Linear Scar Research Articles

Topical oil formulation of plant extracts and vitamins as effective treatment for stretch marks and xerosis—An observational longitudinal study

BackgroundStretch marks are linear scars that result from elastic fiber destruction. They usually occur as the consequence of rapid change in the body mass (weight gain and loss, pregnancy, weightlifting), long‐term steroid use, or endocrinopathies. Treatment is challenging and mainly based on topical and procedural therapies, although the standard of care is still under debate.PurposeTo evaluate the efficacy and tolerance of a topical oil formulation of plant extracts and vitamins on the aesthetic improvement of stretch marks and xerosis.Materials and methodsFifty male and female patients, aged between 14 and 45 years, with stretch marks referring at the University Hospital Federico II, Naples, were enrolled between March and November 2019. Topical application of plant extracts and vitamin‐rich oil was performed twice daily on affected skin for 4 months. Patients were monitored at baseline (T0), and at two‐month (T1) and 4‐month (T2) follow‐ups, through clinical and dermoscopic assessment, confocal microscopy, cutaneous ultrasound, MoistureMeterEpiD, and X‐Rite spectrocolorimeter. Primary endpoints were as follows: 70% clinical improvement of stretch marks and 3‐point decrease in clinical score from baseline to T2. Secondary endpoints were as follows: change in the T0 parallel pattern of collagen fibers at confocal microscopy, cutaneous thickness increase at ultrasounds, cutaneous hydration increase at MoistureMeterEpiD, erythema reduction at X‐Rite spectrocolorimeter, and safety and adverse events (AEs).ResultsAt 4‐month follow‐up, stretch marks improved objectively and subjectively in all patients (p < 0.001). In detail, there was a 29% and 71% improvement in clinical appearance of stretch marks at T1 and T2, respectively, as documented dermoscopically and by the 3‐point reduction in the assessor's mean clinical score at each follow‐up visits [from 8.1±0.7 at baseline to 5.7±1.0 at T1 and 2.3 ±0.5 at T2 (p < 0.001)]. Erythema decreased by 15% and 30% and in parallel hydration increased by 25% and 71%, at T1 and T2, respectively (p < 0.001). At T2 confocal microscopy of stretch marks, dermal collagenous fibers assumed casual disposition with reticular pattern and refractivity, as signs of collagen remodeling and neocollagenesis, and also the T2 cutaneous ultrasound revealed increased epidermal thickness and decreased dermal hypoechogenicity as for a higher skin hydration.ConclusionOur study showed that a topical oil formulation rich in plant extracts and vitamins appears to be effective and safe in treating stretch marks and xerosis.

Exploration on clinical treatment of incisional wound infection after orthopedic internal fixation for lower extremity joint injuries

Exploration on clinical treatment of incisional wound infection after orthopedic internal fixation for lower extremity joint injuries

Clinical effects of bilateral overlength anterolateral femoral perforator flaps connected in series or parallel in repairing large area of wounds in limbs

Objective: To explore the clinical effects of bilateral overlength anterolateral femoral perforator flaps connected in series or parallel in repairing large area of wounds in limbs. Methods: From January 2017 to July 2019, 9 patients with large area of skin and soft tissue defects in limbs were admitted to the Departments of Hand Surgery and Foot and Ankle Surgery of Ruihua Affiliated Hospital of Soochow University, including 8 males and 1 female, aged 36 to 63 years. The retrospective cohort study was conducted. The wound areas of patients after debridement were 20 cm×15 cm to 30 cm×25 cm, and the wounds were repaired with bilateral overlength anterolateral femoral perforator flaps. One main artery defect in the receiving area of 4 patients was repaired with bilateral flaps connected in series. Two main artery defects in the receiving area of 5 patients were repaired with bilateral flaps connected in parallel. A total of 18 flaps were excised, and the area of a single flap ranged from 20 cm×8 cm to 46 cm×9 cm. The donor sites of 17 flaps were sutured directly, and the donor site of 1 flap was repaired with free full-thickness skin graft from hypogastrium. Harvesting time of flaps, survival condition of flaps after surgery, and wound healing time, and flap observation, two-point discrimination distance of flaps, functional recovery of joint and appearance of recipient site, and recovery of donor site during follow-up were recorded. Results: In this group of 9 patients, the flap harvesting time was 1.0 to 4.5 hours, and all the 18 flaps survived. The wound healing time of recipient site was 18 to 72 days after flap transplantation. They were followed up for 6 to 34 months. The shape of the recipient site was satisfactory, with no deep tissue infection such as osteomyelitis. Four flaps in 2 patients were bloated and were thinned in 6 months after operation; 4 flaps in 2 patients had skin pigmentation on the edge of the flap; the flap of one patient was scalded but healed by dressing change, with patchy scar being observed during follow-up. The rest of the flaps were soft, elastic, and painless with good blood supply. All the flaps restored with protective sensation, with only one point in two-point discrimination. Only linear scars remained in the donor sites of 17 flaps. All the limbs had good blood supply in the distal end of donor sites, and no restriction occurred in range of motion of knee joint and quadriceps muscle strength. Conclusions: The bilateral overlength anterolateral femoral perforator flaps connected in series or parallel have constant anatomy, reliable blood supply, and flexible combination. It is an ideal surgical method for repairing large area of skin and soft tissue defects in limbs at one time.

