Surgical Scar Revision Research Articles

Mastectomy is a safe procedure in transgender men with a history of breast reduction

Little is known about the safety and surgical outcomes of mastectomy after breast reduction in the trans male population. Several concerns have been voiced that performing mastectomy with prior breast reduction surgery, increases the risk for complications and revision surgery. All transgender men with a history of breast reduction, who underwent a mastectomy at our center between 01-1990 and 01-2021 were identified from our hospital registry. A retrospective chart study was conducted recording surgical characteristics, surgical complications, revision surgery, and clinical follow-up. A total of 1362 subcutaneous mastectomies were performed between 01-1990 and 01-2021. A total of 36 (2.6%) individuals were included (35 bilateral and 1 unilateral breast reduction). The mean age at mastectomy was 37 ± 10 years, and the median time between breast reduction and mastectomy was 6.3 years (range 1.0–31.1). Most individuals underwent a Wise-pattern breast reduction (91%) and a double incision mastectomy with free nipple grafts (86%). Following mastectomy, one acute reoperation was performed because of hemorrhage (3%). Partial pedicled nipple necrosis was seen in 7% and (partial) non-take of nipple grafts in 4%. Scar revisions were performed in 9%, dogear corrections in 20%, and both nipple corrections, and contour corrections in 6%. When comparing the outcomes in literature for surgical complications, scar revision, contour correction or nipple areolar complex revision, no clear disadvantage seems to be present when performing mastectomy after breast reduction. Mastectomy is a safe procedure in transgender men with a history of breast reduction.

The “Punching-Out” Technique to Reduce the FUT Scar

<h3>Abstract</h3> A widened scar from a previous strip-removal procedure (follicular unit transplant) is a commonly encountered complaint from patients coming in for a second hair restoration surgery. Options for addressing widened scars have included surgical scar revision, transplanting the scar with follicular units, and scalp micropigmentation. The authors present a new approach, where the scar may be thinned with a punching-out technique followed by resuturing the area. Advantages of the technique include that the time spent on this procedure is usually less than 10-15 minutes, it utilizes skills and equipment that most hair restoration surgeons already have, and it also does not use additional precious follicular units. Our experience using this technique in 58 patients showed improved appearance of the scar.

Surgical scar revision using silicone gel sheet as an adjunct.

Introduction:Scar is often referred to as an unattractive mark after healing of a wound. An undesirable scar may have negative social, emotional, and functional impact on the patient. It is our job as surgeons to adequately understand the expectations of the patient and counsel them for a successful procedure.Materials and Methods:Twelve patients were randomly chosen for the study, of which five were males and seven were females. The scar tissue was removed surgically, and silicone gel sheets (SGSs) were applied on the 14th postoperative day, and the dimensions of the new scar was measured periodically up to 12 months.Results:The study comprised of 12 patients- 5 males and 7 females. The descriptive statistics were calculated as median and interquartile range and comparison between time intervals was done using Wilcoxon signed rank test. Out of the 12 patients, 10 showing complete resolution of the scar and 2 patients had partial relapse of scar. However, they were satisfied with the final outcome.Conclusion:Our study found that SGSs applied to surgically revised scars significantly improves their appearance. The ease of use of the SGSs also makes it patient friendly. We observed almost complete resolution of the scar in ten patients and two patients exhibited partial relapse of the scar. However, there was a significant improvement in the overall appearance of the scar, and the patients were satisfied with the results of the procedure.

Secondary Intention Healing After Mohs Surgical Excision as an Alternative to Surgical Repair: Evaluation of Wound Characteristics and Esthetic Outcomes.

A multitude of reconstructive options exist for patients after Mohs surgery of cutaneous neoplasms of the head and neck. Secondary intention healing is often overlooked and underused but has numerous advantages, including superior esthetic outcomes compared with surgical reconstruction for wounds that exhibit particular characteristics. The ability to predict cosmetic results based on wound characteristics can greatly help in the decision between surgical repair and secondary intention healing. Although other studies have discussed results after secondary intention healing on various areas of the head and neck, here, we specifically focus on cases of the nasal area. We conducted a chart review of 37 patients with nasal reconstructions using secondary intention healing by a single surgeon over a 2-year period. Wound outcomes were graded as poor, acceptable, good, or excellent based on definitions found in the literature. We found that overall, the best cosmetic outcomes were associated with concave areas of the nose, such as the nasal ala and sidewall, and that superficial wounds healed better than deep wounds. Furthermore, we found that convex areas of the nose, such as the nasal tip, did not heal as well by secondary intention. However, if the wound was small and superficial enough, the wound still healed with a good to excellent cosmetic outcome. Healing by secondary intention is a reasonable consideration for suitable wounds. The need for surgical scar revision is addressed, if necessary, after the wound has healed. The benefits of secondary intention healing include:Future studies will address a larger cohort size of patients with more varied skin types and ages, as these are characteristics that can influence cosmetic outcome. Furthermore, healed wounds continue to improve in appearance over time, and it would be worthwhile to monitor patients' cosmetic outcomes over a longer follow-up period.

