Scar Appearance Research Articles

P34. CONTINUOUS NEGATIVE PRESSURE WOUND THERAPY REGULATES HEALING AND FIBROSIS IN MURINE EXCISIONAL WOUNDS

PURPOSE: Hypertrophic scarring is a fibroproliferative disorder that can occur post-operatively resulting in significant functional and esthetic morbidity. Mechanical forces are known to modify the wound microenvironment and influence cellular behavior and organization. The potential effects of micromechanical force application through Negative Pressure Wound Therapy (NPWT) on skin scarring have not yet been explored in vivo. Here we investigate the application of continuous NPWT in a murine excisional wound model. METHODS: 20 obese and diabetic (db/db) mice received a 1×1 cm2 full thickness excisional dorsal skin wound and were separated into two groups, treated either with occlusive covering (Control, n=10), or NPWT (continuous, -125 mmHg, 7 days; NPWT, n=10). The wounds were photographed on days 0, 7, and 10, and the animals sacrificed and tissue harvested on day 10 for histological and molecular analysis. RESULTS: Although use of NPWT was shown to significantly increase Yes-associated protein (YAP), Engrailed-1 (En1) was significantly decreased. Use of NPWT significantly increased fibronectin deposition and improved collagen deposition and organization. Western blotting showed significantly increased RhoA and YAP and decreased Caspase-3 in the NPWT group. CONCLUSION: Taken together, our findings indicate that the mechanotransduction forces exerted by NPWT uncouple YAP, a mechanical signaling protein, from En1. Fibroblasts of an En1 lineage are known to mediate fibrotic processes that lead to scarring, while increased expression of caspase-3 has been linked to keloid formation. Therefore, through its actions on fibroblast proliferation and apoptosis, NPWT may play a significant role in final scar appearance.

53 Use of Polylactic-acid-membrane in Split-thickness Skin Graft Donor Sites: A Prospective, Comparative, Randomized Study

IntroductionPolyurethane film (PU) dressings are commonly applied for coverage of split-thickness skin graft (SSG) donor sites, while previous studies have suggested reduced morbidity using a polylactic acid membrane (PLM). To further investigate the optimal treatment approach, the presented study compared outcome of donor sites in patients receiving either PLM or PU.MethodsThis randomized clinical trial allocated patients requiring SSG to receive either PLM or PU at the donor-site. Primary endpoint was difference in donor site scar appearance between groups 3 months postoperatively (Vancouver Scar Scale – VSS). Secondary endpoints included pain, the number of and time required for wound dressing changes, and costs related to the wound dressing.Results30 patients were allocated to each group. The median VSS scored lower for patients receiving PLM (PU: 3 (Q1: 2; Q3: 4) vs. PLM: 2 (Q1: 1; Q3: 3); p=0.049). Pain during change of wound dressing (PU: 2.0 ± 0.2 vs. PLM: 0.5 ± 0.2; p< 0.001) and mobilization (PU: 0.8 ± 0.2 vs. PLM: 0.3 ± 0.1; p=0.032) was reduced in the PLM group. Patients with PLM required less dressing changes per day of hospital stay (PU: 0.44 ± 0.06 vs. PLM: 0.28 ± 0.02; p=0.015). Mean time for wound dressing changes per patient was higher in the PU group (PU: 74.50 ± 5.72 vs. PLM: 21.43 ± 2.61 min; p< 0.001). Costs were higher in the PLM group (PU: 67.83 ± 5.56 vs. PLM: 162.79 ± 21.76 €; p< 0.001).ConclusionsPLM improves outcome of SSG donor sites, however, higher treatment costs must be taken into consideration.

