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Bergus KC, Iske T, Fabia R, Schwartz D, Thakkar RK. Impact of laser treatment on hypertrophic burn scars in pediatric burn patients. Burns 2024; 50:1863-1870. [PMID: 38719695 DOI: 10.1016/j.burns.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: 07/28/2023] [Revised: 03/17/2024] [Accepted: 04/18/2024] [Indexed: 08/30/2024]
Abstract
Paediatric patients with hypertrophic burn scars benefit from laser treatment, but this treatment's effectiveness on burn wounds stratified by specific body region and prior burn wound therapy has not been fully evaluated. We performed a single center retrospective study of pediatric burn patients, treated with fractional CO2, with or without pulse dye, laser between 2018-2022. We identified 99 patients treated with 332 laser sessions. Median age at the time of burn injury was 4.0 years (IQR 1.7, 10.0) and 7.1 years (IQR 3.6, 12.2) at the time of first laser treatment. In the acute setting, 55.2 % were treated with dermal substrate followed by autografting, 29.6 % were treated with dermal substrate alone, and 9.1 % underwent autografting alone. Most body regions showed improvement in modified Vancouver Scar Scale (mVSS) score with laser treatment. mVSS scores improved significantly with treatment to the anterior trunk (-1.18, p = 0.01), arms (-1.14, p = 0.003), and legs (-1.17, p = 0.015). Averaging all body regions, the mVSS components of pigmentation (-0.34, p < 0.001) and vascularity (-0.47, p < 0.001), as well as total score (-0.81, p < 0.001) improved significantly. Knowing the variable effectiveness of laser treatment in pediatric burn scars is useful in counseling patients and families pre-treatment.
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Affiliation(s)
- Katherine C Bergus
- Department of Pediatric Surgery, Burn Center at Nationwide Children's Hospital, Columbus, OH, United States
| | - Taylor Iske
- Department of Pediatric Surgery, Burn Center at Nationwide Children's Hospital, Columbus, OH, United States
| | - Renata Fabia
- Department of Pediatric Surgery, Burn Center at Nationwide Children's Hospital, Columbus, OH, United States
| | - Dana Schwartz
- Department of Pediatric Surgery, Burn Center at Nationwide Children's Hospital, Columbus, OH, United States
| | - Rajan K Thakkar
- Department of Pediatric Surgery, Burn Center at Nationwide Children's Hospital, Columbus, OH, United States.
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Cheng X, Huang J, Shan S, He Y, Zheng H, Jin L, Chen G, Zhou J. Chemotherapy affects the development of pathological scarring after general thoracic surgery in children. Wound Repair Regen 2024. [PMID: 39169718 DOI: 10.1111/wrr.13212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/27/2024] [Accepted: 08/07/2024] [Indexed: 08/23/2024]
Abstract
Globally, a great number of children have been suffering from physical dysfunction and psychological stress due to uncontrollable scar growth and a lack of effective modalities. Despite chemotherapy's established role as a primary treatment for pathological scarring in adults, its efficacy in preventing or minimizing scar formation in paediatric patients remains underexplored. This retrospective cohort study aimed to refine the relevant clinical evidence and investigate the effect of chemotherapy on pathological scars in children. In this single-centre retrospective cohort study, the data of children aged ≤18 years who underwent thoracic surgery at the Children's Hospital of Fudan University between 1 January 2018, and 31 December 2021 were assessed. The primary outcome was pathological scarring, and the secondary outcomes were subjective symptoms accompanying pathological scarring, such as pain and itching. To mitigate indication bias, analysis was performed by inverse probability weighting (IPTW) log-binomial regression models. The cohort comprised 102 children, among whom 36 received adjuvant chemotherapy perioperatively, while 66 did not. Under the IPTW model, a statistically significant difference in pathological scarring incidence was observed between the chemotherapy and non-chemotherapy groups (16.7% vs. 29.4%, p = 0.027). And the children received chemotherapy post-operatively had a lower relative risk of pathological scarring, compared with those received chemotherapy both before and after surgery (19.8% vs. 28.8%). Adjuvant chemotherapy treatment after surgery may reduce the incidence of post-operative pathological scarring in children.
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Affiliation(s)
- Xinwei Cheng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiaxi Huang
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - Shengzhou Shan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yining He
- Biostatistics Office of Clinical Research Unit, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Hongkun Zheng
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lu Jin
- School of Life Science and Technology, ShanghaiTech University, Shanghai, China
| | - Gang Chen
- Cardiovascular Center, Children's Hospital of Fudan University, Shanghai, China
| | - Jia Zhou
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Putri IL, Sindhu FC, Aisyah IF, Pramanasari R, Wungu CDK. Comparison of combination skin substitutes and skin grafts versus skin grafts only for treating wounds measured by Vancouver Scar Scale: A comprehensive meta-analysis. SAGE Open Med 2024; 12:20503121241266342. [PMID: 39139266 PMCID: PMC11320670 DOI: 10.1177/20503121241266342] [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: 04/25/2024] [Accepted: 06/18/2024] [Indexed: 08/15/2024] Open
Abstract
Background Skin is the largest organ in the body and has multiple significant functions. A malformation or injury that compromises its integrity can lead to major issues or even mortality. Wound healing is a vital physiological process of the human skin which facilitates the repair of any damage and the preservation of homeostasis. Possible complications or infections that are fatal may ensue if the patient does not recover within the specified time. Therefore, it is essential to develop biomaterials which facilitate tissue regeneration and exhibit robust biological properties. We conducted a meta-analysis of randomized controlled trials to compare combinations of skin replacements and skin grafts to skin grafts alone for wound treatment, as measured by the Vancouver Scar Scale. Methods This meta-analysis utilized various databases, including as PubMed, ProQuest, Web of Science, Science Direct, Scopus, EBSCOhost, and ClinicalTrials.gov, to conduct a comprehensive search for randomized controlled trials that compared the effectiveness of combined skin substitutes and skin grafts to skin grafts alone in the treatment of wounds. The results primarily consisted of scar features assessed using the Vancouver Scar Scale. Results Meta-analysis was conducted on a sample of 216 participants from 7 randomized controlled trials. The trials were conducted from 2002 to 2015. The study demonstrated that the use of skin substitutes resulted in a statistically significant improvement in Vancouver Scar Scales ratings compared to skin grafts alone. The mean change was 1.38 (95% CI: 0.13-2.63; p = 0.03). Conclusion This meta-analysis indicates that the use of skin replacements provides substantial advantages and effectively aids in the closure of wounds. There is no inherent superiority among different skin substitutes. Instead, their suitability for specific patient wound circumstances is the determining factor. A comprehensive and advantageous skin substitute of significant magnitude is needed, rather than relying solely on grafts.
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Affiliation(s)
- Indri Lakhsmi Putri
- Faculty of Medicine, Department of Plastic Reconstructive and Aesthetic Surgery, Airlangga University, Surabaya, Indonesia
- Plastic Reconstructive and Aesthetic Surgery Unit, Airlangga University Hospital, Surabaya, East Java, Indonesia
| | - Florencia Christina Sindhu
- Plastic Reconstructive and Aesthetic Surgery Unit, Airlangga University Hospital, Surabaya, East Java, Indonesia
| | - Imaniar Fitri Aisyah
- Department of Mechanical Engineering, Institut Teknologi Sepuluh Nopember, Surabaya, Indonesia
| | - Rachmaniar Pramanasari
- Plastic Reconstructive and Aesthetic Surgery Unit, Airlangga University Hospital, Surabaya, East Java, Indonesia
| | - Citrawati Dyah Kencono Wungu
- Faculty of Medicine, Department of Physiology and Medical Biochemistry, Airlangga University, Surabaya, Jawa Timur, Indonesia
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Kaboodkhani R, Sarikhani M, Kazemi T, Zarshenas MM, Shahrizi MM, Sadati MS, Owji SH. The Effects of Aloe Vera Cream on the Alar Scar in Rhinoplasty, A Randomized Double-Blind Controlled Trial. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2024; 36:499-505. [PMID: 38745686 PMCID: PMC11090095 DOI: 10.22038/ijorl.2024.77572.3601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/25/2024] [Indexed: 05/16/2024]
Abstract
Introduction Many studies have been done on the use of aloe vera in wound healing, but fewer studies were done on the influence of this material on the reduction of the alar scar. Therefore, we evaluated the effect of a newly made aloe vera cream on alar wound healing after rhinoplasty. Materials and Methods This was a randomized, double-arm, parallel-group, double-blind controlled trial and was done from June 2021 to February 2022. External wedge resection was done for all patients. The patients were randomly assigned to receive aloe vera cream (n=31) (intervention group) or Face Doux cream (comparison group) (n = 29). A pharmacist prepared the aloe vera cream. The primary outcome measure was the wound scar status which was assessed by two Questionnaires, including the mean Patient Scar Assessment Questionnaire (PSAQ) and Vancouver Scar Scale (VSS). Randomization and Blinding were done. Results The mean PSAQ was significantly lower in group A after two weeks (26.9 versus 31.5, P<0.001), after two months (15.7 versus 19.6, P=0.04), and six months follow-up (8.8 versus 11.8, P=0.005). The mean VSS was significantly lower in group A after two weeks (5.6 versus 7.1, P=0.001), after two months (3.5 versus 4.9, P=0.002), and six months (1.2 versus 2.7, P<0.001). Repeated measurement analysis showed that both interventions significantly affected PSAQ and VSS. Conclusion Although both interventions had a significant effect on PSAQ and VSS, compared to Face Duox, the topical use of Aloe Vera cream significantly reduced scar formation after alar resection, both statistically and clinically.
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Affiliation(s)
- Reza Kaboodkhani
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohsen Sarikhani
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Tayebeh Kazemi
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Mohammad Mehdi Zarshenas
- Department of Phytopharmaceuticals (Traditional medicine), School of Pharmacy, Shiraz University of Medical sciences, Shiraz, Iran.
| | - Mohammad Miaad Shahrizi
- Department of Phytopharmaceuticals (Traditional medicine), School of Pharmacy, Shiraz University of Medical sciences, Shiraz, Iran.
| | - Maryam Sadat Sadati
- Molecular Dermatology Research Center, Shiraz University of Medical Sciences.
| | - Seyed Hossein Owji
- Otolaryngology Research Center, Department of Otolaryngology, Shiraz University of Medical Sciences, Shiraz, Iran.
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
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Meikle B, Simons M, Mahoney T, Reddan T, Dai B, Kimble RM, Tyack Z. Ultrasound measurement of traumatic scar and skin thickness: a scoping review of evidence across the translational pipeline of research-to-practice. BMJ Open 2024; 14:e078361. [PMID: 38594186 PMCID: PMC11015304 DOI: 10.1136/bmjopen-2023-078361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES To identify the ultrasound methods used in the literature to measure traumatic scar thickness, and map gaps in the translation of these methods using evidence across the research-to-practice pipeline. DESIGN Scoping review. DATA SOURCES Electronic database searches of Ovid MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature and Web of Science. Grey literature searches were conducted in Google. Searches were conducted from inception (date last searched 27 May 2022). DATA EXTRACTION Records using brightness mode (B-mode) ultrasound to measure scar and skin thickness across the research-to-practice pipeline of evidence were included. Data were extracted from included records pertaining to: methods used; reliability and measurement error; clinical, health service, implementation and feasibility outcomes; factors influencing measurement methods; strengths and limitations; and use of measurement guidelines and/or frameworks. RESULTS Of the 9309 records identified, 118 were analysed (n=82 articles, n=36 abstracts) encompassing 5213 participants. Reporting of methods used was poor. B-mode, including high-frequency (ie, >20 MHz) ultrasound was the most common type of ultrasound used (n=72 records; 61% of records), and measurement of the combined epidermal and dermal thickness (n=28; 24%) was more commonly measured than the epidermis or dermis alone (n=7, 6%). Reliability of ultrasound measurement was poorly reported (n=14; 12%). The scar characteristics most commonly reported to be measured were epidermal oedema, dermal fibrosis and hair follicle density. Most records analysed (n=115; 97%) pertained to the early stages of the research-to-practice pipeline, as part of research initiatives. CONCLUSIONS The lack of evaluation of measurement initiatives in routine clinical practice was identified as an evidence gap. Diverse methods used in the literature identified the need for greater standardisation of ultrasound thickness measurements. Findings have been used to develop nine methodological considerations for practitioners to guide methods and reporting.
