Patient Observer Scar Assessment Scale Research Articles

Outcomes of Radial Forearm Free Flap Closure With Split-Thickness Skin Graft Versus Primary Closure.

This study compares patient-reported functional and aesthetic outcomes of split-thickness skin graft (STSG) versus hatchet flap closure of radial forearm free flap (RFFF) donor site. Patients with RFFF (2015-2020) were retrospectively identified. Those willing to participate in patient-reported outcomes (PRO) filled out Patient-Observer Scar Assessment Scale (POSAS) and Michigan Hand Outcome Questionnaire (MHOQ). 198 patients met our inclusion criteria and 81 participated in PRO. There was a higher rate of tendon exposure in STSG versus hatchet flap (11 vs. 1, p = 0.0019), but a lower rate of skin necrosis (5 vs. 16, p = 0.0190) and epidermolysis (1 vs. 12, p = 0.0028). Scar quality in STSG was superior to hatchet flap in all domains of POSAS. MHOQ scores were similar between both groups with no statistical difference in overall scores (p = 0.2165). STSG appeared to have less compromise in activities of daily living, better satisfaction and improved scar quality than hatchet flap, but a higher rate of tendon exposure. 3 Laryngoscope, 2024.

Comparative study on outcome of intralesional steroid and combination of intralesional steroid with 5-fluorouracil in keloid treatment

Background: Though the definitive management of keloids are not yet established, many treatment modalities have been described which are being used alone or in combination all over the world with some promise. This study aims to assess the effect of intralesional steroids and 5-fluorouracil (5-FU) in the treatment of keloids. Methods: The study included 40 patients with keloids, out of which 20 received 6 doses of intralesional steroid and the other 20 received alternating three doses of intralesional steroid and three doses of 5-FU. The size of the keloid and the POSAS (Patient observer scar assessment scale) score were marked on the proforma and the patient was reassessed after 6 months. The decrease in volume and POSAS score was statistically analysed using paired and unpaired t tests. Results: There is a statistically significant decrease in POSAS score after intervention in both the steroid and steroid+5 FU groups. However, the decrease in POSAS score is significantly more in the group that received steroids alone. The group that received steroids had a greater decrease in volume (50% reduction) compared to the group that received the steroid-5FU combination (27% reduction). Conclusions: There is a statistically significant decrease in POSAS score after intervention in both the steroid and steroid+5 FU groups. However, the decrease in POSAS score is significantly more in the group that received steroids than the group that received steroid-5 FU combination.

Prospective Evaluation of Fractional Carbon Dioxide Laser Treatment of Mature Burn Scars, Post-traumatic Scars, and Post-acne Scars.

Annually, around 100 million patients worldwide acquire scars, some of which can cause significant problems. Various treatment interventions, such as topical scar creams, steroids, laser therapy, and surgery, have been developed to manage these scars. This study was conducted to evaluate the effectiveness of fractional CO2 laser treatment by assessing outcomes using the Patient Observer Scar Assessment Scale (POSAS) and clinical photographs. A total of 47 patients were included in the study, divided into three groups: a post-acne scar group with 14 patients, a post-burn scar group with 17 patients, and a post-traumatic scar group with 16 patients. Detailed histories were taken, and clinical examinations were performed and recorded on a prepared proforma. Aesthetic outcomes were evaluated based on clinical photographs, and total patient and observer scores were recorded using POSAS at baseline, and after one and three months. POSAS comprises two components: the observer scale (POSAS-O) and the patient scale (POSAS-P). Fractional CO2 laser treatments were performed in each group, with sessions repeated every four weeks for three consecutive sessions. Data were analyzed using the paired t-test for before-and-after comparisons in each study group. Welch's ANOVA test was used for comparisons among the three groups at a significance level of p=0.05, using MS Excel(Microsoft Corporation, Redmond, Washington) and IBM SPSS Statistics for Windows, Version 20 (Released 2011; IBM Corp., Armonk, New York). The mean age for men was 26.38 ± 8.19 years and for women 22.21 ± 6.38 years. The study comprised 34 female patients (72.34%) and 13 male patients (27.66%). The mean POSAS observer and patient scales were recorded and compared for all three types of scars from baseline to three months. The mean percentage change in POSAS-O and POSAS-P (total score) in relation to different scar sites was recorded. The most significant difference in mean percentage change, statistically significant (p-value < 0.05), was observed for facial scars, followed by scars on the neck, and was minimal for scars on the hand, in both observer and patient groups. Even a single session of fractional CO2 laser therapy had profound effects on the overall quality of scars. Fractional carbon dioxide laser therapy improves the quality of scars and produces significant improvements in skin texture, with better effects on post-traumatic scars than on post-burn and post-acne scars. Future studies are needed to better understand the mechanism of action and to optimize the doses and timing of therapy.

