Scar Score Research Articles

Bilateral Pedicled Scrotal Flaps as an Alternative to Skin Graft in Penile Shaft Defects Repair

ObjectiveTo analyze surgical and functional outcomes of bilateral pedicled scrotal flaps for penile shaft reconstruction. Materials and MethodsA retrospective analysis was performed on 22 patients who underwent penile shaft reconstruction with bilateral pedicled scrotal flaps between 2009 and 2017. Demographics, peri-operative data, and surgical complications were collected. Functional outcomes were analyzed using a questionnaire made of the erection hardness score, the patient and observer scar assessment scale, and a 10-point Likert scale measuring patients... satisfaction about their skin coloration, sensitivity, elasticity and thickness, penile size, scrotal volume, erection quality, penetration ability, pain, sexual satisfaction, body image, masculinity, self-esteem, and global satisfaction. ResultsPatients exhibited a wide range of indications, including buried penis (27.2%), or subcutaneous injections of foreign material (27.2%). Early complications were suture dehiscence (31.8%), infection (13.6%) and hematoma (4.6%), associated with 9.1% of surgical revisions. Late complications were skin retraction (27.3%), testicular ascension (22.7%), pyramidal shape (4.6%) or shortening (13.6%) of the penis, associated with 27.3% of surgical revisions. For the 12 patients who answered the questionnaire, median erection hardness score and patient and observer scar assessment scale score [IQR] were 3.5 out of 4 [2.5-4] and 11.5 out of 60 [9.5-22], respectively. The patients reported a positive impact of the surgery on their psychological condition, with a median score of global satisfaction of 8 [IQR 7.5-9.5]. ConclusionBilateral pedicled scrotal flaps seem.ßto be a safe alternative for shaft defects reconstruction despite a potential need of surgical revision, providing satisfactory functional outcomes.

Safety and efficacy of intracoronary artery administration of human bone marrow-derived mesenchymal stem cells in STEMI of Lee-Sung pigs-A preclinical study for supporting the feasibility of the OmniMSC-AMI phase I clinical trial.

This study tested whether early left intracoronary arterial (LAD) administration of human bone marrow-derived mesenchymal stem cells (hBMMSCs, called OmniMSCs) in acute ST-segment elevation myocardial infarction (STEMI) of Lee-Sung pigs induced by 90 min balloon-occluded LAD was safe and effective. Young male Lee-Sung pigs were categorized into SC (sham-operated control, n = 3), AMI-B (STEMI + buffer/21 cc/administered at 90 min after STEMI, n = 6), and AMI-M [acute myocardial infarction (AMI) + hBMMSCs/1.5 × 107/administered at 90 min after STEMI, n = 6] groups. By 2 and 5 months after STEMI, the cardiac magnetic resonance imaging demonstrated that the muscle scar score (MSS) and abnormal cardiac muscle exercise score in the infarct region were significantly increased in the AMI-B than in the SC group that were significantly reversed in the AMI-M group, whereas the left ventricular ejection function by each month (from 1 to 5) displayed an opposite pattern of MSS among the groups (all p < 0.001). By 5 months, histopathological findings of infarct and fibrosis areas and isolectin-B4 exhibited an identical pattern, whereas the cellular expressions of troponin-I/troponin-T/von Willebrand factor exhibited an opposite pattern of MSS among the groups (all p < 0.001). The ST-segment resolution (>80%) was significantly earlier (estimated after 6-h AMI) in the AMI-M group than in the AMI-B group (p < 0.001). The protein expressions of inflammation (IL-1β/TNF-α/NF-κB)/oxidative stress (NOX-1/NOX-2/oxidized protein)/apoptosis (cleaved caspase-3/cleaved PARP)/DNA damage (γ-H2AX) displayed an identical pattern to MSS among the groups, whereas the protein expressions of angiogenesis factors (SDF-1α/VEGF) were significantly and progressively increased from SC, AMI-B, to AMI-M groups (all p < 0.001). Early intra-LAD transfusion of OmniMSC treatment effectively reduced the infarct size and preserved LV function in porcine STEMI.

