Vancouver Scar Scale Research Articles

The Effectiveness of Early Treatment With Intense Pulsed Light Combined With Fractional Erbium Laser in Preventing Post-traumatic Hypertrophic Scar Formation.

Once scars form and begin to proliferate, treatment becomes challenging. Traditional methods of scar treatment often provide suboptimal results. Therefore, early intervention has become widely accepted, with a focus on prevention during the wound-healing phase rather than later treatment. Here, the authors evaluate the effectiveness of early treatment with intense pulsed light (IPL) combined with fractional erbium laser in preventing the formation of post-traumatic hypertrophic scars. A total of 120 patients who underwent emergency cosmetic suture surgery for facial trauma between January 2019 and December 2021 were selected for the study. The control group received conventional antiscar therapy (pressure therapy or antiscar medication), while the observation group received IPL combined with fractional erbium laser in addition to the conventional treatment. The specific treatment doses were adjusted based on the patient's age, scar color, texture, and thickness. A treatment course consisted of 3 to 5 sessions, with 4-week intervals between treatments. Follow-up was conducted within 1 year after treatment to assess the improvement in scar appearance before and after therapy. After IPL combined with fractional erbium laser treatment, patients in the observation group showed significantly lower scores in color, thickness, vascular distribution, softness, and total scores on the Vancouver Scar Scale (VSS) compared with the control group. During the follow-up, 3 complications were observed: 2 cases of skin blisters and 1 case of pigmentation. No immediate skin lesions, depigmentation, infections, ulcers, or other adverse reactions were reported. For patients with early-stage superficial scars following trauma surgery, early treatment with IPL combined with fractional erbium laser not only leads to significant improvements in appearance and effectively prevents hypertrophic scar formation but also promotes rapid recovery with few complications. This approach has clinical value.

Effect of a Chest Compression Device for Scar Prevention Combined with Nurse-Patient WeChat Group on Scar Formation after Keloid Excision

Objective: To investigate the effect of a chest compression device for scar prevention combined with a nurse-patient WeChat group on scar formation after keloid excision. Methods: Forty patients with chest wall keloids who underwent keloid excision surgery at the Department of Plastic and Reconstructive Surgery, First Medical Center of PLA General Hospital from June 2022 to June 2024 were selected. They were randomly divided into two groups: the observation group (20 cases) and the control group (20 cases). Both groups underwent routine keloid excision, followed by compression therapy for 6 months. The observation group used a chest compression device, while the control group used a compression garment. Scar width, hypertrophy, and Vancouver Scar Scale (VSS) scores were compared between the two groups. Results: There were no significant differences between the two groups in terms of gender, age, disease course, lesion area, and lesion site (P > 0.05). The overall effective rate in the observation group was 95.00%, significantly higher than the 65.00% in the control group, with a statistically significant difference (P < 0.05). After a 6-month follow-up, all VSS indicators (except for pliability) in the observation group (using the chest compression device) were significantly lower than those in the control group (P < 0.05). Conclusion: Compared to the traditional compression garment, the chest compression device for scar prevention is more effective in preventing scar hypertrophy after chest wall keloid excision and improving the appearance of scars. It is worth promoting for clinical application.

CO2 laser treatment for scars after cleft lip surgery: a systematic review and meta-analysis

BackgroundCurrent studies are controversial on the optimal treatment of postoperative scar treatment by cleft lip. Our objective is to elucidate the therapeutic effect of CO2 laser on postoperative cleft lip scar treatment.MethodsA systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched five electronic databases (EMBASE, PubMed, Web of Science, Cochrane Library and CNKI, from their inceptions until August 8, 2023) and independently assessed the methodological quality and bias risk of the included studies by two investigators using the Cochrane Handbook for Systematic Reviews. Quality assessment of the certainty of evidence was performed based on the Grading of Recommendations Assessment, Development, and Evaluation guidelines. Weighted mean difference of Vancouver Scar Scale were calculated to conduct meta-analysis by Stata statistical software version 14. We also estimated the pool sensitivity as well as testing the possibility of publication bias.ResultsFive studies were included in this meta-analysis involving 255 subjects. Meta-analysis showed that compared with the control group, CO2 laser was more effective in treating post-cleft lip scars (WMD = 4.39, 95%CI = 0.54–8.23; Five studies with 255 participants; Low evidentiary certainty, I2 = 99.4%).ConclusionsPatients treated with CO2 laser therapy for postoperative cleft lip scar treatment tend to have a significant therapeutic effect especially in the early stages.Trial registrationidentifier CRD42023397042 (18/02/2023) [https://www.crd.york.ac.uk/prospero/].