Reconstruction of Soft Tissue Defects in the Hand with a Free Anterolateral Thigh Deep Fascia Flap.

ObjectiveTo report our experience in the reconstruction of soft tissue defects in the hand with a free anterolateral thigh deep fascia flap and describe the clinical outcomes.MethodsThis study was a retrospective trial. From November 2016 to January 2020, six patients (four men and two women) with soft tissue defects in the hand were included in this study. The average age of the patients was 33.7 ± 12.7 years (range, 20 to 50 years). All patients underwent reconstructions with free anterolateral thigh deep fascia flaps. Relevant clinical characteristics were recorded prior to surgery. The size and thickness of the deep fascia flap and the thickness of the skin were measured intraoperatively. The survival of the flaps and skin grafts and the occurrence of infection were recorded after the operation. At follow‐up, donor site complications and postoperative effects were evaluated according to the outcome satisfaction scale. The pain in the injured hand was assessed using the visual analog scale.ResultsThe average body mass index (BMI) was 26.6 ± 1.7 kg/m2 (range, 23.9 to 28.7 kg/m2). The defect sizes ranged from 5 cm × 5 cm to 13 cm × 8 cm (average, 53.1 ± 27.9 cm2). The six anterolateral thigh deep fascia flaps ranged from 7 cm × 6 cm to 14 cm × 9 cm in size (average, 71.8 ± 29.1 cm2). The thicknesses of skin ranged from 25 mm to 40 mm (average, 32.5 ± 4.8 mm), and the thicknesses of the deep fascia flaps ranged from 2 mm to 3 mm (average, 2.5 ± 0.5 mm). After the operation, the blood supply of the deep fascia flap was normal in all cases. The second‐stage skin grafts of most patients survived completely. The skin graft in one case was partially necrotic and healed after a dressing change. No infection occurred. At follow‐up (average, 16.3 ± 6.9 months), there was only a linear scar and no loss of sensation at the donor site of each patient. According to the outcome satisfaction scale, the outcome satisfaction score ranged from 6 to 8 (average, 7.2 ± 0.9), all of which were satisfactory. Apart from one patient who reported mild pain, all the other patients reported no pain. Three typical cases are presented in this article.ConclusionsThe free anterolateral thigh deep fascia flap, which is suitable for reconstruction of soft tissue defects in the hand, can provide very good outcomes both functionally and aesthetically.

Frequency of Incidental Ageing-Related Lung Findings in an Elderly Population: A Saudi Teleradiology CT Study

Objectives: To assess the frequency of ageing-related lung changes seen on computed tomography (CT) chest examinations performed on teleradiology cohort of elderly patients.&#x0D; Materials and Methods: An experienced radiologist retrospectively assessed at a 3-month worth of teleradiology data of CT chest, abdomen and pelvis performed for detection or staging of malignancy is in asymptomatic patients 60 years old and older, residing in Saudi Arabia. Patients with known smoking history or obscuring abnormalities were excluded. Lung windows were analyzed to detect bronchial wall thickening, mosaic attenuation, linear scars, reticulations and pneumatocoeles. Bronchial thickening and mosaic attenuation were stratified by severity, while the scars and pneumatocoeles were stratified by number.&#x0D; Results: A total of 26 cases were collected out of 137 patients, with a mean age of 67 years old (61% males). Bronchial wall thickening was detected and 56%, with 35% being of moderate degree. Mosaic attenuation was detected in 26%, with 70% being of mild degree. Linear scarring was seen and 61%, in the absence of reticulations. Pneumatocoeles were detected in 26%, with 22% being more than 2 in numbers.&#x0D; Conclusion: In a select teleradiology cohort of asymptomatic CT chest imaging in elderly patients, bronchial wall thickening, mosaic attenuation, linear scarring pneumatocoeles are frequently encountered. Such findings should not lead to clinical or imaging misinterpretations.

Microneedling With and Without Vitamin C versus Fractional CO2LASER in Treating Abdominal Striae Distensae Alba: A ComparativeClinical and Histopathological Study

AbstractBackground: Striae distensae, a common skin condition,represent linear dermal scars accompanied by epidermalatrophy.Aim of Study: The aim of this prospective self controlledcomparative study is to evaluate and compare between micro-needling only, microneedling with topical vitamin C 15%application and fractional CO2 LASER in treatment of ab-dominal striae distensae alba.Patients and Methods: This prospective self-controlledcomparative study included 30 patients with abdominal striaedistensae alba (five patients skipped the study). Samplingmethod equation and program: MedCalc® version 12.3.0.0 (Ostend, Belgium)was used for calculation of sample size,statistical calculator based on 95% confidence interval andpower of the study was 80% with a error 5%. Type of samplingwas simple random sampling.All patients were from the Dermatology Outpatient Clinic,Ain-Shams University Hospitals in the period from December2016 till July 2017.This study was approved by the Research Ethical Com-mittee of Faculty of Medicine Ain Shams University. Allpatients signed an informing written consent with full infor-mation about the description of the procedure of treatment,possible side effects and photo documentation.Results: Microneedling in combination with vitamin C isan effective, safe and low-cost therapy treatment modalityfor abdominal striae distensae alba Addition of topical vitamin C increases the treatment outcome. It is easy to perform with no observable side effects or serious complications and results in great patient satisfaction with high induction of both collagen and elastin and increase in epidermal thickness and rete ridges.Although fractional CO2 LASER has been proven to play a role in collagen and elastin induction but the presence of complications as post inflammatory hyperpigmentation leads to decrease in patient satisfaction.

