Scar Edge Research Articles

Compressed SENSE accelerated 3D single-breath-hold late gadolinium enhancement cardiovascular magnetic resonance with isotropic resolution: clinical evaluation

AimThe purpose of this study was to investigate the clinical application of Compressed SENSE accelerated single-breath-hold LGE with 3D isotropic resolution compared to conventional LGE imaging acquired in multiple breath-holds.Material & MethodsThis was a retrospective, single-center study including 105 examinations of 101 patients (48.2 ± 16.8 years, 47 females). All patients underwent conventional breath-hold and 3D single-breath-hold (0.96 × 0.96 × 1.1 mm3 reconstructed voxel size, Compressed SENSE factor 6.5) LGE sequences at 1.5 T in clinical routine for the evaluation of ischemic or non-ischemic cardiomyopathies. Two radiologists independently evaluated the left ventricle (LV) for the presence of hyperenhancing lesions in each sequence, including localization and transmural extent, while assessing their scar edge sharpness (SES). Confidence of LGE assessment, image quality (IQ), and artifacts were also rated. The impact of LV ejection fraction (LVEF), heart rate, body mass index (BMI), and gender as possible confounders on IQ, artifacts, and confidence of LGE assessment was evaluated employing ordinal logistic regression analysis.ResultsUsing 3D single-breath-hold LGE readers detected more hyperenhancing lesions compared to conventional breath-hold LGE (n = 246 vs. n = 216 of 1,785 analyzed segments, 13.8% vs. 12.1%; p < 0.0001), pronounced at subendocardial, midmyocardial, and subepicardial localizations and for 1%–50% of transmural extent. SES was rated superior in 3D single-breath-hold LGE (4.1 ± 0.8 vs. 3.3 ± 0.8; p < 0.001). 3D single-breath-hold LGE yielded more artifacts (3.8 ± 1.0 vs. 4.0 ± 3.8; p = 0.002) whereas IQ (4.1 ± 1.0 vs. 4.2 ± 0.9; p = 0.122) and confidence of LGE assessment (4.3 ± 0.9 vs. 4.3 ± 0.8; p = 0.374) were comparable between both techniques. Female gender negatively influenced artifacts in 3D single-breath-hold LGE (p = 0.0028) while increased heart rate led to decreased IQ in conventional breath-hold LGE (p = 0.0029).ConclusionsIn clinical routine, Compressed SENSE accelerated 3D single-breath-hold LGE yields image quality and confidence of LGE assessment comparable to conventional breath-hold LGE while providing improved delineation of smaller LGE lesions with superior scar edge sharpness. Given the fast acquisition of 3D single-breath-hold LGE, the technique holds potential to drastically reduce the examination time of CMR.

Клинический случай дезадаптации роговичного рубца у пациента с наличием трансплантированной роговицы после передней послойной кератопластики

Purpose. Demonstration of a clinical case of corneal scar edges disadaptation after removal of sutures in anterior deep layered keratoplasty, assessment of patient's treatment. Material and methods. Patient K., 47 years old, underwent deep anterior lamellar keratoplasty in the right eye for stage 3 keratoconus. The operation went as it planned with no complications. At the time of discharge, maximum corrected visual acuity OD was 0.1 n/c. A year later, the suture was removed from the cornea. 3 instillations of okomistin 0.01 % and dexpanthenol 5 % was prescribed to the patient for 12 days. The next day after the removal of sutures, the patient felt a sharp deterioration in vision, redness of the right eye appeared. In a polyclinic at the place of residence, a divergence of corneal scar edges was detected, lasting from 7 to 12 hours, swelling of the graft and reduction of the anterior chamber. The patient was urgently sent to the eye department of the clinic at the place of residence. There, 7 single sutures were urgently applied to fix the graft. In our clinic, to eliminate the corneal wound edges disadaptation, a circular continuous 10\0 suture was applied. In addition, to stop the detachment of the Descemet's membrane (DM), additional air was injected into the anterior chamber. Results. As a result of the treatment, a complete adaptation of corneal wound edges was achieved, the transparency of the graft was restored due to complete adherence of DM to the corneal stroma. The presence of this complication was probably associated with local disturbances in the reparative processes of the cornea, which led to the formation of zones of inadequate scarring. Conclusion. To prevent disadaptation of the corneal wound after keratoplasty, it is necessary to search for objective criteria for quality of the corneal scar and the optimal timing for removal of the corneal suture. Keywords: disadaptation of the corneal scar; corneal transplant; keratoplasty

Aspirin inhibits the growth of hypertrophic scar in rabbit ears via regulating Wnt/β-catenin signal pathway.

