Minimal Scarring Research Articles

Management of Complex Fistula-in-ano by Interception of Fistula Track with Application of Ksharasutra (IFTAK): A Novel Technique

Abstract Objective Despite all the technological advances, successful management of complex fistula-in-ano is still a challenge due to recurrence and incontinence. The present study evaluates the outcomes of a novel technique, Interception of Fistula Track with Application of Ksharasutra (IFTAK) in terms of success rate and degree of incontinence. Methods In the present prospective study, 300 patients with complex fistula-in-ano were treated by the IFTAK technique, whose surgical steps include: incision at the anterior or posterior midline perianal area, identification and interception of the fistulous track at the level of the external sphincter, rerouting the track (and extensions) at the site of interception, and application of a ksharasutra (medicated seton) in the proximal track (from the site of interception to the internal opening) that is laid open gradually, with the resulting wound healing with minimum scarring. The distal track is allowed to heal spontaneously. Results There were 227 trans-sphincteric and 73 intersphincteric varieties of fistula with supralevator extension in 23 cases, of which 130 were recurrent fistulas, 29 had horseshoe track, while 25 had blind fistula with no cutaneous opening. The mean duration of the ksharasutra application was 8.11 ± 3.86 weeks with an overall success rate of 93.33% at the 1-year follow-up. A total of 3.67% of the cases reported with a mild impairment of continence on the Wexner incontinence scoring system. Pre- and postoperative anal manometry evaluation showed minimal reduction in median basal and squeeze pressures. Conclusion The IFTAK technique is a minimally invasive, daycare surgical procedure for the management of complex fistula-in-ano with low recurrence and minimal sphincter damage.

The use of high and low power lasers in the treatment of mucocele in lip: a case report

Mucocele is an inflammatory lesion of the common salivary gland in the oral cavity, generated by the accumulation of saliva, from the rupture of the minor salivary gland duct. The objective of this report was to describe a case of extravasation phenomena treated with high-power diode laser in association with photobiomodulation. The patient presented a nodular, exophytic lesion on the lower lip, similar in color to the mucosa, measuring 2 cm in diameter. Excisional biopsy was performed with high-power diode laser. Immediately after surgery and weekly thereafter, photobiomulation was performed with lower-power diode. After one-month, total repair of the surgical wound was observed, with minimal scarring, without lesion recurrence during 14 months of follow-up. Therefore, the treatment protocol used proved to be an effective, safe and fast alternative, bringing greater comfort to both professional and patient during the trans and postoperative periods.

Clinical Evaluation of Safety and Efficacy of Radiofrequency-Assisted Lipolysis on Breast Envelope and Nipple-Areola Complex Position.

Breast ptosis as a result of pregnancy and/or breastfeeding, age, genetics, and weight loss is a common complaint among women visiting a plastic surgeon. This study sought to evaluate the utility, efficacy, and safety of radiofrequency-assisted lipolysis on the breast and nipple-areola complex position in women with breast ptosis. This was a single-center (i.e., Maxwell Aesthetics) study of women desiring tightening of the breast envelope and elevation of the nipple-areola complex. Each patient underwent one treatment with radiofrequency-assisted lipolysis in the operating room. Radiofrequency-assisted lipolysis was applied to each breast with a BodyTite Pro handpiece. Patients were evaluated preoperatively and postoperatively at 6 weeks, 3 months, 6 months, and 12 months by means of manual and three-dimensional computer-generated measurements (i.e., Vectra). Ten female patients were enrolled. Ages ranged from 23 to 54 years. Follow-up was 12 months. Data were captured for seven measurements from the nipple longitudinally at five time points. The sternal notch-to-nipple distance, the nipple-to-inframammary fold distance, and the nipple-to-nipple distance improved statistically at 6-week follow-up, which persisted through the 12-month follow-up ( p < 0.05). Patient questionnaires revealed moderate to excellent satisfaction. Radiofrequency-assisted lipolysis with a bipolar device to deliver radiofrequency energy to the breast is an effective modality to moderately improve breast ptosis. This study demonstrates that this treatment improves breast measurements across time, regardless of measurement type (manual versus Vectra). This modality affords a minimally invasive, effective method to improve mild to moderate breast ptosis with minimal scarring and high patient satisfaction. Therapeutic, IV.

