Day Of Suture Removal Research Articles

A novel brief questionnaire using a face rating scale to assess dental anxiety and fear.

This study aimed to evaluate the reliability and validity of a four-item questionnaire using a face rating scale to measure dental trait anxiety (DTA), dental trait fear (DTF), dental state anxiety (DSA), and dental state fear (DSF). Participants were consecutively selected from patients undergoing scaling (S-group; n = 47) and implant placement (I-group; n = 25). The S-group completed the questionnaire both before initial and second scaling, whereas the I-group responded on the pre-surgery day (Pre-day), the day of implant placement (Imp-day), and the day of suture removal (Post-day). The reliability in the S-group was evaluated using the test-retest method, showing a weighted kappa value of DTA, 0.61; DTF, 0.46; DSA, 0.67; DSF, 0.52. Criterion-related validity, assessed using the State-Trait Anxiety Inventory's trait anxiety and state anxiety, revealed positive correlations between trait anxiety and DTA/DTF (DTA, ρ = 0.30; DTF, ρ = 0.27, ρ: correlation coefficient) and between state anxiety and all four items (DTA, ρ = 0.41; DTF, ρ = 0.32; DSA, ρ = 0.25; DSF, ρ = 0.25). Known-group validity was assessed using the initial data and Imp-day data from the S-group and I-group, respectively, revealing significantly higher DSA and DSF scores in the I-group than in the S-group. Responsiveness was gauged using I-group data, showing significantly lower DSA and DSF scores on post-day compared to other days. The newly developed questionnaire has acceptable reliability and validity for clinical use, suggesting its usefulness for research on dental anxiety and fear and for providing patient-specific dental care.

Impact of unilateral mastectomy on body posture: A prospective longitudinal observational study

ObjectiveUnilateral mastectomy is known to induce postural alterations, yet the temporal development pattern of these changes remains elusive. This study aimed to explore the impact of unilateral mastectomy on body posture. MethodsA prospective, longitudinal, observational study with a one-group repeated-measures design was conducted. Patients undergoing unilateral mastectomy were recruited from a university-affiliated hospital in Western China and monitored for 12 months post-surgery. A trained nurse assessed seven postural baseline parameters on the day of suture removal and at 3, 6, and 12 months after unilateral mastectomy. Two parameters were in the sagittal plane (forward head posture and trunk rotation angle), and five were in the coronal plane (neck tilt, shoulder asymmetry, scapular asymmetry, scapular asymmetry relative to the spine, and pelvic tilt). ResultsThe final analysis included 159 patients. Baseline prevalence of most postural abnormalities ranged from 50.94% to 59.75%, with mean deviations between 2.74 and 4.51 mm. At 12 months post-mastectomy, prevalence and mean deviations increased by more than 30% and 3.50 mm, respectively, compared to baseline. Postural abnormalities increased gradually in the first 3 months, notably between the 3rd and 6th months, and slowed between the 6th and 12th months. On the mastectomy side, coronal plane abnormalities significantly increased within 12 months: earlobe to acromion distance (Wald χ2 = 45.283, P < 0.001), depressed shoulder height (Wald χ2 = 42.253, P < 0.001), depressed scapula height (Wald χ2 = 31.587, P < 0.001), scapula to spine distance (Wald χ2 = 45.283, P < 0.001), and elevated pelvic height (Wald χ2 = 48.924, P < 0.001). ConclusionsPostural changes are common post-unilateral mastectomy, with prevalence and deviation increasing gradually, particularly between 3 and 6 months post-mastectomy. Early rehabilitation initiation is recommended to mitigate postural changes. Trial registrationChiCTR2000040897

Outcome of perioperative 24-hour infusion of intravenous lignocaine on pain and QoR-15 scores after breast cancer surgery-A randomised controlled trial.

