Mean Vancouver Scar Scale Research Articles

Efficacy of platelet-rich plasma plus fractional carbon dioxide laser in treating posttraumatic scars.

The management of posttraumatic scars is a great challenge. Autologous platelet-rich plasma (APRP) and fractional carbon dioxide (CO2) laser can be applied as innovative treatments for posttraumatic scars. The aim of this study was to evaluate the efficacy, safety and complications of fractional CO2 laser exposure plus APRP injection in treating traumatic scars versus CO2 laser applied as a monotherapy. Twenty participants were treated 3 times at a 4-week interval with a follow-up visit. The scars were divided into an upper and lower half-treated with fractional CO2 laser exposure plus APRP injection and CO2 laser alone, respectively. The scar was evaluated using the Vancouver scar scale (VSS), along with patient satisfaction. Twenty patients completed the 3 month treatment course. The mean VSS score improved significantly from 7.0 ± 3.97 to 3.25 ± 1.55 and 6.75 ± 1.77 to 3.85 ± 1.59 with fractional CO2 laser exposure plus APRP injection and CO2 laser exposure, respectively (p < .001). However, CO2 laser plus APRP was significantly superior to CO2 laser alone (p = .001), with fewer adverse effects. Our study shows that combined treatment with CO2 laser exposure plus APRP injection is safer and more effective for posttraumatic scar management than CO2 laser exposure alone.

Assessment of outcome of using amniotic membrane enriched with stem cells in scar formation and wound healing in patients with burn wounds

Background: In recent decades, various techniques include flaps and grafts have been deployed to heal deep burn wounds. All efforts tend to use a method which will cause faster epithelization and fewer scars. Amniotic membrane and stem-cells are shown to have unique properties in epithelization and wound healing for depth wounds. Objective: There are many studies in which the prevalence of using fresh amniotic membrane has been discussed as a biological dressing. In this study, we used frozen amniotic membrane enriched with stem-cells to evaluate the outcomes of this biological combination on epithelization rate, wound healing and scar formation in third-degree burn wounds.Method: In this study, we evaluated outcomes of using amniotic membrane enriched with stem-cells in the repair process of third-degree burn for 180 days after the reconstructive surgery. We divided the burn area into two sections of control (skin mesh graft only) and case (skin mesh graft with the dressing of amniotic membrane enriched with stem-cells). All patients were followed-up for 180-days to analyze the risk of infection, scar formation, and pain score during this period.Results: Our findings showed that there is a significant difference between pain score in case and control group only during the first 7-days of follow-up. The mean Vancouver scar scale score in case group is less than it in the control group and has a statistically significant relationship with it. Prevalence of infection in case and control group showed no statistically significant difference and yet, there was a significant difference between satisfaction in both groups.Conclusion: Using frozen amnion, in addition, to maintain the properties of fresh amnion, may reduce the risk of infection transfer. Also because of the unique properties of stem cells in reepithelization and wound healing, using amniotic membrane enriched with stem-cells may be an ideal dressing to treat depth wounds.Â

Surgical Management of Large Periorbital Cutaneous Defects: Aesthetic Considerations and Technique Refinements.

The aim of this study was to repair large periorbital cutaneous defects by an innovative technique called PEPSI (periorbital elevation and positioning with secret incisions) technique with functional and aesthetic outcomes. In this retrospective study, unilateral periorbital cutaneous defects in 15 patients were repaired by the PEPSI technique. The ages of patients ranged from 3 to 46 years (average, 19 years). The outcome evaluations included scars (Vancouver Scar Scale and visual analog scale score), function and aesthetic appearance of eyelids, and patient satisfaction. The repair size was measured by the maximum advancement distance of skin flap during operation. All patients achieved an effective repair with a mean follow-up of 18.3 months. Except one with a small (approximately 0.3 cm) necrosis, all patients healed with no complication. The mean Vancouver Scar Scale and visual analog scale scores were 2.1 ± 1.7 and 8.5 ± 1.2, respectively. Ideal cosmetic and functional outcomes were achieved in 14 patients (93.3%). All patients achieved complete satisfaction except 1 patient with partial satisfaction. The mean maximum advancement distance of skin flap was 20.2 mm (range, 8-50 mm). This study demonstrated that the PEPSI technique is an effective method to repair large periorbital cutaneous defects with acceptable functional and aesthetic outcomes.