Clinical efficacy and inflammatory reaction of submental endoscopic thyroidectomy versus conventional thyroidectomy: A prospective randomized study

ObjectivesThis prospective study aimed to explore the clinical efficacy and inflammatory reaction of submental endoscopic thyroidectomy versus conventional thyroidectomy. MethodsWe prospectively recruited 45 patients (total 90 patients) who met the eligibility criteria to undergo conventional open thyroidectomy or submental endoscopic thyroidectomy from January 2021 to July 2022 in the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. These patients were evaluated using the following indices: number of lymph nodes dissected, complications, pain severity, inflammatory indicators, cosmetic satisfaction, and economic cost. All data were analyzed by the t-test or chi-squared test. ResultsNinety patients were enrolled. The two groups did not significantly differ regarding baseline characteristics. All patients who underwent thyroidectomy had a similar trauma index and increased level of inflammation. There were no significant differences between the open thyroidectomy and submental endoscopic thyroidectomy groups in the total number of lymph nodes dissected, number of positive lymph nodes, drainage volume, and complications. The Vancouver scar score and cosmetic satisfaction score were significantly better in the submental endoscopic thyroidectomy group than the open thyroidectomy group. The submental endoscopic thyroidectomy group had a significantly lower pain scores on postoperative days 1 and 2, less downtime, and cheaper medical and esthetic costs than the open thyroidectomy group. ConclusionCompared with conventional open thyroidectomy, submental endoscopic thyroidectomy did not increase the degree of trauma, had superior clinical efficacy, caused less pain, required a shorter downtime, achieved a better cosmetic effect, and was associated with lower healthcare costs.

Comparison of the Efficacy of Combined Silver Nitrate Coagulation and Shave Excision With Surgical Excision and Linear Closure in the Treatment of Pyogenic Granuloma.

Pyogenic granuloma (PG) is a common benign vascular neoplasia. Optimal treatment should have an aesthetically pleasant scar and a low recurrence rate. No treatment method that is fully effective in solving these has been demonstrated. Silver nitrate cauterization is another method for the management of PG lesions. The effects of silver nitrate on the treatment of PG have not been sufficiently investigated and should be investigated with objective data and a controlled study. The prospective clinical trial was designed to compare silver nitrate cauterization with surgical excision treatment. Procedure times and procedure costs, comfort and satisfaction scales, recurrences, the Patient and Observer Scar Assessment Score, and the Vancouver Scar Scale were compared to evaluate treatments. Silver nitrate treatment had lower procedure times, costs, and better satisfaction and comfort scale scores. The scar assessment scores were better for the silver nitrate treatment. The patients in both groups were successfully treated and no recurrence was seen. Silver nitrate cauterization is low-cost, fast, safe, reliable, and effective with good aesthetic results for the treatment of PG lesions. This study shows that silver nitrate cauterization is a good alternative to surgical excision in the management of PG.