Despite many analgesic modalities available, postoperative pain management after breast cancer surgery remains a challenge, which translates into poor quality of recovery, if untreated. Intravenous lignocaine with its anti-inflammatory, antihyperalgesic, and analgesic properties could provide a good option for these patients. The aim of this study was to evaluate the effect of intravenous lignocaine on postoperative pain relief and quality of recovery in patients undergoing surgery for breast cancer. In this prospective double-blind placebo-controlled randomised study, sixty-six patients undergoing breast cancer surgery were assigned 1:1 to placebo or intravenous lignocaine (Group L). Group L received an intravenous 1.5 mg/kg of lignocaine bolus at induction, followed by an intravenous infusion of 1 mg/kg/h for 24 hours intravenously, while the control group was given equal volume of normal saline. Pain scores, opioid utilisation, and quality of recovery (QoR-15) at 24 hours and on the day of suture removal were compared. Statistically significant reduction was observed in both static (P = 0.01, 6 hours) and dynamic postoperative pain (P = 0.030, 24 hours), with consequential delay in the need for the first dose of opioid (P = 0.014) as well as decreased 24-hour postoperative opioid consumption (P < 0.001) and decreased post-operative nausea and vomiting (PONV) (P < 0.05) in the lignocaine group. Global QoR-15 was significantly better at 24 -hours in group L on postoperative day 1 (P < 0.001), albeit there was no significant difference at suture removal. No lignocaine related side effects were observed. Intravenous lignocaine can be safely used as an alternative perioperative non-opioid analgesic for early postoperative pain and recovery.

Assessment of early wound healing, pain intensity, quality of life and related influencing factors during periodontal surgery: a cross-sectional study

This cross-sectional study assessed early wound healing, pain intensity, quality of life, surgical satisfaction, and related factors during periodontal surgery. A total of 369 patients completed the questionnaire before undergoing periodontal surgery (baseline), immediately after the operation (phase I), on the day of suture removal (phase II), and one month later (phase III). The Early Wound Healing Score (EHS) was assessed, and the short-form McGill Pain Questionnaire (SF-MPQ), tooth hypersensitivity visual analog scale (VAS), oral health-related quality of life measure (OHQoL-UK), and surgical satisfaction VAS were administered and analysed. The EHS was 8.41 ± 2.74 and was influenced by disease severity and surgical factors. Scores on the SF-MPQ, pain intensity scores, and OHQoL-UK scores were significantly increased in phase I and decreased later. Tooth sensitivity decreased significantly one month after periodontal surgery. Psychological factors were positively related to SF-MPQ, pain intensity, OHQoL-UK and tooth sensitivity VAS scores in all phases, while disease severity and surgical factors were only related to these scores at baseline or in phases I/II/III. Surgical acceptance and reoperation willingness continuously decreased after surgery, and all these scores were related to surgical satisfaction. EHS, pain intensity and quality of life were closely related to disease severity, psychological factors and surgical factors in phase I (i.e., immediately after surgery). The findings suggest that surgical details should be enhanced and that behavioural and psychological interventions measures should be implemented to improve outcomes during periodontal operation and during the early postoperative period as well as to improve patient-oriented periodontal surgery experiences. Trial registration This cross-sectional study did not include interventions with human participants, and all the experimental procedures involving humans in this study were approved by the Ethics Committee of West China College of Stomatology, Sichuan University (WCHSIRB-D-2020-284).

Efficacy of Silicone Gel in Healing of Lacerated Wounds in Maxillofacial Region-An Experimental Study.

Face plays the most crucial part in defining personality and anything that hampers the facial esthetics foists a great amount of psychological impact. Hence, it is extremely important to manage the facial injuries efficiently and consider all the three elements of recovery, i.e., psychological, medical and esthetics. Purpose-To evaluate the efficacy of silicone gel in healing of lacerated wounds on face. A sample size of 44 patients in each group undergoing suturing of contused lacerated wound (CLW) was calculated with P-67, q-52 and l-10 Using Formula, N = 4pq/l2 using Statistical Package for Social Sciences (SPSS) software version 23. Patients were divided into two groups, Group A and Group B where Group A was study group who applied silicone over sutured wounds, while Group B was control group who did not applied any gel. In silicone group, a significant difference was observed between 7th day and 30th, 60th, 90th and 120th day in healing scores, while in non-silicone group, no significant difference was observed at the initial period. However, difference started to appear from 90th day and continued till 120th day. Silicone gel has considerable effect in healing of wound and prevention of unesthetic scarring when it is applied immediately from the day of suture removal and continued till 3months.

