Visible Scars Research Articles

Asian upper blepharoplasty and dual‐plane epicanthoplasty: An integrated four‐step technique

Double-eyelid blepharoplasty and epicanthoplasty is usually performed concurrently in Asian patients to achieve aesthetically pleasing eye appearance, but the epicanthal area is prone to scarring. This article introduces an integrated four-step technique that enlarges the eyes with minimal scarring risk. One hundred and thirty-five patients who underwent Asian upper blepharoplasty and dual-plane epicanthoplasty between January 2019 and September 2020 were retrospectively reviewed. Palpebral fissure distance (PFD), inner canthal distance (ICD), and vertical height of the palpebral fissure (VHPF) were measured based on photographs taken pre- and postoperatively, with the diameter of the iris as the reference value, D. Patient-reported outcome measures (PROMs) were collected to evaluate patient satisfaction and complications. A total of 129 female and 6 male patients were included. The average follow-up duration was 12.9months. The average increasing ratio of PFD/D was 8.1%, whereas the average shortening ratio of ICD/D was 3.5%. The average VHPF/D increased by 10.6%. Statistical analysis was conducted using a paired t-test which demonstrated statistically significant results. A total of 96 patients responded to our patient-reported outcome measures (PROMs) at 6months postoperatively, with an average patient satisfaction score of 62.9 out of 70 (89.8%). Barely visible scarring for the upper eyelid and the inner canthus were reported by 90.6% and 85.4% of patients, respectively. Three (3.1%) patients were not satisfied with the scar in the medial canthal area 6months after surgery. The integrated four-step blepharoplasty and dual-plane epicanthoplasty is an effective, reliable, and reproducible method with high patient satisfaction and minimal scarring risk.

Simplified Technique for Creating an Umbilicus with Scarless Caudal Aspect and Superior Hooding.

A non-aesthetic post-abdominoplasty umbilicus is known to be a significant concern for many patients who consider this procedure, due to its central and visible location. The goal of this method is to minimize the visible scar and create a natural-looking and aesthetically pleasing umbilicus. In thismultimedia article, we illustrate our technique that is bothreproducible and easy to perform. It produces a scarless caudal aspect, pleasant depth, and natural superior hooding appearance to the post-op umbilicus. Limitations of this technique are discussed.Level of Evidence IV 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 .

Short-Facelift Approach in Temporal Artery Biopsy: Is It Safe?

Giant cell arteritis (GCA) is a quite common panarteritis of the elderly that affects medium- and large-size arteries. Despite the increasing role of imaging with advancing technology, the gold standard for the diagnosis of GCA is still the temporal artery biopsy. A described complication of superficial temporal artery biopsy (STAB), for which incidence is not clear, is the accidental damage of the frontal branch of the facial nerve. In this paper, we described the short-scar facelift surgical approach for STAB on 23 consecutive patients who underwent unilateral superficial temporal artery biopsy for GCA suspicion. We collected data in terms of postoperative complications, biopsy specimen length, biopsy result and cosmetic appearance of the scar. In our experience, this surgical approach combines the advantage of avoiding incisions within the dangerous anatomical area, minimizing the risk of facial nerve damage, with an acceptable complication rate and a good final aesthetic result which avoids visible scarring.

The severity of facial burns, dental caries, periodontal disease, and oral hygiene impact oral health-related quality of life of burns victims in Pakistan: a cross-sectional study

BackgroundA burn to the face and neck area leaves a visible scar that impacts the victims physically and psychologically. This report was aimed to examine the factors associated with oral health-related quality of life (OHRQoL) in patients with a facial burn injury.MethodsPatients with facial burn who attended the Burn Care Centre in Islamabad, Pakistan were systematically and randomly invited to participate in this cross-sectional study. They underwent extra- and intra-oral examinations and, completed self-administered instruments in the Urdu language. The severity of disfigurement, dental caries experience (DMFT), periodontal disease (CPI) and oral hygiene (OHI-S) statuses were assessed. The validated instruments collected information relating to sociodemographic background, oral health behaviours, OHRQoL and satisfaction with appearance (SWAP). Information relating to the time of the incident, cause and severity (type, TBSA) of the burn were obtained from medical records. The OHRQoL prevalence of impact and severity measures were derived and analysed using simple and multiple, logistic and linear regression.ResultsA total of 271 patients had participated in the study. The OHIP-14 prevalence of impact was 94% with mean severity score = 37 unit (sd = 8.5). The most impacted domains were physical pain (87%), psychological disability (87%), social disability (85%) and physical discomfort (83%). The main determinants of oral health-related quality of life were poor clinical oral conditions - particularly caries, and severity deformity. Other risk factors included poor oral health behaviours, psychological distress and longer time elapsed since the incident, and sex (p < 0.05).ConclusionDental caries, the severity of the facial deformity, oral health behaviour and time are associated with oral health-related quality of life of patients with facial burns. Oral health behaviour improvement can lower the risk of developing dental problems and oral health-related quality of life impact.