Efficacy of a Silicone-Based Gel Containing Pracaxi Oil (Pentaclethra macroloba) for Treating Post-Surgical Scars

Scars are an unavoidable consequence of cutaneous surgery. Healing with an excellent cosmetic outcome is a crucial component to any surgical wound to avoid any negative impact on quality of life. Various products exist which claim to improve post-surgical scar appearance and texture. In this blinded, randomized pilot study, we compared the efficacy of a silicone-based topical gel containing Pracaxi oil (PO Gel; Serica™ Moisturizing Scar Formula; Cynova Laboratories, Houston, TX) against a second silicone-based gel containing Cepalin onion extract (OE Gel; Mederma® Advanced Scar Gel, Merz, North America). The Vancouver Scar Scale (VSS), Physician and Subject Global Assessment of Scar Treatment, and digital photography were used to determine efficacy and superior post-surgical care treatment outcomes. Forty healthy subjects (18-75 years old) with recent surgical scar (1 to 4 months old) were randomized to PO gel or OE gel and asked to apply a topical solution three times daily for 8 weeks. There were six study visits (Baseline and Weeks 2, 4, 8, 12 and 16). The results of this study showed that subjects with post-surgical scars achieved significant improvements at 8 and 12 weeks following application of a product with either Pracaxi oil or onion extract gel, based on mean Vancouver Scar Scale scores. Both products generally improved the individual scar signs and symptoms. Subjects using the onion extract product did not achieve improvement in Pain or Itch at the 8-week evaluation or Pain at the 12-week evaluation.

A Randomized, Placebo-Controlled, Double-Blind, Prospective Clinical Trial of Botulinum Toxin Type A in Prevention of Hypertrophic Scar Development in Median Sternotomy Wound.

Linear hypertrophic scar is a common surgical problem that can be difficult to manage, especially for the median sternotomy scar. Botulinum toxin type A (BTA) is widely used in cosmetic surgery and has been shown to improve scar quality recently. The aim of this study was to evaluate the efficacy of BTA injected in the early postoperative of median sternotomy on preventing scar formation. In this prospective randomized controlled trial, 19 consecutive patients who underwent median sternotomy were enrolled. The median sternotomy wound in each patient was divided into the upper half and the lower half. Both halves of the wound were randomized to receive the treatment with either BTA or normal saline. At 6-month follow-up, scars were assessed using the Vancouver Scar Scale, scar widths were measured, and patients were asked to evaluate their overall satisfaction. Seventeen patients with median sternotomy wounds completed the entire study. At 6-month follow-up, the mean Vancouver Scar Scale score for the BTA-treated group was 3.44 ± 1.68 and for the normal saline control group was 6.29 ± 2.39, and there was a statistically significant difference between the two groups (P < 0.05). There were also significant improvements in scar width and patient satisfaction for the BTA-treated halves of the wounds (P < 0.05). The study demonstrates that early postoperative BTA injection can decrease scar formation and reduce scar width in median sternotomy wounds, and the overall appearance is more satisfactory. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Use of a novel chitosan-based dressing on split-thickness skin graft donor sites: a pilot study.

Split-thickness skin graft (STSG) donor site dressings can play an integral role in reducing donor site morbidity. This study tested a novel, chitosan-based wound dressing, Opticell Ag, as an STSG donor site dressing for wounds <10% total body surface area (TBSA). Between January and December 2016, the chitosan-based dressing was placed on participating patients' donor sites immediately following graft harvest and covered with a transparent occlusive dressing. Pain was evaluated on postoperative day one, before dressing change between days 5-7, and before and after dressing removal between days 10-14 using the Visual Analog Scale (VAS). The extent of re-epithelialisation was determined between day 10-14 and at one month, and healing quality was also evaluated at one month post-operatively using the Vancouver Scar Scale (VSS). A total of 19 patients were recruited, of which 16 completed the study. Patients experienced mild-to-moderate pain in their donor sites when the chitosan-based dressing was used. Pain decreased significantly between postoperative day one and days 10-14, as well as between days 5-7 and 10-14. The mean percentage of re-epithelialisation on days 10-14 was 92% and by one month was 99%. The mean VSS at one month was 3.2±1.4. There were no statistically significant differences between patients' re-epithelialisation rates or VSS scores. There were unplanned dressing changes in four patients. No donor site infections or other adverse events were identified. The chitosan-based dressing tested in this study is safe, effective, and associated with reasonable pain control and acceptable healing quality. The results suggest that it is a promising STSG donor site dressing.

