Depressed Scars Research Articles

The 2910-nm Fiber Laser Is Safe and Effective for Improving Acne Scarring.

Acne scarring results from the inflammation associated with acne papules, which alters dermal collagen, typically producing depressed scars. Lasers have been used to remodel skin improving the texture and appearance of acne scars. Herein, we investigate a new 2910 nm, erbium-doped, fluoride glass, fiber laser for improving acne scars. This novel laser delivers up to 5000 Hz low-energy pulses, providing a unique treatment modality. Fourteen subjects with rolling and/or boxcar acne scars were enrolled in this study. Thirteen subjects completed the final visit and received three treatments with the 2910 nm fiber laser at 6-8-week intervals. Eight subjects were Fitzpatrick type II and five were Fitzpatrick type III. Digital images were taken pre- and 1- and 3-months posttreatment and evaluated by two blinded reviewers in a randomized fashion for improvement. Subjects and the treating physician completed a Global Aesthetic Improvement Scale (GAIS) before treatment and at each visit to subjectively evaluate treatment effect. Histological analysis was performed on ex vivo lower eyelid skin samples. Side effects were evaluated by the treating physician and included erythema, edema, and pinpoint bleeding. Evaluation of blinded digital images revealed a mean improvement of 47.3% ± 14.2% (mean ± SEM) 3 months following the final treatment. GAIS scores demonstrated improvement as evaluated by both the subjects and the treating physician. Side effects averaged trace-to-mild erythema, edema, and pinpoint bleeding. This study shows that the 2910 nm, erbium-doped, fluoride glass, fiber laser is safe and effective for improving the appearance of acne scars.

Recommendations for managing adult acne and adolescent acne based on an epidemiological study conducted in China

There are numerous differences between adult acne and adolescent acne in terms of causes, distribution, and characteristics of skin lesions, as well as treatment. This paper aims to summarize the differences between adult and adolescent acne in China, in order to propose more suitable ways to improve their quality of life. We collected basic information, acne-related information, acne-affecting factors, quality of life scores and treatment-related information of acne patients. A total of 552 questionnaires were collected. Adult acne is typically predominant on the cheeks, similar to adolescent acne, with a relatively lower incidence in other areas, apart from the jawline. Pigmentation and depressed scars are present in nearly half of acne patients, while hypertrophic scars are less frequently observed. Teenagers often have a higher consumption of dairy products, sugary drinks, and high-sugar and high-fat foods. Eczema is more common in adult acne. Additionally, more adults than teenagers experience stress and poor quality of life related to acne. Adolescents are more likely to seek treatment online and on social media. Clinicians must thoroughly evaluate diverse risk factors and formulate personalized acne management strategies for patients with different types of acne.

Four-layer technique for tracheostomy scar treatment.

One important complication of the tracheostomy procedure is the depressed scar left after the tube is removed. A depressed tracheostomy scar can be aesthetically and functionally unacceptable. Tracheostomy scar treatment aims to fill lost soft tissue volume and correct tracheal skin tug. There are various techniques described to manage post-tracheostomy scars, including the use of autologous tissue or allogenic material and the creation of muscle flaps. In this article, the authors introduce a surgical method using four layers: the scar, the strap muscles, the platysma muscle, and the skin. This procedure has been used in two patients with depressed scar after prolonged tracheostomy placement. The tracheal tug was eliminated in each patient, and an imperceptible cutaneous scar remained. In each case, patient satisfaction was complete. The authors recommend this technique as a simple and effective method of closure for these troublesome tracheostomy scars.

Skin-Tarsus-Skin Combined with Orbicularis-Tarsus-Orbicularis Fixation Technique Creates a Double Eyelid: A Case Series.