Scarring Caused by the Percutaneous Approach to Fractures of the Orbit and Orbital Rim.

Percutaneous and transconjunctival approaches are commonly used for fractures of the orbit and orbital rim. However, it leaves visible scarring on the face. Although previous studies reported scarring from the percutaneous approach, few reported the degree of such scarring. The authors examined the degree of scarring associated with percutaneous approaches to fractures of the orbit and orbital rim in the Japanese population. The authors reviewed photographs of patients who were treated surgically for fractures of the orbital floor, medial orbital wall, or zygomatic bone via percutaneous approaches to examine the presence of scarring and deformation. In 36% of all patients, the observers were unable to determine the side on which the surgery was performed. Furthermore, the site of scarring was identified accurately in only 20.6% of the cases in which observers were able to identify the surgical side. The authors' study demonstrated that the subciliary approach left minimal scarring under the eyelashes. On the other hand, the medial canthal approach left depressed and wide scarring, whereas pigmentation was apparent in patients who underwent surgery via the lateral eyebrow approach. Similarly, pigmentation under the eyelashes and at the site of secondary incision was common after the subciliary approach.

Single-Port Laparoscopic Appendectomy Performing by Emergency Operation: An Intervention Study in Vietnam

Background: Appendectomy is one of the most commonly performed surgical procedures of the abdominal area. One of the recent innovations is single-port laparoscopic surgery (SPLS), which can insert multiple ports through a proprietary device with multiple channels. An incision is sited in the umbilicus to result in no visible scar. Objectives: The study aimed to evaluate the results of the treatment of acute appendicitis by applying single-port laparoscopic surgery. Methods: A clinical single-port laparoscopic appendectomy intervention of 122 patients, with the absence of a control group, was carried out by a sole surgeon at the Hue University of Medicine and Pharmacy Hospital, Hue, Vietnam, from August 2013 to December 2017. Research parameters included clinical history, physical examination, laboratory test, ultrasound imaging, intraoperative characteristics, and surgical outcomes. Results: We included 122 patients (64 males and 58 females) who met the inclusion criteria. The mean age was 31.28 ± 13.51 years (range, 16 - 73 years). The average BMI was 20.4 ± 1.39 kg/m2. All patients had abdominal pain, and the average duration of symptoms was 17.39 ± 5.41 hours (range, 6 - 31 hours). Five patients had a history of abdominal surgery. The mean diameter of appendicitis in ultrasound was 8.8 mm (range, 6 - 15 mm). Moreover, 89.3% of patients had an increase in white blood cells. The difficult location of appendicitis was 1.6% under the liver and 20.5% in the retrocecal region. In addition, 18.0% of retroperitoneal appendicitis and 6.6% of appendicitis were under cecalserosa. The mean operative time was 40.19 ± 14.67 mins (range, 23 - 150 min). Two cases (1.6%) required additional trocar insertion. Three cases (2.5%) had wound infection and no other complications. The median hospital stay was 3.64 ± 1.72 days (range, 2 - 13 days). Conclusions: Single-port laparoscopic surgery is the safe and effective treatment of acute appendicitis. This technique may be feasible for acute appendicitis with a difficult location.

Aesthetic Design of Expanded Bilateral Superficial Temporal Vascular Fascial Pedicled Flap for Repairing Maxillocervical Scars.