Evaluation of the donor site after the median forehead flap.

BackgroundForehead flaps are useful for facial reconstruction. Studies of these flaps have mostly focused on the results of the reconstruction. However, due to the scarring and changes on the forehead caused by the median forehead flap (MFF), surgeons may be reluctant to perform this flap. Research into the donor site is needed for practical purposes.MethodsWe examined 42 patients who underwent an MFF at Pusan National University Hospital from 1996 to 2016. Based on a retrospective chart review, we examined the occurrence of complications. We also evaluated scars on the forehead using the Vancouver Scar Scale (VSS) and assessed changes in the eyebrow position of 22 patients.ResultsNo complications occurred in the 42 patients. The mean VSS score of the 22 patients was 2.8±0.79. The ratio of the height of the eyebrow on each side to the distance between the medial canthi increased postoperatively, meaning that both the left and right brows were elevated slightly (P=0.026 and P=0.014). However, the symmetry between the left and right sides did not change (P=0.979). The ratio of the interbrow distance to the distance between the medial canthi decreased slightly, meaning that the interbrow distance narrowed mildly (P<0.001). Moreover, there were no noticeable changes in the brow position as seen in a photo overlay.ConclusionsThere were no notable complications in the forehead. Forehead scarring was acceptable. No change in brow symmetry was observed via photographic measurements and a photo overlay. Therefore, we propose that the MFF is a useful choice for minimizing scarring or deformation of the donor site.

A study of verapamil in treatment of keloid

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Keloid is a common presentation in clinical practice. Symptoms due to keloid are mild, but disfigurement and functional impairment can be severe. It is difficult to treat. Intralesional, injection triamcinolone acetonide, has limited efficacy, causes adverse effects such as local dermal atrophy, telengiectasia and hypopigmentation. Injection verapamil is reported to have similar efficacy, but lesser side effects, and is cheaper. Aim was to study efficacy and adverse effects of intralesional verapamil in treatment of keloid.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; An open label study on 25 patients of keloid, either gender, age 11 to 55 years at a medical college hospital. Injection verapamil 2.5 mg/ml was administered intralesionally, at an interval of 3 weeks, for a total of 6 sittings, over a period of 18 weeks. Vancouver scar scale (VSS) was used to assess the improvement. The statistical analysis was done using SPSS version 21.0.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Median duration of keloids was 8 months. The mean VSS score before treatment was 7.68 which reduced to 4.28 after treatment. Mean percentage change in VSS score was 46.21%, very highly significant (p&amp;lt;0.001). Physician’s assessment was ‘very good’ in 32.0% and 'excellent' in 8.0%. The complaint of post-procedure pain was present in almost all.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Intralesional injection verapamil, gives very good to excellent improvement in 40% of patients of keloid. Post injection pain persists for more than 24 hours. Drug does not cause local dermal atrophy or hypopigmentation.&lt;/p&gt;

