Vancouver Scar Score Research Articles

Versatility of Islanded Nasolabial Flap Based on Facial Artery and Vein for Reconstruction of Oral Cancer Defects, Experience in a Tertiary Care Center.

Conventional nasolabial flap has been widely used for reconstruction for head and neck defects. Recent decades witnessed modification of this flap like islanded version based on subcutaneous pedicle or facial artery and vein. The later modification obviated a need for pedicle division, secondary procedures and facilitates reach of the flap to distant sites. Especially, the islanded nasolabial flap pedicled on facial artery and vein can have a long pedicle to conveniently reach the tongue, floor of mouth when the flap is routed through retromandibular area. A retrospective analysis was done on 14 patients analyzing the functional outcome like deglutition, speech, and aesthetic outcome of flap donor area, recruiting patients in which islanded nasolabial flap was done based on facial vessels for early stages of cancer tongue and lip. In our series of 14 operated cases, all flaps survived. All the flaps were islanded over the skeletonized facial artery and vein. Tip necrosis occurred in one case. The donor site was closed primarily in all cases. The average speech scoring was grade five, Vancouver scar score of the flap donor area was 2.5 and intelligible speech was difficult in only three cases in follow up. We found this flap useful for reconstruction of small to moderate size defects of oral malignancy following excision with acceptable aesthetic and functional outcome in most of the patients.

Airway Management in Pan Facial Fracture: An Outcome Analysis of Elective Tracheostomy and Submental Endotracheal Intubation

Background and Aims. Pan facial fractures are complex and often requiring complex airway management. Elective tracheostomy (ET) and submental endotracheal intubation (SEI) are the two major techniques for airway management. The aim of this article is to compare the management outcome between these techniques. Methods. This study was done in a tertiary care hospital from Jan 2019 to Dec 2019. Data were retrieved for all patients from hospital admission-discharge reports, operation room records, follow-up notes, and clinical photograph records which was recorded prospectively after ethical clearance. Total 38 patients were included in the study after the exclusion criteria into two groups: submental endotracheal intubation (SEI) and elective tracheostomy (ET). Demographic data, intraoperative time (IOT), length of hospital stay (LOHS), postoperative pain score at three and seven days, and Vancouver Scar Score (VSS) at 4 and 12 weeks was compared between the two groups. Results. SEI consisted of 23 patients (60%) while ET had 15 (40%) patients. The mean age was 32.77±8.24 years in the SEI and 29.36±7.32 years in the ET. The IOT in SEI was 15.36±1.53 min and 24.60±1.40 min in the ET which was statistically significant (p = 0.00001). The LOHS was 11±3.87 days in SEI and 25.2±3.88 days in ET (p = 0.0001). The mean VSS at 4 and 12 weeks for SEI were moderate and mild respectively and for the ET was moderate and mild respectively. Both were statistically significant with a p = 0.003 and p = 0.006. Conclusion. Submental intubation is a safe airway management technique in pan facial fracture. It provides the surgeon with an excellent operative field for achieving the proper dental occlusion. Both short- and long-term outcomes are better compared to the alternative airway method of elective tracheostomy.

Autologous nanofat harvested from donor site of full-thickness skin or skin flap grafting for the treatment of early postburn scarring: a case series.