Effect of Leukoreduced Platelet Rich Plasma on Intra-Articular Pro-Inflammatory Cytokines in a Canine Pilot Study

Simple SummaryThis study provides initial information on the effect of platelet rich plasma in some of the most important pro-inflammatory cytokines identified in osteoarthritic stifle joint in dogs. The use of platelet rich plasma is getting more popular in the veterinary field but its effect in those cytokines is not known.Evaluation of effect of Leukoreduced Platelet Rich Plasma (LrPRP) on TNF-α and IL-6 (pro-inflammatory cytokines) in joint fluid in dogs with cranial cruciate ligament rupture (CCLR). Eight client-owned dogs with CCLR were assigned to treatment (2 mL LrPRP) or control (2 mL saline) injection groups. Day of evaluation (day 0) and day of surgery (day 10–14), joint fluid was collected and joint injected. Joint fluid was also collected on day of suture removal (day 20–28). TNF-α and IL-6 concentrations of joint fluid were measured using a bead-based antibody assay. Concentrations at the later time points were expressed as a ratio to the initial level within each stifle. LrPRP had a mean concentration of platelets 1.7 times higher that of whole blood on day of evaluation and 1.4 times higher on day of the surgery. Leukocytes were reduced by 99.7%. On day of surgery, TNF-α ratios in the joint fluid from dogs injected with LrPRP were significantly different that TNF-α ratios of control group. On the day of suture removal ratios of IL-6 and TNF-α were lower in LrPRP treatment group compared with control group; however, differences were not significant. LrPRP modulate ratios of pro-inflammatory cytokine TNF-α in dogs with CCLR.

The Role of Chemoimmobilization in Improving the Outcome of Scar Revision Surgery.

The major goal of scar revision is to make the scar aesthetically more acceptable. The injection of botulinum toxin type A is known to help in improving the outcomes of scars by reducing the tension across the wound edges and by promoting better wound healing. The aim of this article is to evaluate the efficacy of botulinum toxin injection following scar revision surgeries. A prospective, comparative study involving 20 patients with post-traumatic scars over the face was conducted between July 2018 and July 2019. The patients were divided into two groups: group A underwent scar revision surgery followed by BTX injection on the day of suture removal and group B underwent scar revision surgery alone. The photographic assessment was done at the end of a 1-year follow-up, by three blind investigators based on a pre-designed scale to grade improvement. The average grade of improvement of group A (3.02±1.1) was significantly higher when compared with that of group B (2.1±0.8) (P = 0.001). This study demonstrates that the combination treatment of scar revision with BTX injection is very effective in producing aesthetically better scars.

To evaluate the role of antibiotics following periodontal flap surgery

Periodontitis is a multifactorial disease occurring as a result of complex interrelationship between infectious agents and host factors. Moderate to severe cases of chronic periodontitis may warrant periodontal surgical procedures. As postoperative infection can have a significant effect on the surgical outcome. In the study, an attempt has been planned to evaluate the role of antibiotics in periodontal flap surgeries in reducing postsurgical infections. 40 Patients (male and female) aged 25-50 yrs with moderate to severe chronic periodontitis were selected from the Department of Periodontics and Oral Implantology at Desh Bhagat Dental College and Hospital, Mandi Gobindgarh. Therapeutic group (20 patients) - Amoxicillin 250 mg + metronidazole 200 mg for 5 days after surgery. Control group (20 patients) - No antibiotics given postoperatively. Analgesics and antiseptic mouthwash were prescribed for both the group. Patients were evaluated for pain (measured on visual analog scale [VAS]), Modified gingival index, Wound healing index, Swelling, fever, ulceration, delayed wound healing were recorded on the 7 th day of suture removal. Visual analog scale [VAS] recorded in control group was 2.90 and in Therapeutic group was 2.10. Mean modified gingival index score recorded in control group was 0.92 and in Therapeutic group was 0.66.