CO2 Laser Versus Surgical Deroofing for the Treatment of Hidradenitis Suppurativa Tunnels: A Comparative Multicentric, Retrospective Study.

Tunnels of hidradenitis suppurativa (HS) are one of the most challenging aspects to manage, and different surgical techniques have been proposed for their treatment. CO2 laser and surgical deroofing are 2 of the most widely used techniques, but no studies have compared them directly. The objective of this study was to compare the efficacy and outcomes of CO2 laser treatment versus surgical deroofing for HS tunnels, with a focus on healing time, complication rates, pain perception, and cosmetic outcomes. The authors performed a multicentric retrospective analysis of 20 patients with HS tunnels who were treated with either CO2 laser (n = 10) or surgical deroofing (n = 10). The primary end point was to compare the 2 procedures in terms of healing time, complication rates, pain, and cosmetic outcome. Outcome measures included Visual Analog Scale for pain, the Vancouver Scar Scale for scar evaluation, and the relapse rate at 6 months. Secondary end point included the identification of variables associated with the healing time. The mean time to healing was 4.7 ± 1.9 weeks in the CO2 laser group and 10.9 ± 4.1 weeks in the surgical deroofing group (p < .01). Pain score at the first dressing change was lower in the CO2 laser group, with a mean Visual Analog Scale score of 1.7 ± 0.8 in the CO2 laser group and 4.9 ± 1.7 in the surgical deroofing group (p < .01). The mean scar evaluation score using the Vancouver Scar Scale at 6-month follow-up was 2.5 ± 1.3 in the CO2 laser group and 3.4 ± 1.1 in the surgical deroofing group. The number of postprocedural complications was low in both groups (1 in the CO2 laser group and 3 in the surgical deroofing group). The proportion of patients achieving complete healing of the tunnels at 6 months was similar among the CO2 laser and the surgical deroofing group (90% in the CO2 laser group vs 80% in the surgical group). CO2 laser is a safe and effective treatment for HS tunnels, with fast healing rates and low pain perception.

Effect of different degrees of wound eversion sutures on scar formation at donor site of anterolateral thigh flaps: A prospective randomized controlled study

To investigate the effect of different degrees of wound eversion on scar formation at the donor site of anterolateral thigh flaps by a prospective clinical randomized controlled study. According to the degree of wound eversion, the clinical trial was designed with groups of non-eversion (group A), eversion of 0.5 cm (group B), and eversion of 1.0 cm (group C). Patients who underwent anterolateral femoral flap transplantation between September 2021 and March 2023 were collected as study subjects, and a total of 36 patients were included according to the selection criteria. After resected the anterolateral thigh flaps during operation, the wound at donor site of each patient was divided into two equal incisions, and the random number table method was used to group them ( n=24) and perform corresponding treatments. Thirty of these patients completed follow-up and were included in the final study (group A n=18, group B n=23, and group C n=29). There were 26 males and 4 females with a median age of 53 years (range, 35-62 years). The body mass index was 17.88-29.18 kg/m 2 (mean, 23.09 kg/m 2). There was no significant difference in the age and body mass index between groups ( P>0.05). The incision healing and scar quality of three groups were compared, as well as the Patient and Observer Scar Assessment Scale (POSAS) score [including the observer component of the POSAS (OSAS) and the patient component of the POSAS (PSAS)], Vancouver Scar Scale (VSS) score, scar width, and patient satisfaction score [visual analogue scale (VAS) score]. In group C, 1 case had poor healing of the incision after operation, which healed after debridement and dressing change; 1 case had incision necrosis at 3 months after operation, which healed by second intention after active dressing change and suturing again. The other incisions in all groups healed by first intention. At 6 months after operation, the PSAS, OSAS, and patient satisfaction scores were the lowest in group B, followed by group A, and the highest in group C. The differences between the groups were significant ( P<0.05). There was no significant difference between the groups in the VSS scores and scar widths ( P>0.05). Moderate everted closure may reduce the formation of hypertrophic scars at the incision site of the anterior lateral thigh flap to a certain extent.

