Stony Brook Scar Evaluation Scale Research Articles

A Comparative Evaluation of Surgical, Electrosurgery and Diode Laser in the Management of Maxillofacial Nevus.

To compare the post-operative wound healing of patients treated for excision of the nevus/mole from maxillofacial region with surgical, electrosurgery and diode laser. Forty-five clinically confirmed cases of benign nevus were included in the study and randomly divided into three groups according to the technique used for excision, i.e. Group A-surgical excision, Group B-diode laser and Group C-electrosurgery. Post-operative wound evaluation was done using Stony Brook scar evaluation scale on post-operative photographs taken on days 7, 21 and 90 (3months). Statistically, there was no significant difference between the three techniques on post-operative day 90. Clinically, hypopigmentation was noted with diode laser and electrosurgical excision of benign nevus. Since all three techniques yielded statistically comparable results, the patients can be given a choice of technique to undergo surgery. Surgical excision being the most cost effective and nil post-operative hypopigmentation may be the treatment of choice for majority of the patients.

Evaluation of inguinal vascular surgical scars treated with closed incisional negative pressure wound therapy using three-dimensional digital imaging-A randomized controlled trial on bilateral incisions.

Scar formation is an important, permanent surrogate marker for wound healing. The main aim of this randomized trial was to evaluate the effects of incisional negative pressure wound therapy (iNPWT) on scar formation in uncomplicated wound healing with 3-dimensional (3D) digital imaging. Patients undergoing bilateral inguinal incisions after vascular surgery were randomized to receive iNPWT and standard dressing on separate sides. The incisional scars were documented at a median time of 808 days (range 394-1194) after surgery with 3D photography, which were objectively evaluated by two plastic surgeons using the Stony Brook scar evaluation scale (SBSES) and a 10-point graded numeric ranking scale (NRS10). Subjective evaluation was performed with the patient observer scar assessment scale (POSAS). Patients with surgical site infection or other wound complications were excluded to minimize bias. The p-values were calculated using McNemar's and Wilcoxon signed-rank test for paired nominal and paired continuous data, respectively. Among 33 patients, 32 patients had undergone endovascular aortic repair (EVAR) and 31 patients had transverse inguinal incisions. Objective and subjective scar evaluation showed no difference between iNPWT and standard dressing. In objective scorings, 18.8 and 21.9% received the highest possible SBSES total score in the iNPWT and standard dressing groups, while 43.8 and 37.5% received the highest possible NRS10 score, respectively. The inter-rater reliability between the two assessors for SBSES total score and NRS10 showed an intra-class correlation (ICC) of 0.78 and 0.68 for NPWT and 0.70 and 0.77 for traditional dressing, respectively. The present randomized trial showed that iNPWT and standard dressings on closed transverse inguinal incisions after EVAR resulted in equal subtle scar formation. Objective scar evaluation with 3D images showed good inter-rater agreement.

Concealed cosmetic closure in total knee replacement surgery – A prospective audit assessing appearance and patient satisfaction

ObjectiveWith the trend towards accelerated rehabilitation, the method of skin closure has become increasingly important in orthopedic surgery. It is imperative to evaluate a technique that provides superior clinical and cosmetic results specifically for TKA, due to relatively thin skin anterior to the knee making poor wound healing an issue of concern. We conducted a prospective, single-arm audit evaluating the patient assessments of incision cosmesis for a novel technique in TKA wound closure called Concealed Cosmetic Closure (CCC). Methods570 knees were included in the study whose wound was closed with concealed cosmetic subcuticular interrupted sutures (CCCIS) between January 2014 and May 2016. A validated, ordinal questionnaire, Stony Brooks Scar Evaluation Scale (SBSES) designed to elicit a score evaluating scar satisfaction was interviewed by the investigators to patients 6 months to 3 years postoperatively. ResultsCCC is a simple and relatively rapid single-operator technique that takes about 7–10min to close 11–17cm knee incision. In our study, the mean score for Stony Brook Scar Evaluation Scale (SBSES) was 4.4 (SD of 0.73) (range 3–5). The scar was rated highly in terms of cosmesis, patient satisfaction and appearance of the wound. ConclusionCCC is an effective modality for skin closure in total knee arthroplasty providing superior cosmetic healing with minimal complications leading to improved long term patient satisfaction.