Steroidal anti-inflammatory drugs have certain side effects in the treatment of hypertrophic scar, and the scar recurrence is easy after withdrawal of steroid anti-inflammatory drugs. Finding reliable alternative drugs is an effective means to improve this defect. Aspirin, a traditional non-steroidal anti-inflammatory drug, is safe for topical use and has anti-inflammatory effects similar to those of steroidal anti-inflammatory drugs, which may have similar effects on the treatment of hypertrophic scar. This study aims to investigate the inhibitory effect of aspirin on the proliferation of hypertrophic scar in rabbit ears and the underlying mechanism. The rabbit ear hypertrophic scar models were prepared. The rabbits were randomly divided into a normal skin group (group A), a blank control group (group B), a 0.9% NaCl group (group C), a 0.2% aspirin group (group D), a 0.5% aspirin group (group E), a 2% aspirin group (group F), and a triamcinolone acetonide group (group G). Macroscopic observation of hyperplasia was performed 8 weeks after local injection of the scar, followed by collecting the scar tissue samples for HE staining, Masson staining, and immunohistochemistry, respectively to assess the proliferation of fibroblasts and collagen fibers, and calculate the hypertrophic index, microvessel density, and immunohistochemical score. All rabbit ear hypertrophic scar models were successfully constructed. In groups B and C, the hypertrophic scar edge was irregular, with reddish protruding epidermis, significant contracture and hard touch. In group D, E, and F, with the increase of aspirin administration concentration, the scar became thinner and gradually flat, the proliferation of fibrocytes and collagen fibers was weakened, and the hypertrophic index was gradually decreased (P<0.05). Immunohistochemistry showed that the expression of β-catenin was decreased in the group D, E and F in turn, and the immunohistochemical score was gradually decreased (P<0.05). There was no significant difference in hypertrophic index, microvessel density, and immunohistochemical score (all P>0.05). Local injection of aspirin can reduce the generation of hypertrophic scar in a dose-dependent manner within a certain concentration range; aspirin inhibits the growth of hypertrophic scar in rabbit ears by inhibiting Wnt/β-catenin signal pathway; 2% aspirin and 40 mg/mL triamcinolone acetonide have similar curative efficacy on hypertrophic scar.

Cross‐cultural collaboration leads to greater understanding of the rare Spectacled Hare‐wallaby in the west Kimberley, Western Australia

SummaryCross‐cultural collaboration between Yawuru Country Managers (Rangers) and WWF‐Australia ecologists led to new detections of the Spectacled Hare‐wallaby (SHW), (Lagorchestes conspicillatus) in the west Kimberley region of Western Australia where it was presumed to be locally extirpated. This collaboration relied on the expertise of the Yawuru Country Managers to select specific locations for targeted field surveys and resulted in the confirmation of SHW on the Yawuru IPA for the first time in a decade. Subsequent remote camera trap surveys over a larger area included collaboration with two additional neighbouring Indigenous ranger groups, Karrajarri and Nyikina Mangala. These surveys investigated the spatial and temporal relationship between SHW and other mammals which may threaten (e.g., feral Cat [Felis catus], Dingo [Canis familiaris dingo]) or compete (e.g., Agile Wallaby [Macropus agilis]; Cattle [Bos taurus]) with them. We found a negative relationship between SHW and cat activity, suggesting that cats may limit the activity or abundance of SHW. Temporal portioning was evident between SHW and both Cattle and Agile Wallaby suggesting that SHW may avoid times when these species are most active. Further, we found a negative relationship between SHW occurrence and distance to fire scar edge burnt in current or previous fire season. This edge habitat is likely important to SHW because they may require recently burnt areas to forage and dense unburnt areas to shelter. This project highlights the benefits of cross‐cultural research and monitoring partnerships with Indigenous rangers as active observers and managers of their traditional lands.