Clinical effects of in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage in the treatment of hypertrophic scar in non-functional sites after burns

Objective: To investigate the clinical effects of in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage in the treatment of hypertrophic scar in non-functional sites after burns. Methods: A retrospective observational study was used. From June 2017 to June 2019, 33 patients (24 males and 9 females, aged 8-50 years) who met the inclusion criteria with hypertrophic scars in non-functional sites outside the face after burns were treated in General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University). All patients underwent scalp transplantation after perforation of retained split scar matrix in situ (with scar thinning area of 90-500 cm2), and then the vacuum sealing drainage was performed. The hematoma and infection of wounds were observed on the 7th day after operation. At the same time, the survival rate of skin grafting was observed and calculated. The flatness and thickness of the scar in the operative area were observed in 12 months after operation, and the itching and pain of the patients were recorded. Vancouver Scar Scale was used to score the scar of patients before operation and at 3, 6 and 12 months after operation. The healing time and hair growth of donor site were observed. Data were statistically analyzed with repeated analysis of variance, paired sample t test and bonferroni correction. Results: On the 7th day after operation, local subcutaneous hematoma appeared in the wound of 2 patients, which healed after dressing change; no infection occurred. On the 7th day after operation, the survival rate of skin grafting of patients was 94.6%-99.0%(96.8±1.2)%. Scar flatness was well, the thickness of scar was not significantly higher than that of normal skin in 12 months after operation, and the symptoms of itching pain of patients disappeared or significantly relieved. Vancouver Scar Scale scores of patients before operation and at 3, 6, and 12 months after operation were 12.1±2.8, 8.5±1.5, 7.6±1.6, 6.7±1.3, respectively, and the scores of 3, 6, and 12 months after operation were all significantly lower than that before operation (with t values of 4.48, 4.06, and 3.97, respectively, P<0.01). All the donor sites of the head healed well in 4-7 days after operation. By 3-6 months after operation, all patients had good hair growth in the donor site and achieved no scar healing. Conclusions: The treatment of hypertrophic scar in non-functional sites outside the face after burns by in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage can effectively improve the appearance of hypertrophic scar in non-functional areas after burn and reduce its degree of hyperplasia, with scar-free donor site healing.

The Free Myocutaneous Tensor Fasciae Latae Flap-A Workhorse Flap for Sternal Defect Reconstruction: A Single-Center Experience.

Introduction: Deep sternal wound infections (DSWI) after cardiac surgery pose a significant challenge in reconstructive surgery. In this context, free flaps represent well-established options. The objective of this study was to investigate the clinical outcome after free myocutaneous tensor fasciae latae (TFL) flap reconstruction of sternal defects, with a special focus on surgical complications and donor-site morbidity. Methods: A retrospective chart review focused on patient demographics, operative details, and postoperative complications. Follow-up reexaminations included assessments of the range of motion and muscle strength at the donor-site. Patients completed the Quality of Life 36-item Short Form Health Survey (SF-36) as well as the Lower Extremity Functional Scale (LEFS) questionnaire and evaluated aesthetic and functional outcomes on a 6-point Likert scale. The Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scales (POSAS) were used to rate scar appearance. Results: A total of 46 patients (mean age: 67 ± 11 years) underwent sternal defect reconstruction with free TFL flaps between January 2010 and March 2021. The mean defect size was 194 ± 43 cm2. The mean operation time was 387 ± 120 min with a flap ischemia time of 63 ± 16 min. Acute microvascular complications due to flap pedicle thromboses occurred in three patients (7%). All flaps could be salvaged without complete flap loss. Partial flap loss of the distal TFL portion was observed in three patients (7%). All three patients required additional reconstruction with pedicled or local flaps. Upon follow-up, the range of motion (hip joint extension/flexion (p = 0.73), abduction/adduction (p = 0.29), and internal/external rotation (p = 0.07)) and muscle strength at the donor-sites did not differ from the contralateral sides (p = 0.25). Patient assessments of aesthetic and functional outcomes, as well as the median SF-36 (physical component summary (44, range of 33 to 57)) and LEFS (54, range if 35 to 65), showed good results with respect to patient comorbidities. The median VSS (3, range of 2 to 7) and POSAS (24, range of 18 to 34) showed satisfactory scar quality and scar appearance. Conclusion: The free TFL flap is a reliable, effective, and, therefore, valuable option for the reconstruction of extensive sternal defects in critically ill patients suffering from DSWIs. In addition, the TFL flap shows satisfactory functional and aesthetic results at the donor-site.

Scar Perception After Two Surgical Approaches for Total Hip Arthroplasty.

