon in the variability of their presentation and their effect on cosmesis and function. Numerous surgical and nonsurgical options exist for scar management, each with their respective advantages and disadvantages. Each treatment modality should be tailored to the patient to ensure enhanced outcomes. In this review, we discuss different scar presentations, scar management options, and the benefits and risks with undergoing these various treatment modalities.
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Affiliation(s)
- Anna Skochdopole
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Texas
| | - Rami P Dibbs
- Division of Plastic Surgery, Texas Children's Hospital, Texas
| | | | - Robert F Dempsey
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Division of Plastic Surgery, Texas Children's Hospital, Texas
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Ding F, Huang C, Sun D, Zhu Z, Yang J, Jin R, Luo X. Combination of Extended Paramedian Forehead Flap and Laser Hair Removal in the Reconstruction of Distal Nasal Defect. Ann Plast Surg 2021; 86:S293-S298. [PMID: 33651019 DOI: 10.1097/sap.0000000000002588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM The study sought to determine whether extended forehead flap by using part of the scalp combined with laser hair removal is a practical approach when repairing distal nasal defect. METHODS A retrospective study was conducted with 6 patients who underwent reconstruction of nasal defects with extended forehead flaps (including scalp combined with subsequent laser hair removal) at Shanghai Ninth People's Hospital between June 2016 and December 2018. Surgical data collected included age, causes of defects, sizes of defects, invaded nasal subunits, implantation of tissue expander, time elapsed between the formation of defects and surgical treatments, sessions of laser hair removal, and follow-up results. All patients had nasal defects after removal of a benign nevus (diameter, >1.5 cm), which invaded distal nasal subunits (including the nasal tip, soft triangle, columella, and nasal ala) and could not be repaired using adjacent tissue. Preoperative and postoperative assessments of esthetic outcomes were analyzed, including skin color and texture match, appearance deformity, and scar appearance. RESULTS All 6 female patients (ages 4 to 24 years) accepted the extended forehead flap technique and subsequent laser hair removal treatments. Among the 6 patients, 2 had nasal tip defects, 1 had a columella nasi defect, one had an alar defect, and 2 had multiunit defects. All transferred forehead flaps survived with no necrosis and underwent 2 to 5 subsequent laser hair removal treatments. The color and texture of the transferred flaps was similar to the adjacent skin in all patients. All patients were satisfied with the final outcome of the reconstructed nose with no obvious scarring during follow-up. CONCLUSIONS Extending the forehead flap using the scalp is a practical and safe approach for the repair of large and distal nasal defects. Subsequent laser hair removal can eliminate the hair follicles of the scalp and improve the appearance and color of the flap.
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Affiliation(s)
- Feixue Ding
- From the Department of Plastic & Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
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Hudson C, Olson K. Management of Acute Soft Tissue Injuries of the Cheek and Principles of Scar Revision. Facial Plast Surg 2021; 37:480-489. [PMID: 33517573 DOI: 10.1055/s-0041-1722923] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Facial soft tissue injury is a challenging and complex problem for the facial plastic and reconstructive surgeon for cosmetic and functional reasons. This article will focus on the management of soft tissue injuries of the cheek, one of the most important presenting areas of the face. The cheek, like any other part of the face, is susceptible to several types of injury and any of these injuries have the potential to disfigure and debilitate. Knowledge of anatomical structures and wound healing principles is critical to devising an appropriate management plan and achieving superior patient outcomes in scar revision cases. Multiple techniques to improve long-term scarring from facial soft tissue injuries are available.
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Affiliation(s)
- Caroline Hudson
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston, Texas
| | - Krista Olson
- Department of Otolaryngology, Head & Neck Surgery, Baylor College of Medicine, Houston, Texas
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Schwartz C, Philip S, Idicula W, Demke J. Unilateral Tessier 7 cleft: Case report of Z-plasty with geometric broken line repair and literature review. Int J Pediatr Otorhinolaryngol 2021; 140:110546. [PMID: 33310448 DOI: 10.1016/j.ijporl.2020.110546] [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: 08/10/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 11/26/2022]
Abstract
Tessier 7 clefts are a rare congenital anomaly, usually surgically repaired with Z-plasty or other reconstructive methods, although undesirable scars may result. We present a review of the literature and a case of unilateral Tessier 7 cleft repaired with a novel reconstruction technique using a combined Z-plasty and geometric broken line closure (GBLC) to camouflage and irregularize the otherwise linear scar. We present this case to expand the armamentarium of surgical options to address Tessier 7 clefts and to review techniques for repair.