Management of keloid scars: noninvasive and invasive treatments.

Scars vary from mature linear scars to abnormal excessive scars such as hypertrophic scars and keloid scars. Keloid scars are fibro-proliferative disease entities that reflect an abnormal process of wound healing. They can cause pain, itching, stiffness, and psychological distress, all of which can affect quality of life. Various treatment options have been advocated as ways to prevent and treat keloid scars. These include noninvasive treatments such as use of silicone gel sheeting and compression therapy, and invasive treatments such as intralesional corticosteroid injections, surgery, and radiotherapy. Novel treatments include chemotherapy, immunotherapy, and anti-inflammatory therapies. Unfortunately, keloids continue to pose a significant challenge due to the lack of efficacious treatments. Therefore, clinicians should be familiar with various therapeutic options and apply the most suitable treatment plan for patients. In this review, we introduce the current therapeutic options for the management of keloid scars.

Subtarsal Versus Transconjunctival Approach: A Long-Term Follow-Up of Esthetic Outcomes and Complications

There is limited data that compares the long-term esthetic outcomes in patients who undergo traumatic orbital reconstruction with the subtarsal (STA) and transconjunctival approaches. The purpose of this study is to determine the long-term differences in scarring, cosmesis, and complications between the 2 approaches. Sixty-seven patients were examined on average 39months after surgery. Each patient was evaluated for satisfaction in surgical scarring and complications including diplopia, nerve paresthesia, lid malposition, and epiphora. Photographic images of each patient were reviewed by 3 experienced maxillofacial surgeons and 3 nonmedical personnel to determine if scarring was present and quantify it using the Manchester scar scale (MSS). Scarring was then compared using 3 different objective scales; MSS, modified Vancouver scar scale and the modified Stony Brook scar evaluation scale. Recorded data were analyzed using the χ2 test and Fisher exact test to determine statistical significance (P<.05). No visible scar formation was seen in 61 to 76.5% of patients who had an STA using either of the 3 scales, although the MSS proved to be significantly more accurate when assessing linear periorbital scars than the modified Vancouver scar scale and Stony Brook scar evaluation scale (P<.001). Surgeons were able to correctly identify subtarsal scars in 26.3% of patients, in comparison with the nonmedically trained people identifying just 10.6% of scars. Most of these showed only mild scar formation and are unlikely to have any significant effect on patient's quality-of-life. Overall, 93.3% of patients who had an STA were satisfied with the scar formation. While the transconjunctival approach is a useful technique that offers a surgical approach with no scarring, over the long-term, only a small proportion of STA scars are visible to the average person. Surgeons should consider both approaches and their clinical advantages when treating patients with traumatic orbital injuries.

Effects of three kinds of proximal pedicled flaps of hand for relaying repair of degloving injuries of fingertips and the soft tissue defects in the donor sites

Objective: To investigate the effects of the dorsal branch of digital artery pedicled flap combined with V-Y advancement flap for repair of degloving injury of fingertip and reverse dorsal metacarpal recurrent artery pedicled island flap for relaying repair of the soft tissue defects in the donor sites of the proximal dorsum. Methods: A total of 21 patients with degloving injuries of fingertips at the 2nd to 5th fingers were hospitalized in the Department of Hand Surgery of the Second Hospital of Tangshan from June 2016 to January 2019, including 14 males and 7 females aged 24-60 years. The retrospective clinical follow-up study was conducted. The areas of wounds after debridement ranged from 2.0 cm×1.5 cm to 3.5 cm×2.2 cm. The dorsal branch of digital artery pedicled flaps with dorsal branch of the proper digital nerve and dorsal digital nerve were designed in the proximal dorsum of the affected fingers to repair dorsal wounds in the distal dorsum of the affected fingers, and the sizes of the flaps ranged from 1.6 cm×1.5 cm to 2.6 cm×2.4 cm. The V-Y advancement flaps in the palmar side of the affected fingers were designed to repair palmar wounds in the distal segment of the affected fingers, and the sizes of the flaps ranged from 0.8 cm×0.6 cm to 2.0 cm×1.5 cm. The reverse dorsal metacarpal recurrent artery pedicled island flaps were used to repair the soft tissue defects in the donor sites of proximal dorsum, the sizes of the flaps ranged from 1.8 cm×1.7 cm to 2.8 cm×2.6 cm, and the donor sites of the flaps in back of hand were sutured directly. The survivals after the operation and the blood supply and appearance during follow-up of the three flaps were observed. At the final follow-up, the static two-point discrimination distance of the three flaps was measured, the satisfaction degree of patients for the appearance of hand was evaluated based on Michigan Hand Function Questionnaire, and the total active range of motion of the injured finger joints was assessed by the trial standard for the evaluation of the functions of the upper limbs of the Hand Surgery Society of the Chinese Medical Association. Results: All the flaps survived after operation. Tension blisters appeared on the surface of one dorsal branch of digital artery pedicled flap, and the wound healed after removing the stitch at the pedicle and changing dressings. During follow-up of 6-20 months, with an average of 12 months, the three kinds of flaps had good appearance, soft texture, and similar color with surrounding tissue, and with only linear scars in donor sites of the dorsal hand. At the final follow-up, the static two-point discrimination distances of V-Y advancement flaps, dorsal branch of digital artery pedicled flaps, and reverse dorsal metacarpal recurrent artery pedicled island flaps were 4-7 mm, 5-10 mm, and 8-15 mm, respectively. Sixteen patients were strongly satisfied with the appearance of hand, and the remaining five patients were satisfied with the appearance of hand. The total active range of motion of the injured finger joints was evaluated as excellent in 17 cases, good in 4 cases. Conclusions: The operation is simple and reliable for dorsal branch of digital artery pedicled flap combined with V-Y advancement flap to repair the degloving injury of fingertip, and reverse dorsal metacarpal recurrent artery pedicled island flaps to repair the soft tissue defects in the donor sites of the proximal dorsum, and the appearance and function of the affected fingers recover well, with minimal injury.