A COMPARATIVE STUDY ON EFFECTIVENESS OF CO2 LASER + MICRONEEDLING AND CO2 LASERIN PATIENTS WITHACNE SCARS

Introduction: Acne is one of the most common disorders. Quite often, acne results in scar formation due to the preceding inflammation causing either loss or gain of tissue. Ablative CO2 laser resurfacing and microneedling are proven effective modalities for the treatment of acne scarring. However, one out of two techniques is done exclusively in a patient. In the present study we have compared the sequential usage of CO2 laser + Microneedling Versus Only CO2 laser. Materials and Methods: A total of 50 patients were recruited for the study. 25 patients with moderate-to-severe acne scars underwent one sitting of fractional CO2 laser, followed by Microneedling after 3 weeks to follow the same sequence making total of four sittings over 6 months, while other 25 patients underwent total of four fractional CO2 laser sittings within a gap of 3 weeks each. Outcomes were based on GoodmanÂ’s Qualitative and Quantitative assessment. Results: Acne scarring improved significantly in all the 50 patients. Mean scar scores decreased to 9.05% as compared to 58.52% before treatment, decreasing by a mean of 49.47% in Group A, while in Group B, the mean scar scores decreased to 7.45% as compared to 30.20%, decreasing by a mean of 22.75%. Based on quantitative assessment of after treatment reduction of Acne Scars Comparing Group A and Group B. Very good reduction of acne scars was found in 2 (8%) patients in the Group A whereas in the Group B none of the patients had found the very good reduction. Good reduction of Acne scars was found to be in 12 patients (48%) in the Group A, whereas in the Group B was found in the 3 patients (12%), moderate reduction was found in the 10 patients (40%) in the Group A whereas in the group B had found in the 15patients (60%). It was found to be statistically significant association (P value= 0.001). This infers, maximum good reduction was found to be in association with the Group A than Group B. In the Group A, all the 25 patients presented with erythema, edema, needle impression and all the 25 patients in the Group B presented with the erythema respectively Conclusion: The use of combination therapy of CO2 laser + Microneedling and CO2 laser is more efficacious than CO2 laser alone. This combination present with more or less similar side effects as compared to monotherapy.

Predictors of procedural failure of left bundle branch pacing in scarred left ventricle.

Presence of scar at the implantation-site is considered as a major factor in determining the success of left bundle branch pacing (LBBP). We aimed at analyzing the predictors of procedural failure in patients with scarred-left ventricle (LV) as demonstrated by cardiac-magnetic resonance-imaging (CMR). This was a retrospective, observational single-center-study that included consecutive cardiomyopathy patients with LV-scar as demonstrated by late-gadolinium-enhancement (LGE) in CMR requiring LBBP. Procedural-failure was defined as the inability to penetrate the septum to reach the LV subendocardium RESULTS: A total of 25 cardiomyopathy patients demonstrated LGE in CMR and were included in the study. LBBP was successful in 16 patients (group-I; 64% acute-procedural-success). In the remaining 9 patients (group-II) lead could not be penetrated and hence biventricular-pacing was done. LBBP resulted in reduction in QRS-duration and improvement in LV ejection fraction in group-I patients during a mean follow-up of 11.2 ± 3.7 months. Computed-tomography-angiography after LBBP showed the successful lead deployment site (LBBP-Zone) as the overlapping areas of inferior aspect of antero-septum and superior aspect of infero-septum (segment 2/3; AHA-model) in short-axis view(figure-1C). CMR showed LGE in significantly more number of LV-segments and high scar-burden in group-II as compared to group-I (figure-1). A total scar score value of >1.0 predicted failure with 100%-sensitivity and 75%-specificity. CMR revealed transmural-scar in the LBBP-Zone in all patients in group-II (n = 9; 100%). Transmural scar in LBBP-Zone by CMR had 100%-sensitivity and 100%-specificity for predicting the procedural-failure. CMR helps in predicting the procedural failure of LBBP in patients with scarred LV. Presence of transmural-LGE in the LBBP-Zone predicts failure with high sensitivity and specificity.

Burn injury characteristics, referral pattern, treatment (costs), and outcome in burn patients admitted to a hospital with or without a specialized Burn Centre (BURN-Pro)