Factors Affecting Appearance after Thumb Polydactyly Reconstruction - A Caregiver's Perspective in an Asian Population.

Background: Current research on thumb polydactyly reconstruction focusses primarily on clinical evaluations. Details on aesthetic outcomes are relatively lacking. This study aims to address this gap by: (1) investigating the effectiveness of surgical treatment in achieving symmetrical thumb size, length and girth; (2) assessing aesthetic outcomes from a caregiver's perspective and (3) identifying key factors that influence aesthetic outcomes to inform strategies to improve surgical reconstruction. Methods: Patients who underwent thumb polydactyly reconstruction were recalled for assessment. Objective measurements of both the reconstructed and unaffected thumbs were taken. Surgical scars were evaluated by measuring their length and using the Vancouver Scar Scale (VSS). To assess the appearance of the reconstructed thumbs, we used the Visual Analogue Scale (VAS) through surveys completed by the primary caregiver of each patient. Caregivers also provided reasons for any unsatisfactory appearance outcomes and we correlated these with objective factors. Results: This study included 26 paediatric patients with 29 reconstructed thumbs. The mean VAS score for overall thumb appearance was 7.8 ± 2.2. While surgical treatment achieved symmetry in most anthropometric measures, reconstructed thumbs had smaller nail plates and greater joint angulation. Caregiver assessment of thumb width was closely related to the objective interphalangeal joint (IPJ) girth measurements, and perceived excessive angulation was related to the IPJ angle. Symmetry was not associated with nail fold width or scar location. However, perceived scar prominence was linked to VSS score and scar location. Conclusions: Thumb polydactyly reconstruction achieves symmetry in size, length and girth, but nail plate size and joint angulation remain significant challenges. Despite this, caregivers are generally satisfied with the overall appearance. Attention should be focussed on improving thumb IPJ girth, IPJ angulation and scar location to enhance overall aesthetic outcomes. Level of Evidence: Level IV (Therapeutic).

Efficacy and safety of sequential treatment with botulinum toxin type A, fractional CO2 laser, and topical growth factor for hypertrophic scar management: a retrospective analysis

Hypertrophic scars arise from aberrant wound healing and can lead to functional and aesthetic impairments. One of the common interventions for treating hypertrophic scars is fractional carbon dioxide (CO2) laser, which employs narrow laser beams to stimulate dermal collagen deposition. Recent studies and reports have suggested that combining laser therapy with other interventions such as botulinum toxin type A (BTX-A) and topical growth factors may enhance treatment outcomes. Here, we examine the efficacy and safety of a sequential combination of BTX-A, fractional CO2 laser, and topical growth factors, referred to as combined therapy, for treating hypertrophic scars compared with only using fractional CO2 laser and topical growth factors, referred to as monotherapy. Our retrospective study includes 128 patients with hypertrophic scars (56 underwent monotherapy and 72 underwent combined therapy), which were followed-up for up to 15 months after the initiation of treatment to collect demographic and clinical data. Our analysis showed that the combined therapy significantly outperformed monotherapy in improving Vancouver scar scale scores (P < 0.05) and in the reduction of scar thickness (P < 0.05), without increasing adverse complications. Repeated treatments further augmented the efficacy of the combined therapy. Subgroup analysis revealed that combined therapy was notably more effective in reducing Vancouver scar scale scores and scar thickness in early-stage scars compared to late-stage (P = 0.023 and P = 0.045, respectively). Our study suggests that including BTX-A treatment before fractional CO2 laser and topical growth factors offers superior efficacy in reducing hypertrophic scars. We encourage early intervention and repeated treatments for optimal treatment outcomes.