Use of tape for the management of hypertrophic scar development: A comprehensive review.

Introduction:Tapes have been used to aid fresh wound closure. For hypertrophic scars, the use of tapes as a therapy to reduce the mechanical forces that stimulate excessive and long-term scarring is yet to be evaluated. The aim of this comprehensive review was to explore the current clinical application of tapes, as a minimally invasive option, as purposed specifically for the management of hypertrophic scarring, regardless of scar causation.Method:Databases were searched using MeSH terms including one identifier for hypertrophic scar and one for the intervention of taping. Studies included the following: patients who received tape for a minimum of 12 weeks as a method of wound closure specifically for the purpose of scar prevention; those who received tape as a method of scar management after scar formation; reported outcomes addressing subjective and/or objective scar appearance; and were available in English.Results:With respect to non-stretch tapes, their use for the prevention of linear surgical scarring is evident in reducing scar characteristics of height, colour and itch. Statistically significant results were found in median scar width, reduction in procedure times and overall scar rating. Tapes were predominately applied by participants themselves, and incidence of irritation was infrequently reported. After 12 months, significance with respect to scar pain, itch, thickness and overall scar elevation was reported in one study investigating paper tape. Two papers reported the use of high stretch tapes; however, subjective results limited formal analysis. Although the use of taping for abnormal hypertrophic scar management is in its infancy, emerging research indicates tapes with an element of stretch may have a positive impact.Conclusions:Non-stretch tapes, for the prevention of linear surgical scarring, are effective in reducing scar characteristics of height, colour and itch. Paper tapes have shown effectiveness when applied during wound remodelling or even on mature scarring, with reported subjective changes in scar colour, thickness and pliability. Preliminary evidence of the benefits of high-stretch, elasticised tapes for scar management in the remodelling phase of wound healing have also been reported.Lay SummaryPatients are often concerned about unsightly scars that form on their bodies after trauma, especially burn injuries. These scars can be thick, red and raised on the skin, and can impact on the patient’s quality of life. For some scars, the process of skin thickening continues for up to two years after an injury.Unfortunately, scar formation is a part of the body’s healing process, whereby there is a constant pull or tension under and along the skin’s surface. The use of simple tapes, such as microporetm, to help with wound closure are sometimes used as a therapy to reduce the tension on the skin’s surface when a wound is healing to minimise scar formation. However, the effectiveness of taping has not been proven. This paper looks at the available evidence to support the use of taping to reduce scar features of height, thickness and colour. Initial evidence of mixed levels, suggests some benefits of tapes for scar management and show preliminary efficacy for reduction of scar height, thickness and colour. More research is required to determine the direct impact, comparison to other treatments available and patient viewpoint for this therapy.

A clinical and histopathological study comparing efficacy of microneedling versus cryoroller liquid nitrogen therapy in the treatment of striae distensae

Background: Striae distensae (SD) are visible linear scars in areas of dermal damage due to excessive stretching of the skin. Striae can cause cosmetic morbidity and psychological distress, particularly in women. In spite of several advances, no definitive treatment has emerged. Aim: The aim of this study was to evaluate the efficacy of microneedling versus cryoroller liquid nitrogen therapy in the management of striae distensae both clinically and histopathologically. Methodology: Striae of all 27 patients were treated with needling and cryoroller liquid nitrogen therapy on two different sides of each patient. Digital photography and skin biopsy were done to assess clinical and histopathological improvement. Results: On the evaluation of clinical response, poor clinical response (≤2%) was seen in 92.6% (n = 25) of patients on the dermaroller side, followed by moderate clinical response and on the cryoroller side, poor clinical response was seen in all 27 patients. Comparing the two sides, on the dermaroller side, 77.8% (n = 21) were satisfied and on the cryoroller side, 55.6% (n = 15) of the patients were slightly satisfied and 29.6% (n = 8) were satisfied. The histopathological improvement was almost similar on both dermaroller and cryoroller sides. Conclusion: Both microneedling with dermaroller and liquid nitrogen cryoroller were found to be safe and partially effective methods to treat striae. Patients were more satisfied with microneedling than cryoroller.