36 Correlation between the Warrior/Worrier Gene on Post Burn Pruritus and Scarring

Associations between genetic variation and clinical conditions suggest that single nucleotide polymorphisms (SNPs) correlate with post-burn outcomes. One candidate gene, catechol O methyl transferase (COMT), modulates catecholamine metabolism and has been associated with stress and pain tolerance. Whereas individuals with the wild type genotype (GG) demonstrate more effective stress response, persons with an AA polymorphism break down dopamine more slowly and are vulnerable to stress. The aim of this study was to determine whether the rs4680 SNP is associated with post-burn pruritus and scarring. We examined adult burn patients, admitted between 2007 and 2017, with deep partial thickness burns or delayed healing. Subjects provided blood samples for genotyping and self-reported itch scores (0 to 10) within 1 year of injury. Scarring was measured using the Vancouver Scar Scale (VSS). Itch scores 4 and above and VSS scores over 7 were considered severe. Genomic DNA was genotyped for the rs4680 SNP using realtime PCR. Data were analyzed using ANOVA and multivariate logistic regression. Sufficient clinical data was available for 639 subjects. Our analyses corroborates previous reports that burn size ≥20% TBSA and Asian, Native American/Alaskan Indian race are significant risk factors for both severe pruritus and scarring and African American race are risk factors for itch. Severity of scarring and itch decreased with the SNP rs4680 AA variant. Mean itch and VSS scores were highest for GG homozygotes and lowest for AA homozygotes; heterozygote scores were between the two extremes. This relationship was statistically significant for VSS score (p=0.05) but not for itch (p=0.41). Multivariate logistic regression did not identify rs4680 genotype as a significant factor for either scarring or itch. Although our analysis identifies a trend between COMT genotype and both itch and scarring, rs4680 genetic variation does not appear to constitute an independent risk factor. Understanding genetic determinants of wound healing will ultimately allow clinicians to predict and potentially prevent severe pruritus and scarring.

Effects of Botulinum Toxin on Improving Facial Surgical Scars: A Prospective, Split-Scar, Double-Blind, Randomized Controlled Trial.

Early intervention might improve the quality of surgical scars. Botulinum toxin type A has been shown to improve surgical scars in the past decade. The purpose of this study was to evaluate the effect of botulinum toxin type A on surgical facial scars. In this prospective, split-scar, double-blind, randomized controlled trial, 16 consecutive patients who underwent facial surgery between June and October of 2015 were enrolled. Botulinum toxin type A was injected randomly into half of each surgical wound closure immediately after surgery. The scars were assessed independently by two plastic surgeons at a 6-month follow-up visit using the Vancouver Scar Scale and the visual analogue scale. The scar width was also measured. Fourteen patients completed the study. The visual analogue scale score and scar width measurements revealed a significant improvement in appearance and narrower scars for the botulinum toxin type A-treated halves of the scars (p = 0.046 and p = 0.001, respectively). The mean Vancouver Scar Scale score was 4.68 for the botulinum toxin type A-injected group and 5.24 for the control group (p = 0.15). In addition, the Vancouver Scar Scale height score was significantly different between the two groups (p = 0.008). This study demonstrates that early postsurgical botulinum toxin injections can produce better, narrower, and flatter facial surgical scars. Therapeutic, II.

The efficacy of intralesional triamcinolone acetonide (20mg/ml) in the treatment of keloid

Background: Management of keloid is difficult as well as challenging. Intralesional triamcinolone acetonide (TAC) injections have remained a gold standard in non-surgical management of keloid. TAC is generally used in the concentration of 40mg/ml, which causes adverse effects such as local dermal atrophy and hypopigmentation. Aim was to study efficacy and adverse effects of TAC in treatment of keloid, in a lesser concentration of 20mg/ml.Methods: An open label study was conducted from November 2015 to May 2017 on 25 subjects of either gender, in the age group 11-55 years, at a medical college hospital. Intralesional injection TAC 20 was administered in the keloid at an interval of 3 weeks, for a total of 6 sessions, over a period of 18 weeks. Vancouver scar scale (VSS) was used to assess the improvement and SPSS 21 for statistical analysis.Results: Mean age of keloid subjects was 30.72 years and median duration of keloid was 8 months. The mean VSS score before treatment was 8.36 which reduced to 3.20 after treatment. Mean percentage change in VSS score was 62.79%, which was very highly significant (p &lt;0.001). Physician’s assessment was ‘Very Good’ in 52.0% and ‘Excellent’ in 5 (20%). Adverse effect of atrophy was seen in 3 (12%), hypopigmentation in 11 (44%) and telangiectasia in 4 (16%).Conclusions: Intralesional injection triamcinolone acetonide 20mg/ml gives very good to excellent improvement in the majority of patients of keloid. Local adverse effects seen were hypopigmentation, atrophy and telengiectasia.

Postbariatric Brachioplasty with Posteromedial Scar: Physical Model, Technical Refinements, and Clinical Outcomes.