Treatment of scar endometriosis with elagolix

Endometriosis is a chronic inflammatory disorder that affects approximately 5%–10% of women and is a major contributor to chronic pelvic pain. It can result in a significant impact on a woman’s quality of life with a high rate of reoccurrence throughout the woman’s reproductive years. Medical treatment is available but often surgical intervention is required. Scar endometriosis is a rare complication of this disease, mostly involving cesarean section scars. Our case demonstrates a possible new, non-invasive treatment for scar endometriosis with elagolix. The ability to avoid the potential morbidity of surgical scar revision makes this a very attractive potential option. Further studies with larger cohorts and long-term follow up are needed to confirm efficacy.

Indications, complications, and outcomes associated with subdermal plexus skin flap procedures in dogs and cats: 92 cases (2000-2017).

To describe indications, complications, and outcomes associated with subdermal plexus skin flap (SPSF) procedures in dogs and cats. 53 dogs and 20 cats that received SPSFs for reconstruction of skin defects from 2000 to 2017. Medical record data were collected and summarized regarding patient signalment, indication for the SPSF procedure, type and location of SPSF, complications, and outcome. 92 SPSF procedures (64 in dogs and 28 in cats) were included. Indications for the procedures included tumor excision (n = 37 [40%]), acute wound (14 [15%]) or chronic wound (28 [30%]) reconstruction, surgical scar revision (7 [8%]), and other reasons (6 [7%]). Types of SPSFs included advancement (31 [34%]), axillary fold (20 [22%]), inguinal fold (20 [22%]), rotation (16 [17%]), transposition (3 [3%]), and distant direct (2 [2%]). Complications were noted for 47 (51%) procedures at a mean ± SD of 6.9 ± 4.0 days after surgery and were classified as minor (34 [37%]) or major (13 [14%]). Outcome was considered excellent for 44 (48%) procedures, good for 33 (36%), fair for 13 (14%), and poor for 2 (2%). Results suggested that approximately half of SPSF procedures in dogs and cats can be expected to be followed by a complication, occurring at a mean of 1 week after surgery, and yet with appropriate management of these complications, a good to excellent outcome was possible. Owners should be counseled about the likely need for additional visits and costs associated with treatment of postoperative complications.

A Combination Approach to Surgical Scars.

Scar formation from surgical procedures is an unavoidable risk. Despite measures taken by both the surgeon and patient during the perioperative and postoperative periods to maximize cosmesis, some patients will wish to pursue surgical or laser scar revision. The authors propose a treatment algorithm to assist in approaching surgical scar revision with combination treatments. A PubMed search was performed on various surgical scar revision techniques. The authors augment these findings with their own personal experiences. Reports of surgical excision, intralesional corticosteroid injection, intralesional 5-fluorouracil injection, pulse dye laser treatment, nonablative fractional laser resurfacing, ablative fractional laser resurfacing, and microneedling and fractional needle radiofrequency, used in isolation or combination, were found. The authors also provide clinical photographs documenting improvement in appearance of surgical scars using these treatments. Surgical scars are best treated with a combination approach to address various features of the scar. The authors propose a treatment algorithm with multiple treatment options and how to combine them safely and effectively.

Fractional Photothermolysis of a Replanted Nose: A Case Report

Because the nose is one of the most prominent and characteristic features of a face, its successful replantation or replacement of the amputated nasal segment has been a challenging management problem [1-3]. Recently, although several cases of successful microsurgical replantation of an amputated nose have been reported, it still poses significant difficulty from technical and management perspectives. Several factors, such as initial trauma of amputation tissue, medical leech bite wound, infection, arterial insufficiency, or venous congestion induce the marginal or focal skin defect. In the wound healing process, these wounds would be healed with contracted and notable scars. However, scar management for the replanted nose may be out of interest, so far. There are surgical and non-surgical options for management of scars [4]. In the replanted nasal tip, due to hemodynamically unstable tissue and risk of unpredictable outcome, there is hesitation to perform surgical scar revision. It is not clear which option for scar management is the best choice since facial tissue replantation was successful.