The skin-tarsus-skin and orbicularis-tarsus-orbicularis fixation methods are widely used in double-eyelid surgery. Both methods have limitations. In this study, the two surgical methods were integrated and applied to form a stable double eyelid that mimics the natural physiological structure with minimal visible scarring. At the inner, middle, and outer sites of the double-eyelid line, 7-0 silk sutures were passed successively through the orbicularis oculi muscle at the lower edge of the incision, the tarsus/anterior tarsus tissue, and the orbicularis oculi muscle at the upper edge of the incision, and the skin was sutured with 8-0 thread. The remaining parts were fixed with 8-0 silk sutures successively passed through the skin at the lower edge of the incision, tarsus/anterior tarsus tissue, and skin at the upper edge of the incision. Scar formation, incidence of complications, and patient satisfaction were observed and recorded during follow-up. Fifty-eight patients were included. The follow-up ranged from 3 to 24 months (mean, 8 months) with 47 patients undergoing primary and 11 secondary/revision surgery. Twelve cases showed slight linear scars and in 46 cases, surgical marks were almost invisible, and there were no dynamic depressed scars. Evaluation of patient satisfaction showed high satisfaction scores (VAS score, 8.56 ± 0.51). The main reason for dissatisfaction was asymmetry of the double eyelid. There were no significant complications. A skin-tarsus-skin combined with orbicularis-tarsus-orbicularis fixation technique can produce a long-lasting, natural-looking double eyelid.

Advances in laser therapies for the scar.

Scars are classified into 5 types: Superficial scars, hypertrophic scars, atrophic scars, depressed scars, and keloid. These types are primarily characterized by abnormal production of fibroblasts and collagen, as well as the disorderly arrangement of connective tissue. Laser treatment for scars involves the coordinated activation of various signaling pathways and cytokines. However, the exact pathological mechanism for scar formation remains unclear, leading to a lack of radical treatment. Recently, laser treatment has gained popularity as a new minimally invasive approach for scar treatment. The emergence of new theories such as fractional, picosecond laser, and laser-assisted drug delivery has led to continuous advance in laser treatment. Up to now, it has been developed numerous novel treatments, including combined with drug, physical, and other treatments, which have shown superior therapeutic effects. In order to optimize laser treatment in the future, it is crucial to combine new materials with postoperative care. This will help clinicians develop more comprehensive treatment strategies. Therefore, it is important to explore treatment options that have broader applicability.

Surgical Correction of Depressed Scars After Upper Blepharoplasty: A Turnover Orbicularis-Septum Composite Flap Technique.

Depressed scarring is a common complication after incisional upper blepharoplasty and frequently contributes to patient dissatisfaction. Correcting this deformity presents a significant challenge for oculoplastic surgeons. This study aims to investigate the clinical effectiveness of employing the turnover orbicularis-septum composite flap technique in correcting depressed scars after double eyelid surgery. This is a retrospective study of 118 patients who underwent revision blepharoplasty with depressed scar from November 2020 to February 2023. During the revision procedure, the adhesions of the original scar were meticulously dissected, and the residual orbital fat was thoroughly released. The orbicularis-septum composite flap was then inverted downward and smoothly laid over the depressed scar area to address the tissue deficit. After surgery, patient satisfaction was evaluated by assessing the improvement of the depressed scars and the shape of the double eyelid folds. Follow-up assessments were conducted over a period of 6 to 24 months postoperatively. The results were judged as fully satisfied in 78 cases (66.1%), basically satisfied in 32 cases (27.1%), and unsatisfied in 8 cases (6.8%). Among the unsatisfied patients, 5 patients complained of eyelid fold shallow or disappear, and 3 patients complained of asymmetry. All patients exhibited varying degrees of improvement in the depressed scars. The turnover orbicularis-septum composite flap technique provides an effective approach for the treatment of depressed scars with a high satisfaction rate.

Retracted: Effectiveness and Safety Analysis of Plasma Beam in the Treatment of Facial Depressed Scars.

[This retracts the article DOI: 10.1155/2022/1194355.].

Aesthetic Reconstruction of an Old Burr Hole Defect Using a Cancellous Bone Chip and a Porous Polyethylene Implant.

Burr hole trephination is a minimally invasive procedure but can leave a depressed scar at the surgical site. Various materials have been studied to fill such defects; however, to the best of our knowledge, there are no reports of reconstructing old, depressed scars from burr hole surgery. This report presents a patient with depressed scarring near the anterior hairline of the frontal bone on both sides due to burr hole trephination for a subdural hematoma 27 years prior. Computed tomography scans revealed bony defects under the scar. Reconstruction of the bony defect was performed by debriding the bony bed, filling it with hydrated alloplastic cancellous bone, and covering it with a porous SynPOR polyethylene titanium-reinforced implant. During 1 year of follow-up, the reconstruction was maintained without complications. The patient was satisfied with the esthetic outcome. Thus, old bony defects can be repaired using the appropriate materials and techniques.

