Slight Scarring Research Articles

Case Report: A Nursing Challenge - Postoperative Complications of Pacemaker Implantation in Behçet’s Disease

Background: Cardiovascular system involvement in Behçet’s disease is rare, especially requires surgical intervention. We report a case of a 47-year-old Chinese male with Behçet’s disease, treated with immunosuppressive agents, who developed an infection at the surgical site following the postoperative implantation of a pacemaker. Little is known about the approach to managing postoperative wounds in Behçet’s disease. This article aims to provide a reference for nursing care, improve perioperative management, and assist in achieving a good prognosis for Behçet’s disease with cardiovascular system involvement. Method: We used the following three-phase process: 1. Followed authoritative guidelines for the perioperative management of patients with cardiac implantable electronic devices (CIED), which included strict aseptic techniques, pressure bandaging, and the preventive use of antibiotics. 2. Conducted a literature search for reasons and solutions to pain and infection symptoms at the surgical site. 3. Cleaned the wound using different disinfectants and evaluated the wound’s condition; managed pain through a multimodal approach within an Acute Pain Service (APS) team management model. Determined whether to continue immunosuppressive therapy based on the Pathergy test after the patient had suspended immunosuppressive therapy for over a month. Results: Our case illustrates the wound healing process during the patient’s 50-day hospitalization, from a secondary wound with a 5x5 cm rupture and exudation to Grade A healing. The patient’s Numeric Rating Scale (NRS) pain score decreased from 6 points to 0 points upon discharge. Three months post-discharge, follow-up revealed slight scarring at the wound site, normal pacemaker function, and stable control of Behçet’s disease. Conclusion: Patients with Behçet’s disease under immunosuppressive treatment have a higher risk of infection at the surgical site following pacemaker implantation. Using hydrogen peroxide first, followed by iodine, and finally physiological saline during wound debridement is significantly effective in controlling infection. The APS team management model, composed of attending physicians and nurses, can effectively improve pain relief quality during wound recovery. The Pathergy test is an effective method to evaluate whether disease activity affects wound healing after CIED implantation and whether continued use of immunosuppressive therapies is necessary.

Wound Excision and Closure by Secondary Intention and Growth Factor Application in the Management of Rosacea Complicated by Giant Rhinophyma

Background. Rosacea is a significant problem, affecting 5.5% of the world population. Currently used treatment techniques such as transfer flaps and implants are insufficient to meet the needs of many patients, which suggests that alternative approaches are needed. Case Report. This report describes a case of rosacea complicated by giant rhinophyma treated with excision and closure by secondary intention and growth factor application. The patient was admitted to the Department of Dermatology at The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China, in July 2021, and underwent excision of the external nasal redundancy under general anesthesia. The postoperative wound was left open. The patient’s wounds healed completely 2 months after surgery, and there was no recurrence at 6-month follow-up. The wounds recovered well, with only slight scarring. Conclusion. The positive outcomes for this patient suggest that wound excision and closure by secondary intention and growth factor application may be beneficial for patients with rosacea complicated by giant rhinophyma.

Long-term Prognosis of Vision Loss Caused by Facial Hyaluronic Acid Injections and the Potential Approaches to Address This Catastrophic Event.

Vision loss is a serious complication of hyaluronic acid (HA) filler injections, and long-term observations regarding the prognosis, particularly with angiography, are rare. This study aimed to investigate the long-term prognosis and living status of patients with visual defects due to HA filler injections. Nine patients with vision loss caused by HA filler injections and receiving different treatments were included and followed up for 2 to 6 years after their accident. Follow-ups, including outpatient ophthalmologic examinations, were performed. In the follow-up observation, all patients had reintegrated into society and work. The prognosis was similar for all hyaluronidase treatments, including retrobulbar injections and superselective ophthalmic artery thrombolysis. The facial appearance was not remarkably affected, and only 3 patients reported slight scarring. Ptosis disappeared in all the patients, and slight strabismus was found in 5 patients. However, vision improvement was very limited, even in the patients whose occluded retinal central artery received reperfusion. This long-term follow-up showed that the patients with vision loss caused by HA filler injections could reintegrate into society after treatment. Although the embolization of the retinal central artery led to reperfusion, vision was not restored, which further demonstrated the difficulty of recovering vision with the current treatment and the importance of prophylaxis. Autohydrolysis of HA by incorporating hyaluronidase-containing stimuli-responsive nanoparticles and a dual-pipe syringe are potential future approaches to address this catastrophic event.

