Patient Scar Assessment Scale Research Articles

Reliability and Validity of the Turkish Version of Patient and Observer Scar Assessment Scale in Patients with Burns

Reliability and Validity of the Turkish Version of Patient and Observer Scar Assessment Scale in Patients with Burns

Observer-blind randomized controlled study of a cosmetic blend of safflower, olive and other plant oils in the improvement of scar and striae appearance.

The normal process of skin tissue repair following injury invariably results in visual scarring. It is known that topical treatment with hydrophobic cosmetics rich in silicone and mineral oil content can improve the appearance of scars and striae. Given lifestyle preferences of many cosmetic consumers towards so-called natural treatments, the objective of this controlled randomized study was to investigate the efficacy of a plant body oil rich in oleic and linoleic acids (Bio Skin Oil® ) for improving the appearance of scars and striae. A panel of 80 volunteers with non-hypertrophic scars (40) or stretch marks (40) not older than 3 years applied a cosmetic face and body oil for 8 weeks. Compared to an untreated scar/stretch mark region, a blinded investigator as well as volunteer assessments with given observed parameters demonstrated the efficacy of the oil under test. On the Observer Scar Assessment Scale (OSAS), the mean score was reduced on the product-treated area by approximately 5% (P = 0.006). The untreated area remained unchanged. Observed effects by volunteers were more pronounced - Patient Scar Assessment Scale (PSAS) giving a reduction of approximately 20% on the treated area, and on the control untreated area a reduction of approximately 6%. The overall product effect of 14% was shown to be clearly significant (P = 0.001). All statements relating to product traits achieved higher frequencies of agreements than of non-agreements and were therefore assessed positively by the volunteers. Highest frequencies of agreements occurred in statements that the test product provides a long-lasting, soft and supple skin feeling (93%); caring effect (87%); and quick absorbance (84%). Agreement was also found for statements that the product improves the skin appearance (61%) and that scars/striae appear less pronounced (51%). Only 17% of volunteers felt the oil had no benefit to the appearance of their scars/striae. The oil blend under test is effective in improving the appearance of non-keloid scars and striae. Further work is required to understand the mechanisms of how plant oil fatty acids ameliorate scar and striae appearance.

Evaluation of the Role of Laparoendoscopic Single-Site Surgery vs Minilaparoscopy for Treatment of Upper Urinary Tract Pathologies: Prospective Randomized Comparative Study.

To present the first prospective randomized comparison between laparoendoscopic single-site surgery (LESS) and minilaparoscopy (ML) for treatment of upper urinary tract pathologies. Between January 2013 and June 2015, patients with different upper urinary pathologies were blindly randomized to both LESS and ML. All procedures were done by single experienced surgeon. Both cohorts were compared regarding demographic data, peri and postoperative characteristics, and visual analog pain scale (VAS). Cosmetic outcome was assessed after 12 months using patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS). Sixty patients were randomized into two equal groups with comparable demographic and preoperative characteristics. Indications included nephrectomy, pyeloplasty, cyst marsupialization, adrenalectomy, and repair of retrocaval ureter. Operative time was 167 ± 24 and 145 ± 39 minutes in LESS and ML groups, respectively (p = 0.09). Estimated blood loss was 59 ± 34 and 43 ± 42 mL in both groups, respectively (p = 0.2). VAS was 1.7 ± 0.6 and 2.8 ± 0.5 in both groups, respectively (p = 0.02). PSAS and OSAS were 5.9 ± 0.85 and 10.6 ± 1.98 vs 8.9 ± 0.9 and 13.5 ± 6.3 in both groups, respectively (p > 0.05). There were no intraoperative complications, conversions to open surgery, or conventional laparoscopy in both groups. Mean postoperative Diclofenac Na was 151.7 ± 35.6 and 169.7 ± 47.3 mg in both groups, respectively (p = 0.04). Postoperative complications rate and hospital stay were comparable between both groups. Both LESS and ML have comparable operative time, blood loss, complication rate, and hospital stay in treatment of upper urinary tract pathologies. However, LESS is associated with less analgesic requirement and better cosmetic outcome.