Usefulness of direct W-plasty application to wound debridement for minimizing scar formation in the ED

PurposeA suture line placed with the same direction as the relaxed skin tension line leads to good healing, but a suture line with over 30 degrees of angle from the relaxed skin tension line leads to longer healing time and more prominent scarring. W-plasty is widely used to change the direction of the scar or to divide it into several split scars. In this study, we applied W-plasty to patients with facial lacerations in the emergency department. MethodsFrom June 2012 to December 2014, 35 patients underwent simple repair or W-plasty for facial lacerations. Patients in the simple repair group underwent resection following a thermal margin, and the W-plasty group was resected within a pre-designed margin of W-shaped laceration. We assessed prognosis using the Stony Brook Scar Evaluation Scale (SBSES) after 10 days (short-term) and six months (long-term), respectively, following suture removal. ResultsAmong 35 patients, 15 (42.9%) underwent simple debridement and 20 (57.1%) underwent W-plasty. In the W-plasty group, there was no difference between short-term and long-term follow-up showing high SBSES, but in the simple debridement group, long-term follow-up SBSES significantly decreased. W-plasty SBSES was higher than simple debridement at short-term as well as long-term follow-up. ConclusionWe experienced good results of direct W-plasty application at six-month long-term follow-up. Therefore, W-plasty application is more effective in reducing scar appearance than a simple debridement method for facial laceration patients with an angle of 30 degrees or more to the relaxed skin tension line.

FACTORS INFLUENCING THE OCCURRENCE OF HYPERTROPHIC SCARS AMONG POSTOPERATIVE PATIENTS IN GARUT, INDONESIA

Background: Hypertrophic scar causes physical and psychological problems. Thus, understanding the factors related to the occurrence of hypertrophic scar tissue is needed. Little is known about its influencing factors in Indonesia, especially in Garut.
 Objective: This study aims to examine the relationships between hypertrophic scar and its influencing factors, and identify the most dominant factor of the occurrence of hypertrophic scars.
 Methods: This was an observational case control study using retrospective approach in Polyclinic of Surgery of Regional Public Hospital of dr. Slamet of Garut Regency. There were 40 samples recruited in this study by purposive sampling, which was divided to be case group (20 patients) and control group (20 patients). Data were collected using Stony Brook Scar Evaluation Scale by observation and documentation of the medical records of patients. Data were analyzed using logistic regression analysis.
 Results: Findings indicated that there were significant relationships between the surgical wound infection (p = 0.02), family history (p = 0.026), and type of suture (p = 0.043) with the occurrence of hypertrophic scars. The most dominant factor on the occurrence of hypertrophic scars was type of suture, acid polyglactin 910. The variables that had no significant relationships with the occurrence of hypertrophic scar tissue were age (p = 0.34), area of surgical wound (p = 0.177), and smoking habit (p = 0.479).
 Conclusion: There were significant relationships between infection of surgical wound, genetic history, the type of suture, and the occurrence of hypertrophic scar tissue. The most dominant factor that influenced the occurrence of hypertrophic scar tissue was the type of suture. Therefore, it is suggested to health professionals to modify the using of acid polyglactin 910 sutures, and nurses particularly need to provide the information regarding the family history and genetic-related hypertrophic scar, and prevent the infection of surgical wound after operation.