Dermatofibroma Over The Scar – A Rare Entity

Dermatofibroma is a common benign dermal tumour of unknown aetiology. With varied clinical presentation mimicking keloid, desmoid tumour and leiomyoma, the diagnosis of Dermatofibroma sometimes become problematic from the clinician side. Here, we report a case of Dermatofibroma in a not so common site which was clinically diagnosed to be a keloid. But later, the lesion turned out to be a dermatofibroma on histopathological examination. In our patient, the lesion was a single smooth circumscribed nodule over the left side of the abdomen. The lesion had a linear scar on either side and on palpation; it was firm in consistency. It was initially diagnosed to be a keloid which even after multiple intra-lesional steroid injections, failed to show any results. This prompted us to search for an alternate diagnosis; hence lesion was excised and analyzed. The Histopathological examination revealed a circumscribed lesion in the dermis, composed of benign spindle-shaped cells arranged in a storiform pattern. These findings, as mentioned above, were consistent with a diagnosis of Dermatofibroma, which is a slow-growing tumour commonly seen in the extremities. The keloid like a presentation of Dermatofibroma, is one another example of how a similar morphological presentation may have two distinct diagnoses resulting in a delay in providing appropriate treatment.

Methods of repairing large soft tissue defect with latissimus dorsi myocutaneous flap and management of secondary wound in donor site

Objective: To explore the methods of repairing large soft tissue defect with latissimus dorsi myocutaneous flap and the management of secondary wound in donor site. Methods: From June 2015 to June 2019, 30 patients with soft tissue defect caused by various reasons or hyperplastic scar were hospitalized in the First Medical Center of Chinese PLA General Hospital, including 10 males and 20 females, aged 25-64 years, with 18 cases of head soft tissue defects caused by the growth and rupture of tumor, 7 cases of hypertrophic scar in trunk and limbs, and 5 cases of facial and neck soft tissue defects caused by trauma. The area of primary wound after debridement or enlarged lesion resection was 14 cm×10 cm-18 cm×16 cm. Preoperative evaluation of 20 patients showed that the wound was relatively large, and the donor site could not be directly closed by suturing after resection of conventional single-lobe latissimus dorsi myocutaneous flap, so the bilobed latissimus dorsi myocutaneous flap with area of 14 cm×5 cm-18 cm×8 cm was cut to repair the wound, and the donor site was directly closed by suturing. Preoperative evaluation of 10 patients showed that the donor site could be directly closed by suturing after resection of conventional single-lobe latissimus dorsi myocutaneous flap, so that conventional single-lobe latissimus dorsi myocutaneous flap with area of 11 cm×9 cm-13 cm×10 cm was resected to repair the primary wound, resulting in big tension in donor site and secondary wound with area of 6 cm×4 cm-8 cm×6 cm that couldn't be directly sutured, which was repaired with donor site local flap with area of 7 cm×4 cm-9 cm×6 cm, and the second donor site was directly closed by suturing. Intraoperative end-to-end anastomosis was performed between the thoracodorsal arteries and veins of the latissimus dorsi myocutaneous flap and the arteries and veins of the primary recipient wound. The survival of latissimus dorsi myocutaneous flaps and local flaps were observed after surgery, and the appearance and function of the donor and recipient areas were observed during follow-up. Results: All the latissimus dorsi myocutaneous flaps and local flaps survived in the patients after surgery. Follow-up of 6-12 months showed that the latissimus dorsi myocutaneous flap was similar in color to the surrounding normal skin, with soft texture and good elasticity. The donor site of 20 patients repaired with bilobed latissimus dorsi myocutaneous flaps were only left with linear scars, among which 2 patients had hypertrophic scars and none had functional impairment. The donor site of 10 patients repaired with single-lobe latissimus dorsi myocutaneous flaps and donor site local flaps had good appearance, left with linear scar, irregular shape, but no local traction or dysfunction. Conclusions: When repairing a large soft tissue defect, the bilobed latissimus dorsi myocutaneous flap or the single-lobe latissimus dorsi myocutaneous flap combined with the local flap transfer in the donor site can be used after preoperative evaluation so that the donor site wound can be closed at one time while repairing the primary wound. The donor site has less scar, and both the recipient and donor sites have good appearance and function after surgery.