Effect of platelet-rich plasma on patients after blepharoplasty surgery

ABSTRACTAim: To evaluate the effect of platelet-rich plasma (PRP) treatment on patients after blepharoplasty surgery.Materials and methods: After undergoing blepharoplasty, 20 patients were randomly divided into two groups (n = 10 each). One was treated with autologous PRP and the other was not given any post-surgery treatment (basal group). Autologous PRP application was performed intradermically 24 h, 1 month, and 2 months post-surgery, and the outcome of the applications was assessed 1, 2, and 3 months post-surgery. The postoperative wound was assessed on a patient and observer scar assessment scale (POSAS) by patients and by an unblinded clinical observer. Statistical comparison between the two groups was analyzed by using the Mann–Whitney unpaired, two-tailed test. Significant differences were considered with P ≤ 0.05.Results: Patient-reported data indicate that compared to the basal group, the PRP group showed no significant differences regarding pain, itching, or color, but had better values for stiffness and thickness (months 1 and 2) as well as scar irregularity (month 1). Data reported by the clinical observer showed that in comparison with the basal group, the PRP group showed no differences in vascularization or pigmentation, but had lower (better) scores regarding thickness, relief, and pliability (at all assessment times). The total assessment values from patients and the observer were significantly better for the PRP than the basal group.Conclusion: Autologous PRP treatment enhanced some parameters associated with healing properties, suggesting a potential therapeutic value after blepharoplasty surgery.

Aesthetic principles access thyroidectomy produces the best cosmetic outcomes as assessed using the patient and observer scar assessment scale

BackgroundThyroid carcinoma (TC) is more likely to occur in young women. The aim of this study was to compare the aesthetic effect of different thyroidectomies.MethodsOne hundred twenty female patients who underwent thyroidectomy were evenly distributed into three groups: conventional access (CA), aesthetic principles access (APA) and minimally invasive access (MIA). The Patient and Observer Scar Assessment Scale (POSAS) was used as the assessment tool for the linear scar.ResultsThe patients in the MIA group showed significantly less intraoperative blood loss, less drainage, a shorter scar length and a shorter duration of drainage than those in the CA group and the APA group. However, the operation time of 129.0 min in the MIA group was significantly longer than the 79.6 min in the CA group and the 77.0 min in the APA group. The best aesthetic score, as assessed by the Observer Scar Assessment Scale (OSAS), was obtained in the APA group. The Patient Scar Assessment Scale (PSAS) scores were significantly lower in the APA group and CA group than in the MIA group. Significantly lower objective scar ratings were found in the APA group than in the other two groups.ConclusionThese results show that APA produced the best surgical outcomes in TC patients, indicating that conventional thyroidectomy can produce an ideal aesthetic result using the principles of aesthetic surgery. Thyroid surgery need not be performed through excessively short incisions for the sake of patient satisfaction with the scar’s appearance.Trial registrationThis clinical trial was retrospectively registered on ClinicalTrials.gov PRS on August 1st,2017 (NCT03239769).

Advantages of Single-Port Laparoscopic Myomectomy Compared with Conventional Laparoscopic Myomectomy: A Randomized Controlled Study

Study ObjectiveTo compare operative outcomes of single-port laparoscopic myomectomy (SP-LM) vs conventional laparoscopic myomectomy (CLM), including subjective and objective cosmetic aspects. DesignProspective randomized controlled trial (Canadian Task Force classification I). SettingUniversity hospital. PatientsWomen with uterine myoma scheduled for laparoscopic myomectomy. InterventionsSixty-six women were assigned at random to either the SP-LM or CLM group. Surgical outcomes, including patient and observer scar assessments, were evaluated between the groups according to the intention-to-treat principle. Measurements and Main ResultsThere were no significant differences in demographic characteristics and properties of myomectomy between the groups. There also were no differences in surgical outcomes, such as operation time, estimated blood loss, and complications, between the 2 groups. The mean total score of the Observer Scar Assessment Scale was lower in the SP-LM group at 1 week (13.0 ± 3.2 vs 18.3 ± 4.8; p < .001) and 8 weeks (9.9 ± 3.2 vs 14.3 ± 3.8; p < .001) after discharge. Similar results were obtained for the Patient Scar Assessment Scale at 1 week (11.6 ± 7.2 vs 18.5 ± 12.8; p = .024) and 8 weeks (9.5 ± 6.0 vs 18.8 ± 9.1; p < .001) after discharge. Postoperative pain and analgesic consumption did not differ between the groups, except in patient-controlled analgesia consumption at 6 hours after operation, which was lower in the SP-LM group (12.7 ± 6.3 mL vs 16.4 ± 6.2 mL; p = .039). Operative outcomes were similar in the 2 groups. ConclusionSP-LM is associated with more favorable cosmetic outcomes and better patient satisfaction compared with CLM. There were no differences in operative outcomes and complications between the 2 modalities.