Comparison of conventional suturing and tissue adhesive (2-octyl cyanoacrylate) for port site skin closure in laparoscopic surgeries

Background: Today there are numerous methods available for closure of wounds like tissue adhesives, staplers, adhesive tapes and obviously the age old conventional suturing, all of which have their own pros and cons. The aim was to study the complications and results of use of 2-octyl cyanoacrylate on wound healing and compare them without those of conventional suturing. Methods: Study comprised of 100 patients undergoing clean or clean contaminated elective laparoscopic surgery. After randomization 50 patients had their port site skin incision closed using 2-octyl cyanoacrylate. In the rest the port site skin incision was sutured using 3-0 polyamide. The scar was assessed using the stony brook scar evaluation scale. Results: The average Stony Brooke scar evaluation scale score was 4.2±1.03 (95% CI: 3.90 - 4.49) in the 2-octyl cyanoacrylate group and 3.12±1.04 (95% CI: 2.82-3.41) in the suturing group. The score was significantly higher in the 2-Octyl Cyanoacrylate group (p value≤ 0.001). 4 of 50 (8%) patients from the tissue adhesive group developed breaking of adhesive film. 8% and 4% developed wound infection from the suturing and 2-octyl cyanoacrylate group respectively(p value - 0.65). None of the patients showed any hypersensitivity to the product. Conclusions: 2-octyl cyanoacrylate is a safe and effective method for closure of skin incisions without any toxicity to the product. There is no difference in early complications such as breaking of film, wound dehiscence and wound infection when compared with conventional suturing. According to the Stony Brooke scar evaluation scale laparoscopic port sites closed using 2-octyl cyanoacrylate have better short term cosmetic appearance.

Assessing cosmetic results after conventional thyroidectomy using the EASY-EYE_C: a double-blind randomized controlled trial.

PurposeThe incidence of thyroid cancer is relatively high, especially in young women, and postoperative scarring after thyroidectomy is an important problem for both patients and clinicians. Currently, there is no available product that can be used for wound protection during thyroid surgery. We used the EASY-EYE_C, a new silicone-based wound protector.Methods We conducted a double-blind randomized controlled trial to assess the efficacy of the EASY-EYE_C with surgical scars. We studied 66 patients who underwent conventional total thyroidectomy or hemithyroidectomy performed by a single surgeon from August 2015 to June 2016. At 6-week follow-up, a single blinded physician observed the wounds to make clinical assessments using the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS), and a modified Stony Brook Scar Evaluation Scale (SBSES).ResultsThere were no significant differences by sex, age, type of surgery, body mass index, length of wound, incision site (from sternal notch), or thyroid weight, but the duration of operation was significantly shorter in the experimental group (E group). The e-group also had better POSAS scores than the control group (C group), with means of 43.2 (standard deviation [SD], ±15.9) versus 68.3 (SD, ±21.5), respectively (P < 0.05). The modified SBSES and VSS scores were similar to those from the POSAS.ConclusionIn this study, all scores for evaluating outcomes were higher in the E group than in the C group. In addition, the operation time was significantly shorter in the E group. Therefore, the EASY-EYE_C may be useful for improving the cosmetic outcomes of conventional thyroid surgery.

A Comparison of Barbed Sutures and Standard Sutures with regard to Wound Cosmesis in Panniculectomy and Reduction Mammoplasty Patients.

Cosmesis is a vital concern for patients undergoing plastic and reconstructive surgery. Many variations in wound closure are employed when attempting to minimize a surgical scar's appearance. Barbed sutures are one potential method of achieving improved wound cosmesis and are more common in recent years. To determine if barbed sutures differ from nonbarbed in wound cosmesis, we conducted a single-blinded, randomized, controlled trial of 18 patients undergoing bilateral reduction mammoplasty or panniculectomy. Patients were their own controls, receiving barbed sutures on one side and standard sutures on the contralateral side. Surgical scars were evaluated postoperatively by patient preference self-assessment and an observer. Ten patients were evaluated at 3 months postoperatively, yielding a mean Stony Brook Scar Evaluation Scale (SBSES) rating of 4.4 for barbed suture and 3.5 for regular suture (p = 0.15). At 6 months, 8 patients performed self-assessment to determine their preference; 4 preferred the barbed sutures, 1 preferred the regular sutures, and 3 had no preference. Further research with larger sample sizes is needed to determine if barbed sutures convey any advantage over standard sutures in wound healing. However, our results suggest that barbed sutures are a reasonable alternative to standard sutures particularly with regard to wound cosmesis.