Postburn scarring often presents a specific reconstructive challenge from both functional and cosmetic perspectives. The purpose of this study was to investigate whether autologous nanofat harvested from the donor site of full skin or a skin flap can be reused for the treatment of early postburn scaring. From July 2018 to April 2022, patients with early postburn scarring underwent scar reconstruction surgery with full-thickness skin or a skin flap for a contour deformity and/or scar contracture, and autologous nanofat grafting was performed during the same operation. The Vancouver Scar Score (VSS) and the itch and pain scores were evaluated at the preoperation time point as well as at 2-3 weeks and 3-months postoperation. A comparison was made among the same patients at different time points. A total of 17 patients, aged from 18 months to 62 years old were included in this analysis. The VSS was reduced from 10.00 ± 2.12 to 7.41 ± 1.277 at the 2-3-week postoperation time point, and to 5.53 ± 1.37 at the 3-month postoperation time point. The pain and itch score were reduced from 4.65 ± 1.37 and 6.35 ± 1.27, to 3.70 ± 1.10 and 4.94 ± 1.30 at the 2-3-week postoperation time point, and to 3.00 ± 1.28 and 3.94 ± 0.97 at the 3-month postoperation time point respectively. The VSS and pain and itch scores showed a statistically significant reduction (P < 0.05) at the 2-3-week and 3-month postoperative follow-ups compared with the preoperation time point. Autologous nanofat grafting from donor sites of full thickness skin or skin flap may be a promising treatment for an early postburn scaring as it promotes scar softening, improves itching and pain within the scar. However, this is a small case series with only 17 patients. Further conclusions need to be drawn through expanded samples for randomized controlled clinical trials. Hypertrophic scarring is the most common complication after partial thickness burn injury, and the complex pathogenesis and prolonged dynamic process render treatments only marginally effective. In the past few decades, with the technological advances of liposuction and fat grafting, nanofat grafting has been used in a variety of surgical fields, including wound healing, scleroderma, facial rejuvenation, and neuralgia. However, the role of nanofat grafting is not well documented in the prevention and treatment of early postburn scarring. Full-thickness skin grafting or skin flap transplantation is the most common method for the reconstruction of a hypertrophic scaring until now. In the current study, we harvested subcutaneous fat during the preparation of the full-thickness skin or skin flap, prepared nanofat and injected it in the scar located at a nonsurgical site. Comparison of the pre- and postoperation scores for scar color, scar thickness, scar stiffness, and scar regularity showed that the postoperation scores were decreased significantly and that there was a significant improvement in scar pigmentation and thickness as well astheaesthetic outcome after treatment. Most importantly, reductions in the scores for pain and itching could be assessed objectively. It seems that the nanofat grafting is a potential method for prevention and treatment for early postburn scaring.

A comparative study of the efficacy and safety of pure silica gel and chitosan quaternary ammonium salt silica gel in hypertrophic scar treatment

Purpose: To compare clinical efficacy of pure silica gel and chitosan quaternary ammonium salt silica gel (SQASC) in treatment of hypertrophic scars.Methods: Eighty-four patients with hypertrophic scars, who were admitted to hospital, were randomly divided into study group and control group with 42 patients in each group. Study group was treated with SQASC while control group was treated with pure silica gel. Scar scores (Vancouver scar score, VSS), scar aesthetics (Patient and observer scar assessment scale, POSAS), symptom improvement and adverse reactions were compared between groups before and after treatment.Results: Before treatment, there were no differences in VSS and POSAS scores for each aspect between groups. After treatment, VSS and POSAS scores for each aspect in study group were significantly lower than those in control group (p &lt; 0.05). Congestion, itching, pain disappearance and thickness reduction occurred significantly earlier in study group than in control group (p &lt; 0.05). Incidence of adverse reactions in study group was 4.76 %, which was significantly lower than 19.05% in control group (p &lt; 0.05).Conclusion: Compared with pure silica gel, SQASC effectively alleviates symptoms of hypertrophic scars and aesthetics with fewer adverse effects. In future studies, sample size will be increased and study duration will be extended appropriately.

Simplified and modified Limberg flap plus vacuum-assisted closure for treatment of sacrococcygeal pilonidal sinus disease.

