Mean Vancouver Scar Scale Research Articles

Open surgical approach to fractures of the mandibular condyle: surgical technique and associated complications.

This study evaluates anatomical reduction and rigid internal fixation of mandibular condyle fractures using the preauricular retroparotid approach. It also discusses advantages, deficiencies, and associated complications of the technique. This retrospective study reviewed the medical records of a total of 52 mandibular condyle fractures from 42 patients who were treated with open surgery using the preauricular retroparotid approach between January 2019 and January 2024. Preoperative and postoperative assessments included measurements of mouth opening (maximum interincisal distance), vertical mandibular movement, and facial paralysis. Moreover, the Vancouver Scar Scale (VSS) was used to evaluate scar quality at the surgical site. Descriptive statistics were used to summarize patient demographics, preoperative findings, and postoperative outcomes. Anterior open bite was the most common finding, detected in 83% of the patients before surgery. The mean mouth opening of the patients increased significantly from 29 ± 4.94 mm to 37.76 ± 2.12 mm. Vertical mandibular movement exceeding 4 cm was a finding in more than half (52.3%) of the patients. The mean VSS score, indicating scar quality, was 1.64 ± 0.70, suggesting overall good cosmetic outcomes. Plate breakage in two patients was noted as a complication during follow-up. Several surgical techniques have been described for mandibular condyle fractures, each with its own benefits and limitations.

Timing of Laser Intervention on Facial Scars: A 3D Imaging and Scar Scale Analysis in a Retrospective Study.

Scars resulting from injuries or surgical procedures often present both physical and aesthetic challenges. Recent studies have indicated promising results in improving postoperative scar outcomes through the combined use of specific laser technologies. Nevertheless, there remains a crucial need for further exploration to ascertain the optimal timing for initiating such treatments. In this retrospective investigation, a cohort of 47 adult patients who did not require hospitalization was analyzed. These patients were divided into two distinct groups: Group A, which received intervention beginning 2 weeks after their respective operations, and Group B, which commenced intervention 4 weeks postoperation. Each group underwent a comprehensive treatment protocol consisting of five laser sessions. Initially, patients underwent three sessions of V-beam pulsed-dye laser (PDL) therapy followed by two sessions of ablative fractional CO2 laser (AFL) therapy. Evaluation of outcomes was conducted using advanced imaging techniques such as Antera 3D imaging, in conjunction with established scar assessment tools including the Vancouver Scar Scale (VSS) and the University of North Carolina "4P" Scar Scale (UNC4P). All patients successfully completed the full course of five treatment sessions, with no dropouts and no reported adverse events. Baseline cosmetic assessments of scars were equivalent across both groups. In Group A, the mean VSS scores decreased from 7.04 before treatment to 5.29 at 3 months posttreatment and further to 4.33 at 6 months posttreatment. Meanwhile, in Group B, scores decreased from 7.52 to 6.83 at 3 months and 6.17 at 6 months. There were no statistically significant differences in baseline VSS scores between the two groups (p = 0.34). At both the 3- and 6-month follow-up points, mean VSS scores were significantly lower in Group A compared to Group B (p < 0.05). Similar trends were observed in UNC4P scores. Statistically significant differences were noted across all time points (baseline, 3 months, and 6 months posttreatment) for both VSS and UNC4P scores (p < 0.05). Subset analysis revealed greater improvements in texture and depression volume at 3 months posttreatment, while improvements in depression area, depth, elevation variation, and area were more pronounced at the 6-month mark. Early intervention using the combined 595-nm pulse dye laser and CO2 ablative fractional laser (AFL) 2- and 4-weeks post-surgery proves to be an effective and safe method for improving scar outcomes, particularly for facial surgical scars when treatment starts 2 weeks after surgery. However, further research is needed to refine our understanding and address potential study limitations.

A double-blinded randomised control study to compare the effectiveness and safety of intralesional vitamin D3 with intralesional triamcinolone and its correlation with tissue expression of vitamin D receptors in patients with keloid.

