Residual Scarring Research Articles

Long-Term Assessment of Aesthetic Results in Omphalocele Repair with POSAS Scale.

Omphalocele (OM) is a congenital defect of the abdominal wall. The main goal of the surgical management is the survival of the neonate. However, the residual scar following the surgery can be extremely burdensome and negatively impact the quality of life (QoL) of these patients. The aim of this study is to assess the cosmetic results of the surgical treatment, the level of satisfaction of patients and surgeons, and the influence of the scar on the QoL of the patient. We conducted an observational retrospective cross-sectional study collecting all data regarding patients born with OM, operated at our Centre between 1998 and 2021. The cosmetic results of the surgical repair were evaluated using the validated Patient and Observer Scar Assessment Scale (POSAS). The assessment of the quality of life determined by the presence of the scar was conducted using PedQL 4.0. At last, the patients were visited by two paediatric surgeons and a medical student, which then scored the cosmetic result of the scar. Statistical analysis was conducted with Spearman linear correlation and Mann-Whitney test. A P-value below 0.05 was considered statistically significant. In our study, we included a total of 19 patients, with a mean of 12 years of age at the time of the evaluation. The parameters with the major influence on the patient's general opinion of the scar were stiffness, thickness, and irregularity. We discovered significant differences in median values of all scores between the giant OM group and the nongiant OM group, in favour of the latter. Finally, we found a low grade of concordance between PedsQL filled by parents and patients. The POSAS scale is a valid, feasible, and reliable tool for the assessment of the aesthetic outcome of surgical procedures. The original size of the defect is the most important factor acting on the result. However, it is crucial that any decision on plastic surgery to improve the looks of the scar must be postponed to the adult age of the patient. 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 .

Correlates of markers of dyssynchrony in patients with STEMI and multivessel disease: an analysis from the IAEA SPECT STEMI trial.

In this substudy of the Value of Gated-SPECT MPI for Ischemia- Guided PCI of non-culprit vessels in STEMI Patients with Multi vessel Disease after primary PCI trial after primary PCI we aim to assess if infarct size affects conventional measures of dyssynchrony at rest. Additionally, we explore if there is an independent correlation of stress-inducible ischemia with dyssynchrony at rest. The 48 patients with imaging at randomization were analyzed. Gated-single-photon emission computed tomography (SPECT) MPI with vasodilator stress and technetium-99m-labeled tracers was performed. The phase histogram bandwidth (HBW), phase SD, and entropy were obtained with the QGS software. Correlation between dyssynchrony at rest and infarct size and inducible ischemia was performed using the Spearman test. According to normal database limits dyssynchrony parameters at rest were abnormal for men. In women only HBW was abnormal. Correlation between the summed rest score with dyssynchrony was significant only for entropy ( P = 0.035). No correlation was observed for dyssynchrony and stress-induced ischemia. Entropy, as a measure of dyssynchrony, has potential in the assessment of patients with STEMI and multivessel disease after primary PCI. Smaller residual myocardial scars in PCI-reperfused patients with STEMI may contribute to the lack of correlation between dyssynchrony at rest and infarct size and stress-induced ischemia, respectively.

(219) Lengthening Phalloplasty: Combined Technique of a Urologist and a Plastic Surgeon

Abstract Introduction Lengthening phalloplasty is an operation that aims at increasing the length of the penile shaft. This procedure has been gaining popularity with different surgical techniques being described and possible suboptimal patient satisfaction rate that can be optimized. The most popular surgical method used for penile lengthening is release of the suspensory ligament. Our technique differs as it involves a combination of urological and plastic surgical steps to achieve the maximum length with the safest optimum outcome. Objective We are advocating the above unique modified surgical technique aiming to achieve the desired results with higher satisfaction rate. Methods A retrospective study including consecutive male patients presenting for penile lengthening over the last 6years. Patients underwent pre-operative andrology and psychological evaluation. All procedures were performed by the same urologist and plastic surgeon simultaneously. A successful surgical outcome is defined as: achieving a lengthening equal to or more than 2cm. Results A total of 82 married male patients were included. The age ranged from 26 to 40 years with a median of 33years. They had normal sexual activity with no psychiatric nor behavioural disturbance. The average pre-operative penile length was: 9.75 cm. the average additional penile lengthening achieved post-operatively was: 3.7 cm. with a range of 2.8 to 4.7 cm. There was no major complications or failure of the procedure observed. One patient suffered from partial wound dehiscence following return to sexual activity two week after surgery. Patients satisfaction with the outcome 6 months following surgery reached 31/32 with a single case of dissatisfaction owing to the residual scar (success rate of 97%). Conclusions We have concluded that using our multimodality technique that this type of phalloplasty is a safe procedure with 100% anatomical surgical success rate in achieving the desired length gain and overall patient satisfaction rate of 97% which has not been reported using the standard procedure. Disclosure No.