Brachioplasty is an increasingly performed procedure following massive weight loss. A visible scar is the main hindrance to this surgery. The aims of the study were to develop a physical model to investigate the ideal location of the surgical incision and to present the authors' technical refinements with the posteromedial scar approach. Twenty-four postbariatric patients underwent brachioplasty with posteromedial scar placement, concomitant liposuction, fascial plication, and axillary Z-plasty. Skin specimens were tested and a physical model of the arm was set up to investigate the difference in mechanical stress on the posteromedial and medial scars. The validated Patient and Observer Scar Assessment Scale, the Vancouver Scar Scale, and a questionnaire assessing subjective improvements were administered to patients. Preoperative and postoperative photographs were assessed by three independent plastic surgeons. The physical model showed that stress intensity and distribution along the scar were reduced in the posteromedial location, with smaller scar displacement in the loading simulations. Twenty-three patients healed uneventfully. One (4.1 percent) had a 2-cm dehiscence. Mean Patient and Observer Scar Assessment Scale scores were, respectively, 2 ± 0.76 and 2.13 ± 0.64 in the patients' and observers' questionnaires. The mean Vancouver Scar Scale value was 3.5 ± 1.7. Questionnaires assessing the subjective outcomes showed a mean value of 3.45 ± 0.63 of 4. The surgeons' assessment resulted in a score of 4.5 ± 0.4 of 5. The physical model demonstrated that the posteromedial scar was subjected to lower mechanical stress and displacement. The reported technical refinements allowed pleasant arm recontouring to be achieved with acceptable scarring and a low incidence of complications. Therapeutic, IV.

Retrospective observational cohort study on cosmetic outcome of using Ti-Ni memory alloy wire for intradermal suture following mastectomy in patients with breast cancer.

The method of suturing for incisions is crucial for the comprehensive treatment of clinical patients with breast cancer. Suturing is considered a major part of post-surgical recovery and may serve as a marker for evaluation of surgical outcome. The present study aimed to establish an effective means of suturing for patients who received modified radical surgery that helps to improve the cosmetic outcome of the incision. Enrolled patients were divided into an active and a control group. Ti-Ni memory alloy wire for intradermal suture in the active group and silk for interruption suture in the control group were applied to assess the different prognosis-associated factors. The Vancouver Scar Scale (VSS) was used to evaluate the wound size and the recovery time of the scars. The association between diabetes and the number of days of wound healing was also analyzed. The results indicated that the mean VSS score of the active group was decreased compared with that of the control group (P<0.001). The VSS scores of four main features (vascularity, pigmentation, pliability and height) between the two groups also statistically differed (P<0.001). Furthermore, the mean number of days of wound healing was significantly decreased for the active group compared with that for the control group (P=0.0026) in the patients with diabetes. In addition, the usage of Ti-Ni memory alloy wire was able to decrease the mean number of wound healing days between patients with diabetes and their non-diabetic counterparts (P=0.7009). The present study indicated that intradermal suture offers improved cosmetic outcome for patients undergoing mastectomy with or without axillary surgery. This technique may be useful for preventing scar overgrowth and for facilitating the recovery process in patients with diabetes.

Stepwise, Multi-Incisional, and Single-Stage Approach to Reshape Facial Contour After Large Cutaneous Lesion Resection.

Removal of large facial benign cutaneous lesions remains challenging. Serial or complete excisions together with local flaps or expander-based reconstructions are required. However, those techniques are time-consuming and may contribute to poor cosmetic and functional outcomes. The authors describe the resection and reconstruction of large facial benign cutaneous lesions by using Stepwise, Multi-Incisional, and Single-Stage (SMISS) approach. The authors performed a retrospective review from all patients with large facial benign cutaneous lesions who underwent "SMISS" approach for reconstruction between September 2013 and December 2014. The authors treated 47 patients (32 female and 15 male; mean age 23.5 years, range 9-50 years). Follow-up was for 12 months or longer. The mean length of major axis was 43.91 mm, minor axis 32.10 mm, and scar 66.91 mm. Good to excellent outcomes were achieved in all patients with a mean Vancouver scar scale score of 3.46 ± 0.39 (Cronbach α = 0.890) and mean visual analog scale score of 8.02 ± 0.69 (Cronbach α = 0.946). This was a nonrandomized, unblinded clinical case series with a limited sample size. For the excision and reconstruction of large facial benign cutaneous lesions, "SMISS" technique can be considered as a suitable option, leading to excellent results and a high patient satisfaction.