A new treatment for reliable functional and esthetic outcome after local facial flap reconstruction: a transparent polycarbonate facial mask with silicone sheeting

BackgroundFacial flap surgery predominantly leads to good functional results. However, in some cases, it can cause unsatisfactory esthetic results. They include persistent erythema, pincushioning, and development of hypertrophic scars. Conservative, reliable treatment for facial flaps is lacking. Pressure and silicone therapy have proven to result in significant improvement in scar erythema, pliability, and thickness in postburn hypertrophic scars. By combining these therapies in a facial mask, the esthetic outcome of facial flaps could be improved. In this retrospective study, the efficacy of a unique transparent face mask containing silicone sheets on the esthetic outcome of postsurgical facial flaps is assessed.MethodsTwenty-one patients were assigned to facial pressure mask therapy after they underwent facial flap surgery between July 2012 and September 2015. Patients were treated for a mean duration of 46 weeks. The effects of pressure mask therapy were examined by means of the Patient and Observer Scar Assessment Scale (POSAS).ResultsAll POSAS components showed a reduction between start and end of therapy, while itchiness, pigmentation, pliability, thickness, and relief of the flap improved significantly (P < 0.05). Mean total and patient score showed significant reduction between start and end of therapy.ConclusionsThis study shows that a facial pressure mask layered with silicone results in noticeable flap improvement with a long-lasting result.Level of Evidence: Level III, therapeutic study.

Observation on the clinical application effects of skin distractor on the treatment of scars

Objective: To explore clinical application effects of skin distractor on the treatment of scars and to observe effects of skin distractor with different pull speeds on different parts scars of human body. Methods: One hundred and four patients with scars, conforming to the study criteria, were hospitalized in our unit from January 2014 to June 2015. Patients were divided into 2 mm/d group and 4 mm/d group according to the random number table, with 52 patients in each group. After admission, skin distractors were pasted on scars in face and neck, trunk, and extremities of patients in 2 groups, with inner edges of pasteboards close to outside edges of longer sides of scars. Skin distractors in 2 mm/d group and 4 mm/d group were pulled to scars axis direction as speeds of 2 mm/d and 4 mm/d, respectively. Pull time equals values of pull speeds divided by width of scars. Scars were resected after finishing pulling. Immediately after scars resection, skin distractors were pasted again with inner edges of pasteboards close to outside edges of longer sides of incision and removed when stitches were taken out. Scars of patients were scored by Vancouver Scar Scale (VSS), and Patient and Observer Scar Assessment Scale (POSAS) was used to record scores of patient scar assessment scale (PSAS), observer scar assessment scale (OSAS) and overall scores of patients and observers of scars of patients before and one year after scars resection. Data were processed with χ(2) test, independent samples t test, paired samples t test, independent samples non-parametric rank-sum test and paired samples non-parametric rank-sum test. Results: (1) Scores of all scars of patients in 2 groups before scars resection were close (with t values from -1.384 to 0.622, P values above 0.05), obviously higher than those of one year post scars resection (with t values from 11.085 to 24.835, P values below 0.01). Scores of scars in face and neck, trunk and extremities in 2 groups before scars resection were close (with Z values from -1.651 to -0.035, t values from -1.549 to 0.219, P values above 0.05), significantly higher than those of one year post scar resection (with Z values from -2.992 to -2.555, t values from 8.739 to 19.076, P values below 0.01). (2) Scores of all scars of patients in 2 mm/d group of one year post scars resection were lower than those in 4 mm/d group (with t values from -2.583 to -2.018, P values below 0.05). PSAS scores of scars in face and neck and trunk in 2 mm/d group of one year post scars resection were lower than those in 4 mm/d group (with Z values respectively -2.385 and -2.198, P values below 0.05), other scores of scars in face and neck and trunk of patients in 2 groups of one year post scars resection were close (with Z values from -1.841 to -0.363, P values above 0.05). VSS scores, PSAS scores, OSAS scores, patients' overall scores, and observers' overall scores in 2 mm/d groups were (4.6±0.8), (28±4), (28±4), (4.7±0.7), (4.8±1.4) points, respectively, lower than those in 4 mm/d group[(5.2±0.8), (32±4), (31±6), (5.5±1.2), (5.5±1.0) points, respectively, with t values from -3.712 to -2.105, P<0.05 or P<0.01]. Conclusions: Skin distractor has better effects on the treatment of scars, and treatment effects of skin distractor in extremities pulled by 2 mm/d are better than those pulled by 4 mm/d.