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Affiliation(s)
- Cynthia Schwartz
- Department of Otolaryngology-Head and Neck Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, 79430-8312, USA.
| | - Stacy Philip
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, 79430-8312, USA
| | - Winslo Idicula
- Department of Otolaryngology-Head and Neck Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, 79430-8312, USA; Division of Pediatric Otolaryngology.
| | - Joshua Demke
- Department of Otolaryngology-Head and Neck Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, 79430-8312, USA; Division of Facial Plastics Reconstruction.
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Ong SL, Bajuri MY, Abdul Suki MH, Nadira F, Zamri KS. Hypertrophic Scar With Contracture Over the Fourth Toe Secondary to Snake Bite Wound: To Salvage or Amputate? Cureus 2020; 12:e9451. [PMID: 32864272 PMCID: PMC7451078 DOI: 10.7759/cureus.9451] [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: 06/04/2020] [Accepted: 07/28/2020] [Indexed: 11/05/2022] Open
Abstract
Hypertrophic scar formation is a major clinical problem that results in both cosmetic issues and functional loss. The management of a hypertrophic scar varies according to the severity of the sequelae from the scar. We describe a method of treatment in a patient who had a history of multiple debridements due to snake bite resulting in severe contracture of the fourth toe complicated with a hypertrophic scar.
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Affiliation(s)
- Shir Lee Ong
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Mohd Yazid Bajuri
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
| | | | - Fatin Nadira
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
| | - Kamarul Syariza Zamri
- Orthopaedics and Traumatology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, MYS
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31
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Kim YJ, Kim JH, Kim YS, Cheon YW. Pin-site scar revision with subcisions and acellular dermal matrix. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2020. [DOI: 10.14730/aaps.2019.01935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kim DY, Kwon HJ, Moon SH, Jun YJ, Rhie JW, Oh DY. Scar dermal transposition flap for depressed scars: A valuable technique for depressed scar management. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2019. [DOI: 10.14730/aaps.2019.01718] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bhooshan LS, Devi MG, Aniraj R, Binod P, Lekshmi M. Autologous emulsified fat injection for rejuvenation of scars: A prospective observational study. Indian J Plast Surg 2019; 51:77-83. [PMID: 29928084 PMCID: PMC5992940 DOI: 10.4103/ijps.ijps_86_17] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: The skin rejuvenation potential of the autologous emulsified nanofat was studied by Tonnard et al. in 2013. This property is due to the viable adipose-derived stem cells present in the nanofat; although, there are no viable adipocytes. The aim of this study was to determine the aesthetic outcome of autologous emulsified nanofat injection in scars using a standardised and validated Patient Observer Scar Assessment Scale (POSAS) and photographs. Materials and Methods: A total of 34 patients with scars of varied aetiologies were included in the study as per inclusion criteria. Pre-operative scoring of the scars with the POSAS scale was done, and photographs were taken. Fat aspiration was done from the lower abdominal wall using syringe liposuction under tumescent anaesthesia. The lipoaspirate was mechanically emulsified, filtered and injected intralesionally into the scar using 26G needle and insulin syringe. Post-operative scar reassessment was done at 3 months with the POSAS scale score and photographs. The improvement in scar characteristics and symptoms were tested statistically using a paired t-test. Pre-operative and post-operative photographic comparison was also done. Results: Out of the 34 patients included in the study, male:female ratio was 22:12. Majority (79.4%) had post-traumatic facial scars. On statistical analysis, there was statistically significant improvement in symptoms such as pain (P = 0.001), itching (P = 0.001), stiffness (P = 0.001), thickness (P = 0.001), colour (P = 0.001), irregularity (P = 0.001) and scar characteristics such as vascularity (P = 0.005), relief (P = 0.001), pliability (P = 0.001), thickness (P = 0.001) and pigmentation (P = 0.001) 3 months after injection. The photographic comparison also showed good aesthetic outcome. Conclusion: Autologous emulsified nanofat injection is effective in improving the scar characteristics as well as symptoms and helps in scar rejuvenation.
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Affiliation(s)
- Lekshmi S Bhooshan
- Department of Plastic Surgery, Government Medical College, Kottayam, Kerala, India
| | - M Geetha Devi
- Department Of Community Medicine, Government Medical College, Kottayam, Kerala, India
| | - R Aniraj
- Department of Plastic Surgery, Government Medical College, Trivandrum, Kerala, India
| | - P Binod
- Department of Plastic Surgery, Government Medical College, Kottayam, Kerala, India
| | - M Lekshmi
- Department of Plastic Surgery, Government Medical College, Kottayam, Kerala, India
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Coentro JQ, Pugliese E, Hanley G, Raghunath M, Zeugolis DI. Current and upcoming therapies to modulate skin scarring and fibrosis. Adv Drug Deliv Rev 2019; 146:37-59. [PMID: 30172924 DOI: 10.1016/j.addr.2018.08.009] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 07/08/2018] [Accepted: 08/26/2018] [Indexed: 12/12/2022]
Abstract
Skin is the largest organ of the human body. Being the interface between the body and the outer environment, makes it susceptible to physical injury. To maintain life, nature has endowed skin with a fast healing response that invariably ends in the formation of scar at the wounded dermal area. In many cases, skin remodelling may be impaired, leading to local hypertrophic scars or keloids. One should also consider that the scarring process is part of the wound healing response, which always starts with inflammation. Thus, scarring can also be induced in the dermis, in the absence of an actual wound, during chronic inflammatory processes. Considering the significant portion of the population that is subject to abnormal scarring, this review critically discusses the state-of-the-art and upcoming therapies in skin scarring and fibrosis.