Intermittent Topical Bevacizumab for Treatment of Pediatric Corneal Neovascularization after Keratitis

Introduction : Corneal neovascularization imposes pediatric patients to risk of amblyopia. Current treatment of corneal neovascularization consists of topical steroids, nonsteroidal anti-inflammatory medications, immunomodulatory agents, anti-Vascular Endothelial Growth Factor (anti-VEGF) and few surgical procedures. Anti-VEGF shows promising results in treating corneal neovascularization but is difficultto obtain in developing countries such as Indonesia. We report intermittent topical use of Bevacizumab as antiVEGF in a child experiencing corneal neovascularization in the settings of limited antiVEGF availability.
 Case Illustration : A 5-year-old girl presented with corneal neovascularization after keratitis. Topical fluorometholone 4 times a day for 3 weeks was given with no clinical improvement. An intermittent topical Bevacizumab was started, each episode of treatment lasted 4 days. Corneal neovascularization regressed after 1 episode of treatment and thus continued until a total of 2 treatment episodes. She improved clinically on treatment, with some residual corneal scarring. Visual acuity improved from logMar 0.5 to logMar 0.2 following treatment.
 Discussion : Bevacizumab regresses corneal neovascularization by inhibiting proangiogenic factor VEGF which is upregulated in neovascularization. Topical Bevacizumab ability to penetrate cornea was contributed by defective corneal epithelial overlying neovascularization. Long-term use of antiVEGF may hinder VEGF beneficial role on wound recovery and trigger unwanted side effects.
 Conclusion : Intermittent short-term use of topical bevacizumab may be effective to treat corneal neovascularization during acute period in pediatric patient and is safely tolera

Lichen Striatus: An Updated Review.

Lichen striatus is a benign dermatosis that affects mainly children. This condition mimics many other dermatoses. The purpose of this article is to familiarize pediatricians with the clinical manifestations of lichen striatus to avoid misdiagnosis, unnecessary investigations, unnecessary referrals, and mismanagement of lichen striatus. A search was conducted in June 2023 in PubMed Clinical Queries using the key term "Lichen striatus". The search strategy included all observational studies, clinical trials, and reviews published within the past ten years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of this article. Lichen striatus is a benign self-limited T-cell mediated dermatosis characterized by a linear inflammatory papular eruption seen primarily in children. The onset is usually sudden with minimal or absent symptomatology. The eruption in typical lichen striatus consists of discrete, skin- colored, pink, erythematous, or violaceous, flat-topped, slightly elevated, smooth or scaly papules that coalesce to form a dull red, potentially scaly, interrupted or continuous band over days to weeks. Although any part of the body may be involved, the extremities are the sites of predilection. Typically, the rash is solitary, unilateral, and follows Blaschko lines. In dark-skinned individuals, the skin lesions may be hypopigmented at onset. Nails may be affected alone or, more commonly, along with the skin lesions of lichen striatus. The differential diagnoses of lichen striatus are many and the salient features of other conditions are highlighted in the text. Lichen striatus is a self-limited condition that often resolves within one year without residual scarring but may have transient post-inflammatory hypopigmentation or hyperpigmentation. As such, treatment may not be necessary. For patients who desire treatment for cosmesis or for the symptomatic treatment of pruritus, a low- to mid-potency topical corticosteroid or a topical immunomodulator can be used. A fading cream can be used for post-inflammatory hyperpigmentation.