Painting CROSS TCA technique: Modification of the CROSS method for the treatment of atrophic acne scars-Case series.

The Chemical Reconstruction of Skin Scars (CROSS) technique was first described in 2002 and has since demonstrated safety and efficacy in multiple studies. We describe the treatment of six patients with a modified version of the CROSS method-the Painting CROSS trichloroacetic acid (TCA) technique. This technique has the advantage of offering even higher tissue selectivity and better control of the scar edges, enhancing both safety and efficacy. We retrospectively evaluated 31scars of six patients who underwent a single treatment by the Painting CROSS TCA method. A 0.3ml insulin syringe with a 30-gauge needle was filled with 0.05ml of 85% TCA solution and then applied to the scar base with slight pressure until frosting was achieved. Patients were evaluated before and 3months after treatment for scar volume deficit by a high-resolution three-dimensional imaging system. The average volume of the 31scars assessed in our study was 2.71mm3 before treatment and 1.96mm3 after treatment. There was a 26.3% average decrease in the volume of the scars after one treatment. Transient mild hyperpigmentation was noted in two patients after the treatment. Painting CROSS TCA technique has demonstrated efficacy in the treatment of acne scars after a single treatment.

Study of quality of life indicators in patients with atrophic postacne scars after laser ablation techniques

Introduction. Atrophic postacne scars are a persistent cosmetic defect, cause psychological discomfort, and significantly reduce patients' quality of life. Laser technologies are effectively used for their treatment. The aim of the study was to investigate the quality of life in patients with atrophic post-cancerous scars before and after the use of laser methods of scar correction. Materials and methods. A randomized comparative clinical trial included 120 patients with atrophic postacne scars divided into two comparable groups of 60 patients each. Patients received laser ablation procedures with an Erbium laser (2940 nm). The Dermatological Quality of Life Index (DQLI) questionnaire was used to assess the quality of life before and after the laser procedures. Results. The DICG of patients before treatment ranged from 8 to 17 points and averaged 12.962.05 points. In women the mean value of DICG was 14.221.34 points and was higher compared to men (11.141.45 points) (p0.05). After fractional laser ablation procedures and the procedures of its combination with the treatment of the scar edge with a solid stain, improvement of the DICG scores was observed; intergroup differences were found in self-esteem, in the choice of clothing, in personal and intimate relationships, and in the assessment of daily routine. Discussion. The pre-treatment DICG scores of patients with postacne scars indicate a strong impact of the disease on quality of life. The DICG in women was higher than in men, which may be associated with a greater degree of women's anxiety about the aesthetic condition of the skin and appearance. After treatment, the degree of impact of the disease on patients' quality of life decreased to moderate in both groups. Conclusion. The combined method of treatment contributes to the reduction of DICG compared to fractional ablation procedures, which indicates greater patient satisfaction with the result of these procedures.

Wound occlusion and annual stem growth rates of five woodland tree species in South Africa

Sustainable management strategies for trees are informed by research on growth rates and regeneration. In a 1998 study of bark thickness and tree size, six species (all used for traditional medicine) were sampled by removing 5 cm-diameter bark disks at four height intervals on 210 stems at 15 sites in South Africa. An impromptu revisit to one site in 2003 revealed that wounds for one species exhibited very little wound occlusion. These observations prompted a 2004 study on wound occlusion and stem growth for five of the species at six sites (Albizia adianthifolia, Balanites maughamii, Elaeodendron transvaalense, Searsia chirindensis, Warburgia salutaris), where 84 stems were re-measured. There were species-specific stem growth and wound occlusion rates. In general, annual lateral stem growth at 1.3 m was inversely related to stem size (corroborated by lateral widening responses of the original wound edges). There was also a tendency for smaller and/or faster growing stems to exhibit more wound occlusion and faster rates of bark regrowth – except in W. salutaris, where smaller individuals exhibited comparatively lower rates of occlusion compared to bigger individuals. All wound occlusion was by bark edge growth (typically <3 mm y−1); only A. adianthifolia showed complete wound closure, whereas B. maughamii showed the least (17%±19%). An inverse relationship existed between density (timber and bark) and stem growth, wound occlusion and lateral widening of the old scar edges – except for S. chirindensis. Hence trees with softer wood and bark generally grew quicker and exhibited more wound occlusion than trees with harder wood and bark.

