Scar Cosmesis Assessment And Rating Research Articles

Quantitative comparison of three thyroidectomy approaches on neck muscles, voice, and swallowing functions

ObjectiveThis study compares endoscopic thyroidectomy by gasless unilateral axillary approach (ETGUA) and sternocleidomastoid leading-edge approach (SLEA) with conventional open thyroidectomy (COT) in hemithyroidectomy. The main focus is on the protection of neck muscles (sternocleidomastoid, omohyoid, sternothyroid) and the postoperative function of voice and swallowing yielded through these common approaches. MethodsA total of 302 patients who underwent hemithyroidectomy were enrolled and divided into three groups: ETGUA (n = 101), SLEA (n = 100), and COT (n = 101). Ultrasound was used to measure the thickness of bilateral neck muscles, including the sternocleidomastoid, omohyoid, and sternothyroid. The changes in thickness on the surgical side compared to the non-surgical side. Analyzed factors included muscle thickness changes, Swallowing Impairment Score (SIS), Voice Handicap Index (VHI), Scar Cosmesis Assessment and Rating (SCAR), Neck Incision Index (NII), surgery duration, drainage volume, hospitalization, and number of lymph nodes. ResultsThe clinical characteristics among the three groups were consistent except for differences in sex, age, and BMI. Metrics such as sternocleidomastoid muscle, NII, hypocalcemia, postoperative PTH, transient hoarseness, and number of lymph nodes showed no significant differences among the three groups. However, significant differences were found in the duration of surgery, drainage volume, hospitalization period omohyoid muscle, Sternohyoid muscle, VHI, SIS, and SCAR (all p < 0.001). ConclusionIn comparison to COT, ETGUA and SLEA demonstrate superiority in protecting neck muscles and preserving voice and swallowing function without compromising surgical safety or radicality.

Safety and efficacy of autologous skin tissue cells grafting for facial sunken or flat scars

ImportanceIt is necessary to determine whether safety and efficacy of autologous skin tissue cells grafting for facial sunken or flat scars. ObjectiveTo identify autologous skin tissue cells grafting can reduce facial sunken or flat scars. Design, setting, and participantsIn this retrospective cross-sectional study, a total of 128 patients with scar (exclude pathological scar patients), who were receiving autologous skin tissue cells grafting therapy from January 1, 2016, to December 31, 2019. InterventionsAutologous skin tissue cells grafting. Main outcomes and measuresChanges in scar severity, color changes in the scar area, infection rate and patient satisfaction. ResultsA total of 128 patients with scar (89 females [69.5%]; mean [SD] age, 30.6 [13.12] years) received autologous skin tissue cells grafting therapy. SCAR (Scar Cosmesis Assessment and Rating), with scores ranging from 0 (best possible scar) to 15 (worst possible scar). After treatment 12 months, the mean [SD] of SCAR score went down from 9.85 [1.33] to 2.67 [1.21]. No infection was observed during treatment or recovery, and the main drawback after autologous skin tissue cells grafting is that the color recovery time is longer. The patient satisfaction 6 months after treatment was 85.2%, furthermore 12 months after treatment patient satisfaction was 94.7%. Conclusions and relevanceIn this study, autologous skin tissue cells grafting was safe and effective to treat facial scars. Therefore, autologous skin tissue cells grafting may be recommended as a reliable treatment for facial scar.

Evaluation of Facial Trauma Scars After Treating by Refining Plastic Surgery Techniques: A Follow-Up Study.

Although early debridement and refining plastic surgery techniques have been shown to be effective in the treatment of facial scars after trauma, their postoperative outcomes have not been quantitatively evaluated by the relevant Scar Cosmesis Assessment and Rating (SCAR) Scale. This study was designed to provide a fair assessment of the appearance and local symptoms of scars after treatment by refining plastic surgery techniques and to share the operational skills of surgical repairs. Patients who received refining plastic surgery techniques were followed up, and facial scars were taken as high-definition photos, which were presented to 6 professional observers, 6 lay observers, and patients themselves to score the facial scars, including: scar spread, erythema, dyspigmentation, track marks or suture marks, hypertrophy/atrophy, itch and pain according to the SCAR. There were 56 patients who met the inclusion criteria and 25 agreed to participate in the study. No hypertrophic scar was found, and all patients were satisfied with the scar control effect. The scores showed that the treatment was achieved good results in scar spread (pro group: 0.85±0.55, lay group: 0.96±0.68, patients: 0.92±0.64), erythema (pro group: 0.34±0.26, lay group: 0.45±0.37, patients: 0.32±0.48), hypertrophy/atrophy (pro group: 0.21±0.27, lay group: 0.21±0.31, patients: 0.32±0.48), and there was no significant difference in the scores of the 3 observation groups ( P >0.05). However, it is difficult to eliminate dyspigmentation (pro group: 0.29±0.26, lay group: 0.30±0.30, patients: 0.40±0.50), track marks or suture marks (pro group: 0.45±0.33, lay group: 0.59±0.30, patients: 0.36±0.49). Two (8%) patients complained of itch and 1 (4%) patient complained of both itch and pain in the past 24 hours. The appearance of facial scars is satisfactory, the local symptoms are mild, and the evaluation among different aesthetics is affirmative after receiving refining plastic surgery techniques, which is just in line with the purpose of seeking beauty for the patients, and meanwhile can provide a good foundation for the comprehensive treatment of late scars, so that the treatment plan should be promoted.