Use of Medical Robots in Allowing Surgeons to More Dexterous Manipulate Surgical Instruments or Catheters Inside the Patient's Body During Minimally Invasive Surgeries

Robots are used in surgery to improve the entire surgery process. Most surgery robots are able to do open surgery and have different kinds of benefits such as shorter hospitalization, quick recovery, reduction of pain, little incision, less possibility of infection, minimal blood loss and minimum scarring. Surgery robots are able to do fast surgery and as a result the patients recover quickly. Surgical robots have been developed to overcome the surgical limitations [1]. Long time hospitalization is not needed for the patient's surgery by robots. Mostly the patients return to normal conditions quickly due to fast surgery and for this reason short hospitalization is possible in robot surgery. Currently robots are used to do surgery and mostly medical experts control the robots to do surgery with robots. Robotics technology has improved and the development has helped to make surgical robots in the field of medical care. Surgical robots have a long history in the medical field. This kind of robot was started to be used in the medical field in the year 1985 with the Puma 560. Stanford Research Institute has started research on developing robots which have surgical senses that can help to do various critical surgeries. Keywords : Catheters, Invasive, Robots, Surgeons, Surgery robots

Treatment of Diaphyseal Fractures of the Femur in Paediatric Age Group: A Comparative Study of Locking Compression Plate Versus Titanium Elastic Nailing System (TENS).

Background: Diaphyseal femur fractures are commonly seen in the paediatric age group as there is an increase in the incidence of road traffic accidents. Titanium elastic nailing system (TENS) and plating are the common methods used for paediatric long bone fracture fixation. The purpose of our study was to evaluate and compare functional and radiological outcomes of paediatric femur diaphyseal fractures treated with locking compression plates and with TENS.Methods: Our study included 59 patients diagnosed with femur shaft fracture. Twenty-eight patients included in group one underwent open reduction and internal fixation with locking compression plates and 31 patients in group two underwent open reduction/closed reduction with intramedullary TENS. All post-operation patients were evaluated at four, eight, 10, 12, 16, 20, 24, and 36 weeks. The functional outcome was assessed based on the Flynn scoring system and radiological union based on fracture union on X-ray.Results: We analyzed our data using the Flynn scoring system. In group one, out of 28 cases treated with locking compression plates, 25 (89%) were excellent, two (7.5%) were satisfactory, and one (3.5%) was poor. In group two, out of 31 cases treated with intramedullary TENS, 26 (83.8%) were excellent and five (16.2%) were satisfactory. In our study, the average union time in group one was 11.4 weeks and in group two was 14.41 weeks. Fracture union was 100% in both groups.Conclusion: In our study, we noted that the union of the femur shaft was early with the use of locking compression plates. In TENS, there was less intraoperative blood loss, very minimal postoperative scar, and less soft tissue damage. Also, implant removal was easier compared to locking compression plates.

Furuncular cutaneous myiasis in Saudi Arabia

Myiasis is the infestation of a living vertebrate by a fly's larva, completing its obligate life cycle. Exposed skin remains the most affected site. The botfly, Dermatobia hominis , is the most common cause of cutaneous furuncular myiasis in tropical areas. Few cases have been reported in Saudi Arabia, mainly in the Southern region. A one-year-old medically free child presented to our pediatric surgery clinic with a painful, itchy discharging nodule on the inner aspect of his right forearm for one-week. The patient's mother and sibling had a similar former presentation after visiting Taif city. We dilated the central punctum and extracted the larva fully intact. The larva was identified morphologically as Dermatobia hominis by a parasitologist. The lesion was left to heal secondarily, which resulted in an acceptable cosmetic result and minimal scarring. Raising this clinical entity's awareness between pediatric surgeons will set aside misdiagnosis, delayed management, and possible complications. A high level of suspicion and careful history taking are required to recognize myiasis, particularly in patients with a recent history of global traveling or those with close contact with cattle.

Silver Nanoparticles and Its Mechanistic Insight for Chronic Wound Healing: Review on Recent Progress.