High spatial resolution free-breathing 3D late gadolinium enhancement cardiac magnetic resonance imaging in ischaemic and non-ischaemic cardiomyopathy: quantitative assessment of scar mass and image quality

PurposeTo compare breath-hold (BH) with navigated free-breathing (FB) 3D late gadolinium enhancement cardiac MRI (LGE-CMR)Materials and methodsFifty-one patients were retrospectively included (34 ischaemic cardiomyopathy, 14 non-ischaemic cardiomyopathy, three discarded). BH and FB 3D phase sensitive inversion recovery sequences were performed at 3T. FB datasets were reformatted into normal resolution (FB-NR, 1.46x1.46x10mm) and high resolution (FB-HR, isotropic 0.91-mm voxels). Scar mass, scar edge sharpness (SES), SNR and CNR were compared using paired-samples t-test, Pearson correlation and Bland-Altman analysis.ResultsScar mass was similar in BH and FB-NR (mean ± SD: 15.5±18.0 g vs. 15.5±16.9 g, p=0.997), with good correlation (r=0.953), and no bias (mean difference ± SD: 0.00±5.47 g). FB-NR significantly overestimated scar mass compared with FB-HR (15.5±16.9 g vs 14.4±15.6 g; p=0.007). FB-NR and FB-HR correlated well (r=0.988), but Bland-Altman demonstrated systematic bias (1.15±2.84 g). SES was similar in BH and FB-NR (p=0.947), but significantly higher in FB-HR than FB-NR (p<0.01). SNR and CNR were lower in BH than FB-NR (p<0.01), and lower in FB-HR than FB-NR (p<0.01).ConclusionNavigated free-breathing 3D LGE-CMR allows reliable scar mass quantification comparable to breath-hold. During free-breathing, spatial resolution can be increased resulting in improved sharpness and reduced scar mass.Key Points• Navigated free-breathing 3D late gadolinium enhancement is reliable for myocardial scar quantification.• High-resolution 3D late gadolinium enhancement increases scar sharpness• Ischaemic and non-ischaemic cardiomyopathy patients can be imaged using free-breathing LGE CMR.

The Lymphatic Response to Injury with Soft-Tissue Reconstruction in High-Energy Open Tibial Fractures of the Lower Extremity.

Severe compound tibial fractures are associated with extensive soft-tissue damage, resulting in disruption of lymphatic pathways that leave the patient at risk of developing chronic lymphedema. There are limited data on lymphatic response following lower limb trauma. Indocyanine green fluorescence lymphography is a novel, real-time imaging technique for superficial lymphatic mapping. The authors used this technique to image the superficial lymphatic vessels of the lower limbs in patients with severe compound tibial fracture. Baseline demographics and clinical and operative details were recorded in a prospective cohort of 17 patients who had undergone bone and soft-tissue reconstruction after severe compound tibial fracture between 2009 and 2014. Normal lymphatic images were obtained from the patients' noninjured limbs as a control. In this way, the authors investigated any changes to the normal anatomy of the lymphatic system in the affected limbs. Of the 17 patients, eight had free muscle flaps with split-thickness skin grafting, one had a free fasciocutaneous flap, one had a full-thickness skin graft, six had local fasciocutaneous flaps, and one had a pedicled gastrocnemius flap. None of the free flaps demonstrated any functional lymphatic vessels; the fasciocutaneous flaps and the skin graft demonstrated impaired lymphatic vessel function and dermal backflow pattern similar to that in lymphedema. Local flaps demonstrated lymphatic blockage at the scar edge. Severe compound fractures and the associated soft-tissue injury can result in significant lymphatic disruption and an increased risk for the development of chronic lymphedema.

