Incidence Of Hypertrophic Scarring Research Articles

The impact of COVID-19 on clinical outcomes of burn patients

Abstract Background Multiple studies have shown the SARS-CoV-2 virus (COVID-19) to be associated with deleterious outcomes in a wide range of patients. The impact of COVID-19 has not been well investigated among burned patients. We suspect that patients will have worsened respiratory and thrombotic complications, ultimately leading to increased mortality. The objective of this study is to determine the impact a concurrent infection of COVID-19 has on clinical outcomes after a burn injury. Methods This is a retrospective, propensity matched, cohort study. We examined a de-identified database of electronic medical records of over 75 million patients across 75 health care associations in the United States for patients treated for thermal burns from 1 January 2020, to 31 July 2021, and those who also were diagnosed with COVID-19 infection within one day before or after injury based on International Classification of Disease, tenth revision (ICD-10) codes. Study participants included adults who were treated for a burn injury during the study period. Results We included 736 patients with burn injury and concomitant COVID-19 infection matched to 736 patients with burn injury and no concurrent COVID-19 infection (total 1472 patients, mean age 36.3 ± 24.3). We found no significant increase in mortality observed for patients with concurrent COVID-19 (OR 1.203, 95% CI 0.517–2.803; p = 0.6675). We did observe significant increase in infections (OR 3.537, 95% CI 2.798–4.471; p = 0.0001), thrombotic complications (OR 2.342, 95% CI 1.351–4.058; p = 0.0018), as was the incidence of hypertrophic scarring (OR 3.368, 95% CI 2.326–4.877; p = 0.0001). Conclusions We observed that concurrent COVID-19 infection was associated with an increase in infections, thrombosis and hypertrophic scarring but no increase in mortality in our cohort of burn patients.

547 Clinical Outcomes for Burned Patients with Covid-19

IntroductionThe COVID-19 epidemic has affected all aspects of medical care including a reduction in elective procedures, however, the incidence of burns and treatment for this condition has continued undaunted. Some of these patients were also diagnosed with COVID-19 infection, but it is unclear what effect, if any the SARS-CoV 2 virus has on patients recovering from a burn injury. In this study we examined the outcomes of burned patients with a concomitant diagnosis of SARS-CoV 2 virus.MethodsWe examined a de-identified database of patient electronic medical records across 55 health care associations containing over 75 million patients. ICD 10 codes were used to identify those with thermal or chemical burns from January 1, 2020 to July 31, 2021 and those also diagnosed with Sars-CoV 2 virus infection within 1 month of injury. We found 49,501 patients suffered burns during the study time period; of these 474 patients (0.96%) also experienced a concomitant COVID-19 infection. We compared outcomes based on ICD 10 and CPT codes.ResultsWe found no significant increase in mortality between groups during the study period. However, we did find a significant increase in infections, pneumonia, respiratory failure and sepsis in those with Sars-CoV infection (p< 0.05). However, there was no significant increase in ventilator management days (p >0.05) In terms of wound healing, patients with COVID-19 also experienced significantly more excision and grafting procedures and had a higher incidence of hypertrophic scarring (p< 0.05).ConclusionsCOVID-19 infection is well known to worsen respiratory outcomes, but in burned patients was also associated with an increase in other infections and poorer wound outcomes. These outcomes may emanate from a change in inflammatory status for patients with the SAR-CoV 2 virus infection. This is the first broad-based study to examine outcomes of burn victims with concomitant SARS-CoV 2 infection. Further investigation is indicated as more long-term data becomes available.

