External Scar Research Articles

Single-incision laparoscopic cholecystectomy

Single-incision laparoscopic surgery (SILS) has been proposed as a minimally invasive technique with the advantages of smaller external scars and reduced pain. Furthermore, usage of the flexible endoscope for SILS in lieu of the standard laparoscope provides distinct visualization advantages. This video shows a single-incision cholecystectomy performed using a single incision placed through the umbilicus. A 39-year-old woman with chronic symptomatic cholelithiasis was enrolled under institutional review board protocol to undergo SILS. She had previously undergone a laparoscopic tubal ligation. A single incision was made using the previous umbilical incision, and the abdomen was entered in an open fashion. The flexible endoscope was placed directly through the fascial incision, with two 5-mm ports on either side. Adhesions to the gallbladder were taken down with the harmonic scalpel. Dissection proceeded using an articulating grasper and retraction to identify the cystic duct and artery. The duct and artery were serially clipped and divided. The cystic duct was additionally secured with a loop ligature. The gallbladder was cauterized from the liver bed using the articulating hook cautery and extracted through the wound. The final incision placed at the base of the umbilicus was 7mm long. The operative time was 58min, with minimal blood loss recorded. The patient was discharged home on the day of the procedure and did not experience any postoperative complications. Single-incision cholecystectomy can be performed safely through one incision in the umbilicus, optimizing cosmesis. Substitution of the flexible endoscope for the standard laparoscope allows many greater degrees of visualization in SILS. This allows clear identification of the biliary ductal anatomy, allowing cholecystectomy to proceed safely. Placement of the endoscope directly through the incision decreases the profile of ports through the incision and increases maneuverability.

Multiplane technique for simultaneous submuscular breast augmentation and internal glandulopexy using inframammary crease incision in selected patients with early ptosis

Augmentation mammoplasty is a procedure with a high satisfaction rate. On the other hand, augmentation in a ptotic breast requires conventional mastopexy which has a high surgical morbidity. In selected cases, the multiplane technique, a simultaneous submuscular augmentation with internal glandulopexy, is a procedure which avoids the external scarring of mastopexy. Between June 2005 and October 2008, the author operated on 44 patients (12 unilateral for nipple level asymmetry not exceeding 1.5 cm and 32 bilateral procedures in patients with nipple-areolar complexes (NAC) below the inframammary crease (IMC) but not exceeding 1.5 cm). The procedure is performed under general anesthesia through an IMC incision. The average age of the patient was 33.5 years (range 19–50), and in all but one patient, a round, high-profile cohesive gel silicone implants with an average size of 354 cm3 (range 260–440) in bilateral and 350 cm3 (range 300–440) in unilateral procedures, were used. The average preoperative suprasternal notch to NAC measurement in unilateral (n = 12) and bilateral (n = 32) procedures was 22.2 cm (range19–24) and 23.2 cm (range 20–26) respectively. The preoperative average NAC distance to IMC distance in bilateral and unilateral cases was 8.03 cm (range 6–12) and 7.2 (range 4–9) cm respectively. The measured postoperative supra-sternal notch to NAC distance, 22.0 cm (range 19.5–23) in unilateral (n = 12) and 22.4 cm (range 20–26) in bilateral procedures (n = 32) respectively, shows the reduction in suprasternal notch to NAC distance. Postoperative NAC to IMC distance in bilateral and unilateral breasts was 9.3 cm (range 7–11) and 9.1 cm (range 7–10) respectively. When a unilateral procedure is performed, the contra lateral breast is used as a control to compare the results. One patient had an infection and of the 12 unilateral and 32 bilateral procedures, nipple sensation was present in 8 unilateral and 28 bilateral cases. Only one patient with bilateral procedure reported a bilateral loss of nipple sensation in the early part of her recovery. Two patients did have residual ptosis and one requested a bilateral vertical scar mastopexy. The multiplane procedure for submuscular augmentation with internal subglandular mastopexy is an option in selected patients with early ptosis or patients presenting with minor NAC asymmetry in the vertical axis. If necessary, conventional external mastopexy remains a possibility in patients with inadequate results.