Dermo-Fascial Suspension for Better Contouring and Long Lasting Results in Reduction Mammoplasty.

Recent techniques use the superficial fascia system for anchoring the glandular tissue to the chest wall for minimal tension skin repair in contrast to classic dermal suspension. To evaluate the use of dermo-fascial flap in suspension of the breast tissue to the chest wall in reduction mammoplasty to achieve better breast shape, projection, and contour. Forty patients who underwent superiomedial reduction mammoplasty were divided into two equal groups. Group I patients underwent classic superior-medial dermo-glandular pedicle (Findlay's technique) reduction mammoplasty, while in group II, a laterally based dermo-fascial flap was used for suspension of the breast tissue to the chest wall. Preoperative and postoperative measurements of the suprasternal notch-nipple and nipple-inframammary fold distances were recorded and statistically analyzed. Mild asymmetry occurred in nine cases (5-GI, 4-GII), surgical scar revision was done in seven patients (4-GI, 3-GII), and superficial infection occurred in four patients (2-GI, 2-GII). Group II showed better clinical satisfaction and highly significant statistical differences in postoperative measurements compared to GI (P < 0.0001). The use of a dermo-fascial flap to support the glandular pedicle in reduction mammoplasty improves the shape; projection and contour of the breast. It also helps to have long lasting results and reduce recurrent breast ptosis especially in patients with poor skin quality.

Brachial lifting using the balanced triple-vector (BTV) technique with dual opposing flaps

BackgroundBrachioplasty often involves removing excess skin. Many traditional approaches to this form of surgery are prone to complications and imperfect healing of the incisions. Traditional techniques usually take little or no account of the force vectors that are subsequently applied to the incision after the operation. This contributes towards scarring and other complications.MethodThe proposed technique involves the explicit application of three balanced force vectors that greatly reduce scar-related complications. Although the scar is longer, it is on the medial side of the arm and usually fades away completely over time, with greatly improved aesthetic results. A closely related aspect of this technique is the application of anthropometric techniques in order to plan the operation for best results.ResultsThe proposed technique has been applied in practice to 23 patients. There were no long-term complications. Temporary paresthesia was observed in 5 patients and temporary swelling of hands in 2 patients. One case of seroma was also detected. Two patient required surgical scar revision. One patient was unsastified with the final scar quality.ConclusionsDue to the superficial resection in this technique, no damage to the subcutaneous tissue and lymphatic network occurs, resulting in a more predictable outcome with greatly reduced risk of complications. This technique is particularly good at reducing the scar retraction issues most common when using other single-vector approaches.Level of Evidence: Level IV, therapeutic study.

Ulnar Polydactyly

Postaxial polydactyly type B (PAPD-B) refers to the nonfunctional, floppy extra digit on the ulnar border of the hand. Suture ligation is applied in the newborn unit if the base is narrow or pedunculated. However, wart-like scars, residual bumps, or neuromas are frequent complications. Wider-based extra digits are treated at a later age by surgical excision under general anesthesia. Surgical clip application expands the indications for PAPD treatment in the newborn unit or outpatient setting with lesser incidences of complications. A retrospective review identified 231 hands with PAPD-B in 132 newborns treated with surgical clips between January 1, 1996, and November 30, 2010, having a minimum of 2 years of follow-up. Medical records were queried for complications, revision procedures, and parent satisfaction. A relative cost survey compares the costs of surgical clips to surgery. In all, 16 extremities in 9 patients (7%) required surgical scar revision. No wound complications were noted.