Blue Laser (450 nm) Treatment of Solar Lentigines.

This study tested a blue light source for the treatment of solar lentigines. A total of 14 patients with solar lentigines were treated with radiation from a novel, high-power 450 nm blue laser that was created for this project. The group contained eight patients with solar lentigines on the face, two patients with the lesions on the dorsal of the hands, and four patients with the lesions on the trunk and forearms. The best results (complete recovery) have been achieved for the lesions on the face and dorsal of the hands. The treatment of lesions on the trunk and forearms was not fully satisfying due to the occurrence of slight scarring. This study shows that, in some cases, the use of a blue laser may be an alternative to the use of longer wavelength sources.

Combined surgical ablation with superpulsed CO2 laser for treatment of facial basel cell carcinoma

Basal cell carcinoma (BCC) is the most common skin cancers in face region. The most concern for surgeons is success of treatment with high cure rate and good cosmetic result. There are several methods for treatment , including laser therapy. The objectives of the present study were to evaluate the healing of wounds (recurrence and cosmetic outcome) after treatment by surgical ablation and irradiation by superpulsed mode of laser CO2.A total of 18 patients with BCC, age between 58-71 years, from both gender (7 males and 11 females) were included in the study. The tumorous mass was ablated firstly, then the tumor bed was irradiated using 5-8W Pulsed CO2 laser. The wounds were left open to secondary epithelization. Recurrence and cosmetic outcomes were observed after one year follow-up. The mean age of the participants was 66 years (range 58-71 years). The mean size (maximal diameter of lesion) was 9.3 mm (range: 7.2-11.3mm). 12 tumors (66.6%) were of the superficial type, 6 tumors (33.3%) were of the nodular type. No recurrence was observed one year after surgery. Slight scar was found in 3 cases (16.6%). There were no complications during the wound healing period .The present study showed that the surgical ablation combined with superpulsed CO2 laser is an effective option to treat BCC and to achieve high cure rates and good esthetic outcomes.

Repair of severe flexion contracture deformity of adjacent fingers with trifoliated flap from toe web in six patients

From May 2014 to January 2018, 6 patients with severe flexion contracture deformity caused by palmar cicatricial hyperplasia of adjacent 2 or 3 fingers were admitted to the Yidu Central Hospital of Weifang. There were 4 males (8 fingers) and 2 females (5 fingers), aged 13-51 years.The degrees of flexion of proximal interphalangeal joint of affected fingers and metacarpophalangeal joint were respectively 60-90°and 60-80°, and the total degree of passive extension of metacarpophalangeal joint, proximal interphalangeal joint, and distal interphalangeal joint was from -180 to -120°. After scar resection, tendon release, and extension of affected fingers, bone and/or tendon were exposed, and the wound area was 4.0 cm×2.0 cm-8.5 cm×4.0 cm.The wound was repaired with trifoliated flap composed of fibular flap of great toe, abdominal flap of the second toe, and plantar metatarsal flap, with flap area of 4.5 cm×2.5 cm-9.0 cm×4.5 cm.The plantar metatarsal wound of the donor site was sutured directly, and the remaining wound was repaired with full-thickness skin graft from the outside of the thigh. All the wounds of patients were healed. All flaps survived and had good blood circulation without vascular crisis after operation.During follow-up of 6 months to 2 years, the flaps were with good appearance, no swelling, similar in color to the surrounding skin, soft in texture, good in sensations of touch and pain, and the distance of discrimination of 6-8 mm. The active and passive flexion and extension of the affected fingers were good, and there was no dysfunction in the donor site of foot, only with slight scar. The article showed that trifoliated flap from toe web is one of the best methods to repair the severe contracture flexion deformity of fingers caused by severe cicatricial hyperplasia of palmar side, especially the soft-tissue defect of the skin after the cicatricial hyperplasia of adjacent 2 or 3 fingers is removed.