Time to removal of sutures from the palmar surface of the hand in dark-skinned patients: Results in a prospective cohort of 146 hands

The objective of this study was to estimate the time to removal of a suture from the palmar surface of a dark-skinned adult hand. A descriptive and analytical study included a cohort of 146 patients, 57% male, with a mean age of 37 ± 14 years, covering a period of 10 years. The mean time to removal of sutures on the palmar surface of the dark-skinned adult hands was 21 ± 2 days. Complete epithelialization of the suture path was the clinical indication for the ideal day for removal. After removal, closure was total in 90% of cases (132 hands) and partial in 9% (14 hands). The day of suture removal was significantly (p = 0.006) related to wound healing (complete closure). Eighty-five percent of patients without complete wound closure at suture removal had history of use of skin-lightening products. Tobacco use significantly lengthened time to suture removal (p < 0.001). There was a correlation between patient age and time to suture removal. On multivariate analysis, three factors were predictive of suture removal later than day 21: being a manual worker (44% of patients) (p 0.006), suture location in a palmar fold area (<0.001) and the age of patient, the 41–50 years (p = 0.001) and >50 years (p < 0.001).

Evaluation of postoperative pain in patients submitted to periodontal surgeries

Introduction Different periodontal surgeries are used to treat a variety of periodontal conditions in favour of a healthy and aesthetic periodontium [1]. However, the fear of surgical treatment is common, most often depriving patients of undergoing complete dental treatments. Patients' questions and concerns are often pain-related [2]. Adequate understanding of the intensity and variables that affect pain is essential because it can produce emotional responses that may influence treatment adherence [3]. The objectives of this study are evaluation of pain after periodontal surgery and its relationship with variables related to the patient, surgery and postoperative care. Materials and methods This study was approved by the Egas Moniz Ethics Committee and by the Direction of the Egas Moniz University Clinic (CUEM). All patients referred in the sample signed an informed consent form. Questionnaires were applied to 63 patients submitted to periodontal surgeries at the Post-graduation Course of Periodontology at the CUEM. Data was collected through the completion of two questionnaires. The first questionnaire was composed of two parts and was applied in the presence of the patient. The part A was done on the day of surgery for the purpose of collecting data from the patient’s clinical history and related with the surgery; and the part B on the day of suture removal about post-operative care. The second was delivered on the day of surgery with the Visual Analogue Scale. The patient was asked to fill it on the day of surgery, on the next two days after surgery and also on the day of suture removal, returning it on that day. Results It was found that the highest pain levels were experienced by the patients on the day of surgery, with a median value of 6.9. The degree of postoperative pain is not related with gender, type of periodontal disease, type of periodontal surgery, technique performed, teeth involved, duration of surgery, antibiotic intake, use of chlorhexidine gel and mouthwash, absence of mechanical plaque control and absence of physical exercise. On the other hand, the degree of postoperative pain is dependent on factors such as age (with older patients experiencing less pain), smoking habits and smoking cessation (non-smoking patients or those who stopped the habit in the postoperative period showed less postoperative pain). The use of nonsteroidal anti-inflammatory drugs and its duration influence the postoperative pain. Discussion and conclusions Periodontal treatment often includes several surgical procedures, so a bad postoperative period may prevent the patient from continuing treatment, which may in some cases jeopardise the maintenance of teeth. Smoking habits have been shown to be the most prominent variable in postoperative pain. It is therefore extremely important to encourage patients to stop smoking or when it is not possible to interrupt during the postoperative period.

Effect of an implant-retained complete overdenture on the hearing ability of edentulous patients: A clinical pilot study

Statement of problemEdentulism has been associated with sensoneurinal hearing reduction, but whether hearing is improved by the provision of an implant-retained overdenture is unclear. PurposeThe purpose of this pilot clinical study was to provide completely edentulous participants with implant-retained complete overdentures and to evaluate the effect on their hearing ability by pure tone audiometry (PTA). Material and methodsFifteen completely edentulous first-time denture wearers were enrolled, and their hearing was evaluated with PTA for air conduction and bone conduction at 6 time intervals: before denture insertion (R1), after denture insertion (R2), 1 month after denture insertion (R3), on the day of suture removal after implant surgery (R4), 3 months later, at the time of loading (R5), and 1 month after implant loading (R6). The Friedman test was performed to find significant differences in the measurements from the completely edentulous state to rehabilitation with a complete denture and an implant-retained complete overdenture. The post hoc Tukey test was used for multiple comparisons (α=.05). ResultsSignificant differences were found between R1 and R6, between R2 and R6, between R3 and R6, and between R4 and R6 in PTA in multiple comparisons (P<.05). The post hoc test revealed significant difference in the R1and R6 and R3 and R6 pairs (P<.05) at 500 Hz, 1 kHz, and 8 kHz, whereas only between R1 and R6 (P<.05) at 2 kHz for the air conduction test. In the bone conduction test, a significant difference was observed between the R1 and R6 and the R3 and R6 pairs (P<.05) at 500 Hz and 4 kHz, but only between R3 and R6 (P<.05) at 1 kHz and 2 kHz. ConclusionsThe study showed that the placement of dental implants improved hearing acuity via the acoustic pathway through air and bone conduction.