P29 Erosive and vesicular dermatitis

Abstract We present a case of a 3 year old girl, born at term via normal vaginal delivery, with significant erosive lesions present from birth. Finger and toenails were small and she was systemically well. At day three, there was already evidence of healing and by week two, the erosions had almost fully healed with residual scaling. Once fully resolved, areas of hypopigmented, reticulate scarring remained. Investigations included swabs for bacterial, fungal and viral infections were negative. There was no concern regarding perinatal infection and apart from oligohydramnios, there were no other issues in pregnancy. She was managed on the burns unit with nutritional support, antibiotics, emollients and dressings. She subsequently developed a left micro-ophthalmia and cataract, right severe myopia and a mild developmental delay with microcephaly. Older siblings aged 7 and 5 had a history of mild developmental delay and microcephaly. Parents had no relevant medical issues and were both of Jewish background. Genetic testing was carried out which did not identify a genetic cause with normal microarrays of her siblings. A diagnosis of vesicular and pustular dermatosis was made, a rare condition, first described in 1985 by Cohen et al. Lesions typically consist of erythema, erosions, crusting, vesicles and fissures which start to heal within 10 days with residual reticulate scarring. Most cases occur in premature infants, making our case less typical. Nail, ophthalmological abnormalities and developmental delay are other associations, seen in our case.

An Assessment of Quality-of-Life Following Tissue Expansion in Pediatric Patients

Introduction: There is limited data on the effects of tissue expansion (TE) surgery on quality-of-life (QOL) in pediatric patients. Evidence-based information may help clinicians, patients, and their families with treatment decision-making and post-operative expectations. This study explores QOL following TE in pediatric patients. Methods: A post-intervention QOL survey and retrospective chart review was performed. Patients who underwent TE at a pediatric tertiary hospital between October 2004 and March 2020 completed the Glasgow Children's Benefit Inventory or the Glasgow Benefit Inventory. Total scores range from −100(worsened QOL) to +100(improved QOL). Participants were also asked if they would recommend TE to other patients with the same indication. Results: The response rate was 38% (n = 20; 14 females, 6 males). The median QOL score was +17[−2,+49]. Higher QOL scores were found for TE indications of scar (+49) and alopecia (+40), compared to giant congenital melanocytic nevus (−2). Higher scores were also associated with shorter time in active treatment ( r = −0.65) and fewer complications ( r = −0.56). 18/20 participants would recommend TE. Participants whose QOL improved (n = 11, 55%) reported increased self-confidence, fitting in with peers, and improved function. Participants with unchanged or decreased QOL (n = 9, 45%) described a negative experience with residual scarring. However, 7/9 with unchanged or decreased QOL would still recommend TE. Conclusions: This preliminary descriptive study demonstrated variable QOL following TE. Patient and treatment-related factors impact QOL outcomes. Despite the range in QOL outcomes, the majority of participants would recommend TE. Further research evaluating QOL following TE is necessary to better understand this relationship.

Diagnostic dilemma- choroidal granuloma as an atypical rare presentation: A case report

Purpose: To report a rare atypical case of ocular toxoplasmosis presenting as choroidal granuloma in a young adult. Case presentation: A 16-year-old male presented with sudden diminution of vision in the right eye. The visual acuity was 6/12p in the right eye. The anterior segment examination was normal. No relative afferent pupillary defect was present. The fundus examination of the right eye showed grade 1 vitritis, a normal disc with a well circumscribed active choroidal lesion on the posterior pole, inferior to the fovea along with surrounding Subretinal Fluid (SRF) pocket. The Optical Coherence Tomography (OCT) of the right eye showed choroidal elevation with the highest dimension just inferior to the fovea, along with surrounding SRF at the fovea. Fluorescein angiography showed punctate hyperfluorescent leakage points around the lesion. Intervention: Blood hemogram was normal with a raised erythrocyte sedimentation rate. Serological screening was positive for toxoplasmosis (IgM and IgG antibodies). Human Immunodeficiency Virus (HIV) and tuberculosis (QuantiFERON Gold test) were negative. Oral medications spiramycin 500 mg three times a day for 3 weeks along with folic acid once a day was started after paediatrician consult. Result: Follow up at 1 week, the visual acuity improved to 6/9 and the choroidal elevation along with the SRF was resolving on the OCT scan. After 3 weeks of treatment the visual acuity improved to 6/6 and the fundus showed complete resolution of the choroidal granuloma along with the surrounding SRF with no residual chorioretinal scar formation. Conclusions: Our case reports a rare atypical presentation of ocular toxoplasmosis with only one more case available in the literature of ocular toxoplasmosis presenting as a posterior pole choroidal granuloma. Timely intervention lead to complete resolution of the lesion and complete restoration of the visual acuity.