Celecoxib to improve scar quality following acute burn injury: Lessons learned after premature termination of a randomised trial

BackgroundPre-clinical studies suggest that non-steroidal anti-inflammatory therapy may reduce acute inflammation and modulate scar formation after burn injury. The objective of this trial was to determine if celecoxib administered soon after acute burn improved scar quality. MethodsA single centre, parallel group, placebo-controlled, randomised, superiority trial. Adults with non-major acute burn injury were eligible for recruitment. Participants within 48 h of admission for acute burn injury received either six weeks of celecoxib 200 mg twice daily or identically packaged placebo capsules. The primary outcome was participant-reported Patient Observer Scar Assessment Scale (POSAS) at day 42 following burn injury. The best possible score using this assessment is 7 and the worst 70. Key safety outcomes included study drug side effects. ResultsRestrictions imposed during the COVID-19 pandemic resulted in slow recruitment and early termination after 59 of the 150 planned participants were enrolled. The primary outcome was available for 21/30 (70 %) participants in the celecoxib arm and for 23/29 (79 %) who received placebo. There was no significant difference in the primary outcome between treatment groups with a mean POSAS of 33.4 (standard deviation 12.7) in the celecoxib arm and 36.9 (13.7) in the control arm giving a difference of −3.49 (95 % CI [-11.57, 4.59], p =.39). Gastrointestinal symptoms occurred in 3/30 (10 %) allocated celecoxib and in none allocated placebo. Secondary outcomes including graft loss and delayed healing were similar between groups. ConclusionsAnti-inflammatory therapy did not improve scar quality. Due to early trial termination and significant loss to follow up these findings should be interpreted cautiously. To improve generalisability and to attain recruitment targets, future trials should apply different approaches to improve participant retention as well as including patients with larger burn injuries and an older population.Trial registration: ACTRN12618000732280.

Comparing Cosmetic Outcomes of Straight-Line Versus W-Plasty Techniques for Linear Postauricular Wound Closure: A Randomized Evaluator Blind Split-Scar Trial.

Surgeons' opinions vary on the cosmetic outcome of straight-line (SL) versus broken-line (W-plasty) closure methods. To date, no studies have compared the 2 techniques in the split-scar design model that resolves the confounding individual patient factors that affects the scar outcome. Compare outcomes and wound cosmesis with SL versus W-plasty closure techniques. This clinical trial was conducted with 50 linear surgical wounds randomized to SL closure on half and W-plasty on the other half. At 3 months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (Patient Observer Scar Assessment Scale [POSAS]). The mean (SD) sum of the POSAS observer component scores were 16.6 (6.18) for the SL side and 15.5 (6.37) for the W-plasty side ( p = .49). The mean (SD) sum of the POSAS patient scores were 14.4 (6.8) in SL and 15.1 (8.2) in W-plasty ( p = .59). The mean (SD) complications were 0.08 (0.06) for SL and 0.02 (0.14) for W-plasty ( p = .18). No statistically significant difference in wound cosmesis or complications was noted between SL versus W-plasty closure techniques. Surgeons may want to consider whether the extra time involved in placing zigzag W-plasty lines is worthwhile.

Prognostic Factors for Long-term Aesthetic Outcome of Infantile Haemangioma Treated with Beta-blockers.