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Affiliation(s)
- Brandon Meikle
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
| | - Megan Simons
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Occupational Therapy, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Tamsin Mahoney
- Surgical, Treatment and Rehabilitation Services (STARS), Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Tristan Reddan
- Medical Imaging and Nuclear Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bryan Dai
- The University of Queensland, Saint Lucia, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Zephanie Tyack
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Australian Centre for Health Service Innovation (AusHI), Centre for Healthcare Transformation, and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Bandopadhyay A, Kapoor A, Kundu K, Jagtap M, Chattopadhyay D. Translation and validation of Hindi version of patient scar assessment scale in patients with postburn facial scar. J Cutan Aesthet Surg 2024; 17:55-59. [PMID: 38736860 PMCID: PMC11086925 DOI: 10.4103/jcas.jcas_11_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background Patient scar assessment scale (PSAS) is a reliable and standard tool for assessment of scars by the observer and the patient. Till now the scale has not been translated to Hindi. The objective of the study was to translate and validate the PSAS to Hindi. Materials and Methods We did forward and backward translation of the English PSAS together with its validation. In total, 64 patients with postburn facial scars were included. The validation committee consisted of 6 bilingual members. Results The PSAS-Hindi showed good internal consistency with Cronbach's α of 0.86. Test-retest reliability showed good correlation with intra class coefficient being 0.94 (95% confidence interval: 0.83-0.97). Conclusion The PSAS was successfully translated to Hindi, and cross-cultural adaptation was made.
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Affiliation(s)
- Arkapal Bandopadhyay
- Department of Pharmacology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Akshay Kapoor
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Kaustav Kundu
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Manish Jagtap
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Debarati Chattopadhyay
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Drake VE, Moyer JS. The Measure of a Scar: Patient Perceptions and Scar Optimization after Skin Cancer Reconstruction. Facial Plast Surg 2023; 39:501-507. [PMID: 37290453 DOI: 10.1055/s-0043-1769807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
In facial reconstruction after skin cancer resection, management and optimization of postoperative scar is a complex paradigm. Every scar is unique and presents a different challenge-whether due to anatomic, aesthetic, or patient-specific factors. This necessitates a comprehensive evaluation and an understanding of the tools at hand to improve its appearance. How a scar looks is meaningful to patients, and the facial plastic and reconstructive surgeon is tasked with its optimization. Clear documentation of a scar is critical to assess and determine optimal care. Scar scales such as the Vancouver Scar Scale, the Manchester Scar Scale, the Patient and Observer Assessment Scale, the Scar Cosmesis Assessment and Rating "SCAR" Scale, and FACE-Q, among others, are reviewed here in the context of evaluating postoperative or traumatic scar. Measurement tools objectively describe a scar and may also incorporate the patient's assessment of their own scar. In addition to physical exam, these scales quantify scars that are symptomatic or visually unpleasant and would be best served by adjuvant treatment. The current literature regarding the role of postoperative laser treatment is also reviewed. While lasers are an excellent tool to assist in blending of scar and decreasing pigmentation, studies have failed to evaluate laser in a consistent, standardized way that allows for quantifiable and predictable improvement. Regardless, patients may derive benefit from laser treatment given the finding of subjective improvement in their own perception of scar, even when there is not a significant change to the clinician's eye. This article also discusses recent eye fixation studies which demonstrate the importance of careful repair of large and central defects of the face, and that patients value the quality of the reconstruction.
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Affiliation(s)
- Virginia E Drake
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Livonia, Michigan
| | - Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Livonia, Michigan
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Wasson E, Thandi C, Hitchens E, Thomas K, Keith D. An audit of the use of fractional CO2 laser for hypertrophic burn scars: a real-life perspective. Lasers Med Sci 2023; 38:144. [PMID: 37347311 DOI: 10.1007/s10103-023-03814-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Affiliation(s)
- Elizabeth Wasson
- Foundation School, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.
| | - Charankumal Thandi
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
| | - Emma Hitchens
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
| | - Kay Thomas
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
| | - Daniel Keith
- Department of Dermatology, North Bristol NHS Trust & Bristol Laser Centre, Bristol, UK
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Ngo DQ, Le DT, Ngo QX, Van Le Q. Transoral endoscopic thyroidectomy vestibular approach as a novel technique for pediatric populations: Results from a single surgeon. Front Endocrinol (Lausanne) 2023; 14:1177633. [PMID: 37334309 PMCID: PMC10272734 DOI: 10.3389/fendo.2023.1177633] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/23/2023] [Indexed: 06/20/2023] Open
Abstract
Background The transoral endoscopic thyroidectomy vestibular approach (TOETVA) is increasingly being adopted worldwide because of its many advantages. However, there are few reports on the effectiveness and safety of TOETVA in children. In this study, we report the results of the application of TOETVA on 27 pediatric patients in Vietnam. To the best of our knowledge, this is also the largest sample size of the TOETVA technique performed by a single surgeon on pediatric patients worldwide. Patients and methods: From June 2020 to February 2022, we performed TOETVA on 27 pediatric patients (≤ 18 years old). The outcomes of the procedure were retrospectively reviewed. Results Our study was conducted on 27 pediatric patients, of whom 24 were female (88.9%). The mean age was 16.3 ± 2 (range 10-18). Fifteen patients had benign thyroid nodules with a mean nodule size of 31.6 ± 7.1 (range 20-50mm), and 12 patients had papillary thyroid carcinoma with a mean nodule size of 10.2 ± 5.6 (range 4-19mm). All 27 patients underwent successful TOETVA without any conversion to open surgery. The 15 patients with benign thyroid nodules had lobectomies with a mean operative time of 83.3 ± 10.5 (range 60-105 minutes). Among the 12 patients diagnosed with thyroid cancer, ten had a lobectomy, isthmusectomy, and central neck dissection, with a mean operative time of 89.8 ± 5.7 (range 80-100 minutes). The other two underwent total thyroidectomy with central lymph node dissection with a mean operative time of 132.5 minutes. The mean hospital stay was 4.7 ± 0.9 (range 3-7 days). No patient had permanent complications, such as hypocalcemia, recurrent laryngeal nerve injury, or mental nerve injury. The rates of temporary recurrent laryngeal nerve injury and mental nerve injury were 3.7% and 11.1% respectively. Conclusions TOETVA may be a feasible and safe surgical method for children with thyroid disease. However, we recommend that only high-volume thyroid surgeons with experience in TOETVA should perform TOETVA on the pediatric population.
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Affiliation(s)
- Duy Quoc Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
| | - Duong The Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Quy Xuan Ngo
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
| | - Quang Van Le
- Department of Head and Neck Surgery, Vietnam National Cancer Hospital, Hanoi, Vietnam
- Department of Oncology, Hanoi Medical University, Hanoi, Vietnam
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Ten Voorde W, Saghari M, Boltjes J, de Kam ML, Zhuparris A, Feiss G, Buters TP, Prens EP, Damman J, Niemeyer-van der Kolk T, Moerland M, Burggraaf J, van Doorn MBA, Rissmann R. A multimodal, comprehensive characterization of a cutaneous wound model in healthy volunteers. Exp Dermatol 2023. [PMID: 37051698 DOI: 10.1111/exd.14808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/13/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
Development of pharmacological interventions for wound treatment is challenging due to both poorly understood wound healing mechanisms and heterogeneous patient populations. A standardized and well-characterized wound healing model in healthy volunteers is needed to aid in-depth pharmacodynamic and efficacy assessments of novel compounds. The current study aims to objectively and comprehensively characterize skin punch biopsy-induced wounds in healthy volunteers with an integrated, multimodal test battery. Eighteen (18) healthy male and female volunteers received three biopsies on the lower back, which were left to heal without intervention. The wound healing process was characterized using a battery of multimodal, non-invasive methods as well as histology and qPCR analysis in re-excised skin punch biopsies. Biophysical and clinical imaging read-outs returned to baseline values in 28 days. Optical coherence tomography detected cutaneous differences throughout the wound healing progression. qPCR analysis showed involvement of proteins, quantified as mRNA fold increase, in one or more healing phases. All modalities used in the study were able to detect differences over time. Using multidimensional data visualization, we were able to create a distinction between wound healing phases. Clinical and histopathological scoring were concordant with non-invasive imaging read-outs. This well-characterized wound healing model in healthy volunteers will be a valuable tool for the standardized testing of novel wound healing treatments.
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Affiliation(s)
- Wouter Ten Voorde
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
| | - Mahdi Saghari
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
| | - Jiry Boltjes
- Centre for Human Drug Research, Leiden, the Netherlands
| | | | | | - Gary Feiss
- Cutanea Life Sciences, Wayne, Pennsylvania, USA
| | - Thomas P Buters
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
| | - Errol P Prens
- Department of Dermatology Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Jeffrey Damman
- Department of Pathology Erasmus Medical Centre, Rotterdam, the Netherlands
| | | | | | - Jacobus Burggraaf
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
- Leiden Academic Center for Drug Research, Leiden University, Leiden, the Netherlands
| | | | - Robert Rissmann
- Centre for Human Drug Research, Leiden, the Netherlands
- Leiden University Medical Centre, Leiden, the Netherlands
- Leiden Academic Center for Drug Research, Leiden University, Leiden, the Netherlands
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11
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Mekereș GM, Buhaș CL, Tudoran C, Csep AN, Tudoran M, Manole F, Iova CS, Pop NO, Voiţă IB, Domocoș D, Voiţă-Mekereş F. The practical utility of psychometric scales for the assessment of the impact of posttraumatic scars on mental health. Front Public Health 2023; 11:1103714. [PMID: 37089486 PMCID: PMC10113612 DOI: 10.3389/fpubh.2023.1103714] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/02/2023] [Indexed: 04/09/2023] Open
Abstract
BackgroundScars are a natural consequence of the healing process, but with an impact on the psychological and social level for the individual, which can even lead to withdrawal and social stigmatization. We aimed to analyze the psychosocial impact determined by post-traumatic scars, using psychometric scales, to assess the effectiveness of the Mekereș’ Psychosocial Internalization Scale (MPIS), and to identify relevant predictors of traumatic and surgical scar internalization.MethodsOur cohort included 293 participants, 149 women and 144 men, aged 18–64 years who were screened for scar characteristics and completed a set of psychological scales. We compared the results obtained in two subgroups: 153 subjects with posttraumatic scars and 140 with surgical scars.ResultsRelevant predictors for posttraumatic scar internalization (R2 = 0.721) are adaptation time, age of the occurrence and subjective appraisal, while for the depression, and hopelessness relevant predictors are the subjective appraisal of the scars and the posttraumatic quality of life.ConclusionThe psychological and social reporting of the aftermath of trauma, that has been followed by scar-ring, is an indicator of how a person will react and could indicate the susceptibility to psycho-pathology.
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Affiliation(s)
| | | | - Cristina Tudoran
- Department VII, Internal Medicine II, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara, Romania
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, Timisoara, Romania
- County Emergency Hospital “Pius Brinzeu”, Timisoara, Romania
- *Correspondence: Cristina Tudoran,
| | | | - Mariana Tudoran
- County Emergency Hospital “Pius Brinzeu”, Timisoara, Romania
| | - Felicia Manole
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | | | | | - Ioan Bogdan Voiţă
- Regional Institute of Gastroenterology and Hepatology “Prof. Octavian Fodor”, Cluj-Napoca, Romania
| | - Daniela Domocoș
- Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
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Mid-Term Follow-Up Study of Children Undergoing Autologous Skin Transplantation for Burns. Life (Basel) 2023; 13:life13030762. [PMID: 36983917 PMCID: PMC10053383 DOI: 10.3390/life13030762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/28/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Deep partial and full-thickness burns require surgical treatment with autologous skin grafts after necrectomy, which is the generally accepted way to achieve permanent wound coverage. This study sought to examine the grafted and donor areas of children who underwent autologous skin transplantation, using two assessment scales to determine the severity of the scarring and the cosmetic outcome during long-term follow-up. At the Surgical Unit of the Department of Paediatrics of the University of Pécs, between 1 January 2015 and 31 December 2019, children who had been admitted consecutively and received autologous skin transplantation were analyzed. Twenty patients met the inclusion criteria in this retrospective cohort study. The authors assessed the results using the Patient and Observer Scar Assessment Scale (POSAS) and the Vancouver Scar Scale (VSS). There was a significant difference in how parents and examiners perceived the children’s scars. In the evaluation of the observer scale, the most critical variables for the area of skin grafted were relief and thickness. Besides color, relief was the worst clinical characteristic on the patient scale. However, when medical professionals evaluated the donor site, significantly better results were obtained compared to the transplanted area (average observer scale score: 1.4 and 2.35, p = 0.001; VSS: 0.85 vs. 2.60, p < 0.001), yet it was similar to the graft site in the parents’ opinion (Patient Scale: 2.95 and 4.45, p = 0.181).