Cosmetic outcomes of improved microscopic subinguinal varicocelectomy in patients with varicoceles.

To the Editor: Varicoceles (VCs) refer to the dilation of the veins of the pampiniform plexus. The primary treatment method for VCs with definite surgical indications is the surgical treatment. With the development of minimally invasive technology, the application of microscopic subinguinal varicocelectomy (MSV) has gradually increased in recent years and has become the standard treatment method for VCs.[1] In the long-term clinical practice of our department, some young people have required surgery for VCs due to physical examination in special industries (e.g., military physical examination). They have wanted the incision to be esthetic, seamless, and concealed. With the expectation of cosmesis, we have made some improvements in the selection of the surgical incision. Using the Scar Cosmesis Assessment and Rating (SCAR) scale,[2] we comprehensively evaluated the cosmetic effects of patients undergoing improved MSV (IMSV) and MSV in this study. This retrospective study was approved by the Ethics Committee of the General Hospital of Northern Theater Command (No. Y[2022]005) and the requirement for written informed consent was waived. Left VC patients treated at the General Hospital of Northern Theater Command from January 2020 to May 2021 were included in this study. We conducted a retrospective observational cohort study involving patients with varicoceles who underwent surgery via IMSV (n= 35) or MSV (n= 26). The inclusion criteria were as follows: (1) the patients with VC who met the criteria of 2019 Edition of Chinese Guidelines for Diagnosis and Treatment of Urology and Andrology Diseases; (2) those who had good treatment compliance. The exclusion criteria were as follows: (1) patients with incomplete data; (2) patients with bilateral and right varicocele. Cosmesis was evaluated using a comprehensive survey administered ≥3 months postoperatively. The indicators included in the analysis were as follows: age; body mass index (BMI); operation time; the number of internal spermatic arteries, veins, and lymphatic vessels; early morning pain score on the first day after the operation (0–10); SCAR scale score (0–15); and postoperative patient satisfaction and comfort score (0–100; very satisfied: 80–100 points; satisfied: 60–79 points; and dissatisfied: < 60 points). Two surgeons performed all preoperative assessments, consultations, and operations. Incision selection: The patients in the IMSV group received an oblique incision 2 to 3 cm in length at the root of the scrotum [Figure 1], whereas the patients in the MSV group received a transverse incision 2 to 3 cm in length under the external inguinal ring [Figure 1]. SPSS 23.0 (SPSS Inc, Chicago, IL, USA) was used for analysis. Continuous variables with normal distribution are shown as the mean ± standard and analyzed with Student's t test. Continuous variables with skewed distribution are presented as the median (Q1,Q3) and analyzed with Mann-Whitney U test. P < 0.05 was considered statistically significant and each analysis was two-tailed.Figure 1: (A) a: Subinguinal incision. b: Incision at the scrotal root. (B) IMSV: Incision at the scrotal root after the operation. (C) MSV: Subinguinal Incision after the operation. (D) IMSV: Scrotal root incision (arrow) three months after the operation. (E) MSV: Subinguinal incision (arrow) three months after the operation. IMSV: Improved microscopic subinguinal varicocelectomy; MSV: Microscopic subinguinal varicocelectomy.The results showed no significant difference in age (IMSV υs. MSV: 22.0 [20.0, 29.0] years υs. 22.0 [19.8, 25.6] years, U= 402.0, P = 0.437) or BMI (IMSV υs. MSV: 23.0 ± 2.7 kg/m2υs. 22.7 ± 2.5 kg/m2, t = 0.439, P = 0.662) between the two groups. The results showed no significant difference in the number of spermatic arteries (IMSV υs. MSV: 2.0 [1.0,2.0] υs. 2.0 [2.0,3.0]), U = 528.0, P = 0.245) or lymphatic vessels (IMSV υs. MSV: 5.1 ± 0.8 υs. 5.3 ± 0.9, t = 0.822, P = 0.414) between the two groups, but the number of veins in the IMSV group was significantly different from that in the MSV group (IMSVυs. MSV: 13.0 [11.0,17.0] υs. 12.0 [9.0,14.0], U = 275.0, P = 0.008). The operation time was longer in the IMSV group than in the MSV group (IMSV υs. MSV: 84.2 ± 10.7 min υs. 74.5 ± 13.1 min, t = 3.179, P = 0.002). The results showed that the early morning pain score was lower in the IMSV group than that in the MSV group (IMSV υs. MSV: 3.0 ± 0.9 υs. 4.2 ± 0.9, t = 5.159, P < 0.001). The SCAR scale score was lower in the IMSV group than in the MSV group (IMSV υs. MSV: 1.0 [1.0, 2.0] υs. 2.5 [1.8, 3.3], U= 658.0, P = 0.002). Compared with those in the MSV group, the satisfaction and comfort scores of patients were significantly higher in the IMSV group (IMSV υs. MSV: 91.6 ± 8.6 υs. 83.0 ± 8.9, t= 3.744, P < 0.001). Previous publications praised the esthetic advantages of the MSV method but did not objectively study the esthetic results. There is no effective survey on the satisfaction of patients with scars after VC surgery. Kantor[2] evaluated beauty using multidimensional surveys, which proved that photos can reliably replace real-time patient assessments. Body image has a great influence on patients’ satisfaction and evaluation of the subjective benefits of surgery. Using Kantor's method, our study investigated VC patients using the SCAR scale score. VCs are the most reasonable cause of surgical correction in male infertility. Presently, the treatment of VCs can be divided into two categories: surgical treatment and interventional treatment. Although each approach has advantages and complications, the incidence of hydroceles and recurrence rate after MSV are the lowest.