Comparative Study of Complications and Incision Esthetic Satisfaction Between Single-Port Laparoscopy and Traditional Laparoscopy in Benign Gynecological Surgery

Objective Single-port laparoscopic surgery (SPLS) is an effective, minimally invasive, feasible, and promising surgical technique for the treatment of various benign and malignant gynecological diseases. This study aimed to evaluate the differences in surgical conditions, complications, and esthetic incisions between SPLS and traditional laparoscopic surgery (TLS) in benign gynecological surgeries. Methods Fifty-one eligible patients were included, and their general information (age, surgical approach), surgical conditions (surgical time, blood loss, postoperative first flatus), postoperative pain, and incision healing were collected. Results There was a significant difference in the results of hysterectomy between the two groups. The surgical time in the SPLS group was significantly shorter than that in the TLS group (p = 0.026). Furthermore, the SPLS group had less blood loss (p < 0.05) and earlier postoperative first flatus (p < 0.05) than the control group. There was no significant difference in postoperative conditions between the two groups. During the follow-up, it was found that the Vancouver Scar Scale score was 8.37 ± 2.30 in the control group and 6.81 ± 2.14 in the study group. The cosmetic effect and satisfaction were better in the SPLS group (p = 0.018). Subgroup analysis showed that in other benign gynecological diseases without uterine lesions, SPLS significantly improved surgical time, intraoperative blood loss, and postoperative first flatus (p < 0.05). Conclusion SPLS demonstrated good clinical efficacy in benign gynecological surgery, with shorter surgical time, less blood loss, earlier postoperative first flatus, fewer complications, and better cosmetic effects of scars.

Syndactyly release with full-thickness skin graft harvested from the wrist: About 24 webspaces

The management of congenital syndactylies often requires the use of a full-thickness skin graft to reconstruct the affected web space. Traditionnally, full-thickness skin grafts are harvested from the groin region, but using the anterior aspect of the wrist may offers benefits in terms of scar quality while simplifying surgical time.This descriptive study evaluates scar quality (at donor and recipient site) associated with full-thickness skin graft harvested from the volar wrist in syndactyly release.We conducted a retrospective single-center study including patients who underwent syndactyly release with full-thickness skin graft harvested from the anterior wrist. Scar assessment was performed using the Observer Scar Assesment Scale, the Vancouver Scar Scale and the Withey Score.Overall, our results show high scores for scars at both donor and recipient sites.In conclusion, harvesting full-thickness skin graft from the volar wrist in syndactyly release is a simple and effective option for covering defects on the digits, while producing high-quality scars.

Pulsed dye laser in jellyfish-induced keloids

ABSTRACT Jellyfish stings can cause acute inflammatory skin lesions that may hesitate in keloids. Pulsed dye laser (PDL) represents one of the most effective treatments for newly developed keloids. Aim of this study was to evaluate the efficacy of PDL on newly developed keloids specifically induced by jellyfish stings in pediatric patients.We conducted a retrospective observational study on pediatric patients with newly developed keloids from jellyfish stings, treated in the last two years with 595 nm wavelength PDL with a duration of 0.45–1.5 msec, spot-size 7 mm and fluence 8.5–9.5 J/cm2. PDL therapy was administered for a mean of 7.4 treatment sessions, every 1–3 months. Two expert dermatologists evaluated the vascularity, pigmentation, height, and pliability of keloids, according to the Vancouver Scar Scale (VSS), pre-and-post treatment. A total of 17 patients (7 males, 10 females) were included in the study, mean age of 11 years. Overall, mean pre-treatment global VSS was 11.0 ± 1.50. After treatment, global VSS was 3.88 ± 1.87. At paired t-test, the difference between pre-treatment and post-treatment was highly statistically significant (p < .0001). Commonly, manipulation and therapeutic intervention on jellyfish scars and keloids is feared. The present study supports the use of PDL in keloids secondary to jellyfish stings, though conducted on a limited number of patients.

Comparative Retrospective Analysis of Cross-Finger Flap Outcomes: A Study on Split-Thickness Skin Graft vs. Full-Thickness Skin Graft in Donor Fingers.

