Average Vancouver Scar Scale Score Research Articles

Extralesional cryotherapy combined with intralesional triamcinolone injections after keloid excision

Background Keloid treatment is challenging because of the high likelihood of recurrence and a lack of definitive treatment combinations. The treatment of bulky and recurrent keloids is particularly difficult. We investigated the administration of extralesional cryotherapy (EL) in conjunction with intralesional (IL) triamcinolone (TA) injections as adjuvant therapy after surgical excision for the management of keloids.Methods Among all patients who visited our scar laser center between January 2016 and August 2017, 54 patients who underwent IL keloid excision with EL cryotherapy and IL TA injection as adjuvant therapy were included in this retrospective study. We examined sex, site, the number of cryotherapy sessions and TA injections, symptoms after surgery, and recurrence. The Vancouver Scar Scale (VSS) was used as to quantify treatment outcomes.Results Among 54 cases of IL keloid excision, after an average of 6.26 cryotherapy sessions and IL TA injections as combined adjuvant treatment, the lesion was controlled without recurrence in 49 cases. Relapse occurred in five patients, requiring additional treatment and reoperation. For 49 patients with photographic data, the average VSS score before and after treatment improved from 10.1 to 5.0. In 17 patients in whom symptoms recurred after surgery, all symptoms were controlled and maintained with adjuvant therapy.Conclusions Initial direct surgical excision, followed by a combination of EL cryotherapy and IL TA injections, was shown to be effective in challenging cases of large and recurring keloids.

Early Intervention with Autologous Fat Grafting to Reduce Hypertrophic Scar Formation: A Prelimilary Study.

Once an early-stage immature scar develops into a hypertrophic scar, it is difficult to achieve satisfactory improvement with existing treatments. Therefore, the prevention of hypertrophic scar formation should be given priority. Fat grafting was previously proven to be an effective treatment for mature scars, but it has not been used in the early-stages of (less than three months) scar formation. We present our experience with the use of combined grafting of macro fat and emulsified fat for prevention of hypertrophic scar formation in patients. Thirty-five patients who received fat grafting for facial scar repair were included as a treatment group and another 35 patients without particular interventions were classified as the control group. Patients in both groups were followed up every three months during one year, and the Vancouver Scar Scale (VSS) was used for evaluation of the clinical outcomes at baseline (within one to three months after trauma, burn or surgery) and after 12 months of follow-up. All patients in the treatment group achieved a marked improvement after their first fat grafting procedure. Thirteen patients (37.1%) underwent the second procedure and seven (20%) underwent the third procedure. Statistical analysis of average VSS score also showed significant differences between the treatment and control groups. The results of this retrospective study suggest that treatment of immature scars with combined grafting of macro fat and emulsified fat can successfully prevent the formation of hypertrophic scars. 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 .

Application of Zunyi's Suture Method for donor site of anterolateral thigh flap

To investigate the effectiveness of multiple tension reduction suture of in-situ return needle vertical mattress suture and in-situ return needle horizontal mattress suture combination with intradermal intermittent continuous suture (denominated as Zunyi's Suture Method) on suturing the donor site of the anterolateral thigh flap. Between January 2019 and December 2019, 62 patients were treated with anterolateral thigh flaps to repair wounds. There were 46 males and 16 females, aged 9-67 years (mean, 31 years). The size of anterolateral thigh flap ranged from 6 cm×5 cm to 25 cm×7 cm. The donor site of the flap was sutured directly by the Zunyi's Suture Method. The skin on both sides of the incision was advanced to the middle, and the wound edge was attached and in a state of negative tension. The intradermal suture line was removed at 7 days after operation. The complications and scars at donor site were observed during follow-up. The Vancouver Scar Scale was used to assess the appearance of scars and the width of scars were measured at 6 months after operation. The flaps survived smoothly, and the wounds healed by first intention. The incisions at donor sites healed by first intention at 2 to 3 weeks after operation. All patients were followed up 7-16 months, with an average of 10.7 months. There was no ischemic necrosis of the donor site or skin threading. There was pigmentation of the needle back point in the early stage, and the pigmentation completely disappeared after 3 to 6 months without scar hyperplasia. At 6 months after operation, liner scars were achieved in all the patients with an average Vancouver Scar Scale score of 2.5 (range, 1.0-3.5) and an average width of 2.4 mm (range, 0.8-9.1 mm). The suture of the donor site of the anterolateral thigh flap with Zunyi's Suture Method can effectively reduce the tension on wound edges and scar hyperplasia.