Parents of infants treated with beta-blockers for infantile haemangioma are often concerned about the long-term aesthetic outcome. This cross-sectional study assessed the influence on the long-term aesthetic outcome of characteristics of the infantile haemangioma, the beta-blocker treatment, and the infant. The study included 103 children aged 6-12 years, treated with beta-blockers (propranolol or atenolol) for infantile haemangioma during infancy (age at treatment initiation ≤1 year) for ≥6 months. Dermatologists and parents scored the Patient Observer Scar Assessment Scale, and the child scored a visual analogue scale. Dermatologists identified whether telangiectasia, fibrofatty tissue, and atrophic scar tissue were present. The long-term aesthetic outcome of infantile haemangioma was judged more negatively by dermatologists and parents in case of a superficial component, ulceration, older age at treatment initiation, higher cumulative dose, and/or shorter follow-up time. According to children, infantile haemangioma located on the head had better aesthetic outcome than infantile haemangioma located elsewhere. Close monitoring, particularly of infantile haemangioma with a superficial component, is essential for early initiation of treatment, and to prevent or treat ulceration. These outcome data can support parental counselling and guide treatment strategy.

Carbon dioxide laser treatment of burn-related scarring: Results of the ELIPSE (Early Laser Intervention Promotes Scar Evolution) prospective randomized controlled trial

To investigate the impact of ablative fractional carbon dioxide laser (AFCO2L) on patient-reported outcomes measures, subjective scar appearance, dermal architecture, and gene transcription in early burn scars. Fifteen adult patients with a burn-related scar were recruited. Inclusion criteria were two non-contiguous scar areas of 1% total body surface area, similar baseline Vancouver scar scale (VSS) score and 3months since the time of injury. All participants acted as their own control. Scars were randomized to treatment or control. Treatment scars received three AFCO2L treatments at 6-week intervals. Outcome measures were recorded at baseline, 3, 6, and 12-months post-treatment. Measures included blinded VSS, Patient Observer Scar Assessment Scale (POSAS), Brisbane Burn Scar Impact Profile (BBSIP), blinded scar photo assessment, histological tissue analysis, and RNA sequencing analysis. No significant difference was found in VSS, scar erythema, or pigmentation. Patient POSAS improved in scar thickness and texture following AFCO2L. All elements of BBSIP improved in control and laser groups. AFCO2L-treated scars were scored better than control scars by blinded raters. RNA sequencing illustrated that AFCO2L induced sustained changes in fibroblast gene expression. AFCO2L treated scars had significantly altered scar thickness and texture 6 months post-laser and were rated better than controls on blinded photo analysis after 3 treatments. RNASeq results suggest laser treatment alters the transcriptome of treated fibroblasts for at least 3 months after treatment. Expansion of this research to study in more depth fibroblast changes in response to laser, as well as assessing the impact on daily activity and quality of life, will be beneficial.

Laparoscopic surgery of large adnexal masses (>12 cm): Single port or conventional?

We aimed to compare single-port laparoscopic surgery (SPLS) and conventional multiport laparoscopic surgery (CMLS) for large adnexal mass (AM). Patients undergoing laparoscopy (LS) due to huge AMs (≥12 cm) between 2016 and 2021 were evaluated retrospectively. The SPLS procedure was applied in 25 cases, and CMLS was performed in 32 cases. The premier result was the grade of the postoperative improvement according to the Quality of Recovery (QoR)-40 questionnaire score (24 h after the surgical procedure; postoperative day 1). Observer Scar Assessment Scale (OSAS) and Patient Observer Scar Assessment Scale (PSAS) were also evaluated. A total of 57 cases undergoing SPLS (n=25) or CMLS (n=32) due to a large AM (≥12 cm) were analyzed. No meaningful distinctions in age, menopausal status, body mass index, or mass size were observed between the two cohorts. The operation time was shorter in the SPLS than CPLS cohort (42.2 ± 3.3 vs. 47.6 ± 6.2; p < 0.001). Unilateral salpingo-oophorectomy was performed in 84.0% of cases in the SPLS cohort and 90.6% of patients in the CMLS cohort (p=0.360). The QoR-40 points were significantly higher in the SPLS than the CMLS group (154.9 ± 12.0 vs. 146.2 ± 17.1; p=0.035). The OSAS and PSAS scores were lower in the SPLS than the CMLS group. LS can be used for large cysts that are not considered to be at risk of malignancy. The postoperative recovery time was shorter in patients undergoing SPLS compared to CMLS.