Application effect of sustainable skin-stretching device in scalp and soft tissue defect

Objective: To explore the application effect of sustainable skin-stretching device in scalp and soft tissue defect. Methods: From June 2017 to January 2020, 5 patients (3 males and 2 females, aged 31-57 (38.0±2.1) years) with large area of scalp and soft tissue defect and skull exposure were admitted to Department of Reparative and Reconstructive Surgery of the Second Hospital of Dalian Medical University. The wound area ranged from 16.0 cm×8.0 cm to 18.0 cm×12.0 cm. The sustainable skin-stretching device was installed after debridement operation for scalp wound. The wound was stretched from the 3rd day after installation of the device, at a basic speed of 1 mm/d and finished for 3 times on average. During stretching, close attention was paid to the changes in blood flow of the wound margin and the subjective feeling of the patients. When the result was negative in the squeezing and pinching test for wound margin after stretching, the further stretching was stopped, the final stretching state was maintained for 3 days, and the wounds were sutured directly. The wound healing during stretching of sustainable skin-stretching device and the occurrence of complications were observed. The rest wound areas after stretching for 5, 10, 15, and 20 days were measured. The wound healing and hair growth were observed during follow-up. Results: All the wounds of 5 patients was sutured directly after stretching for 19-23 d. There was no tension blister on the margin of wounds during stretching, and the margin of wounds healed well after being sutured without skin necrosis. After stretching treatment for 5-20 d, the wound areas were gradually decreased. During follow-up of 2-11 (4.5±1.5) months, the elasticity, color, feeling, and regenerated hair growth of the stretched scalp tissue were close to those of the surrounding normal skin tissue. The linear scar formed on the margin of wounds, but no scar formed on the wounds. Conclusions: The application of sustainable skin-stretching device can reduce the difficulty in repairing scalp and soft tissue defect, with the regenerated hair growing well after treatment, which is worthy of clinical promotion.

Ocorrência de fogo no Parque Nacional da Chapada dos Veadeiros, Goiás, Brasil: histórico recente no contexto da sua ampliação

&lt;p&gt;O presente estudo tem como objetivo aferir, para o período entre 2008 e 2019, o regime de queima no Parque Nacional da Chapada dos Veadeiros (PNCV), Unidade de Conservação (UC) localizada no estado de Goiás que teve sua área ampliada neste período. A partir de imagens dos satélites Landsat e CBERS, cicatrizes de incêndio foram identificadas, vetorizadas e analisadas quanto à localização, ao tamanho e à frequência. A área atual do PNCV queimou cerca de 542.113 hectares, i.e., mais de 225% da área da UC. Aproximadamente 76% das cicatrizes foram registradas na área ampliada do Parque, a qual teve a maior participação de incêndios em 10 dos 11 anos analisados. Foi possível discriminar dois regimes de queima: um que abrange o limite antigo do Parque, caracterizado por baixa ocorrência de queimada, com presença de feições que se assemelham a aceiros e baixa frequência de incêndios; e outro na área ampliada, com histórico de queima anual com valores mais próximos à média, ausência de cicatrizes lineares e frequência máxima de 10 ocorrências. A unificação destes panoramas em um só território exigirá esforços para homogenização dos regimes e poderá, associada a outras ações, diminuir a imprevisibilidade dos incêndios, e respectivos impactos, legitimando o papel que as UCs possuem para a conservação e a preservação da natureza.&lt;/p&gt;&lt;p&gt;Abstract&lt;/p&gt;&lt;p&gt;OCCURRENCE OF FIRE IN THE CHAPADA DOS VEADEIROS NATIONAL PARK, GOIÁS, BRAZIL: RECENT HISTORY IN THE CONTEXT OF ITS EXPANSION&lt;/p&gt;&lt;p&gt;The present study aims to assess, for the period between 2008 and 2019, the burning regime in the Chapada dos Veadeiros National Park (CVNP), Conservation Unit (CU) located in the state of Goiás that had its area expanded in this period. From images of Landsat and CBERS, fire scars were identified, vectorized, and analyzed for their location, size, and frequency. The current area of the CVNP burned about 542,113 hectares, i.e., more than 225% of the area of the CU. Approximately 76% of the scars were recorded in the expanded area of the Park, which had the highest participation of fires in 10 of the 11 years analyzed. It was possible to discriminate two burning regimes: one that covers the old limit of the Park, characterized by the low occurrence of fire, with the presence of features that resemble firebreaks and low frequency of fires; And another in the enlarged area, with a history of annual burning with values closer to the average, absence of linear scars and a maximum frequency of 10 occurrences. The unification of these panoramas in a single territory will require efforts to homogenize the regimes and may, associated with other actions, reduce the unpredictability of fires, and their impacts, legitimizing the role that CU have in the conservation and preservation of nature.&lt;/p&gt;

Epidermoid cyst removal with CO2 laser fenestration: A retrospective cohort study.

Epidermoid cyst (EC) is a common and benign tumor, which can occur anywhere on the skin. Surgical excision is usually considered as the first-line treatment. However, linear scars arising after excision for EC remain a cosmetic problem. To evaluate the efficacy and safety of EC removal assisted with CO2 laser fenestration. All patients diagnosed with EC and treated with CO2 laser fenestration, content extrusion, and removal of the cyst wall between January 1, 2016, and December 31, 2018, were included in this study. After a follow-up period ranging from 6 to 27months, scarring, recurrence, complications, and satisfaction were assessed and analyzed. Forty-three of the 47 patients have been cured by a single operation. The recurrence rate was 8.5%, which was not significantly correlated with tumor sizes or locations. 46.8% of the patients had no obvious scar after treatment. No infections or complications were observed in any of these cases. 89.4% of the patients were satisfied with the effectiveness of the treatment, while 95.7% and 87.2% were satisfied with the comfort and the cosmetic results, respectively. CO2 laser fenestration-assisted removal procedure is effective for the treatment of ECs with good aesthetic outcome.