Pilonidal sinus disease (PSD), a chronic inflammatory disease, affects the sacrococcygeal soft tissue, especially in young adults. The ideal treatment for PSD remains divergence. This study evaluated the application of a simplified modified Limberg flap combined with vacuum-assisted closure for treating PSD. This prospective study was conducted from 1 June 2017 to 31 March 2022 in Changhai Hospital, Naval Military Medical University, Shanghai, China. The study included 88 male patients (91.7%) and 8 female patients (8.3%). The 96 patients ranged in age from 15 to 34 years (mean ± SD, 23 ± 4.4). Under general anaesthesia, all patients underwent simplified modified Limberg flap reconstruction with vacuum-assisted closure. The patient's weight, surgical time, extubation time, hospital stay, time to return to normal life or work, wound infection, wound dehiscence and recurrence rate were recorded. The visual analogue scale (VAS) score and the Vancouver scar score were used to score patients' pain and scars in the surgical area. The volume of resected diseased tissue was 13.5-120 (mean ± SD, 34.993 ± 24.406) cm2 . The average surgical time during the treatment period was 97.68 ± 18.72 min, and the average extubation time was (6.36 ± 1.55) days, the mean hospital stay was 19.4 days; no patients were lost to follow-up. None of the patients experienced post-operative recurrence, wound infection, seroma or hematoma. Six patients (6.3%) experienced wound dehiscence at the flap tip around the natal cleft. The mean time to the resumption of daily activities was 26.3 days. The average VAS pain score was (6.00 ± 1.53) points, and the average Vancouver scar score was (5.96 ± 1.51) points, 12 patients (12.5%) were dissatisfied with their aesthetic results, and the average beauty satisfaction score is (6.64 ± 1.28) points. Simplified modified Limberg flap reconstruction with vacuum-assisted closure surgery is an effective and innovative method for the treatment of PSD, with a low recurrence rate and rapid recovery.

Lipofilling-A Regenerative Alternate for Remodeling Burn Scars: A Clinico-Immunohistopathological Study.

Introduction Any injury involving the dermis will lead to scarring. Scar tissue can cause functional limitations, cosmetic impairments, pain, and itch. Adipose-derived stem cells have also been shown to play a role in scar modulation. This study evaluates changes in lipofilled scar over the period of time and compares it with non-lipofilled scar tissue. Materials and Methods A prospective case-control study with intraindividual follow-up was performed on 30 adult patients with post-burn scars from November 2016 to May 2019. Clinical, histopathological, and immunohistochemical parameters were assessed among the case and control regions of the scar. Results Mean age of the study population was 30.6 years. The duration of the scar included in this study ranged from 1 to 28 years, with a mean duration of 5.91 years. There was a significant reduction in pain, itch, stiffness, and an increase in the pliability of the scar, and a substantial improvement in the modified Vancouver Scar Score in the lipofilled group. In histopathological analysis, the case group showed organized parallel collagen fibers, a significant reduction in melanocytes, improvement in vascularity, and a significantly increased amount of collagen fibers at the reticular dermis. Immunohistochemical analysis indicated new cell synthesis in the scar tissue and reduced melanocytes. Conclusion The remodeling effect of adipocyte-derived stem cells is long-lasting, and there is a gradual improvement in most of the parameters. Lipofilling has regenerative capacity, which leads to the improved overall appearance of scar and improvement at the cellular level.

Clinical efficacy and inflammatory reaction of submental endoscopic thyroidectomy versus conventional thyroidectomy: A prospective randomized study

ObjectivesThis prospective study aimed to explore the clinical efficacy and inflammatory reaction of submental endoscopic thyroidectomy versus conventional thyroidectomy. MethodsWe prospectively recruited 45 patients (total 90 patients) who met the eligibility criteria to undergo conventional open thyroidectomy or submental endoscopic thyroidectomy from January 2021 to July 2022 in the Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine. These patients were evaluated using the following indices: number of lymph nodes dissected, complications, pain severity, inflammatory indicators, cosmetic satisfaction, and economic cost. All data were analyzed by the t-test or chi-squared test. ResultsNinety patients were enrolled. The two groups did not significantly differ regarding baseline characteristics. All patients who underwent thyroidectomy had a similar trauma index and increased level of inflammation. There were no significant differences between the open thyroidectomy and submental endoscopic thyroidectomy groups in the total number of lymph nodes dissected, number of positive lymph nodes, drainage volume, and complications. The Vancouver scar score and cosmetic satisfaction score were significantly better in the submental endoscopic thyroidectomy group than the open thyroidectomy group. The submental endoscopic thyroidectomy group had a significantly lower pain scores on postoperative days 1 and 2, less downtime, and cheaper medical and esthetic costs than the open thyroidectomy group. ConclusionCompared with conventional open thyroidectomy, submental endoscopic thyroidectomy did not increase the degree of trauma, had superior clinical efficacy, caused less pain, required a shorter downtime, achieved a better cosmetic effect, and was associated with lower healthcare costs.