Intralesional steroids commonly used for keloid treatment have adverse effects like cutaneous atrophy and telangiectasias. Safer and more effective therapies are needed. Preliminary studies suggest intralesional vitamin D as a potential alternative treatment. The aim of this study was to compare efficacy and safety of intralesional vitamin D with triamcinolone for keloids, and correlate tissue expression of vitamin D receptors (VDRs) with treatment outcomes. Sixty patients were randomly assigned to two groups: Group A (intralesional vitamin D) and Group B (intralesional triamcinolone). Four injections were given at 4-week intervals, with an 8-week follow-up. Biopsies were taken pre- and post-treatment to examine VDR expression levels and treatment response correlation. The primary outcome of interest was the proportion of patients achieving a 50% reduction in Vancouver Scar Scale (VSS). Secondary outcomes included incidence of adverse effects, and changes in VDR expression before and after treatment. Baseline VSS scores were 9.73 ± 1.01 (vitamin D group) and 10.13 ± 1.07 (triamcinolone group). After treatment, mean VSS decreased to 5.17 ± 0.59 (vitamin D group, p < 0.001) and 4.77 ± 0.77 (triamcinolone group, p < 0.001), with significantly better response in latter (p = 0.03). More than 50% reduction in VSS score was higher in the triamcinolone group (76.7% vs. 50%, p = 0.032). No recurrences were noted during the 8-week follow-up. Hypopigmentation (80% vs. 36.7%, p < 0.001) and atrophy (73.3% vs. 40%, p = 0.009) were more common in the triamcinolone group. No significant difference in pre- and post-treatment VDR receptor expression was observed in either group. Both triamcinolone acetonide and vitamin D were effective for keloids. Triamcinolone was more efficacious, whereas vitamin D was safer, suggesting it as a viable alternative for keloid management.

Effects of Kinesio tape on vascularity, pliability and height of the hypertrophic scar in burns patients: a randomized pilot clinical trial.

Deep burns damage the reticular dermis and may lead to the formation of hypertrophic scars. Compression therapy reduces local vascularity and realigns collagen fibers, resulting in esthetic and functional improvements. This study evaluated the effect of Kinesio tape compression with maximum mechanical tension on vascularity, pliability and the height of hypertrophic scars following deep burns. A single blind, randomized pilot clinical trial was carried out. The elastic compression of Kinesio tape was applied at maximum stretch in the intervention group (n=11) and no stretch in the sham group (n=11). Vascularity, pliability and height (the primary outcomes) were evaluated at 0, 45 and 90 days using the Vancouver Scar Scale (VSS). The association between the VSS scores, the intervention and the evaluation moment were analyzed using linear mixed-effects regression models, while comparisons of means between the groups were performed using the t Student test was. Significance was set at 5%. The mean VSS scores were similar between the groups. Significant improvement occurred in both groups when post-treatment and baseline scores were compared. No further improvement was found in the vascularity, pliability or height of hypertrophic scars resulting from deep burns when an elastic compression of Kinesio tape was used at maximum tension compared to lesser mechanical tension.

Long-Term Functional Outcomes Following Enzymatic Debridement of Deep Hand Burns Using Nexobrid®: A Retrospective Analysis.

Background: For years, surgical debridement with autografting has been considered the standard of care in the treatment of severe burns of the hand. However, in recent years, enzymatic debridement has increasingly been reported as a good alternative, especially for burns of the hand, as it selectively preserves viable tissue. In this study, we aim to evaluate the long-term function of the hand after enzymatic debridement in deep dermal burns. Methods: A retrospective chart review was conducted as well as measurements of subjective and objective outcome measures through physical examination and Disabilities of the Arm, Shoulder, and Hand (DASH), Patient and Observer Scar Assessment Scale (POSAS), and Vancouver Scar Scale (VSS) scores. Results: A total of 32 enzymatically debrided hands of 24 patients were included with a mean age of 42.4 ± 16.8 years and a mean follow-up of 31 months. Postoperatively, 19 of these could be managed conservatively using skin substitutes such as "Suprathel", 13 had to undergo subsequent autografting. The mean DASH score for the entire study population was eight with a mean value of four in the conservatively managed group and fourteen in the autografted group. The mean Patient, Observer POSAS, and VSS values were nineteen, thirteen, and two. A total of 30 cases showed an effortless complete fist closure, and, also in 30 cases, patients attested to be satisfied with the esthetic appearance of the hand on being asked. Conclusions: The descriptive analysis of these results in our study population suggests that the enzymatic debridement of deep burns of the hand, especially combined with subsequent conservative management with skin substitutes, was associated with low long-term hand disability scores at a follow-up of two years.