A prospective randomized study in 20 patients undergoing bilateral TKA comparing midline incision to anterolateral incision

BackgroundLateral flap numbness is a known side-effect of midline skin incision in total knee arthroplasty (TKA) and a cause of patient dissatisfaction. Anterolateral incision is an alternative approach which preserves the infrapatellar branches of the saphenous nerve and avoids numbness. Studies have compared both incisions, but in different patients. However, different patients may assess the same sensory deficit dissimilarly, because of individual variations in anatomy and healing responses. We compared the two incisions in the same patient at the same time, using an anterolateral incision on one knee and a midline incision on the other knee in simultaneous bilateral TKA. Other surgical steps including medial arthrotomy were idential. We also correlated subjective and objective findings.Materials and methodsTwenty patients were prospectively randomized. Sensory loss and skin healing were assessed at 6, 12 and 52 weeks. Subjective preference for the knee with less numbness was charted on Wald’s Sequential Probability Ratio Test. Sensation scores for touch, vibration, static and moving two-point discrimination were measured. Scar healing was evaluated using the Patient and Observer Scar Assessment Scale (POSAS). Functional scores were measured.ResultsA statistically significant difference favoring knees with anterolateral incision was observed in patient preference at all assessment points and this correlated with sensation scores. A statistically significant difference was observed in POSAS score favoring knees with anterolateral incision at 6 and 12 weeks which became statistically insignificant at 1 year. Functional scores remained comparable.ConclusionWe recommend anterolateral incision as a safe and effective method to circumvent the problem of lateral flap numbness with midline incision.Level of evidenceI.

Patient body image, self-esteem, and cosmetic results of minimally invasive robotic cardiac surgery

BackgroundPatient-reported outcome measures reveal the quality of surgical care from the patient's perspective. We aimed to compare body image, self-esteem, hospital anxiety and depression, and cosmetic outcomes by using validated tools between patients undergoing robot-assisted surgery and those undergoing conventional open surgery. Materials and methodsThis single-center, multidisciplinary, randomized, prospective study of 62 patients who underwent cardiac surgery was conducted at Hospital from May 2013 to January 2015. The patients were divided into two groups: the robotic group (n = 33) and the open group (n = 29). The study employed five different tools to assess body image, self-esteem, and overall patient-rated scar satisfaction. ResultsThere were statistically significant differences between the groups in terms of self-esteem scores (p = 0.038), body image scores (p = 0.026), overall Observer Scar Assessment Scale (p = 0.013), and overall Patient Scar Assessment Scale (p = 0.036) scores in favor of the robotic group during the postoperative period. Robot-assisted surgery protected the patient's body image and self-esteem, while conventional open surgery decreased these levels but without causing pathologies. Preoperative depression and anxiety level was reduced by both robot-assisted surgery and conventional open surgery. The groups did not significantly differ on Patient Satisfaction Scores and depression/anxiety scores. ConclusionThe results of this study clearly demonstrated that a minimally invasive approach using robotic-assisted surgery has advantages in terms of body image, self-esteem, and cosmetic outcomes over the conventional approach in patients undergoing cardiac surgery.

Objective and subjective scar aesthetics with topical Manuka honey post-thyroidectomy: A randomized control study.

ObjectiveLeptospermum Honey (Manuka honey) has proven to be effective in improving acute and chronic wound healing presumably due to its antibacterial and anti-inflammatory properties. The aim is to determine if Manuka honey decreases scar formation and results in a cosmetically appealing scar.MethodsA prospective single-blinded randomized control trial was performed. All patients received an 8 cm incision. Patients randomized to honey treatment were instructed to apply Manuka honey paste topically to the incision site once per day post surgery for 4 weeks. The patients' scar was then analyzed objectively by a blinded observer and subjectively at 4 and 8 weeks postoperatively. The primary outcome measure used was the Patient and Observer Scar Assessment Scale (POSAS).ResultsA total of 21 patients completed the entire scar analysis (honey treatment = 9, standard treatment = 12). There was no statistically significant difference between patient scar assessment scale and observer scar assessment scale at 4 and 8 weeks postoperatively.ConclusionDespite Leptospermum Honey's reported anti-inflammatory and antibacterial properties, this study did not show a difference in scar appearance when applied.