Coblation removal of laryngeal Teflon granulomas

AbstractLaryngoscope, 2010

Psychosocial and marketing challenges for Natural Orifice Transluminal Endoscopic Surgery and Laparoendoscopic Single‐site Surgery

The introduction of laparoscopic techniques in the late 1980s and early 1990s has ushered in a novel era in the surgical treatment of human diseases. Following the first laparoscopic nephrectomy done by Clayman et al . in 1991 [1], the initially noted advantages of minimally invasive urological surgery were later proved [2,3]. This soon led to the transition from novelty to the current concept of established ‘expectations’. Despite the success of conventional laparoscopic urological surgery, incisions ranging from 1 to 3 cm in length and three to five ports in number are still required. Each additional working port increases the inherent risk of bleeding, infection, concordant organ damage, hernia formation and decreased cosmetic outcome.

Facial degloving approach to the midface

The purpose of this article is to describe the facial degloving approach for ablative surgery for various pathologies involving the midface skeleton. The main advantages of the facial degloving procedure are wide exposure of the midface skeleton, the associated low morbidity, and excellent cosmetic outcome that avoids external scars.

A new permian bivalve (megadesmidae, plesiocyprinellinae) from the serrinha member, Rio do Rasto Formation, Paraná Basin, Brazil

During a recent inspection in the Paleontological Collection of the Institute of Geosciences, University of Sao Paulo, we have identified some specimens of undescribed mollusk bivalves. These called our attention for the following reasons: a) all specimens are internal molds of conjugated and closed articulated valves, some of them presenting fragments of silicified shells; b) all internal molds have similar general shape and internal characters, representing specimens of the same taxon; c) the internal molds and silicified valves are well preserved, including fragile structures, which are hardly preserved, such as the internal mold of the external ligament and muscle scars; d) and equally important, according to the labels of all specimens, they were collected from rocks of the Passa Dois Group (Permian), Serrinha Member of the Rio do Rasto Formation. Although who collected the shells and the precise geographic location of the specimens are still unknown, the detailed study of these fossils brings us to the conclusion that they are morphologically distinct from any heretofore published genus of the endemic fauna of bivalves from Passa Dois Group. Based in its general shape, hinge structure and muscles scars, the new form can be classified under the Family Megadesmidae Vokes, 1967, the most diverse group of Permian bivalves of the Parana Basin. The specimens are referred as Beurlenella elongatella new gen. and sp. The shell shape and taphonomy indicate that this bivalve was a shallow, rapid, active burrower, suspension feeder, probably preserved in situ, in event deposits.

W1645 Laparo-Endoscopic Single Site (LESS) Cholecystectomy With Epidural Anesthesia: A Safe, Cost Effective, and Appealing Approach

the 66 women choosing this approach and only 48% of the 42 men (P=0.02). Age >50 (P= 0.34), college or graduate level education (P=0.44), history of a prior cholecystectomy (P= 0.85) and an operation in the past 10 years (P=0.19) were not found to be significantly correlated with NOTES preference. The most commonly cited reason for choosing NOTES was less post-op pain (73%), followed closely by less family inconvenience (71%) and less risk of infection (71%). The lack of external scarring ranked fourth out of the six reasons, with 44% of patients selecting this as a factor in their decision. Other less commonly cited reasons were earlier return to work/income (59%) or sports (23%). For patients choosing laparoscopy over NOTES, more available data (86%) and surgical experience (83%) were both commonly selected factors. The oral orifice was most popular, with 64% of all participants preferring this approach. Conclusion: Female gender was significantly associated with a preference for NOTES. Other demographic factors did not correlate significantly with selection of either technique. Decreased pain, family inconvenience and risk of infection were found to be more important than scarring, earlier return to work/income or sports. The oral orifice was preferred by a majority of patients. Patients consider NOTES a reasonable alternative to laparoscopy.

A comparative study between transbuccal and extra-oral approaches in treatment of mandibular fractures