115 Analyzing Temporal Trends and Outcomes Associated with High Prevalence Bacterial Infections in Burn Patients

IntroductionBacterial infections are a leading cause of complications in burn patients. However, ambiguity remains around the most common infectious etiologies and their resulting complications. Our study identifies which bacterial infections will lead to specific complications and tracks infection rates of these bacteria over time.MethodsBurn patients diagnosed with a bacterial infection within 6 months of burn were identified in the TriNetX database using ICD-10 codes; those with bacterial infections prior to injury were excluded. Occurrence of the following outcomes within 12 months of injury were compared for those with bacterial infections and those without, including acute kidney injury (AKI), congestive heart failure (CHF), hypertrophic scarring, sepsis, and death. The top 4 bacterial infections, by incidence, were then identified and analyzed for the outcomes. Lastly, infection rates were stratified by year from 2010-2020. Data was analyzed using chi-square with p < .05 considered significant, and regressions.ResultsWe identified 457,383 burn patients, of whom 4,688 (1.0%) were diagnosed with a bacterial infection within 6 months of injury. The bacteria that constituted the highest proportion of infected patients were Staph aureus (51.1%), E. Coli (20.2%), Pseudomonas (17.6%), and Enterococcus (9.6%). When outcomes were stratified by bacteria, Enterococcus infection was associated with the highest incidence of AKI (23.1%), sepsis (25.2%), and mortality (16.03%). E. Coli was associated with the highest incidence of CHF (17.7%) and Pseudomonas was associated with the highest incidence of hypertrophic scarring (13.3%). All data was found to be statistically significant (p< .05). Time trend data from 2010 to 2020 stratified by bacterial infection is displayed in Figure 1. Of note, Pseudomonas infection rates increased by 90% (r2 = 0.6717) while E. Coli infection rates increased by 33%. (r2 = 0.7223). In contrast, Staph Aureus infection rates have decreased since 2013. Lastly, Enterococcus infection rates displayed a fluctuating pattern with an increasing trend since 2017.ConclusionsSpecies identification of a post-burn bacterial infection is an important step in outcome management. Despite its low incidence, Enterococcus infection was associated with the highest incidence of AKI, sepsis, and mortality, and has displayed recent increases in infection rates. Pseudomonas has shown a similar increasing trend and is notable for hypertrophic scar formation.

Factors Influencing Hypertrophic Scarring after Thyroidectomy

To identify the risk factors of hypertrophic scarring (HS) after thyroidectomy and construct a risk prediction model. From November 2018 to March 2019, the clinical data of patients undergoing thyroidectomy were collected for retrospective analysis. According to the occurrence of HS, the patients were divided into an HS group and a non-HS group. Univariate analysis and binary logistic regression analysis were conducted to explore the independent risk factors for HS. Receiver operating characteristic analysis was also carried out. In this sample, 121 of 385 patients developed HS, an incidence of 31.4%. Univariate analysis showed significant differences in sex, age, postoperative infection, history of abnormal wound healing, history of pathologic scar, family history of pathologic scar, and scar prevention measures between the two groups (P < .05). Binary logistic regression analysis indicated that age 45 years or younger (odds ratio [OR], 1.815), history of abnormal wound healing (OR, 4.247), history of pathologic scarring (OR, 9.840), family history of pathologic scarring (OR, 5.708), and absence of preventive scar measures (OR, 5.566) were independent factors for HS after thyroidectomy. The area under the receiver operating characteristic curve was 0.837. When the optimal diagnostic cutoff value was 0.206, the sensitivity was 0.661, and the specificity was 0.932. The development of HS after thyroidectomy is related to many factors, and the proposed risk prediction model based on the combined risk factors shows a good predictive value for postoperative HS. When researchers consider the prevention and treatment of scarring in patients at risk, the incidence of HS in different populations can provide theoretical support for clinical decision-making.