A Comparative Study of Pain Control and Early Rehabilitation after Total Knee Replacement: Local Wound Infiltration versus Epidural Bupivacaine in the Immediate Postoperative Period

Aim: To study the efficacy and safety of a periarticular analgesic cocktail injection for early rehabilitation after total knee replacements. Patients and Methods: One hundred patients who are included for TKR were posted for unilateral total knee arthroplasty. This prospective randomized controlled study compared pain relief and functional recovery in immediate postoperative patients (initial 72 h) of total knee replacement where one group of patients are given local analgesia and the other group are given epidural analgesia. The patients were randomized into two arms by block randomization. In one arm, the patients received epidural analgesia for 48 h postoperatively. In the other arm, the patients received periarticular injection of an anesthetic cocktail of drugs. Results: The pain relief on the day of surgery (day 1) was significantly better in patients who received pericapsular injection as compared to those who used the epidural injection for postoperative pain relief. The postoperative range of motion and the distance walked in on the day of suture removal (day 14) was marginally better in the epidural group though the difference was not significant. Side effects including nausea, vomiting, pruritus, urinary retention, and respiratory depression were significantly higher in the epidural group as compared to those who received the analgesic cocktail injection. Conclusion: Patients who received epidural infusion for postoperative pain control required more medications as supplements, as evidenced by higher incidence of bolus injections/increased infusion rates/tramadol injections. There were no surgical site infections in either group.

Results of skin closure using skin staples versus nylon sutures in distal 1/3rd lower limb surgery

Background: This study was conducted to compare the results of skin closure using skin staples versus sutures in distal 1/3rd of lower limb surgery using Southampton Wound Scoring System. This study suggested there was higher incidence of inflammation wound gaping associated with skin staples however it was associated with better surgical scar after removal.Methods: Out of 60 participants who underwent distal 1/3rd lower limb surgery, in 30 patients wounds were closed with conventional nylon sutures and in other 30 patients wounds were closed with skin staples. Patients were evaluated post-operatively every 3rd day untill the day of suture removal and results were compared on the basis of Southampton wound scoring system, surgical time for closure and in terms of cosmetic appearance of scar. Results: Out of 60 patients, 34 were males and 26 were females. The Mean age group of this study population was 46.6 years with SD of 12.5 years. Wound infection rate was found to be higher with skin staples (13.33%) as compared to conventional nylon sutures (6.66%). However average surgical time for closure for skin staples was low (2.4 min) as compared to conventional sutures (5.7 min). But skin closure with nylon sutures resulted in a better surgical scar post-operatively. Conclusion: Primary wound closure in distal 1/3rd of lower limb surgeryis very important to reduce postoperative morbidity and complications. Wound closure with nylon sutures not only results in lesser rates of infection as compared to skin staples but also it gives better cosmetic results post sutures removal. The only advantage of using skin staples bekng less surgical time for wound closure.

A Comparative Study between Staplers and Suture (Silk 2-0) for Skin Closure in Cesarean Sections at Gandaki Medical College Teaching Hospital

Background: Skin closure in the abdominal surgeries is an important factor that affects the prognosis of wound in terms of hospital stay as well as overall outcome of the surgery.Objectives: Cesarean section being the commonly performed operation, choice of suture material has the unexceptional role on it. This study has been performed with an objective to look for the merits and demerits of the skin closure by suture (Silk 2-0) and stapler.Methods: Prospective comparative study conducted among the patients admitted in a Maternity Ward of Gandaki Medical College Teaching Hospital for elective and emergency cesarean section. The comparison has been made in terms of time taken during the skin closure, presence or absence of soakage and wound dehiscence, day of suture removal and pain during the suture removal.Results: The average time taken for skin closure for suture group was found to be 5.46 min (±0.97) and the same for stapler group was found to be 1.22 min (±0.15) respectively. Similarly, the mean day of stitch removal in suture and staples were found to be 6.94 (±1.75) and 7.95 (±1.89) respectively. Surgical site infection (SSI) i.e. soakage was present in eight percent of those in suture group and 20% in stapler group. Wound dehiscence was present in two percent among the suture group and five percent among the stapler group. The severity of pain is more in stapler group than that of suture group during its removal.Conclusions: Our study concluded suture being superior to staplers for skin closure during cesarean section. Though time taken for the closure is less in the stapler group, other factors like wound complications, duration of hospital stay, pain during its removal favored for the suture to be used.J-GMC-N | Volume 11 | Issue 01 | January-June 2018, Page: 1-4