Indications and functional outcome of the use of integra® dermal regeneration template for the management of traumatic soft tissue defects on dorsal hand, fingers and thumb

Few studies have been conducted to explore the utility of the Integra® dermal regeneration template (IDRT) combined with a delayed split-thickness skin graft (STSG) for reconstructing complex dorsal hand, digit, and thumb injuries. This study reports the indications and outcomes for 14 patients treated with this technique via a two-stage process. We retrospectively reviewed all patients treated by IDRT combined with STSG from May 2015 to October 2018. The inclusion criterion was traumatic or post-infectious soft tissue defects (STDs) of the dorsal hand, fingers, and thumb, not suitable for direct wound closure and requiring local, pedicle, or free flap reconstruction. After debridement, a two-stage procedure was applied, namely IDRT followed by STSG. Indications, functional outcomes, aesthetic results, complications, patient satisfaction, and the STSG take rate were evaluated over a 36-month follow-up using standardised instruments. A total of 14 patients with 15 reconstructions (average age = 48years) were included. The dominant hand was involved in 50% of cases. Dorsal STDs involved the hand, fingers, thumb, and hand and thumb in 7, 3, 2 and 2 cases, respectively. The mean STD size was 35cm2 (range: 3-150cm2). The wound was associated with exposed tendons (without peritenon), bone (without periosteum), and joints (without a capsule) in eight cases (57%). The IDRT/STSG take rate was 97%. The average Vancouver Scar Scale score was 2 (1-4). The 36-month follow-up demonstrated that IDRT is a safe and reliable technique that can be considered a viable alternative to flap reconstruction for the management of traumatic STDs in selected patients. The aesthetic outcomes are acceptable, functional recovery of the fingers is excellent, patient satisfaction is very high and the rate of complications is very low.

Autologous mesenchymal stem cells application in post-burn scars treatment: a preliminary study

Mesenchymal stem cells (MSCs) are multi-potent cells characterized by long term self-renewal and by potential for differentiation into cells of different mesenchymal tissue types such as fibroblasts, osteocytes, chondrocytes, and adipocytes. Their unique properties offer broad therapeutic potentials. Bone marrow has been used as the most common MSCs source, but it is gradually going to be replaced by adipose tissue which showed to contain more MSCs per unit than the bone marrow and clinical application of MSCs procured from the adipose tissue have been demonstrating at least similar results. Post-burn scars result frequently in severe both functional and aesthetic impairments in restitution and rehabilitation periods of the burn disease. Despite extensive research in the last decades, the exact mechanisms of scar formation remains unclear. The development of post-burn scars is influenced by multiple factors such as initial depth of the burn, methods of burn wound therapy, duration of the open wound until final wound closure, burn wound infection, genetic predisposition, and many others in both acute and rehabilitation periods. The aim of this study was to point out versatility of the implementation of this method with respect to different types of scars (atrophic scars, hypertrophic scars, keloids). Autologous adipose tissue derived MSCs were applied to post-burn scars in all 8 patients undergoing surgical scar reconstructions at the Department of Burns and Reconstructive Surgery of the University Hospital in Bratislava. The study was approved by Ethical Committee of Ruzinov Hospital. The procedures used for scar reconstructions included dermabrasion, scar excisions, contractures corrections and local plasties combined by lipografting of lipoaspirate containing parenchymal adipocytes and stromal vascular fraction including MSCs, or application of separated autologous MSCs isolated from lipoaspirates. Based on desired result one of these MSCs application methods was selected depending on characteristics of reconstructed scar and required volume of transferred fat. Isolation of MSCs following procurement was provided by the Central Tissue Bank cell culture laboratory which is one of the parts of the burn department. The average time of scars duration was 79months, ranging from 6 to 216months. The postburns scars were assessed clinically according to Vancouver Scar Scale (VSS) prior to surgery, including photo documentation, and re-evaluated after 6months following MSCs application. As the results have shown, the average VSS score before treatment was 7.88 points ranging from 4 to 11 points. The average VSS 6months after surgical procedure and MSCs application was 2.34 points ranging from 1 to 4 points. According to the results obtained, the favourable effect of adipose tissue derived autologous MSCs application on scar remodelling following surgical reconstruction of post-burn scars could be promising.