Use of Tattooing to Camouflage Various Scars

Tattooing often is overlooked by plastic surgeons when treating scars. However, some scars are not apt for surgical scar revision and cannot be dramatically improved by laser treatment either. Tattooing can be considered as a simple alternative in such situations. The medical records of all the patients who underwent medical tattooing for causes other than routine nipple-areolar reconstruction between 2008 and 2010 were collected. Pre- and postoperative photographs were reviewed. A total of 32 mature scars in 28 patients were treated with tattooing. The scars treated were mainly categorized as depigmented (skin or vermilion) or hairless. The median follow-up period was 14months, and a retouch procedure was required in 31% of the cases. No significant complications developed, and the patients were generally satisfied. Tattooing can be applied in treating scars when conventional methods are not indicated. It can be used for the alopecia scar of a patient who does not want a hair graft, for the depigmented scar that would not benefit dramatically from laser treatment, or as camouflage for a three-dimensional structure when surgical reconstruction is not feasible.

Improving scars with minimally invasive and topical treatment

Suboptimal facial scarring can be a stigma, leading many affected patients to seek treatment. An increasing array of minimally invasive techniques and topical treatments can improve many scars either as standalone interventions or as an adjunct to surgical scar revision. Familiarity with the science of normal wound healing, competence in minimally invasive techniques, and an evidence-based approach to using the wide array of available medical therapies will assist the head and neck surgeon in obtaining the best facial scars possible.

Efficacy Varies Among Options for Surgical Scar Revision

Efficacy Varies Among Options for Surgical Scar Revision

Scar management: prevention and treatment strategies

Aberrant wound healing results in unsightly scar, hypertrophic scar, and keloid formation, causing functional and cosmetic deformities, discomfort, psychological stress, and patient dissatisfaction. Scar prevention and management, both surgical and nonsurgical, continue to be important issues for the otolaryngologist. Both animal and human models continue to point to the integral role of transforming growth factor-beta in aberrant healing. Multiple extracts have promising results as therapies for scarring and are widely marketed but need to be further investigated. Scar prevention advancements include refinements in surgical technique, nutritional supplementation, and optimal wound care. Steroid injections continue to play a major role in the regression of scars and keloids. Dermatography assists in the minimization of scar appearance. Dermatography, laser therapies, intralesional 5-fluorouracil, and adjuvant radiotherapy are emerging therapies. Topical vitamin E utility is revisited. New surgical scar revision techniques include modified excision techniques and skin grafting. Despite optimal efforts to avoid scar formation, aberrant wound healing may occur. The use of topical agents and intralesional steroid injections can minimize early scar formation. Strategies for prevention and management of keloids and hypertrophic scars continue to develop, as the basic science mechanisms underlying aberrant wound healing are elucidated.

Non‐ablative scar revision using a long pulsed frequency doubled Nd:YAG laser

OBJECTIVE: Unsightly scars often are the only reminder of a previous surgical or traumatic wound. Surgical or ablative scar revision is sought by patients, sometimes unnecessarily. When the aesthetic drawback is mainly a result of hypervascularity or hyperpigmentation, these problems can be specifically targeted with a wavelength that is well absorbed by the two above mentioned chromophores. Some degree of epidermal tightening can also be achieved, which is sometimes useful in slightly atrophic scars.The average improvement after 2–3 sessions was 81% (75%–100%) clearance, as judged by an independent observer who reviewed pre‐ and post‐treatment photographs. No undesired effects were reported. All our patients were satisfied and required no further treatment.METHODS: Selective photothermolysis by means of a long pulsed frequency doubled Nd:YAG laser (DioLite™ 532, IRIDEX Corporation, Mountain View, CA, USA) was used to eliminate the unsightly vascular and pigmented components of 23 mature scars (scars older than 2 years) in 22 consecutive patients. Energy densities of 17–22 j/cm2 were used with a 500 micron spot, or 65–90 j/cm2 with a 200 micron spot.RESULTS: overall scar clearance averaged 81% after 2.4 treatments. Facial scars showed the best clearance averaging 94% after 2 treatments. Inframammary scars were the most difficult to clear averaging 46%. Postoperative undesired effects were immediate erythema and swelling that subsided within 2–10 hours and microcrusting on 19/22 (88%) patients that resolved within one week. No other temporary or permanent undesired effects such purpura, hypo‐ or hyperpigmentation were noticed, even in patients with darker skin types.

Nonoperative techniques for scar management and revision.