Reliability of the Patient and Observer Scar Assessment Scale and a 4-point scale in evaluating linear facial surgical scars.

In order to evaluate and improve aesthetic outcome for patients undergoing dermatological surgery, a reliable evaluation tool must be used. The 4-point scale and the Patient and Observer Scar Assessment Scale (POSAS) were both developed for this purpose. To compare the reliability of the POSAS scale with the 4-point scale for facial linear surgical scars and to assess the influence of different scar characteristics on the overall impression. Patients visiting the outpatient clinics of the Maastricht University Medical Centre with linear facial scars were included. The 4-point scale and the Observer Scar Assessment Scale (OSAS) were completed by three independent observers. The Patient Scar Assessment Scale (PSAS) was completed by the patient on the day of the visit and 2 weeks later. The intra-class correlation coefficient (ICC) with corresponding 95% confidence intervals (CI) were calculated to assess the reliability of the scales. Linear multivariate regression analyses were performed to evaluate how the score on each aspect affected the overall opinion. Fifty scars in 50 patients were included. The ICC of the 4-point scale was 0.819 (95% CI: 0.708-0.892) for multiple observers and 0.602 (95% CI: 0.447-0.734) for single observer. These were superior to the ICCs of total OSAS scores (0.783 95% CI: 0.547-0.888 for multiple observers and 0.546 95% CI: 0.287-0.726 for single observer). ICCs of individual sub-items on the OSAS scored even lower. The sub-items contributed differently to the overall opinion among the different observers or patient. In terms of reliability, the overall opinion and the 4-point scale were superior to the total POSAS score or the sub-items. Observers do not weight individual scar characteristics equally to arrive at an overall opinion, which challenges the assumption that calculating a total POSAS score by summing of the scores on the individual items is a valid approach.

Usability and effectiveness of Suprathel\xae in partial thickness burns in children

PurposeEvaluation of usability and effectiveness of Suprathel® in the treatment of partial thickness burns in children.MethodsA prospective, observational study to evaluate adherence of Suprathel® to the wound bed, reepithelialization time, grafting, wound colonization and infection, pain, dressing changes, length of hospital stay (LOS) and scar formation.ResultsTwenty-one children (median age 2.4 years, range 5 months–14 years) with a median total body surface area (TBSA) of 4 % (range 1–18) were included. Median LOS was 10 days (range 3–20). Median outer layer dressing changes was 3 (range 1–14). Suprathel® was only adherent in wounds debrided with Versajet®. Median reepithelialization time was 13 days (range 7–29). Three patients needed a split skin graft. There were 7 (33 %) patients with wound colonization before application of Suprathel®. This increased to 12 (57 %) patients during treatment. One patient developed a wound infection. Median visual analog scale (VAS) scores for background and procedural pain in patients >7 years were 3.2 (range 2–5) and 3.5 (range 2–5), respectively. In younger patients, median background and procedural COMFORT-B scores were 13.8 (range 10–23) and 14.8 (range 13–23, p = 0.03), respectively. Patient and Observer Scar Assessment Scale (POSAS) scores were favorable after 3 and 6 months post burn.ConclusionsSuprathel® provides potential advantages regarding pain and scar formation, but extensive wound debridement is needed to achieve adequate adherence.