Hand injuries, particularly those involving the fingers, are complex and often necessitate meticulous surgical interventions. Cross-finger flaps (CFFs) are a reliable technique for covering finger defects, with the choice of skin graft at the donor site playing a crucial role in the procedure's success. Split-thickness skin grafts (STSGs) and full-thickness skin grafts (FTSGs) are commonly used, each offering distinct advantages and drawbacks. This study compares the functional and aesthetic outcomes of donor fingers covered with STSG versus FTSG in CFF procedures. This retrospective observational study was conducted from January 2020 to 2024. A total of 82 patients who underwent CFF surgery were included, with 41 patients each in Group A (STSG) and Group B (FTSG). The functional and aesthetic outcomes were assessed. Statistical analysis was performed using SPSS version 26.0 (IBM Corp., Armonk, NY), with significance set at p < 0.05. The study revealed that Group B had superior outcomes across all measured parameters. The mean visual analog scale (VAS) score for aesthetic outcomes was significantly higher in Group B (8.5 ± 1.2) compared to Group A (7.0 ± 1.5, p < 0.01). Functional recovery in proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints, measured by range of motion, was also better in Group B compared to Group A (p = 0.002). Sensory recovery was more favorable in Group B, with 85% achieving S3+ or better, compared to 60% in Group A (p < 0.05). Additionally, the graft donor site scar was significantly less noticeable in Group B, with a Vancouver Scar Scale score of 3.5 ± 1.1, compared to 5.0 ± 1.4 in Group A (p < 0.01). FTSG offers superior functional and aesthetic outcomes compared to STSG in this study. The findings suggest that FTSG should be preferred for covering donor fingers. These results provide strong evidence for the use of FTSG in optimizing surgical outcomes and improving patient satisfaction.

Open surgical approach to fractures of the mandibular condyle: surgical technique and associated complications.

This study evaluates anatomical reduction and rigid internal fixation of mandibular condyle fractures using the preauricular retroparotid approach. It also discusses advantages, deficiencies, and associated complications of the technique. This retrospective study reviewed the medical records of a total of 52 mandibular condyle fractures from 42 patients who were treated with open surgery using the preauricular retroparotid approach between January 2019 and January 2024. Preoperative and postoperative assessments included measurements of mouth opening (maximum interincisal distance), vertical mandibular movement, and facial paralysis. Moreover, the Vancouver Scar Scale (VSS) was used to evaluate scar quality at the surgical site. Descriptive statistics were used to summarize patient demographics, preoperative findings, and postoperative outcomes. Anterior open bite was the most common finding, detected in 83% of the patients before surgery. The mean mouth opening of the patients increased significantly from 29 ± 4.94 mm to 37.76 ± 2.12 mm. Vertical mandibular movement exceeding 4 cm was a finding in more than half (52.3%) of the patients. The mean VSS score, indicating scar quality, was 1.64 ± 0.70, suggesting overall good cosmetic outcomes. Plate breakage in two patients was noted as a complication during follow-up. Several surgical techniques have been described for mandibular condyle fractures, each with its own benefits and limitations.

The Efficacy of Botulinum Toxin Type A (BTA) in the Treatment of Hypertrophic Scars and Keloids: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Hypertrophic scars cause significant physical and emotional discomfort. Botulinum toxin type A (BTA) has shown promising outcomes in reducing scar formation. Research suggested its effectiveness in managing hypertrophic scars and keloids. This systematic review and meta-analysis were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including randomized controlled trials (RCTs). The included studies involved patients with hypertrophic scars treated with BTA. Five databases were searched from inception to August 2024. Studies were screened and selected by two independent reviewers.Data on study design, patient demographics, and interventions was extracted. The risk of bias (ROB) was assessed using the ROB revised tool developed by Cochrane (ROB2). Meta-analysis was performed using RevMan Web (The Cochrane Collaboration, London, UK) with a random-effects model due to high heterogeneity, calculating mean differences for the primary and secondary outcomes. Outcomes included VancouverScar Scale (VSS) scores, scar thickness, vascularity, pliability, and pigmentation. The systematic review identified 182 records from five databases. The screening process resulted in seven studies included in the final analysis after assessment for eligibility. The efficacy of BTA in treating hypertrophic scars and keloids was assessed. The meta-analysis showed that BTA significantly improved VSS scores, with a pooled mean difference of -1.69 (P = 0.01). However, BTA did not show a statistically significant effect on reducing scar height/thickness or improving vascularity. Scar pliability was significantly improved by BTA, with a pooled mean difference of -0.76 (P = 0.002), while there was no significant effect on pigmentation. High heterogeneity was observed across the studies. BTA could be used as an effective treatment for the components of hypertrophic scars and keloids, especially regarding their pliability and improving scar quality. However, for functions such as the change in scar height, vascularity, and pigmentation, more research is still required among larger RCTs. Future research should focus on refining the treatment regimens and the mode of action of BTA to the scar tissue.