A wide depressed scar deformity treated with cutting wire and autologous fat graft: a case report

Scars are still a challenging problem in medical practice, despite advancements in treatment modalities. Numerous treatment modalities, ranging from simple revision, Z-plasty, and W-plasty to laser treatments, have been used to treat scar deformities. However, for wide depressed scars, additional methods are needed to completely restore the contour of the depression caused by tissue adhesion. We report on the case of a 34-year-old woman with a wide depressed scar deformity on the left upper buttock and the encouraging results of an autologous fat graft injection technique that utilized a cutting wire to form a pocket for the fat graft site, while simultaneously resolving the adhesion caused by the tissue. This method is safe and easily reproducible, making it a useful addition to the surgeon’s toolkit when dealing with such lesions.

Extended Superolateral Cheek Lift With a Short Preauricular Scar: A Local Anesthesia-based Practicable Technique for the Correction of Moderate-degree Facial Aging Signs.

An ideal technique applicable to middle-aged individuals with a moderate degree of facial aging signs has not yet been established. This study aimed to evaluate the utility of an extended superolateral cheek lift with a short preauricular scar technique for the correction of facial aging signs. A total of 200 female patients (mean age: 43y, range 27-56y) who underwent a local anesthesia-based extended superolateral cheek lift for the correction of facial aging signs confined to the malar and nasolabial area, lower eyelid, jawline, and neck were included. Data on the Global Aesthetic Improvement Scale, patient-reported outcomes, and complications were recorded at 1, 6, 12, and 24 months postoperatively. The Global Aesthetic Improvement Scale scores revealed exceptional improvement in 90% of patients along with no complications at month 24. None of the patients developed a depressed scar, skin necrosis, breaking of the superficial musculoaponeurotic system plication sutures, asymmetry, or facial nerve problems. At postoperative month 24, the appearance was reported to be very much improved by 90% of patients, and 94% of patients reported that they were very satisfied with the treatment and that they would recommend this treatment to friends and acquaintances. Our findings revealed the potential utility of an extended superolateral cheek lift with a short preauricular scar as a local anesthesia-based practicable technique for the correction of facial aging signs in middle-aged patients, offering a favorable postoperative outcome, lack of complications and high patient satisfaction in addition to invisible scars and a short-term postoperative recovery.

Pest categorisation of the avocado sunblotch viroid.

The EFSA Panel on Plant Health conducted a pest categorisation of the avocado sunblotch viroid (ASBVd) for the EU. The identity of ASBVd, a member of the genus Avsunviroid (family Avsunviroidae) is clearly defined and detection and identification methods are available. The pathogen is not included in the EU Commission Implementing Regulation 2019/2072. ASBVd has been reported in Australia, Ghana, Guatemala, Israel, Mexico, Peru, South Africa, USA (California, Florida) and Venezuela. In the EU, it has been reported in Greece (Crete Island) and Spain. The pathogen could establish in the EU wherever avocado (Persea americana) is grown. The only known natural host of ASBVd is avocado to which it causes the severe 'avocado sunblotch' disease, characterised by white, yellow, red or necrotic depressed areas or scars on the fruit surface, bleached veins and petioles of the leaf, and rectangular cracking patterns in the bark of the old branches. Fruit yield and quality are severely diminished. ASBVd infects under experimental conditions a few more species in the family Lauraceae. The viroid is naturally transmitted at an extremely high rate by seeds (up to 100% in asymptomatically infected trees), but with a low efficiency by pollen (only to the produced seeds), and possibly through root grafts. Plants for planting, including seeds, and fresh avocado fruits were identified as the most relevant pathways for further entry of ASBVd into the EU. Avocado crops are cultivated in southern EU countries. Should the pest further enter and establish in the EU, impact on the production of avocado is expected. Phytosanitary measures are available to prevent entry and spread of the viroid in the EU. ASBVd fulfils the criteria that are within the remit of EFSA to assess for it to be regarded as a potential Union quarantine pest.

Hybrid double-dermal flap technique for vest-over-pants-closure correction of depressed abdominal scars.