Flying brevet: a technique for mastectomy in female-to-male gender reassignment

Background: Several techniques are described for chest wall contouring in female-to-male (FTM) transgender patients, each with specific applications and limitations. Factors to consider are the aesthetic requirements of the male chest, elimination of anatomical female breast features, operative technique, scar minimisation and success of outcome. We describe the ‘flying brevet’ technique, named for the pattern of excised skin that resembles pilot’s wings. This procedure is tailored to FTM patients but can also be used for large gynaecomastia patients. We present a description of the technique with a retrospective review of outcomes and case series of patients who have undergone this procedure.&#x0D; Methodology: This is a retrospective review of a single surgeon experience with 113 consecutive patients who have undergone the flying brevet technique. The approach involves a semicircular areolar incision, with superior skin resection and glandular resection. A planned second stage procedure may be performed for larger breasts if required.&#x0D; Results: Seven per cent incidence of postoperative haematoma, one case of fat necrosis, one case of partial nipple-areolar-complex (NAC) necrosis and one case of full NAC necrosis in the series. There was one postoperative infection and six per cent incidence of hypertrophic scarring.&#x0D; Conclusions: The flying brevet provides a consistent method of mastectomy for FTM chest wall reconstruction. It permits large glandular and skin resection in ptotic breasts with preservation of NAC circulation. The flying brevet is an additional technique that can be added to the current options for mastectomy in FTM chest wall reconstruction.

Burn scar outcome at six and 12 months after injury in children with partial thickness scalds: Effects of dressing treatment.

In line with other researchers in the field of burns' care, we think that research investigating the long-term outcome of scars is largely lacking. As scarring is of the utmost importance to the patient, clinicians who treat burns must aim to find treatments that lead to a good end result. The aim of this study was to study scar outcomes at six and 12 months after injury. It is an extension of a previous randomised controlled trial (RCT) in which two dressings (porcine xenograft and silver foam dressing) were examined with respect to their ability to help heal partial thickness scalds. Children aged six months - six years with acute partial thickness scalds, on the trunk, or extremities, or both, were included. In the previous study, the silver foam was found to have significantly shorter healing times than the xenograft. Children were assessed at six and 12 months after injury for this study, and photographs were taken of the burn site, and both the patient and observer scar assessment scale (POSAS) and the Vancouver scar scale (VSS) were completed and evaluated by blinded observers. Of the 58 children from the original RCT, 39 returned to the clinic for evaluation of their scars at six months, and 34 at 12 months after injury. There were no differences in POSAS, VSS total scores, or incidence of hypertrophic scarring between the different dressings. Fifteen children were assessed as having hypertrophic scarring, all of whom had healing times that had extended beyond 14 days. This study compared burn scarring after two different treatments for burns in children with partial-thickness scalds and the data suggested that neither dressing had a more favourable impact on scar outcome. The conclusion is, however, tempered by the non-return of all the patients to the follow up. However, as anticipated, regardless of the dressing used, longer healing times were associated with higher scar scores (more scarring) and hypertrophic scarring.

Arm Contouring After Massive Weight Loss: Liposuction-Assisted Brachioplasty Versus Standard Technique.

Massive weight loss (MWL) brachioplasty is frequently requested for the improvement of the appearance and function of arms. Despite its diffusion, this procedure can be associated with significant complications. Liposuction-assisted brachioplasty (LAB) preserves the vascular, nervous, and lymphatic network and reduces the incidence of postoperative complications. This retrospective cohort study is aimed at analyzing two different modalities of arm contouring after MWL by evaluating the outcomes and complications. Of 31 patients (all females, average age 43.5 years), 20 were managed with standard brachioplasty represented by a swallowtail scar and monobloc resection and 11 with brachioplasty combined with aggressive liposuction. Evaluated parameters included age, body mass index, method of weight loss, and complications rate. No statistical analysis was used. Major postoperative complications (reoperation, bleeding, or thromboembolism) were not reported in both groups. The incidence of minor complications (wound separation, wound infection, and seroma) was globally 42%; the incidence of complications was significantly lower in the LAB group (9% vs. 60%). The incidence of hypertrophic scarring or keloid was higher in the control group (55% vs. 18%). Most patients were satisfied after surgery: in the LAB group, 81.8% of the patients expressed a high degree of satisfaction and 18.2% a good degree of satisfaction after 4 months of follow-up. In our experience, the LAB should be preferred in MWL patients because it has a lower rate of complications and a faster recovery than the standard technique. Proper execution requires considerable technical skill and experience.