[3] Based on MSV, some improvements were made using the natural folds of the scrotal skin, and some unexpected benefits were obtained. There was no significant difference in age between the two groups. According to Park et al's[4] research on the selection of a kidney operation method, young people have higher beauty standards. However, our research does not show the trend of Samuel's research. The reason for this may be that the onset age of VC patients is relatively young. In the clinical practice of our hospital, surgical incisions of IMSV are made at the skin fold at the root of the scrotum and are oblique incisions approximately 2 to 3 cm in length. Compared with MSV, our technique can alleviate the postoperative pain of patients. A possible reason for this is that our surgical technique avoids damaging the inguinal canal. Additionally, the spermatic cord is more superficial, the subcutaneous fat layer is thinner, the surrounding connective tissue is looser, and there is less pulling of the spermatic cord. All operations were carried out using a microscope at 8 to 10 × magnification. After exposing the internal spermatic vein, the arterial pulsation area was carefully observed to find the most vital arterial pulsation point. The testicular artery was confirmed and protected by arterial pulsation. At the same time, delicate operation principles should be followed when separating spermatic vessels. There are usually 1–3 arteries,[5] which are in line with our observations. To preserve the artery to the maximum extent, tying the remaining spermatic vessels in bundles after finding one artery is not recommended. Lymphatic vessels are transparent and easy to identify under a microscope. After finding arteries and lymphatic vessels, they are marked and protected with silk thread, and the veins are ligated one by one. Usually, the higher the position of the spermatic vein is, the lower the number of branches,[5] as found in our study. In the whole operation, ligation was performed on the same plane perpendicular to the spermatic cord to avoid missing veins and damaging arteries. Because the surgical incision is located at the scrotal skin fold and to achieve a better cosmetic effect, we usually use subcutaneous sutures. Over time, the natural folds of the scrotum, growth of pubic hair, pigmentation of the scrotum, and self-healing of the incision conceal the surgical incision. We evaluated this result objectively with the SCAR scale score which was higher in the IMSV group. A custom-made 100–point questionnaire revealed that the satisfaction and comfort scores of patients were higher in the IMSV group than in the MSV group. Unfortunately, the IMSV slightly prolonged the operation time. We thought about this problem and analyzed it. In fact, the operation time can be shortened by the operator's more skilled operation and by ligating veins in a cluster. Maybe there are other ways for us to further shorten the operation. In addition, we discussed some other advantages. Because the incision is located closer to the testicle, the ligation of VCs can be performed simultaneously with other procedures, such as ligation of the leading testicular vein, sperm extraction by a testicular incision under a microscope, and removal of testicular hydroceles, without the need for an additional incision. We are aware of some limitations of our research. First, this study is a small nonrandom analysis conducted at a single institution, introducing possible bias in baseline data and views on cosmetic appearance. In addition, the IMSV is not a complete improvement; this was also not our original intention. The main research direction of this study was esthetics. Finally, we did not use Doppler to explore all the arterioles. Usually, we can determine the location of arteries by arterial pulsation. When arterial pulsation disappears, the location of arteries can be judged by the alternating strength of blood vessels. If this does not work, we usually use the surface instillation of papaverine to restore arterial pulsation. Despite these limitations, there is no doubt that these findings provide valuable insights into the cosmetic effect of treatment in VC patients. Multicentre and large-sample prospective studies will be needed to further evaluate and/or confirm these findings. In summary, IMSV has a better cosmetic effect than MSV. Considering the greater scar satisfaction achieved with IMSV, we infer that this surgical method is better for patients with higher cosmetic standards. Funding This work was supported by the grant from 2018 National Key Research & Development Plan Foundation (No. SQ2018YFC10002704). Conflicts of interest None.