Efficacy of Hydrogen Sulfide Baths in Complex Burn Rehabilitation: a Single-Center Observational Study

INTRODUCTION. The healing of burn wounds often leads to pathological scars and scar contractures, significantly deteriorating the quality of life for patients who have experienced burn trauma. In comprehensive anti-scar therapy, balneotherapy with sulfide (hydrogen sulfide) waters can be applied alongside primary methods. However, due to a lack of modern information on its effectiveness, this method is not frequently included in rehabilitation programs. AIM. To determine the significance of hydrogen sulfide baths in comprehensive rehabilitation and improve treatment outcomes for patients with hypertrophic post-burn scars. MATERIALS AND METHODS. In the years 2021–2022, 110 patients, including adults and children, participated in an observational study at the Matsesta Balneological Resort (Sochi, Russia) titled “Evaluation of the Effectiveness of Balneotherapy for Post-Burn Scars in Adults and Children”. All patients received a course of 10 hydrogen sulfide irrigations or baths at the Matsesta Balneological Resort. Before the start of the procedure and after completion, scar tissue assessment using the Vancouver Scar Scale and patient surveys were conducted by a physiotherapist. RESULTS AND DISCUSSION. Among the patients, there were 40 adults and 60 children. The age of patients ranged from 2 to 61 years, with an average of 19.8 years; 49 were male, and 51 were female. The burn area in patients ranged from 5 to 90 % (average 33.1 %) of the body surface. After the first course of sulfide irrigations, the scar tissue assessment on the Vancouver Scar Scale decreased by 2.1 points in children and 2.2 points in adults. After a repeat course of sulfide irrigations, scar tissue assessment decreased by 1.3 points in children and 1.8 points in adults. According to surveys based on the Dermatology Life Quality Index, before treatment, patients subjectively rated their condition on average at 3.45 points, and after treatment, at an average of 2.76 points. The decrease in scores was mainly due to the reduction or disappearance of symptoms such as dryness, burning, pain, and paresthesia in the scar. CONCLUSION. Balneotherapy with sulfide waters for patients with hypertrophic post-burn scars within the first 24 months after burn trauma is effective for both children and adults.

Efficacy of Nd:YAG Laser and Intralesional Triamcinolone Injection Combination Therapy in the Postoperative Management of Keloids.

Keloids, characterized by protruding scars that extend beyond the original skin damage site, cause significant emotional stress and reduced quality of life. Their exact pathogenesis remains unclear, with various hypotheses including growth factor imbalances and extracellular matrix changes. No single treatment is universally accepted, but multiple modalities like triamcinolone acetonide injection (TAC), laser therapies, and surgery are commonly used. This retrospective study involved East Asian patients who underwent keloid scar excision between March 2019 and June 2022. Patients were divided into two groups: one receiving only TAC injections and the other a combination of TAC and Nd:YAG laser therapy. The efficacy of treatments was evaluated using the modified Vancouver Scar Scale (mVSS) and the Patient and Observer Scar Assessment Scale (POSAS), with follow-ups at six and twelve months after operation. The study involved 111 patients. Both treatment groups showed significant improvements in mVSS and POSAS scores, but the combination therapy group demonstrated a statistically significant improvement in POSAS scores and lower recurrence rates at 12months compared to the TAC-only group. However, there was no significant difference in patient satisfaction between the groups. Dual therapy involving TAC injection and Nd:YAG laser treatment was more effective than TAC injection alone for managing keloid scars after surgery. This combination therapy showed better outcomes in preventing keloid recurrence and improving scar status at 12months after operation, along with significant improvements in patient-reported outcomes. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The Effect of Adding Stromal Vascular Fraction (SVF) to Hydrocolloid Dressing to Enhance Healing of Donor Sites of Split Thickness Skin Grafts