Facial plastic surgeons are frequently called upon to manage facial scars, whether iatrogenic or traumatic. Numerous treatment modalities are available for scar management depending upon scar characteristics, age, and patient expectations. The focus of this article is to review commonly used nonsurgical methods of scar revision. These include topical applications (silicone, vitamin E, pressure dressing, herbal extracts), intralesional medication (steroids, antimitotics), soft tissue augmentation (collagen, fat), laser applications (585-nm flashlamp-pumped pulsed dye, CO(2)), cryotherapy, and make-up camouflage. Nonsurgical modalities can be used as prophylactic prevention of adverse scar formation, as definitive treatment, as intervening therapy until further surgical repair can be made, or as adjunctive treatment following surgical scar revision.

Spinal Cord Stimulation for Post-Herniorrhaphy Pain

Objective. Post-herniorrhaphy pain syndrome can be difficult to treat. The exact mechanism of pain is not always apparent. Multiple therapeutic modalities have been suggested for the treatment of this syndrome. Method. This includes both conservative (medical management), surgical (scar revision, excision of neuroma), and/or interventional approaches (local blocks to the entrapped nerves or sympathetic ganglion). Results. Two cases of intractable post-herniorrhaphy pain syndrome which failed to respond to conservative therapy are reviewed. Both cases had a successful trial therapy with spinal cord stimulation for their pain. Both then had permanent implantable systems inserted with favorable outcomes. Conclusion. Post-herniorrhaphy pain can have the same features of both nociceptive and neuropathic pain syndromes. In cases which have failed conservative therapy we believe that a trial of spinal cord stimulation is warranted as in other cases of neuropathic pain syndromes.

Scar resurfacing with high-energy, short-pulsed and flashscanning carbon dioxide lasers.

Scars have a significant effect on a person's physical and social being. Many treatment modalities for scar improvement such as surgical scar revision, electrosurgical planing, chemical peeling, filler substance implantation, and dermabrasion have been developed. Recently, the resurfacing carbon dioxide (CO2) laser systems have proven to be a useful and safe treatment in the treatment of facial rhytides and acne scarring. The purpose of this study was to evaluate the resurfacing CO2 lasers in the treatment of various surgical, traumatic, acne, and varicella scars. Thirty subjects, aging between 14 and 84 years, with surgical, traumatic, acne, or varicella scars were evaluated. Two types of resurfacing laser systems were utilized in this study, a high-energy, short-pulsed CO2 laser and a continuous wave CO2 laser with an optico-mechanical computer flash-scanner. Post-surgical scars were treated with laser resurfacing between 4 and 6 weeks after scar formation. Traumatic, acne, and varicella scars were treated after scar maturation (range, 1-10 years). Scar improvement was evaluated by photographic analysis of before and after images by four independent health care workers using a quartile scale of improvement (< 25%, 25-49%, 50-74%, > 75%) as well as optical profilometry using silicone surface impressions in 12 scars. Twenty of 24 surgical scars had greater than 75% improvement, and 24 of 24 had greater than 50% improvement by photographic analysis. All six traumatic, acne and varicella scars had greater than 50% improvement. Optical profilometry and surface topography maps reveal a significant flattening of related and depressed scars. The high-energy, short-pulsed CO2 laser and the continuous wave CO2 laser with flash-scanning attachment are safe and effective as a treatment modality for scar revision. In general, elevated scars improve more dramatically than depressed scars.

Surgical Excision of Periorbital Capillary Hemangiomas.

Background: Periorbital capillary hemangiomas of childhood can produce ptosis, strabismus, and anisometropia, resulting in amblyopia. Traditional therapy with either systemic or local corticosteroids occasionally yields incomplete resolution of these lesions and may be associated with numerous adverse complications. The authors report their experience performing surgical resection of periorbital capillary hemangiomas. Methods: Twelve children with periorbital capillary hemangiomas were treated surgically. Six of these children had previously failed to adequately respond to steroid injections and six were primarily treated with surgical resection. All lesions were believed to be localized and did not appear to be infiltrative on preoperative computed tomographic scans. Results: All lesions were completely resected, except for two in which there was a small area of residual hemangioma surrounding the lacrimal drainage system that was left intact. Controlled intraoperative hemorrhage in two patients required intraoperative directed-donor blood transfusion. Perioperatively, in one patient a wound dehiscence developed, which required minor repair. This same patient elected to have surgical scar revision postoperatively. The patients have been followed up to 5 years. All did well with improved cosmesis, and they have good lid function. No recurrences have been noted. Conclusion: Surgical resection of pediatric capillary hemangiomas should be considered a treatment option in those that fail to respond to corticosteroids and/or are isolated and noninfiltrative in nature.