PurposeData on the epidemiology, treatment, and outcome of burn patients treated at non-burn centre hospitals are not available. The primary aim was to compare the burn characteristics of patients admitted to a hospital with or without a specialized burn centre.MethodsThis multicentre, prospective, cohort study enrolled patients with burns admitted to a hospital without a burn centre and patients with < 10% total body surface area (TBSA) burned admitted to the burn centre. Primary outcome measure was the burn-related injury characteristics. Secondary outcome measures were adherence to the Emergency Management of Severe Burns (EMSB) referral criteria, treatment (costs), quality of life, and scar quality.ResultsDuring the 2-year study period, 48 patients were admitted to a non-burn centre and 148 patients to the burn centre. In the non-burn centre group, age [44 (P25–P75 26–61) versus 30 (P25–P75 8–52) years; P = 0.007] and Injury Severity Score [2 (P25–P75 1–4) versus 1 (P25–P75 1–1); P < 0.001] were higher. In the burn centre group, the TBSA burned was significantly higher [4% (P25–P75 2–6) versus 2% (P25–P75 1–4); P = 0.001], and more surgical procedures were performed (in 54 versus 7 patients; P = 0.004). At 12 months, > 85% of the non-burn centre group and > 75% of the burn centre group reported no problems in quality of life. Scar quality score was < 1.5 in both groups, with significantly poorer scores in the burn centre group (P ≤ 0.007).ConclusionBoth groups differed in patient, burn, and treatment characteristics. At 12 months, quality of life and scar quality were good in both groups. Significantly poorer scar quality scores were found in the burn centre group. This might be related to their larger burns and more frequent surgery. The organization of burn care in the Netherlands seems to work adequately. Patients are treated locally when possible and are transferred when necessary.

The utility of single-incision retrograde surgery for the infection preauricular fistula

Objective:To investigate the clinical effectiveness of the single-incision retrograde surgery（SIRS） of the infection preauricular fistula. Methods:A retrospective analysis was performed from April 2016 to May 2021. In the observation group, there were 15 cases of infected preauricular fistula using single-incision retrograde surgical excision. Twenty-four infected preauricular fistulas by double-incision surgery（fistula and infection incisions） were selected as the control group. The recurrence rates, wound healing scores, and scar assessment were compared between the two groups. Results:There were no significant differences in recurrence rate and incision healing between groups（P>0.05）, and the preserved fistula in SIRS group were good without infection recurrence. Moreover, The scar score and the surgical wound in SIRS group were better than that in the control group（P<0.05）. Conclusion:The single-incision retrograde surgery is an effective method of treating infected preauricular fistulas with fewer wounds and fewer scars.

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

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

Prognostic relevance of HRDness gene expression signature in ovarian high-grade serous carcinoma; JGOG3025-TR2 study.

This study aimed to evaluate the homologous recombination repair pathway deficiency (HRD) in ovarian high-grade serous carcinoma (HGSC). In the ovarian cancer data from The Cancer Genome Atlas, we identified genes differentially expressed between tumours with and without HRD genomic scars and named these genes "HRDness signature". We performed SNP array, RNA sequencing, and methylation array analyses on 274 HGSC tumours for which targeted sequencing of 51 genes and clinical data were available to generate JGOG3025-TR2 dataset. TheHRDness signature was tested on external datasets, including the JGOG3025-TR2 cohort, by computational scoring and machine-learning prediction. High scores and positive predictions of theHRDness signature were significantly associated with BRCA alterations, genomic scar scores, and better survival. On the other hand, among cases with high scores and/or positive predictions, those with BRCA1 methylation showed poorer survival. In the JGOG3025-TR2 cohort, HRD status was significantly associated with the use of olaparib after relapse and progression-free survival after its initiation. TheHRDness gene expression signature is associated with a good prognosis, while BRCA1 methylation is associated with a poor prognosis. The newly generated JGOG3025-TR2 dataset will be useful in future HGSC studies.

Clinical Observation of Sequential Laser Therapy Combined with Tension Reducer for Postoperative Tension Incision Scar Growth.