AATS 2023: Left ventricular restoration with scar exclusion in the surgical treatment for ischemic heart failure

ObjectivePost-infarction myocardial scar as detected by cardiac magnetic resonance (CMR) is associated with adverse left ventricular (LV) remodeling and negatively affects the prognosis. We sought to analyze the impact of left ventricular restoration (LVR) with asynergic scar exclusion on long-term outcomes for patients with ischemic heart failure (IHF). MethodsFrom January 2005, 134 consecutive patients with IHF underwent scar-exclusive LVR. Among the 131 survivors, 108 patients had paired late gadolinium enhancement (LGE)-CMR preoperatively and one year after, and represent the study population. Patients were divided into two groups according to whether their post-LVR residual percentage of scarred LV perimeter was <35% (%Scar <35; n = 55) or more (%Scar ≥35; n = 53). We compared the two groups, by looking at LGE-CMR outcomes, and at long-term survival and cardiac event (hospitalization for cardiac causes)-free survival. ResultsPostoperative LV end-systolic volume index decreased significantly and ejection fraction increased with significant increase in stroke volume index (P < 0.05 for both). LV diastolic function of the left atrial volume index was significantly improved in patients with residual %Scar <35 than in those with %Scar ≥35 (P interaction = 0.005). Median survival in patients with residual %Scar <35 and ≥ 35 were 8.3 (4.5–12.2) years and 6.8 (1.8–11.8) years respectively (P = 0.106). Median cardiac event-free survival in patients with %Scar <35 and ≥ 35 were 8.0 (3.9–12.1) years and 4.8 (0.8–8.8) years respectively (P < 0.001). ConclusionsScar-exclusive LVR yielded sustainable improvement in LV function and favorable long-term survival regardless of the extent of residual scar. The LVR should be performed to attain scar exclusion in the surgical treatment for IHF, which in turn might protectively affect LV diastolic function and cardiac event-free survival.

Endoscopic full-thickness resection of a residual scar in ascending colon to assess post-EMR complete removal of an Abrikossoff tumor

Endoscopic full-thickness resection of a residual scar in ascending colon to assess post-EMR complete removal of an Abrikossoff tumor

PD11 Photodynamic therapy for treating acne vulgaris

Abstract In recent years, photodynamic therapy (PDT) has been advised as a possible adjunct to conventional therapy for acne vulgaris (acne). Both the 2021 National Institute for Health and Care Excellence acne guidelines and the 2018 British Association of Dermatologists’ PDT guidelines include PDT as an option to consider for acne in those aged 18 and older and if other treatments are ineffective, not tolerated or contraindicated. There is, at present, insufficient evidence to suggest an exact dosage or treatment protocol. Herein, we present a case of successful use of PDT in a patient with difficult-to-manage acne and the protocol employed. A 21-year-old woman has been attending dermatology for 10 years for acne, with keloid scarring, which is most extensive on her back. She was previously treated with spironolactone and a combined oral contraceptive pill. Topical retinoids and antibiotics, including trimethoprim (to which she developed erythema multiforme), clindamycin, azithromycin and tetracyclines, had all been used for various periods without sustained successful clearance. The patient has a general anxiety disorder with low mood and is taking quetiapine. She is a social media advocate for people with mental health issues and has good insight into her mood. She is educated regarding isotretinoin and contraindications to its use. The patient was treated with a trial of two sessions of PDT 1 week apart. The target area was prepared 3 h in advance of light with methyl aminolaevulinate 16% (as hydrochloride) spread to a thickness of 1–5 mm beyond the area border. Red light (635 nm) with a total dose of 37 J cm−2 was provided for 7 min and 50 s each time. The patient has Fitzpatrick skin type I and experienced moderate postprocedural erythema, which later resolved. At both the 3- and 6-month clinical follow-up, the patient is effectively clear of active acne in the treated area. There is previous residual scarring. The patient is not using any topical or systemic acne treatments. Options for acne treatment are diverse. However, some patients experience ineffective clearance or tolerance, and are not good candidates for isotretinoin. Dermatology centres with PDT may help provide an alternative solution. This case illustrates the successful application of PDT for acne and adds to the body of literature to support its inclusion in the aforementioned guidelines.

Impact of the introduction of minimally invasive treatments of the thyroid (MITT) for benign thyroid nodules in an Italian hospital: a cost-minimization analysis.