Evaluation of Negative Pressure Dressings for Closed Surgical Incisions in Decreasing Surgical Site Infections After Emergency Laparotomy: A Randomized Controlled Study.

Objectives The aim of this study is to compare the effectiveness of negative pressure dressings (NPDs) versus conventional dressings for closed surgical incisions after emergency midline laparotomy, focusing on their impact on surgical site infection (SSI) rates, wound dehiscence, hospital stay duration, and cosmetic outcomes. Methods The randomized controlled study was conducted over 24 months, involving 80 patients aged 18-65 years who had peritonitis and underwent emergency midline laparotomies. Patients with diabetes mellitus, a BMI >35 kg/m², immunocompromised conditions, or those requiring re-exploration within 30 days of surgery were excluded. The participants were randomly assigned into two groups using a computer-generated randomization table: Group A, the case group, consisted of 40 patients who received NPDs, while Group B, the control group, included 40 patients who received conventional dressings. Data were recorded in Microsoft Excel (Microsoft Corporation, Redmond, WA, USA) and analyzed using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, NY, USA), with a p-value of <0.05 considered statistically significant. Results The overall occurrence of SSIs within the 30-day follow-up period was significantly lower in the NPD group compared to the conventional dressing group (30% vs. 70%, p < 0.05). The mean duration of hospital stay was 14.85 ± 10.43 days for the NPD group and 15.4 ± 9.75 days for the control group, with no statistically significant difference (p = 0.712). The mean Vancouver Scar Scale score was 5.3 ± 2.47 in the NPD group and 6.5 ± 2.14 in the control group, also showing no statistically significant difference (p = 0.11). Conclusions NPDs significantly reduced the incidence of SSIs compared to conventional dressings, but they did not have a significant impact on scar cosmesis or the duration of hospital stay.

The W-Plasty Serial Excision Method for Treating Medium Congenital Melanocytic Nevi: A Retrospective Analytical Study.

Serial excision remains the most commonly used surgical procedure for treating congenital melanocytic nevus (CMN). It is critical to remove as much of the lesion as possible with each procedure to reduce the number of procedures and to shorten the treatment duration. To investigate the clinical efficacy of W-plasty serial excision for the repair of postoperative CMN defects. A retrospective analysis of patients with medium CMN was conducted from April 2018 to March 2022. Treatment options were divided into elliptical serial excision (10 cases) and W-plasty serial excision (10 cases). Follow-up occurred over 6 months. The number of elliptical excision procedures was 2 to 4 (mean 2.9). The scar-to-lesion length ratio was 1.5 to 2.0 (mean 1.7). The mean Vancouver Scar Scale (VSS) score was 5.40 ± 0.42. The number of W-plasty excision procedures was 2 to 3 (mean 2.2). The scar-to-lesion length ratio was 1.2 to 1.5 (mean 1.4). The mean VSS score was 2.70 ± 0.26. W-plasty excision was superior to elliptical excision regarding the number of procedures and the effect on postoperative scars. W-plasty serial excision can be considered a suitable option for the excision of medium CMN, leading to excellent results.

The Effects of Aloe Vera Cream on the Alar Scar in Rhinoplasty, A Randomized Double-Blind Controlled Trial.