To investigate the clinical effectiveness of laser and secure wound-closure system (Tension reducer) in the treatment of postoperative scarring after tension incision. A retrospectively observational study was conducted. Twenty-six patients who underwent surgical treatment in our department between June 2017 and December 2021 were selected, and those treated with laser and tension reducer were treated as a combined treatment group, and those treated with laser were treated as a conventional treatment group. Fifteen patients in the conventional group were treated with the pulsed dye laser and CO2 fractional laser at 1-2 month intervals. Eleven people in the combined treatment group were treated with the laser in addition to a tension reducer for 3-6 months. The scar width, scar thickness, scar hardness, pruritus score, modified Vancouver scar scale and complication rates between the two treatment modalities were compared between the two groups at 6 months postoperatively. The scar thickness, scar hardness and modified Vancouver scar scale of 1.25 (0.14, 1.90) mm, 31.80 (21.00, 37.20) HA, (6.00 ± 2.17) in patients in the combined treatment group were less than those of patients in the conventional treatment group of 5.50 (4.00, 11.50) mm, 42.60 (32.50, 47.00) HA, (8.25±1.91), (Z=2.883, 2.718, t=2.904, p<0.05). The scar width and pruritus score in the combined treatment group, were 8.00 (5.00, 18.00) mm and 0 (0, 1) respectively, while the scar score and pruritus score in the conventional treatment group, were 5.50 (4.00, 11.50) mm respectively, with no statistically significant difference between the two groups. The complication rate was 55% in the combined treatment group and no adverse reactions occurred in the control group. Sequential laser combined with tension reducer treatment can effectively inhibit the proliferation of postoperative tension incision scar.

Evaluation of Adverse Reactions and Effects of Triamcinolone Acetonide Combined with Compound Betamethasone in Keloid

To explore the drug effect and adverse reaction of triamcinolone acetonide combined with compound betamethasone in keloid is the objective of the study. 100 patients were randomly divided into study group and control group (50 patients in each group). The research group received sequential treatment with triamcinolone acetonide injection combined with compound betamethasone injection and the control group received compound betamethasone injection. Both groups had 3 courses of treatment and each course of treatment lasted for 3 w. The Vancouver scar scale score, treatment effect and adverse reactions were compared between the two groups and the recurrence rate was followed up for 1 y after the end of medication. Before treatment, there was no significant difference in Vancouver scar scale scores between the two groups but after medication, the study group was better than that of the control group (p<0.05). The total effective rate of the study group (82 %) was higher than that of the control group (54 %, p<0.05). The total incidence of adverse drug reactions in the study group was 8 % while in the control group it was 6 % and the comparison between the two groups was not statistically significant. The recurrence rates of the study group and the control group were 28 % and 34 % 6 mo after the end of medication and 32 % and 42 % after 12 mo. There was a significant difference between the two groups. The sequential injection of triamcinolone acetonide combined with compound betamethasone is effective in the treatment of keloids, with high safety and low recurrence rate, which is worthy of clinical recommendation.

Fractional Erbium YAG Laser Resurfacing Versus 20% Trichloroacetic Acid Chemical Peeling in the Treatment of Acne Scars: A Comparative Study.

Acne scarring not only affects the aesthetic appearance of an individual but also has a detrimental effect on mental health and social life. Various treatment modalities are available for acne scars. In this study, fractional erbium-doped yttrium-aluminum-garnet (Er:YAG) laser resurfacing was compared with 20% trichloroacetic acid (TCA) peeling in terms of efficacy and safety. This prospective comparative study included 50 subjects of acne scar who were randomly divided into Groups A and B, 25 patients in each group. Group A was treated with 4 sessions of fractional Er:YAG laser and Group B with 4 session of 20% TCA application as chemical peeling, repeated every 21 days over a period of 3 months. The patients were evaluated for improvement at each visit using Goodman and Baron's qualitative and quantitative acne scar grading. Statistically significant improvement in Goodman and Barron's qualitative acne scar grades was observed in both groups. At the end of therapy, that is, after 12 weeks of therapy, the mean percentage reduction in Goodman and Baron's quantitative acne scar scores was 21.69% ± 16% in Group A and 20.97% ± 8.70% in Group B. In regards of complications, both procedures were well tolerated. We concluded that fractional Er:YAG laser resurfacing and 20% TCA peel application in the treatment of atrophic acne scar are equally efficacious. Both procedures are safe and well tolerated by the patients.