Plating versus elastic stable intramedullary nailing for displaced pediatric midshaft clavicular fractures

IntroductionTraditionally, operative treatment for displaced midshaft clavicle fractures in adolescents has been achieved by using a plate and screws. However, a minimally invasive trend has led surgeons to use the elastic stable intramedullary nail (ESIN) for displaced midshaft clavicle fractures. This study aims to compare the clinical outcomes of adolescent patients who were operated on with an ESIN vs. a plate.MethodsAll patients aged between 10 and 14 years with displaced midshaft clavicle fractures who were operated on at our institute between January 2014 and January 2018 were reviewed retrospectively. The preoperative data, including baseline information on the patients, and types of surgical procedure were collected from the hospital database. The postoperative data, including clinical outcome and complications, were collected during the follow-up visits. Clinical outcome was evaluated during outpatient visits using the American Shoulder and Elbow Surgeons (ASES) score. The scar problem was evaluated according to the Scar Cosmesis Assessment and Rating (SCAR) scale.ResultsA total of 73 patients were included. Patients were categorized into two groups: ESIN (n = 45; 27 males, 18 females) and plate (n = 28; 17 males, 11 females), according to surgical technique. The average age of the patients in the ESIN group was 12.2 ± 1.5 years, and that in the plate group was 12.2 ± 1.4 years. The ESIN group presented significantly less operative time (31.1 vs. 59.8 min), a shorter hospital stay (1.5 vs. 2.5 days), and a smaller incision (2.4 vs. 5.4 cm) as compared to the plate group (P < .001). The rate of scar concern was much higher in the plate group (71.4%) than the ESIN group (22.2%) (P < .001). There was no statistically significant difference in shoulder function between the ESIN group and the plate group at different time points.ConclusionA conservative approach remains the first choice for a pediatric clavicle fracture. Both the ESIN and the plate are safe and effective treatment methods for displaced midshaft clavicle fractures in adolescents. The ESIN is superior to the plate given its shorter operative time, shorter hospital stay, lower rate of scar concern, and easier implant removal.Level of evidenceIII, retrospective observational study.

Outcome comparison between thoracodorsal artery perforator flap and muscle-sparing latissimus dorsi flap in axillary reconstruction after hidradenitis suppurativa excision.

Thoracodorsal artery perforator (TDAP) flap and muscle-sparing latissimus dorsi (MSLD) flap have been frequently used for axillary coverage after hidradenitis suppurativa (HS) excision. However, none showed superiority to others. This study compared both flaps to define the ideal option, highlighting flap outcomes and functional and aesthetic results. A retrospective study was conducted to compare both flaps that were used for axillary reconstruction in nine patients with bilateral HS Hurley stage III between 2017 and 2020. Eight TDAP and 10 MSLD flaps underwent functional evaluation using shoulder abduction angle (SA); the Disabilities of the Arm, Shoulder, and Hand (DASH) score; visual analog scale (VAS) for pain; and the Dermatology Life Quality Index (DLQI) questionnaires. Aesthetic assessment included the Scar Cosmesis Assessment and Rating (SCAR) scale and arm-chest interval. The mean operating time was 194.4 ± 51.58 and 128.5 ± 31.45 min for TDAP and MSLD (p =.009), respectively. Flap complications were significantly higher in the TDAP group (p =.034). There was no significant difference between both groups regarding SA; DASH, DLQI, VAS, and SCAR scale (p > .05). The mean arm-chest interval was significantly longer in the MSLD than in the TDAP group by 6.9 mm (p =.001). TDAP and MSLD are comparable versatile flaps to eradicate axillary HS with higher TDAP flap complications. Although the TDAP flap is less bulky than the MSLD flap, the MSLD flap shortens the harvesting time without a significant difference in functional outcomes and scar results.

Can high transverse skin incision (Modified Maylard) be a new alternative in placenta accreta spectrum management with cesarean hysterectomy?