Effect of expanded lateral thoracic abdominal flap transferred with pedicle on repairing large area of hypertrophic scar after burn of the upper extremity

Objective: To observe the effect of expanded lateral thoracic abdominal flap transferred with pedicle on repairing large area of hypertrophic scar after burn of the upper extremity. Methods: Twelve patients with large area of secondary hypertrophic scar 8 month to 3 years after healing of burn wound on the upper extremity were hospitalized in Zhengzhou First People's Hospital from October 2008 to October 2015, with scar area ranging from 11 cm×7 cm to 20 cm×10 cm. Five patients were with limited straightening and bending of elbow. The scars were reconstructed with ipsilateral expanded lateral thoracic abdominal flap or that combined with expanded upper extremity flap according to the area of scar. Lateral thoracic abdominal incision was located near the anterior axillary line, and upper extremity incision was located near scar edge. A capsule cavity was formed by blunt dissection in the superficial fascia layer. Expander with suitable capacity was implanted with the injection pot being built-in. Volume of water reaching 1 time to 3 times of the capacity of expander was injected for excessive expanding. The expanded lateral thoracic abdominal flap supplied by lateral thoracic cutaneous artery and expanded upper extremity flap were dissected after the completion of expanding. The expanded upper extremity flap was advanced locally to cover the surrounding secondary wound after resection of hypertrophic scar. The expanded lateral thoracic abdominal flap was transferred with pedicle to reconstruct scar, with pedicle being sutured in skin tube-like shape, and the flap donor site was sutured directly. Flap pedicle separation was carried out 3 weeks after surgery. Anti-scar treatment was carried out after healing of sutured area. Results: Totally 18 expanders were implanted, without complications such as infection, exposure of expander, and so on. The areas of expanded lateral thoracic abdominal flaps were from 11 cm×7 cm to 16 cm×11 cm. The combined application of expanded upper extremity flaps with area ranging from 8 cm×4 cm to 9 cm×6 cm was used in 6 patients. All the flaps survived with incision healed. The color, texture, and thickness of skin area repaired by flap were close to those of the normal skin of upper extremity after 6 months to 2 years' follow-up afer discharge. The limited straightening and bending of elbow in 5 patients were rectified. Obvious linear scar was observed in the sutured area of surgery in 3 patients, while light linear scar was observed in the sutured area of surgery in 9 patients. Conclusions: Expanded lateral thoracic abdominal flap has constant blood vessel and is easy to be dissected. It can achieve well reconstruction of appearance and function in repairing large area of hypertrophic scar after burn of the upper extremity.

Evolution of wear damage in Inconel 600 alloy due to fretting against type 304 stainless steel

Fretting wear damage is a concern in heat exchanger tube of Inconel 600 in nuclear power plants. Fretting wear tests of Inconel 600 alloy against stainless steel type 304 were performed for the purpose to identify changes in the wear mechanisms with number of cycles. The results indicated that as cycles increased, the wear volume, worn scar depth and plastic regime at the scar edge first slowly increased, and then showed a significant increase. Correspondingly, the wear mechanism transformed from local adhesive damage to a combination of oxidation and delamination wear. A tribologically transformed structure (TTS) layer formed after a minimum number of cycles had been reached. Fatigue cracks nucleated in the stick–slip zone, and propagated along a direction of 40–50° to the worn surface, then into TTS layer after it was formed. With further increases of cycle number, fatigue cracks destroyed the TTS layer, and that eventually led to a transition in the wear mechanism.

Spatial resolution of defibrillator electrograms to detect distinct exit sites of scar-related ventricular tachycardia.