Single-stage acellular dermal matrix reconstruction of defects in the nose and ears with exposed cartilage: a prospective case series

BackgroundThe treatment of soft tissue defects with exposed cartilage after tumor excision is challenging. Local flap reconstruction causes occasional scarring, especially in non-Caucasian populations. Scar treatment requires secondary procedures for aesthetic modifications. Two-step reconstruction with an acellular dermal matrix addresses this issue and yields highly acceptable aesthetic resultsWe aimed to investigate the efficacy of an artificial dermal matrix cover using one-step reconstruction for defects with cartilage exposure.MethodsFrom July 2018 to September 2020, seven patients were enrolled and underwent a single-stage operation using acellular dermal matrices. Patients were followed up for at least 6 months and the size of the wound, days to heal, patient satisfaction, and scar scale scores were recorded.ResultsPatients were followed up for an average of 25.7 months. The average time to heal was 23.4 days postoperatively. No hyperpigmentation, tumor recurrence, or retraction was noted. High acceptance and satisfaction with the outcome were observed in all patients.ConclusionsSingle-stage reconstruction yielded high acceptance of aesthetic results similar to that in two-stage reconstruction. Less time and cost make this an effective and efficient treatment for soft tissue defects compared with traditional techniques.

CO2 fractional laser combined with triamcinolone acetonide injection for the hypertrophic scars: which is first?

The aim of this study is to investigate and analyze the effect of different application sequences of CO2 fractional laser and triamcinolone acetonide injection on the application effect of hypertrophic scar in one operation. Patients with hypertrophic scars who received CO2 lattice laser combined with triamcinolone acetonide injection from January 2021 to December 2022 were retrospectively analyzed. According to the different initial operations, they were divided into CO2 FL-TA group and TA-CO2 FL group. The Vancouver Scar Scale score and scar thickness of the two groups before and after treatment were analyzed. The complications occurred in the two groups during the treatment period. The clinical efficacy of the two groups before and after the treatment was calculated. Before treatment, there was no difference in scar thickness and VSS score between the two groups (P > 0.05). After treatment, the above indexes in CO2 FL-TA group were significantly better than those in TA-CO2 FL group (P < 0.05);the incidence of adverse reactions in CO2 FL-TA group was 9.38%,which was significantly lower than that in TA-CO2 FL group (18.75%) (P < 0.05);the total effective rate of CO2 FL-TA group was 90.63%, which was significantly higher than that in TA-CO2 FL group (65.63%) (P < 0.05).In the process of combined CO2 fractional laser and triamcinolone acetonide injection in the treatment of hypertrophic scars, CO2 fractional laser treatment first, and then triamcinolone acetonide injection can reduce the number of treatments, reduce the incidence of adverse reactions, and achieve more satisfactory treatment effect.

Transverse incision versus longitudinal incision in the implantation of PICC-port: A before-after study.

The peripherally inserted central catheter-port (PICC-port) technique is an innovation of the standard arm-totally implantable vascular access device. The design of surgical skin incision may have an important impact on the postoperative life of patients, the cosmetic result is important for patient satisfaction as well. To compare two different incision methods in the implantation of PICC-port. A before-after study. A total of 62 adult patients with malignant tumor requiring chemotherapy in Shanghai General Hospital were selected by convenience sampling, 31 in each group. All participants agreed to install PICC-port with signature from 1 Jan to 30 April, 2022. 31 patients were given longitudinal incision, about 3 cm below the puncture point obliquely. Another 31 patients were given transverse incision, about 3 cm below the puncture point. T-test, chi-square test and rank sum test were used to compare the differences between the two groups in incision healing, scar score, and operation time. There was no statistically significant difference in incision healing between the two groups(p > 0.05). The scar scores of patients with transverse incision were higher than that of patients with longitudinal incision at 3 months (p < 0.05). And the operation time of longitudinal incision group was longer than that of transverse incision group(p < 0.05). Our study revealed that PICC-port implantation could be considered as safe as PICC insertion conducted by nurse. During our follow-up, all patients with PICC-port implantation had good wound healing, and there were no complications such as local infection happened. The transverse incision was more easier to be operated in bag making in PICC-port implantation.

A Single Center, Prospective, Randomized, Blinded Study to Evaluate the Efficacy and Safety of a Topical Tripeptide/Hexapeptide Anhydrous Gel When Used Pre- and Post- Hybrid Fractional Laser for the Treatment of Acne Scars.