Reduced low-traumatic access thyroidectomy with central neck dissection

Background. In the year 2014 in Russia there were about 10 thousand patients with newly diagnosed thyroid cancer (TC), the bulk of which need surgical treatment. Currently, special requirements to the quality of surgical intervention, which is determined by the radicalness, minimum number of complications and a good cosmetic result. Materials and methods. In this paper we present the treatment results of 76 patients with differentiated TC, who received surgical treatment at S.P. Botkin City Clinical Hospital in 2012–2015. All patients underwent an extrafascial operation under general anesthesia in volume thyroidectomy with central lymph node dissection. The operation was carried out with reduced low-traumatic approach length 4–5 sm in front the neck without crossing prelaringeal muscules. For prophylaxis of laryngeal paresis, visualization and indenification laryngeal nerves were performed, with using magnifying devices and neuromyography. To prevent the development of hypoparathyroidism, visualization and preservation of the parathyroid glands was also conducted. To this end, among other measures, a photodynamic method of parathyroid gland visualization using a photosensitizer, a blue light source and local spectroscopy was employed. Results. In the postoperative period, there were 3 (3.9 %) cases of transient hypoparathyroidism. On the scale of intervention POSAS (Patient and observer scar assessment scale) 68 (89.5 %) patient was recognized as a excellent, and 8 (10.5 %) as good. Conclusion. Thus, thyroidectomy and central neck dissection with reduced low-traumatic approach using the suggested methodological approaches gives completeness of our surgical intervention, possibility to avoid the development of permanent specific complications, and better functional and aesthetic results.

MP23-16 EVALUATION OF THE ROLE OF LAPAROENDOSCOPIC SINGLE-SITE SURGERY VERSUS MINILAPAROSCOPY FOR TREATMENT OF DIFFERENT UPPER URINARY TRACT PATHOLOGIES: PROSPECTIVE RANDOMIZED COMPARATIVE STUDY

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I1 Apr 2016MP23-16 EVALUATION OF THE ROLE OF LAPAROENDOSCOPIC SINGLE-SITE SURGERY VERSUS MINILAPAROSCOPY FOR TREATMENT OF DIFFERENT UPPER URINARY TRACT PATHOLOGIES: PROSPECTIVE RANDOMIZED COMPARATIVE STUDY Aly Abdel-Karim, Elsaid Yahia, Mohamed Hassouna, and Salah Elsalmy Aly Abdel-KarimAly Abdel-Karim More articles by this author , Elsaid YahiaElsaid Yahia More articles by this author , Mohamed HassounaMohamed Hassouna More articles by this author , and Salah ElsalmySalah Elsalmy More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.738AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Direct comparative prospective studies between laparoendoscopic single-site surgery (LESS) and minilaparoscopy ML are still lacking. We present the first prospective double-blind randomized study to compare between LESS and ML for treatment of different upper urinary tract pathologies. METHODS During the period of January 2013 and June 2015, patients with different upper urinary pathologies who were candied for laparoscopic surgical intervension were blindly randomized to both LESS and CL. ML was done by 3-mm instruments; including 3-mm laparoscope. All procedures were done by a single experienced laparoscopist. Exclusion criteria included children less than 3 years and absolute contraindications of laparoscopy. Both groups were compared regarding patients demographic data, operative time, intraoperative and postoperative complications, estimated blood loss (EBL), hospital stay, analgesic requirement, visual analogue pain scale (VAS) on discharge and cosmetic outcome. Cosmetic outcome was assessed at 6 months postoperatively using the patient scar assessment scale (PSAS) and observer scar assessment scale (OSAS). RESULTS Included were 60 patients with mean age of 40.7±9.2 years and 39.6±16.7 years both in LESS and ML, respectively. Mean BMI was 29.5±3.4 and 28.6±4.37 kg/m2 in LESS and ML groups, respectively. In LESS group there were 2 adrenalectomies, 9 nephrectomies (5 simple and 4 radical), 9 pyeloplasties and 9 cyst marsuplizations and a case of retrocaval ureter. While in ML group there were 3 adrenalectomies, 9 nephrectomies (5 simple and 4 radical), 9 pyeloplasties and 9 cyst marsuplizations. Operative time in LESS was 167 ±24 min which was longer than that of ML group (145±39 min) but statistically insignificant. EBL in LESS was 59±34 ml Vs 43± 42 ml in ML and the difference was statistically insignificant. VAS was significantly less in LESS group (1.7±0.6 in LESS and 2.8±0.5 in ML). In LESS group, PSAS was 5.9±0.85 while OSAS was 10.6±1.98. Meanwhile, In ML group, PSAS was 8.9±0.9 and OSAS 13.5±6.3. The difference was statistically significant. There were no intra-operative complications in both groups. Post-operative complications were reported in 6.6% and 3.3% both in LESS and ML groups; respectively. Mean hospital stay was 1.8±1.3 days in LESS Vs 2.1±0.8 days in ML. Mean analgesic requirements in the post-operative period was 151.7±35.6 mg of Diclofenac Na in LESS Vs 169.7±47.3 mg in ML. There were no conversions to either open surgery or conventional laparoscopy in both groups. 5-mm extra port was added in 4 cases of LESS. Meanwhile, in ML group we used a 10-mm port in 12 cases in order to use the Hem-O-lock clip applier. CONCLUSIONS Both LESS and ML are feasible and safe options for treatment of different upper urinary tract pathologies with comparable operative time, blood loss, hospital stay and complication rate. However, LESS is associated with less analgesic requirement and better cosmetic outcome. Each procedure has its own technical limitations. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e267-e268 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Aly Abdel-Karim More articles by this author Elsaid Yahia More articles by this author Mohamed Hassouna More articles by this author Salah Elsalmy More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Retroauricular full-thickness skin grafts in syndactyly repair: outcome and comparison with inguinal full-thickness skin grafts: retrospective (cross-sectional) study