BackgroundThere is a paucity of literature examining patients’ and health-care providers’ perception of surgical scars after total hip arthroplasty (THA). This study examined perception of surgical scars after direct anterior (DAA) or posterior approach (PA) for THA using validated scar-assessment scales.Material and methodsSeventy-five DAA and 75 PA THA patients underwent scar assessment using the Patient Observer Scar Assessment Scale (POSAS) and Stony Brook Scar Evaluation Scales. Mean age was different between the cohorts (DAA 67 vs PA 62 years, P = .01). All patients had subcuticular running closure, secured with skin adhesive glue. Mean time from THA to scar assessment was 3.1 and 3.6 years for the DAA and PA groups, respectively (P = .18).ResultsScar opinion on the POSAS patient-reported scale was graded closer to normal skin more often for DAA than for PA patients (P = .03). More irregularities were graded for the DAA scars on the POSAS observer scale (P = .02) and the Stony Brook Scar Evaluation Scales (P = .04). Age did not predict scar opinion on any of the scales (P > .05). Female gender and a history of keloids predicted poorer scar appearance (P = .001 and P = .02). Overall scar appearance was rated as “good” in 93% of the DAA and 91% of the PA patients (P = .63).ConclusionDifferences exist in DAA and PA scar perception based on validated scales. Future randomized trials in scar assessment may control for confounding variables such as age and gender, as well as potential biases when using scar assessment scales.

Morbidity after thyroid surgery in children: patient perspective

Abstract Aim To explore the children’s/parents’ perception of morbidity after thyroid surgery. Methods Retrospective analysis of consecutive unselected patients who had undergone a thyroid operation under joint care of Paediatric and Endocrine surgeons. Electronic patients records were used to obtain relevant information and a standardised questionnaire was mailed to all children. Results Between Jan2009- Dec2020 62 children age 2–18 (median 15.2) had thyroid lobectomy (n=27) or total thyroidectomy (n=35). In-hospital stay ranged 1–3 days (mode1). Replies were received from 20 children at a median 37 months (range 5–60 months) after lobectomy (n= 8) or total thyroidectomy (n=12). Subjective voice assessment using a visual analogue scale remained normal in all children. Voice handicap index scores were normal in 13 (65%) children and increased in 7 (35%) to a median of 4 (range 1–10). Voice-related quality of life was excellent in 18 (90%) children and very good in two children. Swallowing was normal in 14 children, moderately affected in four children and severely affected in 2 children. Appearance of the scar assessed using the Manchester score ranged from 5–16, median 9, with only one child with an ideal score of 5. Three children have had or are waiting for scar revision. There was no persistent hypoparathyroidism. Conclusion In this cohort of children undergoing thyroid surgery, there were no significant voice changes and swallowing morbidity was infrequent. Concerns related to scar appearance were far more common than in the adult population and this should be highlighted in the consent process.

Measuring Stakeholder Assessments of Postsurgical Facial Scars: A Retrospective Cohort Inter-rater Analysis of Patients, Physicians, and Medical Student Observers.

The relationship of postoperative facial scar assessments among patients, physicians, and societal onlookers is not clearly defined. To identify differences in perceived scar outcomes by different stakeholders. Retrospective cohort study at a single Mohs micrographic surgery (MMS) center during which scars were assessed by: patients, physicians, and medical student observers not involved in patients' care using the Patient and Observer Scar Assessment Scale (v.2). Eighty-one patients graded their scars at 2 visits: 1 to 2 weeks post-MMS and 3 months post-MMS. Deidentified patient photographs were taken at each visit and graded by 4 physicians and 12 observers. At week 1, there was a significant difference in overall opinion of scar appearance between patient and physicians (p = .001) and medical student observers and physicians (p < .001). Physicians graded scars more favorably. At 3 months, there remained a difference in scar evaluations between patient and physicians (p = .005), whereas medical student observers rated scars more similarly to physicians (p = .404). Postoperative scar perceptions differ among stakeholders. Physicians must be mindful of this disparity when counseling patients in the perioperative setting to align patient expectations with realistic scar outcomes.