Prevalence of thyroid nodules is high in the adult population, approaching 60% in women and older people. Most thyroid nodules are benign and asymptomatic. However, a not negligible part of them causes compressive symptoms and/or cosmetic concerns and need to be treated. In the last two decades, minimally-invasive treatments of the thyroid (MITT) have been proposed in routine clinical practice as a reliable cost-effective alternative to surgery in patients with symptomatic benign thyroid nodules (SBTNs). To perform a cost-minimization analysis comparing direct, indirect and intangible costs of radiofrequency (RFA) and laser thermal ablation (LTA) with traditional surgery in patients with SBTNs. Data of patients treated by MITT for SBTNs from October 1st 2019 to September 30th 2022 in a single Italian tertiary Center were analyzed. Costs were compared to those of traditional surgery reported in the 2022 Associazione Medici Endocrinologi Guidelines on the Management of SBTNs. In the study lapse, 157 MITT of SBTNs were performed in 148 patients, 114 females and 34 males (mean age: 59 yrs; median age: 57 yrs). Before MITT, the mean thyroid nodule volume was 19 ml; 1 year after MITT, volume reduction rate >50% and symptom relief were achieved in 89% and 93% of patients, respectively. No major complications occurred. Adding up pre-operative, operative and post-operative costs, total direct costs per single procedure are the following: 1361.43 € for LTA when using one optic fiber; 1761.43 € for LTA when using two optic fibers; 1968.53 € for RFA; 3338.39 € for hemithyroidectomy plus isthmectomy; 4034.99 € for total thyroidectomy. Surgery was impactful on direct-i.e., preoperative, operative and postoperative-costs, due to longer operating room occupation time and hospital stay. Overall, a total saving for the Italian National Health Service of 285,377.15 € has been obtained treating the 148 patients by MITT instead of surgery. Likewise, MITT was advantageous also for indirect costs-i.e., those related to "loss of productivity" caused by time off work due to hospital stay and recovery time-, for both the self-employed workers and the Government, the latter saving 53,838.50 € overall. Finally, intangible costs, related to patients' quality of life-e.g., residual surgical scar, stress related to general anesthesia, convalescence, and life-long intake of L-Thyroxine replacement therapy-were all in favor of MITT. This real-life cost-minimization analysis demonstrates that LTA and RFA are safe and cost-effective procedures for the treatment of SBTNs. In our 3 years experience, adding the savings of 285,377.15 € for direct costs to those of 53.838,50 € for indirect costs, in total 339,215.65 € were saved. The saving concern patients, the National Health System and the Government.

C84 OUTCOME AND MORPHO–FUNCTIONAL CHANGES ON CARDIAC MAGNETIC RESONANCE IN PATIENT WITH ACUTE MYOCARDITIS FOLLOWING MRNA COVID 19 VACCINATION

Abstract Background MessengerRNA (mRNA) COVID–19 vaccination has been associated with a higher–than–expected occurrence of acute myocarditis. Scarce information is available on mid–term prognosis and changes in cardiac function, volumes, and tissue characterization on cardiac magnetic resonance (CMR). Methods Retrospective, multicenter study including patients with a definite diagnosis of acute myocarditis within 30 days from mRNA COVID–19 vaccination. The diagnosis is based on endomyocardial biopsy (EMB) or autopsy or by the coexistence of positive biomarkers (troponin &amp;gt;99th upper reference limit or elevated creatine kinase myocardial band [CK–MB]) and cardiac MRI findings consistent with AM according to the 2018 updated Lake Louise Criteria. Results 77 patients (median age 25 years [IQR 20–35], 15% female) were included and followed–up for 147 days [IQR 74–215]. Follow–up CMR was available in n=49 patients and showed no changes in biventricular ejection fraction (EF) as compared to CMR at diagnosis (left ventricular EF: 59%[55–65]vs. 60%[57–64], p=0.507, right ventricular EF: 56%[52–62]vs. 57%[52–61], p=0.563, respectively). Late gadolinium enhancement was present in all patients at diagnosis and persisted in only n=39 (79.6%) at follow–up (p=0.001), generally sparing the anterior wall and the septum. N=10 (20.4%) had a persistent edema based on T2–weighted short tau inversion recovery (STIR) sequences, with predominant involvement of inferior or inferior–lateral walls. The proportion of patients with increased T1 and T2 mapping signals significantly decreased at follow–up (n=13 (68%) vs. n=4 (13%),p&amp;lt;0.001, and n=21 (84%) vs. n=3 (10%),p&amp;lt;0.001, respectively), as well as the presence of pericardial effusion (n=16 (33%) vs. n=3 (6%),p=0.004). No differences in morpho–functional CMR parameters based on the type of vaccine administered were found (BNT162b2 Pfizer/BioNTech®, n=36, 73.5%, m–RNA–1273 Moderna®, n=13, 26.5%). Among patients with available follow–up (N=75, 97.4%), no major adverse cardiovascular events nor myocarditis recurrence or death were reported. Conclusions At mid–term follow–up, patients who experienced an acute myocarditis after a mRNA COVID–19 vaccine had preserved biventricular EF. The rate and localization of residual scar or edema on CMR is in line with classic viral myocarditis with a good prognosis. This new piece of information should further reassure patients who experience acute myocarditis after mRNA COVID–19 vaccination.