Healing time and incidence of hypertrophic scarring in paediatric scalds

IntroductionScald burns, which heal in less than 14 days, are seen to be at low risk of hypertrophic scar (HTS) formation. Consequently surgery is usually reserved for scalds likely to take more than 14 days to heal. With the use of silver based dressings over the past few years, anecdotally, we have observed a tendency to improved healing of scalds with conservative management and reduced need for surgical intervention. We aimed to investigate the effect of overall healing time of paediatric scalds on HTS formation over a five-year period (2011–15). MethodsWe retrospectively identified all new patients attending the Royal Children's Hospital (RCH) burns clinic from 31st January 2011–31st July 2015. Medical histories were reviewed for burns caused by scalds. Scar quality was determined from written records or clinical photographs. Patients were compared in groups based on healing time of <10 days, 10–14 days, 15–21 days, 22–30 days or >30 days. ResultsWe studied 322 children, of which 52 (16.1%) developed HTS. There was a significantly higher incidence of HTS with increased time to healing (mean 34.5 days compared to 12.1 days, p<0.01). There were 25 patients that underwent surgical treatment with excision or debridement and split thickness skin graft of which 21 (84%) developed HTS. Grafting offered no benefit in HTS rate in the 22–30 days to heal group. ConclusionsOur study confirms that there is a link between prolonged healing time of scald wounds and HTS. The danger of slow healing for scarring despite grafting, suggests this operation should be performed earlier than current practice to allow complete healing in less than 3 weeks.

A Modified, Direct Neck Lift Technique: The Cervical Wave-Plasty.

BackgroundMajor problems with cervicoplasty by direct skin excision include the subjective nature of skin markings preoperatively and the confusing array of procedures offered. This technique incorporates curved incisions, resulting in a wave-like scar, which is why the procedure is called a "wave-plasty".MethodsThis prospective study includes 37 patients who underwent wave-plasty procedures from 2004 to 2015. Skin pinching technique was used to mark the anterior neck preoperatively in a reproducible fashion. Intra-operatively, redundant skin was excised, along with excess fat when necessary, and closed to form a wave-shaped scar. Patients were asked to follow up at 1 week, 6 weeks, and 6 months after surgery.ResultsThe mean operation time was 70.8 minutes. The majority (81.3%) was satisfied with their progress. On a scale of 1 to 10 (1 being the worst, and 10 being the best), the scars were objectively graded on average 5.5 when viewed from the front and 7.3 when seen from the side 6 months after surgery. Complications consisted of one partial wound dehiscence (2.3%), one incidence of hypertrophic scarring (2.3%), and two cases of under-resection requiring revision (5.4%).ConclusionsIn select patients, surgical rejuvenation of the neck may be obtained through wave-like incisions to remove redundant cervical skin when other options are not available. The technique is reproducible, easily teachable and carries low morbidity and high patient satisfaction in carefully chosen patients.

Postauricular skin: an excellent donor site for split-thickness skin grafts for the head, neck, and upper chest.

Postauricular skin is one of the potential donor sites for split-thickness skin grafts (STSGs). To objectively quantify how postauricular donor sites heal after STSG harvesting. A cohort of 39 Mohs micrographic surgery patients repaired with STSGs (total 41 surgical defects) was established. Scars resulting from postauricular donor site harvesting were objectively quantified by applying the Vancouver Scar Scale (VSS), in which healing of scars is ranked from 0 (best possible outcome) to 13 (worst possible outcome). Vancouver Scar Scale scores were 1.87 for sites followed for ≥6 months (n = 16), 3 for sites followed for 3 to 6 months (n = 7), and 1.61 for sites followed for 6 to 11 weeks (n = 18). Four patients developed mild hypertrophic scarring that resolved spontaneously or with intralesional triamcinolone injections at a concentration of 10 mg/mL. The postauricular skin is an excellent donor site for small-to-moderate sized STSGs (<10 cm). The donor sites healed well, as noted by the low scores on the VSS consistent with mild changes in erythema, pigmentation, and texture. The incidence of hypertrophic scarring was low and resolved with observation or treatment.