Clinical effect of Zhang's super tension-relieving suture for high-tension wound closure

Objective: To investigate the clinical effect of Zhang's super tension-relieving suture applied in high-tension wound closure. Methods: From January to August 2019, 19 eligible patients with scar or black hairy nevus were treated with Zhang's super tension-relieving suture for outpatient operation in the Department of Plastic and Reconstructive Surgery of Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. The patients were composed of 6 males and 13 females, aged 10-68 years, with 8 keloids, 3 hypertrophic scars, 5 atrophic scars, and 3 black hairy nevus. The operation sites included lower jaw in 2 cases, neck in 3 cases, chest in 4 cases, abdomen in 2 cases, and limbs in 8 cases. The size of scars and black hairy nevus before surgery ranged from 1.4 cm×1.1 cm to 10.0 cm×4.0 cm. All the lesions underwent excision alone with both sides of the incision undermined for 1 to 2 cm, and the wound size ranged from 2.6 cm×2.6 cm to 12.6 cm×6.8 cm. Zhang's super tension-relieving suture was applied with barbed suture, and the wound edges were naturally jointed with relaxation and low tension by pushing normal skin on both sides to the middle. Two patients with keloids underwent superficial radiotherapy within 24-hour interval after the surgery, with a total of 20 Gy delivered in 4 times, once a day. All the patients were followed up at outpatient clinics, with tension-relieving duration and adverse effects recorded. Six months after operation, the Vancouver Scar Scale (VSS) was used to evaluate scar appearance, while scar width and recurrence were recorded. Results: All the wounds of 19 patients healed completely after surgeries. Two patients experienced transient hyperpigmentation at puncture points and recovered without intervention, and one of them had hypertrophic scar at the puncture point, which was relieved after intralesional injections of corticosteroids. One patient underwent transient erythema, dry desquamation, and hyperpigmentation after radiotherapy, which recovered without intervention. Follow-up time ranged from 7.1 to 13.6 months, with an average of 9.6 months. Tension-relieving duration ranged from 4 to 26 weeks, with an average of 11.2 weeks. Two patients underwent Zhang's super tension-relieving suture again 8 weeks after operation due to their short tension-relieving duration which lasted for only 4 weeks after the first suture. Six months after operation, liner scars were achieved in all the patients with an average width of 2.2 mm (0.8 to 7.0 mm) and an average VSS score of 2.1 points (1.0 to 4.3 points). Three keloid patients had local recurrence 3 months after surgery for not receiving radiotherapy, which was obviously relieved following laser treatment in combination with intralesional injections of corticosteroids and 5-fluorouracil, etc. Conclusions: Zhang's super tension-relieving suture technique with barbed suture is able to effectively relieve the tension on wound edges, extend the tension-relieving duration, and reduce the hypertrophic scar risk when applied in high-tension wound.

(CONSORT) Wound closure using Dermabond after excision of hemangioma on the lip.

Background:As the lip contains ample blood supply, hemangiomas often occur in this area. When surgical excision is performed, wound closure is important. To prevent infection from saliva and food, watertight wound closure is needed. The purpose of this study is to demonstrate the usefulness of Dermabond for wound closure after hemangioma excision on the lip.Methods:Between December 2015 and August 2017, 11 patients with lip hemangioma underwent surgical excision. When closing the wound, Dermabond was used for skin closure after subcutaneous sutures. Demographic data and complications were recorded. Scars were evaluated with the Vancouver scar scale (VSS), and the postoperative shape of the lip was assessed on a 10-point satisfaction scale at 1 month and 6 months postoperatively.Results:All cases completely healed without any complications, such as wound dehiscence or infection. There were no recurrences at postoperative 1 month during the follow-up period. The aesthetic results of the scars were also excellent. The average VSS score on postoperative 1 month was 4.2, and it decreased to 2.2 at postoperative 6 months. The average patient satisfaction score at postoperative 1 month was 7.4, and it increased to 9.5 at postoperative 6 months.Conclusion:Dermabond is useful for wound closure after hemangioma excision on the lip. It prevents wound contamination, and yields acceptable aesthetic results.