Description and post-operative evaluation of tie-in technique in tibial osteosynthesis in dogs

ABSTRACT: The aim of this study was to describe and analyse the adaptability and functionality of tie-in configuration in tibial osteosynthesis in dogs. Twenty dogs with tibial fracture were included in this study. An orifice was made on the proximal tibial fragment, on the medial side, close to the tibial crest. The drill piece was angled at 45º and projected into the same orifice on the distal sense of the bone. Others orifices made with the aid of a low rotation drill and drill piece with diameter smaller than the chosen implant. After 10 days post-operative, the animals were evaluated. X-ray analysis was performed at the time of clinical examination; immediate post-operative period; and at 30, 60, 90, and 120 days post-surgery. A questionnaire was given to the owners to provide details on the post-operative period. There were no trans-operative complications or suture dehiscence up to the day of suture removal. Partial development of bone callus was observed in 20 dogs within a mean period of 76 days. Three animals showed bone consolidation within 35 days, nine by 60 days, three by 90 days, and 5 by 120 days post-operative. Dynamization was carried out in 9 animals. The surgical access to the tibial medullary canal through the orifice at the proximal medial face, by the tibial tuberosity, enables the insertion of IMP without risks to articular and peri-articular lesions in the knee in dogs.

Antibiotics in periodontal surgeries: A prospective randomised cross over clinical trial.

Aims and Objectives:(1) To evaluate the need of antibiotics in periodontal surgeries in reducing postsurgical infections and explore if antibiotics have any key role in reducing or eliminating inflammatory complications. (2) To establish the incidence of postoperative infections in relation to type of surgery and determine those factors, which may affect infection rates.Materials and Methods:A prospective randomized double-blind cross over clinical study was carried out for a period of 1-year with predefined inclusion and exclusion criteria. All the patients included in the study for any periodontal surgery were randomly divided into three categories: Group A (prophylactic), Group B (therapeutic), and Group C (no antibiotics). Patients were followed up for 1-week after surgery on the day of suture removal and were evaluated for pain, swelling, fever, infection, delayed wound healing and any other significant findings. Appropriate statistical analysis was carried out to evaluate the objectives and P < 0.05 was considered as statistically significant.Results:No infection was reported in any of 90 sites. Patients reported less pain and postoperative discomfort when prophylactic antibiotics were given. However, there were no statistical significant differences between the three groups.Summary and Conclusion:There was no postoperative infection reported in all the 90 sites operated in this study. The prevalence of postoperative infections following periodontal surgery is <1% and this low risk does not justify the routine use of systemic antimicrobials just to prevent infections. Use of prophylactic antibiotics may have role in prevention of inflammatory complication, but again not infection.

Recognition and Management of Nerve Entrapment Pain After Uterosacral Ligament Suspension

To estimate the incidence, risk factors, and characteristics of neuropathic pain related to nerve entrapment after uterosacral ligament suspension. A review of patients who underwent uterosacral ligament suspension from January 2007 to August 2011 was performed. Patients with neuropathic pain attributable to nerve entrapment from uterosacral ligament suspensory suture placement were identified. Factors including surgeon's dominant hand, side of pain, onset of pain, day of suture removal, number of sutures placed and removed, patient age, and body mass index (BMI) were collected. Follow-up of patients with neuropathic pain was performed at postoperative visits and by telephone contact. Eight (1.6%) of 515 patients had neuropathic pain requiring suture removal from the affected side. The postoperative pain was recognized after discontinuation of intravenous narcotics on postoperative day 1. Patients reported their pain improved after removal of all sutures on the affected side. Patients with neuropathic pain did not differ from those without in regard to age, BMI, and preoperative prolapse stage, or in the number of sutures placed. None of the eight had recurrent pelvic organ prolapse (POP), with a median follow-up of 5 months. Eight patients (1.6%) had postoperative neuropathic pain that resolved after all sutures were removed on the affected side. The removal of sutures was not associated with recurrent POP in the short-term. II.