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Affiliation(s)
- João Q Coentro
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland; Science Foundation Ireland (SFI), Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland
| | - Eugenia Pugliese
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland; Science Foundation Ireland (SFI), Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland
| | - Geoffrey Hanley
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland; Science Foundation Ireland (SFI), Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland
| | - Michael Raghunath
- Center for Cell Biology and Tissue Engineering, Institute for Chemistry and Biotechnology (ICBT), Zurich University of Applied Sciences (ZHAW), Wädenswil, Switzerland
| | - Dimitrios I Zeugolis
- Regenerative, Modular & Developmental Engineering Laboratory (REMODEL), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland; Science Foundation Ireland (SFI), Centre for Research in Medical Devices (CÚRAM), Biomedical Sciences Building, National University of Ireland Galway (NUI, Galway), Galway, Ireland.
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Improved outcomes of scar revision with the use of polydioxanone suture in comparison to polyglactin 910: A randomized controlled trial. J Plast Reconstr Aesthet Surg 2018; 71:1159-1163. [DOI: 10.1016/j.bjps.2018.03.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/19/2018] [Accepted: 03/30/2018] [Indexed: 11/20/2022]
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A new treatment for reliable functional and esthetic outcome after local facial flap reconstruction: a transparent polycarbonate facial mask with silicone sheeting. EUROPEAN JOURNAL OF PLASTIC SURGERY 2017; 40:407-416. [PMID: 28989235 PMCID: PMC5610215 DOI: 10.1007/s00238-017-1306-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Facial flap surgery predominantly leads to good functional results. However, in some cases, it can cause unsatisfactory esthetic results. They include persistent erythema, pincushioning, and development of hypertrophic scars. Conservative, reliable treatment for facial flaps is lacking. Pressure and silicone therapy have proven to result in significant improvement in scar erythema, pliability, and thickness in postburn hypertrophic scars. By combining these therapies in a facial mask, the esthetic outcome of facial flaps could be improved. In this retrospective study, the efficacy of a unique transparent face mask containing silicone sheets on the esthetic outcome of postsurgical facial flaps is assessed. METHODS Twenty-one patients were assigned to facial pressure mask therapy after they underwent facial flap surgery between July 2012 and September 2015. Patients were treated for a mean duration of 46 weeks. The effects of pressure mask therapy were examined by means of the Patient and Observer Scar Assessment Scale (POSAS). RESULTS All POSAS components showed a reduction between start and end of therapy, while itchiness, pigmentation, pliability, thickness, and relief of the flap improved significantly (P < 0.05). Mean total and patient score showed significant reduction between start and end of therapy. CONCLUSIONS This study shows that a facial pressure mask layered with silicone results in noticeable flap improvement with a long-lasting result. Level of Evidence: Level III, therapeutic study.
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Min JH, Park KH, Choi HL, Park JS, Lee JH, Kim H, Lee BK, Lee DH, Lee TG. Usefulness of direct W-plasty application to wound debridement for minimizing scar formation in the ED. Am J Emerg Med 2017; 35:1804-1809. [PMID: 28587949 DOI: 10.1016/j.ajem.2017.05.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/26/2017] [Accepted: 05/28/2017] [Indexed: 11/26/2022] Open
Abstract
PURPOSE A suture line placed with the same direction as the relaxed skin tension line leads to good healing, but a suture line with over 30 degrees of angle from the relaxed skin tension line leads to longer healing time and more prominent scarring. W-plasty is widely used to change the direction of the scar or to divide it into several split scars. In this study, we applied W-plasty to patients with facial lacerations in the emergency department. METHODS From June 2012 to December 2014, 35 patients underwent simple repair or W-plasty for facial lacerations. Patients in the simple repair group underwent resection following a thermal margin, and the W-plasty group was resected within a pre-designed margin of W-shaped laceration. We assessed prognosis using the Stony Brook Scar Evaluation Scale (SBSES) after 10 days (short-term) and six months (long-term), respectively, following suture removal. RESULTS Among 35 patients, 15 (42.9%) underwent simple debridement and 20 (57.1%) underwent W-plasty. In the W-plasty group, there was no difference between short-term and long-term follow-up showing high SBSES, but in the simple debridement group, long-term follow-up SBSES significantly decreased. W-plasty SBSES was higher than simple debridement at short-term as well as long-term follow-up. CONCLUSION We experienced good results of direct W-plasty application at six-month long-term follow-up. Therefore, W-plasty application is more effective in reducing scar appearance than a simple debridement method for facial laceration patients with an angle of 30 degrees or more to the relaxed skin tension line.