Single-stage soft tissue reconstruction and orbital fracture repair for complex facial injuries

Orbital fractures with open periorbital wounds cause significant morbidity. Timing of debridement with fracture repair and soft tissue reconstruction is controversial. This study focuses on the efficacy of early single-stage repair in combined bony and soft tissue injuries. Retrospective review. Twenty-three patients with combined open soft tissue wounds and orbital fractures were studied for single-stage orbital reconstruction and periorbital soft tissue repair. Inclusion criteria were open soft tissue wounds with clinical and radiographic evidence of orbital fractures and repair performed within 48h after injury. Surgical complications and reconstructive outcomes were assessed over 6 months. The main outcome measures were enophthalmos, pre- and post-CT imaging of orbits, scar evaluation, presence of diplopia, and eyelid position. Enophthalmos was corrected in 16/19 cases and improved in 3/19 cases. 3D reconstruction of CT images showed markedly improved orbital alignment with objective measurements of the optic foramen to cornea distance (mm) in reconstructed orbits relative to intact orbits of 0.66, 95% confidence interval [CI] (lower 0.33, upper 0.99) mm. The mean baseline of Stony Brook Scar Evaluation Scale was 0.6, 95%CI (0.30-0.92), and for 6 months, the mean score was 3.4, 95%CI (3.05-3.73). Residual diplopia in secondary gazes was present in two patients; one patient had ectropion. Complications included one case of local wound infection. An early single-stage repair of combined soft tissue and orbital fractures yields satisfactory functional and aesthetic outcomes. Complications are low and likely related to trauma severity.

Outcomes of Cutaneous Scar Revision During Surgical Implant Removal in Children with Cerebral Palsy.

Children who have had surgery involving the placement of an implant frequently undergo a subsequent surgery for hardware removal. The cosmesis of surgical scars following initial and subsequent surgeries is unpredictable. Scar incision (subsequent surgical incision through the initial scar) or excision (around the initial scar) is selected on the basis of the quality of the initial scar. The outcomes following these techniques have not been determined. This prospective, consecutive case series was designed to compare outcomes following surgical scar incision versus excision at the time of implant removal in children with cerebral palsy. Photographs of the scars were made preoperatively and at 6 and 12 months following implant removal and were graded for scar quality utilizing the modified Stony Brook Scar Evaluation Scale (SBSES). Parental assessment of scar appearance was performed at the same time points utilizing a visual analog cosmetic scale (VACS). The scars that were selected for incision had significantly worse SBSES scores at 6 and 12 months following the second surgery compared with preoperative values. However, parents' VACS scores of the incised scars, although worse at 6 months, were comparable with preoperative scores at 12 months. Scars that were selected for excision had significantly worse SBSES scores at 6 months but scores that were comparable with preoperative values at 12 months. VACS scores for the excised scars were comparable at the 3 time points. Surgical incisions that initially healed with good scar quality generally healed well (from the parents' perspective) following subsequent incision through the previous scar. Surgical incisions that initially healed with poor scar quality did not heal better following excision of the previous scar. In such situations, surgical excision of the existing scar should occur in conjunction with additional adjuvant therapies to improve cosmesis. Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

Clinimetric properties and clinical utility in rehabilitation of postsurgical scar rating scales: a systematic review.