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Mekeres GM, Buhaș CL, Csep AN, Beiușanu C, Andreescu G, Marian P, Cheregi CD, Fodor R, Manole F. The Importance of Psychometric and Physical Scales for the Evaluation of the Consequences of Scars-A Literature Review. Clin Pract 2023; 13:372-383. [PMID: 36961059 PMCID: PMC10037630 DOI: 10.3390/clinpract13020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Scars affect patients after trauma, burns, or surgical procedures and can generate both physical and psychosocial changes. The aesthetic damage represents the modification of a person's physical appearance, in its bodily integrity, causing numerous sufferings and determining social or economic consequences. The aim of this research is to evaluate the advantages and disadvantages offered by the available psychosocial and physical scar scales in assessing the physical, aesthetic, psychosocial, and juridical consequences of scars. This will aid to inform medical examiners about the most valued existing scales to allow them to select the most appropriate instrument to manage their patient. METHODS A broad search of relevant scientific studies on the psychosocial determinants of post-traumatic and surgical scars was conducted by using the following international database tools: PsycINFO, MedLine Social Science Index, Scopus, Web of Science, published from 1960 until 2022. RESULTS We analyzed 63 scientific studies to assess the advantages and limits of several psychometric and physical scar evaluation scales. CONCLUSIONS The researchers analyzed in this review highlight the advantages and limitation of existing instruments, evidencing the demand for future scar evaluation instruments and a scar-assessing algorithm that takes into account the physical, aesthetic, psychosocial, and legal consequences of scars.
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Affiliation(s)
- Gabriel Mihai Mekeres
- Doctoral School of Biomedical Sciences, University of Oradea, Faculty of Medicine and Pharmacy, 410087 Oradea, Romania
| | - Camelia Liana Buhaș
- Morphological Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
- Department of Legal Medicine, County Clinical Emergency Hospital of Oradea, 410169 Oradea, Romania
| | - Andrei Nicolae Csep
- Medical Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Corina Beiușanu
- Morphological Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Gineta Andreescu
- Morphological Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Paula Marian
- Medical Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Cornel Dragoș Cheregi
- Surgical Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Radu Fodor
- Doctoral School of Biomedical Sciences, University of Oradea, Faculty of Medicine and Pharmacy, 410087 Oradea, Romania
| | - Felicia Manole
- Surgical Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
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Lubczyńska A, Garncarczyk A, Wcisło‐Dziadecka D. Effectiveness of various methods of manual scar therapy. Skin Res Technol 2023; 29:e13272. [PMID: 36973982 PMCID: PMC10155853 DOI: 10.1111/srt.13272] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/30/2022] [Indexed: 03/05/2023]
Abstract
BACKGROUND The skin is a protective barrier of the body against external factors, and its damage leads to a loss of integrity. Normal wound healing results in a correct, flat, bright, and flexible scar. Initial skin damage and patient specific factors in wound healing contribute that many of these scars may progress into widespread or pathologic hypertrophic and keloid scars. The changes in cosmetic appearance, continuing pain, and loss of movement due to contracture or adhesion and persistent pruritis can significantly affect an individual's quality of life and psychological recovery post injury. Many different treatment methods can reduce the trauma and surgical scars. Manual scar treatment includes various techniques of therapy. The most effectiveness is a combined therapy, which has a multidirectional impact. Clinical observations show an effectiveness of manual scar therapy. MATERIAL AND METHODS The aim of this work was to evaluate effectiveness of the scar manual therapy combined with complementary methods on the postoperative scars. Treatment protocol included two therapies during 30 min per week for 8 weeks. Therapy included manual scar manipulation, massage, cupping, dry needling, and taping. RESULTS Treatment had a significant positive effect to influence pain, pigmentation, pliability, pruritus, surface area, and scar stiffness. Improvement of skin parameters (scar elasticity, thickness, regularity, color) was also noticed. CONCLUSION To investigate the most effective manual therapy strategy, further studies are needed, evaluating comparisons of different individual and combined scar therapy modalities.
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Affiliation(s)
- Agnieszka Lubczyńska
- Department of Cosmetology, School of Pharmaceutical Science in SosnowiecMedical University of SilesiaKatowicePoland
| | - Agnieszka Garncarczyk
- Department of Cosmetology, School of Pharmaceutical Science in SosnowiecMedical University of SilesiaKatowicePoland
| | - Dominika Wcisło‐Dziadecka
- Department of Cosmetology, School of Pharmaceutical Science in SosnowiecMedical University of SilesiaKatowicePoland
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15
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Montemurro P, Cheema M, Pellegatta T, Hedén P. Patient and Clinician Reported Outcomes of the Inframammary Incision "Short Scar Technique" in Primary Breast Augmentation. Aesthet Surg J Open Forum 2023; 5:ojad003. [PMID: 36793399 PMCID: PMC9924772 DOI: 10.1093/asjof/ojad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background Breast augmentation is a common aesthetic surgery procedure and surgeons are constantly trying to develop techniques that help improve patients' outcome. One of the most important aspects is achieving a favorable scar. The "traditional" breast augmentation scar is in the inframammary fold (IMF), whereas trans-axillary and trans-umbilical approaches have been described as an attempt to move the "location" of the scar and make it less noticeable. Nonetheless, relatively little attention has been paid to improving the IMF scar, which remains the most commonly used scar for silicone implants. Objectives The authors have previously described a technique that uses an insertion sleeve and custom-made retractors to allow implant insertion through a shorter IMF scar. However, at the time, the authors did not evaluate the quality of the scar and patient satisfaction. In this manuscript, the authors describe patient and clinician-reported outcomes for this short scar technique. Methods All consecutive female patients, undergoing primary aesthetic breast augmentation with symmetric implants were included in this review. Results Three different scar-assessment scales demonstrated good results at 1-year postop, as well as the good correlation between patient-reported and clinician-observed scores. BREAST-Q subscale for overall satisfaction also demonstrated good overall patient satisfaction. Conclusions Besides providing an added aesthetic value to the result of breast augmentation, a shorter scar may also appeal to patients who are concerned about the size and quality of postoperative scars and like to search for "before and after" pictures prior to scheduling consultations. Level of Evidence 4
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Affiliation(s)
- Paolo Montemurro
- Corresponding Author: Dr Paolo Montemurro, Akademikliniken, Storängsvägen, 1011541 Stockholm, Sweden. E-mail:
| | - Mubashir Cheema
- Department of Plastic Surgery, University Hospitals Birmingham, United Kingdom
| | | | - Per Hedén
- private practice in Stockholm, Sweden
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Quantification of Erythema Associated With Varying Suture Materials in Facial Surgery Repair: A Randomized Prospective Study. Dermatol Surg 2022; 48:1289-1293. [DOI: 10.1097/dss.0000000000003625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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17
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Edwards J. Hypertrophic scar management. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S24-S31. [PMID: 36370406 DOI: 10.12968/bjon.2022.31.20.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Scarring has major psychological and physical repercussions. Scars are often considered trivial, but they can be disfiguring and aesthetically unpleasant and may cause severe itching, tenderness, pain, sleep disturbance, anxiety, depression and disruption of daily activities. It is more efficient to prevent hypertrophic scars than treat them; early diagnosis of a problem scar can considerably impact the overall outcome. Therefore, nurses need to be as knowledgeable about scar products as they are about wound products, and their responsibility should not end once the wound has healed. Appropriate management of the scar will ensure that the wound remains healed and that the patient is happy with the outcome. The nurse is ideally placed to ensure that scars are appropriately identified and treated as early as possible.
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Affiliation(s)
- Jacky Edwards
- Consultant Nurse (Burns), Programme Lead and Representative for Major Trauma and Burns Clinical Reference Group, Manchester Burns Course
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18
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DARWISH AS, ELNAGGAR OA, ZAKI AA, KAMEL NM, DAHAB MM, EL-SAYEM K. Role of autologous platelet rich plasma in hypospadias repair. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.20.05217-1] [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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19
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Quality of Life and Surgical Outcome of Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) versus Open Thyroid Surgery: Experience from a Single Center in Vietnam. J Thyroid Res 2022; 2022:2381063. [PMID: 36268522 PMCID: PMC9578921 DOI: 10.1155/2022/2381063] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 09/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background It has been widely assumed that TOETVA has demonstrated a new technique and a promising approach as it is both minimally invasive and optimally cosmetic. The objective of this study was to assess the surgical outcome, aesthetic satisfaction, and postoperative quality of life of TOETVA in comparison with open thyroid surgery. Patients and Methods. The study was designed as a prospective study, in which 121 patients from a single center in Vietnam underwent thyroid surgery, and the study was divided into two groups: 60 patients in the TOETVA group and 61 patients in the open surgery group. The patients have been followed up including surgical outcomes, cosmetic satisfaction, and quality of life. These criteria were assessed at 4 weeks, 8 weeks, and 12 weeks after the surgery using SF-36 and thyroid surgery-specific questionnaire. Results Patients in the TOETVA group are significantly younger than patients in the open surgery group (35.8 + 10.3 vs 46.9 + 11.5, p < 0.001). The mean operating time was longer in the TOETVA group (102.9 ± 26.1 mins) than that in the open surgery group (66.8 ± 23.8 mins) with p = 0.0001. Cosmetic outcomes and overall satisfaction were significantly greater in the TOETVA group p = 0.0001. The SF-36 QOL scores of the patients in the TOETVA group were generally higher than the open surgery group. Conclusions TOETVA has been widely used with a low complication rate, cosmetic appeal, and surgical efficacy. Postoperative quality of life, cosmetic outcomes, and overall satisfaction were significantly superior to the open surgery group.
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Qu L, Liang Z, Wang J, Zhang J, Yu Z, Song B. Comparison of Postoperative Scarring in Asian Women After Supra-brow and Sub-brow Blepharoplasty: A Retrospective Study. Aesthetic Plast Surg 2022; 46:2280-2286. [PMID: 35668229 DOI: 10.1007/s00266-022-02954-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/15/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Supra-brow and sub-brow blepharoplasty are two types of upper eyelid blepharoplasties that are commonly performed in middle-aged Asian women to correct skin laxity of the upper eyelid; the postoperative scar formation of the two procedures may be different. Therefore, we designed this retrospective study to explore the differences in postoperative scarring between patients receiving supra- or sub-brow blepharoplasty. METHODS We identified 52 patients who underwent supra-brow blepharoplasty and 54 patients who underwent sub-brow blepharoplasty. For each patient, the scar quality was assessed using photographs, the Observer Scar Assessment Scale (OSAS), and the Patient Scar Assessment Scale (PSAS) 1 year following surgery. RESULTS For OSAS, higher scores for pigmentation, thickness, relief, pliability, surface, and overall opinion were observed in patients who underwent supra-brow blepharoplasty (p < 0.05) except for the "vascular score" (p = 0.148). The average overall opinion scores of the supra- and sub-brow blepharoplasty were 3.90 ± 0.41 and 2.33 ± 0.48, respectively, indicating that acceptance of postoperative scars in patients who underwent supra-brow blepharoplasty was worse than that in patients who underwent sub-brow blepharoplasty. Significantly higher scores were observed in all items of PSAS items for patients with supra-brow blepharoplasty (p < 0.05). CONCLUSIONS The postoperative scars in patients who underwent supra-brow blepharoplasty were more obvious than those in sub-brow blepharoplasty. From the perspective of postoperative scar formation, sub-brow blepharoplasty may be a more suitable choice for patients. 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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Affiliation(s)
- Linghan Qu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Zhen Liang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Jianzhang Wang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Juan Zhang
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xincheng District, Xi'an, Shaanxi, China
| | - Zhou Yu
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xincheng District, Xi'an, Shaanxi, China.
| | - Baoqiang Song
- Department of Plastic and Reconstructive Surgery, Xijing Hospital, Fourth Military Medical University, 127 Changle West Road, Xincheng District, Xi'an, Shaanxi, China.