Surgical procedures performed during neonatal period or childhood that result in vertical midline, transverse left upper quadrant, or central upper abdominal scars create significant psychological concerns in adulthood. Various surgical techniques correct depressed scars, including scar revision, Z- or W-plasty flaps, sub-incision tunnelling, fat grafting, and autologous or alloplastic dermal grafting. This article describes a novel technique for repairing depressed abdominal scars using hybrid double-dermal flaps. We included patients with psychosocial concerns who underwent abdominal scar revision because of wedding plans. Hybrid local de-epithelised dermal flaps were used to correct the depression of the abdominal scar. Superior and inferior skin flaps, medial and lateral to the depressed scar, were de-epithelised for 2 to 3 cm and sutured using the vest-over-pants technique with 2/0 nylon permanent sutures. Six female patients who want to marry were included in this study. Depressed abdominal scars were successfully fixed using hybrid double-dermal flaps, either from the superior-inferior aspect for transverse scars or from the medial-lateral aspect for vertical scars. No postoperative complications were noted, and the patients were satisfied with the outcomes. De-epithelialised double-dermal flaps in the vest-over-pants technique are an effective and valuable surgical technique for correcting depressed scars.

Investigating the Efficacy of Modified Lipoaspirate Grafting to Improve the Appearance of Atrophic Acne Scars: A Pilot Study.

Processed lipoaspirate grafting describes several techniques theorized to leverage the inflammatory and regenerative capacities of mechanically processed adipocytes to rejuvenate and correct skin pathology. Although lipoaspirate grafting is typically leveraged to fill visible defects such as depressed scars and dermal lines, additional fat processing allows grafts to stimulate mechanisms of wound healing, including the promotion of fibroblast activation, neovascularization, and neocollagenesis. This study intends to assess the efficacy and tolerability of processed lipoaspirate grafting monotherapy to improve the clinical appearance of atrophic acne scars. Patients underwent a single autologous processed lipoaspirate grafting procedure at the site of atrophic acne scars. Objective and subjective scar analysis was performed at 3 and 6 months posttreatment. Scars were assessed with standard photography, topographic analysis, and noninvasive skin measurements. In addition, microbiopsies were obtained before and after treatment to assess histological or genetic changes. Clinical improvement was assessed with patient and clinician Global Aesthetic Improvement Scales (GAIS) and blinded photographic evaluation. Ten patients between ages 18 and 60 completed the study. Clinical evaluation demonstrated that fat grafting improved the appearance of atrophic acne scars. Clinician GAIS and patient GAIS scores showed clinical improvement at both 3- and 6-month follow-up compared with baseline (P < .05). Blinded clinician GAIS scores also showed statistically significant improvement when clinicians compared clinical photographs taken at 6-month follow-up to baseline (P < .0001). The attenuation coefficient increased at 6-month follow-up, suggesting collagen remodeling and reorganization over the study period. Patients experienced anticipated posttreatment symptoms including transient erythema and edema; however, no unexpected adverse events were reported. Micronized lipoaspirate injection is a viable and effective option to improve the appearance of facial acne scarring. Favorable improvements in atrophic acne scarring were captured by objective analysis of skin ultrastructure as well as improvement in subjective assessments of scarring.

Histopathological spectrum of lesions of kidney: A morphological study

Introduction: The kidneys, as essential organs with diverse functions, are of paramount importance in the human body. Their primary role involves eliminating metabolic waste products and maintaining the balance of water, salt, calcium, phosphorus, anions, and cations to uphold the plasma's acid-base equilibrium. The objective of the current study is to investigate and understand the various morphological patterns exhibited by renal diseases, as well as assess their distribution across different age groups and genders. Material and Methods: The present study was conducted at Department of Pathology, Mamata Medical College, Khammam. A total of 32 nephrectomy specimens were studied.Results: The study shows, male to female ratio is 2.5:1 with male preponderance and among 32 nephrectomy specimens 20 were non-neoplastic and 12 were neoplastic. Neoplastic lesions constitute about 20 cases with chronic pyelonephritis being the most common cause (8 cases) leading to nephrectomy. Hydronephrosis (5 cases) majority of them showed enlarged kidneys with depressed scars and loss of corticomedullary differentiation. In the age group between 5th to 6th decades maximum number of non-neoplastic lesions was seen and least is observed in between 1st to 2nd decade. Conclusion: To conclude, these findings provide valuable insights into the histopathological patterns and distribution of kidney diseases in the studied population, contributing to our understanding of the prevalence and characteristics of these conditions.