The treatment of keloids with pneumatic technology: a pilot study

Keloid scars derive from abnormal fibrous wound healing when the mechanisms controlling tissue repair and regeneration malfunction. Previous studies have reported a reduction in hyaluronic acid among fibroblasts cultured from keloid tissue compared with the levels in normal skin. Here, we evaluated the efficacy and safety of subdermal minimal surgery using hyaluronic acid as a novel treatment in keloid scars. To evaluate the clinical efficacy and safety of subdermal minimal surgery technology in the treatment of keloids. Ten Korean patients (Fitzpatrick skin type II-IV) with keloids on the upper arms were enrolled in this study. All patients underwent three sessions of subdermal minimal surgery at three-week intervals. Scar assessments were performed at baseline, before each treatment session, and three months after the final treatment, with three different assessment methods. Specifically, in addition to the Vancouver Scar Scale (VSS), two independent physicians performed global assessment evaluations regarding the final cosmetic results. As a final form of assessment, participant satisfaction was assessed using a four-point scale. All volunteers completed three treatment sessions, and nine of 10 patients were satisfied with the procedure. The average VSS score decreased three months after the final treatment, and global assessment showed clinical improvement of the scars. No adverse events occurred, except transient spot bleeding at entry points and slight post-procedure edema, which resolved within 48 hours. Subdermal minimal surgery technology may help to improve keloids on the upper arm without noticeable adverse effects.

Prevention of Thyroidectomy Scars in Asian Adults Using a 532-nm Potassium Titanyl Phosphate Laser

Prediction of whether postoperative wound healing will result in a hypertrophic scar or keloid is difficult. Diverse treatment options have been developed in an effort to prevent excessive scar formation. To evaluate the efficacy and safety of a 532-nm potassium titanyl phosphate (KTP) laser in the prevention of scar formation after total thyroidectomy. Twenty-eight individuals with Fitzpatrick skin types IV and V and linear surgical suture lines after total thyroidectomy by the same surgeon were enrolled. Twenty participants were treated using a 532-nm KTP laser two times at 2-week intervals. Eight participants were assigned to the control group. The Vancouver Scar Scale (VSS), global assessment score (GAS), and participants' subjective satisfaction were used to determine the effect of scar prevention. These results were compared with those of the control group. The average VSS score was remarkably lower in the KTP laser treatment group. Average GASs indicated better cosmetic outcomes in the treatment group. Participant satisfaction was also higher in the treatment group. No significant side effects were observed during follow-up. A 532-nm KTP laser can be used safely and efficiently on Asian skin to reduce scar formation after thyroidectomy. The authors have indicated no significant interest with commercial supporters.

Use of split thickness plantar skin grafts in the treatment of hyperpigmented skin-grafted fingers and palms in previously burned patients

Palmar and finger burns are often seen in children, and are usually as a result of contact burns. Some patients with deep hand burns are treated with full-thickness or split-thickness skin grafts. Skin graft is commonly used for hand reconstruction. However, the grafted skin would be more pigmented than the adjacent skin and different from skin texture. 19 patients who showed hyperpigmentation after skin graft of finger and palm were treated. They all were injured by hand burns. We performed mechanical dermabrasion of the hyperpigmentation scar and application of a split thickness skin harvested from medial aspect of plantar of foot. Patients were asked about their level of satisfaction with the procedure and scar appearance was assessed using a five-point Likert scale. Also scar appearances were assessed using a Vancouver Scar Scale (VSS). The grafts were completely taken in all 19 patients. The color of the graft became similar to adjacent tissue. 15 patients were very satisfied, and four patients were relatively satisfied. The average score of the patients postoperative appearance improvement was 4.5 (improved to significantly improved postoperative appearance). Average VSS score was improved from 9.53 to 2.53. There was no hypertrophic scar on plantar donor site. The technique of the split-thickness plantar skin graft after mechanical dermabrasion is simple and provided good results in both color and texture for the patients who showed hyperpigmentation after grafting.