Comparison of Aesthetic Outcomes of Epidermal Staples vs Sutures in Deep Epigastric Perforator Flap Breast Reconstruction

Abstract Background A secondary benefit of abdominally based autologous breast reconstruction may be improving the abdominal contour; however, poor scaring can lead to aesthetic dissatisfaction and complications. Although studies have demonstrated favorable aesthetic results and decreased operative time using dermal or subcuticular stapling (Insorb), no reports exist regarding epidermal stapling. Objectives The aim of this study is to compare the aesthetic abdominal scar outcomes, closure time, and postoperative complications of abdominally based breast reconstruction patients who have undergone suture closure vs epidermal staple closure. Methods A total of 217 patients who underwent abdominally based autologous breast reconstruction from 2011 to 2022 were included and retrospectively analyzed (staples = 41, suture = 176). Twenty-four patients’ postoperative abdominal scar photographs were randomly chosen (staples = 12, sutures = 12) and assessed by 3 board-certified plastic surgeons using a modified patient observer scar assessment scale (POSAS) and visual analog scale (VAS). Closure time (minutes per centimeter) using staples or sutures was also analyzed. Results The assessment of abdominal scars closed by epidermal staples revealed significant improvements in thickness (P = .033), relief (P = .033), surface area (P = .017), overall opinion (P = .033), POSAS score (P = .034), and VAS scar score (P = .023) in comparison with scars closed by sutures. Closing the abdominal wound with staples was significantly faster than closing with sutures (P &amp;lt; .0001). Staple and suture closure had similar postoperative complication rates. Conclusions Abdominal donor-site scar quality may be superior and faster using the epidermal staple compared to traditional suture closure. Level of Evidence: 2

Aesthetic Outcome of Propranolol vs Atenolol Treatment of Children with Infantile Haemangioma.

Infantile haemangiomas are common benign tumours of infancy, which can be treated effectively with beta-blockers such as propranolol and atenolol. Different types of beta-blockers may result in different long-term aesthetic outcomes. This study evaluated the difference in long-term aesthetic outcomes between infantile haemangiomas treated with either propranolol or atenolol, including the perspective of physicians, parents, and children. Children, aged ≥6 years, treated with propranolol or atenolol for infantile haemangioma during infancy, participated in this 2-centre cross-sectional study. The primary endpoint was change in appearance of the infantile haemangioma from pre-treatment to follow-up, using a physician-rated visual analogue scale (VAS). Secondary outcomes were the Patient Observer Scar Assessment Scale (physician- and parent-rated) and a VAS (child-rated), assessing the residual lesion. In total, 103 children (35 treated with propranolol, 68 with atenolol) were analysed. No differences were found between children treated with propranolol and children treated with atenolol on physician-rated VAS (p = 0.10) or any secondary outcomes. Physicians indicated a large aesthetic improve-ment from pre- treatment to follow-up. Physicians, parents and children were positive about the current state of the residual lesion. Minor sequelae were common (86%). These results, in combination with the favourable safety profile of atenolol, should be considered when choosing beta-blocker treatment for infantile haemangioma.

Influence of vitamin D receptor polymorphism rs2228570 on pathological scarring.