FIRE EATER'S LUNG

SESSION TITLE: Medical Student/Resident Occupational and Environmental Lung Disease SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: A 24 year-old male without medical history presented with acute onset dyspnea, pleuritic chest pain and epigastric discomfort. He reported one episode of bloody emesis, bilateral pulsating frontal headache, and subjective fevers with chills. He had immigrated from Guatemala 8 months prior to current presentation. Occupational history revealed exposure to hydrocarbons – his job required him to siphon gasoline while trying to dilute paints. CASE PRESENTATION: Physical Exam:He was afebrile, tachycardic and normotensive, pulse oximetry of 92 – 99% on room air. He was in moderate respiratory distress. Auscultation revealed diffuse crackles throughout lung fields. Diagnostic Exam:Imaging revealed bilateral lower lobe patchy airspace opacities on chest x-ray and patchy alveolar consolidation in the lower lobes, right middle lobe and lingula on chest CT. Initial bronchoalveolar lavage of right middle lobe showed abundant macrophages and inflammatory cells with cultures negative. Autoimmune workup, respiratory viral panel, and pneumonia workup were all negative. Clinical course:Chest CT during the hospitalization demonstrated worsening lower lobes opacities with cavitation. The patient improved with supportive care and was discharged home after 23 days. Follow up chest CT 6 months later showed complete resolution of lung opacities with minimal linear scarring in lower lobes. Diagnosis:Fire eater’s lung (hydrocarbons aspiration) DISCUSSION: Fire eater’s lung, also known as hydrocarbon pneumonitis, is a rare disease that develops after aspiration of low viscosity, volatile hydrocarbons such as petroleum derivatives1. The low viscosity of hydrocarbons allows for rapid diffusion throughout the bronchial mucosa leading to an acute presentation of symptoms as seen in this patient1. Fire eater’s lung is characterized by acute onset of choking, coughing, respiratory distress, pleuritic chest pain, fever, and gastrointestinal symptoms1. Radiographic findings generally demonstrate patchy alveolar opacities localized in lower lungs that initially predominate on the right side that become confluent and dense within 24 hours2. The pathologic findings generally demonstrate necrotizing acute bronchiolitis and necrotizing acute fibrinous pneumonia3. The clinical picture of hydrocarbon pneumonitis mirrors that of bacterial pneumonia, but the results of the infectious workup are usually negative. Our patient’s exposure with siphoning gasoline raised the suspicion of fire eater’s lung. The course of fire eater’s lung usually resolves within a few weeks to 3 months1. The mainstay treatment is supportive, although glucocorticoids and antibiotics have been used in some cases. CONCLUSIONS: Hydrocarbon aspiration can cause acute respiratory failure and lung opacities. The majority of the cases resolve with supportive care. Clinicians should provide education about the risk of siphoning gasoline to prevent this complication. Reference #1: Franzen, Daniel et al. “Fire Eater’s Lung: Retrospective Analysis of 123 Cases Reported to a National Poison Center.” Respiration. 87.2 (2014): 98–104. Web. Reference #2: Gentina, T et al. “Fire-Eater’s Lung: Seventeen Cases and a Review of the Literature.” Medicine 80.5 (2001): 291–297. Web. Reference #3: Tas, Sule, Yasemin Durum, and Can Karaman. “Fire-Eater’s Pneumonia.” Diagnostic and Interventional Radiology 21.3 (2015): 267–268. Web. DISCLOSURES: No relevant relationships by Sujith Cherian, source=Web Response No relevant relationships by Rosa Estrada-Y-Martin, source=Web Response No relevant relationships by Brandilyn Monene, source=Web Response

Clinical study on a skin stretching technique with adjustable external fixators to treat skin defects.

The aim of this study was to determine the effectiveness of a skin stretching technique with adjustable external fixators in treating skin defects.Eighteen patients treated with a skin-stretching technique with adjustable external fixators for skin defects from April 2017 to October 2019 were included. Visual Analogue Scale (VAS) scores were collected during therapy. The skin defects gradually became smaller until they were completely resolved according to the blood flow of the affected limb and wound skin (the color, temperature, elasticity, and capillary response). The defect sizes ranged from 4 cm × 2 cm to 20 cm × 6 cm.The 18 adjustable external fixators were dismantled in 2 to 9 days (mean, 4.05 days) after the operation, and the defects were completely closed and the sutures were removed after 2 to 3 weeks. The average VAS score was 5.97. The follow-up period was 4 to 12 months (mean, 6.3 months); 17 patients healed well with linear small scar, and no infections or patients of necrosis were observed. Sensory recovery was assessed using the Medical Research Council scale, and all the sensation scores were S3+. Eight patients were healed after the first stage. Nine patients were closed totally while small sinus or skin defect were observed after sutures were removed; 3 patients were healed after the second debridement, and 6 patients finally healed after the dressings were changed. Patellar osteomyelitis recurred in 1 patient who was transferred to the Orthopedic Department for further treatment, and a flap graft procedure was performed.The operation was simple and obviously reduced the course of the disease, the costs, and the damage to the donor site, and it is also significantly superior to skin graft or flap transplantation procedures in terms of the resulting skin sensation, color, texture, elasticity, and appearance.