The aim of this study was to review and critically assess the most used and clinimetrically sound outcome measures currently available for postsurgical scar assessment in rehabilitation. We performed a systematic review of the Medline and Embase databases to June 2015. All published peer-reviewed studies referring to the development, validation, or clinical use of scales or questionnaires in patients with linear scars were screened. Of 922 articles initially identified in the literature search, 48 full-text articles were retrieved for assessment. Of these, 16 fulfilled the inclusion criteria for data collection. Data were collected pertaining to instrument item domains, validity, reliability, and Rasch analysis. The eight outcome measures identified were as follows: Vancouver Scar Scale, Dermatology Life Quality Index, Manchester Scar Scale, Patient and Observer Scar Assessment Scale, Bock Quality of Life (Bock QoL) questionnaire, Stony Brook Scar Evaluation Scale, Patient-Reported Impact of Scars Measure, and Patient Scar Assessment Questionnaire. Scales were examined for their clinimetric properties, and recommendations for their clinical or research use and selection were made. There is currently no absolute gold standard to be used in rehabilitation for the assessment of postsurgical scars, although the Patient and Observer Scar Assessment Scale and the Patient-Reported Impact of Scars Measure emerged as the most robust scales.

Botulinum toxin for the prevention and healing of wound scars: A systematic review of the literature

Background Botulinum toxin injections have been investigated for the treatment or prevention of hypertrophic scars in several clinical studies. However, its clinical effectiveness has not yet been established. Objective To examine all available evidence that support the use of botulinum toxin injections for the treatment or prevention of hypertrophic scars in current clinical practice. Methods A systematic review searching the MEDLINE (1966 to 2014), Scopus (2004 to 2014), Popline (1974 to 2014), ClinicalTrials.gov (2008 to 2014) and Cochrane Central Register of Controlled Trials (CENTRAL) (1999 to 2014) databases together with reference lists from included studies was conducted. Results Te n studies (255 patients) were included. Of these, 123 patients were injected with botulinum toxin type A, nine patients were offered botulinum toxin type B and the remaining 123 patients represented the control groups. Significantly improved cosmetic outcomes were observed among certain studies using the visual analogue scale (experimental group: median score 8.25 [range 6 to 10]) versus control group: median score 6.38 [range 2 to 9]; P&lt;0.001) and the Stony Brook Scar Evaluation Scale (experimental group score: 6.7 versus control group score: 4.17; P&lt;0.001) assessments. However, the methodological heterogeneity of the included studies, the lack of control group in the majority of them, the use of subjective scales of measurement and the frequent use of patient self-assessment precluded unbiased results. Conclusions Current evidence does not support the usage of botulinum toxin. Future randomized controlled trials are needed in the field to reach firm conclusions regarding its place in current clinical practice.

Aesthetic assessment in periciliary "v-incision" versus conventional external dacryocystorhinostomy in Asians.

To determine the functional and aesthetic outcomes of periciliary "v-incision" external dacryocystorhinostomy (DCR) and to compare with conventional approach. Charts review of consecutive cases of "v-incision" (VDCR) or conventional DCR performed in a single institute, between January 2007 and March 2014. All procedures were performed or supervised by a single surgeon. Two periciliary incisions were made near the skin-mucosal junction at the upper and lower eyelid margins medial to the punctum joining at the medial canthal angle to form a "v" shape. Subcutaneous dissection was carried out inferomedially to reach the anterior lacrimal crest. DCR was then performed in the usual manner. Functional success was defined as no persistent or recurrent epiphora and patency on irrigation of the lacrimal drainage system at least 6 months post-surgery. A cross-sectional aesthetic survey was conducted by asking the patients to rate their scar appearance satisfaction on a visual analogue scale (VAS). External photographs were graded by two independent, masked physicians using VAS as well as the Stony Brook scar evaluation scale (SBSES). Sixty-one patients with median age of 64 years met the inclusion criteria, with median follow-up duration of 28 months. Thirty-eight eyes underwent VDCR, and 23 had conventional DCR. The functional success rate for VDCR was 83.3, 95 % confidence intervals (95%CI) [lower 0.68, upper 0.92] and for conventional DCR was 73.9 %, 95%CI [lower 0.54, upper 0.87]; without statistically significant difference (p = 0.38). VDCR patients rated higher aesthetic outcome on VAS (mean scores 95.5 ± 16.8 vs 82.9 ± 25.1, p = 0.03). On the SBSES, both observers gave higher aesthetic scores to the VDCR group (observer #1 4.6 ± 1.1 and #2 4.7 ± 1.2, p < 0.01) than conventional DCR (observer #1 3.1 ± 2.8 and #2 2.8 ± 2.1, p < 0.01). More patients reported that they could wear spectacles within 1 week post-VDCR (44.7 vs 4.3 %, p < 0.01). "V-incision" external DCR has a similar functional success rate to that of the conventional approach and has superior aesthetic outcomes as reported by surgeons and patients. However, a higher proportion of trainees under supervision performed conventional DCR, and it is uncertain whether the outcomes were also influenced by the level of surgeon's expertise.