Rhomboid flap scar assessment: A patient reported outcome study. A case series

Introduction and importanceLocal skin flap techniques, including rhomboid flap, have been developed to reconstruct cutaneous defects. Rhomboid flap advantages include easy design, excellent contour, texture, thickness, color match, and long-term good cosmesis. There is no patient reported outcome study in literature detailing patients’ perception of appearance and satisfaction of scar appearance. MethodsWe studied 100 consecutive rhomboid flaps performed in 73 patients by a single surgeon. After at least one year from flap completion, a validated published Patient Scar Assessment Questionnaire (PSAQ) by Durani et al. was completed for each flap. ResultsThe median age was 73 years, with a range of 21 years–94 years. Gender breakdown was 65 flaps in males and 35 flaps in females. For appearance, there were significantly greater frequency of “very well-matched scar” patients compared to “well-matched scar” patients (p < 0.001). There were no “a little matched” or “poorly matched” patients. For satisfaction of appearance scores, there were significantly greater frequency of “very satisfied” patients compared to “satisfied” patients (p < 0.001). There were no “dissatisfied” or “very dissatisfied” patients. Although size of primary defect was not statistically significant (p 0.071), there was a trend towards better appearance scar match and scar satisfaction for smaller defects. Age was not statistically significant (p 0.086), there was a trend towards better appearance scar match and scar satisfaction among older patients. There was no significant difference in appearance match and satisfaction scores based on the gender (p 0.733). There were no post-operative complications. ConclusionsOur study confirms, in experienced hands, the long-term patient perception of well-matched scar appearance and scar satisfaction with rhomboid flap technique. A significantly greater frequency of patients were “very satisfied” than “satisfied”, with no “dissatisfied” patients. There was no statistically significant difference based on age, gender, and size of the primary defect.

Skin Wound Tension Reduction Device Combined with Ablative Fractional Carbon Dioxide Laser to Reduce Scar Formation After Excision of Pediatric Facial Skin Lesions: A Prospective Cohort Study.

PurposeTo investigate the efficacy of skin wound tension reduction device (SWTRD) combined with ablative fractional carbon dioxide laser (CO2-AFL) for the prevention of scar formation following the excision of facial cutaneous lesions in children.MethodsPatients undergoing surgical excision of facial cutaneous lesions in our hospital between May 2019 and April 2021 were enrolled. After the excision of facial cutaneous lesions and based on the personal intents and conditions, patients were assigned to undergo SWTRD combined with CO2-AFL. Outcome evaluations were as follows: defect size, incision width, scar width, the Vancouver Scar Scale (VSS) and University of North Carolina 4P Scar Scale (UNC4P).ResultsA total of 25 pediatric patients (mean age, 9.88 years) were enrolled in the study. Following the treatment of SWTRD+CO2-AFL, scar widths were relatively narrow and the appearance of the incision scars was significantly improved. A significant reduction in the patient-reported UNC4P scores at 6 months (3, 1–4) was observed when compared with that at 2 months (0, 0–1) after surgery (p<0.001). A similar reduction in the VSS scar scale was also evident (6 months: 1, 0.75–2.5 vs 2 months: 6.5–8.5; p<0.001).ConclusionCombined SWTRD and CO2-AFL treatment effectively modulates the scar formation after the incision is healed and resulting in preventing scar widening, leading to the improvement of scar appearance, reduction in wound pain and pruritus and its overall prognosis.

Comparative study between skin micrografting (Meek technique) and meshed skin grafts in paediatric burns

BackgroundGlobally, burn injuries are the 3rd principal cause of death due to injury among children aged 1–9 years. Yet, the management of paediatric burns is always challenging; due to limited donor sites and the cosmetic appearance that will affect the child later in life, either at the donor or the recipient site. Skin grafts may need to be expanded to minimise donor skin size or in patients with limited donor sites. Multiple techniques were described for graft expansion, mainly the mesher and the Meek technique. Patients and methodsA prospective comparative randomised study was done from January 2019 to June 2020 on 40 paediatric burn patients with deep dermal and full-thickness burns. Patients were divided into two groups, Meek and meshed groups. The skin graft take, epithelialization time, total time of the surgery and the aesthetic outcomes (using the POSAS – Patient and observer scar assessment scale) in each group were evaluated at three months postoperatively. ResultsThe percentage of take in the Meek group (84.25%) was significantly better than with the meshed group (71.5%) (P = 0.006). Epithelialization time was better for the Meek group (27.11 days) compared to the meshed group (33.5 days) (P = 0.176). In addition, infection rates were lower in the Meek group (25%) than the meshed group (40%) (P = 0.311). Subjectively POSAS scar assessment scale exhibited better results for the Meek group with a mean score of 3.17 & for the meshed group was 4.2 (P = 0.048). The observer’s overall score was as well better for the Meek group with a mean overall opinion score of 2.89 & for the meshed group was 4.1 (P = 0.003). The operative time was longer with the Meek technique than the traditional mesher (P < 0.001). ConclusionThe Meek technique for expanding the skin grafts is useful in covering burn wounds with greater expansion rate, more accessible application, better graft take & a better scar appearance than the traditional mesher. Still, the Meek technique has a considerable learning curve, longer procedure time & is more expensive.