Clinical effects of individualized free anterolateral thigh flap in repairing complex refractory wound

Objective: To explore the clinical effects of individualized free anterolateral thigh flap in repairing complex refractory wound. Methods: From July 2015 to May 2019, 19 patients with complex refractory wounds were hospitalized in Yulin NO.1 People's Hospital of Guangxi Zhuang Autonomous Region, including 12 males and 7 female, aged 13-67 years. There were 5 patients with multiple tissue defects, 7 patients with large area of wounds, and 7 patients with wounds in special areas. The sizes of wounds after complete debridement were 8 cm×5 cm-23 cm×7 cm. According to the repair demand, the wounds in 5 patients were repaired with anterolateral thigh flaps and flow-through, the wounds in 7 patients were repaired with anterolateral thigh flaps chimed with lateral thigh muscle flaps, with vascular anastomosis in 2 patients, the wounds in 6 patients were repaired with unilateral anterolateral thigh lobulated flaps, and the wound in 1 patient was repaired with bilateral anterolateral thigh flap in series connection. The sizes of flaps were 10 cm×7 cm-25 cm×9 cm. The donor sites were sutured directly or repaired with thin split-thickness skin graft of head. The survival of the flaps, the appearance of the donor sites, and wounds repair after the operation and during follow-up were observed. Results: The lobulated flap in 1 patient had local necrosis after the operation and finally healed by debridement, dressing change, and transplanting medium split-thickness skin graft in groin. The flaps in 18 patients survived with good blood supply, and the lobulated flap tissue was swollen in 1 of 18 patients. The donor sites which were directly sutured in 18 patients only had linear scar, and the donor site which was repaired with thin split-thickness skin graft of head in 1 patient had flaky scar. Follow-up of 1-12 months showed that all the wounds healed well, the flap thinning operations were performed in 5 patients in 3 months post operation because the flaps were slightly bloated. The CT angiography after the operation showed that the anastomosed blood vessels were unobstructed in 7 patients with reconstructed local blood supply. Conclusions: The special forms of anterolateral thigh flap, such as lobulation, series connection, and chimerism can be designed according to the anatomical characteristics of the descending branch of the lateral femoral artery to meet individualized repair demand for complex refractory wounds, and achieve the double purposes of making full use of the donor site tissue and good repair of the recipient site.

Effects of ilioinguinal composite tissue flaps in repairing skin and soft tissue defects on hand or foot

Objective: To explore the effects of ilioinguinal composite tissue flaps in repairing skin and soft tissue defects on hand or foot and reconstructing the flexion and extension functions of wrist, finger, ankle, and toe. Methods: From February 2012 to March 2018, 4, 5, and 3 patients (11 males and 1 female, 23-62 years old) with skin and soft tissue defects on hand or foot were admitted to Traditional Chinese Medicine Hospital of Zhongmu County of Henan Province, Henan Armed Police Corps Hospital, and the Affiliated Jiangyin Hospital of Medical College of Southeast University, respectively. Five patients had hand defects, and 7 patients had foot defects. The areas of skin and soft tissue defects after debridement were 10 cm×8 cm-15 cm×10 cm. The ilioinguinal composite tissue flaps were designed and resected according to the wound area and the length of tendon defects, and the areas of flaps were 10 cm×8 cm-15 cm×12 cm. According to the specific condition of the recipient area, the superficial iliac circumflex artery in the tissue flap was reconstructed by end-to-side anastomosis in 2 patients and end-to-end anastomosis in 1 patient with ulnar artery, end-to-side anastomosis in 4 patients with the dorsal foot artery, end-to-side anastomosis in 2 patients with the posterior tibial artery, and end-to-end anastomosis in 1 patient with the external tarsal foot artery in the recipient area, and the superficial epigastric artery in the tissue flap was reconstructed by end-to-side anastomosis in 1 patient with the radial artery and end-to-end anastomosis in 1 patient with the ulnar artery in the recipient area. The donor sites were sutured directly or repaired with medium split-thickness skin grafts. The survival of tissue flap after the operation and the appearance, texture, and the two-point discrimination distance of the tissue flaps during follow-up were observed. The hand function and foot function were evaluated by the total active movement standard of hand and the Maryland foot score standard, respectively. Results: All the tissue flaps in 12 patients survived. During follow-up of 6-36 months after operation, the tissue flaps were slightly bloated, with linear scars at the junction site in the recipient area, and the two-point discrimination distances of the tissue flaps were 15-22 mm. The hand function was excellent in 3 cases, good in 1 case, and fair in 1 case, and the foot function was excellent in 4 cases, good in 2 cases, and fair in 1 case, and all the patients were satisfied with the function and appearance of hand or foot. Conclusions: The ilioinguinal composite tissue flaps can repair the hand and foot wounds and reconstruct the flexion and extension functions of wrist, finger, ankle, and toe at the same time, which is an effective method to repair this kind of defects.