Acne scarring remains a significant problem. Laser therapy has produced varying results with deeper ablative therapies occasionally associated with side effects including delayed healing, infection, scarring, erythema, acne, milia, edema and dyspigmentation. Can adjuvant topical therapy impact the healing process and outcome of patients treated with fractional laser for acne scarring? Ten patients were randomized to receive either Regenerating Skin Nectar with TriHex Technology®- RSN or a bland moisturizer. Patients underwent two laser procedures one month apart with Hybrid Fractional Laser. The topical was applied twice daily for 2 weeks prior to the first laser procedure, and through completion of the study. Seven study visits occurred over a 90-day period. Measurements were conducted in lesional and non-lesional areas - transepidermal water loss (TEWL), erythema, photography, Goodman and Baron qualitative scale, Global Aesthetic Improvement Scale and patient questionnaires - to assess functional recovery and aesthetic outcomes in the scarred areas. One patient from each cohort consented to biopsy before the procedures and 90 days after the first procedure. Reduced TEWL scores in the RSN group were evident at all time points with statistically significant reductions occurring 4 days after first and second procedures indicating more efficient fluid conservation at a critical point in the healing trajectory. Erythema index demonstrated a consistent decrease in the RSN cohort over the control from day 4 through day 90 on lesional and non-lesional skin. Acne scar assessment scores improved in the RSN cohort compared with the control at all time points. Biopsy results showed early elastin regeneration in the RSN biopsy with controlled non-hypertrophic collagen formation evident. The use of RSN pre- and post- laser resurfacing significantly decreased postprocedural TEWL and erythema, and increased aesthetic improvement in acne scars and patient satisfaction, when compared with bland moisturizer.

Single-stage Flexor Hallucis Longus transfer and Gracilis free flap cover for failed Achilles tendon repair with soft tissue defect

IntroductionReconstruction of failed Achilles tendon repair, with infection and loss of overlying skin, is a surgical challenge. This paper aims to deal with the technical considerations and study the outcome of reconstructing such defects by radical debridement and reconstruction with combined Flexor hallucis longus (FHL) transfer and free Gracilis flap cover. Materials and methodsA retrospective study of six patients with failed Achilles tendon repair with overlying skin and soft tissue loss reconstructed by FHL transfer and free Gracilis flap cover performed between January 2017 and August 2020 was conducted. Postoperatively, they were assessed with the Mean Functional Gait Assessment score(MFGA), the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score, the Achilles tendon Total Rupture Score (ATRS), and Modified Vancouver scar scale score (mVSS). ResultsAll six patients reported a good gait at nine months of follow-up. The MFGA score at six months was 24.8. The mean ankle plantar flexion at nine months follow up was 39.1° . The mean nine-month postoperative AOFAS and ATRS scores were 86.33 ± 2.654 and 88.5 ± 5.54, respectively. At nine months, all the patients could perform a single-leg heel raise on the operated foot. The overall mean mVSS score was 1.41. In about 12 months, the peak forefoot to hindfoot ratio matched the uninjured opposite foot. ConclusionSimultaneous reconstruction of the Achilles tendon with FHL transfer with free Gracilis flap for the coverage of overlying soft tissue loss is a good management option for failed Achilles tendon repair with overlying skin loss.

Clinical Utility of the Portable Pressure-Measuring Device for Compression Garment Pressure Measurement on Hypertrophic Scars by Burn Injury during Compression Therapy.