Skin Grafting Compared with Conservative Treatment in Patients with Deep Second-Degree Burn Wounds of the Trunk and Buttocks.

BACKGROUNDBurns are among the most common causes of injury and result in long-term morbidity, psychological complications, and reduced quality of life. We aimed to evaluate and compare the results of skin grafting versus nonsurgical treatment in patients with deep second-degree burn wounds of the back and posterior trunk.METHODSThis is a descriptive-analytical cross-sectional study of patients with trunk and buttock burns admitted to Burn Hospital in Shiraz, Iran from 2017 to 2019. The skin surface with burns and the final repaired tissue was measured. The Vancouver Scar Score (VSS) and pigmentation, vascularity, thickness, and pliability were assessed. VSS, pigmentation, vascularity, thickness and pliability were considered as outcomes. RESULTSSeventy-five patients met the criteria for participation; thirty-two patients had skin grafts. The mean age was 27.79±20.03 yr and 53 patients (70.7%) were male. Scars were compared based on pigmentation, vascularity, thickness, and pliability, which was also statistically significant (P<0.001). The mean of VSS was higher in patients with skin graft than those without graft (P<0.001).CONCLUSIONThe mean VSS was significantly higher in patients with grade 2 deep burns who received skin grafting than in patients without skin grafting. Due to the lack of donor sites and the need to prioritize skin grafts in burn patients with high total body surface area, it is better to perform skin grafts on the posterior trunk and buttocks in areas with deep grade 2 burns as a last priority and treat this wound with conservative therapy.

Evaluation of Efficacy of Corticosteroid and Corticosteroid Combined with Botulinum Toxin Type A in the Treatment of Keloid and Hypertrophic Scars: A Meta-Analysis.

Both keloid and hypertrophic scars are common benign skin lesions manifested by hyperplasia of fibroblasts. Clinically, this will not only have physiological effects on patients, but also cause psychological damage. However, there is no unified standard treatment method at present. Intralesional corticosteroid injection alone and corticosteroid combined with botulinum toxin type A has been gradually found to be useful for the treatment of keloid and hypertrophic scars, but the difference in efficacy between the two is controversial. A systematic search was made of the relevant experiments from Web of Science, PubMed, Scopus, Google Scholar, Cochrane Library, and China National Knowledge Infrastructure (CNKI). The scores of Visual Analog Scale (VAS), Vancouver Scar Score sheet (VSS), scar thickness, itching degree and patient satisfaction after the combination of corticosteroid and botulinum toxin type A were superior than those after corticosteroid (P<0.05). Compared with corticosteroid alone, corticosteroid combined with botulinum toxin type A is more effective in the treatment of keloid and hypertrophic scar. Although clinical case studies for the treatment of keloid or hypertrophic scars are limited, it is necessary and helpful to understand the effectiveness of corticosteroid combined with botulinum toxin type A in the treatment of keloid or hypertrophic scars. 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 .

A retrospective study of comparison of collagen dressing versus conventional dressing for skin graft donor site