Analysis of implantable cardioverter-defibrillator electrograms (IEGMs) with pacing along the scar edge is often used to approximate distinct exit sites of scar-related ventricular tachycardia (VT). We evaluated the spatial resolution of IEGMs in identifying distinct exit sites of scar-related VT. Seventeen patients with scar-related VT were included. Threshold pacing (500-ms cycle length) was performed at sites spaced 10 mm apart along the scar border, as defined by high-density bipolar voltage mapping. Twelve-lead electrocardiogram and near-field and far-field IEGMs were recorded at each pacing site and assessed for morphology. The average scar size was 60 ± 30 cm(2) and the scar border perimeter measured 28 ± 9 cm. A median of 18 pacing sites per patient were collected, spaced 14 ± 11 mm apart. The mean spatial resolution for the near-field, far-field, and combination of both was 82.7 ± 76 mm, 62.7 ± 53.6 mm, and 56.7 ± 50 mm (P for trend < 0.001). In all cases, IEGM analysis failed to identify distinct VT exit sites spaced <2 cm apart. Analysis of IEGM morphology with pacing around the edge of the scar is unable to distinguish distinct VT exit sites spaced <2 cm apart, with an average spatial resolution of 5 cm. Given the wide range of values observed, detailed pace mapping over a perimeter of 10-15 cm along the scar edge appears crucial to define the boundaries of a linear ablation strategy to target the VT exit site based on IEGM pace match alone.

Vegetation Recovery in Slash‐Pile Scars Following Conifer Removal in a Grassland‐Restoration Experiment

AbstractA principal challenge to restoring tree‐invaded grasslands is the removal of woody biomass. Burning of slash piles to reduce woody residues from forest restoration practices generates intense, prolonged heating, with adverse effects on soils and vegetation. In this study, we examined vegetation responses to pile burning following tree removal from conifer‐invaded grasslands of the Oregon Cascades. We quantified the longevity and magnitude of fire effects by comparing ground conditions and the cover and richness of plant species in burn‐scar centers (higher‐intensity fire) and edges (lower‐intensity fire) with adjacent unburned vegetation 7 years after treatment. We interpreted patterns of recovery through the responses of species with differing growth forms, habitat affinities, and clonality. Cover of bare ground remained elevated at the centers, but not at the edges of scars; however, much of this effect was due to gopher disturbance. Total plant cover, consisting entirely of native species, was comparable in and adjacent to scars. However, richness remained depressed at the scar centers. Cover of grass, meadow, and non‐clonal species was comparable in and adjacent to scars, but cover of forb, sedge, residual forest, and clonal species was reduced at the centers. Although scar centers had a simpler community structure (fewer but more abundant species) than the adjacent vegetation, they remained free of exotics and recovered quickly, aided by the soil‐disturbing activities of gophers and the regenerative traits of native, disturbance‐adapted species. Pile burning can be a viable and efficient approach to fuel reduction in the absence of exotics.

Fabrication and tribological behavior of sputtering TaN coatings

Tantalum nitride, TaN, coatings with crystalline and amorphous microstructure features are fabricated by magnetron reactively sputtering through Ar/N2 gas flow control. The high Ar/N2 flow ratio of 18/2 sccm/sccm enhances the formation of crystalline fcc TaN phase, while amorphous structure with excess N content in the TaN coating is obtained under a low ratio of 12/8. The multilayer coating with alternating stacking of the amorphous and crystalline TaN nanolayers, i.e., heterostructural a-TaN/c-TaN, is deposited for comparison. The c-TaN exhibits higher hardness and modulus around 21 and 232GPa, respectively, as compared to the a-TaN. The a-TaN/c-TaN multilayer coating possesses hardness and modulus between those of a-TaN and c-TaN layers. Tribological behavior, including scratch and wear, of various TaN coatings are evaluated. The single TaN coatings, either with amorphous or crystalline structure, show an early stage severe cracking and chipping in scratch results. The brittle failure along the scratch scars of the single-layer TaN coatings is suppressed by the multilayer feature. Similar brittle failure modes are found for the a-TaN and c-TaN single-layer coatings under the pin-on-disc wear test. Smooth wear scar edge and limited delamination of the multilayer a-TaN/c-TaN coating are observed, indicating a tougher mechanical behavior and stronger adhesion of the multilayer coating as compared to single TaN layers.