Microneedles Facilitate Small-Volume Intracochlear Delivery Without Physiologic Injury in Guinea Pigs.

Microneedle-mediated intracochlear injection through the round window membrane (RWM) will facilitate intracochlear delivery, not affect hearing, and allow for full reconstitution of the RWM within 48 hours. We have developed polymeric microneedles that allow for in vivo perforation of the guinea pig RWM and aspiration of perilymph for diagnostic analysis, with full reconstitution of the RWM within 48 to 72 hours. In this study, we investigate the ability of microneedles to deliver precise volumes of therapeutics into the cochlea and assess the subsequent consequences on hearing. Volumes of 1.0, 2.5, or 5.0 μL of artificial perilymph were injected into the cochlea at a rate of 1 μL/min. Compound action potential (CAP) and distortion product otoacoustic emission were performed to assess for hearing loss (HL), and confocal microscopy was used to evaluate the RWM for residual scarring or inflammation. To evaluate the distribution of agents within the cochlea after microneedle-mediated injection, 1.0 μL of FM 1-43 FX was injected into the cochlea, followed by whole mount cochlear dissection and confocal microscopy. Direct intracochlear injection of 1.0 μL of artificial perilymph in vivo , corresponding to about 20% of the scala tympani volume, was safe and did not result in HL. However, injection of 2.5 or 5.0 μL of artificial perilymph into the cochlea produced statistically significant high-frequency HL persisting 48 hours postperforation. Assessment of RWMs 48 hours after perforation revealed no inflammatory changes or residual scarring. FM 1-43 FX injection resulted in distribution of the agent predominantly in the basal and middle turns. Microneedle-mediated intracochlear delivery of small volumes relative to the volume of the scala tympani is feasible, safe, and does not cause HL in guinea pigs; however, injection of large volumes induces high-frequency HL. Injection of small volumes of a fluorescent agent across the RWM resulted in significant distribution within the basal turn, less distribution in the middle turn, and almost none in the apical turn. Microneedle-mediated intracochlear injection, along with our previously developed intracochlear aspiration, opens the pathway for precision inner ear medicine.

Safety and Efficacy of Contact Lenses in Eyes After Simple Limbal Epithelial Transplantation.

The aim of this study was to evaluate the safety and efficacy of contact lenses (CLs) in eyes after simple limbal epithelial transplantation (SLET) for limbal stem cell deficiency (LSCD). This retrospective study included 61 eyes with partial or total LSCD which underwent SLET and were fitted with corneal or scleral rigid gas-permeable CLs. The primary outcome measure was best-corrected visual acuity (BCVA) with CLs. The median age at presentation was 22 years. The most common cause of LSCD was chemical injury [47/61 eyes (77%)]. Twenty-seven eyes (44%) were fitted with corneal rigid gas-permeable lenses, while 34 eyes (56%) were prescribed scleral lenses. The median duration of interval between SLET and CL trial was 10 months (interquartile range: 4-17). The median preoperative BCVA was logarithm of minimal angle of resolution (logMAR) 1.8. This improved to logMAR 1 (P < 0.001) after SLET and to logMAR 0.6 (P < 0.001) with CLs. Eyes with chemical injury (logMAR 1 vs. 0.6, P = 0.0001), grade 1 (logMAR 0.8 vs. 0.4, P < 0.0001), and grade 2 (logMAR 0.9 vs. 0.6, P = 0.004) corneal scarring had better improvement in BCVA with CLs. No complications were noted until the last follow-up visit. CLs, both corneal and scleral lenses, provide significant visual improvement in eyes after SLET with residual corneal scarring. These can be safely prescribed in such eyes without any adverse effects. This option can be considered before offering keratoplasty in these eyes.

Analysis of the Risk Factors for Mechanical Allodynia in Herpetic Neuralgia: A Retrospective Cross-Sectional Study.