ATROPHODERMA VERMICULATUM: A RARE CASE WITH ISOLATED PRESENTATION

Atrophoderma vermiculata is a rare and benign follicular disorder of the skin occurs due to abnormal keratinisation in follicular pilosebaceous unit. It presents as multiple, symmetric, depressed pitted scars with reticular/ honeycomb atrophy of skin. It usually presents in face but in our case lesions are seen over chest, back, shoulder and gluteal region. The onset is mostly sporadic or sometimes inherited Autosomal Dominant. It is a clinical variant of Keratosis Pilaris Atrophicans. This condition is difcult to treat cosmetically. Hereby we report a rare case of Atrophoderma Vermiculatum with isolated presentation and different site involvement, treated with oral Isotretinoin showing good response

Role of enkephalin derivative in promoting wound healing and scar remodeling via increased epidermal growth factor in a mouse model

Background Enkephalin, an endogenous neuropeptide, binds to the delta (δ) opioid receptor and exerts an antinociceptive effect. Recent studies have suggested that neuropeptides might effectuate cutaneous wound healing. Therefore, we investigated the effects of an enkephalin derivative on wound healing and scar formation in vivo.Methods Enkephalin derivatives (leucine-enkephalin) were synthesized using the alanine scan method, and the most promising derivative (E10) was selected for further testing. In 15 C57BL/6N mice, two full-thickness skin defects (10 mm in diameter) were made on both sides of the back (left side, enkephalin group; right side, control group). The enkephalin group was administered 100 μL of E10 (AGGFL, 200 μg/mL), and the control group received phosphate-buffered saline. The wound size was digitally analyzed on days 2, 4, 7, and 10. After 21 days, the scar tissues were histologically evaluated for the scar depression index (SDI), and the epidermal growth factor (EGF) concentration was assessed using an enzyme-linked immunosorbent assay.Results The skin defect percentages were 98.4%±17.9% (day 2), 83.2%±24.0% (day 4), 39.7%±17.4% (day 7), and 16.2%±10.0% (day 10) in the control group and 86.1%±15.0% (day 2), 61.4%±11.6% (day 4), 26.6%±8.8% (day 7), and 16.4%±8.8% (day 10) in the enkephalin group. The SDI values were significantly lower in the enkephalin group (0.06±0.19) than in the control group (0.22±0.13, P&lt;0.001). The EGF level was significantly higher in the enkephalin group (102.2±22.6 pg/mL) than in the control group (42.1±20.5 pg/mL, P&lt;0.001).Conclusions An enkephalin derivative promoted wound healing and reduced depressed scar formation in a mouse model.

Application of Trapezoid Orbital Septum Membrane Flap in Double-Eyelid Blepharoplasty.

For a long time, to achieve the natural shape of double-eyelid crease, multiple techniques of double-eyelid plastic surgery have been developed. We describe the trapezoid orbital septum membrane flap in blepharoplasty to achieve a dynamic double-eyelid crease and avoid a depressed static scar. The authors developed a trapezoid orbital septum membrane flap in double-eyelid blepharoplasty. The flap base is fixed on the pretarsal plate with the distal end of the flap positioned between the superior and inferior edges of the incision. Layer-by-layer contraposition suturing is then performed. One hundred ninety-one cases of double-eyelid blepharoplasty were performed by a senior surgeon using the trapezoid orbital septum flap method. Patients were followed for 6 to 17 months. Twelve cases were revised secondarily. Patients were satisfied with the palpebral folds, which showed a dynamic crease followed with movements of the eyelids. The authors introduce a trapezoid orbital septum flap in upper eyelid blepharoplasty. The flap relies on the elasticity of the orbital septum flap as the levator aponeurosis extension segment to produce a natural crease without a depressed static scar.

Safety and efficacy of CO2 dot matrix laser combined with platelet-rich plasma on depressed scar after acne vulgaris and influencing factors of its repair effect: A retrospective analysis.