The physiological process of scarring is a common denominator of interest in a plethora of medical specialties. The molecular basis whereby this process results in pathological scarring for some individuals is poorly understood at present, with clues pointing towards individual predisposition for pathological scarring. Vitamin D and its subsequent pathway plays a key role in skin metabolism and homeostasis, with alterations in the level of vitamin D receptor (VDR) seen within pathological scars. The present study investigated the role of the rs2228570 polymorphism of VDR with regards to scar formation and evolution in a group of 71 female patients recovering from Caesarian section. Blood samples were taken at the time of surgery, and the follow-up was collected remotely at 3 and 6 months after surgery. The rs2228570 polymorphism was investigated using an RFLP-PCR protocol. The results demonstrated that the CC genotype, in combination with the Patient Observer Scar Assessment Scale (POSAS) and SCAR scores are associated with pathological scarring, with more studies being necessary to draw a firm conclusion.

Scar Perception After Two Surgical Approaches for Total Hip Arthroplasty.

BackgroundThere is a paucity of literature examining patients’ and health-care providers’ perception of surgical scars after total hip arthroplasty (THA). This study examined perception of surgical scars after direct anterior (DAA) or posterior approach (PA) for THA using validated scar-assessment scales.Material and methodsSeventy-five DAA and 75 PA THA patients underwent scar assessment using the Patient Observer Scar Assessment Scale (POSAS) and Stony Brook Scar Evaluation Scales. Mean age was different between the cohorts (DAA 67 vs PA 62 years, P = .01). All patients had subcuticular running closure, secured with skin adhesive glue. Mean time from THA to scar assessment was 3.1 and 3.6 years for the DAA and PA groups, respectively (P = .18).ResultsScar opinion on the POSAS patient-reported scale was graded closer to normal skin more often for DAA than for PA patients (P = .03). More irregularities were graded for the DAA scars on the POSAS observer scale (P = .02) and the Stony Brook Scar Evaluation Scales (P = .04). Age did not predict scar opinion on any of the scales (P > .05). Female gender and a history of keloids predicted poorer scar appearance (P = .001 and P = .02). Overall scar appearance was rated as “good” in 93% of the DAA and 91% of the PA patients (P = .63).ConclusionDifferences exist in DAA and PA scar perception based on validated scales. Future randomized trials in scar assessment may control for confounding variables such as age and gender, as well as potential biases when using scar assessment scales.

Role of hTERT rs2736100 in pathological scarring.

Hypertrophic and atrophic scars are the effect of a dysregulated wound-healing process in genetically predisposed individuals. The genetic predisposition has acquired significant attention due to the diverse phenotype of pathological scarring in individuals with a positive personal and family history. Recent studies have identified telomere shortening and decreased hTERT activity in pathological scarring, proposing the rs2736100 variant of human telomerase reverse transcriptase (hTERT) gene as a valuable variant gene candidate. We examined the scarring process in 71 female patients who had undergone Caesarean section and developed hypertrophic and atrophic scars with the objective to investigate the role of single nucleotide polymorphism (SNP) rs2736100 in pathological scarring. Genotyping was performed using RT-PCR and follow-up included the Patient Observer Scar Assessment Scale (POSAS) and SCAR scales. Comparative analysis for mean POSAS value between the check-ups at 3 and 6 months revealed a statistical decreased difference of 1.71 points [95% confidence interval (CI), 0.4-2.89; P=0.01], while SCAR highlighted a decreased difference of 0.670 (95% CI, -0.04-1.38; P=0.055). The C variant allele revealed a borderline statistical value for the risk of developing pathological scarring (OR=1.44; 95% CI, 0.876-1.332: P=0.066). In our study a pre-conceptional body mass index (BMI) >25 kg/m2 was statistically associated with pathological scarring. The Fitzpatrick type 4 phototype displayed an increased frequency for the heterozygous genotype in the current study, and it was demonstrated that dark skin tone was associated with abnormal scar formation. Our study investigated the role of hTERT gene variant rs2736100 in hypertrophic and atrophic scarring in a Caucasian population group. We report a borderline statistically significant value for the variant C allele of hTERT SNP for the risk of developing pathological scarring in female patients that had undergone Caesarean section.