Adjuvant chemotherapy reduces the incidence of abdominal hypertrophic scarring following immediate TRAM breast reconstruction

Among the many factors that affect the degree of completion and satisfaction of breast reconstruction, the scarring is one issue that a surgeon cannot completely control. We hypothesized that the administration of cytotoxic drugs following the immediate breast reconstruction using transverse rectus abdominis musculocutaneous (TRAM) flap might affect the process of scarring, thus resulting in reduced incidence of hypertrophic scarring at the donor site. Data have been collected from 1,000 consecutive patients between July 2001 and December 2009. The relationship between the adjuvant chemotherapy and the incidence of hypertrophic scarring was studied, and the influence of other presumed risk factors was analyzed. The incidence of hypertrophic scarring was 18.6% (75 of 404) in the non-CTX group and 3.8% (20 of 530) in the CTX group. Univariate analysis using logistic regression modeling confirmed the statistical significance of the reducing effect of chemotherapy on the incidence of hypertrophic scarring (p<0.001; OR: 0.172). The incidence of donor-site hypertrophic scarring following immediate TRAM breast reconstruction was found in nearly 20% of the patients without chemotherapy, showing a significant difference from the patients with chemotherapy. We believe that Asian patients who undergo immediate TRAM breast reconstruction without chemotherapy are a high-risk group that is prone to hypertrophic scarring, requiring active preventive measures.

Epidemiology and Impact of Scarring After Burn Injury

The purpose of this study was to perform a systematic review of the existing literature on the incidence of hypertrophic scarring and the psychosocial impact of burn scars. In a comprehensive literature review, the authors identified 48 articles published since 1965 and written in English which reported the incidence and risk factors for hypertrophic scarring or assessed outcomes related to scarring. Most studies had important methodological limitations limiting the generalizability of the findings. In particular, the absence of standardized valid measures of scarring and other outcome variables was a major barrier to drawing strong conclusions. Among studies on hypertrophic scarring, the prevalence rate varied between 32 and 72%. Identified risk factors included dark skin, female gender, young age, burn site on neck and upper limb, multiple surgical procedures, meshed skin graph, time to healing, and burn severity. With regard to psychosocial outcomes, two studies compared pediatric burn survivors with a nonburn comparison group on a body image measure; neither study found differences between groups. Across studies, burn severity and location had a modest relationship with psychosocial outcome variables. Psychosocial variables such as social comfort and perceived stigmatization were more highly associated with body image than burn characteristics. To advance our knowledge of the epidemiology of scars and the burden of scars, future studies need to implement more rigorous methodologies. In particular, standardized valid measures of scarring and other outcomes should be developed. This process could be facilitated by an international collaboration among burn centers.

Moist occlusive dressing (Aquacel® Ag) versus moist open dressing (MEBO®) in the management of partial-thickness facial burns: A comparative study in Ain Shams University

IntroductionThe face is the central point of the physical features; it transmits expressions and emotions, communicates feelings and allows for individual identity. Facial burns are very common and are devastating to the affected patient and results into numerous physical, emotional and psychosocial sequels. Partial thickness facial burns are very common especially among children. This study compares the effect of standard moist open technique management and a moist closed technique for partial thickness burns of the face. Patients and methodsPatients with partial-thickness facial burns admitted in the burn unit, Ain Shams University, Cairo, Egypt in the period from April 2009 to December 2009 were included in this study. They were divided into two groups to receive either open treatment with MEBO® (n=20) or coverage with Aquacel® Ag (n=20). Demographics (age, gender, ethnicity, TBSA, burn areas), length of hospital stay (LOS), rate of infections, time to total healing, frequency of dressing changes, pain, cost benefit and patient discomfort were compared between the two groups. The long-term outcome (incidence of hypertrophic scarring) was assessed for up to 6 months follow-up period. ResultsThere were no significant differences in demographics between the two groups. In the group treated with the Aquacel® Ag, the mean time for re-epithelialization was 10.5 days, while it was 12.4 days in the MEBO® group (p<0.05). Frequency of changes, pain and patient discomfort were less with Aquacel® Ag. Cost was of no significant difference between the two groups. Scar quality improved in the Aquacel® Ag treatment group. Three and 6 months follow-up was done and long-term outcomes were recorded in both groups. ConclusionMoist occlusive dressing (Aquacel® Ag) significantly improves the management and healing rate of partial thickness facial burns with better long-term outcome compared to moist open dressing (MEBO®).