Abstract Background Wound healing is complex process, which requires suitable environment to enhance the healing process. With the advancement in technology, many new wound dressings have been introduced for use on split-thickness skin graft donor sites to treat different types of wounds by targeting various aspects of healing process. An ideal donor site wound dressing can reduce pain, lower the risk of infection, encourage hemostasis, and accelerate the healing process. This dressing would also be simple to manage, simple to apply in the operating room, and affordable. The use of hydrocolloid dressing to promote healing of donor site of STSG is a well-established technique. Aim of the Work The main aim of this study was to evaluate the effect of adding Stromal Vascular Fraction (SVF) to Hydrocolloid Dressing to enhance reepithelization and quality of scars of donor Sites of Split Thickness Skin grafts. Patients and Methods Twenty-seven post burn and post traumatic patients admitted to plastic, burn and maxillofacial department in Ain Shams University hospitals which need coverage with STSG were included in this study. A prospective comparative interventional self-controlled clinical study was conducted on donor sites of STSG, In which donor sites of STSG were divided into two equal halves where the upper half was injected intradermally with SVF with application of hydrocolloid dressing (group A), and the other half was covered with hydrocolloid dressing only (group B).follow up of reepithelization at donor sites were evaluated at day 10th, 15th, 21th and 1 month post harvesting of STSG also Vancouver scar scale was used to assess the quality of the scar after 1 month. Results The result showed that among the studied population 51.9% were males and 48.2% were females with mean age of the study population was 33.37 ± 9.55 years ranged from 18 to 52 years. 85.2% of patients had burn raw areas, while only 14.8% had post-traumatic raw areas. The comparison between (group A) and (group B) according to time for reepithelization by days, we found that (group B) needed more time for healing by (18.56 ± 4.69) compared to (group A) which need (11.33 ± 1.92) days and this difference was statistically significant as p-Value &amp;lt;0.05. Also using Vancouver scar scale to assess the quality of scar, there was statistically significant difference between both (group A) and (group B) as (p-value = &amp;lt;0.001). Among study cases, there were only two cases (7.41%) where complicated by superficial infection, which settled in both halves of each case, was improved on repeated dressing. Conclusion The intradermal injection of SVF in donor site resulted in significant reduction in healing time, increased epithelium thickness and a significant improvement in scar quality with low rate of infection.

A systematic review of procedural treatments for burn scars in children: Evaluating efficacy, safety, standard protocols, average sessions and tolerability based on clinical studies.

Managing burn scars in children presents significant challenges. This study investigates effective treatment methods for burn scars, focusing on efficacy, safety, standard protocols and tolerability. Major databases such as PubMed, Scopus and Web of Science were thoroughly searched up to August 2024, emphasizing procedural treatments for burn scars in children. Key data collected included participant demographics, sample sizes, intervention methods, follow-up protocols, treatment effectiveness and reported adverse events. A total of 256 children were assessed, with all procedural treatments yielding satisfactory outcomes. Among the various methods, trapeze-flap plasty and percutaneous collagen induction showed improvements in all patients. In the laser treatment group, which included 161 children, the Vancouver Scar Scale (VSS) score reduction ranged from 55.55% to 76.31%, with outcomes rated as good (24.61%) to excellent (60%). Laser treatment using local anaesthesia proved to be well tolerated by children. Our findings indicate that various methods-including trapeze-flap plasty, percutaneous collagen induction, phototherapy and fractional CO2 laser-demonstrate a relatively good response and an acceptable safety profile. Notably, light-based therapies/lasers may serve as safe, effective and tolerable options for scar treatment in this age group, often eliminating the need for general anaesthesia.

Immediately Injections of Botulinum Toxin A After Surgical Excision for Ear Keloids: A Retrospective Study.