Many studies have been done on the use of aloe vera in wound healing, but fewer studies were done on the influence of this material on the reduction of the alar scar. Therefore, we evaluated the effect of a newly made aloe vera cream on alar wound healing after rhinoplasty. This was a randomized, double-arm, parallel-group, double-blind controlled trial and was done from June 2021 to February 2022. External wedge resection was done for all patients. The patients were randomly assigned to receive aloe vera cream (n=31) (intervention group) or Face Doux cream (comparison group) (n = 29). A pharmacist prepared the aloe vera cream. The primary outcome measure was the wound scar status which was assessed by two Questionnaires, including the mean Patient Scar Assessment Questionnaire (PSAQ) and Vancouver Scar Scale (VSS). Randomization and Blinding were done. The mean PSAQ was significantly lower in group A after two weeks (26.9 versus 31.5, P<0.001), after two months (15.7 versus 19.6, P=0.04), and six months follow-up (8.8 versus 11.8, P=0.005). The mean VSS was significantly lower in group A after two weeks (5.6 versus 7.1, P=0.001), after two months (3.5 versus 4.9, P=0.002), and six months (1.2 versus 2.7, P<0.001). Repeated measurement analysis showed that both interventions significantly affected PSAQ and VSS. Although both interventions had a significant effect on PSAQ and VSS, compared to Face Duox, the topical use of Aloe Vera cream significantly reduced scar formation after alar resection, both statistically and clinically.

Usage of Dermal Regeneration Templates (Pelnac) for Coverage of Exposed Hand Tendons in Acute Setting.

The loss of soft tissue coverage of tendons is a challenging reconstructive problem after acute hand trauma. Subsequent tendon adhesions and the loss of range of movement in addition to the poor aesthetic outcome and donor site scarring should be avoided when deciding the plan of management. Pelnac is one of the commonly used skin substitutes in reconstructive surgery that can be used for coverage of exposed tendons, but the postoperative functional outcome needs to be addressed in detail. Twenty-six patients with acute isolated tendon injuries distal to the wrist joint were included. Two-stage reconstructive procedures were performed; the first one was the application of Pelnac. The second stage was carried out after the complete integration of Pelnac via the application of a split-thickness graft. The function outcome assesses the return of the normal range of motion to the affected hand and the QuickDASH score questionnaire. The aesthetic outcome was assessed using the Vancouver scar scale. The Pelnac was integrated in 100% of cases, with complete grafts taken in 22 of 26 patients. The mean QuickDASH score was 20.5 ± 15.7, and mean Vancouver scar scale was 3.53 ± 3.2. The full range of motion returned in 22 of 26 patients. Using Pelnac to cover the exposed hand tendons in an acute setting is a convenient and efficient procedure with minimal morbidity. It can offer a good option for their coverage with preservation of hand function and acceptable aesthetic outcome.

Clinical Efficacy, Safety, and Complications of the Arthroscopic Cartilage Shaving Procedure for Secondary Osmidrosis Treatment

Background Axillary osmidrosis is a common disease with negative psychosocial impact on patients. Further, many treatment modalities are not sufficient and result in recurrence. Objective We aimed to evaluate the effectiveness and safety of using a cartilage shaver in patients with recurrent osmidrosis to remove tightly attached apocrine glands and subdermal scars. Methods We retrospectively evaluated 24 patients with secondary axillary osmidrosis who underwent cartilage shaving surgery between January 2013 and May 2022. We analyzed the incidence of complications, including seroma, infection, pigmentation, wound dehiscence, skin necrosis, scarring, shoulder movement limitation, comedones/sebaceous cysts, and nerve injury. Clinical effectiveness was also evaluated. Results Excellent or good efficacy with improved malodor was achieved in 24 patients (47 axillae [100%]). Complications were observed in 16 (36.17%) axillae, including hematomas (n = 2), pigmentation (n = 7), skin necrosis (n = 3), and comedones/sebaceous cysts (n = 4); one patient (2.13%) required local debridement. Mean Vancouver Scar Scale scores were markedly low (5.41 to 4.67). Scar tissue did not interfere with the shaving surgery, allowing for successful removal of the apocrine glands. Conclusions Secondary osmidrosis treatment using a cartilage shaver system yielded satisfactory and better scar results than the patients' previous treatments.