Background: Split-skin grafting is commonly employed for covering skin defects in case of ulcers, deep burns and following trauma. It involves harvesting of the epidermis and upper 1/3rd of dermis resulting in a wound called donor site wound (DSW). These wounds pose a kind of burden to patients during the process and after the process of wound healing. These wounds tend to cause pain, are at risk of getting infected, pruritis and cosmetic inconvenience. DSW has been managed with closed or open dressings. Out of many methods, we aim to compare the efficacy of collagen dressing with that of conventional dressing in this study.Methods: A retrospective study including 30 subjects were stratified into 2 groups; group A-collagen dressing and group B- conventional dressing. Patients aged between 18 to 60 years undergoing split thickness skin grafting were included. Patients who are immunocompromised, diabetic, with underlying skin disease and infected wounds were excluded. The outcome was compared in terms of pain, pruritis and scar assessment using Vancouver scar scale.Results: In the present study there was significant difference in median pain score, pruritus and median Vancouver scar score in collagen group compared to conventional group at all the intervals. Also, the incidence of surgical site infection was lower in the collagen dressing group.Conclusions: Collagen dressing is superior compared to conventional dressing in terms of lower pain score, pruritus score and Vancouver scar score.

Prediction model of laparoendoscopic single-site surgery in gynecology using machine learning algorithm.

IntroductionMinimally invasive surgery has been widely used in gynecology. The laparoendoscopic single-site surgery (LESS) risk prediction model can provide evidence-based references for preoperative surgical procedure selection.AimTo determine whether the patients are suitable for LESS and to provide guidance for the clinical operation plan, we aimed to compare the clinical outcomes of LESS and conventional laparoscopic surgery (CLS) in gynecology. We constructed a LESS risk prediction model and predicted surgical conditions for the preoperative evaluation system.Material and methodsA retrospective analysis was carried out among patients undergoing LESS (n = 1019) and CLS (n = 1055). Various clinical indicators were compared. Multiple machine model algorithms were evaluated. The optimal results were chosen as the model to form the risk prediction model.ResultsThe LESS group showed advantages in the postoperative 12/24 h visual analog scale and Vancouver scar score compared with the CLS group (p < 0.05). The comparisons in other clinical indicators between the two groups showed that each group had advantages and the difference was statistically significant (p < 0.05), including operative time, estimated blood loss, and hospital stay. We evaluated the predictive value for various models using AUC values of 0.77, 0.77, 0.76, and 0.67 for XGBoost, random forest, GBDT, and logistic regression, respectively. The decision tree model was shown to be the optimal model.ConclusionsLESS can reduce postoperative pain, shorten hospital stay and make scars acceptable. The risk prediction model based on a machine learning algorithm has manifested a high degree of accuracy and can satisfy the doctors’ demand for individualized preoperative evaluation and surgical safety in LESS.

Long Term Outcome After Open Abdomen Treatment: Function and Quality of Life.

Background: Open abdomen treatment (OAT) is widely accepted to manage severe abdominal conditions such as peritonitis and abdominal compartment syndrome but can be associated with high morbidity and mortality. The main risks in OAT are (1) entero-atmospheric fistula (EAF), (2) failure of primary fascial closure, and (3) incisional hernias. In this study, we assessed the long-term functional outcome after OAT to understand which factors impacted most on quality of life (QoL)/daily living activities and the natural course after OAT.Materials and Methods: After a retrospective analysis of 165 consecutive OAT patients over a period of 10 years (2002–2012) with over 65 clinical parameters that had been performed at our center (1), we initiated a prospective structured follow-up approach. All survivors were invited for a clinical follow-up. Forty complete datasets including clinical and social follow-up with SF-36 scores were available for full analysis.Results: The patients were dominantly male (75%) with a median age of 52 years. Primary fascial closure (PC) was achieved in 9/40 (23%), while in 77% a planned ventral hernia (PVH) approach was followed. A total of 3/4 of the PVH patients underwent a secondary-stage abdominal wall reconstruction (SSR), but 2/3 of these reconstructed patients developed recurrent hernias. Fifty-five percent of the patients with PC developed an incisional hernia, while 20% of all patients developed significant scarring (Vancouver Scar Score >8). Scar pain was described by 15% of the patients as “moderate” [Visual Analog Scale (VAS) 4–6] and by 10% as “severe” (VAS > 7). While hernia presence, PC or PVH, and scarring showed no impact on QoL, male sex and especially EAF formation significantly reduced QoL.Discussion: Despite many advantages, OAT was associated with relevant mortality and morbidity, especially in the early era before the implementation of a structured concept at our center. Follow-up revealed that hernia incidence after OAT and secondary reconstruction were high and that 25% of patients qualifying for a secondary reconstruction either did not want surgery or were unfit. Sex and EAF formation impacted significantly on QoL, which was lower than in the general population. With regard to hernia incidence, new strategies such as prophylactic mesh implantation upon fascial closure should be discussed analogous to other major abdominal procedures.