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Shahparonyan RG, Poghosyan AY, Minasyan AM, Bablumyan AY, Malkhasyan IE, Gnuni AS, Matosyan KH, Sargsyan AM, Tadevosyan AE, Muradyan AA. Evaluation of post-tracheostomy scars and their impact on persons' quality of life: A case-control study. Int Wound J 2022; 20:372-380. [PMID: 35801258 PMCID: PMC9885458 DOI: 10.1111/iwj.13885] [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: 05/26/2022] [Revised: 06/14/2022] [Accepted: 06/25/2022] [Indexed: 02/03/2023] Open
Abstract
Tracheostomy is one of the more commonly performed procedures in critically ill patients under mechanical ventilation. Postoperative scarring is one of the bothersome sequelae of tracheostomies. Scars distort physical appearance, especially when found on the head and neck, which could have a negative impact on quality of life. The aim of this study was to evaluate and assess the impact of post-tracheostomy scars on quality of life according to the tracheostomy method. A prospective, single-center, observational, case-control study was conducted. One hundred fifty-six persons with a post-tracheostomy surgical scar for more than four months were observed using the Patient and Observer Scar Assessment Scale and Dermatology Life Quality Index questionnaire. Persons were divided into two groups depending on the method of tracheostomy, and the duration of the cannulated period was considered in both groups. Statistical analyses were performed using SPSS ver. 16.0 (SPSS Inc., Chicago, IL, USA), and P values of <0.05 were considered significant. The patients who had a tracheostomic tube cannulation period of fewer than 15 days had better cosmetic results than those who had tracheostomic tubes for more than 15 days, regardless of the tracheostomy method: 6.64 ± 0.082 versus 16.15 ± 0.096 (P < 0.001) in the surgical tracheostomy group and 7.26 ± 0.211 versus 14.17 ± 0.379 (P < 0.05) in the percutaneous dilatational group. The Dermatology Life Quality Index scores had a mean value of 0.6 ± 0.01, which means that post-tracheostomy scarring in the present study had no effect on the person's quality of life. The aesthetic outcomes of post-tracheostomy scars after the open surgical tracheostomy technique did not significantly differ from those of the percutaneous dilatational technique in the present study. Persons with a long duration of tracheostomic tube ventilation showed worse aesthetic outcomes than those with short-term tracheostomic cannulation, which was not dependent on the tracheostomy technique. The Dermatology Life Quality Index showed that post-ttracheostomy scarring in the present study had no effect on the person's quality of life.
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Affiliation(s)
- Rafik G. Shahparonyan
- ENT and Maxillofacial Surgery Department, Yerevan State Medical University"Heratsi" №1 University HospitalYerevanArmenia
| | - Anna Yu Poghosyan
- ENT and Maxillofacial Surgery Department, Yerevan State Medical University"Heratsi" №1 University HospitalYerevanArmenia
| | - Armen M. Minasyan
- Administrative DepartmentYerevan State Medical UniversityYerevanArmenia
| | - Aren Yu Bablumyan
- Administrative DepartmentYerevan State Medical UniversityYerevanArmenia
| | - Irina E. Malkhasyan
- Department of Anesthesiology and Intensive CareYerevan State Medical UniversityYerevanArmenia
| | - Anatoly S. Gnuni
- Department of Anesthesiology and Intensive CareYerevan State Medical UniversityYerevanArmenia
| | - Khachatur H. Matosyan
- ENT and Maxillofacial Surgery Department, Yerevan State Medical University"Heratsi" №1 University HospitalYerevanArmenia
| | - Ani M. Sargsyan
- ENT and Maxillofacial Surgery Department, Yerevan State Medical University"Heratsi" №1 University HospitalYerevanArmenia
| | - Artashes E. Tadevosyan
- Department of Public Health and HealthcareYerevan State Medical UniversityYerevanArmenia
| | - Armen A. Muradyan
- Administrative DepartmentYerevan State Medical UniversityYerevanArmenia
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22
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Fronek LF, Dorton D. Surgical Outcomes Following Mohs Micrographic Surgery for Basal Cell Carcinoma on the Distal Third of the Nose. THE JOURNAL OF CLINICAL AND AESTHETIC DERMATOLOGY 2022; 15:32-36. [PMID: 35783569 PMCID: PMC9239128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The primary aim of this study is to determine a quantifiable difference in surgical outcomes between local skin flap, full thickness skin graft (FTSG), and secondary intention (SI) following Mohs micrographic surgery (MMS) for basal cell carcinoma (BCC) on the distal third of the nose. METHODS A retrospective chart review of 66 MMS defects on the distal third of the nose performed by a single surgeon between June 2019 to June 2020 was completed. Clinical images of MMS defects and postoperative scars at six months were recorded and measured by the Vancouver Scar Scale (VSS). Pearson Chi-square and Fisher's Exact tests were utilized to determine the relationship between the main predictor variables and VSS. RESULTS Of the 66 patients retained, 52 were deemed to have low VSS (77.61%), 11 had medium VSS (16.42%) and three had high VSS (4.48%). Of the 52 patients with low VSS, 40 underwent local flap (76.92%), nine underwent FTSG (17.31%), and three healed by SI (5.77%). Of the 11 patients with medium VSS, two underwent local flap (18.15%), nine underwent FTSG (81.82%), and zero healed by SI. Of the three patients with high VSS, zero underwent local flap or SI, while all three underwent FTSG (100%). Bivariate analysis demonstrated that repair type employed was associated with VSS at six months (p<0.0001) with patients treated with local skin flap having better outcomes. CONCLUSION Our data illustrate that local skin flaps might result in a lower VSS at six months compared to FTSG or SI, therefore offering superior surgical outcomes in the treatment of BCC on the distal third of the nose.
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Affiliation(s)
- Lisa Faye Fronek
- Both authors are with the Department of Dermatology, HCA Healthcare/USF Morsani College of Medicine at Largo Medical Center Program in Largo, Florida
| | - David Dorton
- Both authors are with the Department of Dermatology, HCA Healthcare/USF Morsani College of Medicine at Largo Medical Center Program in Largo, Florida
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23
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Evaluation of Quality of Life (BREAST-Q) and Scar Quality (POSAS) after Breast Augmentation. Plast Reconstr Surg Glob Open 2022; 10:e4313. [PMID: 35620506 PMCID: PMC9116954 DOI: 10.1097/gox.0000000000004313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/23/2022] [Indexed: 11/25/2022]
Abstract
This study examines the effects of breast augmentation on women who underwent surgery in Germany regarding their quality of life (QOL) and scar quality using patient-reported surveys. The purpose of this study was to determine if there is an increase in women’s QOL after surgery compared with preoperative, and to evaluate their postoperative scar quality.
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24
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Cox C, Bettiol P, Le A, MacKay BJ, Griswold J, McKee D. CO 2 laser resurfacing for burn and traumatic scars of the hand and upper extremity. Scars Burn Heal 2022; 8:20595131211047694. [PMID: 35003761 PMCID: PMC8738873 DOI: 10.1177/20595131211047694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Scar formation is a normal part of the proliferative phase in wound healing where collagen is remodelled to better approximate normal skin. When collagen is not effectively redistributed, excessive scarring may occur. Recently, CO2 laser has emerged as an adjunct in improving scar quality via remodelling and redistribution of dermal collagen fibres. Due to the paucity of literature related to its use in the hands and upper extremities, we created a study to examine its effects on hypertrophic scars focused on the hands and upper extremities. Methods Patients treated with CO2 laser for hypertrophic scars of the hand and upper extremity were included. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) were used to assess the progression of scar quality. Unpaired t-tests were performed to determine statistical difference between pre- and post-treatment scores on each scale. Pearson correlation coefficients were used to understand the relationship between number of treatments and scar quality. Results Of the 90 patients enrolled, 54 patients completed serial scar assessment forms. All patient and observer-reported POSAS domains showed improvement (P < 0.05) apart from Itching. All VSS domains showed improvement (P < 0.05). There was moderate correlation between overall patient-reported opinion of scar quality and Discoloration, Stiffness and Thickness, and strong correlation between overall patient opinion and Irregularity (r = 0.715). All observer-reported domains were strongly correlated (r = 7.56–8.74) with overall observer opinion of scar quality. Conclusion The results of this study may further substantiate CO2 laser as a treatment modality for excessive scarring in a variety of surgical subspecialties. Lay Summary Complex trauma and burns that impact the skin sometimes result in abnormal healing of the skin called, “hypertrophic scarring”. In our study we assessed how using focused CO2 laser therapy impacts patients and health care provider assessment of wound progression. Our results were based upon patient reported and healthcare provider observations based upon two standardized forms the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). What we found is that after CO2 Laser Therapy, our 64 patients with 77 treated scars received on average almost 3 treatments and these treatments helped them with physical function and improved aesthetic appearance of their scars. The health care providers also found that the treatments improved functional and aesthetic end points. Overall, our study helps substantiate the body of evidence that using CO2 laser therapy improves aesthetics and function of hypertrophic scars in the upper extremity.
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Affiliation(s)
- Cameron Cox
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Patrick Bettiol
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Audrey Le
- Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Brendan J MacKay
- Texas Tech University Health Sciences Center, Lubbock, TX, USA.,University Medical Center, Lubbock, TX, USA
| | - John Griswold
- Texas Tech University Health Sciences Center, Lubbock, TX, USA.,University Medical Center, Lubbock, TX, USA
| | - Desirae McKee
- Texas Tech University Health Sciences Center, Lubbock, TX, USA.,University Medical Center, Lubbock, TX, USA
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Witting S, Ingwersen M, Lehmann T, Aschenbach R, Eckardt N, Zanow J, Fahrner R, Lotze S, Friedel R, Lenz M, Schmidt C, Miguel D, Ludriksone L, Teichgräber U. Wound Closure After Port Implantation-a Randomized Controlled Trial Comparing Tissue Adhesive and Intracutaneous Suturing. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:749-755. [PMID: 34615593 DOI: 10.3238/arztebl.m2021.0324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 02/13/2021] [Accepted: 08/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Wound healing after pectoral port implantation is a major factor determining the success or failure of the procedure. Infection and wound dehiscence can endanger the functionality of the port system and impede chemotherapy. The cosmetic result is important for patient satisfaction as well. METHODS From August 2015 to July 2017, adult patients with an indication for port implantation were entered into a prospective, randomized and controlled single-center study. The skin incision was closed either with tissue adhesive or with an intracutaneous suture. The primary endpoints were the total score of the scar evaluated by the patient and the investigator on the POSAS scale (Patient and Observer Scar Assessment Scale: 6 [normal skin] to 60 points), blinded assessment of photographic documentation by ten evaluating physicians, and the patient's reported quality of life. The calculation of case numbers was based only on the patients' overall POSAS assessment, which was tested for non-inferiority. The secondary endpoints were other complications (infection, dehiscence) and the duration of wound closure (trial registration number NCT02551510). RESULTS 156 patients (60 ± 13 years, 64% women) participated in the study. The patientassessed total POSAS score of tissue adhesive revealed non-inferiority to suturing (adhesive 11.7 ± 5.8 vs. suture 10.1 ± 4.0, p for non-inferiority <0.001). Both the investigators in their POSAS assessments and the blinded physician evaluators in their assessment of photographically documented wounds rated wound closure by suturing better than closure with tissue adhesive. No significant differences were found between groups with respect to quality of life or the frequency of wound infection or dehiscence. CONCLUSION Closure of the upper cutaneous layer with tissue adhesive is a suitable and safe method of wound closure after port implantation.