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Affiliation(s)
- Jin Hong Min
- Department of Emergency Medicine, Gimpo Woori Hospital, 160, Gamam-ro, Gimpo-si, Republic of Korea
| | - Kyung Hye Park
- Department of Medical Education, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea
| | - Hong Lak Choi
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea
| | - Jung Soo Park
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea; Department of Emergency Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea.
| | - Ji Han Lee
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea
| | - Hoon Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea; Department of Emergency Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju, Republic of Korea
| | - Dong Hun Lee
- Department of Emergency Medicine, Chonnam National University Medical School, 160, Baekseo-ro, Dong-gu, Gwangju, Republic of Korea
| | - Taek Gu Lee
- Department of Surgery, Chungbuk National University Hospital, 776, Sunhwan-ro, Seowon-gu, Cheongju, Republic of Korea
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Surgical Scar Revision with A-Plasty. Plast Reconstr Surg 2017; 139:1212e-1213e. [PMID: 28085715 DOI: 10.1097/prs.0000000000003312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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A New Technique for Correction of Tethered and Depressed Scars: Layered Dermal Support. Aesthetic Plast Surg 2016; 40:749-54. [PMID: 27369841 DOI: 10.1007/s00266-016-0672-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Many methods have been used for correcting tethered and depressed scars, but most of these methods have had unsatisfying results and ended up with recurrence. The aim of this study is to present a new surgical technique that overcomes these problems. MATERIALS AND METHODS Twenty-two depressed scars were corrected using the layered dermal support technique. With this technique, the depressed part of the scar is deepithelialized and used in a layered fashion to support the skin flaps. RESULTS All of the patients were evaluated 1 year postoperatively. There was no recurrence of tethering or depression. CONCLUSION The layered dermal support technique is a relatively quick procedure that uses only basic plastic surgery principles. It offers a good solution for the correction of tethered and depressed scars without recurrence. LEVEL OF EVIDENCE V 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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Nagasao T, Hamamoto Y, Tamai M, Kudo H, Ensako T, Kogure T, Takano N, Tanaka Y. The "Sea" should not be operated on in scar revision for "Island-Like" scars. Med Hypotheses 2015; 85:215-8. [PMID: 25978927 DOI: 10.1016/j.mehy.2015.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 04/20/2015] [Accepted: 04/25/2015] [Indexed: 10/23/2022]
Abstract
Scars developing on body surfaces not only restrict body movement, but are also problematic from a cosmetic standpoint. Hence, revision is conducted by removing the scar and re-suturing the resultant defects. In performing scar revision, care should be taken to prevent the re-sutured wounds from developing hypertrophy again. Scars often present a pattern where hard, red parts are separated by soft parts in between. As the hard and soft parts may be analogized as islands and seas respectively, we call this the "Island-Like" scar. Two strategies can be taken to treat scars of this type. The first is to remove the entire scar-including both hard and soft parts; the second is to remove only the hard parts and leave the soft parts untouched. The authors conducted a biomechanical study using finite element analyses and found that as a body moves, greater stresses occur in the peri-wound regions with the first strategy than with the second strategy. A wound's likelihood to develop hypertrophy increases as the stresses working on it increase. Hence, it is hypothesized that the second strategy carries less risk of the operated wounds developing re-hypertrophy than the first strategy. Based on this logic, in performing scar revision for scars consisting of hard and soft parts, it is recommended only to remove only hard parts and not to operate on soft parts in between.
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Affiliation(s)
- Tomohisa Nagasao
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Japan.
| | - Yusuke Hamamoto
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Japan
| | - Motoki Tamai
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Japan
| | - Hiroo Kudo
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Japan
| | - Toshiya Ensako
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Japan
| | - Tetsukuni Kogure
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Japan
| | - Naoki Takano
- Department of Mechanical Engineering, Keio University, Japan
| | - Yoshio Tanaka
- Department of Plastic and Reconstructive Surgery, Faculty of Medicine/Graduate School of Medicine, Kagawa University, Japan
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