Wounds are structural and functional disruptions of skin that occur because of trauma, surgery, acute illness, or chronic disease conditions. Chronic wounds are caused by a breakdown in the finely coordinated cascade of events that occurs during healing. Wound healing is a long process that split into at least three continuous and overlapping processes: an inflammatory response, a proliferative phase, and finally the tissue remodeling. Therefore, these processes are extensively studied to develop novel therapeutics in order to achieve maximum recovery with minimum scarring. Several growth hormones and cytokines secreted at the site of lesions tightly regulates the healing processes. The traditional approach for wound management has been represented by topical treatments. Metal nanoparticles (e.g., silver, gold and zinc) are increasingly being employed in dermatology due to their favorable effects on healing, as well as in treating and preventing secondary bacterial infections. In the current review, a brief introduction on traditional would healing approach is provided, followed by focus on the potential of wound dressing therapeutic techniques functionalized with Ag-NPs.

Subcutaneous Nodules in a 28-week-old Girl.

Subcutaneous Nodules in a 28-week-old Girl.

Surgical considerations in skin of colour: minimizing pathological scars.

In most surgeries, the primary aim, for both surgeons and patients, is the success of the operation being undertaken. A secondary aim is for optimal wound healing with minimal scar formation. The normal wound-healing process involves four distinct but overlapping stages: haemostasis, inflammation, proliferation and remodelling. In some patients, the cellular process involved in the proliferation and remodelling stages can be deranged, resulting in the formation of hypertrophic or keloid scars, a phenomenon more frequently seen in skin of colour. The first report of excessive scarring is thought to be the Smith papyrus about 1700 BC. In the 20th century, both Mancini and Quaife (in 1962) and Peacock etal. (in 1970) classified excessive scarring into hypertrophic and keloid scar formation. Clinicians can minimize the risk of these pathological scars developing by using good preoperative, perioperative/intraoperative and postoperative surgical practices. This paper reviews the wound-healing processes in association with good surgical principles and practice, discusses how implementing these principles in practice helps in this prevention and management of pathological surgical scars such as hypertrophic scars and keloid scars. and offers a practical step-by-step clinical guide that can be used by any clinician.

Hybrid threshold laser to treat diabetic macular edema: A retrospective analysis single center cohort study

BackgroundDiabetic patients suffers from reduction of vision that one of its main causes is clinically significant macular edema (CSME).The purpose of this study to determine if hybrid threshold can reduce macular thickness in Diabetic Macular Edema. Materials and methodsThis study is a retrospective analysis single center cohort study. 12 eyes in 10 patients diagnosed with diabetic macular edema using SD-OCT treated with Hybridthreshold laser as the leaking microaneurysms were treated with threshold laser on the 5% duty cycle settings.A complete fundus exam, including best-corrected visual acuity changes, and monthly measuring retinal thickness using SD-OCT for 24 weeks follow up. ResultsReduction of retinal thickness from 336.58 ± 86.26 μm to 264.33 ± 61.41 μm (p = 0.02) at 24 weeks follow up without significant changes of best-corrected visual acuity from 0.16 LogMAR to 0.08 LogMAR (p = 0.2) with minimal scar formation in 24 weeks follow up. Conclusion532 nm Hybridthreshold laser reduces macular thickness up to 20% and stabilizes diabetic macular edema for 24 weeks follow up.

Irregularly Irregular Stellate Incisions for Selective Reduction of Benign Facial Lesions.

Background:Cosmetic outcomes are among patients’ top concerns when discussing treatment options for facial nevi. Benign lesions of the face often enlarge with time, and many patients seek care to minimize the perceived deformity. Complete excision remains the frontline treatment for facial lesions, but a choice must be made between the deformity from the lesion itself and scar deformity incurred from its removal. Traditional elliptical excision results in a linear scar that is often conspicuous, while alternatives to surgical excision seek to minimize scarring but possess their own disadvantages. We report a new application for nevus reduction (subtotal or near-total excision) to diminish deformity from the lesion itself while minimizing scar visibility with a novel “irregularly irregular stellate incision” approach.Methods:Incisions are made in a stellate pattern with irregularly irregular borders circumscribed within the lesion. Therefore, the scar is restricted to the lesion surface, while a reduction in area and projection off the skin surface can be tailored to fit the patient’s wishes for any benign skin feature.Results:This technique has been employed with hundreds of facial lesions, with two representative cases shown. No significant complications have been observed and the method has been used on a wide variety of sizes and types of lesions.Conclusions:The technique presented meets the need for minimal scarring when reducing benign lesions of the face. The method is applicable to a wide range of presentations and can also function as a method to biopsy lesions, should there be concerns about pathology.