Mechanical allodynia is reportedly common during herpetic neuralgia. The purpose of this study was to establish a risk prediction model to predict the individual risk of allodynia in herpetic neuralgia. Three hundred and eighty-six patients with trunk herpetic neuralgia were divided into two regions, T2-5 and T6-11. The causality between allodynia and other factors was analyzed by a binary logistic regression model. 42.2% of subjects had allodynia, 137 suffered from dynamic allodynia, and 110 with dynamic allodynia experienced local sweating. The following 5 items as predictors determined this model: local sweating (Odd Ratio = 27.57, P<0.001), lesion location (Odd Ratio=2.46, P =0.017), pain intensity (Odd Ratio=1.38, P =0.020), pain duration (Odd Ratio=0.94, P =0.006), and local scars (Odd Ratio=0.07, P<0.001). The presence and development of allodynia are associated with local sweating. The positive proportion of the Iodine-starch test between the T2-5 (50.0%) with the T6-11 (23.7%) had a statistically significant difference (χ2=5.36, P=0.021). 29.5% of patients at the T2-6 had obvious sweating, which was different from only sticky feelings at the T6-11 (70.5%, χ2=10.88, P=0.001). 19.2% of patients with residual scars and allodynia was significantly lower than 48.5% of patients without allodynia (χ2=15.28, P<0.001). This analysis suggests that local sweating is a concomitant symptom in dynamic allodynia, which imply the sympathetic nerves innervating the sweat glands of the skin were also involved during herpetic neuralgia. This may assist in the evaluation of dynamic allodynia and prove the role of sympathetic nerve intervention for herpetic neuralgia.

Anatomical study and clinical application of thoracoacromial artery perforator flap

Objective:To study the anatomical characteristics of thoracoacromial artery perforator flap（TAAP）, and to explore the advantages and disadvantages of TAAP in head and neck reconstruction. Methods: Four fresh cadavers （8 hemichests） were collected for anatomical observation, the blood supply of chest skin was observed through autopsy, the presence, number, location, caliber, and landmark on the chest surface of all thoracoacromial artery perforators per hemichest were recorded, including the distance of each from the midpoint of the clavicle. The diameters of the thoracoacromial artery and perforating vessels were measured with vernier calipers （accuracy 0.05 mm）, the pedicle length and thickness were measured with a cm scale （accuracy: 1 mm） after the flap was obtained, and the retained photos were recorded. Results:No perforating branch （12.5%） was found on one side of the 8 hemichests, two perforating branches （12.5%） were found on one hemichest, and one perforating branches （75.0%） were found on the rest of the hemichests. The perforating point was about between the clavicular head of pectoralis major （clavicular part） and the sternocostal head （sternocostal part）. The vessels at the beginning of perforation were generally bulky, with an average diameter of 2.25 mm, however, the vessel diameter was significantly reduced after the perforation of the flap. The pedicle length of thoracoacromial artery perforator flap ranged from 5.43 cm to 9.03 cm, with an average length of 7.14 cm. The pedicle length from the exit point of perforator muscle gap to the flap was 2.32-4.63 cm, with an average length of 3.28 cm. The distance between the exit point of perforator muscle space and the lower edge of the midpoint of the clavicle was 3.31-4.52 cm, with an average distance of 3.77 cm. Conclusion:The thoracoacromial artery perforator flap has some advantages such as similar color as head, neck and maxillofacial region, stable blood supply, relatively consistent vascular pedicle length and caliber size, relatively larger flap, less damage to pectoralis major muscle, and protection of chest shape, thoracic movement and shoulder joint movement function. Although the clinical application of this flap is limited by the uncertainty of perforating vessels, postoperative asymmetry of the nipple and residual chest scar, it still has a broad application prospect in head and neck reconstruction.

138 OUTCOME AND MORPHO-FUNCTIONAL CHANGES ON CARDIAC MAGNETIC RESONANCE IN PATIENT WITH ACUTE MYOCARDITIS FOLLOWING MRNA COVID 19 VACCINATION