On-top plasty combined with modified Bilhaut-Cloquet procedure for reconstructing complicated radial polydactyly

To present a surgical technique of combining the on-top plasty with modified Bilhaut-Cloquet procedure for reconstructing a rare type of complicated radial polydactyly and evaluate the outcomes. Fourteen complicated radial polydactyly in 13 patients were corrected by combining the on-top plasty with modified Bilhaut-Cloquet procedure. Osteotomies were performed as required, and the acral part of the ulnar thumb was transposed onto the proximal part of the radial thumb. The distal parts of the two thumbs were isolated as neurovascular pedicled composite tissue flaps, including part of the distal phalanx and nail bed, and were attached together in an extra-articular way. The tendons were rebalanced, and the nail bed was reconstructed. Objective and subjective outcomes were assessed. The average follow-up time was 32.4 months (6-60 months). All reconstructed thumbs were rated as good in appearance and function. The mean Vancouver Scar Scale score was 1.3 (range 1-2) and the mean Wang-Gao score of the reconstructed thumbnail was 9.4 (range 8-11). The Tada score for the function of the reconstructed thumb was 5.5 (range 5-6). The main active range of motion (ROM) of the interphalangeal joint (IPJ) was 2.1-38.9°. All parents were satisfied with the outcomes. Because of the diverse manifestations of thumb polydactyly, individualized surgical treatment is recommended, and careful preoperative planning should be made with the principle of combining the best parts of the two thumbs. By combining an on-top plasty with modified Bilhaut-Cloquet procedure, a satisfactory result can be achieved for treating complicated radial polydactyly.

Efficacy of autologous adipose-derived stem cells and fractional carbon dioxide laser in the treatment of atrophic linear scars

Background Atrophic linear scars are scars that exhibit indentation or depression in the skin below the level of the surrounding tissues. Hyperpigmentation or hypopigmentation may be present. They are often caused by surgery, burns, and trauma. Objective To evaluate the efficacy of autologous adipose-derived stem cells (ADSCs) combined with fractional carbon dioxide (CO2) laser in the treatment of atrophic linear scars. Patients and methods This randomized, controlled preliminary study included 20 patients aged 20–45 years of both sexes with facial atrophic linear scars. The patients were randomized systematically into two groups: group A (combined ADSCs and fractional CO2 laser procedure) and group B (fractional CO2 laser only) of 10 patients each. The scar was evaluated using the Vancouver scar scale, along with a subjective satisfaction questionnaire, and ultrasound skin analysis at baseline and 1 month after the third treatment session. Results All participants completed the study. The mean Vancouver scar scale score improved significantly from 3.60±0.69 to 1.20±0.79 and from 2.20±1.03 to 1.60±0.52 with fractional CO2 laser plus ADSCs and CO2 laser procedure, respectively (P&lt;0.001). However, CO2 laser plus ADSCs was significantly superior. Ultrasound skin examination showed a statistically significant increase in dermal collagen density (thickness) in both groups. Conclusion Our study shows that treatment with CO2 laser exposure plus ADSCs is safe and more effective for atrophic linear scar management than CO2 laser exposure alone.

Versatility of the perforator radial artery flap in the reconstruction of the upper limbs and comparison of the outcomes with the “classic” radial flap, a retrospective study