Comparative study of drainage of breast abscess by conventional incision and drainage versus percutaneous placement of suction drain

Breast abscess is common in puerperal period secondary to mastitis with incidence of 4.8%-11%. The conventional method of incision and drainage of breast abscess has undergone a gradual change from invasive to minimally invasive method of percutaneous placement of suction drain. We present 50 cases of puerperal breast abscess treated by I and D and percutaneous placement of suction drain alternatively. Aims and Objectives: To compare management of breast abscess by incision and drainage v/s percutaneous suction drainage with reference to – 1. Post operative pain 2. Residual abscess 3. Duration of hospital stay 4. Time required for complete healing 5. Appearance of scar. Material and Methods: 50 patients with primary diagnosis of puerperal breast abscess were taken for this prospective study. 25 patients underwent I & D and 25 patients underwent percutaneous placement of suction drain. Results: Minimal post operative pain was observed in all the patients of percutaneous drain placement (VAS G1 and G2) compared to I and D group (G4 and G5). Residual abscess was found in one case in I and D group and two cases in PDP group which were treated by incision and drainage. Mean duration of hospital stay in I and D group was 4-6 days and in PDP group was. Mean duration of complete healing in I and D group was 10-12 days and in PDP was weeks. Patients who underwent PDP had a minimal scar at entry and exit wounds, where as the patients who underwent conventional method had a large ugly scar. Conclusion: Percutaneous placement of suction drain in puerperal breast abscess is less invasive(less pain), has faster resolving rate, heals with minimal scarring and has low complication rate as compared to the conventional method.

Two-port Endoscopic Surgery for Carpal Tunnel Syndrome - A Prospective Cohort Study.

Introduction:Carpal tunnel syndrome (CTS) is one of the most common peripheral neuropathies affecting patients' life. Performing endoscopic carpal tunnel release is now a new technique that is being gradually applied in Vietnam. This paper seeks to investigate the effectiveness of Chow’s method for CTS treatment.Materials and methods:This is a prospective cohort study involving seventy-seven patients with CTS who underwent Chow’s endoscopic method at our hospital from March 2019 to January 2020. The Boston Carpal Tunnel Questionnaire and electromyography (EMG) were used primarily to evaluate surgical decompression pre-operatively, one week, three weeks, three months, and six months after surgery. We also recorded incision length, pain at the scar, the improvement of symptoms and thenar atrophy and return-to-work time after surgery.Results:A total of 85.7% of the patients were women. A moderate severity of EMG was seen in 64.9% of cases. Six-month post-operative functional status scale (FSS) (1.05±0.1) and symptom severity scale (SSS) (1.05±0.1) showed significant improvement when compared with preoperative FSS (2.8±0.5) and SSS (3.2±0.5). Post-operative EMG showed the distal sensory latency (DSL) and distal motor latency (DML) had returned to the norm in 88% and 89.3%, respectively. The average incision length was 12.1±1.2mm. Six months after surgery, numbness and hand pain had resolved in 97.4%, a painless scar was seen in 94.7%, but full recovery of thenar atrophy was only seen in 9.1%. Patients could get back to work after 10.2±2.4 days.Conclusion:Chow’s endoscopic carpal tunnel release is a safe and effective procedure for patients suffering from carpal tunnel syndrome that showed promising outcomes on clinical symptoms and functions on EMG with minimal pain and scarring, and early return to work.