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Oley MH, Oley MC, Kepel BJ, Manginstar C, Rawung R, Langi FLFG, Barends D, Aling DMR, Wagiu AMJ, Faruk M. Post-skin incision scar tissue assessment using patient and observer scar assessment scales: A randomised controlled trial. Ann Med Surg (Lond) 2021; 71:103006. [PMID: 34840756 PMCID: PMC8606832 DOI: 10.1016/j.amsu.2021.103006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/30/2021] [Accepted: 10/31/2021] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The scalpel was once the gold standard for surgical incisions. Electrosurgery has started to supplant scalpels but is not yet acceptable for skin incisions due to the risk of burns and deeper injury relative to the scalpels' neat incision with less tissue damage. The unnecessary burden of excessive scar formation makes comparing these two methods challenging. Therefore, this study aims to compare post-incision skin scarring created after monopolar electrosurgery and scalpel surgery, and evaluate the Patient and Observer Scar Assessment Scale (POSAS) suitability for assessing skin incision scars by comparing patients' and observers' scores. METHODS This self-controlled study involved patients undergoing elective and emergency skin surgery procedures. A singular wound site was created using two incision methods (monopolar electrosurgery and scalpel) simultaneously. Post-incision scar tissue formation was evaluated using the POSAS, a subjective scar assessment tool that involved patients self-reporting on pain, itching, color, thickness flexibility, and surface relief. Observer-rated vascularity, pigmentation, thickness, flexibility, and surface relief both using a 5-point Likert-type scale. We performed this assessment three months post-surgery, and the results were analyzed by a battery of statistical tests and linear mixed models. RESULTS Twenty patients were included in this study. Data analyzed using the paired t-test or Wilcoxon rank-sum test indicated no statistically significant differences between the scar tissue created by monopolar electrosurgery and scalpels according to both the patients and the observers. Correlation analyses between the patients' and observers' total POSAS scores indicated these followed a moderate linear relationship (r = 0.51; p < 0.001). Linear mixed models further supported the agreement of POSAS total scores between patients and observers. They also confirmed that electrosurgery was not inferior to the scalpel technique. CONCLUSION Scar tissue from skin incisions made by monopolar electrosurgery were indistinguishable from those created with a scalpel. The POSAS instrument is an acceptable means of assessing scar formation on the skin.
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Affiliation(s)
- Mendy Hatibie Oley
- Division of Plastic Reconstructive & Aesthetic Surgery, Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, North Sulawesi, Indonesia
- Division of Plastic Reconstructive & Aesthetic Surgery, Department of Surgery, R. D. Kandou Hospital, Manado, North Sulawesi, Indonesia
- Hyperbaric Centre Siloam Hospital, Manado, North Sulawesi, Indonesia
| | - Maximillian Christian Oley
- Hyperbaric Centre Siloam Hospital, Manado, North Sulawesi, Indonesia
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, North Sulawesi, Indonesia
- Division of Neurosurgery, Department of Surgery, R. D. Kandou Hospital, Manado, North Sulawesi, Indonesia
| | - Billy Johnson Kepel
- Department of Chemistry, Faculty of Medicine, Sam Ratulangi University, Manado, North Sulawesi, Indonesia
| | - Christian Manginstar
- Division of Surgical Oncology, Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, North Sulawesi, Indonesia
- Division of Surgical Oncology, Department of Surgery, R. D. Kandou Hospital, Manado, North Sulawesi, Indonesia
| | - Rangga Rawung
- Division of Orthopedic and Traumatology Surgery, Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, North Sulawesi, Indonesia
- Division of Orthopedic and Traumatology Surgery, Department of Surgery, R. D. Kandou Hospital, Manado, North Sulawesi, Indonesia
| | - Fima Lanra Fredrik G. Langi
- Division of Public Health, Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, North Sulawesi, Indonesia
| | - David Barends
- Department of Surgery, Faculty of Medicine, Sam Ratulangi University, Manado, North Sulawesi, Indonesia
| | | | | | - Muhammad Faruk
- Department of Surgery, Faculty of Medicine, Hasanuddin University, Makassar, South Sulawesi, Indonesia
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Voiță-Mekeres F, Buhaș CL, Mekeres GM, Tudoran C, Racovita M, Faur CI, Tudoran M, Abu-Awwad A, Voiță NC, Maghiar TA. Mekeres' Psychosocial Internalization Scale: A Scale for the Evaluation of Aesthetic Prejudice in Victims of Accidents and Violence. Healthcare (Basel) 2021; 9:healthcare9111440. [PMID: 34828487 PMCID: PMC8623774 DOI: 10.3390/healthcare9111440] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/15/2021] [Accepted: 10/20/2021] [Indexed: 01/10/2023] Open
Abstract
Background and objectives: One important forensic activity is the assessment of aesthetic injuries where expert criteria and analysis are insufficiently outlined due to the subjective elements related to the traumatized victim. Unaesthetic morphological changes may occur due to various circumstances committed under the Penal Code, resulting in permanent unaesthetic morphological scarring. Considering that most of the existing scales for the assessment of aesthetic prejudices refer only to morphometric changes, our aim was to create a modern method for the evaluation of aesthetic damage that also considers its social and psychological consequences. Materials and Methods: In this study, we developed the Mekereș Psychosocial Internalization Scale (MPIS), which proposes a clear boundary between the presence or absence of aesthetic damage. The traumatized person is evaluated after a minimum of six months (in the case of an average scar, necessary for defining the character of the scar) to assess changes in the physiognomy or even alterations in the victim’s aesthetic perception of their own body. Our study was conducted on 103 patients with scars, and the results were compared to 101 controls (subjects without scars). Results: Individuals with scars have a distorted perception (compared to controls) of the support provided by significant people [t (202) = 2.473; p = 0.01]. Hypothetically, they will most likely exhibit a nuanced socio-cognitive and psycho-emotional vulnerability that may be the source of future dysfunctions. The fidelity of the MPIS scale was estimated by employing Cronbach’s alpha coefficient, resulting in a value of 0.934 (15 items). The exploratory factorial analysis with Varimax rotation mode sustains a single dominant factor, indicating a good internal consistency. The results of this study provide evidence regarding the psychosocial or psychometric worthiness of MPIS. Conclusions: MPIS can be used for research and as an instrument to assess aesthetic damage or disfigurement by forensic physicians and lawyers.
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Affiliation(s)
- Florica Voiță-Mekeres
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (F.V.-M.); (C.L.B.); (M.R.); (N.C.V.); (T.A.M.)
| | - Camelia Liana Buhaș
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (F.V.-M.); (C.L.B.); (M.R.); (N.C.V.); (T.A.M.)
| | - Gabriel Mihai Mekeres
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (F.V.-M.); (C.L.B.); (M.R.); (N.C.V.); (T.A.M.)
- Correspondence: (G.M.M.); (C.T.); Tel.: +40-770-679-808 (G.M.M.); +40-722-669-086 (C.T.)
| | - Cristina Tudoran
- Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300041 Timisoara, Romania;
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300041 Timisoara, Romania
- County Emergency Hospital, 300736 Timisoara, Romania
- Correspondence: (G.M.M.); (C.T.); Tel.: +40-770-679-808 (G.M.M.); +40-722-669-086 (C.T.)
| | - Mariana Racovita
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (F.V.-M.); (C.L.B.); (M.R.); (N.C.V.); (T.A.M.)
| | - Cosmin Ioan Faur
- Department XV, Orthopedy-Traumatology, Urology and Imagistical Medicine, Discipline of Orthopedy, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300041 Timisoara, Romania; (C.I.F.); (A.A.-A.)
| | - Mariana Tudoran
- Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300041 Timisoara, Romania;
- Center of Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300041 Timisoara, Romania
- County Emergency Hospital, 300736 Timisoara, Romania
| | - Ahmed Abu-Awwad
- Department XV, Orthopedy-Traumatology, Urology and Imagistical Medicine, Discipline of Orthopedy, University of Medicine and Pharmacy “Victor Babes” Timisoara, 300041 Timisoara, Romania; (C.I.F.); (A.A.-A.)
| | - Nuțu Cristian Voiță
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (F.V.-M.); (C.L.B.); (M.R.); (N.C.V.); (T.A.M.)
| | - Teodor Andrei Maghiar
- Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania; (F.V.-M.); (C.L.B.); (M.R.); (N.C.V.); (T.A.M.)
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Full-Thickness Skin Graft according to Surrounding Relaxed Skin Tension Line Improves Scar Quality in Facial Defect Coverage: A Retrospective Comparative Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:7398090. [PMID: 34568495 PMCID: PMC8460372 DOI: 10.1155/2021/7398090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/12/2021] [Indexed: 11/23/2022]
Abstract
A full-thickness skin graft (FTSG) is useful for covering small skin and soft tissue defects. In this paper, we suggest FTSG in consideration of the relaxed skin tension line (RSTL) concept for scar quality improvement since FTSG has disadvantages, including contour irregularities and mismatches of color and texture. We conducted a retrospective chart review of twenty-one patients with skin cancer on the face who underwent wide excision and FTSG by a single surgeon from October 2013 to July 2019. Twenty-one patients with skin cancer on the face were divided into RSTL-matched and RSTL-unmatched groups, and FTSG was performed. Each group was subjected to scar assessment three months after surgery. Observer assessment was performed by five independent observers using the observer component of the patient and observer scar assessment scale (POSAS) and Vancouver scar scale (VSS). Our results indicate that there were significant differences between the RSTL-matched and RSTL-unmatched groups in the VSS and POSAS components. In addition, the RSTL-matched group showed a natural appearance with surrounding tissue in the dynamic animation phase compared to the unmatched group. RSTL-matched FTSG can be an attractive option for face skin and soft tissue defect coverage. (An earlier version of this paper has been presented at the International Conference on PRS Korea 2020.)
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Romero-Cullerés G, Amela-Arévalo A, Jané-Feixas C, Vilaseca-Grané A, Arnau A, Torà N. [Efficacy of collagen infiltrations in the pelvic pain caused by episiotomy and caesarean scars. Pilot randomized clinical trial]. Rehabilitacion (Madr) 2021; 56:85-92. [PMID: 34489100 DOI: 10.1016/j.rh.2021.04.001] [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: 10/30/2020] [Revised: 03/24/2021] [Accepted: 04/04/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS Pelvic pain is a frequently consulted symptom in pelvic floor rehabilitation units. The aim of this study was to evaluate the efficacy of collagen infiltrations in pain and the appearance of scars from perineal tears, episiotomies and caesarean sections. MATERIAL AND METHODS Pilot randomized, controlled and single-blind clinical trial. Control group (CG) patients received conventional rehabilitation treatment. Additionally, those in the intervention group (IG) received 3-5 collagen infiltrations. The patients were evaluated at baseline and 6 weeks post-intervention. The main outcome was pain and it was evaluated with the visual analog scale and McGill Pain Questionnaire. As secondary outcomes, the appearance of the scar was evaluated by Vancouver Scar Scale and the Patient Scar Assessment Scale. A sample of 15 women was analyzed, 8 in the CG and 7 in the IG. RESULTS The mean age was 33.1 years (SD 4.1). The intragroup analysis showed a significant decrease of the visual analog scale punctuation and total McGill Pain Questionnaire score and the PRI-Emotional dimension of the McGill Pain Questionnaire. In the IG, a significant decrease was also observed in the PRI-Sensorial and PRI-Evaluative dimensions in comparison with baseline situation. In both groups, a significant improvement in the appearance of the scar was observed. In the intergroup analysis, a greater decrease in pain was observed in PRI-Sensorial subscale of the McGill Pain Questionnairein the IG (-15.1 vs. -6; P=.040). CONCLUSIONS Collagen infiltrations may improve pain and the appearance of painful scars.