IntroductionRadial forearm flap, first described in the early eighties in China, is a well-known and handy flap to cover soft tissue defects of the distal upper limb. It has, though, some inconveniences, such as the sacrifice of the radial artery and non-neglectable esthetic sequelae in the donor site. In the following years, a similar flap based on the perforators of the radial artery has been described as achieving similar results, allowing to spare a main vessel. The authors reviewed retrospectively the patients that underwent surgery with one of those two flaps in their center to compare outcomes. Materials and methodsPatients operated between January 2016 and January 2022 have been reviewed. Ten had a classic radial artery flap, and ten had a radial artery perforator flap. Twelve weeks after surgery, Vancouver Scar Scale was used to assess the results at the donor site and over the flap. Reintervention and failure rate within one year and patient satisfaction -using a visual analog scale ranging from 0 to ten-at 12 months were also assessed. ResultsAll classic radial artery flap group patients had “successful” surgery, and none needed secondary surgery. On the other side, three patients required a second surgery in the perforator flap group, and nine out of ten ended up with “successful” flaps. Mean Vancouver Scar Scale results regarding the flap are comparable, whereas those at the donor site are significantly better in the patients with the perforator flap. Patients’ satisfaction results are similar in both groups. ConclusionThe radial artery perforator flap is an important flap to be held in mind by all surgeons approaching reconstruction of the elbow, the forearm, and the hand, and should be preferred, when possible, to the classic radial forearm flap.

DS11 A double-blinded randomized control study to compare the effectiveness and safety of intralesional vitamin D3 with intralesional triamcinolone and its correlation with tissue expression of vitamin D receptors in patients with keloid

Abstract Intralesional steroids are the first line of treatment for keloids, and intralesional vitamin D has shown promise in the management of keloids in a few small studies. The aim was to compare the efficacy and safety of intralesional vitamin D with intralesional triamcinolone and its correlation with tissue expression of vitamin D receptors (VDRs) in the treatment of keloids. Sixty patients were randomly divided into two groups in 1 : 1 ratio. Patients in group A received intralesional vitamin D (200 000 IU, dose 0.2 mL cm−2); those in group B received intralesional triamcinolone acetonide (20 mg mL−1, dose 0.1 mL cm−2). Four monthly injections were given, and the patients were followed-up for a further 24 weeks. The Vancouver Scar Scale (VSS) was used for keloid evaluation. Pre- and post-treatment biopsies of 20 patients from both groups were taken to assess the correlation between the expression of VDR receptor levels before and after treatment. The mean VSS scores of patients in both groups were statistically significantly reduced over the course of the follow-up (P &amp;lt; 0.001). Mean (SD) reduction in VSS at the end of treatment period was 5.17 (0.59) in patients in group A and 4.77 (0.77) in those in group B. The proportion of the patients showing &amp;gt; 50% reduction in VSS score was higher in patients in group B vs. those in group A (77% vs. 50%; P = 0.032). Rates of recurrence were comparable between the two groups (P = 0.51). Hypopigmentation (80% vs. 37%; P &amp;lt; 0.001) and atrophy (73% vs. 40%; P = 0.009) were more common in patients in group B than in those in group A. There was no significant difference in pre- and post-treatment values of tissue VDR expression in either group. Both triamcinolone and vitamin D are effective in the management of keloids. Although the reduction in VSS score was higher with corticosteroids than vitamin D, an intralesional injection of vitamin D had lower incidence of adverse effects such as atrophy and hypopigmentation.

P60 Intralesional steroids vs. liquid nitrogen cryotherapy vs. 595 nm pulsed dye laser in the management of chest keloids: a comparative study