Funktionelle und ästhetische Therapiekonzepte von Keloiden im Kopf-Hals Bereich

Keloids are fibroproliferative extreme variants of an impaired wound healing, developing a tumour-like growth. In the ENT area keloids arise mainly at auricle. Often caused by piercings or trauma. They grow bulging excessively over the original scar edges and adopt sometimes bizarre morphologies. The patients complain often of dysesthesias such as burning pain, severe itching and are suffering often from stigmatization. The huge number of therapy methods, for the treatment of keloids described in the literature (silicon therapy, compression, intralesional corticoids, intra- or extralesional surgical excision, kryosurgery, radiatio, Interferon- or Bleomycin-therapy) emphasize the enormous challenge for the treating doctor, particularly in facial plastic surgery.

Recurrent Melanocytic Nevi and Melanomas in Dermoscopy

IMPORTANCE Differentiating recurrent nevi from recurrent melanoma is challenging. OBJECTIVE To determine dermoscopic features to differentiate recurrent nevi from melanomas. DESIGN, SETTING, AND PARTICIPANTS Retrospective observational study of 15 pigmented lesion clinics from 12 countries; 98 recurrent nevi (61.3%) and 62 recurrent melanomas (38.8%) were collected from January to December 2011. MAIN OUTCOMES AND MEASURES Scoring the dermoscopic features, patterns, and colors in correlation with the histopathologic findings. RESULTS In univariate analysis, radial lines, symmetry, and centrifugal growth pattern were significantly more common dermoscopically in recurrent nevi; in contrast, circles, especially if on the head and neck area, eccentric hyperpigmentation at the periphery, a chaotic and noncontinuous growth pattern, and pigmentation beyond the scar's edge were significantly more common in recurrent melanomas. Patients with recurrent melanomas were significantly older than patients with recurrent nevi (mean [SD] age, 63.1 [17.5] years vs 30.2 [12.4] years) (P<.001), and there was a significantly longer time interval between the first procedure and the second treatment (median time interval, 25 vs 8 months) (P<.001). In a multivariate analysis, pigmentation beyond the scar's edge (P=.002), age (P<.001), and anatomic site (P=.002) were significantly and independently associated with the diagnosis of recurrent melanoma in dermoscopy. CONCLUSIONS AND RELEVANCE Dermoscopically, pigmentation beyond the scar's edge is the strongest clue for melanoma. Dermoscopy is helpful in evaluating recurrent lesions, but final interpretation requires taking into account the patient age, anatomic site, time to recurrence, growth pattern, and, if available, the histopathologic findings of the first excision.

Postburn Edge Shoulder Adduction Contracture

Postburn scar shoulder adduction contracture is the most common among big joints' contractures. As the contracture impedes all upper limb function, surgical reconstruction is indicated as early as the contracture is formed. Many flaps and techniques have been suggested, yet the problem is not resolved completely. Three hundred forty-six edge scar shoulder adduction contractures were eliminated personally in 277 patients. Contracture anatomy was studied before and during surgery. Effectiveness of the existing and newly developed techniques was evaluated. Edge shoulder scar adduction contracture is caused by scars located on anterior and/or posterior shoulder joint surface and is characterized by the presence of the fold along the axillary fossa edge. Crest of the fold is the edge of scars. The fold's lateral sheet is scars (causes contracture); medial sheet and axillary fossa skin stay uninjured. Lateral scar sheets have surface deficit in length; the deficit spreads from the fold's crest to the shoulder joint rotation axis and has a trapezoid form. The conclusion was made that the adequate technique should consist of sheet surface deficit compensation with the flap of the same (trapezoid) shape. The medial fold sheet and axillary fossa served as an excellent donor site for the flap. Depending on contracture severity, several variants of the trapeze-flap plasty were developed: trapeze-flaps alone or in combination with skin grafts. In all cases, contractures were eliminated completely with trapeze-flap plasty without serious complications. No flap loss and contracture recurrence took place. The proposed techniques are based on the anatomy of the contracture. They are easy to plan and perform, allow complete restoration of the upper limb's function, and improve shoulder joint region appearance in general. The author believes that the trapeze-flap plasty procedure is a preferred technique for adult and pediatric patients with edge scar shoulder adduction contracture.