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Affiliation(s)
- G Romero-Cullerés
- Servicio de Medicina Física y Rehabilitación, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España; Facultat de Ciències de la Salut, Universitat de Vic-Universitat Central de Catalunya (UVicUCC), Manresa, Barcelona, España
| | - A Amela-Arévalo
- Servicio de Ginecología y Obstetricia, Hospital de Igualada, Igualada, Barcelona, España.
| | - C Jané-Feixas
- Servicio de Medicina Física y Rehabilitación, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España
| | - A Vilaseca-Grané
- Servei d'Atenció a la Salut Sexual i Reproductiva (ASSIR) Bages, Centre d'Atenció Primària Bages, Manresa, Barcelona, España
| | - A Arnau
- Unitat de Recerca i Innovació, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España
| | - N Torà
- Unitat de Recerca i Innovació, Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Barcelona, España
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Albayati WK, Qassim YN. Evaluation of bilateral interdigitated Pacman flap for reconstruction of skin defects in different parts of the body. Ann R Coll Surg Engl 2021; 103:e292-e297. [PMID: 34435505 PMCID: PMC9774017 DOI: 10.1308/rcsann.2021.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Restorative surgical repair using different surgical modalities is required on the excision of skin lesions or when treating traumatic lacerations; each modality has advantages and drawbacks. In this article, we evaluate the efficacy of using a bilateral interdigitated Pacman flap to reconstruct circular and oval cutaneous defects on different parts of the body. Fourteen patients with soft tissue defects on different parts of the body underwent reconstruction using a bilateral interdigitated Pacman flap. The design of this flap is similar to that of a conventional bilateral V-Y advancement flap; however, the limbs of the V are drawn as slightly curved convex lines. All patients were followed-up for more than 6 months. All soft tissue defects were reconstructed completely using this technique, and no significant complications were noticed except in one patient who developed partial flap necrosis. However, aesthetic issues remain a limiting factor in using this technique. This flap is a reliable, practical and effective option for closure of circular and oval soft tissue defects, although there are certain limitations when used on the face and in younger patients.
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Affiliation(s)
- WK Albayati
- Iraqi Board of Medical Specializations, Baghdad, Iraq
| | - YN Qassim
- University of Baghdad, Baghdad, Iraq
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Ramanathan D, Chu S, Prendes M, Carroll BT. Validated Outcome Measures and Postsurgical Scar Assessment Instruments in Eyelid Surgery: A Systematic Review. Dermatol Surg 2021; 47:914-920. [PMID: 33988553 DOI: 10.1097/dss.0000000000003077] [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: 11/25/2022]
Abstract
BACKGROUND Determining which postsurgical scar assessment instruments, if any, cover important eyelid outcome measures can either attest to the strength of one or more instruments or reveal the need for a more comprehensive scale. OBJECTIVE To systematically review validated outcome measures after eyelid surgery and postsurgical scar assessment tools to see whether any individual or combination of 2 assessment tools encompass all relevant, validated eyelid outcome measures. METHODS Systematic reviews of validated eyelid outcome measures and postsurgical scar assessment tools were conducted using PubMed/MEDLINE and Ovid. Outcome measure papers that met inclusion criteria were sorted into 8 categories: Patient Subjective, Visual Function, Mechanical Function, Daily Activities, Adverse Effects, Aesthetic Quantitative: Clinical Measurements, Aesthetic Qualitative: Global, and Aesthetic Qualitative: Specific. Outcome measure papers were categorized into tiers of evidence support, and assessment tools were evaluated based on which outcome measures each covered. RESULTS No one or combination of 2 assessment tools covered all selected eyelid outcome measures. Although measures related to the subjective patient experience were included in several of the assessment scales, none covered measures of visual function or eyelid-specific clinical measurements. CONCLUSION There is currently no existing postsurgical scar assessment instrument that covers all important eyelid-specific outcome measures.
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Affiliation(s)
- Diya Ramanathan
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sherman Chu
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Northwest, Lebanon, Oregon
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Mark Prendes
- Department of Ophthalmology and Visual Sciences, University Hospitals, Case Western
- Reserve University School of Medicine, Cleveland, Ohio
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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da Costa PTL, Echevarría-Guanilo ME, Gonçalves N, Girondi JBR, Gonçalves ADC. Subjective Tools for Burn Scar Assessment: An Integrative Review. Adv Skin Wound Care 2021; 34:1-10. [PMID: 33979826 DOI: 10.1097/01.asw.0000749732.09228.a9] [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: 11/25/2022]
Abstract
OBJECTIVE To review the clinical and scientific literature on the subjective ways of assessing burn scars and describe their main characteristics. DATA SOURCES The Latin American, Caribbean Health Sciences Literature, Nursing Database, PubMed, CINAHL, and Scopus and Web of Science databases were used to search for studies published between 2014 and 2018 using descriptors in Portuguese, Spanish, and English. STUDY SELECTION After establishing the research question and the location and definition of the studies, as well as accounting for differences among databases and application of filters based on inclusion and exclusion criteria, 886 references remained. DATA EXTRACTION Investigators reviewed the titles and abstracts of the sample and selected 188 relevant studies for full review. DATA SYNTHESIS Twenty-six subjective forms of assessment were found; most research concerned the Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale. CONCLUSIONS The Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale are the most common scales for assessing burn scars and have similar evaluation points such as vascularization, pliability, pigmentation, and height, which are the main parameters that contribute to the general assessment and severity of a scar. There is a need to improve instructions for application of the scales to facilitate better understanding and improve agreement among evaluators.
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Affiliation(s)
- Pollyana Thays Lameira da Costa
- At the Department of Nursing, Universidade Federal de Santa Catarina, Florianópolis, Brazil, Pollyana Thays Lameira da Costa, MSN, RN, is a Doctorate Student and Maria Elena Echevarría Guanilo, DNP, RN; Natália Gonçalves, PhD, RN; and Juliana Balbinot Reis Girondi, PhD, RN, are Professors. Adriana da Costa Gonçalves, PhD, is Professor of Physical Therapy, Centro Universitário Barão de Mauá de Ribeirão Preto, Brazil. Acknowledgment: This study was completed as part of a scholarship funded by the Higher Education Personnel Improvement Coordination (Coordenação Aperfeiçoamento Pessoal do Nível Superior). The authors have disclosed no other financial relationships related to this article. Submitted September 3, 2020; accepted in revised form November 5, 2020
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Oda T, Kato H, Nakamura M, Morita A. Analysis of biomonitoring data after full-thickness skin grafting. J Dermatol 2021; 48:1035-1043. [PMID: 33811395 DOI: 10.1111/1346-8138.15873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/13/2021] [Accepted: 03/15/2021] [Indexed: 11/28/2022]
Abstract
Skin graft vascularization is investigated mainly by histological evaluation. Immunohistochemical analysis has been conducted only in mice. Transcutaneous oxygen tension (TcPO2 ), which is an index of blood flow, has not been evaluated in skin grafts and only a few studies have reported biologic monitoring data using color tone evaluation and surface temperature. In humans, these tests can be performed non-invasively. To evaluate human skin graft vascularization, we analyzed biomonitoring data after skin grafting. We evaluated 14 patients who underwent skin grafting surgery at Nagoya City University Hospital. The TcPO2 , color tone, surface temperature, and dermoscopic observations at recipient sites were measured at postoperative day (POD) 4, 6, and 11. Mean TcPO2 levels at POD4, 6, and 11 were 12.7, 15.2, and 33.5 mmHg, respectively, and significantly higher at POD11 than at POD4 (p = 0.003, Steel-Dwass test). Dermoscopic observation revealed gradually increasing redness and yellowness. Color tone evaluation measured by spectrophotometry supported the appearance. The a*(redness) value at POD4, 6, and 11 was 6.19, 9.20, and 11.27, respectively, and significantly higher at POD11 than at POD4 (p < 0.001, Steel-Dwass test). The b*(yellowness) value at POD4, 6, and 11 was 8.83, 9.24, and 13.02, respectively, and significantly higher at POD11 than at POD4 (p = 0.020, Steel-Dwass test). The surface temperature did not significantly differ between graft and control sites. These findings suggest that skin graft vascularization started by POD6 and stabilized by POD11. Because TcPO2 increases after POD4, skin grafts should remain undisturbed until at least POD11.
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Affiliation(s)
- Takao Oda
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Ghanbarzamani A, Salehifar E, Jafarirad A, Hesamirostami MH, Bagherzadehsaba A, Saeedi M, Ghazaeian M, Khorasani G, Moosazadeh M. Efficacy and Safety of 0.25% Timolol Gel in Healing Split-Thickness Skin Graft Site. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2021; 20:178-186. [PMID: 34903980 PMCID: PMC8653643 DOI: 10.22037/ijpr.2020.114565.14915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
As a common intervention among burn patients, skin graft has some risks such as infections and delay of wound healing. The aim of this study was to assess the efficacy and safety of topical 0.25% Timolol Gel (TG) in promoting wound healing in split-thickness skin graft donor sites. We conducted a double-blind, randomized clinical trial to assess re-epithelialization time, the level of pain based on the Visual Analog Scale (VAS), and the wound infection incidence. The scar status was also evaluated by the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Totally, 64 patients were randomly assigned to the study groups. The two groups showed a significant difference in healing time (14.5 ± 3.2 vs. 11.5 ± 2.3 days, P < 0.001). No infection occurred in either group, and 3 cases of transplant rejection were observed in the placebo group. The VAS was significantly different on days 1, 2, 3, 4, and 7 (P < 0.05). In the third month, the results showed a significant difference in terms of VSS (P = 0.005). Topical TG, due to its favorable effects on wound healing and pain reduction, can be administered as a therapeutic agent in patients with a skin graft.
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Affiliation(s)
- Amirhossein Ghanbarzamani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Mazandaran, Iran.
| | - Ebrahim Salehifar
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Mazandaran, Iran.
| | - Abdolreza Jafarirad
- Department of Surgery, Zare Psychiatry and Burn Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
| | | | - Ali Bagherzadehsaba
- Department of Surgery, Zare Psychiatry and Burn Hospital, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Majid Saeedi
- Department of Pharmaceutics, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Monireh Ghazaeian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Mazandaran, Iran. ,Corresponding author:E-mail:
| | - Ghasemali Khorasani
- Department of Plastic Surgery, Imam Khomeini Hospital, Tehran University of Medical Science, Tehran, Iran.
| | - Mahmood Moosazadeh
- Health Sciences Research Center, Addiction Institute, Mazandaran University of Medical Sciences, Sari, Iran.
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Park B, Seong G, Yeom K, Yun D, Choi M, Kim M. A retrospective study to evaluate the efficacy and safety of staged purse-string sutures for the reconstruction of surgical defects on skin using computer image analysis program. Indian J Dermatol 2021; 66:645-648. [PMID: 35283493 PMCID: PMC8906307 DOI: 10.4103/ijd.ijd_402_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Staged purse-string suturing has been recently introduced for the reconstruction of round or oval defects following tumor excision. Objective: The aim of this study was to evaluate the clinical advantage of staged purse-string suturing for the reconstruction of relatively large skin defects. Materials and Methods: Twenty-one patients who received staged purse-string sutures were included in the study. To evaluate the defects and scar sizes objectively, computer-based image analysis was used. A modified observer scar assessment scale (OSAS) was applied for evaluating the clinical efficacy. Results: The mean primary postsurgical defect size in the total 21 cases was 1446.2 ± 1187.2 mm2, and the mean final scar size was about 268.1 ± 252.3 mm2. The defect area decreased gradually as staged purse-string suturing was performed. The mean total modified OSAS was 7.96 ± 1.69. Conclusion: Staged purse-string sutures might be an alternative reconstructive method for relatively large round or oval skin defects.
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Gherasim O, Puiu RA, Bîrcă AC, Burdușel AC, Grumezescu AM. An Updated Review on Silver Nanoparticles in Biomedicine. NANOMATERIALS (BASEL, SWITZERLAND) 2020; 10:E2318. [PMID: 33238486 PMCID: PMC7700255 DOI: 10.3390/nano10112318] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022]
Abstract
Silver nanoparticles (AgNPs) represent one of the most explored categories of nanomaterials for new and improved biomaterials and biotechnologies, with impressive use in the pharmaceutical and cosmetic industry, anti-infective therapy and wound care, food and the textile industry. Their extensive and versatile applicability relies on the genuine and easy-tunable properties of nanosilver, including remarkable physicochemical behavior, exceptional antimicrobial efficiency, anti-inflammatory action and antitumor activity. Besides commercially available and clinically safe AgNPs-based products, a substantial number of recent studies assessed the applicability of nanosilver as therapeutic agents in augmented and alternative strategies for cancer therapy, sensing and diagnosis platforms, restorative and regenerative biomaterials. Given the beneficial interactions of AgNPs with living structures and their nontoxic effects on healthy human cells, they represent an accurate candidate for various biomedical products. In the present review, the most important and recent applications of AgNPs in biomedical products and biomedicine are considered.