Pulsed dye laser treatment with different onset times for new surgical scars: a single-blind randomized controlled trial

In humans, regeneration of wounds is limited and the wound repair process leads to a nonfunctioning mass of fibrotic tissue known as a scar, which can be more or less visible [1]. The final appearance of a surgical incision is an important concern for patients and physicians. Scarring can cause discomfort and psychological stress for patients. Surgical scars can be flat, hypertrophic or atrophic. The etiology and mechanism of scarring are not fully understood. Scars are thought to be difficult to treat and almost impossible to prevent. Several nonsurgical (pressure garments, topical and systemic corticosteroids, silicone gel sheeting, 5-fluorouracil, radiotherapy, interferon, bleomycin, topical retinoic acid, colchicine, D-penicillamine) and surgical interventions (laser, cryosurgery, skin grafting, scar revision, dermatography) have been investigated for the treatment of scars [2–6]. Laser treatment may provide an alternative to the long list of current treatment options. Different laser systems have been used to prevent or treat scars. The argon laser was introduced in 1978 [7]. Abergel et al. showed the effectiveness of the 1,064 nm Nd:YAG laser in the treatment of scars [8]. Castro et al. [9] found that the effect of the Nd:YAG laser (at an energy level of 1.7×10 J/cm) could be due to selective inhibition of collagen production with no effect on DNA synthesis or cell viability. The diode laser has also been used for the treatment of scars. A preliminary study has suggested that treatment with the diode at 810 nm in the early phases can change the physiology of wound healing significantly, and thus prevent scar formation [10]. In 1993, Alster reported that the flashlamp pulsed dye laser (PDL) at 585 nm significantly improves erythematous and hypertrophic scars [11]. PDL is currently the laser of choice for the treatment of scars. The exact mechanism by which PDL exerts antiscarring effect remains unclear. The majority of the lasers including PDL emit light energy that is absorbed by hemoglobin, generating heat and resulting in damage to the microvasculature [12]. It has been reported that the 585-nm PDL can decrease fibroblast proliferation and collagen type III deposition [13]. McCraw et al. were the first to describe the use of laser therapy of postsurgical scars. In an uncontrolled study they found that early laser therapy was safe and effective [14]. Nouri et al. in a controlled study found that the 585-nm PDL on the day of suture removal is effective and safe in the treatment of fresh surgical scars [15]. This finding was confirmed again in another study using a cryogen-cooled 595-nm PDL laser [16]. On the other hand it seems that one single pass of the PDL on the day of suture removal does not improve the appearance of surgical scars and more than one pass is recommended [17]. In a trial comparing the 585-nm with the 595-nm PDL, Nouri et al. found that 585 nm was the preferred wavelength, as it markedly normalized the height, vascularity and elasticity of scars [18]. Additionally, Nouri et al. reported that both shortand long-pulse PDL started on the day of suture removal effectively and safely improve the quality and cosmetic appearance of surgical scars [19]. Although laser treatment on the day of suture Clinical trial registration number: NCT00506363 P. Davari : F. Gorouhi : P. Hashemi : F. Behnia : M. Nasiri-Kashani :A. Firooz (*) Center for Research and Training in Skin Diseases and Leprosy, Tehran University of Medical Sciences, 415 Taleghani Ave, Tehran 14166, Iran e-mail: firozali@sina.tums.ac.ir

Comparison of the effects of short- and long-pulse durations when using a 585-nm pulsed dye laser in the treatment of new surgical scars