Large-scale maxillocervical scars impair face and neck function and damage appearance. The forehead expanded bilateral superficial temporal pedicled flap is a good treatment strategy for this area; however, the traditional cutaneous pedicled flap damages the temporal hair area. This impairs aesthetics and causes alopecia; furthermore, requires an additional pedicle-cut operation. A retrospective study was performed on 7 patients with large-scale maxillocervical scars from January 2014 to August 2018. Forehead expanders were implanted in the first-stage operation for all patients. After the injection and rest period, patients were treated using the forehead expanded bilateral superficial temporal vascular fascial pedicled flap. Superficial temporal vascular fascia pedicles were carefully harvested. The use of an intralesional or hidden retrotragus incision was determined by the presence of a preauricular scar. Patient satisfaction with postoperative neck activity and the incision scar was evaluated. Intralesional and retrovagus incisions were used in 4 and 3 cases, respectively. One flap developed hematoma, which recovered completely after conservative treatment; all other cases had no complications. All flaps healed well. The neck mobility of the patients was significantly improved with no visible scar in the temporal region. Six cases reported being "very satisfied" and one was "relatively satisfied" with their improvement in neck mobility. All cases reported being "very satisfied" with frontotemporal morphology. The forehead expanded bilateral superficial temporal vascular fascial pedicled flap is a good choice for patients with large-scale maxillocervical scars. This technique can maintain the aesthetics of temporal hair and reduce patients extra surgical injury.

Transoral thyroid surgery vestibular approach: is there an increased risk of surgical site infections?

Transoral endoscopic thyroidectomy vestibular approach (TOETVA) is an upcoming surgical technique with the aim to optimize cosmetic outcome avoiding visible scars in the neck. However, the transoral access bears the risk of contamination and microbial allocation from the mouth into the thyroid region. Therefore, some authors recommend extended antibiotic therapy up to 7 days after surgery. Our aim was to evaluate infection rates and parameters before and after transoral surgery and to suggest a viable and safe routine in transoral surgery. Prospectively collected data of patients who were eligible for transoral surgery in Austria and Germany between June 2017 and July 2020 were retrospectively evaluated focussing on clinical and laboratory infection signs pre and postoperatively. White blood cell count (WBC) and C-reactive protein levels (CRP) were estimated before and after surgery. Patients` characteristics, surgical outcome and complications were also determined and compared to the current results reported in the literature. 113 transoral operations were performed in 108 patients. In 37 of 108 (36%) patients an additional retroauricular incision in the hairline and in two patients a submental skin incision was performed to extract thyroid specimen of more than 40 ml. Intravenous antibiotic prophylaxis and enoral mucosal disinfection were used in all patients before surgery. WBC and CRP levels were available in 75 patients. Median WBC was 5800/µl (range 3500–10,500/µl) before and significantly higher (median 8900/µl, range 4500–18,800 µl; p < 0.01) at day one after surgery. WBC returned to normal range (4500–11,500/µl) in all patients within the first 7 days postoperatively (median 5300/µl, range 3400–8700/µl). CRP levels were normal before (< 0.5 mg/dl) and slightly elevated within the first two days after surgery (Median 2.0 mg/dl, range 0.5–6.4 mg/dl, n.s.). In one patient oral antibiotic therapy was necessary due to transient erythema in the chin region which occurred 10 days after surgery and resolved completely without surgical intervention. Despite a transient increase in WBC transoral thyroid and parathyroid surgery via the vestibular approach does not seem to be associated with a significant number of wound infections in our patients. Intravenous antibiotic prophylaxis and enoral mucosal disinfection might be reasonable procedures to avoid microbial allocation from the mouth into the thyroid region. However, further investigations are required to finally estimate the need of antibiotics in transoral surgery.

Transvaginal Sonographic Evaluation of Cesarean Section Scar Niche in Pregnancy: A Prospective Longitudinal Study