Background: Assess optimal surgical management of cases with placenta accreta spectrum (PAS) disorder. Methods: This was a retrospective study conducted between January 2012 and November 2020. Two alternative types of incision were performed in patients diagnosed with PAS. (1) A high transverse skin incision, 12–14 cm in length, was performed through the skin 5–8 cm above the pubic symphysis. (2) A vertical skin incision was made from the xiphoid process to the pubic symphysis, passing around the umbilicus. We compared intraoperative and postoperative outcomes of both types of incisions in patients undergoing caesarean hysterectomy. The aesthetic appearance of the scar was assessed using the scar cosmesis assessment and rating (SCAR) scale. Results: Forty-four placenta accreta spectrum patients were evaluated. No differences were observed between the skin incision groups regarding exploration and surgical manipulation. Lengths of hospitalization and operative times were less in patients undergoing high transverse skin incision compared to vertical incision (5.5 ± 1.1, 8.0 ± 1.1, p = 0.03; respectively). Wound site complications were lower in high transverse skin incision patients. Patients in the high transverse incision group had significantly better SCAR scores than patients in the vertical incision group (3.3 ± 0.9 vs 11.4 ± 1.8; p &lt; 0.001) and a significantly higher proportion in the high transverse incision group were very satisfied or satisfied with the cosmetic aspects of the scar (p = 0.001). Conclusion: The high transverse incision method in women with PAS is a better method of skin incision giving reduced operative and hospitalisation times and improved cosmetic outcomes.

Scar Appearance and Patient Satisfaction after the Tear Trough Incision for External Dacryocystorhinostomy

Background: Postoperative scar is the major disadvantage of external dacryocystorhinostomy (DCR). Modified incision should be performed to reduce postoperative scarring. Objective: To evaluate scar appearance and patient satisfaction after the tear trough incision for external DCR. Materials and Methods: The present study was a descriptive study with information collected by telephone survey and retrospective chart review. Patients that underwent external DCR over a period of eight years were enrolled and completed the validated Patient Scar Assessment Questionnaire (PSAQ). Scar appearance, consciousness, symptom, and satisfaction were determined. Patient demographics, surgical information, and postoperative scar evaluation using the Scar Cosmesis Assessment and Rating (SCAR) scale were obtained from the medical records. Results: Fifty-eight patients responded to the telephone interview with 71 DCR surgeries performed. The most common scar characteristic and symptom reported by patients was color mismatch in 11.3% of scars and itching in 15.5%. Scar evaluated by patients was invisible in 57.7% of scars, minimally visible in 40.8%, and moderately visible in 1.4%. Among all patients with noticeable scars, 92% of these made no attempt to conceal the scars. The average patient scar grade was 0.44 (scale 0 to 3). The majority (93.1%) of patients were very satisfied with the scar outcome. Of the 64 scars evaluated by physician using the SCAR scale, common scar characteristics were scar spread (40.6%), hypopigmentation (15.6%), and hypertrophic scar (12.5%). The scar evaluated by physician was invisible in 59.4% of scars, minimally visible in 34.4%, and moderately visible in 6.3%, with an average scar grade of 0.47 (scale 0 to 3). Conclusion: The tear trough incision for external DCR results in minimal postoperative scarring, providing a very high satisfaction rate in most patients. Keywords: External dacryocystorhinostomy, DCR, Scar, Tear trough incision, Patient satisfaction

Cosmetic outcomes following transoral versus transcervical thyroidectomy

Central neck scars following thyroidectomy can negatively impact patient quality of life. Transoral endoscopic thyroidectomy can reduce postoperative cosmetic burden. Prospective cohort study of patients seen between June 2018 and January 2019. Scar cosmesis was determined using the validated Scar Cosmesis Assessment and Rating (SCAR) scale and a Visual Analog Scale (VAS) measuring color, contour, and irregularity. Eighty-one patients (80% female, mean age 43.7 years) were analyzed, with 60% and 40% receiving transcervical and transoral thyroidectomy. Median time from surgery was 3.4 (range: 1-37.1) weeks. Mean SCAR score was greater for transcervical recipients (4.69 vs transoral 0.99, P < .001), indicating worse cosmesis. Mean surgeon-rated total VAS score was similarly increased for transcervical recipients (72.84 vs transoral 16.73, P < .001). Interrater reliability for both SCAR and total VAS scores was excellent (intraclass correlation 0.93; 95% CI: 0.90-0.95 for both). Transoral thyroidectomy provides significantly enhanced early cosmesis over the transcervical approach.

Comparison of Postsurgical Scars Between Vegan and Omnivore Patients.