Evaluation of nanofat injection in postburn and post-traumatic facial scars

Background In addition to the physical deformity, there is often great psychological trauma due to facial scars among patients. Fat grafting in its various forms could be considered as a hallmark in scar rejuvenation therapy in the twenty-first century. This is due to the viable adipose-derived stem cells present in the nanofat. Objective The aim of this study was to evaluate the effect of nanofat grafting on postburn and post-traumatic facial scars using a standardized and validated scale [patient observer scar assessment scale (POSAS)] and photographs. Materials and methods A total of 20 patients with facial scars (10 patients post-traumatic and 10 patients postburn) were studied. Preoperative scoring of the scars was performed with the POSAS, and photographs were taken. Fat aspiration was performed from the lower abdomen and thighs using syringe liposuction under tumescent anesthesia. The lipoaspirate was mechanically emulsified, filtered, and injected intralesionally into the scar using a 27 G needle. Postoperative scar reassessment was performed at 3 months using the POSAS scale and photographs. The improvements in scar characteristics and symptoms were tested statistically. Results On statistical analysis, there was a statistically significant improvement in symptoms such as pain, itching, stiffness, thickness and irregularity and scar characteristics such as vascularity, relief, pliability, thickness, and pigmentation 3 months after injection. The photographic comparison also showed good anesthetic outcome. Conclusion Autologous emulsified nanofat injection is effective in improving the scar characteristics as well as symptoms and aiding in scar rejuvenation.

Scar Prevention With Prolonged Use of Tissue Adhesive Zipper Immediately After Facial Surgery: A Randomized Controlled Trial

Postsurgical scar management significantly affects patient satisfaction. However, reliable skin support options are limited. The present study aimed to determine the efficacy and safety of using tissue adhesive zippers in postsurgical scar prevention among patients undergoing surgical excision of the face. The primary outcome was a reduction in scar width, which was evaluated 1, 3, 6, and 12 months postoperatively. Scar width at Month 12 was considered the final outcome. This was a prospective, randomized, controlled, rater-blinded trial. Sixty-four patients were randomly assigned to 2 groups (the zip group, defined as those using a tissue adhesive zipper for 3 months after surgery, and the control group). Outcomes were evaluated 1, 3, 6, and 12 months postoperatively based on scar width and Patient Observer Scar Assessment Scale score. Skin irritation was monitored during the first 3 months after surgery. The incidence of hypertrophic scar formation was recorded at a 12-month follow-up. Scar width differed significantly between the zip (mean [standard deviation], 1.68 [0.45] mm) and control groups (2.15 [0.64] mm). The scars spread rapidly in the first month after surgery but slowed down and stabilized after 6 months. The Patient Observer Scar Assessment Scale scores of the zip group were significantly lower than those of the control group. Neither group experienced significant complications. Prolonged use of tissue adhesive zippers immediately after surgery reduced scar width and improved scar appearance without obvious side effects.

Rectourethral Fistula Induced by Localised Prostate Cancer Treatment: Surgical and Functional Outcomes of Transperineal Repair with Gracilis Muscle Flap Interposition

BackgroundTransperineal repair of rectourethral fistula (RUF) following prostate cancer treatment with gracilis muscle flap interposition (GMFI) leads to favourable outcomes, but published data are still lacking, notably concerning functional aspects. ObjectiveTo assess surgical and functional outcomes of this treatment of RUF. Design, setting, and participantsA retrospective study was conducted in two referral hospitals including 21 patients who underwent RUF transperineal repair with GMFI between 2008 and 2020. Surgical procedureThe standard vertical perineal approach is performed for fistula dissection. Bladder and rectal defects are closed separately. After dissection from its facia, the flap is harvested, preserving its pedicle; it is brought to the perineum and placed between the urethra and the rectum to fully cover the sutures. MeasurementsFistula closure (clinical data and postoperative cystography), digestive stoma closure, and complications graded according to the Clavien-Dindo classification were reviewed. Functional results were assessed using the Urinary Symptom Profile (USP) questionnaire, anal incontinence St Mark’s score, Patient Observer Scar Assessment Scale (POSAS) score, and a nonvalidated Likert scale questionnaire assessing issues with lower extremity functionality. Results and limitationsThe median (interquartile range) follow-up was 27 (8–47) mo. Fistula closure was successful for 20 patients (95% success). Digestive stoma was closed in 10/12 shunted patients (83%). Two (9%) Clavien-Dindo grade ≥3b complications were reported (one urinoma in a kidney transplant patient and one thigh haematoma evacuation). Eighteen patients (86%) completed the postoperative questionnaire; 11/18 (61%) had significant urinary incontinence. The mean (standard deviation) USP dysuria score was 1/9 (1.2), mean St Mark’s score was 5/24 (5), mean POSAS score was 19/70 (11), mean lower extremity functionality score was 2/20 (4), and mean procedure patient satisfaction score was 9/10 (2). The retrospective design and limited number of patients are the main limitations. ConclusionsThe present study found an excellent success rate and low morbidity for RUF transperineal repair with GMFI. Functional outcomes were satisfactory despite a high urinary incontinence rate. Patient summaryWe performed an analysis of the outcomes of perineal approach surgery with muscle interposition for closing abnormal communication between the bladder and the rectum after prostate cancer treatment. This surgical technique was found to be safe to perform and provides a high success rate, with patients being satisfied despite poor urinary continence outcomes.