Mandibular angle fractures continue to be a common type of facial injury. The objectives in treatment are to effect rapid healing by anatomic reduction and fixation and to restore function and appearance with minimal disability and complications. Traditionally, when open techniques are utilised, the extra-oral approach is performed through a skin incision concealed in the submandibular crease. However, patients develop unsightly scars and there is a risk of injury to the marginal mandibular nerve. In comparison, the trans-oral approach, performed through an oral mucosal incision, results in minimal external scarring or injury to the marginal mandibular nerve and allows direct visualisation and confirmation of the desired occlusion during the placement of the miniplates. The basic aim of the study was to provide a treatment for the mandibular fractures which results in minimal scarring and fulfills all the functional needs of the patient. Patients coming to KLES PK Hospital and MRC with mandibular angle fractures requiring open reduction and internal fixation admitted under OMFS were taken for the study. The sample size of the study was 15. In one group, the patients were treated by extra-oral approach and the other group by transbuccal approach. In patients treated by transbuccal approach, special armamentarium consisting of trocar, cannula, and cheek retractor were used; and in both the groups, semirigid fixation was done using two miniplates with around a distance of 1cm. Total of 15 patients were treated, 10 with transbuccal approach and 5 with submandibular approach. It has been found that both techniques fulfill the functional requirements of the patients. Patients treated with submandibular approach developed obvious unsightly scars, whereas transbuccal approach results in minimal scarring. The results associated with clinical observations suggest that transbuccal approach is a superior and less time consuming approach than extraoral approach, but it requires special instruments, lots of skill by the operating surgeon in using the armamentarium, and a skilled assistant.

Adhesive Bowel Obstruction: Letter to the Editor

Dear Sir, I read with interest the article by Butt et al. [1] regarding the rare but possible relevance of de novo adhesional bowel obstruction, i.e., cases of small bowel occlusion arising without previous abdominal surgery. In a study performed in Bulawayo, Zimbabwe [2], the pattern of small bowel obstruction changed with cases caused by postoperative adhesions becoming much more frequent than those due to inguinal hernia. However, a significant number of cases of small bowel obstruction in young women was found to be due to previous pelvic sepsis (PID) treated conservatively with antibiotics. This remains a considerable problem in resource-poor countries. An important impression was that de novo small bowel obstruction in men warranted early exploration because significant pathology was found in almost all cases. This message remains important in those circumstances where access to sophisticated scanning methods is unavailable. Of course, it goes without saying that even more careful inspection of the abdomen is necessary in today’s patient who may have had laparoscopic surgery with hardly any external scarring. Moreover, pervaginal or pergastric surgery leaves entirely no trace, thus forcing the examiner to rely on the patient’s own recollection or records or those of his relatives.

Hypopharyngeal pharyngoplasty for the management of piriform fossa sinus

Hypopharyngeal pharyngoplasty for the management of piriform fossa sinus

Surgical Results of the Intraoral Removal for Plunging Ranula

Background and Objectives : Although sclerotherapy has been recently applied for plunging ranula, surgical approaches such as marsupialization have been the primary mode of treatment. Marsupialization may be done through simple excision via transcervical approach or via combined approach, intraorally and trabscervically. This study examined the effectiveness of intraoral excision for the treatment of plunging ranula. Subjects and Method : This prospective clinical study was comprised of 15 patients who were treated for plunging ranula through intraoral excision of the raluna and sublingual gland. Results : All of the 15 patients showed a complete removal of sublingual gland. The cystic wall of ranula could be dissected for only three patients (20%) and for twelve patients (80%), it could not be dissected intraorally. Rupture of ranula developed in all patients (100%) during intraoral dissection. Recurrence did not occurr at all during a median follow-up period of 14 months (range, 7-35 month) after the intraoral excision. There were no side effects and external scarring. Conclusion : The intraoral approach for removal of the plunging ranula is highly effective as a primary treatment modality of plunging ranula.

Minimally‐Invasive Submandibular Transfer (MIST) for Prevention of Radiation‐Induced Xerostomia

To develop a minimally invasive intraoral technique to transfer the submandibular gland into the submental space. Experimental cadaver study. Five cephalus specimen, a total of 10 submandibular glands, underwent this intraoral approach. Primary outcome measures included operative time, length of gland transfer, adequate ligation of facial vessels, and preservation of lingual nerve, hypoglossal nerve, and submandibular duct. All glands were successfully transferred. Operative times ranged from 60 to 120 minutes, mean time= 77 minutes. Length of gland repositioning ranged from 2.5 to 4 cm, mean length= 3.35 cm. Both nerves and the submandibular duct remained intact. Facial vessels were adequately visualized and ligated successfully if necessary for gland repositioning. The submandibular gland can be transferred to the submental space through an intraoral incision without damaging the duct or neighboring nerves. The major advantage of this approach is the avoidance of an external neck scar and more rapid wound healing.