Botulinum toxin for the prevention and healing of wound scars: A systematic review of the literature.

Botulinum toxin injections have been investigated for the treatment or prevention of hypertrophic scars in several clinical studies. However, its clinical effectiveness has not yet been established. To examine all available evidence that support the use of botulinum toxin injections for the treatment or prevention of hypertrophic scars in current clinical practice. A systematic review searching the MEDLINE (1966 to 2014), Scopus (2004 to 2014), Popline (1974 to 2014), ClinicalTrials.gov (2008 to 2014) and Cochrane Central Register of Controlled Trials (CENTRAL) (1999 to 2014) databases together with reference lists from included studies was conducted. Ten studies (255 patients) were included. Of these, 123 patients were injected with botulinum toxin type A, nine patients were offered botulinum toxin type B and the remaining 123 patients represented the control groups. Significantly improved cosmetic outcomes were observed among certain studies using the visual analogue scale (experimental group: median score 8.25 [range 6 to 10]) versus control group: median score 6.38 [range 2 to 9]; P<0.001) and the Stony Brook Scar Evaluation Scale (experimental group score: 6.7 versus control group score: 4.17; P<0.001) assessments. However, the methodological heterogeneity of the included studies, the lack of control group in the majority of them, the use of subjective scales of measurement and the frequent use of patient self-assessment precluded unbiased results. Current evidence does not support the usage of botulinum toxin. Future randomized controlled trials are needed in the field to reach firm conclusions regarding its place in current clinical practice.

Wide-Open Dorsal Approach Rhinoplasty for Droopy Noses.

Because rhinoplastic surgery predominantly deals with the osseocartilaginous skeleton, droopy noses with thick skin remain a problem to be solved. In these noses, neglecting excess skin can impair long-lasting and complete correction of the nasal deformity. As these noses already require redundant dorsal skin resection, surgical manipulations can be executed entirely through the dorsal skin excision window instead of the transcolumellar approach. The wide-open dorsal approach rhinoplasty (WoDAR) was developed to allow removal of excess dorsal skin and reconstruction of the nasal osseocartilaginous framework through the excised dorsal skin avoiding a transcolumellar incision. Nine male patients with thick skin and significantly ptotic noses were operated with WoDAR. The cosmetic appearance of the noses was evaluated by the patients before and after the operation using a visual analog scale (VAS). The nasal obstruction symptom evaluation (NOSE) scale was evaluated individually preoperatively and postoperatively. The nasolabial angle (NLA) was measured preoperatively, at the third, twelfth, and twenty-fourth months postoperatively. Dorsal scars were evaluated by means of the Stony Brook's scar evaluation scale (SBSES). Patients (mean age: 51.4 ± 4.8 years) were followed for an average duration of 20.6 ± 8.4 months. Cosmetic evaluation revealed that the mean patient preoperative VAS score was 23.3 ± 25.6, whereas the postoperative VAS score was 92.6 ± 14.8. Preoperative and postoperative NOSE scores were 79.5 ± 16.5 and 11.5 ± 11.5, respectively. The mean preoperative NLA was 72.9 ± 2.9° and at the third and twelfth month postoperatively was 92 ± 6.5 and 91 ± 5.4. The NLA measurements of all four patients followed for 24 months revealed less than 2° derotation compared to third postoperative month. The mean SBSES score was 4.1 ± 0.8 out of 5. WoDAR allowed esthetically and functionally pleasing outcomes. This advantageous technique can be regarded as a surgical alternative for carefully selected aged patients with severely ptotic, thick-skinned noses who might otherwise end up with unsatisfying results both for surgeon and patients.