Sprayed Cultured Mucosal Epithelial Cell for Deep Dermal Burns

Mucosal epithelial cells have various advantages compared with epidermal cells, such as their high proliferation ability and long biologic activity. The objective of this study was to assess the clinical results after sprayed application of cultured mucosal epithelial autograft (CMEA) suspensions onto deep dermal burn wounds. Ten patients with deep dermal burns were included in a prospective study. The average total-body-surface-area burn was 17.7% (8%-45%). The average Abbreviated Burn Severity Index was 6.3 points (4-9 points). The application of sprayed CMEA suspension was performed onto an average body surface area of 2.05% (0.5%-5%; median, 2%). Eight patients were recruited for clinical follow-up after an average of 10 months (3-18 months). The average Vancouver Scar Scale score at follow-up was 1.5 points (range, 0-5 points). The average period of epithelialization in wound surface was 12.5 days. Our data show that enzymatic and careful surgical debridement and consecutive application of CMEA suspensions using a spray technique result in excellent cosmetic outcomes compared with any other methods.

Prevention of Thyroidectomy Scar Using a New 1,550-nm Fractional Erbium–Glass Laser

Surgical scars are a common cosmetic problem that occurs in various surgical fields including dermatology. Diverse trials have been made to prevent this annoying scar formation. Recently, 585- and 595-nm pulsed dye laser irradiation presented satisfactory cosmetic outcome for the treatment of surgical scars. Other fractionated lasers or light devices were also applied for scar treatment. To determine the effectiveness and safety of a newly developed 1,550-nm fractional erbium-glass laser in the prevention of scar formation after total thyroidectomy. Twenty-seven ethnic South Korean patients with linear surgical suture lines after total thyroidectomy operation were treated with a 1,550-nm fractional erbium-glass laser. The same surgeon performed all of the operations using the same surgical techniques. Each patient was treated four times at 1-month intervals using the same parameters (5- x 10-mm spot size, 10 mJ, 1,500 spot/cm(2), static mode). Initiation of the first irradiation was made approximately 2 to 3 weeks after the thyroidectomy. The scar prevention effects were evaluated each month for 6 months after thyroidectomy. Two kinds of assessment methods were applied in this evaluation. First, the Vancouver Scar Scale (VSS) was used. Second, three independent physicians gave a global assessment valuation to the final cosmetic results: poor (1), fair (2), good (3), or excellent (4). These results were compared with the surgical scars of a control group (patients who denied laser treatments and had no other treatments during the 6 months after total thyroidectomy by the same surgeon). The average VSS score was lower in the laser treatment group. The global assessment also presented better cosmetic outcomes in the treatment group than in the controls. A new 1,550-nm fractional erbium-glass laser may efficiently repress the formation and hypertrophy of thyroidectomy scars on the neck, and it can be safely applied in relatively dark Asian skin without noticeable adverse effects.

Sprayed Cultured Epithelial Autografts for Deep Dermal Burns of the Face and Neck

The objective of this study was the assessment of clinical results after sprayed application of cultured epithelial autograft (CEA) suspensions onto deep dermal burn wounds of the face and neck. Nineteen patients with deep dermal burns of the face and neck were included into a prospective study. The average total body surface area burn was 15.1% (7%-46%; median: 13%). The average Abbreviated Burn Severity Index (ABSI) was 6.7 points (4-12 points; median: 7 points). The application of sprayed CEA suspension was performed onto an average body surface area of 2% (0.5-5%; median: 2%). Thirteen patients were recruited for clinical follow-up after an average of 10 months (3-18 months). The average Vancouver Scar Scale score at follow-up was 2.4 +/- 2.2 points (range, 0-8 points), and the average Donnersmarck and Hörbrand score was 9.3 +/- 6.8 points (range, 0-22). Four patients had less than 9 months' follow-up. Excluding these patients from the analysis resulted in an average Vancouver Scar Scale score of 1.3 +/- 0.9 points (range, 0-3 points) and an average Donnersmarck and Hörbrand score of 8.0 +/- 7.4 points (range 0-22) for the remaining 9 patients.Our data show that enzymatic and careful surgical debridement and consecutive application of CEA suspensions using a spray technique results in excellent cosmetic outcomes compared with any other method.