Flexion Crease and Web Space Reconstruction for Aesthetic and Functional Correction of Congenital Syndactyly

Purpose: To investigate the efficacy of congenital syndactyly correction with flexion crease and web space reconstruction using a dorsal hourglass-shaped flap without skin graft. Methods: We studied 116 syndactylies in 96 patients. Surgical strategy focused on flexion crease and web space reconstruction using an hourglass-shaped dorsal advancement flap. We assessed for flap necrosis, height and width of the webs according to the criterion of D’Arcangelo, and total active digital motion compared with the normal side. Scar formation was measured by the Vancouver Scar Scale score. We also administered a parent-based satisfactory questionnaire. Results: Mean follow-up was 4.2 years. All syndactylies could be corrected without skin grafts. Dorsal flap plasty facilitated the reconstruction of commissure with a slope of 45° in an hourglass shape. Two cases encountered partial flap loss but healed without surgical intervention. There were no recurrences. According to the criterion of D’Arcangelo, the height and width of 98 webs were good, 16 webs were fair, and 2 webs were poor. Mean total active motion of the index, middle, ring, and little fingers of the affected side was 160, 158, 153, and 150, respectively. Mean Vancouver Scar Scale score was 1.4. After surgery, all parents were satisfied with the appearance and function of the separated fingers. Conclusions: Reconstruction of the flexion crease and web space simultaneously with an hourglass-shaped dorsal advancement flap can achieve good aesthetic and functional outcomes.

Genome-wide Association Study of Postburn Scarring Identifies a Novel Protective Variant.

To identify genetic variants associated with the severity of postburn hypertrophic scarring (HTS) using a genome-wide approach. Risk of severe postburn HTS is known to depend on race, but the genetic determinants of HTS are unknown. We conducted a genome-wide association study (GWAS) in a prospective cohort of adults admitted with deep-partial-thickness burns from 2007 through 2014. Scar severity was assessed over time using the Vancouver Scar Scale (VSS), and DNA was genotyped with a >500,000-marker array. We performed association testing of single-nucleotide polymorphisms (SNPs) with minor allele frequency (MAF) >0.01 using linear regression of VSS height score on genotype adjusted for patient and injury characteristics as well as population genetic structure. Array-wide significance was based on Bonferroni correction for multiple testing. Of 538 patients (median age 40 years, median burn size 6.0% of body surface area), 71% were men and 76% were White. The mean VSS height score was 1.2 (range: 0-3). Of 289,639 SNPs tested, a variant in the CUB and Sushi multiple domains 1 (CSMD1) gene (rs11136645; MAF = 0.49), was significantly associated with decreased scar height (regression coefficient = -0.23, P = 7.9 × 10). In the first published GWAS of HTS, we report that a common intronic variant in the CSMD1 gene is associated with reduced severity of postburn HTS. If this association is confirmed in an independent cohort, investigating the potential role of CSMD1 in wound healing may elucidate HTS pathophysiology.

Preventive Effect of Human Acellular Dermal Matrix on Post-thyroidectomy Scars and Adhesions: A Randomized, Double-Blinded, Controlled Trial.

Acellular dermal matrix (ADM) has been used for antiadhesion formation along with wound healing in various surgical fields. The aim is to assess the efficacy of ADM implantation in the prevention of postoperative scars and adhesions after conventional, open, total thyroidectomy. Forty-four patients with papillary thyroid carcinoma undergoing thyroidectomy were randomly assigned to the study (ADM implantation) or control group (without ADM). Global photographic assessment, Vancouver scar scale (VSS), objective scar assessment, and swallowing impairment index were assessed at baseline, immediately after surgery, and at 1 and 2 months after surgery. Nineteen control and 20 study group participants completed the study. The mean VSS score of the study group was significantly lower than the controls at both 1 month (3.06 ± 1.25 vs 4.41 ± 1.54, respectively) and 2 months (2.76 ± 1.56 vs 4.35 ± 1.58, respectively) after surgery. Scar quality measures (mean melanin and erythema indexes) were significantly lower in the study group compared with controls. Study group participants had significantly lower swallowing impairment scores than controls. The mean postoperative hospitalization of both groups was not significantly different. Acellular dermal matrix-assisted implants appear to improve post-thyroidectomy scar and swallowing impairments without delays in operation time.