Background and Objectives: To investigate the prevalence of a Cesarean section (CS) scar niche during pregnancy, assessed by transvaginal ultrasound imaging, and to relate scar measurements, demographic and obstetric variables to the niche evolution and final pregnancy outcome. Materials and Methods: In this prospective observational study, we used transvaginal sonography to examine the uterine scars of 122 women at 11+0–13+6, 18+0–20+6 and 32+0–35+6 weeks of gestation. A scar was defined as visible on pregnant status when the area of hypoechogenic myometrial discontinuity of the lower uterine segment was identified. The CS scar niche (“defect”) was defined as an indentation at the site of the CS scar with a depth of at least 2 mm in the sagittal plane. We measured the hypoechogenic part of the CS niche in two dimensions, as myometrial thickness adjacent to the niche and the residual myometrial thickness (RMT). In the second and third trimesters of pregnancy, the full lower uterine segment (LUS) thickness and the myometrial layer thickness were measured at the thinnest part of the scar area. Two independent examiners measured CS scars in a non-selected subset of patients (n = 24). Descriptive analysis was used to assess scar visibility, and the intraclass correlation coefficient (ICC) was calculated to show the strength of absolute agreement between two examiners for scar measurements. Factors associated with the CS scar niche, including maternal age, BMI, smoking status, previous vaginal delivery, obstetrics complications and a history of previous uterine curettage, were investigated. Clinical information about pregnancy outcomes and complications was obtained from the hospital’s electronic medical database. Results: The scar was visible in 77.9% of the women. Among those with a visible CS scar, the incidence of a CS scar niche was 51.6%. The intra- and interobserver agreement for CS scar niche measurements was excellent (ICC 0.98 and 0.89, respectively). Comparing subgroups of women in terms of CS scar niche (n = 49) and non-niche (n = 73), there was no statistically significant correlation between maternal age (p = 0.486), BMI (p = 0.529), gestational diabetes (p = 1.000), smoking status (p = 0.662), previous vaginal delivery after CS (p = 1.000) and niche development. Uterine scar niches were seen in 56.3% (18/48) of the women who had undergone uterine curettage, compared with 34.4% (31/74) without uterine curettage (p = 0.045). We observed an absence of correlation between the uterine scar niche at the first trimester of pregnancy and mode of delivery (p = 0.337). Two cases (4.7%) of uterine scar dehiscence were confirmed following a trial of vaginal delivery. Conclusions: Based on ultrasonography examination, the CS scar niche remained visible in half of the cases with a visible CS scar at the first trimester of pregnancy and could be reproducibly measured by a transvaginal scan. Previous uterine curettage was associated with an increased risk for uterine niche formation in a subsequent pregnancy. Uterine scar dehiscence might be potentially related to the CS scar niche.

Laparoscopic Excision of Patent Processus Vaginalis for Pediatric Hydroceles.

BackgroundThe standard surgical practice for pediatric hydrocele is resection and ligation of the patent processus vaginalis (PPV). Non-ligation of PPV for pediatric hydrocele is another possibility that can be repaired laparoscopically.Material & methodsA retrospective study was undertaken over 10 years (Jan 2011-Feb 2020), of a case series of boys with hydroceles that underwent laparoscopic PPV (Lap PPV) excision. Exclusion criteria were for parents who requested open surgery (10 cases) or an omental plug noted at the PPV site during laparoscopy (one case). Laparoscopic PPV excision was performed via a transperitoneal approach.ResultsThere were 43 cases of Lap PP excision, including three recurrences after open surgery. There were no conversions, complications, or recurrences in any patients. The average operative time for unilateral cases was 21 mins (range 15-30 mins). Three concurrent contra-lateral hydroceles were noted and resected during the primary procedure. Time to regular activity was within one day. There was no visible scar or recurrence after Lap PPV at six months post-surgery review.ConclusionLap PPV excision appears to be at least equivalent to the “open and ligation” approach. During laparoscopy, both internal rings are assessed for a PPV.By avoiding an inguinal incision(s), a better cosmetic result is possible. It is conceivably safer than open surgery in recurrent cases.

First Report of Root Rot Caused by Calonectria montana on Sugar Beet in Heilongjiang Province, China.