Postsurgical skin healing can result in different scars types, ranging from a fine line to pathologic scars, in relation to patients' intrinsic and extrinsic factors. Although the role of nutrition in influencing skin healing is known, no previous studies investigated if the vegan diet may affect postsurgical wounds. The aim of this study was to compare surgical scars between omnivore and vegan patients. This is a prospective observational study. Twenty-one omnivore and 21 vegan patients who underwent surgical excision of a nonmelanoma skin cancer were enrolled. Postsurgical complications and scar quality were evaluated using the modified Scar Cosmesis Assessment and Rating (SCAR) scale. Vegans showed a significantly lower mean serum iron level (p < .001) and vitamin B12 (p < .001). Wound diastasis was more frequent in vegans (p = .008). After 6 months, vegan patients had a higher modified SCAR score than omnivores (p < .001), showing the worst scar spread (p < .001), more frequent atrophic scars (p < .001), and worse overall impression (p < .001). This study suggests that a vegan diet may negatively influence the outcome of surgical scars.

Angiotensin-converting enzyme inhibitor and angiotensin II type 1 receptor blocker: Potential agents to reduce post-surgical scar formation in humans.

Studies on the effectiveness and mechanisms of reducing scar formation by interfering with the renin-angiotensin-aldosterone-system (RAAS) have been demonstrated in animals, but not in humans due to the lack of clinical support. Our aim was to investigate whether angiotensin-converting enzyme inhibitor (ACEI) and angiotensin II type 1 receptor blocker (ARB) could inhibit scar formation in humans. Thus, an observational and hypothesis-generating study using a designed questionnaire was carried out. A total of 347 patients with postoperative scars secondary to thyroid tumours were enrolled. They were divided into four groups: ACEI group, ARB group, other antihypertensive drugs control group and blank control group according to the administration of antihypertensive drugs. The width of scar was measured, and the Scar Cosmesis Assessment and Rating (SCAR) Scale was filled out. Results showed that patients of ACEI group (mean scar width 1.60mm) and ARB group (mean scar width 1.57mm) formed smaller scars than those of other antihypertensive drugs control group (mean scar width 2.09mm) and blank control group (mean scar width 2.0mm). Oral administration of ACEI and ARB may be associated with better post-surgical scar formation in humans. These two kinds of antihypertensive drugs may be active components of anti-scar medicine.

Comparison of the modified direct closure method and skin grafting for wounds at the anterolateral thigh flap donor site

ObjectiveThis study was performed to compare the modified direct closure method and traditional skin grafting for wounds at the anterolateral thigh (ALT) flap donor site.MethodsAmong 29 consecutive patients with wounds at the ALT flap donor site, 14 underwent the modified direct closure method (MDC group) and 15 underwent traditional skin grafting (SG group). The operative time, follow-up time, complications, Vancouver Scar Scale (VSS) score, and Scar Cosmesis Assessment and Rating (SCAR) score of the two groups were statistically analyzed.ResultsThe mean follow-up times in the MDC and SG group were 16.1 and 16.7 months, respectively. Two patients showed partial skin necrosis after skin grafting, but the remaining patients’ wounds healed uneventfully. The operative time in the MDC group was an average of about 64 minutes shorter than that in the SG group. The average VSS and SCAR scores in the MDC group were 2.1 and 3.0 points lower, respectively, than those in the SG group.ConclusionsCompared with traditional skin grafting, the modified direct closure method is more efficient for repair of wounds at the ALT flap donor site because of its shorter operative time, better postoperative appearance of the donor site, and higher patient satisfaction.

Modified Mini-laparoscopic Surgery Optimized the Laparoscopic Decortication of Renal Cyst.

This study was to introduce the modified mini-laparoscopic surgery for renal cyst and investigate itsadvantages on operative time, cosmetic effect and pain reduction by comparison with laparo-endoscopic single sitesurgery (LESS) and conventional laparoscopic surgery. Between May 2015 and October 2018, 140 consecutive patients with benign renal cystunderwent laparoscopic decortication of renal cyst. Of which, 48 cases were in mini-laparoscopic surgery group(M group), 56 cases in LESS group and 36 cases in conventional laparoscopic surgery group (C group). The operativetime, blood loss, visual analog scale (VAS) and Scar Cosmesis Assessment and Rating (SCAR) Scale wasrecorded. The mean operative time in M group (26.08±7.70 min) and C group (28.56 ± 7.99 min). was significantlyless than that in LESS group (47.32 ±10.53 min) (P < 0.01). Mean blood loss did not differ between the 3 groups(P > 0.05). Mean VAS pain scores in M group were significantly lower than that of LESS group and C group onpostoperative day (POD) 1 and 3 (P < 0.01). The SCAR scale of POD 30 in C group (6.25 ± 1.0) was significantlyhigher than that in M group (0.77 ± 0.59) and LESS group (0.98 ± 0.70). The postoperative course was uneventfulwith no morbidity within 1to 6 months of follow-up. Modified mini-laparoscopic decortication of renal cyst have more comprehensive advantages comparingwith LESS and conventional laparoscopic surgery. It is convenient and offered significant cosmetic benefitand reduced incisional pain.