Early Laser for Burn Scars (ELABS): protocol for a multi-centre randomised, controlled trial of both the effectiveness and cost-effectiveness of the treatment of hypertrophic burn scars with Pulsed Dye Laser and standard care compared to standard care alone [version 1; peer review: 2 approved

This paper outlines the protocol for a study that is being carried out at multiple centres across the UK in the next three years. It is a Research for Patient Benefit (RfPB) study funded by the National Institute for Healthcare Research (NIHR). The aim is to assess the effectiveness of treating hypertrophic burns scars with pulsed dye laser (PDL) at an early stage of scar formation. The objective is to improve Quality of Life for the patient by improving both the appearance and quality of burn scarring, as well as reducing its psychological impact.This is a parallel-arm randomised, controlled trial to compare PDL and standard care against standard care alone. The difference is measured between baseline and six-month follow-up. Recruits are within three months of healing from a burn injury; with wounds showing a defined potential for hypertrophic scarring. A total of 120 patients are recruited in a multi-centre study; with randomisation in a 1:1 allocation to each arm. The treatment arm receives 3 PDL treatments at six-week intervals in addition to standard care, whereas the control arm receives standard care alone. The primary outcome is the patient-rated part of the Patient and Observer Scar Scale (POSAS). Psychological and psycho-social impact is evaluated using the CARe burn scale (UWE, Bristol) and Quality Adjusted Life Years (QALY) is determined using the Short-Form Health Survey (SF-12). The study evaluates both the cost-effectiveness through an economic analysis and the patient-reported experience of the treatment by phone interviews.

Experimental comparative study of the effect of fractional CO2 laser combined with pulsed dye laser versus each laser alone on the treatment of hypertrophic scar of rabbit ears.

The use of fractional CO2 laser and pulsed dye laser (PDL) therapy to treat and/or prevent scarring following burn injury is becoming more widespread with a number of studies reporting reduction in scar erythema and pruritus following treatment with lasers. The objective of this study was to directly compare the efficacy of PDL, fractional CO2 , and PDL and fractional CO2 laser therapy in immature red hypertrophic scars in a standardized animal model. Ten New Zealand big-eared rabbits were used to make rabbit ear hypertrophic scar models. A total of 80hypertrophic scar models were obtained and randomly divided into groups: control (Group A), Fractional CO2 laser (Group B), pulse dye laser (Group C), combined (Group D), 20 in each group. Wound sites were treated with PDL, Fractional CO2 laser, or both at 28days post-grafting. Grafts receiving no laser therapy served as controls. Hypertrophic scar appearance, morphology, size, and erythema were assessed, and punch biopsies were collected. At days 7 and 28, additional tissue was collected for biomechanical analyses and markers for HE staining, Masson staining, immunohistochemical method to determine the CD31 content in the scar; Western blot to detect the expression of VEGF protein in scars. After the day 7 and 28, the scars were collected. Histomorphological change in scars was observed by hematoxylin-eosin staining, Masson staining. The expression of CD31, VEGF protein, and the cell apoptosis rate was detected by immunohistochemical method. (i) In morphological observation, HE staining and Masson staining, both the number of fibroblasts and amount of collagen fibrils in the experimental group were significantly reduced compared with those in control group. (ii) Micro-vessel Density (MVD) value can be found much smaller in the experimental groups than the control (p<0.05). Among the four experimental groups, there was a significant difference among 14d, 21d, and 28d groups (p<0.05). (iii) On days 7 and 28 after treatment, expression of VEGF could be regulated in experimental group (p<0.05). Among the three experimental groups, the decrease of VEGF in the combined group was significantly stronger than that of the other two. The effect of Fractional CO2 laser combined with pulsed dye laser treatment was shown to be better than that of Fractional CO2 laser or pulsed dye laser alone and inhibits the early hypertrophic scar in rabbit ears.