Objective: Most surgeons recommend the use of full-thickness skin grafts for syndactyly repair. Common donor sites include the groin and elbow, but only one publication has previously mentioned retroauricular skin. No publication has compared the results for full-thickness skin grafts between retroauricular and other donor sites. This study aims at comparing functional and aesthetic outcomes and parents’ satisfaction with retroauricular vs inguinal full-thickness skin grafts. Methods: Eleven children with retroauricular and 15 with inguinal full-thickness skin grafts were included in this retrospective study. Examination included the Patient and Observer Scar Assessment Scale, parent satisfaction, and a colour match measurement. Results: Both pigmentation match and parents’ overall impression of the donor site were significantly better for retroauricular than for inguinal full-thickness skin grafts. Conclusion: Due to the excellent pigmentation match and the inconspicuousness of the donor site, this study recommends the use of retroauricular full-thickness skin grafts for syndactyly repair.

The three flaps technique in severe Dupuytren's contractures. Technique and clinical evaluation

Introduction Many techniques have been described to cover the skin defect created by perioperative extension of the joints after fasciectomy in Dupuytren's finger contracture. Material and methods In severe stages of Dupuytren's contractures, we have been using a combination of three flaps, designed to allow a full primary closure of the skin incisions, even in grades III or IV of this disease. This strategy includes a palmar advancement flap (similar to the so-called “Hueston's flap”). A rotational lateral triangular flap (similar to those designed by Colson and Razemon) and an opposite distally based palmar triangular flap (similar to those described by Harrison and Pelissier). Results obtained with this combination spurred us on to undertake a retrospective study to look at the efficiency of this strategy. We looked for local complications, scar quality, pre- and postoperative extension scores. Results Among the 10 patients we reviewed, ten combinations of three flaps were performed (mostly 3rd and 4th fingers). Four patients had preoperative stage IV, three stage III and three stage II contracture. No one needed volar skin graft. No local complication occurred, especially no flap necrosis (partial or total). Average patient and Observer Scar Assessment Scale score was 29.2 over 120 [13–56], which can be considered satisfying, 12 being the score for normal skin and 120 for the worst scar imaginable. At the time of the revision, finger extension was complete for three patients, six had stage I and one stage II lack of extension. Mean revision time was 9.5 months [1–23]. Discussion In our experience, the three flaps technique permits to achieve primary closure even in severe cases of contracture, when perioperative extension of the finger leads to an extensive skin defect. It gives satisfying clinical results with low morbidity and permits to avoid volar skin graft. Although a longer follow-up should be required to fully establish the efficiency of this technique, early results are promising. Careful and precise planification of the three flaps is required to get full advantage from this technique. Conclusion The three flaps technique is a simple and reliable method for volar skin closure after fasciectomy in Dupuytren's disease when skin defect is important.