Focus on application of dermabrasion in the treatment of deep partial-thickness burn wound at early stage

There are several advantages in using dermabrasion to treat burn wound of deep-partial thickness at early stage, including accurate positioning, little damage to normal tissue, partial-damaged tissue preservation, easy to operate, no limited by burn wound location and area, fast wound healing, short hospital-stay, less hospitalization cost, slight scarring, wide indications, etc. It is of important clinical value for the treatment of deep partial-thickness burn wound at early stage.

Piezocision-assisted orthodontic treatment using CAD/CAM customized orthodontic appliances: a randomized controlled trial in adults.

The aim of this study was to investigate the effects of piezocision (surgical protocol with sutures) in orthodontic treatment using CAD/CAM (computer-aided design and computer-aided manufacturing) customized orthodontic appliances. The study is designed as a parallel group, randomized controlled trial (RCT). University Hospital. The study was approved by the ethic committee of the University Hospital Liege, Belgium. This RCT was conducted on 24 adult patients requiring orthodontic treatment to release mild overcrowding. Patients were all treated with a customized appliance and randomly assigned by means of sealed envelopes containing group codes to either a test group treated with piezocision or a control group without any further treatment. A blinded orthodontist validated appliance removal or further adjustments based on the model study. The overall treatment time and the time between archwire changes were recorded. Moreover, clinical and radiological features such as tooth resorption, gingival recessions, and the presence of scars were evaluated. A total of 24 patients (12 control and 12 test) completed the study. The overall treatment time was significantly shorter in the test group than the control group. Likewise, the time difference between all arch changes was significantly lower when piezocision was performed, except for the first arch at the mandible and the last arches at both maxillae. During the fine-tuning phase, no significant difference was found between the two groups. All periodontal and radiographic parameters remained stable from the start to the end of treatment in both the groups. However, minor scars were found in 66 per cent cases. This trial was a single-centre trial. Piezocision seems to be an effective method to accelerate orthodontic treatment in cases of mild overcrowding. However, the effect was only observed during the alignment phase and a greater efficiency was found in the maxilla. The technique may be contraindicated in patients with a high smile line since the risk of slight scarring exists. ClinicalTrails.gov (Identifier: NCT03406130).

Treatment of mycobacterium tuberculousis induced with cosmetic injection

Objective To explore the diagnosis and treatment of non-tuberculosis mycobacteria (NTM) infection after cosmetic injection via scientific debridement surgery combined with regular application of anti-NTM drugs. Methods 14 patients who were infected with NTM after cosmetic injection and were not cured over a long period of time in other hospitals from 2012 to 2016. The patients were treated with VSD thorough surgical debridement, the bacterial type of NTM was identified by bacterial culture and PCR identification and anti-NTM drugs were systematically used according to the results of drug sensitivity. Results Fourteen patients who were treated with scientific debridement surgeries combined with regular anti-NTM drug treatment in our hospital for 2-4 months were discharged after their skin lesions were cleared and healed and they were continually treated with anti-NTM drugs for 12 months. Fourteen patients were completely cured by using the above treatments without severe side effects, such as liver and kidney dysfunction, nervous system disorders and so on. Only colpitis mycotica occurred in 3 patients. In addition, one patient presented the decrease of leukopenia after using anti-NTM drugs for 2 months and continued to complete the treatment after we adjusted the treatment plan to returning the level of leukopenia to the normal. These 14 patients were followed up for 1-5 years with no recurrence of the lesion. The facial appearance of 12 patients were almost normal with slight scars. The facial surgery area of 2 patients were uneven and nearly recovered to normal facial appearance by tissue transplantation and photoelectric therapy. Conclusions For the NTM patients caused by invasive procedures such as injection, the comprehensive treatment program, which combined scientific debridement surgery and systematically targeted drug treatment, not only can effectively cure NTM infection, but also minimize secondary injury and restore the patients' appearance, which is worthy of clinical application. Key words: Improving looks; Injections; Mycobacterium infections, nontuberculous; Debridement; Drug therapy

Clinical efficacy and strategy of complications of blepharoplasty for double eyelids