More than 70 million surgical procedures are performed annually in the USA with the majority involving a skin lesion and almost all individuals in their lifetime will have one or more surgical procedures resulting in scars. Patients and physicians alike are thereby motivated to improve the cosmetic outcome of scars. Prior studies have shown that the pulsed dye laser (PDL) is effective in improving the quality and appearance of the scar when using the 585-nm PDL immediately after the removal of sutures. Most published studies used a pulse duration of 450 micros, which along with the other study parameters, has led to an overall improvement of the scars. However, a pulse duration of 1.5 ms is also available when using the pulsed dye laser and it should theoretically cause fewer side-effects. To our knowledge, there are no other studies comparing the effectiveness of different pulse durations in the treatment of surgical scars starting on the day of suture removal. The purpose of this study is to compare the effect of different pulse durations (450 micros vs. 1.5 ms) in the treatments of postsurgical linear scars immediately after suture removal when using the 585-nm pulsed dye laser (PDL). Twenty non-hospitalized male and female patients (older than 18 years of age) with skin types I-IV and with postoperative linear scars measuring at least 2.1 cm were enrolled in this prospective study. Scars were randomly divided into three equal sections. The different fields were randomly chosen to receive treatment (two out of three fields) or remain as control (one field). The two fields chosen to be treated received treatment with the 585-nm PDL using a 7-mm spot size at 4.0 J. One of the treated sections was randomly selected to receive a pulse duration of 450 micros, and the other section to receive a 1.5-ms pulse. The remaining scar section was designated as control (no treatment). The three sections were mapped and recorded. The patient received treatment immediately after the sutures were removed from the wound and then monthly for 3 months. Evaluations were performed before each treatment and 1 month after the last treatment. The short-pulse and long-pulse 585-nm PDL-treated sections demonstrated a statistically significant overall average improvement of the VSS of 92 and 89%, respectively, compared to 67% for the control site (Fig. 1). Further, for individual parameters of the Vancouver scar scale (VSS), there were significant (p < 0.05) differences between control and treatment groups for all parameters, but there were no differences between the short- and long-pulse treatment groups for any parameter. Both short-pulse and long-pulse PDL are safe and effective in improving the quality and cosmetic appearance of surgical scars in skin type's I-IV starting on the day of suture removal with no significant difference between the two pulse durations.

Comparison of the effectiveness of the pulsed dye laser 585 nm versus 595 nm in the treatment of new surgical scars

The aim of this study was to compare the effects of the pulsed-dye laser (PDL) at a wavelength of 585 nm with those at 595 nm in the treatment of post-surgical scars, starting on the day of suture removal. The study was a prospective, non-randomized, double-blind, controlled, clinical trial, set in an outpatient clinic. Fifteen outpatients with 21 post-operative scars at least 3 cm long were recruited, and 14 patients with 19 scars completed the study. Scars were divided into three equal portions. Each outer portion was randomly allocated to PDL at 585 nm or at 595 nm (3.5 J/cm(2), 450 micros, 10 mm spot size), and the center was an untreated control; treatment was composed of three laser sessions at 4-week intervals. A blinded examiner evaluated the three scar sections using the Vancouver scar scale for pigmentation, vascularity, pliability, and height. Cosmetic appearance was evaluated with a visual analog scale. Punch biopsies of three randomly selected scars were evaluated. Pigmentation: more scars after laser treatments were of normal color than in the control, but the difference was not statistically significant. Vascularity: after treatment, more scars had normal vascularity in all three groups than at baseline (P < 0.05); the largest increase was with a wavelength of 585 nm (10.5-94.7%), then 595 nm (15.8-78.9%), then control (5.2-36.6%). Pliability: there was more normal pliability in all three groups than at baseline (P < 0.05), with greater improvements in the laser-treated groups. Height: significantly more flat scars after 585 nm PDL (63.2%) than at baseline (21.1%) (P < 0.05). We observed a slight but non-significant decrease in the scar heights with 595 nm PDL in comparison with the control. after laser irradiation, the treated sections were more similar to a non-scarring process than the control. Cosmetic outcome: visual analog scales increased in all groups (P < 0.05), but the greatest increases were observed in the 585 nm and 595 nm laser-treated groups (50% and 60%, respectively) compared with controls (30%). There were significantly higher scores with the lasers than for the control (P < 0.001) at each visit after baseline. Both the 585 nm and 595 nm PDL treatments were effective in improving the appearance and normalizing the vascularity and pliability of post-operative scars. Both wavelengths improved the scars' visual appearance more than controls. We found that 585 nm appears to be the preferred wavelength, as it substantially normalized the height in addition to the vascularity and pliability in a significant number of scars.