Sugar beet (Beta vulgaris L.) is an important crop that has significant economic value in northern regions of China, especially in Heilongjiang Province. In October 2019, root rot was discovered on the sugar beet cultivar HDW09 in Hulan (126°64' E, 46°00' N), Heilongjiang Province, China. Typical symptoms included lesions on root tissues, which were initially small and dark brownish, then gradually turned into irregular shapes and black in color. As the disease progressed, the extent of necrosis penetrated from external layers into inner tissue. Root tissues suffered from severe decay, which resembles symptoms of several previously reported root rot diseases of sugar beet(Harveson 2006). To identify the pathogen, pieces of the transition zones (3-5mm) between asymptomatic and symptomatic tissues were surface sterilized for 15 seconds in 1% NaClO, rinsed twice with sterilized distilled water， plated on corn meal agar supplemented with penicillin G (50 mg/L), and incubated at 25 ± 2°C in the dark. Isolates belonging to a Calonectria sp. were recovered and purified using the hyphal tipping technique. Four isolates including A1, A5, A6, and A7 were used for morphological characterization and identification by DNA sequencing. The seven-day-old colonies on malt extract agar produced buff and wooly aerial mycelia. They were sienna to umber in color. Chlamydospores and microsclerotia were produced abundantly throughout the medium. For further identification, the isolates were cultured on potato dextrose agar (PDA) at room temperature(25°C) under near-ultraviolet light irradiation. Macroconidiophores comprised of a stipe, a penicillate arrangement of fertile branches, a stipe extension, and a terminal vesicle. Stipe extension were septate, straight to flexuous, 61-117 μm long, 2-4 μm wide at the apical septum, terminating in a sphaeropedunculate vesicle, 5-9 μm diam. Conidiogenous apparatus were 31-177 μm long, and 16-110 μm wide(n=30). Primary branches of conidiogenous apparatus were aseptate or 1-septate, 16-51 × 3-7 µm; secondary branches aseptate, 6-31 × 2-7 µm; tertiary branches aseptate, 8-19 × 2-6 µm, each terminal branch producing 1-6 phialides. Conidia cylindrical were rounded at both ends, straight, 32-53 × 3-5 µm, (mean = 47 × 4 µm), 1-septate, lacking a visible abscission scar, held in parallel cylindrical clusters by colorless slime(n=100). Partial sequences of calmodulin (Carbone et al. 1999), histone H3, the translation elongation factor 1-alpha, and beta-tubulin 2 (Crous et al. 2004) genes of the four isolates were obtained and deposited into GenBank under accession numbers MW118652 to MW118667. BLAST results showed that the calmodulin, histone H3, the translation elongation factor 1-alpha and beta-tubulin 2 sequences of A1, A5, A6 and A7 were highly identical to the sequences of Ca. montana strain CERC 8957 MF527082.1 (CAL) (99-100%), CERC 8930 MF527061.1 (HIS) ( 98-99%), HSP4 MN356465.1 (EF1-alpha) (100%) and HSP4 MN356460.1 (tub2) (98-99%), respectively. A phylogenetic tree using the maximum likelihood algorithm and sequences of the four concatenated genes was reconstructed in RAxML and revealed that the four isolates clustered in the clade of Ca. montana. The pathogen was identified as Ca. montana based upon these morphological and molecular traits(Liu et al. 2017; Stępniewska et al. 2020). Ten eight-week-old sugar beet plants without root rot symptoms were selected for pathogenicity test. The roots near the ground were carefully cleaned with hands. One mycelial plug (5 mm in diameter) from a seven-day-old colony of isolate A1 were used to inoculate each sugar beet root. Ten plants inoculated with plugs of noncolonized PDA served as the control plants. Pathogenicity tests were repeated three times. Plants were incubated under greenhouse conditions at 25 ± 2°C and watered when the surface soil appeared dry. All inoculated plants showed symptoms that resembled those in the field after 30 days, while the control plants remained healthy. The symptomatic tissues were plated in corn meal agar for 7 days at 25°C. Ca. montana was reisolated from 100% of the inoculated tissues, and identification was confirmed by molecular sequencing, validating Koch's postulates. This is the first report of Ca. montana in China causing root rot on sugar beet. The study suggests its broader host range and wider geographical distribution than ever known and lays a basis for further monitoring and managing this important pathogen.

Surgical Results and Patient Satisfaction After A New Surgical Technique for Asian Medial Epicanthoplasty: A Modified Skin Redraping Method Using a Horizontal Point Incision and Staged 'Y-Shaped' Dog Ear Correction.

The double eyelid operation is the most common cosmetic procedure conducted in Asians. However, the epicanthal fold presents a conundrum that limits the cosmetic results of double eyelid surgery. Despite not being a pathologic condition, numerous procedures have been developed and introduced to address this issue, but these techniques have potential disadvantages that include an unnatural ciliary position of the lower lids and prominent scarring. A total of 156 patients who underwent a double eyelid operation with medial epicanthoplasty using the modified skin redraping method using a horizontal point incision and staged dog ear correction between 2015 and 2019 at our medical center were enrolled in the study. A single senior plastic surgeon performed all surgical procedures. The Patient-Reported Outcome Measures (PROM) questionnaire was used to obtain objective satisfaction scores, and patient satisfaction scores were obtained using some criteria. Of 147 patients, 8 (0.05) complained of visible scarring at the medial epicanthal and upper fold line region; there were only 2 (0.01%) epicanthal fold recurrences and 1.36% wound-related complications. The PROM scores and patient satisfaction scores showed a strong positive linear correlation according to linear regression analysis (P < 0.001). We performed double eyelidplasty with epicanthoplasty by using "a modified skin redraping method using a horizontal point incision and a staged 'Y-shaped' dog ear correction." Few complications were encountered, and almost all patients were satisfied with their surgical outcome as determined by the PROM questionnaire.