Objective To investigate the causes, the prevention and the treatment of the complications of blepharoplasty for double eyelids. Methods The clinical data, the surgery methods and the causes were analyzed in 100 cases of blepharoplasty from July 2011 to December 2017. Results All of these patients underwent these perfect procedures with satisfied anesthesia. Incisions were all healed in one stage with no infection. Double eyelid width was (7.0±1.2) mm with natural and smooth lines after 3 months operation, 86 patients (86%) had double eyelid with natural and smooth lines, slight scars and good bilateral symmetry. 14 patients (14%) required surgical revision for complications, as asymmetry of supratarsal folds (7%), over narrow of supratarsal folds (4%), over width of supratarsal folds (2%), disappearance of supratarsal folds (2%), multiple eyelid (3%) and ptosis (1%), and the effects were satisfactory. Conclusions In order to achieve the natural and smooth double eyelids, it is important for plastic surgeons to have the comprehensive grasp of overall outline and operational details in blepharoplasty for double eyelids. Preoperative design should be accurate, intraoperative procedures should be careful, and postoperative care should be standardized. Key words: Blepharoplasty; Postoperative complications; Treatment outcome; Retrospective studies; Double eyelids

Treatment and long‐term follow‐up of distichiasis, with special reference to the Friesian horse: A case series

Distichiasis is very uncommon in horses and treatment options and outcome remain unknown. To describe treatment and long-term follow-up of distichiasis in the horse. Retrospective clinical study. Case records of horses admitted for diagnosis and treatment of uni- or bilateral distichiasis between 2003 and 2012 were reviewed. Long-term (>6 months after last treatment) follow-up was by telephone conversation with the owner or referring veterinarian. Data were analysed using a Chi-squared test. Eighteen cases were identified, of which 17 were Friesians. All horses had signs of corneal irritation or ulceration concurrent with distichiasis. In total, 29 eyes were affected with distichiasis of which 23 had clinical signs. All corneas were stained with fluorescein and 13 had fluorescein positive defects (45%). The lower eyelid was affected more often. Two different electrocautery devices were used for treatment. The complications were slight scarring of the eyelids (100%) and clinical recurrence (54%). Successful resolution of the clinical signs after one treatment occurred in 46% of the horses and in 77% of the horses satisfactory long-term results were found after a mean of 2 treatments (range: 1- 6 treatments). There was significant correlation between number of hairs and recurrence (P<0.002). There is a breed predisposition of distichiasis in the Friesian horse. In Friesian horses that present with uni- or bilateral corneal irritation or corneal ulceration, careful examination of the eyelid margins should be performed to diagnose distichiasis. Electrocautery is a valid and successful therapeutic modality which is minimally invasive, inexpensive, has a low complication rate and is easy to perform in the standing sedated horse. The recurrence rate is low in horses with less than 5 distichiae.

Solitary Type of Congenital Self-healing Reticulohistiocytosis

Congenital self-healing reticulohistiocytosis is a rare, congenital, benign, self-healing variant of Langerhans cell histiocytosis. It usually appears as multiple papules or nodules; however, occurrence of the solitary type is very rare. We report on a case of solitary congenital self-healing reticulohistiocytosis in a 29-day-old girl who presented with a papule on her sole. Two months later, the lesion regressed with a slight scar. Based upon clinical and histologic findings, we made a diagnosis of solitary congenital self-healing reticulohistiocytosis. In this report, we summarized reported cases of solitary congenital self-healing retioculohistiocytosis in Korea with a review of the literature.

Composite flap transfer from the foot for treatment of multi-finger complex soft tissue defects

Objective To introduce the clinical application of composite flap transfer from the foot for treatment of multi-finger complex soft tissue defects. Methods This method was applied to treat 7 cases and 19 fingers. All the cases involved complex dorsal soft tissue defect of 2 to 4 fingers with extensor tendons missing and phalanx or interphalangeal joint exposed. The combined soft tissue defect area was 5.0cm×1.5cm to 9.0 cm× 2.5 cm. The flaps were designed along the axis extending from the fibular and plantar margin of the great toe to the interspace between the first and second metatarsal bones. The flap was slightly larger than the dorsal finger defect combined and the shape of the flap was the same as the combined defect. The greater saphenous vein, dorsal digital veins and dorsal metatarsal or plantar metatarsal artery and nerves were included in the flap. They were sutured with dorsal digital veins, digital artery and nerves, respectively. Extensor digitorum brevis tendons and extensor digitorum longus tendons were included in the flap to reconstruct the missing tendons. Results All the flaps survived with good texture and good appearance. Two-point discrimination recovered 6 to 8 mm. Finger extension function was restored, and active finger flexion and extension recovered satisfactorily. The donor feet were with slight scar, good appearance and normal function. Conclusion Combined dorsalis pedis,toe web and great toe fibular flap including extensor digitorum brevis and extensor digitorum longus tendon is a good option to treat multi-finger dorsal complex defects. Key words: Surgical flaps; Finger injuries; Tendon injuries; Transplantation