A retrospective study comparing post-aural versus endaural approach for myringoplasty in cases of chronic otitis media

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Patients diagnosed with chronic otitis media mucosal disease with a mild degree of conductive hearing loss require myringoplasty as their treatment. Various approaches to myringoplasty are defined. The aim of the present study was to compare outcomes of the post-aural versus end aural approach for myringoplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A retrospective cohort study of 26 patients operated over a period of one year at tertiary otorhinolaryngology center.  &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Distribution of approaches among post-aural and end aural was 11 and 15 patients respectively.&lt;strong&gt; &lt;/strong&gt;Otorrhea was the presenting complaint in 65% (n=17) of patients. Preoperative mean pure-tone average (PTA) of all patients was 34.8 dBHL (range 28 to 40 dBHL) while postoperatively 3 months mean PTA was 21.63 and 25.13 dBHL for patients undergoing end aural and post-aural approaches respectively (p=0.008). The success rate in terms of no re-perforation was 76.9% overall, 81.81% for the end aural approach and 73.33% for the post-aural approach with no statistically significant difference (p=0.612). Disease-free survival, as calculated with Kaplan-Meier analysis, was 9.7 and 13.9 months respectively (p=0.807). Cosmetic outcome was analyzed using the scar cosmesis assessment and rating (SCAR) scale. Mean SCAR scale score in our series was 5.36 and 6.20 for patients with end aural and post-aural approaches respectively with no statistically significant difference.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Both approaches, end aural and post-aural, are good approaches for the purpose of myringoplasty with no statistically significant difference between the two in terms of re-perforation rates or cosmetic outcomes. However, based on our study, the end aural approach has better hearing outcomes in terms of hearing improvement.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Comparison of Cosmetic Effect and Pain Reduction Outcomes of Modified Mini-Laparoscopy Versus Laparoendoscopic Single-Site Surgery for Adrenalectomy.

Objective: This study was to introduce the modified mini-laparoscopic adrenalectomy and investigate the advantage of operative time, cosmetic effect, and pain reduction by comparing the modified mini-laparoscopic adrenalectomy and laparoendoscopic single-site surgery (LESS). Methods and Patients: Between May 2015 and Jun 2018, 76 consecutive patients with adrenal tumor underwent laparoscopic adrenalectomy. Of which, 36 cases were in the mini-laparoscopic surgery group (the M group) and 40 cases in the LESS group. Medical records of the consecutive patients were analyzed. The operative time, blood loss, the Visual Analog Scale (VAS) scores and the Scar Cosmesis Assessment and Rating (SCAR) Scale scores were recorded. Results: The mean operative time in the M group was significantly less than that of in the LESS group (54.75 ± 9.37 min vs. 106.48 ± 19.71 min, P < .01). Mean estimated blood loss did not differ between the 2 groups (12.22 ± 5.29 mL vs. 10.80 ± 6.66 mL, P > .05). The mean VAS scores in the M group were significantly lower than those of the LESS group on postoperative days (POD) 1 and 3. The SCAR scale scores at POD 60 were similar in the M group and the LESS group (0.86 ± 0.64 vs. 0.95 ± 0.71, P > .05). Conclusions: Modified mini-laparoscopic adrenalectomy is safe and convenient. It offered less operative time, significant cosmetic benefit, and reduced incisional pain.

Use of Cyanoacrylate N-Butyl Versus Subcuticular Suture in the Dermal Closure Following Cesarean Delivery: A Randomized Controlled Trial