Is the future scarless? - Fibroblasts as targets for scarless wound healing: a narrative review.

Introduction: Scarless healing is the ideal outcome of wound healing and is exhibited in some species. This narrative review assembles the current understanding of fibroblast heterogenicity along with the latest fibroblast-related targets for scar reduction therapies. Human regenerative wound healing is deemed possible due to the wound regeneration already seen in the early gestation foetus. Methods: This literature narrative review was undertaken by searching PubMed and Web of Science databases and Google Scholar to find articles concerning the fibroblast involvement in wound healing. We evaluated and collated these articles to form a consensus of the current understanding of the field. Discussion: This article describes current understanding of fibroblast heterogenicity and involvement in wound healing, focusing on the role of fibroblasts during physiological scarring. We also present the current most promising targets involving fibroblasts in the reduction of scarring and how we can manipulate the behaviour of fibroblasts to mimic the wound regeneration models in the human foetus. These targets include the pro-fibrotic EN1 positive fibroblast lineage, TGFβ1 inhibition, and genetic therapies utilising miRNAs and siRNAs. Conclusion: No therapies are currently available to eradicate scarring; however, treatment options are available to reduce the appearance of scarring. Further research into the heterogenicity and interactions of fibroblasts in both the foetus and adult is needed, and this may lead to the development of novel treatments against scarring.Lay SummaryScarless healing refers to the repair of a wound with minimal residual scarring. The main cell responsible for the repair process is the fibroblast. It is now understood that there are different types of fibroblasts. Simply, some of these fibroblasts lead to scarring and some lead to regeneration. The early human foetus has mainly regenerative fibroblasts, but during aging the number of scarring fibroblasts increase to become the majority in the adult . Understanding how we can modify this process may ultimately result in the reduction in scarring. Currently, scar reduction therapies are aimed at optimal wound healing, surgical removal of abnormal scars, and using steroids and other drugs to encourage better wound repair by limiting the effect of scarring fibroblasts. Future therapies aim to target specific groups of fibroblasts to encourage regenerative wound healing. This narrative review aims to cover the current understanding of the different groups of fibroblasts and their effect on wound healing. We also cover the current and potential therapies that can be used to reduce scarring and suggest further areas for research in this field.

"Never Trust the Skin": A Rationale for Using Polydioxanone Internal Support Matrix to Minimize Scarring in Primary Mastopexy-Augmentation-An Observational Study.

BackgroundThe process of scar formation is complex and multi-factorial. Basic plastic surgery tenets focus on tension-free techniques to optimize aesthetic outcomes and minimize scarring.ObjectivesProphylactic use of a polydioxanone (PDO) internal support matrix in cosmetic mastopexy-augmentation to decrease scar burden has never before been described.MethodsA high volume (n = 41) single-surgeon mastopexy-augmentation experience (S.S.K.) followed scar quality in consecutive cases from June 2020 to July 2021. A minimum of 6 months of postoperative evaluation was required to assess scar quality. Fitzpatrick scores were also evaluated and compared. All surgeries in this study were performed in the dual plane using silicone gel implants, a superior or superomedial dermal pedicle blood supply, and a wise-pattern or vertical scar. Scar quality was evaluated by photography and scored according to an internally developed scar quality scale.ResultsThere have been no cases of hypertrophic or keloid scarring. All patients receiving mastopexy-augmentation with prophylactic PDO mesh have a favorable appearance with fine line scars, and the mean scar quality scale score across the cohort was 4.341/5. The mean Fitzpatrick scale score across the cohort was 2.97, and, of the patients who scored a 5 on the scar quality index, the mean Fitzpatrick scale score was 3.545.ConclusionsProphylactic use of PDO internal support matrix in silicone gel mastopexy-augmentation offers further protection against poor scarring in patients across the Fitzpatrick scale, with varying degrees of skin quality, and across medium to high-volume implant augmentations. Patients who received PDO prophylaxis demonstrated a better-than-average scar appearance.Level of Evidence: 4

In vivo comparative study of the efficacy of β-sitosterol, ketoconazole 2% and mupirocin for the treatment cutaneous leishmaniosis.