Abstract Background MessengerRNA (mRNA) COVID-19 vaccination has been associated with a higher-than-expected occurrence of acute myocarditis. Scarce information is available on mid-term prognosis and changes in cardiac function, volumes, and tissue characterization on cardiac magnetic resonance (CMR). Methods Retrospective, multicenter study including patients with a definite diagnosis of acute myocarditis within 30 days from mRNA COVID-19 vaccination, with a confirmed myocarditis diagnosis based on endomyocardial biopsy (EMB) or autopsy or by the coexistence of positive biomarkers (troponin &amp;gt;99th upper reference limit or elevated creatine kinase myocardial band [CK-MB]) and cardiac MRI findings consistent with AM according to the 2018 updated Lake Louise Criteria. Results 77 patients (median age 25 years [IQR 20-35], 15% female) were included and followed-up for 147 days [IQR 74-215]. Follow-up CMR was available in n=49 patients and showed no changes in biventricular ejection fraction (EF) as compared to CMR at diagnosis (left ventricular EF: 59%[55-65]vs. 60%[57-64], p=0.507, right ventricular EF: 56%[52-62]vs. 57%[52-61], p=0.563, respectively). Late gadolinium enhancement was present in all patients at diagnosis and persisted in only n=39 (79.6%) at follow-up (p=0.001), generally sparing the anterior wall and the septum. N=10 (20.4%) had a persistent edema based on T2-weighted short tau inversion recovery (STIR) sequences, with predominant involvement of inferior or inferior-lateral walls. The proportion of patients with increased T1 and T2 mapping signals significantly decreased at follow-up (n=13 (68%) vs. n=4 (13%),p&amp;lt;0.001, and n=21 (84%) vs. n=3 (10%),p&amp;lt;0.001, respectively), as well as the presence of pericardial effusion (n=16 (33%) vs. n=3 (6%),p=0.004). No differences in morpho-functional CMR parameters based on the type of vaccine administered were found (BNT162b2 Pfizer/BioNTech®, n=36, 73.5%, m-RNA-1273 Moderna®, n=13, 26.5%). Among patients with available follow-up (N=75, 97.4%), no major adverse cardiovascular events nor myocarditis recurrence or death were reported. Conclusions At mid-term follow-up, patients who experienced an acute myocarditis after a mRNA COVID-19 vaccine had preserved biventricular EF. The rate and localization of residual scar or edema on CMR is in line with classic viral myocarditis with a good prognosis. This new piece of information should further reassure patients who experience acute myocarditis after mRNA COVID-19 vaccination.

The Impact of Uterine Incision Closure Technique on the Post Cesarean Residual Myometrial Thickness and Scar Defects. A Novel Technique at a Tertiary Care Hospital

The Impact of Uterine Incision Closure Technique on the Post Cesarean Residual Myometrial Thickness and Scar Defects. A Novel Technique at a Tertiary Care Hospital

Cardiac magnetic resonance follow-up of COVID-19 vaccine associated acute myocarditis

Mass COVID-19 vaccination campaigns have helped impede the COVID-19 pandemic. In rare cases, some vaccines have led to vaccine associated myocarditis in a specific subset of the population, usually young males. Cardiac magnetic resonance (CMR) can reliably diagnose vaccine associated myocarditis, but follow-up data of CMR proven acute myocarditis is scarce. Nine patients with acute vaccine associated myocarditis underwent baseline and follow-up CMR examinations and were compared to baseline parameters at initial presentation and to a group of 20 healthy controls. CMR protocol included functional assessment, T1 and T2 mapping, T2 signal intensity ratio, strain feature tracking, and late gadolinium enhancement (LGE). Myocarditis patients (n = 9, aged 24 ± 6 years, 8 males) underwent CMR follow-up after an average of 5.8 ± 4.3 months. All patients showed a complete resolution of visual myocardial edema while also demonstrating a reduction in overall LGE extent from baseline to follow-up (4.2 ± 2.1 vs. 0.9 ± 0.8%, p < 0.001), although visual LGE was still noted in all patients. Left ventricular ejection fraction was normal at baseline and at follow-up (58 ± 6 vs. 62 ± 4%, p = 0.10) as well as compared to a healthy control group (60 ± 4%, p = 0.24). T1 (1024 ± 77 vs. 971 ± 34 ms, p = 0.05) and T2 relaxations times (57 ± 6 vs. 51 ± 3 ms, p = 0.03) normalized at follow-up. Most patients reported a resolution of clinical symptoms, while two (22%) reported new onset of exertional dyspnea. Patients with COVID-19 vaccine associated acute myocarditis showed a complete, uncomplicated resolution of myocardial inflammation on follow-up CMR, which was associated with a near complete resolution of symptoms. Minor, residual myocardial scarring was present on follow-up LGE imaging. The long-term implications of the remaining myocardial scar-tissue after vaccine associated myocarditis remain unknown warranting further studies.