Compression therapy for burn scars can accelerate scar maturation and improve clinical symptoms (pruritus and pain). This study objectively verified the effect of pressure garment therapy in maintaining a therapeutic pressure range for hypertrophic scars. Sixty-five participants (aged 20~70 years) with partial- or full-thickness burns, Vancouver scar scale score of ≥4, and a hypertrophic scar of ≥4 cm × 4 cm were enrolled. Compression pressure was measured weekly using a portable pressure-monitoring device to regulate this pressure at 15~25 mmHg for 2 months. In the control group, the compression garment use duration and all other burn rehabilitation measures were identical except for compression monitoring. No significant difference was noted in the initial evaluations between the two groups (p &gt; 0.05). The improvements in the amount of change in scar thickness (p = 0.03), erythema (p = 0.03), and sebum (p = 0.02) were significantly more in the pressure monitoring group than in the control group. No significant differences were noted in melanin levels, trans-epidermal water loss, or changes measured using the Cutometer® between the two groups. The efficacy of compression garment therapy for burn-related hypertrophic scars can be improved using a pressure-monitoring device to maintain the therapeutic range.

In Multiple Myeloma Patients without Known Cytogenetic Risk Features, Genomic Features Contribute to Early Death Risk at Diagnosis

Multiple myeloma (MM) is a heterogeneous disease, and cytogenetic abnormalities such as t(4;14) and del17p are well-established independent high-risk features in newly diagnosed patients. In two clinical trials (N=1422), the IFM2009 and Determination, patients with del17p or t(4;14) had a hazard ratio of 1.9 (95% CI 1.5-2.4) and 1.6 (95% CI 1.2-2.1), respectively. However, the same study also showed that 25% of the remaining patients had a similar short PFS without any identified known high-risk features. To understand the genomic etiology of the high-risk in these patients, we generated WGS data from 640 newly diagnosed patients (GAMER dataset) in 3 categories (low risk [PFS > 36 months] without known risk features (LR), high-risk [PFS < 18 months] without known risk features (unknownHR, uHR) and high-risk with known risk features) (HR). Our primary focus was to find factors that contribute to high-risk without known risk features. As a validation set, we used WGS samples from newly diagnosed patients who enrolled in the DFCI 2009 study. Overall, we observed that t(14;16) was the only primary translocation that differs between uHR (7%) and the LR group (1%) (p value < 0.01). We found more frequent driver mutations in TP53(7%), ATM(6%), and EGR1(4%), in the uHR group (FDR < 0.05). In uHR group, we found that the cancer cell fraction carrying these mutations was significantly lower compared to double hits events observed in HR (p value = 6.4e-05), suggesting their presence in high-risk subclones. Chromosome 1q gain vs amplification were associated with similar outcomes in these patients (p value = 0.81), but both significantly differed from chr1q wild type (p value = 1.8e-07). High-risk patients with and without known risk features had a significant enrichment of mutations in the Genome Integrity pathways (24%) compared to the LR group. However, the enrichment in MAPK signaling pathway mutations (60%) was significantly different between the two high-risk groups. Features that contribute to genome integrity, such as structural variants (insertion, deletion, translocation and inversion, p value<0.001), mutational load (p=0.00025), and genomic scar scores (p=0.0007), were all significantly lower in the low-risk group compared to the uHR. The number of copy number alterations that have not been described before, such as del16, del8p and gain 9 and 19, were also significantly different between low-risk and high-risk patients without known risk features. We further searched for genomic factors that contribute to the classification of uHR using multiple statistical modeling and machine learning tools. All models were run using a 10-fold cross-validation for choosing variables to put into the final model. Using all variables in the final model, we created a classification model using the variables' significance and the model's accuracy. Out of 27 variables, we found that 7 (mutational load, structural variants, del8p, t(14;16), Genome Integrity Pathway, MAPK pathway and ISS > 2) significantly contributed to the classification model. On training and validation data, this model successfully detected the risk group (p value = 3.5e-09 and 0.0027, respectively). Our dataset gives the ability to identify genomic risk markers that are not currently considered in newly diagnosed MM and allows us to extend our understanding beyond traditional risk. The absence of unique and mutually exclusive markers between uHR and LR suggests the additive risk model in MM patients without known high risk markers. Additional risk features might be hidden in the transcriptome and regulation of the transcriptome. We are currently building an integrative model from the same patients with WGS, RNA-seq and methylation data. This will allow us to fine-tune our risk model and help us develop simplified and complex models on MM risk beyond known cytogenetic risk features.