Background: Currently the use of tissue adhesives for surgical wound closure has multiplied; however, its use in cesarean sections is still not well determined. The objective of this study was to compare the surgical wound healing following cesarean sections between N-butyl cyanoacrylate (Tisuacryl) and suture (Monocryl 2-0). Methods: A randomized, non-blinded controlled clinical trial was conducted from October 2017 to March 2018 at the Instituto Nacional de Perinatologia. Forty women undergoing cesarean delivery were randomly assigned to skin closure group using a random number table: 20 with N-butyl cyanoacrylate (Tisuacryl) (cases group) and 20 with Monocryl (control group). Scars were evaluated at 24 h, 1 week, 1 month and 3 months. Primary objective was to evaluate the esthetics of the scar with the scar cosmesis assessment and rating (SCAR) scale. Secondary objectives were skin closing time, the satisfaction of the patient and the satisfaction of the surgeon. Results: Demographic characteristics, including average age, body mass index and number of pregnancies, were similar in both groups. The skin closing time showed a significant decrease with a P value of 0.000 between Tisuacryl and Monocryl (54.95 ± 10.353 s in the first group vs. 407.5 ± 72.61 s) . The esthetic evolution of surgery using the SCAR scale showed a better evolution in the first visits (weekly and monthly) in the Monocryl group (2.05 ± 0.60 and 1.68 ± 0.477) vs. Tisuacryl (2.77 ± 0.685 and 2.55 ± 0.74) with a P value of 0.001 in SCAR 1 (first visit) and 0.000 in SCAR 2 (second visit). However, no significant differences were observed in the last result at 3 months (SCAR 3). Similarly, no significant differences were observed regarding the satisfaction of the surgeon or the patient. Conclusions: The results of skin healing with Tisuacryl vs. Monocryl were similar in terms of the esthetics and satisfaction of the patient or the surgeon. Therefore, the use of each one depends on surgeon/patient preferences and the availability of materials. J Clin Gynecol Obstet. 2019;8(3):85-90 doi: https://doi.org/10.14740/jcgo560

The SCAR (Scar Cosmesis Assessment and Rating) scale: new evaluation method for postoperative scars.

The SCAR (Scar Cosmesis Assessment and Rating) scale: new evaluation method for postoperative scars.

Reliability and Photographic Equivalency of the Scar Cosmesis Assessment and Rating (SCAR) Scale, an Outcome Measure for Postoperative Scars

Until recently, no ideal valid, feasible, and reliable scar scale existed to effectively assess the quality of postoperative linear scars. The Scar Cosmesis Assessment and Rating (SCAR) scale was developed and validated as a tool to assess the quality of postoperative scars in clinical and research settings. To assess the reliability of using photographs in lieu of live patient scar rating assessments, and to determine the interrater and intrarater reliability of the SCAR scale. This was a reliability study to assess clinicians' interrater and intrarater reliability, as well as the reliability of using high-quality macrophotographs of postoperative scars. Patients were from a private practice dermatology clinic, with assessed scars representing a range of surgical procedures including those performed by dermatologists, plastic surgeons, and general surgeons. Assessments were performed by an international multidisciplinary team from dermatology, plastic surgery, surgical oncology, emergency medicine, and physiatry, using photographs and live patient assessments. A single photograph was assessed for each patient's scar. Data were obtained between August 3, 2015, and January 18, 2016. Data analysis occurred between January 18, 2016, and July 29, 2016. Using the intraclass correlation coefficient (ICC), the scale was tested for photographic equivalency as well as interrater reliability and intrarater reliability by 5 raters on a set of 80 total patient scars, 20 of which were analyzed for photographic equivalency and the remaining 60 of which were analyzed for interrater and intrarater reliability. The SCAR scale that measures postoperative scar cosmesis, with scores ranging from 0 (best possible scar) to 15 (worst possible scar), based on 6 clinician and 2 patient items was used. Of those 60 in the photographic subgroup, 10 were rated using not only the SCAR scale but also the Patient and Observer Scar Assessment Scale and the Vancouver Scar Scale, and 10 were assessed twice by the same rater at different times to assess intrarater reliability. Patients' ages ranged from 18 to 96 years, with Fitzpatrick skin types I through VI. Thirty-seven were male, and 43 were female. A set of 20 live patient scars with associated photographs, as well as a separate set of 60 photographs, were rated; 10 patients were assessed twice for intrarater reliability. The SCAR scale ratings using photographs were found to be largely equivalent to live patient assessments, with ICCs of 0.99 (95% CI, 0.96-0.99) and 0.98 (95% CI, 0.96-0.99). The interrater reliability of the overall scale showed an ICC of 0.95 (95% CI, 0.96-0.99) using a 2-sample random-effects model. Intrarater reliability found ICCs ranging from 0.96 to 0.99 with 5 separate raters. Modeling the overall SCAR score predicted whether the rater would consider the scar undesirable, with an odds ratio of association of 1.76 (95% CI, 1.24-2.2). A secondary analysis of Fitzpatrick skin types IV, VI, and VI demonstrated a sustained interrater reliability, with an ICC of 0.93 (95% CI, 0.86-0.98). The SCAR scale is a reliable rating scale for postoperative linear scars, and photographs may reliably be used in lieu of live patient assessments. The SCAR scale therefore represents a reliable standard rating scale for postoperative scar cosmesis.