Ear keloids are pathologic scar hyperplasia in the ear region. The most therapeutic approach was surgical shave excision with radiation therapy. However, radiation therapy is easily delivered to healthy surrounding tissues. In the last years, injections with botulinum toxin type A (BTX-A) have been proven to improve surgical scars effectively in clinical trials. This study aimed to evaluate the effect of immediate injections of BTX-A after surgical excision for ear keloids. From January 2020 to January 2023, 33 consecutive patients with ear keloids were enrolled. All patients underwent scar excision and revision at the same time when they needed BTX-A. It was injected into surgical wound closure immediately after surgery. The results of this study were evaluated at follow-up from 7 to 18 months using the Vancouver Scar Scale (VSS) and the Visual Analogue Scale (VAS). From January 2020 to January 2023, 33 patients received concomitant therapy of immediate injections of BTX-A after surgery for ear keloids. The patients were evaluated at follow-ups lasting 7 to 18 months. Only one case recurred within the follow-up period, and no adverse effects were reported. This study demonstrates that significant cosmetic outcomes in ear keloid treatment were achieved after early postsurgical BTX-A injections. The patients reported high satisfaction and few complications.

Evaluation of the efficacy, safety and satisfaction rates of platelet-rich plasma, non-cross-linked hyaluronic acid and the combination of platelet-rich plasma and non-cross-linked hyaluronic acid in patients with burn scars treated with fractional CO2 laser: A randomized controlled clinical trial.

Skin scarring can result from burns, injuries, stretch marks and acne, leading to cosmetic and functional difficulties. Treatments for burn scars encompass a range of options, such as lasers, corticosteroid injections, surgery and regenerative techniques such as platelet-rich plasma (PRP). Hyaluronic acid-based products offer skin hydration and shield against aging effects. A study is being conducted to evaluate how effective PRP injection, hyaluronic acid and their combination improve burn scars and their effects on quality of life and potential disabilities. In our study, PRP and non-cross-linked hyaluronic acid treatments were compared in 10 individuals with burn scars between 2022 and 2023. Patients received CO2 fractional laser treatment followed by injections in scar areas. Evaluations included the Vancouver scar scale (VSS), biometric assessments, ultrasounds and satisfaction ratings. Two therapy sessions were conducted at 1-month interval, and assessments were done before treatment, 1 month after the first session, and 3 months after the first session. Biometric assessments showed significant improvements in various parameters (tewametry, corneometry, erythema index, melanin index, cutometry, thickness and density) in the intervention groups compared to the placebo group (p <0.05). PRP-non-cross-linked hyaluronic acid, PRP and non-cross-linked hyaluronic acid treatments exhibited the best clinical responses with significant differences between groups (p <0.05). Dermal thickness did not show significant improvement during treatment sessions, and changes among subjects were not significantly different. The colorimetry parameter improved in all groups except the placebo group, with no significant difference between intervention groups. The VSS significantly decreased in all treatment groups except the placebo group. PRP, non-cross-linked hyaluronic acid and especially the combination of these two treatment options are very effective in treating burn scars.

Individualized surgical treatment using decellularized fish skin transplantation after enzymatic debridement: A two years retrospective analysis

Over the past few years, treatment of burn injuries has evolved beyond primary surgical therapy with the development of enzymatic debridement and new types of skin replacement materials by providing complex personalized therapy concepts aimed at preserving and replacing the dermal layer of the skin.The aim of our study was to develop an individualized treatment algorithm for mixed depth burn wound and evaluate the outcomes of individualized combined treatment of mixed depth burn wounds with enzymatic debridement and decellularized fish skin.A total of 18 patients with a mean age of 34.8 years and mean follow-up of 447.6 days were included. The mean total burn surface area was 12.3%. All patients received enzymatic debridement and an average area of 247.2 cm2 of decellularized fish skin. Days until complete epithelization were 49.4 ± 25.79 days. No patient developed scar contracture or keloid. The Patient and Observer Scar Assessment Scale (POSAS) observer scale showed an overall impression average of 2.2 ± 0.83. The POSAS patient scale showed an overall impression average 2 ± 0.7. The Vancouver Scar Scale showed an average score of 1.89 ± 1.45. In conclusion, combined treatment using enzymatic debridement and decellularized fish skin, polylactide membrane, or split skin grafts allows for a more individualized therapy for mixed depth burn wounds. Fish skin was found to provide a satisfying result in terms of the overall outcome of the developed scar tissue and could lead to a reduction in the area that requires autologous transplantation.