Acne vulgaris (AV) is the most pervasive inflammatory disease of hair follicle and sebaceous gland in the dermatology department, and depressed scar (DS) is the most common and serious sequela of AV. To explore the clinical value of CO2 dot matrix laser combined with platelet-rich plasma (PRP)-treated AV. Total 81 patients with DS at the rear of AV from December 2018 to October 2019 were selected, randomly divided into observation group (OG, n=39) and control group (CG, n=42). Patients in the OG group were treated with CO2 dot matrix laser combined with PRP, and those in the CG group were treated with CO2 dot matrix laser. To observe clinical outcomes in both groups. According to experimental analysis, compared with the CG group, CO2 dot matrix laser combined with PRP can more strongly improve the clinical efficacy on patients, shorten the scar scabbing time and decrustation time, more effectively contributed to their scar repair, comfort, skin condition, psychological state and satisfaction, and reduced their pain. The subsequent follow-up results also showed that patients in the OG group experienced better quality of life. Moreover, according to the logistic regression analysis, the course of disease, scar degree, and staying up late were independent risk factors for the repair effect, and the repair method of CO2 dot matrix laser combined with PRP was an independent protection factor. To sum up, CO2 dot matrix laser combined with PRP can strongly enhance the scar repair effect, psychological state, and life quality of patients with DS after AV, so it is worth popularizing in clinical practice.

The correlation between Intra-abdominal Adhesions and body mass index in Women Undergoing elective repeated Cesarean Section

Background: Intra-abdominal adhesion formation is serious post-surgery problem that occurs frequently after caesarean section. Obesity is associated with many hemostasis disturbances, particularly impaired fibrinolysis, which may increase the incidence of intra-abdominal adhesions. Aim of Work: Goal of the work was to correlate between intra-abdominal adhesions and body mass index in women scheduled for a repeated cesarean section. Patients & Methods: This was observational cross-sectional research that was carried out at Obstetrics & Gynecology department, faculty of medicine, Al-Azhar university hospitals during the period between October 2021 and April 2022, and total of 232 pregnant women undergoing repeated cesarean section, were enrolled in our study. They were separated into 2 categories according to the BMI: Category I: BMI < thirty kg/m2 (N = 30) and Category II: BMI ≥ thirty kg/m2 (N = 202); Group IIa (N = 96): BMI thirty – 34.9 kg/m2; Group IIb (N = 81): BMI thirty five – 39.9 kg/m2, and Group IIc (N = 25): BMI ≥ 40 kg/m2. Results: no statistically significant variation was discovered among categories regarding preoperative Hgb. However, group II was associated with more significant blood loss compared to group I. Furthermore, the incidence of intraoperative visceral injuries was greater in category II compared to category I. Conclusion: in women undergoing cesarean section, there was a significant association between body mass index and formation of intra-abdominal adhesion with no effect on scar thickness, more frequent depressed scar and dense adhesions, larger adhesion size, longer operation duration and no effect on intraoperative bleeding.

Bernese Periacetabular Osteotomy: A Comparative Study of Four Types of Incisions.

Bernese periacetabular osteotomy has diverse complications associated with incisions, such as dehiscence, hypertrophy, depression, and hyperpigmentation on scars, which affect patient satisfaction. The objective was to evaluate aesthetics and satisfaction outcomes in four different incisions. We evaluated 176 incisions in 148 patients. The incisions performed were the original modified (16, group I), straight and shortened, (64, group II), "Z" shaped (16, group III), and oblique inguinal (48, group IV). The scars were evaluated for width and length, development of a hypertrophic scar, depression or hyperpigmentation, and dehiscence and resuture. A scale of satisfaction was applied (points ranging from 1 to 10). The Bartlett test and Kruskal-Wallis test were used. The mean width and length of the scars were 20.3 and 6.8 cm for group I, 6.5 and 8.1 for group II, 12.1 and 7.1 cm for group III, 13 and 1.4 cm for group IV, respectively. Hypertrophic scars were found in 18% in group I, 12.5% in group II, and 31.2% in group III. Depressed scars were found in 10.8% in group I and 7.1% in group II. Hyperpigmentation was found in 16% in groups I and II, 37% in group III, and 2% in group IV. Dehiscence was found in 8.1% in group I and 8.9% in group II. Satisfaction for group IV was nine points. The difference in length and width and satisfaction were statistically significant (P < 0.05). The oblique inguinal incision (group IV) showed a smaller percentage of complications, with an adequate aesthetic result, and a high grade of patient's satisfaction.