Case report on management of oral mucocele in pediatric patient using electrocautery

Background: Mucocele is defined as a mucus filling cavity that can appear in the oral cavity. Children are most commonly affected with a clinical history of painless swelling and often with a history of recurrence. Electrocautery was chosen as a treatment to minimize postoperative discomfort, provide better vision during procedure, and to minimalize scarring. The purpose of this case report is to present the treatment of mucocele present on the lower lip in a Pediatric patient who was treated using electrocautery, the clinical outcomes, and also clinical advantages and disadvantages of electrocautery compared with various treatment options for the mucocele. Case Report: A 15 years old female patient came to the Department of Pediatric Dentistry, Universitas Airlangga Dental Hospital, with the chief complaint of swelling present in the lower lip. Based on the history and clinical features a provisional diagnosis of mucocele due to retained #83 was given. Case Management: The management of mucocele was by using electrocautery. The patient was recalled after 1 week with no post-operative discomfort reported and minimal scarring shown. Discussion: Electrocautery is well received by patients, with a relative lack of discomfort, no bleeding, and minimal to no scarring after healing. Conclusion: There are various treatment options available for treating mucocele, but electrocautery is a valuable treatment of choice pertaining to reduced pain and minimal scarring.

Laparoscopic Retrieval of multiple Sharp Foreign Bodies from Stomach in a Patient of Acuphagia – A Case Report

Foreign body ingestion is a common clinical scenario encountered in the emergency room with commonest cases presenting among children and in psychiatric adults. The key principle of management is dependent upon appropriate diagnosis and exact localization of the foreign body ingested and its type. Once an appropriate characterization of the ingested foreign body is made, further decision about its retrieval is based on whether any complication related to the foreign body, such as peritonitis is present or not. The method of retrieval can vary from minimally invasive to open surgery mostly dependent on availability of instruments and surgeon’s expertise. Unless any complication has occurred, surgeons in the current era are erring more towards minimally invasive methods. In cases where large or sharp foreign bodies are involved, that would demerit the use of endoscopy for its removal, surgeons are nowadays opting for laparoscopic removal instead of the traditional laparotomy. This case report highlights the use of laparoscopy for salvaging such foreign bodies especially when advantages such as, early post-operative recovery, less pain, minimal scar and decreased hospital stay over traditional laparotomy is involved Keywords: Gastro-intestinal tract, stomach, Foreign body, Acuphagia, Laparoscopic retrieval, Complications

Absorbable sutures: chronicles and applications

Surgical sutures are used to bind tissues together to help in wound closure and healing after surgery or trauma. Surgical suture materials for medical purposes are available in a variety of forms, the most common of which are absorbable and non-absorbable. Absorbable sutures were traditionally exclusively utilised for approximating internal tissues. However, using absorbable sutures in percutaneous wound closure has recently gained popularity. Absorbable sutures provide many advantages, including eliminating the need for another clinic visit to remove the sutures as well as low risk of infections and minimal scarring. One of the recent advances in absorbable sutures: barb sutures, by removing knots, dispersing wound tension, and increasing closure efficiency, have changed the way doctors work on them. Suture material classes have recently been developed based on their qualities and abilities to promote tissue approximation and wound healing. Surgeons should choose an appropriate suture material for tissue approximation which enhances the healing effect and minimises scaring possibilities. To avoid ischemia, excessive wound tension, and tissue damage, it is necessary to understand their properties. Antibacterial agents have also been added to the absorbable suture materials to provide an extra layer of protection by making it more resistant to infection while still maintaining its high tensile strength and good handling. The present article attempts to describe different absorbable suture materials available along with their respective applications.

Color Doppler Sonography Assisted Subcutaneous Mastectomy with Inferior Pedicled Nipple-Areola Complex in Female-to-Male Transsexuals: A Retrospective Cohort Analysis.

The surgical goals of gender reassignment surgery of the breast in female-to male transsexuals (FMT) is the aesthetic shaping of a male thoracic wall with minimal scarring, while preserving the sensitivity of the nipple-areola complex (NAC). For large and ptotic breasts, we perform a mastectomy over an inframammary access with inferior pedicled NAC under color Doppler visualization of the perforators. This paper presents the technique, including complications and assessment of quality of life, as part of a unicentric analysis. This was a retrospective analysis of 23 patients (46 mastectomies) performed between September 2014 and September 2020. The complication rate and the number of corrective surgeries were recorded for quality assessment. A semiquantitative score was used to evaluate aesthetic outcome, nipple sensitivity, quality of life, and sexuality. A total of 46 mastectomies were performed in 23 patients. The patient survey showed high patient satisfaction. Loss of nipple sensitivity was observed after one mastectomy (2.17%). In 91.67% of cases, patients reported that their appearance reflected how they feel on the inside. In 75% of cases, patients reported feeling equal to other men. The overall complication rate was 10.87%. Shape correction due to persistent excess of volume was rare (2.17%, equivalent to one mastectomy). Subcutaneous mastectomy with inferior nipple pedicle can be performed with a high degree of safety and satisfaction in FMT. Color Doppler-guided visualization of the perforator vessels is helpful in allowing a thin pedicle preparation, thus reducing the need for secondary surgeries to optimize the shape. 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 .