Hypertrophic Scar Formation Following Burns and Trauma: New Approaches to Treatment

Hypertrophic scar formation is a major clinical problem in the developing and industrialized injuries, and surgical procedures can give rise to exuberant scarring that resaults in permanent functional loss and the stigma of disfigurement. Figure 1 illustrates the scope of the problem. Annually, over 1 million people require treatment for burns in the United States [1], 2 million are injured in motor vehicle accidents [2], and over 34 million related surgical procedures are performed [3]. Although the incidence of hypertrophic scarring following these types of injuries is not known, it is a common outcome that creates a problem of enormous magnitude. Treatment of these cases is estimated to cost at least $4 billion per annum in the US alone [4]. The incidence of burns and traumatic injuries is even greater in the developing world [5]. This review will examine the process of hypertrophic scar formation, the results of current treatments, and areas likely to lead to significant advances in the field. Figure 1 Complications of Hypertrophic Scarring

Hypertrophic scarring: Dexon suture in a randomized trial

In a randomized prospective trial of three methods of skin suture an increased incidence of hypertrophic scarring in paramedian and inguinal wounds has been found to be associated with the use of 2/0 Dexon suture subcuticularly. However, the variance associated with the type of suture was less than that associated with the sex of the patient. The patient's opinion of the appearance of the scar was the same for all three suture methods used in skin closure.

Formal Decision Trees in Plastic Surgery

Formal Decision Trees in Plastic Surgery

Treatment of second degree facial burns with allografts—preliminary results

Facial burns are very common and have significant clinical impact. However, the treatment regimen for superficial to deep facial burns is not well defined. The purpose of this study was to investigate the effects of cadaver skin grafting in deep partial thickness facial burns in comparison to standard care. In a prospective open study design severely injured patients with superficial and deep partial thickness burns were randomized into the group receiving open treatment with silversulfadiazine (standard n = 5) or into the group receiving early superficial debridement followed by coverage with glycerolized cadaver skin ( n = 5). The outcome measures were time and quality of wound healing, and incidence of hypertrophic scarring at 3 and 6 months post burn. There were no significant differences in demographics between groups. In the group treated with the allogenic material time to reepithelialization was 10.5 days, while it was 12.4 days in the silversulfadiazine group ( p < 0.05). Scar quality was found to be significantly improved in the allogenic treatment group. Three and 6 months postburn there were no patients with significant hypertrophic scarring in the allogenic group while there were two patients who developed hypertrophic scars in the silversulfadiazine group ( p < 0.05). In this study, we demonstrated that glyzerolized cadaver allograft skin represents a superior biological dressing for shallow and deep partial thickness facial burns. This is in concordance with other reports on scalds. It would be worthwhile to perform more clinical studies with a larger number of patients to further evaluate the effect and function of allogenic skin for facial burns.