In Response: Tissue Expansion and Latissimus Dorsi Transfer for Arm Thorax Synechia

The Journal of Burn Care and Research recently published an article titled “Tissue Expansion and Latissimus Dorsi Transfer for Arm Thorax Synechia” by Lykoudis et al.1 In conclusion the authors stated, “... the combined use of tissue expansion and latissimus dorsi transfer may prove to be a very good option in the treatment of complex postburn axillary contractures.” The statement can mislead the reader, implying that the suggested excessively complex and traumatic technique should be used to solve relatively simple surgical problems. The reviewed article deals with an edge shoulder posterior adduction contracture that is caused by scars on the posterior shoulder joint, trunk, and shoulder surfaces. These contractures can be eliminated using a shorter, easier, less traumatic, single-stage, safe, and effective reconstructive technique: trapeze-flap plasty.2 Edge shoulder posterior adduction contracture is caused by the fold located along posterior axillary fossa's edge. Lateral fold sheet (according to axilla) is scars; medial fold sheet and axillary fossa are healthy skin; and the crest of the fold is the edge of scars. Contracture is caused only by the lateral scar sheet, having scar surface deficiency in length. The deficiency spreads from the fold's crest to the joint rotation axis and has a trapezoid form which can be seen clearly after contracted sheet's dissection with a Y-shaped incision. Therefore, contracture elimination should use a flap of a similar (trapezoid) shape to compensate scar surface deficiency.

The Elimination of Postburn Nasal Contracture in Children With Trapeze-Flap Plasty

One consequence of a facial burn is nasal contracture. In pediatric patients, scar tension presents a particular problem because of facial growth. The forehead and nasal scar contraction deform the nose dorsum, especially between the eyes. The nasofrontal angle becomes smoothened, wide, and flat; the scar edges cover the inner canthus. The dorsum nose scar stretching delays nasal development, pulls the nose up, making it shorter, and causes nasal ectropion. Secondary deformity of the nose's solid structures develops as a consequence of scar contracture, and its reconstruction poses a major problem. At the same time, it is suggested that nasal reconstruction in the pediatric patients should be planned as a staged procedure. Therefore, scar contracture release should be performed early, at the first stage of pediatric nasal reconstruction, to create conditions for normal nasal development. In this author's opinion, the most suitable procedure is trapeze-flap plasty. The scar tissue surplus in the nasofrontal angle allows contracture release with local tissues. Reconstruction with local trapezoid flaps releases the scar tension and elongates the nasal dorsum surface by approximately 1.5 cm; the epicanthus is eliminated, and the nasofrontal angle (nasal root) is restored. Eight children were operated. Good results were observed in all patients for the duration of 3 years.

Anatomical changes induced by fire-damaged cambium in two native tree species of the Chaco Region, Argentina

This study examined anatomical responses to fire damage of the cambium in Schinopsis lorentzii and Aspidosperma quebracho-blanco. Bole cross sections were extracted from specimens with external signs of fire damage. Samples were taken from zones designated normal, discoloured and wound altered. The vessel, fibre, axial and ray parenchyma percentages, tangential vessel diameter, vessels per mm2, rays per mm, and ray width and height of these zones were compared. Fire scars and fire marks were identified on cross sections of S. lorentzii and A. quebracho-blanco. The fire marks reflect minor wounds that did not affect wood formation. The fire scars, on the other hand, are the result of wounds that interrupted cambial activity thus affecting the shape of the bole and causing discolouration of pre-existing wood adjacent to wounds. The wood formed after fire damage included callus, barrier zones at fire scar edges and the formation of ribs of wound wood. The wound altered zone was characterised by a decrease in the percentage of vessels and fibres, an increase in the percentage of axial parenchyma, the formation of grouped rays, a decrease in vessel tangential diameter, and occurrence of fibres with atypical structure. Disorientation in the axial xylem system was observed in the barrier zone. The anatomical responses to cambium damage and formation of discoloured wood and woundwood ribs suggest that wood quality and utilisable volume of bole in the studied species is affected by fire.