Abstract Chest keloids often result in cosmetic disfigurement, contractures, pruritus and pain. Inflammatory truncal acne often triggers chest keloid. Management is often challenging as they are relatively resistant to treatment and recurrence rates are high. The objective of the study was to compare the clinical efficacy and safety of intralesional triamcinolone acetonide (40 mg mL−1) vs. liquid nitrogen cryotherapy vs. 595 nm pulsed dye laser in the management of chest keloids. We conducted a comparative prospective study in a total of 42 patients with chest keloids from July 2021 to July 2022. These patients were randomly divided into three treatment groups via the envelope method. The Vancouver Scar Scale (VSS) was used to assess the clinical efficacy of the treatment modality. Patients were scored at the initiation of therapy and every 4 weeks until 16 weeks. Seven patients were lost to follow-up (response rate 83%). Treatment arms consisted of intralesional triamcinolone acetonide (n = 10), liquid nitrogen cryotherapy (n = 11) and pulsed dye laser (n = 14). There was a near-equal sex distribution of chest keloids (male-to-female ratio 1.21 : 1), with 15 patients (35.7%) having additional keloids in other body parts. The mean (SD) age of patients with chest keloids was 27.2 (13.6) years with a common incidence in those aged 20–30 years. Comparison of mean VSS as baseline and at 16 weeks revealed a statistically significant decrease in the score in all three treatment arms (P &amp;lt; 0.05). Comparison between the three different treatment arms revealed pulsed dye laser to be the most effective modality in decreasing VSS at the 16-week follow-up (Anova followed by post hoc analysis with Tukey’s test). With regard to the adverse clinical event profile, acneiform eruptions were reported following steroid injections, blistering and depigmentation were reported following liquid nitrogen cryotherapy, and blistering was reported following pulsed dye laser therapy. Thus, the pulsed dye laser (595 nm) appears to be a safe and efficacious treatment modality in the management of chest keloids.

Autologous Skin Grafts, versus Tissue-engineered Skin Constructs: A Systematic Review and Meta-analysis.

A systematic review was conducted using PRISMA guidelines, querying MEDLINE, Embase, Web of Science, and Cochrane to assess graft incorporation, failure, and wound healing. Case reports/series, reviews, in vitro/in vivo work, non-English articles or articles without full text were excluded. Sixty-six articles encompassing 4076 patients were included. No significant differences were found between graft failure rates (P = 0.07) and mean difference of percent reepithelialization (p = 0.92) when split-thickness skin grafts were applied alone versus co-grafted with acellular TCs. Similar mean Vancouver Scar Scale was found for these two groups (p = 0.09). Twenty-one studies used at least one cellular TC. Weighted averages from pooled results did not reveal statistically significant differences in mean reepithelialization or failure rates for epidermal cellular TCs compared with split-thickness skin grafts (p = 0.55). This systematic review is the first to illustrate comparable functional and wound healing outcomes between split-thickness skin grafts alone and those co-grafted with acellular TCs. The use of cellular TCs seems promising from preliminary findings. However, these results are limited in clinical applicability due to the heterogeneity of study data, and further level 1 evidence is required to determine the safety and efficacy of these constructs.

Correlation between Collagen Type I/III Ratio and Scar Formation in Patients Undergoing Immediate Reconstruction with the Round Block Technique after Breast-Conserving Surgery.

The aim of this study was to investigate the relationship between the collagen type I/III ratio and scarring in patients who underwent immediate reconstruction with the round block technique (RBT) after breast conservation surgery. Seventy-eight patients were included, and demographic and clinical characteristics were recorded. The collagen type I/III ratio was measured using immunofluorescence staining and digital imaging, and scarring was assessed using the Vancouver Scar Scale (VSS). The mean VSS scores were 1.92 ± 2.01 and 1.79 ± 1.89, as assessed by two independent plastic surgeons, with good reliability of the scores. A significant positive correlation was found between VSS and the collagen type I/III ratio (r = 0.552, p < 0.01), and a significant negative correlation was found between VSS and the collagen type III content (r = -0.326, p < 0.05). Multiple linear regression analysis showed that the collagen type I/III ratio had a significant positive effect on VSS (β = 0.415, p = 0.028), whereas the collagen type I and collagen type III content had no significant effect on VSS. These findings suggest that the collagen type I/III ratio is associated with scar development in patients undergoing RBT after breast conservation surgery. Further research is needed to develop a patient-specific scar prediction model based on genetic factors affecting the collagen type I/III ratio.