Cutaneous leishmaniosis (CL) is an important parasitic disease characterized by specific skin lesion, includes the vector that cause the CL and treatment in general. The study aimed to identify the effect of three different drugs which are β-sitosterol, ketoconazole 2% and mupirocin in the treatment of cutaneous leishmaniosis. The study was conducted at Dermatological Unit of Al Hussein Teaching Hospital/Thi-Qar/Iraq from October to November 2021. The patients presented with a lesion will be involved in this study and its involved isolation of parasites from the lesion of patients and the parasite was replicated in (NNN) media then the inoculum was concentered. A total of 40 male of mice (Mus musculus) of BALB/c strain injected by parasite suspension, after the appearance of lesion, β-sitosterol, ketoconazole 2% and mupirocin was applied on a lesions daily for 2 weeks, the statistical analysis was done by SPSS program. In the current study, the β-sitosterol was most effective in the treatment of skin leishmanial lesion than the other drugs with mean is (11.9±1.449 mm) in compared with the other drugs under P-value < 0.046 with the complete recovery. β-sitosterol was highly effect on the L. tropica infections with complete recovery and no scar appearance than ketoconazole and mupirocin and can be used for treatment of the disease lesion.

Tissue Stromal Vascular Fraction Improves Early Scar Healing: A Prospective Randomized Multicenter Clinical Trial.

Wound healing and scar formation depends on a plethora of factors. Given the impact of abnormal scar formation, interventions aimed to improve scar formation would be most advantageous. The tissue stromal vascular fraction (tSVF) of adipose tissue is composed of a heterogenous mixture of cells embedded in extracellular matrix. It contains growth factors and cytokines involved in wound-healing processes, eg, parenchymal proliferation, inflammation, angiogenesis, and matrix remodeling. The aim of this study was to investigate the hypothesis that tSVF reduces postsurgical scar formation. This prospective, double-blind, placebo-controlled, randomized trial was conducted between 2016 and 2020. Forty mammoplasty patients were enrolled and followed for 1 year. At the end of the mammoplasty procedure, all patients received tSVF in the lateral 5 cm of the horizontal scar of 1 breast and a placebo injection in the contralateral breast to serve as an intrapatient control. Primary outcome was scar quality measure by the Patient and Observer Scar Assessment Scale (POSAS). Secondary outcomes were obtained from photographic evaluation and histologic analysis of scar tissue samples. Thirty-four of 40 patients completed follow-up. At 6 months postoperation, injection of tSVF had significantly improved postoperative scar appearance as assessed by the POSAS questionnaire. No difference was observed at 12 months postoperation. No improvement was seen based on the evaluation of photographs and histologic analysis of postoperative scars between both groups. Injection of tSVF resulted in improved wound healing and reduced scar formation at 6 months postoperation, without any noticeable advantageous effects seen at 12 months.

Scar Prevention With Prolonged Use of Tissue Adhesive Zipper Immediately After Facial Surgery: A Randomized Controlled Trial

Postsurgical scar management significantly affects patient satisfaction. However, reliable skin support options are limited. The present study aimed to determine the efficacy and safety of using tissue adhesive zippers in postsurgical scar prevention among patients undergoing surgical excision of the face. The primary outcome was a reduction in scar width, which was evaluated 1, 3, 6, and 12 months postoperatively. Scar width at Month 12 was considered the final outcome. This was a prospective, randomized, controlled, rater-blinded trial. Sixty-four patients were randomly assigned to 2 groups (the zip group, defined as those using a tissue adhesive zipper for 3 months after surgery, and the control group). Outcomes were evaluated 1, 3, 6, and 12 months postoperatively based on scar width and Patient Observer Scar Assessment Scale score. Skin irritation was monitored during the first 3 months after surgery. The incidence of hypertrophic scar formation was recorded at a 12-month follow-up. Scar width differed significantly between the zip (mean [standard deviation], 1.68 [0.45] mm) and control groups (2.15 [0.64] mm). The scars spread rapidly in the first month after surgery but slowed down and stabilized after 6 months. The Patient Observer Scar Assessment Scale scores of the zip group were significantly lower than those of the control group. Neither group experienced significant complications. Prolonged use of tissue adhesive zippers immediately after surgery reduced scar width and improved scar appearance without obvious side effects.