Surgical approach to benign small papular and dome‐shaped melanocytic naevi on the face

Patients frequently request removal of benign papular and dome-shaped naevi for cosmetic or functional reasons. Melanocytic naevi can be removed by elliptical, round, punch or shave excision or destroyed using electrodessication or cryotherapy. Total elliptical excision is probably the most widely used method of removal. If malignancy is suspected, adequate specimens for histological interpretation are required. When malignancy is not suspected, the cosmetic result becomes the first priority. Smaller incisions minimize tissue trauma and so give cosmetically superior results. Round excision has been recommended for the removal of moles but has not been widely practised. Round excision and punch excision may be better alternatives than conventional fusiform excision of benign dome-shaped or papular naevi of the face, as more tissue is preserved. Shave excision of naevi may be preferable to elliptical excision in sites where the incidence of hypertrophic scarring is high, as preservation of some thickness of the dermis may result in a more acceptable scar or even avoid a scar entirely. Expedient and simple surgery with excellent cosmetic results can be accomplished by the use of punches. Cryotherapy with cutting or curetting and electrodesiccation combined with shaving have been described. Round excision may be a better alternative to conventional fusiform or shave excision of benign papular or dome-shape nevus of the face because it leaves an almost imperceptible scar. In this technique, less skin is excised and histopathological examination can be done.

Adjunctive treatment of congenital pigmented nevi with phenol chemical peel.

The purpose of this study was a retrospective evaluation of the treatment of congenital pigmented nevi using the phenol chemical peel technique. Patients were treated with standard Baker formula in the operating room under general anesthesia or intravenous sedation with continuous electrocardiogram monitoring. A total of 20 patients were reviewed (13 girls and 7 boys, mean age 3.8 years). Eight patients had nevi located on the face, five patients had trunk lesions, and three patients had lesions on the thighs. Two patients had nevi located on both the face and the trunk, and two patients had involvement of the face, trunk, and thigh. Three of the above patients had the classic "bathing trunk" distribution of the nevi. A test area was peeled in four patients, and in five patients preoperative biopsies were performed to rule out malignancy before initiation of therapy. An average of 2.6 treatments were performed per patient. Two patients had adjunctive dermabrasion to increase the depth of peel and to contour surface irregularities. The length of follow-up ranged from 6 to 84 months with a mean of 28 months. Healing of the wounds occurred within 2 to 3 weeks postoperatively. Seventy-five percent of patients had satisfactory cosmetic improvement in the appearance of the lesions following treatment. Four patients had recurrence of the pigmentation after an initial lightening response, three of whom had their nevi subsequently excised. There was no incidence of hypertrophic scarring or cardiac and/or renal complications. There was one death from complications of leptomeningeal melanocytosis. Chemical peeling of congenital pigmented nevi is an acceptable alternative method of therapy for those lesions that are too large for excision and primary closure or for lesions in which excision would result in unacceptable scars in areas such as the face.

Reduction mammaplasty and mastopexy with superficial fascial system suspension.

Classic descriptions of breast reduction and mastopexy techniques have relied on dermal suspension with or without glandular shaping to contour the breast. Dermal suspension is often an unreliable and inconsistent anchor for high-tension wound repairs, resulting in unpredictable or poor scarring along with inadequate long-term lifting of the soft tissues. Hypertrophic scarring commonly occurs after dermal suspension reduction mammaplasty, being noted in 50 to 55 percent of patients at 6 months. Current studies regarding the anatomy and function of the superficial fascial system (SFS) have led to multiple applications of suspension with permanent (nonabsorbable) sutures in high-tension wound repairs of the body. As in other areas of the body, this system can be used effectively for suspension of breast-contouring procedures. Suturing the anterior SFS layer with nonabsorbable sutures (separately from the breast tissue or dermis) provides minimal tension skin repair. This should result in more predictable scarring with reduced risk of scar widening and hypertrophy. In addition, using SFS suspension in mammaplasties may result in longer-lasting contour results. The keyhole pattern used for dermal suspension techniques must be modified for SFS suspension. Reduction mammaplasty or mastopexy using these suspension wound repair techniques was performed in 109 patients (218 breasts) with a 6- to 36-month follow-up. The incidence of hypertrophic scarring was 3 percent at 6 months in this series. Suspension in mammaplasty procedures improved scar quality and provided more predictable and stable breast contours over long-term follow-up.