Endoscopic Browlift in Patients With Receding Hairlines.

Patients with receding or high hairlines have traditionally been considered unfavorable candidates for endoscopic brow lift as this can further lengthen the hairline. We analyzed outcomes in patients that underwent a novel endoscopic brow lift technique with placement of incisions and anchoring Endotine Forehead Devices (CoApt Systems Inc, Palo Alto, CA, USA) directly at the natural forehead crease lines, in an effort to minimize elevation of the hairline, whereas providing well-hidden scars. We retrospectively reviewed all patients who underwent this new Endotine and incision placement between 2016 and 2020. Preoperative and postoperative photographs of all patients were analyzed to determine the postoperative changes in brow elevation and forehead length proportion (defined as length from cranium to chin).The forehead length proportion was unchanged pre- and post-operatively, with no statistically significant differences noted (P = 0.48). The average brow position elevation ranged from 2.78 mm in the medial location to 5.05 mm in the lateral location. All patients were happy with their appearance and had improved visual fields postoperatively. The forehead scars healed well and were well hidden in forehead rhytids at long term follow-up.This novel endoscopic brow lift technique provides an option to utilize a minimally invasive approach in patients with receding hairline. With this technique, visible scars were minimized, whereas still being able to achieve reasonable brow elevation. Thus, our approach enables long term maintenance of brow elevation with inconspicuous scars in the forehead.

Stigma and illness uncertainty among patients with visible burn scars: A cross-sectional study

The purpose of this research was to understand the current status of stigma and illness uncertainty in patients with visible burns and explore the correlation between them. Measures to help patients alleviate shame and uncertainty in illness are also discussed. A cross-sectional study was conducted in a tertiary hospital from November 2020 to March 2021 for patients with burns on exposed parts of the face, neck, or limbs. The scales used in this study include demographic data questionnaires, the Social Impact Scale (SIS), and the Mishel Uncertainty in Illness Scale for Adults (MUIS-A). A two-tailed independent t-test was used to evaluate the differences in the respondents’ sociodemographic characteristics, stigma, and illness uncertainty. The total stigma and illness uncertainty scores of 146 patients were 57.03 ± 6.762 and 68.59 ± 12.901, respectively. Spearman correlation analysis showed that stigma was positively correlated with illness uncertainty (r = 0.398, p < 0.01). Multiple regression analysis showed a relationship between stigma and uncertainty of illness (B = 0.215, p = 0.000), itching (B = 2.555, p = 0.01), residence (B = 2.545, p = 0.029), and age (B = 0.074, p = 0.037). The stigma level of patients with visible burns increased with increasing uncertainty regarding illness. Therefore, reducing the patients’ uncertainty in illness is a way to intervene in stigma.

Silicone gel sheeting for treating hypertrophic scars.

Silicone gel sheeting for treating hypertrophic scars.

Subthreshold 577 nm laser photocoagulation vesus conventional 532 nm laser photocoagulation for diabetic macular oedema

Purpose: To evaluate the visual and anatomic outcomes of the subthreshold micropulse 577 nm yellow diode laser (MYL) and to compare its efficacy with the conventional green 532 nm diode laser (CGL) in Asian eyes with diabetic macular oedema (DME).Study design: Prospective randomized controlled clinical trialMethods: Sixty-seven eyes of 43 patients with clinically significant macular oedema (CSME) were randomized to receive either MYL (n = 37) or CGL (n = 30) at baseline and were followed up for 12 months. Titration in the MYL group was performed with 15% duty cycle, 300 ms duration, and double the threshold power, while the modified Early Treatment of Diabetic Retinopathy Study (mETDRS) protocol was used for the CGL arm with the power titrated to a barely visible burn. Parameters noted included best-corrected visual acuity (BCVA) (logMAR), central subfoveal thickness (CST), macular volume (MV), and average macular thickness (AMT) using optical coherence tomography, and presence of visible laser scars on colour fundus photographs and fundus autofluorescence, at baseline and at 12 months.Results: At 12 months follow-up, BCVA improved by 4.7 and 8.8 letters, respectively, for the MYL and CGL treatment arms (p &lt; 0.05). There was a significant reduction in all retinal thickness parameters (CST, MV, and AMT) when compared to baseline in both laser treatment arms at 12 months. There was no significant difference in either BCVA or retinal thickness parameters between the two treatment arms at 1, 3, 6, 9, or 12-month follow-up. Laser scars were observed in 26.7% of patients in the MYL group compared to 75% of patients in the CGL group (p = 0.029).Conclusions: MYL is an effective, safe, and patient-friendly treatment option for clinically significant macular oedema, with improvement in BCVA, reduction in macular thickness, and less scarring after treatment at 12 months.