Efficacy of combined treatment with intense pulsed light and fractional erbium:YAG Laser in scar prevention: A randomized split wound trial.

Various methods have been used for scar prevention; however, the optimal method remains unclear. We investigated the efficacy of combinational intense pulsed light (IPL)/fractional erbium-doped yttrium aluminum garnet (Er:YAG) laser treatment in early wound healing. This was a prospective, randomized, controlled split wound trial. Scars were divided into three sites: the combined IPL/fractional Er:YAG treatment, fractional Er:YAG laser treatment, and untreated control sites. Treatment was conducted in three sessions: at removal of stitches and after 4 and 8 weeks. Treatment efficacy was evaluated using the Patient Observer Scar Assessment Scale (POSAS) and Vancouver Scar Scale (VSS) scores. The erythema index (EI) and melanin index (MI) were measured. In the total POSAS score, the IPL/fractional Er:YAG site showed steady and significant improvement, in contrast to the other sites. At week 8, the combined treatment sites had better POSAS scores than the fractional Er:YAG laser alone sites (p=0.001) and the control sites (p=0.000). The effect of combinational treatment was maintained until the follow-up period by comparing the Er:YAG (p=0.015) and control sites (p=0.007). In terms of VSS scores, the IPL/fractional Er:YAG combined treatment sites had consistent improvement at week 8 (p=0.005) and week 20 (p=0.02) compared to that at week 4, while the other sites showed no such improvement. In conclusion, the combination of IPL and Er:YAG showed more favorable effects on scar prevention than Er:YAG or no treatment. IPL/Er:YAG therapy could be an effective and safe strategy in the early wound healing process for reducing scar formation.

Long-term cosmetic results of video-assisted thyroidectomy: a comparison with conventional surgery.

We present the long-term cosmetic results of the video-assisted thyroidectomy (MIVAT) in comparison to the conventional operation. Forty-eight patients (four males, 44 females; mean age 47.4 ± 12.5 years) constituted the video-assisted group (VA-Group). These were compared with 48 patients (10 males, 38 females; mean age 47.4 ± 12.5 years) operated by conventional surgery (C-Group). The patients were selected from all thyroid operations performed between January 2016 and June 2017. Patient Scar Assessment Scale (PSAS) and Observer Scar Assessment Scale (OSAS) were used for the evaluation performed by an independent surgeon. Both scales contained six items scored numerically on a ten-step scale ranging from 1 (normal skin) to 10 (worst result). Moreover, photos of all scars were taken and analyzed by six team surgeons using modified OSAS. The mean follow-up time was 31.7 ± 6.4 months for the MIVAT group and 32.9 ± 4.6 months for the conventional group (p = 0.39). The mean scar length in the VA-Group was 2.6 cm vs. 3.8 cm in the C-Group (p < 0.0001). The total score of PSAS was 9.93 (6-35) for MIVAT and 9.72 (6-29) for conventional thyroidectomy (p = 0.22). The total OSAS score by the independent surgeon showed a better cosmetic outcome for conventional surgery (13.19 vs. 12.33; p = 0.01). The total OSAS score by the six team surgeons did not differ between both groups in five of six ratings; one surgeon favored MIVAT (12.2 vs. 13.6; p = 0.04). This study does not find cosmetic advantages of minimally invasive video-assisted thyroidectomy compared to conventional thyroidectomy.