The Somatic and Textural Language of Patricia Belli: Recrafting Social and Political Bodies in 1990s Nicaragua

“The Somatic and Textural Language of Patricia Belli: Recrafting Social and Political Bodies in 1990s Nicaragua” looks at early textile assemblages by the contemporary Nicaraguan artist Patricia Belli. Opening with the seminal exhibition MESóTICA II: Centroamérica/re-generación—which took place in Costa Rica in 1996—the essay positions Belli as part of an emerging generation of experimental artists who were working in the aftermath of the Central American Crisis. Contextualized within this period, I argue that Belli’s textile assemblages from the early 1990s emerge as affective containers of personal and collective memories endured by the region. By reworking secondhand clothes imported from the United States, Belli recrafts garments into visceral containers that evoke disfigured and mutilated bodies. Thinking beyond normative constructions of the body—and in particular, feminized bodies—Belli’s textile assemblages emerge as subversive constructions that privilege unruly and undisciplined bodies. Through these textile inquiries, I explore how the artist forges a system of sensitive communication that emerges as a medium for healing—evidenced through the recurrent appearance of lesions, scars, and fractures. Looking at her work alongside other feminist practices taking place regionally, this essay also explores emerging feminist artist networks that are rooted in somatic languages that challenge normative modes of knowledge-production and communication.

Hydrocolloid dressing versus conventional wound care after dermatologic surgery

BackgroundHydrocolloid dressings (HCD) are helpful in chronic wound care, but research is limited in acute postoperative wounds. HCD can potentially be incorporated into a simplified wound care regimen after excisional surgeries.ObjectiveTo examine whether a one-time HCD application after dermatologic surgery results in greater patient satisfaction and improved postoperative outcomes compared with conventional daily dressings (CDD).MethodsWe examined patients who underwent Mohs or standard surgical excision with linear closure followed by HCD. The patients additionally had a history of excisional surgery with CDD in the past 5 years. A modified version of the validated Bluebelle Wound Healing Questionnaire was administered.ResultsThe survey response rate was 74.4% (64/86). Compared with CDD, HCD rated higher in comfort, convenience, scar appearance, and simplicity of wound care instructions (P < .0001). Nearly all patients (96.8%) preferred HCD over CDD.LimitationsVariability in time from prior dermatologic surgery may introduce recall bias. Prior surgeries involving CDD were sometimes performed by a different surgeon, which could introduce other confounding factors.ConclusionsA simplified wound care regimen involving HCD can potentially lead to increased comfort, convenience, simplicity, and a subjective improvement in scar appearance, though additional studies are needed.

Arabic Translation and Linguistic Validation of the SCAR-Q Scale Module.

Scars are a fairly common complaint in the clinical setting; they can arise from trauma, burns, or after surgical procedures. They can have a detrimental impact on the quality of life of patients. A well-established method of quantifying such an impact is through patient-reported outcome measures (PROM). SCAR-Q is a relatively new and robust questionnaire that was developed and validated by McMaster University. Our study aims to translate SCAR-Q to Arabic. SCAR-Q has a holistic approach to scars and does not target scars of a specific etiology. It has three main components: scar appearance, psychological impact, and symptoms associated with the scar. This translation will enable data collection, analysis, and interpretation from a previously untouched demographic. This article explains the steps taken to develop an accurate and validated Arabic SCAR-Q questionnaire based on World Health Organization (WHO) and The Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines. We were able to methodically produce a validated translation of the SCAR-Q into Arabic that should potentially allow data collection and feedback from a very large segment of the world population regarding the impact of scars on their quality of life.