Is sclerotherapy useful for cherry angiomas?

Sclerotherapy is a safe, effective, and easily available treatment modality, its role in cherry hemangioma is still unexplored. This study aims at establishing the role and efficacy of sclerotherapy in treating cherry angiomas and its dermatological complications. This prospective study included 20 patients with 100 lesions of cherry hemangiomas of size >0.2 mm. Intralesional injection of 0.1 mL of 3% sodium tetradecyl sulfate was used. Scarring, if any, was evaluated using "The Stony Brook Scar Evaluation Scale." Patients were called for weekly sessions for a maximum of 4 weeks. Of 100 lesions treated, 42 lesions responded with a single dose of sclerosant, 44 lesions required a second setting. Remaining lesions were injected for 3 weeks, of which 14 lesions did not remit completely and required a fourth sitting. Depending on response to sclerotherapy, patients were divided into 2 groups (Group A and Group B). On comparing these groups, no statistically significant (χ test) difference in the rate of healing was observed. Sclerotherapy with sodium tetradecyl sulfate 3% is effective in the treatment of cherry hemangiomas. It offers an economical alternative to other available conventional methods.

Early postoperative treatment of thyroidectomy scars using botulinum toxin: a split-scar, double-blind randomized controlled trial.

Operational scars, especially those located on the exposed parts of the body, can be distressing. Despite high demand for an early intervention to minimize surgical scars, there is yet no universal consensus on optimal treatment. A split-scar, double-blind randomized controlled trial was held to assess the safety and efficacy of early postoperative botulinum toxin type A (BTA) injection in surgical scars. A single session of treatment was performed where BTA was allocated to one half of the scar and 0.9% saline to the control half. Scars were assessed using the modified Stony Brook Scar Evaluation Scale (SBSES) with standardized photographs. Fifteen patients completed the study, and their data were analyzed. At 6 months' follow-up, a significant improvement in SBSES score was noted for the BTA-treated halves of the scars (p < 0.001), with minimal change on the saline-treated side (p = 0.785). The mean calculated difference in SBSES scores (final/initial) between the BTA-treated side and the saline-treated side was also significant (p < 0.001). Early postoperative BTA injection was safe and effective in modulating thyroidectomy scars and may be a promising option for scar prevention.

A comparative study evaluating the clinical efficacy of skin tapes versus silicone gel for the treatment of posttrauma scar in the rabbit model

Background: Skin tape and silicone gel are two common over-the-counter preparations used to enhance the cosmesis of keloids and hypertrophic scars of posttrauma wounds. This animal study was performed to determine the clinical efficacy of skin tape versus silicone gel in subjects with scars. Materials and Methods: Three New Zealand rabbits that received total 12 incision wounds which two incision wounds on one ear side and subsequent primary suturing were studied. Stitches were removed after 1 week. Silicone gel was applied right upper side of the rabbit's ear directly on surgical incision wounds, and skin tapes were also applied left upper side of the rabbit's ear directly on another surgical incision wounds after 1 week of surgery. The lower incisions in both ears were covered with sterilized gauze and served as controls. We compared two experimental groups at binaural with using Vancouver Scar Scale, Manchester Scar Scale, and The Stony Brook Scar Evaluation Scale. These are widely used in clinical practice and research to document change in scar appearance. Results: We describe a rabbit model for incisional wounds and scarring outcome measures. The results of scar measuring devices demonstrated that skin tape reduced scar formation as well as silicone gel. Conclusions: The results of cosmetic demonstrated that skin tape reduced scar formation as well as silicone gel. However, the economical and effective materials were the important subject that suffices for clinical requirement. The application of these scar prevention devices to reduce scar formation after surgical incision is worthy of future investigation. Moreover, skin tape may represent a low-cost alternative and low scar formation for closure of surgical incisions.