Reconstruction of the severe Achilles tendon and soft-tissue loss with the bi-pedicled conjoined flap and vascularized fasciae latae: A consecutive case series of 15 patients

BackgroundHistorically, the segmental loss of the Achilles tendon with overlying soft-tissue defects had been frequently reconstructed with the composite anterolateral thigh (ALTP) flap, including the iliotibial tract or fasciae latae. This study aimed to present our modified combination using the bi-pedicled conjoined flap with vascularized fasciae latae, for the approximately total reconstruction of the Achilles tendon and extensive soft tissue. MethodsFrom May 2015 to March 2018, 15 patients (9 male and 6 female) with a mean age of 36 years (ranged, 18–52 years) underwent microvascular Achilles tendon reconstruction. Harvested on the abdomen and groin, the conjoined flap was chimeric with the vascularized fasciae latae. Primary donor-site closure was accomplished in all patients. A standard assessment of the functional and esthetical outcomes was completed. ResultsMean follow-up time was 42 months (ranged, 32–48 months). The average dimension of the conjoined flap was 25 × 14 cm (ranged, 18 × 10–35 × 18 cm), and the average size of the folded fasciae latae was 15 × 6 cm (ranged, 12 × 5–25 × 8 cm). At the last follow-up, the Thompson test was negative in all patients. The mean American Orthopedic Foot and Ankle Society (AOFAS) score was 91.0. The mean Achilles tendon total rupture score (ATRS) was 18.5. The mean Vancouver Scar Scale (VSS) score was 3.0. ConclusionsThe composite bi-pedicled flap including vascularized fasciae latae provides an alternative approach with great functional and esthetic outcomes, in selected patients who suffered severe Achilles tendon and skin defects. The one-stage procedure facilitates better rehabilitation postoperatively.

Reconstruction of Macrocheilia on the Lower Lip Through Bilateral Limited Excision and a Stepwise Single-Stage Approach (BLESS).

The surgical management of macrocheilia secondary to port-wine stains is complicated. This study aimed to propose an innovative method for treating macrocheilia on the lower lip. Patients who underwent the reconstruction of macrocheilia on the lower lip through the innovative approach were examined. Their preoperative and postoperative standard photographs were taken to evaluate the changes in lip length and thickness. The scores on Vancouver scar scale (VSS) and visual analog scale (VAS) were evaluated. Thirty-two patients who underwent the reconstruction of macrocheilia were examined. A follow-up of 12.2 months (6-36 months) was conducted. The lower lip contour and the mentolabial groove were reconstructed to normal appearance. The lip length was shortened from 5.38 ± 0.49 cm pretreatment to 4.59 ± 0.30 cm posttreatment (p = .016). The exposed vermilion was shortened from 2.05 ± 0.48 cm to 1.26 ± 0.12 cm posttreatment (p < .01). The mean VSS and VAS scores were 2.2 ± 1.5 and 8.4 ± 1.3, respectively. The bilateral limited excision and stepwise single-stage approach were safe and effective for reconstructing prominent macrocheilia on the lower lip. The technique was also easy to command for the beginners.

Reconstruction of polysyndactyly of the fused fifth toe with the fourth toe.

Polysyndactyly of the fused fifth toe with the fourth toe is a common subtype of postaxial polydactyly. The aim of the study was to present an operative technique for cosmetic improvement and reconstruction of polysyndactyly of the fused fifth toe with the fourth toe. We retrospectively reviewed the details of 22 patients with postaxial polydactyly treated from January 2018 to May 2021. The operation involved medial toe excision and web space reconstruction using a dorsal rectangular flap without skin grafting and simultaneous correction of a valgus deformity by chondroplasty and soft tissue balancing without an osteotomy. The web shape, scar, and aesthetic outcomes were evaluated on the criteria of the D'Arcangelo, Vancouver Scar Scale score, and satisfactory questionnaire, respectively. The patients were followed up for 7-43 months. At the last follow-up, valgus deformity was completely corrected without recurrence. On the basis of the criterion of D'Arcangelo, the height and width of the webs were good in 24 of the feet, fair in four of the feet, and poor in none of the feet. The mean Vancouver Scar Scale score was 1.55. All parents and patients were satisfied with the appearance and function. The described medial toe excision technique and reconstruction of the web space without a skin graft corrected the valgus deformity and were able to satisfy functional and cosmetic requirements.