Strategies to Minimize Surgical Scarring: Translation of Lessons Learned from Bedside to Bench and Back.

Significance: An understanding of the physiology of wound healing and scarring is necessary to minimize surgical scar formation. By reducing tension across the healing wound, eliminating excess inflammation and infection, and encouraging perfusion to healing areas, surgeons can support healing and minimize scarring. Recent Advances: Preoperatively, newer techniques focused on incision placement to minimize tension, skin sterilization to minimize infection and inflammation, and control of comorbid factors to promote a healing process with minimal scarring are constantly evolving. Intraoperatively, measures like layered closure, undermining, and tissue expansion can be taken to relieve tension across the healing wound. Appropriate suture technique and selection should be considered, and finally, there are new surgical technologies available to reduce tension across the closure. Postoperatively, the healing process can be supported as proliferation and remodeling take place within the wound. A balance of moisture control, tension reduction, and infection prevention can be achieved with dressings, ointments, and silicone. Vitamins and corticosteroids can also affect the scarring process by modulating the cellular factors involved in healing. Critical Issues: Healing with no or minimal scarring is the ultimate goal of wound healing research. Understanding how mechanical tension, inflammation and infection, and perfusion and hypoxia impact profibrotic pathways allows for the development of therapies that can modulate cytokine response and the wound extracellular microenvironment to reduce fibrosis and scarring. Future Directions: New tension-off loading topical treatments, laser, and dermabrasion devices are under development, and small molecule therapeutics have demonstrated scarless wound healing in animal models, providing a promising new direction for future research aimed to minimize surgical scarring.

Inter thenar skin sparing carpal tunnel release- role of incisions and endoscope - A case report

Endoscope in plastic surgery has played a role, wherever minimal scarring is required. An attempt to decrease the length of scar is one of the priorities of a surgeon, as this brings down the chance of scarring, pain and associated morbidity, with decreased hospital stay. Hand is an organ with intricate anatomy and many vital structures are densely packed in hand. This makes the available space scarce for another instrument to add into the hand. Hence endoscopic intervention in hand is negligible. The margin of error also remains negligible in hand, as it would compromise on the function of hand, which is an absolute necessity. Aesthetic appearance of hand is not as important as function; nevertheless if possible, one should also consider giving an aesthetic scar with good function of hand and these criteria will be the goal for any hand surgeon.

The use of radio-wave surgery: An underestimated method for small hyperpigmented flat or macular lesions on face.

Although choosing the appropriate treatment method is relatively easy for papular or protuberant lesions, for small macular lesions it may not be so, because they are generally percepted as mild lesions by the patient and she/he usually has the anxiety of final disfigurement which may result esthetically worse than the original one. It is reasonable to choose the method which will reveal the least scar formation and lowest recurrence rate with cost-effectiveness, in removal of superficial small macular lesions for cosmetic purposes. Fifty-six male and female patients with small hyperpigmented flat or macular lesions, less than or equal to 5mm diameter on their face, who referred to hospital dermatology clinic for removal and received an interventional therapy with a radio-wave surgery unit in the years 2018-2019 were retrospectively recruited. Besides the observation of scar formation and residual erythema, 3-month recurrence rates were also analyzed. At the end of 3months, there was no scar on any lesion site. Mild erythema was detected on 15lesion sites out of a total of 218 (6.9%).The total recurrence rate was 7.7%. The mean age of the patients with at least one recurrence was significantly greater than the patients with no recurrence, and the lesions greater than 3mm were more prone to recur than the lesions less than or equal to 3mm. Although no method of lesion removal can warrant a scarless result without recurrence, for benign macular hyperpigmented lesions of the face up to 5mm in diameter, radio-wave surgery may be preferred due to both its minimal scar formation and recurrence rate, in addition to its cost-effectiveness.