Superficial incisional surgical site infection rate after cesarean section in obese women: a randomized controlled trial of subcuticular versus interrupted skin suturing

To compare the superficial incisional surgical site infection (SSI) rate after cesarean section (CS) in obese women using subcuticular versus interrupted skin suturing. The current randomized controlled clinical trial was conducted at Ain Shams University Maternity Hospital. Obese non-diabetic women who underwent elective CS were randomized into two groups: group I included women who had their skin closed with interrupted mattress suture using non-absorbable polypropylene, and group II included women who had their skin closed with subcuticular suture using the same suture material. Primary outcome measure was superficial incisional SSI and secondary outcome measures were skin closure time, postoperative pain assessed by ten-point visual analog scale (VAS) and short-term cosmetic wound outcome according to the Stony Brook Scar Evaluation Scale (SBSES). A total of 130 obese women were finally analyzed. Group II (n = 67) was associated with higher incidence of superficial incisional SSI. There were nine cases (13.4 %) compared to three cases (4.8 %) in group I (n = 63); however, this difference was statistically not significant (P = 0.088). Skin closure time was significantly prolonged in group I (8.6 ± 2.3 min versus 5.7 ± 2.2 min, respectively, P < 0.001). Postoperative pain was significantly lower in group I and the mean VAS in group I was 4.7 ± 2 versus 5.5 ± 1.8 in group II (P = 0.017). Using SBSES, group II had mean score 4.5 ± 0.7, while group I had mean score 2.7 ± 1.1. This was statistically significant (P < 0.001), which means a better cosmetic outcome in group II. Subcuticular skin closure during CS for non-diabetic obese women was significantly associated with better short-term cosmetic outcome, less skin closure time, yet, with slightly higher risk of superficial incisional SSI and significantly more postoperative pain.

Effect of Nose Skin on the Columellar Incision Scar in a Turkish Population

To investigate the causes of columellar scar formation in a Turkish population in relation to nasal skin thickness, texture, and type and discuss possible solutions for better results. Prospective, clinical study. Otorhinolaryngology department of a tertiary hospital. The preoperative dermal thickness of 50 consecutive patients undergoing "external approach" septorhinoplasty was measured (using a 14 MHz ultrasound probe) at the midportion of the right and left nostril, tip, supratip, and columella. Surgery was performed using a middle columellar gullwing incision. All patients had a minimum follow-up of 6 months after surgery. Assessment of the columellar scar was performed according to the Stony Brook Scar Evaluation Scale modified for columellar scars. The mean values of skin thickness measurements, skin type (according to the Fitzpatrick skin classification scale), skin texture (oily, combination, normal, dry, and sensitive types), smoking habit, and patient gender were recorded and compared with the columellar incision scar scores. There was no statistically significant difference in healing between the skin thickness of the tip, supratip, left nostril, right nostril, columella and mean skin thickness values, skin types (Fitzpatrick 2, 3, 4, 5), skin textures, and smoking with regard to columellar scar formation (P > .05). However, men healed significantly better than women (P < .05). The columellar incision heals independently of the influence of skin thickness; texture; Fitzpatrick skin types 2, 3, 4, and 5; and smoking. Male gender seems to be a significant factor in healing.