A prospective randomized comparative study of facial scar modulation using topical silicone gel versus coconut oil

Context: Scar following facial trauma is an important problem affecting aesthetics and function. Aim: The aim of the study is to compare the usefulness of topical silicone gel versus coconut oil in facial scar modulation. Design: Prospective randomized comparative study was done between January and December 2016. Subjects and Methods: Seventy-four post-traumatic facial scar patients were randomized into three groups − Group A topical silicone gel only, Group B coconut oil only, and Group C both. Observational data were collected and photographs were taken at 2 weeks, 1 month, 3 months, and 6 months. Vancouver scar score and visual analog scale score were done for observational data. Photographs were analyzed by two independent blind observers at the end of the study. Results: Topical silicone gel gave superior results in reducing vascularity and pliability at 1 month and hyperpigmentation at 3 months. Coconut oil has better antipruritic effects at 1 month as compared topical silicone gel. Conclusions: Topical silicone gel is a superior product for initial management of facial scars compared to coconut oil.

Randomised Control Clinical Trial of Topical Silicone Gel in Post-Lower Segment Caesarean Section Closure scar in Primigravida

Scar following caesarean section surgery is an important aspect affecting aesthetics and function in young ladies. This study was done to compare the effectiveness of scar modulation using topical silicone gel in post-lower segment caesarean section scar in primigravida. Case series analysis was conducted between 01 Jul 2018 and 30 Jun 2019 in a tertiary care centre. Post-lower segment caesarean section scars in 52 primigravida were randomised into 2 groups. Group A used topical silicone gel once daily for 3 min of massage. Group B had normal natural scar maturation without any intervention. Observational data collected and photographs were taken at 2 weeks, 4 weeks and 12 weeks. Vancouver scar score used to assess observed data and result compiled. Topical silicone gel gave superior results in reducing overall scar quality at 1 month and 3 months. Topical silicone gel was a superior product for initial management of caesarean scars.

Efficacy of Botulinum Toxin Type A in Improving Scar Quality and Wound Healing: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Botulinum toxin type A-induced "chemoimmobilization" has long been utilized for improved scar quality and wound healing; however, current evidence is limited to small studies, and evidence-based information is inadequate to make well-informed decisions. The purpose of this study was to evaluate the efficacy of botulinum toxin type A (BTA) to improve scars and wound healing. The authors searched databases, including Pubmed, Embase, and Cochrane Library, to identify randomized clinical trials (RCTs) that compared outcomes of surgical scars and wounds treated with BTA vs those treated with blank or placebo controls. The Visual Analog Scale, Vancouver Scar Score, scar width, and reported patient satisfaction were utilized in evaluating outcomes. Adverse events were also recorded. Eleven RCTs involved a total of 486 cases (374 patients). Quantitative synthesis suggested that compared with the control group, patients in the BTA treatment group had significantly higher Visual Analog Scale scores (mean difference [MD] = 1.30, 95% confidence interval [CI]: 1.05 to 1.55), lower Vancouver Scar Scores (MD = -1.62, 95% CI: -2.49 to -0.75, P = 0.0003), and thinner scars (MD = -0.15, 95% CI: -0.20 to -0.11, P < 0.00001). Patient satisfaction was higher in the BTA group than in the control group (risk ratio: 1.25, 95% CI: 1.06 to 1.49, P = 0.01). Trivial adverse events were reported. This meta-analysis of RCTs provides reliable evidence that BTA injection is superior to placebo or blank control group in improving scar quality and wound healing in the face and neck for Asians, and negative outcomes for BTA treatment in these patients include only trivial adverse events. However, inadequate evidence supports utilization of BTA in Caucasians for primary surgical scars or for scars in locations other than the face and neck. Further studies on the standardized injection regimen and technique of BTA are warranted for clinical practice.