Effect of Recombinant Human Epidermal Growth Factor Against Cutaneous Scar Formation in Murine Full-thickness Wound Healing

A visible cutaneous scar develops from the excess formation of immature collagen in response to an inflammatory reaction. This study examined the role of epidermal growth factor (EGF) in the formation of cutaneous scars. Twenty Crl:CD-1 (ICR) mice were used and 2 full-thickness skin wounds were made on the dorsum of each mouse. One of the wounds was treated with recombinant human EGF by local application and the other was treated with saline for control until complete healing was achieved. The EGF-treated group's wounds healed faster than the control group's. The width of the scar was smaller by 30% and the area was smaller by 26% in the EGF-treated group. Inflammatory cell numbers were significantly lower in the EGF-treated group. The expression of transforming growth factor (TGF)-β1 in the EGF-treated group was increased. It was observed that the amount of collagen in the EGF-treated group was larger than the control group. In the EGF-treated group, the visible external scars were less noticeable than that in the control group. These results suggest that EGF can reduce cutaneous scars by suppressing inflammatory reactions, decreasing expression of TGF-β1, and mediating the formation of collagen.

Reconstructing a Natural Looking Umbilicus

An attractive umbilicus is an essential component of the abdominal wall. It defines the midline abdominal sulcus and adds to a shapely abdominal curvature. Certain procedures place the umbilicus at risk thus providing a need for a neoumbilicus. Three-hundred and twenty cases of abdominoplasties, panniculetomies, and TRAM flaps for breast reconstruction were reviewed. Five patients underwent an umbilical reconstruction after loss of the native umbilicus. A crescent-shaped incision was used to create an inferiorly based skin flap. The flap was inset to the abdominal fascia. A small full-thickness skin graft was used to form the superior hood. All patients attained an esthetically pleasing umbilicus with minimal scarring. No contracture, flap necrosis, or graft loss were noted. We present a novel, simple, and reliable technique of umbilical restoration. It circumvents the need for external scars and allows for achieving a naturally appearing umbilicus.

An intraoral surgical approach to the styloid process in Eagle’s syndrome

The purpose of this study is to present an alternative method to the extraoral surgical approach to remove the elongated styloid process, the intraoral surgical approach, and discuss their advantages and disadvantages. A literature review is also presented. A casuistic of intraoral surgical approach to remove the elongated styloid process is presented in five patients. Four patients experienced postoperative moderate pain and trismus for 1 week. Bilateral surgery in one patient caused severe trismus, great discomfort, and moderate difficulty in breathing. All were followed up for 6 months and showed complete relief of the oral pharyngeal symptoms and complete improvement in functional ability. The advantages of the external approach are good visualization and reduced possibility of deep neck space infection. The disadvantages are an external scar, longer duration of surgery, and risk of injury to the facial nerve. The advantages of the intraoral approach are that the method is safe, simple, and less time consuming and an external scar is avoided. The disadvantages are possible infection of deep neck spaces, risk of injury to major vessels, and poor visualization. Intraoral resection of the styloid process is a safe treatment technique of Eagle's syndrome. It is not recommended the bilateral intervention at the same surgery, because of possible great discomfort at postoperative time.

Transoral excision of the submandibular gland: Techniques and results of nine cases

We will discuss the transoral surgical approach to excising the submandibular gland, the relevant anatomy, the indications, and the risks and benefits of the procedure. We will present our case series of nine patients. A retrospective review of a series of nine patients in which transoral submandibular gland excision was attempted over the past 10 years was performed. The series of nine patients who underwent transoral submandibular gland excision was examined for age, indication for operation, complications, length of stay, and postoperative pathology. Relevant indications, risks, and benefits are also discussed in conjunction with relevant surgical anatomy and approach utilized. Of nine patients who underwent attempted transoral submandibular gland excision, eight operations were completed transorally. Only one operation was converted to a standard external approach due to severe scarring. Six of nine patients presented with chronic sialadenitis, three of nine having obstructing sialoliths. Three patients presented with other benign cystic lesions consistent with a ranula, an infected mucocele, and a cystic teratoma. There was only one patient with a complication of incision breakdown and delayed healing in an irradiated field. There were no long-term complications involving the lingual or hypoglossal nerves, and there were no hemostatic complications. Transoral excision of the submandibular gland is a viable and safe approach to be utilized. There are no external scars caused, there is minimal risk to the marginal mandibular branch of the facial nerve, and skin incisions through irradiated fields are avoided. Although the surgical anatomy is somewhat novel, the transoral approach has been used effectively and without complication in removing benign submandibular gland pathology in our series.