The Use of an Hourglass Dorsal Advancement Flap Without Skin Graft for Congenital Syndactyly

To investigate the efficacy of congenital syndactyly correction with flexion crease and web space reconstruction using a dorsal hourglass-shaped flap without skin graft. We studied 116 syndactylies in 96 patients. Surgical strategy focused on flexion crease and web space reconstruction using an hourglass-shaped dorsal advancement flap. We assessed for flap necrosis, height and width of the webs according to the criterion of D'Arcangelo, and total active digital motion compared with the normal side. Scar formation was measured by the Vancouver Scar Scale score. We also administered a parent-based satisfactory questionnaire. Mean follow-up was 4.2 years. All syndactylies could be corrected without skin grafts. Dorsal flap plasty facilitated the reconstruction of commissure with a slope of 45° in an hourglass shape. Two cases encountered partial flap loss but healed without surgical intervention. There were no recurrences. According to the criterion of D'Arcangelo, the height and width of 98 webs were good, 16 webs were fair, and 2 webs were poor. Mean total active motion of the index, middle, ring, and little fingers of the affected side was 160, 158, 153, and 150, respectively. Mean Vancouver Scar Scale score was 1.4. After surgery, all parents were satisfied with the appearance and function of the separated fingers. Reconstruction of the flexion crease and web space simultaneously with an hourglass-shaped dorsal advancement flap can achieve good aesthetic and functional outcomes. Therapeutic IV.

Safety of Salvaging Impending Flap Congestion in Breast Reconstruction by Venous Supercharging of the Cephalic Vein

Autologous flap breast reconstruction is an established technique that carries a risk of vascular failure. We evaluated the safety of salvaging impending venous congestion by using the cephalic vein for supercharging autologous abdominal flaps. Our main outcome measures were flap survival, triggering or impairing lymphedema as measured by the physician or reported by the patient, and scar severity as measured by the Vancouver scar scale. We were able to save 100% of the flaps, but could not find any statistical association with or without increased lymphedema before and after the procedure. One patient reported that lymphedema worsened. The patients accepted the scars (mean Vancouver scar scale score, 5.7). In sum, using the cephalic vein to improve venous drainage of autologous breast reconstruction was safe and did not trigger or impair lymphedema, but scarring in the upper arm was unavoidable.

Donor-site morbidity following minimally invasive costal cartilage harvest technique.

ObjectivesAutologous costal cartilage is a promising alternative for mastoid obliteration. However, donor-site morbidities of the chest wall limit the use of this graft. To address this issue, we have developed a minimally-invasive technique of harvesting costal cartilage and report donor site morbidity associated with the procedure.MethodsDonor site morbidities were evaluated for 151 patients who underwent costal cartilage harvest, canal wall down mastoidectomy, and mastoid obliteration. Pain and cosmetic concern were evaluated via visual analogue scale (VAS). Scars were evaluated via the modified Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). Postoperative complications were assessed during the follow-up period.ResultsThe mean duration of noticeable pain was 5.3 days post operation. The mean VAS score for pain was 3.0 of 10 on the first day after the operation and gradually declined. At the 6 months post operation, the mean VAS cosmetic score at the costal cartilage harvest site was 0.6 of 10. The mean VSS score was 9.5 out of 10 total, and the mean POSAS score was 23.27 out of 110 total.ConclusionThe minimally-invasive chopped costal cartilage harvest technique resulted in acceptable pain, cosmetic concern, and postoperative complications for most patients. There were no major postoperative complications. Costal cartilage is an acceptable donor for mastoid obliteration in canal wall down mastoidectomy, especially in the context of the extremely low donor site morbidity of the minimally-invasive technique presented in the study.