Antera 3D camera: A novel method for evaluating the therapeutic efficacy of fractional CO2 laser for surgical incision scars.

To introduce a novel method for evaluating the therapeutic efficacy of fractional CO2 laser for incision scars. A total of 72 patients after incision healing for at least 2years were included in the series, with scars on neck, thyroid, chest, and limb from September 2013 to September 2016. The image of scar was taken by Antrea 3D camera before the treatment, VSS, and UN4P were also applied for scar evaluation. A total of four sessions at 4-6 intervals were conducted to each patient. After 3months of last session, a final assessment was carried out by Antera 3D and VSS, UN4P independently. The Antera scores for color after 4 sessions were 8.78±2.11, which were significantly lower than the prior treatment (9.62±1.90, t=2.51, P<0.05). The Antera scores for texture after four sessions were 22.80±5.23, which was significantly lower than the prior treatment (30.33±5.41, t=8.48, P<0.05). The Antera scores for melanin levels after four sessions were 0.52±0.05, which was significantly lower than the prior treatment (0.54±0.05, t=2.4, P<0.05). The Antera scores for hemoglobin levels after four sessions were 1.88±0.50, which was significantly lower than the prior treatment (2.11±0.45, t=2.90, P<0.05). The Vancouver Scar scores after four sessions were 7.1±2.0, which showed no statistically significant differences with the prior treatment (7.5±2.4, t=1.09, P=0.25>0.05). The University of North Carolina "4P" Scar scores after four sessions were 6.6±1.5, which also showed no statistically significant differences with the prior treatment (7.0±1.9, t=1.40, P=0.15>0.05). For scar therapeutic evaluation, Antera 3D camera is objective and accurate, and is worthy of wide promotion.

Application of transitional care on prevention of scar hyperplasia after burn

Objective To explore the application effects of transitional care on the prevention of scar hyperplasia after burn. Methods A total of 110 burn patients, who were treated in our hospital from February 2015 to February 2016, were divided into two groups according to the order of admission, 55 cases respectively. Patients in the control group were given regular discharge guidance and follow-up, while patients in the experimental group were given additional transitional care. The treatment compliance and the score of Vancouver Scale were compared between the two groups at six months after discharge. Results At six months post discharge, the proportions of patients who were prescribed medication, adhered to stress treatment, rehabilitation exercise, and on-time referral in the experimental group were 80.39%, 74.51%, 76.47% and 84.31% respectively, all of which were significantly higher than those in the control group (χ2=9.607, 7.985, 10.471, 11.411, P<0.05) . At six months after discharge, the Vancouver scar scores were (6.03±1.98) in the experimental group and (7.56±2.03) in the control group, with statistically significant differences between the two groups (t=-3.815, P<0.05) . Conclusions Transitional care can improve the treatment compliance of burn patients and reduce the degree of scar hyperplasia. Key words: Burn's; Cicatrix; Transitional care; Treatment compliance

Evaluation of the Efficacy of Ablative vs. Fractional Er:YAG Laser Modes as a Treatment of Post-Burn Scars

Aim: To determine the effect of Er:YAG laser in the management of post-burn scars and to compare its effect to ablative and fractional lasers.Patients and methods: 50 patients with post-burn scars were recruited and randomly divided into 2 groups: Group I patients had ablative Er:YAG laser mode therapy and Group II patients had fractional Er:YAG laser rmode therapy. Vancouver scar score (VSS) was recorded for each group pre- and postoperatively, both groups showed an increase in the VSS and histopathological findings.Results: The obtained results showed morphological changes immediately after treatment, the skin surface displayed a white-gray frost, which on close inspection revealed a point pattern corresponding to individual laser columns done by fractional laser treatment.Conclusion: Ablative and fractional modes of Er:Yag laser can be used for treatment of post-burn hypertrophic scars. Ablative laser mode had better results than fractional laser mode as indicated by clinical assessment, VSS and changes of histopathological findings.