Vessel anastomosis for repairing in site of skin avulsion injury in hand

Objective To identify the practical microsurgical procedure for repairing in site of skin avulsion injury in hand, and evaluate the long-term following-up results. Methods From January 2001 to May 2005, 21 cases of skin avulsion injury in hand were treated in our department. The surgical procedures thumb skin was revascularized with vein graft from forearm, and the other part of injuried hand was resuffaced by the thickness skin graft taken from the original degloved skin, which was suitable for degloving injury in-graft, the dorsum and palm of hand was skin grafted by the original skin thinned, which was suitable for complete degloved injury at the proximal interphalangeal level. Results All the repaired skin were survival in 16 patients, partial necrosis occurred in 4 cases, which was severely crushed, required debridement and skin graft on the residual defect. Whole failure in 1 case, which underwent secondary amputation. Follow-up at 10-28 months shows acceptable cosmetic and sensible results, slight scarring was present on the volar as-pects of hand. The range of motion of the thumb and fingers was almost complete. All patients regained new jobs. Conclusion Individualization of mierosurgical methods for repairing in site of skin avulsion injury in hand does represent the best solution. Key words: Hand; Surgical flaps; Transplantation ; Skin; Degloving injury

Autologous Fat Transplantation for Depressed Linear Scleroderma-Induced Facial Atrophic Scars

Facial linear scleroderma results in depressed atrophic scars. Autologous fat transplantation has been widely used, and fat appears to be an ideal material for filling depressed atrophic scars and contour deformities, but long-term results for autologous fat transplantation are controversial. To review the short- and long-term results of 20 patients who underwent multiple autologous fat transplantations for depressed atrophic scar correction. Twenty patients with clinically inactive facial linear scleroderma were included. They received at least two transplantations and had a 12-month follow-up evaluation. On the forehead, 51% to 75% improvement (average grading scale: 2.4) was achieved when observed at least 12 months after the last treatment. For the chin, correction was poor (average grading scale: 0.7) with less than 25% improvement. The infraorbital area showed fair correction, but the nose showed poor correction. Two of three patients with scalp reduction surgery showed excellent results, showing only slight scar widening. Autologous fat transplantation is an effective method for long-term correction of depressed atrophic scars left by linear scleroderma on the forehead but is less effective for corrections on the nose, infraorbital area, and chin.

Modeling thermotherapy in vocal cords novel laser endoscopic treatment

Vocal cords pathologies can be classified in difficulty of movement, lesion formation, and difficulty or lack of mucosal wave movement. There are therapies for the first two cases, but the last one presents nowadays no efficient solution. In this paper, a novel laser endoscopic thermotherapy treatment is proposed to improve vocal cords vibration in sulcus vocalis or slight scars by increasing temperature around 8 degrees C. To predict the availability of this treatment, a complete model of laser-tissue interaction is shown. Optical propagation radiation transport theory model is solved with a Monte Carlo approach, spatial-temporal thermal distributions are obtained via a bioheat equation, and thermal damage uses an Arrhenius integral. Two widely used lasers, Nd:YAG (1,064 nm) and KTP (532 nm), with different source powers, exposition times, and distances to vocal cords are considered to investigate the availability of an efficient and safe laser treatment.