External Rhinoplasty Columellar Scar Analysis

The LaryngoscopeVolume 119, Issue S1 p. S173-S173 Triological Society Poster Presentation West External Rhinoplasty Columellar Scar Analysis Vanessa R. Erickson MD, Vanessa R. Erickson MDSearch for more papers by this authorJ. David Kriet MD, J. David Kriet MDSearch for more papers by this authorSam P. Most MD, Sam P. Most MDSearch for more papers by this author Vanessa R. Erickson MD, Vanessa R. Erickson MDSearch for more papers by this authorJ. David Kriet MD, J. David Kriet MDSearch for more papers by this authorSam P. Most MD, Sam P. Most MDSearch for more papers by this author First published: 30 March 2009 https://doi.org/10.1002/lary.20453AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume119, IssueS1Supplement: Triological Society Poster Presentations from the Eastern, Western, Southern and Middle Section Meetings2009Pages S173-S173 RelatedInformation

ENDOSCOPIC TRANSCONJUNCTIVAL SURGICAL APPROACH TO THE OPTIC NERVE AND MEDIAL INTRACONAL SPACE

Surgical approaches to the orbit require great precision and care because of the functional and aesthetic importance of this region. Conventional approaches to the posterior orbit often require bone removal, may disrupt extraocular muscles, and may create external surgical scars. We conceived a transconjunctival surgical approach to the medial intraconal space that is aided by a minimally invasive endoscopic technique and avoids muscle transection. Assisted by a rigid endoscope measuring 2.7 mm in diameter, with 0- and 30-degree lenses, we made a medial conjunctival incision along the limbus to approach the medial intraconal space and optic nerve in 7 fresh cadaver heads (a total of 9 procedures). This approach provided direct and quick access to the medial intraconal space and intraorbital optic nerve with the use of endoscopes via an aesthetically acceptable conjunctival incision, and it provided an excellent view of the operative area. Unlike conventional techniques, this approach left the anatomy relatively undisturbed and did not require detachment of the medial rectus muscle. The endoscopic medial transconjunctival surgical approach provides minimally invasive direct access to the medial intraconal space and the intraorbital optic nerve. The approach is easy; minimally disturbs structures; and lends itself to biopsy, drainage, and even excision of selected lesions in this region without muscle transection and with aesthetically acceptable anatomic closure.

Surgical results of the intraoral removal of the submandibular gland

Most patients with benign submandibular disorders have been treated surgically without difficulty via the transcervical approach. An alternative to the standard transcervical approach has been reported such as an intraoral approach. Retrospective chart review of the 77 patients with benign submandibular disorders. All patients underwent an excision of the submandibular gland via intraoral approach. Early postoperative complications developed in 74.0% of the temporary lingual sensory paresis followed by 70.1% of temporary limitation of tongue movement. However, these complications soon resolved in all patients spontaneously. Two cases of postoperative bleeding and 1 case of abscess formation were developed. Whereas late complications developed in 4 cases of residual salivary gland and abnormal sense of mouth floor and 1 case of gustatory sweating (Frey's) syndrome. The major advantages of this approach are no external scar, no injury to the marginal mandibular nerve. The disadvantage is a more difficult dissection to transcervical approach before proper expert, especially in the severe adhesion of salivary gland to surrounding tissue.

Endoscopic repair of orbital floor fractures

A variety of surgical approaches to orbital floor fractures have been described. These approaches include the subciliary, transconjunctival, transmaxillary, endonasal, and, recently, the endoscopic transmaxillary approach. As in other surgical specialties, technological advances continue to be used for the betterment of patients with facial trauma. The treatment of orbital fractures has benefited from these advances, particularly in the endoscopic arena. Currently, most orbital floor fractures are repaired with either a transcutaneous or transconjunctival eyelid approach. The use of endoscopy can easily be added to these approaches to enhance the surgeon's visualization, particularly deep in the orbital cavity. Endoscopy also can be used in a minimally invasive, transmaxillary approach to the orbital floor that eliminates complications associated with eyelid incisions (ie external scarring, eyelid edema, ectropion, entropion, and granuloma formation). In this article, we review the technique for transmaxillary, endoscopic repair of orbital blow-out fractures.