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Affiliation(s)
- Oana Gherasim
- Department of Science and Engineering of Oxide Materials and Nanomaterials, University Politehnica of Bucharest, 1-7 Gheorghe Polizu Street, 011061 Bucharest, Romania; (O.G.); (R.A.P.); (A.C.B.); (A.-C.B.)
- Lasers Department, National Institute for Lasers, Plasma and Radiation Physics, 409 Atomistilor Street, 077125 Magurele, Romania
| | - Rebecca Alexandra Puiu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, University Politehnica of Bucharest, 1-7 Gheorghe Polizu Street, 011061 Bucharest, Romania; (O.G.); (R.A.P.); (A.C.B.); (A.-C.B.)
| | - Alexandra Cătălina Bîrcă
- Department of Science and Engineering of Oxide Materials and Nanomaterials, University Politehnica of Bucharest, 1-7 Gheorghe Polizu Street, 011061 Bucharest, Romania; (O.G.); (R.A.P.); (A.C.B.); (A.-C.B.)
| | - Alexandra-Cristina Burdușel
- Department of Science and Engineering of Oxide Materials and Nanomaterials, University Politehnica of Bucharest, 1-7 Gheorghe Polizu Street, 011061 Bucharest, Romania; (O.G.); (R.A.P.); (A.C.B.); (A.-C.B.)
| | - Alexandru Mihai Grumezescu
- Department of Science and Engineering of Oxide Materials and Nanomaterials, University Politehnica of Bucharest, 1-7 Gheorghe Polizu Street, 011061 Bucharest, Romania; (O.G.); (R.A.P.); (A.C.B.); (A.-C.B.)
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 90-92 Panduri Road, 050657 Bucharest, Romania
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Berg A, Kaul S, Rauscher GE, Blatt M, Cohn S. Successful Full-Thickness Skin Regeneration Using Epidermal Stem Cells in Traumatic and Complex Wounds: Initial Experience. Cureus 2020; 12:e10558. [PMID: 33101805 PMCID: PMC7577303 DOI: 10.7759/cureus.10558] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Skin grafts generated from cultured autologous epidermal stem cells may have potential advantages when compared to traditional skin grafting. In this report, we will share our initial experience with a new technique for the treatment of difficult cutaneous wounds. Eight patients with traumatic or complex wounds underwent full-thickness skin harvesting and processing of epidermal stem cells, followed by the application of our novel management protocol. The patients were at high risk for non-healing and/or severe scar formation due to large traumatic de-gloving crush injuries, wounds from necrotizing fasciitis, or chronic wounds from osteomyelitis. We examined the percent graft success, recipient to donor size ratios, the median time to epithelialization, and two-point sensory discrimination. An international scale (The Patient and Observer Scar Assessment Scale - POSAS) was used to evaluate wound cosmesis and included parameters such as pain, pruritus, vascularity, pigmentation, and thickness of the healing wound. In total, 10 out of 11 wounds had 100% survival of the graft, and one patient had an 80% graft take. The largest wound was 1600 cm2, and all wounds were harvested from small-donor sites, which were closed primarily. The mean wound to donor ratio was >25:1. Most wounds were fully epithelialized within 30 days. Neurologically, four out of six patients studied exhibited two-point discrimination similar to the adjacent native uninjured skin. The majority of patients reported their wounds to have limited pain or pruritus, and similar pigmentation to adjacent skin.
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Affiliation(s)
- Arthur Berg
- Department of Trauma and Surgical Critical Care, Hackensack University Medical Center, Hackensack, USA
| | - Sanjeev Kaul
- Department of Trauma and Surgical Critical Care, Hackensack Univeristy Medical Center, Hackensack, USA
| | - Gregory E Rauscher
- Department of Trauma and Surgical Critical Care, Hackensack University Medical Center, Hackensack, USA
| | - Melissa Blatt
- Department of Trauma and Surgical Critical Care, Hackensack University Medical Center, Hackensack, USA
| | - Stephen Cohn
- Department of Trauma and Surgical Critical Care, Hackensack University Medical Center, Hackensack, USA
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Qassim YN, Ali AA, Alfeehan MJ, Albayati WK. Double vest lipodermal flaps for depressed facial scars. Ann R Coll Surg Engl 2020; 102:621-624. [PMID: 32735124 DOI: 10.1308/rcsann.2020.0154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Depressed tethered scar is a common problem that can cause emotional, social and behavioural problems, especially when it involves the exposed body parts. Several techniques have been described for treating these depressed scars, but none of these can fulfil the optimal results. AIM Evaluating the aesthetic outcome of using a double vest lipodermal flaps for treating depressed facial scars. MATERIALS AND METHODS The study included 25 patients with depressed facial scars who underwent scar revision. Their mean age was 31 years. Under local anaesthesia, the scarred area was de-epithelialised and double dart lipodermal flaps were used for revision. Visual analogue and Vancouver scar scales were used as subjective and objective parameters of evaluation, respectively. RESULTS All the patients followed up for five to eight months. No complications were observed during the scar healing period. Patients satisfaction according to the visual analogue scale showed an average value of 8. The mean total scale according to the Vancouver scar scale was 2.6. CONCLUSION The new technique of using double vest lipodermal flaps is simple and offers a promising alternative for revising depressed scars.
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Affiliation(s)
- Y N Qassim
- College of Medicine, University of Baghdad, Baghdad, Iraq
| | - A A Ali
- College of Medicine, University of Kirkuk, Kirkuk
| | - M J Alfeehan
- College of Medicine, University of Anbar, Ramadi, Al Anbar, Iraq
| | - W K Albayati
- Ghazi al-Hariri Surgical Specialties Hospital, Baghdad Medical City, Baghdad, Iraq.,Iraqi Board of Medical Specializations, Baghdad, Iraq
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Schmitz L, Hessam S, Scholl L, Reitenbach S, Segert MH, Bechara FG. Wound Care With a Porcine Extracellular Matrix After Surgical Treatment of Rhinophyma. J Cutan Med Surg 2020; 24:253-258. [PMID: 32096427 DOI: 10.1177/1203475420906774] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Rhinophyma surgery is commonly associated with prolonged wound healing and the need for multiple wound dressings. OBJECTIVES To evaluate clinical outcome with a porcine extracellular matrix (ECM) after shave excision of rhinophyma compared with common wound care procedure. MATERIALS AND METHODS Retrospective analysis of patients with common dressings (CD) compared with patients with additional ECM (OASIS) application. Clinical findings were assessed prior to treatment and at follow-up visit using the Patient and Observer Scar Assessment Scale (POSAS), Vancouver Scar Scale (VSS), and Rhinophyma Severity Index (RHISI). RESULTS Overall, 28 patients (67.5 ±9.0 years) with a mean wound area of 33.9 (±8.5) cm² were included. After a mean follow-up period of 132 (±73) days, scales of POSAS, VSS, and RHISI showed significant (P< .0001) reductions of 47.0% (±11.1), 56.0% (±12.0), and 62.3% (±14.3), respectively. Subgroup analysis showed no significant differences of aforementioned parameters between the ECM group (n= 17) and CD group (n= 11). In contrast, the number of dressing changes were significantly (P< .006) less in the ECM group (1.4 ±0.8) compared with CD group (4.1 ±2.6). The ECM group showed a significant (P< .017) shorter time to re-epithelization (10.5 ±1.7 days) than the CD group (13.1 ±2.2 days). CONCLUSIONS The application of porcine ECM is practicable and reduces the number of dressing changes and time to re-epithelization clearly. Crusts are scaling off spontaneously without any aggressive action needed. Our findings indicate that ECM application is a promising approach for rhinophyma wound care.
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Affiliation(s)
- Lutz Schmitz
- 9142 Dermatologic Surgery Unit, Department of Dermatology, Faculty of Medicine, Ruhr University Bochum, Germany
| | - Schapoor Hessam
- 9142 Dermatologic Surgery Unit, Department of Dermatology, Faculty of Medicine, Ruhr University Bochum, Germany
| | - Lisa Scholl
- 9142 Dermatologic Surgery Unit, Department of Dermatology, Faculty of Medicine, Ruhr University Bochum, Germany
| | - Sarah Reitenbach
- 9142 Dermatologic Surgery Unit, Department of Dermatology, Faculty of Medicine, Ruhr University Bochum, Germany
| | - Marc H Segert
- 9142 Dermatologic Surgery Unit, Department of Dermatology, Faculty of Medicine, Ruhr University Bochum, Germany
| | - Falk G Bechara
- 9142 Dermatologic Surgery Unit, Department of Dermatology, Faculty of Medicine, Ruhr University Bochum, Germany
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El Ayadi A, Jay JW, Prasai A. Current Approaches Targeting the Wound Healing Phases to Attenuate Fibrosis and Scarring. Int J Mol Sci 2020; 21:ijms21031105. [PMID: 32046094 PMCID: PMC7037118 DOI: 10.3390/ijms21031105] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/20/2020] [Accepted: 02/04/2020] [Indexed: 02/06/2023] Open
Abstract
Cutaneous fibrosis results from suboptimal wound healing following significant tissue injury such as severe burns, trauma, and major surgeries. Pathologic skin fibrosis results in scars that are disfiguring, limit normal movement, and prevent patient recovery and reintegration into society. While various therapeutic strategies have been used to accelerate wound healing and decrease the incidence of scarring, recent studies have targeted the molecular regulators of each phase of wound healing, including the inflammatory, proliferative, and remodeling phases. Here, we reviewed the most recent literature elucidating molecular pathways that can be targeted to reduce fibrosis with a particular focus on post-burn scarring. Current research targeting inflammatory mediators, the epithelial to mesenchymal transition, and regulators of myofibroblast differentiation shows promising results. However, a multimodal approach addressing all three phases of wound healing may provide the best therapeutic outcome.
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Franchignoni F, Giordano A, Vercelli S, Bravini E, Stissi V, Ferriero G. Rasch Analysis of the Patient and Observer Scar Assessment Scale in Linear Scars. Plast Reconstr Surg 2019; 144:1073e-1079e. [DOI: 10.1097/prs.0000000000006265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lenzi L, Santos J, Raduan Neto J, Fernandes CH, Faloppa F. The Patient and Observer Scar Assessment Scale: Translation for portuguese language, cultural adaptation, and validation. Int Wound J 2019; 16:1513-1520. [PMID: 31599117 DOI: 10.1111/iwj.13228] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 09/01/2019] [Accepted: 09/03/2019] [Indexed: 11/28/2022] Open
Abstract
Evaluating scars is fundamental to analyse the outcome of treatments that include surgical intervention. Scales facilitate this type of assessment, but most of these measuring instruments are in different languages. The Patient and Observer Scar Assessment Scale (POSAS) is one of the most robust instruments available in the literature for the evaluation of scars, although there is no validated version in Brazilian Portuguese. The aims of this study were to culturally translate and validate POSAS for the Portuguese language of Brazil and to test its reproducibility, face validity, content, and construct. Following the methodology proposed by Beaton DE, Bombardier C, Guillemin F, Ferraz, MB, Spine 2000, 25, 3186, the questionnaire was translated and adapted to the Brazilian culture. The reproducibility, face, content, and construct validity were then analysed. In all, the scale was applied to 35 patients with postoperative scars (patient version) and 35 hand surgery specialists (version for the observer). The internal consistency was tested by Cronbach's alpha, and construct validation was performed by correlating the translated instrument with the Brazilian Portuguese translation of the Vancouver Scar Scale (VSS). The cultural adaptation of POSAS Escola Paulista de Medicina/Universidade Federal de São Paulo (EPM/UNIFESP) was confirmed. Both subscales showed strong internal consistency (Cronbach's α = 0.77-0.93), demonstrating reliability. The reproducibility was excellent, and the adapted scale demonstrated significant intra- and inter-observer reproducibility (r > 0.9) (P < 0.05). The validity of the construct was significant and showed good sensitivity between POSAS EMP/UNIFESP and the VSS. This study confirmed that POSAS EPM/UNIFESP can be used to evaluate patients with surgical scars in the Brazilian population. It has proven to be useful for clinical and research purposes, lending itself to capturing medical opinions and those of the patients themselves.