Skin closure methods after single port laparoscopic surgery: a randomized clinical trial

ObjectiveTo compare postoperative cosmetic outcomes according to different umbilical closure methods after single port laparoscopic surgery (SP-LS). Study designA total of 138 women who were scheduled to receive elective SP-LS were randomized to undergo closure of the umbilical incision with either a subcutaneous suture only without subcuticular skin suture (case group, n=68) or both a subcutaneous suture and subcuticular skin suture (control group, n=70) after fascial closure. At postoperative months 1 and 3, the umbilical scar was evaluated using the Vancouver scar scale (VSS), the patient and observer scar assessment scale, and a visual analog scale (VAS). Overall satisfaction with scar cosmesis and surgery was assessed with the VAS. ResultsThere was no significant difference in the clinical characteristics and operative data between the groups. The objective and subjective scar assessments and the overall satisfaction with scar cosmesis were not different between the groups. In the control group, four (5.7%) women experienced wound discharge and were treated with conservative treatments and delayed closure. In women who completed the first and second assessments, the changes in the scar assessment and overall satisfaction with the scar according to time after surgery were not different in either group, but the patient scar assessment scale in both groups and the VSS in the case group improved. ConclusionsAfter SP-LS, the approximation of the fascia and subcutaneous layer seems to be enough for the closure of an umbilical incision. Skin closure with subcuticular sutures did not improve the postoperative cosmetic outcomes and might lead to impaired wound healing. However, large randomized trials with various closure techniques and materials are needed to confirm this finding.

A randomized controlled trial comparing cosmetic outcome after skin closure with ‘staples’ or ‘subcuticular sutures’ in emergency Cesarean section

To compare staples with subcuticular sutures for skin closure in emergency Cesarean sections (CS). One hundred and thirty women (undergoing emergency CS without previous abdominal delivery) were randomly assigned to either staples or subcuticular skin closure (monocryl 3-0). Primary outcome of the study was cosmetic outcome [as assessed by patient and independent observer: Patient Scar Assessment Scale (PSAS) and Observer Scar Assessment Scale (OSAS), respectively], 6weeks post-operative. Secondary outcomes were wound complications, operating time, post-operative pain (visual analogue scale day 3 post-operative and patient assessment of pain in scar 6weeks post-operative), and duration of hospital stay. 112 women were available for evaluation of scar 6weeks post-operative. Cosmetic result of staples was significantly better than subcuticular sutures (PSAS and OSAS: p value 0.022 and 0.000, respectively), with significantly lesser duration of surgery (24 vs. 32min: p value 0.000) and comparable post-operative pain (pain on day 3 and 6weeks post-operatively: p value 0.474 and 0.179, respectively) and wound complications (p value 0.737). However, duration of stay in hospital was increased (6 vs. 3days: p value 0.001). Staples are the method of choice for skin closure in emergency CS as they are significantly better than subcuticular sutures with respect to cosmesis and duration of surgery. Post-operative pain and wound complications are comparable in two groups. However, staples are associated with significantly increased duration of hospital stay. Trial registered in clinical trial registry CTRI: REF/2013/05/005087.

Continuous Absorbable Intradermal Sutures Yield Better Cosmetic Results than Nonabsorbable Interrupted Sutures in Open Appendectomy Wounds: A Prospective, Randomized Trial

Acute appendicitis is the most common reason for abdominal surgery in young adults and children. Open appendectomy is still the treatment often chosen because it is simple, safe, and effective. Our aim was to study whether cosmetic results of appendectomy wounds are better after using continuous absorbable intradermal (A) sutures compared with wound closure with interrupted nonabsorbable (NA) sutures. A total of 206 adult patients with clinically suspected appendicitis were allocated to the study and prospectively randomized into two wound-closure groups: the interrupted NA suture group and the A suture group. Of these, 193 patients with sufficient data were invited to the outpatient clinic for cosmetic analysis. Cosmetic results were evaluated after a median of 14 months. For subjective scar assessment, the Vancouver scar scale, the patient and observer scar assessment scale (POSAS), and a visual analog scale (VAS) were used. Objective evaluation was carried out by measuring surface area, average width, and estimated concentration change (ECC) of hemoglobin and melanin in the scar using spectrocutometry. For statistical analyses we used the Mann-Whitney test and Student's t test. Both objective and subjective analyses showed better cosmetic results for absorbable intradermal suturing. The difference between the two groups was statistically significant as regards POSAS in both patient (p = 0.032) and observer scales (p = 0.001), and VAS (p = 0.002). Scar surface area was significantly smaller in group A than in group NA (p = 0.002). ECC measurements showed higher values for melanin in group NA than in group A (p = 0.034). Continuous intradermal absorbable suturing yields a better cosmetic result than interrupted nonabsorbable suturing in lower abdominal transverse appendectomy.