Granulomatous jellyfish dermatitis

The induction of a granulomatous inflammation by jellyfish toxins is rare. More typically, acute toxic and urticarial reactions are seen. An 11-year-old boy developed a striated urticarial erythema on the left cheek after contact with a gelatinous mass while swimming in the sea in Croatia. After initial erosion, a striated induration developed in the area of contact. Histological examination revealed a granulomatous inflammation with some eosinophils. While topical steroid-based antiinflammatory and antibacterial therapy over several weeks was not effective, topical therapy with tacrolimus 0.1% for two two-week treatment periods led to healing of the skin changes with a slight scar. There was no clinical recurrence after 5 month of follow-up.

Aesthetic Lip-chin Splitting Incisions for Oral and Oropharyngeal Surgery

Objective: To evaluate aesthetic lip-chin splitting incisions for oral and oropharyngeal surgery for patients with cancer.Patients and Methods: Two different incisions were used for 46 patients and were evaluated for their aesthetic outcome.Results: The aesthetic results of the 2 different lip-chin splitting incisions were found to be excellent. Three aesthetic patterns of the lip-chin area were recognised: clear aesthetic units, good aesthetic units with the incision camouflaged by relaxed skin tension lines, and slight scarring after surgery. None of the patients developed lip vermilion notching.Conclusion: Aesthetic lip splitting incisions are an important component of treatment. Resection of malignant tumours must be performed with due consideration of the functional and aesthetic results.

Evaluation of mammographic and clinical follow-up after 755 stereotactic vacuum-assisted breast biopsies

Purpose Stereotactic vacuum-assisted breast biopsy (VB) is a new method that promises high accuracy and reliability. In order to avoid surgery in cases with benign histology the examination must be quality assured and the accuracy should be well established. We present follow-up data of 755 VBs with benign results. Methods In all, 984 of 1268 consecutive VBs proved histopathologically benign (lobular carcinoma in situ and atypical ductal hyperplasia not included). Follow-up data are available for 755 of 984 (77%) lesions and constitute the basis of this evaluation. Follow-up mammograms were performed of 728 lesions at 6 to 67 months (mean 24, median 17.8) after VB. Results Seven technically unsuccessful cases underwent immediate rebiopsy; 3 unsuccessful cases were diagnosed otherwise. No false negative occurred among the 752 followed-up, eventually successful VBs. On follow-up mammography 444 of 728 (61%) benign lesions proved radiologically completely removed, 284 (39%) partially. In 6 cases (0.8%) a surgical biopsy was performed again during the follow-up time confirming the benign result. No scar was seen in 96%, a slight scar in 3.8%, and a small stellate scar with possible diagnostic interference in 0.3%. Conclusions A benign diagnosis of quality assured VB is very reliable and leads to no or minimal scarring.

Endoscope-assisted management of varicose veins in the posterior thigh, popliteal fossa, and calf area.

Varicose veins of the posterior thigh, popliteal fossa, and calf area were managed with the assistance of endoscopic surgery in 136 patients. Patients were divided into four types according to the normal veins involved in varicosities. With good illumination and magnified monitor viewing by means of a surgical endoscope, the main channel, tributaries of varicosities, incompetent perforating veins, and healthy veins could be clearly visualized and identified. Even though these varicosities had aberrant and tortuous courses, they could be completely dissected, divided, and then removed through one or more access incisions (2.5-3.0 cm in length). The incompetent perforating veins were also dissected and divided. The mean number of access incisions for each lower extremity was 2.2, 1.9, 1.3, and 1.0 for types I, II, III, and IV respectively. In all cases, the mean number of incisions was 1.6 in each lower limb. The most frequent morbidity was maceration of the access incision. Three wounds in 3 patients required debridement and resuturing, but the other wounds healed satisfactorily. Transient discoloration caused by bruising and numbness may present at the dissected area. There was no hematoma formation. Ischemic change with bleb formation of the dissected skin occurred in 1 patient. Subsequent secondary healing resulted in slight scarring in this area. With the assistance of endoscopic surgery, all the varicosities and the incompetent perforating veins could be completely dissected and removed. Accomplishment of removal of varicosities was double-checked between the preoperative skin marks of varicosities and the endoscopic findings. There is very little possibility for recurrence, because there were no residual varicosities or incompetent perforating veins after this operation. There was no recurrence in follow-up at least 2 months postoperatively. Patients were satisfied with the minimal surgical scarring and the complete absence of disfiguring varicosities.