Construction of Skin Graft Seams in Burn Patients: A Prospective Randomized Double-Blinded Study.

Prominent scars and contractures may form along the seams between adjacent skin grafts. Seams may be constructed either by approximating the graft edges (AP), or by slightly overlapping the graft edges (OV), but it is not known if one technique creates a less conspicuous seam scar. The purpose of this study was to compare seam scars between seams constructed using the AP and OV techniques. This was a prospective within-patient and within-seam controlled study in adult burn patients treated at an American Burn Association-verified burn center. At skin graft application and seam construction, study seams were divided in half. One half of the seam was made by approximating the graft edges (AP group), while the other half was made by overlapping graft edges (OV group), before identical staple or suture fixation of each half. The AP or OV technique was randomly assigned to the medial or lateral ends of transversely oriented seams or to the proximal and distal ends of longitudinally oriented seams. At 3, 6, and 12 months post surgery, a blinded rater compared the two halves of each study seam scar using the Vancouver Scar Score (VSS). Subjects were also blinded and rated each half of their study seam using a 0 (poor) to 10 (excellent) visual analogue scale. Values are shown as the median (Q1-Q3). There were 44 study seams among 19 subjects (age 51 [36-70] years, with % TBSA burn 10 [7-18], % BSA full-thickness burn 8 [6-15]). Study seams were constructed at 10 (4-15) days post burn. Study seam length was 14.5 (10.3-18.0) cm, with 25% transversely oriented and 75% longitudinally oriented, and with 35/44 seams (80%) between meshed grafts and 9/44 (20%) between sheet grafts. There were no significant differences in any of the individual domain VSS scores (height, pliability, vascularity, and pigmentation) or total VSS score between AP and OV seams at 3, 6, and 12 months. At 12 months, among the 30 study seams that were visible to the subjects, the visual analogue scale score for the AP seams was 9 (8.5-10), which did not differ significantly from the OV seams (9.5 [8.45-10], P = .821). Overlapping or approximating adjacent skin grafts at the time of seam construction does not appear to affect final seam scar quality.

Treatment of hypertrophic scars and keloids by fractional carbon dioxide laser: a clinical, histological, and immunohistochemical study.

Treatment of keloids (K) and hypertrophic scars (HTS) is challenging. A few case reports reported good results in HTS treated by fractional CO2 laser. The aim of the present study was the assessment of the clinical response as well as histological changes in K and HTS treated by fractional CO2 laser and the role of matrix metalloproteinase 9 (MMP9) in the response. A randomized half of the scar was treated by fractional CO2 laser in 30 patients (18 K, 12 HTS) for a total of four sessions 6 weeks apart. Vancouver scar score (VSS) was done before and 1, 3, and 6 months after the last laser session by a blinded observer. Biopsies taken from normal skin, untreated scar, and treated scar tissue 1 and 3 months after the laser sessions were stained by HX & E for histological changes and Masson trichrome for collagen fiber arrangement. Immunohistochemical staining for MMP9 was done in before and 1 month after samples. Quantitative morphometric analysis was done for collagen and MMP9 by image analyzer. Nineteen patients completed the 6-month follow-up period (12 K, 7 HTS). VSS score was significantly lower in the treated compared to untreated areas after 3 and 6 months in both K and HTS but was mainly due to improved pliability of the scar. Histologically, dense inflammatory infiltrate and increased vascularity was apparent 1 month after laser sessions and disappeared at 3 months. Thinner better organized collagen bundle could be seen in 3 months after samples. MMP9 was significantly increased in after treatment samples but without significant correlation with VSS. Fractional CO2 resurfacing is safe but affects mainly pliability of K and HTS with collagen remodeling apparent 3 months after therapy. MMP9 may play a role in mechanism of action of CO2 laser in K and HTS.