Lipofilling as an Adjuvant Therapy for Postburn Grafted Hand: Functional and Aesthetic Outcome.

Background : Background: Fat transfer is widely used as an adjuvant therapy to achieve the deficiencies faced minor burning regeneration. Aim of the study: The study aimed to represent our experience with autologous fat grafting in improving hand function and cosmesis in cases that undergo skin grafts after burns to the hand dorsum. Patient and methods: A case series study where patients aged 16-60 with post-burn grafted hand contractures, evaluating functional and aesthetic outcomes after a single session of lipofilling; A case series study carried out from May 2019 to August 2020 on twenty patients with post-burn grafted hand contractures. All patients underwent autologous fat transfer to their burnt grafted hands. Hand function and cosmesis and Patients’ contentment were evaluated utilizing the Patient Observer Scar Assessment Scale. Results: Follow after lipofilling showed general improvement of the burnt hand. Regarding the assessment of hand function, there was a statistical development throughout the total active movement. Regarding the assessment of patient satisfaction, there were significant improvements in pain, itching, scar color, volume, stiffness, skin softening (P-value< 0.001 for all). Regarding the assessment of doctor opinion, vascularity, pigmentation, pliability, and pain relief were significantly improved (P-value<0.001) Conclusion: Lipofilling is an effective and safe adjuvant therapy to improve the hand's post-burn contractures and aesthetic appearance.

117 Feasibility and Scar Outcome with a Single-use Adhesive Silicone in Pediatric Burn Survivors

Abstract Introduction Silicone sheets are commonly used for prevention and treatment of burn scars and silicone-based products have recently been recommended as the gold standard non-invasive treatment choice. One problem with silicone gel sheets application is that the sheets lose their adhesive qualities making them difficult to affix to the patient and costly to replace when lost. A new ultra-thin, clear and adhesive silicone gel sheet layered on a semi-permeable polyester backing was trialed at our burn center. The silicone is designed to be a one-time application, worn during all activities until it naturally falls off, thus eliminating the need for daily removal and cleaning. The purpose of this study was to evaluate the feasibility and effectiveness of the single-use adhesive silicone sheets with pediatric burn survivors. Methods Medical records of pediatric burn survivors who used the adherent silicone sheets between September 2019 and July 2020 were retrospectively reviewed. Information regarding details of silicone use and scar outcome scores were extracted from the records. Data were analyzed using paired Student t-tests and Wilcoxon Signed Rank to compare scars before and after using the silicone. Results The silicone was applied to 22 body areas of 9 patients. The average age of the patients was 7.4 (±8.5) years and TBSA 53 ±17%. The time from injury or grafting to when the silicone was applied was 200.5 (±13.4) days. The silicone was worn without interruption for an average of 12.8 days. Total Patient Observer Scar Assessment Scale (POSAS) scores for both the patient and observer evaluations significantly improved after use with the single-use adherent silicone (↓13.83 patient p=.005, ↓5.4 observer p=.01). Evaluating individual scar parameters showed 4/7 patient reported and observed areas of the POSAS evaluation improved significantly with adherent silicone use (Figure 1). Only one patient reported a complication of itch at day 5 and the silicone was removed. Conclusions The single-use adhesive silicone investigated in this study appears to adequately adhere to patients over multiple days, thus overcoming common barriers to silicone use of the products falling off, getting lost and needing to be replaced. Use of such a product could improve ease and continuity with scar management. In addition, for this small cohort of patients, scar improvement was noted with silicone use. The results of this study indicate that larger prospective studies evaluating the silicone efficacy may be beneficial.