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Affiliation(s)
- Lgs Lenzi
- Department of Orthopedics and Hand Surgery, Escola Paulista de Medicina-UNIFESP, São Paulo, Brazil
| | - Jbg Santos
- Department of Orthopedics and Hand Surgery, Escola Paulista de Medicina-UNIFESP, São Paulo, Brazil
| | - J Raduan Neto
- Department of Orthopedics and Hand Surgery, Escola Paulista de Medicina-UNIFESP, São Paulo, Brazil
| | - C H Fernandes
- Department of Orthopedics and Hand Surgery, Escola Paulista de Medicina-UNIFESP, São Paulo, Brazil
| | - F Faloppa
- Department of Orthopedics and Hand Surgery, Escola Paulista de Medicina-UNIFESP, São Paulo, Brazil
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Quantification of Erythema Associated With Continuous Versus Interrupted Nylon Sutures in Facial Surgery Repair: A Randomized Prospective Study. Dermatol Surg 2019; 46:757-762. [PMID: 31490310 DOI: 10.1097/dss.0000000000002145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patients are often concerned about the cosmetic appearance of scars following Mohs micrographic surgery (MMS), including residual erythema. However, few studies have compared the cosmetic outcomes between different suturing techniques. OBJECTIVE To compare the erythema intensity (EI) associated with interrupted sutures (IS) and continuous sutures (CS), and the degree of its reduction over time. MATERIALS AND METHODS Mohs micrographic surgery patients were randomized to have half of their defect repaired with IS and the other half with CS. Postoperatively, subjects were assessed at 1 week, 2 months, and 6 months and close-up photographs of their scars were taken. Computer-assisted image analysis was utilized to quantify the EI in each half-scar. RESULTS The average EI of IS was greater than that of CS by 9.3% at 1 week (p < .001) and 7.2% at 2 months (p < .021) but comparable at 6 months. These differences were clinically detectable, but EI differences resolved by 6 months in most cases. At 6 months, EI regressed by 33.5% in IS and 26.3% in CS. CONCLUSION Continuous sutures are associated with less erythema during early scar maturation but are comparable to IS at 6 months. These results may guide the choice of suturing technique to improve early cosmetic outcomes and overall patient satisfaction.
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Erring M, Gaba S, Mohsina S, Tripathy S, Sharma RK. Comparison of efficacy of silver-nanoparticle gel, nano-silver-foam and collagen dressings in treatment of partial thickness burn wounds. Burns 2019; 45:1888-1894. [PMID: 31383609 DOI: 10.1016/j.burns.2019.07.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/25/2019] [Accepted: 07/10/2019] [Indexed: 11/16/2022]
Abstract
INTRODUCTION This study was carried out to compare the efficacy of silver nanoparticle gel (SG), nanosilver foam (SF) and collagen (C) dressings in partial thickness burn wounds. METHODS This was a single-center, prospective cohort study carried out over a period of 1 year on patients with 15-40% partial thickness thermal burns ≤48 h. Each patient received all three dressings (silver-nanoparticle gel, nanosilver foam, collagen) simultaneously at 3 randomly selected areas which were comparable in terms of burn depth and surface area. Efficacy of the dressings was assessed in terms of healing rates, time taken and ease of application, pain at dressing change, cost, wound-swab culture and scar quality (at 3 months). RESULTS A total of 20 patients were included. In SF group, number of patients with 60%-80% re-epithelialization on day10 (SG: 10/20; C: 10/20; SF: 16/20; p = 0.042) and complete healing on day14 (SF: 11/20, C: 6/20, SG: 4/20; p = 0.032) was significantly higher. The time for dressing change was similar at admission (p = 0.918) and day 10 (p = 0.163), although majority of the patients in SF group needed less than 10 min. The time taken (<10 min) was significantly lower in SF group by 14th day (SF: 18/20 C: 6/20 SG: 6/20; p < 0.001). The ease of application rated by clinicians as "extremely easy" was significantly better in SF group (SG: 78%, C: 80%, SF: 95%; p = 0.011). There was a significantly faster decrease in pain scores in SF group by 5th day (VAS score SF: 6, C: 8; SG: 8; p = 0.038), however, pain scores were comparable at 2 weeks. The scar quality (p = 0.82), cost (p = 0.09) and infection rates (SG: 7/20; C: 4/20; SF: 3/20; p = 0.05) were comparable. The need for skin-graft cover was lower in SF group (SG: 5/20; C: 3/20; SF: 1/20). CONCLUSION Nanosilver-foam dressings were found to be more efficacious for re-epithelialization, healing, ease of application, tolerance when compared to silver nanoparticle gel and collagen dressings in partial-thickness burns. All were found to be safe.
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Affiliation(s)
- Miying Erring
- Department of Plastic and Reconstructive Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sunil Gaba
- Department of Plastic and Reconstructive Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Subair Mohsina
- Department of Plastic and Reconstructive Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Satyaswarup Tripathy
- Department of Plastic and Reconstructive Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ramesh Kumar Sharma
- Department of Plastic and Reconstructive Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Stoecker A, Blattner CM, Howerter S, Fancher W, Young J, Lear W. Effect of Simple Interrupted Suture Spacing on Aesthetic and Functional Outcomes of Skin Closures. J Cutan Med Surg 2019; 23:580-585. [DOI: 10.1177/1203475419861077] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Dermatologic surgeons are trained in fundamental wound closure techniques that minimize wound tension and tissue ischemia to optimize healing and create discrete scars. These include orienting excisions along resting skin tension lines, handling tissue edges with care, and avoiding strangulation while tying suture. Another variable that may affect wound healing and cosmetic outcomes is the spacing between sutures. Objective This prospective, single-centre, randomized, split-scar comparison trial was designed to explore how suture spacing distance affects wound complication rate and scar cosmesis. Methods Elliptical surgical wounds of the trunk and extremities were repaired with simple interrupted sutures with varying suture spacing. One half of each wound was repaired with high-density suture spacing (approximately 5 mm apart) and the other with low-density suture spacing (approximately 10 mm apart). Wounds were evaluated at 2-week suture removal for complications, and then reevaluated at 3 and 6 months for cosmesis using the Patient and Observer Scar Assessment Scale score. Results Results revealed no significant difference in minor wound complications during the early healing process between high- and low-density suture spacing. At 3 months postoperatively, physicians and patients alike preferred the aesthetics of the low-density suture placement. By 6 months postoperatively, this preference disappeared. Conclusions These results suggest that suture spacing may affect early scar formation. Additionally, placing sutures farther apart results in fewer total puncture wounds, decreases tissue trauma, and saves surgical time while conserving suture material. Therefore, dermatologic surgeons should consider placing fewer percutaneous sutures during wound repair.
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Affiliation(s)
- Allison Stoecker
- Department of Dermatology, Good Samaritan Regional Medical Center/Silver Falls Dermatology, Salem, OR, USA
| | - Collin M Blattner
- Department of Dermatology, Good Samaritan Regional Medical Center/Silver Falls Dermatology, Salem, OR, USA
| | - Stephanie Howerter
- Department of Dermatology and Dermatologic Surgery, Good Samaritan Regional Medical Center/Silver Falls Dermatology, Salem, OR, USA
| | - Whitney Fancher
- Department of Dermatology and Dermatologic Surgery, Good Samaritan Regional Medical Center/Silver Falls Dermatology, Salem, OR, USA
| | - John Young
- Department of Dermatology, Good Samaritan Regional Medical Center/Silver Falls Dermatology, Salem, OR, USA
| | - William Lear
- Department of Dermatology and Dermatologic Surgery, Good Samaritan Regional Medical Center/Silver Falls Dermatology, Salem, OR, USA
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Pourang A, Crispin MK, Clark AK, Armstrong AW, Sivamani RK, Eisen DB. Use of 5-0 Fast Absorbing Gut versus 6-0 Fast Absorbing Gut during cutaneous wound closure on the head and neck: A randomized evaluator-blinded split-wound comparative effectiveness trial. J Am Acad Dermatol 2019; 81:213-218. [DOI: 10.1016/j.jaad.2019.02.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 01/23/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
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Kim JH, Ahn CH, Kim S, Lee Y, Oh SH. Comparative Measurement of Biophysical Parameters in Consideration of Skin Graft Donor Site for Nasal Defects. Ann Dermatol 2019; 31:1-5. [PMID: 33911532 PMCID: PMC7992696 DOI: 10.5021/ad.2019.31.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 01/22/2018] [Accepted: 02/22/2018] [Indexed: 11/23/2022] Open
Abstract
Background In planning a skin graft, the texture, color, and size of the recipient and donor site tissues should be considered. Objective We determined the optimal donor sites for nasal full-thickness skin grafting based on biophysical parameters. Methods Thirty women over the age of 60 were selected for this study. Four recipient sites (nasal root, dorsum, tip, ala) and three donor sites (preauricle, postauricle, forehead) were considered. Biophysical parameters such as transepidermal water loss (TEWL), capacitance, sebum output, erythema/melanin value, and skin replica technique were tested. Results The nasal root was correlated with the forehead in terms of TEWL and sebum output. The nasal dorsum was correlated with the preauricle in terms of TEWL, erythema/melanin value, and skin replica measurements. The nasal tip was correlated with the preauricle in terms of TEWL, sebum output, erythema/melanin value, and skin replica measurements. The ala was correlated with the forehead in terms of TEWL and skin replica measurements. Conclusion The preauricule is the optimal donor site for resurfacing of the nasal dorsum and tip. The forehead is a good donor site for alar defects. For resurfacing of the nasal root, the forehead and postauricle are good choices.
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Affiliation(s)
- Joo-Hak Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Chang Hwan Ahn
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sungmin Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Young Lee
- Department of Dermatology, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Sang-Ha Oh
- Department of Plastic and Reconstructive Surgery, College of Medicine, Chungnam National University, Daejeon, Korea
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Combination of Melolabial Interpolation Flap and Nasal Sidewall and Cheek Advancement Flaps Allows for Repair of Complex Compound Defects. Dermatol Surg 2018; 44:785-795. [PMID: 29360657 DOI: 10.1097/dss.0000000000001471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The paramedian forehead flap (PMFF) is the repair of choice for large nasal defects involving multiple cosmetic subunits. However, the PMFF may not be optimal for all patients. The combination of a melolabial interpolation flap (MLIF) and a nasal sidewall flap may serve as an alternative. OBJECTIVE To present the surgical technique and aesthetic outcomes of the alternative reconstruction for surgical defects of the lower nose. MATERIALS AND METHODS Fourteen patients with multisubunit nasal Mohs defects reconstructed alternatively were identified from 2 academic centers in this retrospective case series. Illustrations and photographs were used to demonstrate surgical technique and outcomes. Final aesthetic results were analyzed using the Patient and Observer Scar Assessment Scale. RESULTS The physician observer rated the scar outcome a mean score of 10.9 ± 3.3. Patients rated their results as a mean of 9.1 ± 4.7. The mean "Patient" Overall Opinion score was 2.3 ± 2.6 and the mean "Observer" Overall Opinion score was 1.9 ± 0.9. No patients reported problems with nasal airflow or obstruction, and cosmetic complications such as pincushioning or alar buckling were not observed. CONCLUSION The combined MLIF and nasal sidewall flap is an alternative repair for complex distal nasal defects.
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Automated VSS-based Burn Scar Assessment using Combined Texture and Color Features of Digital Images in Error-Correcting Output Coding. Sci Rep 2017; 7:16744. [PMID: 29196632 PMCID: PMC5711872 DOI: 10.1038/s41598-017-16914-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 11/20/2017] [Indexed: 11/08/2022] Open
Abstract
Assessment of burn scars is an important study in both medical research and clinical settings because it can help determine response to burn treatment and plan optimal surgical procedures. Scar rating has been performed using both subjective observations and objective measuring devices. However, there is still a lack of consensus with respect to the accuracy, reproducibility, and feasibility of the current methods. Computerized scar assessment appears to have potential for meeting such requirements but has been rarely found in literature. In this paper an image analysis and pattern classification approach for automating burn scar rating based on the Vancouver Scar Scale (VSS) was developed. Using the image data of pediatric patients, a rating accuracy of 85% was obtained, while 92% and 98% were achieved for the tolerances of one VSS score and two VSS scores, respectively. The experimental results suggest that the proposed approach is very promising as a tool for clinical burn scar assessment that is reproducible and cost-effective.
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