The monstrosity of humiliation: an ethnography among women who’ve been attacked with chemicals

Based on ethnography in Colombia among women who had chemical agents tossed in their faces, I argue that this act marks and amputates faces in particular as a way of leaving the victim alive, but sub-humanized, ashamed, and removed from social life. I analyze the initial effects of this act as an undoing, as an act that affects and alters relationships and the very perception that the subject has of themselves; as a humiliation that seeks to be ever renewed, stretching through time as a visible scar; as a tool for making monsters. I also analyze collective and subjective movements of victims refusing to be humiliated.

Tiroidectomía endoscópica transoral por vía vestibular: TOETVA

Transoral Endoscopic Thyroidectomy Vestibular Approach (TOETVA) is a novel technique that allows the thyroid to be approached without visible scars, as it is performed through a natural orifice. It was first described and developed in Asia where due to sociocultural reasons neck scars are considered a stigma. This technique, as we now nowadays, and its preliminary results, were first reported by Angkoon Anuwong in August 2015 at the International Association of Endocrine Surgeons (IAES) world surgery congress held in Bangkok.Here we present the TOETVA approach, step-by-step, in order it could be safely replicated, aiming also it can be spread within the therapeutic framework of endocrine surgery. However, it is important to remark that, as happens in most of remote approaches, it is only suitable for a small percentage of patients.

Feasibility, Safety, Nodal yields and Learning curves in Retroauricular Robot/Endoscope Assisted Neck Dissection in the Management of Head and Neck Cancer.

Head and neck cancer is one of the most common in India. There is an increasing incidence of oral cancer in young patients. Where the primary lesion is amenable to transoral resection for early cancer, young patients are concerned about cosmesis and would prefer a surgical approach that would avoid a visible scar in the neck. Robot/endoscope-assisted neck dissection by retroauricular approach was performed in a total of 28 patients of cN0 patients between June 2016 and December 2019. The duration of surgery, perioperative complications, number of lymph nodes retrieved, and cosmetic outcomes were analyzed. Robot- and endoscope-assisted neck dissections were done in 15 and 13 cases, respectively. The mean age of the cohort was 46.18 ± 9.68years. Twenty-four patients had tongue cancer. Mean time for skin flap raising, docking, and robotic console use was 48.21 ± 7.48min, 10 ± 3.16min, and 176.67 ± 47.27min, respectively. Mean neck dissection time from skin incision to skin closure was 231.79 ± 54.94min for completing level I to IV neck dissection. The mean number of retrieved nodes was 33.69 ± 12.81. Majority of the patients were highly satisfied with their cosmetic outcomes. During a median follow-up of 19.5months, 3 patients developed recurrence. Robot/ endoscope-assisted neck dissection was feasible and safe but took a longer time to perform. Nodal yields were adequate and better cosmetic outcomes were achieved.

The Passot Technique Revisited: No Vertical Scar Reduction Mammoplasty in Unmarried Females: A Case Series.

BACKGROUNDMacromastia in adolescent girls is a distressing condition. There is an increase in the number of patients opting for reduction mammoplasty in the late teens. The semicircular horizontal method of breast reduction, first described by Passot in 1925 has the advantage of being able to do larger reduction, particularly suitable for pendulous breasts and having a hidden scar in the inframammary fold.METHODSEleven patients of adolescent macromastia were included in this study. It was conducted over a period of 4 years (2013-17) at two teaching institutions in Kolkata and Rishikesh, India. The mean age of the patients was 19.2 years. The Passot technique of reduction mammoplasty was performed in each case and the volume of resected breast tissue recorded by weighing the specimen. The aesthetic outcome was assessed by Lowery scale (volume, contour, placement of the breast mound and inframammary fold). Patient satisfaction was assessed after 6 months of follow up on a scale of 1 to 10, where 1-4 was poor, 5-6 fair, 7-8 good and 9-10 excellent. RESULTSMean total reduction per breast was 856 gm. Patients reported a mean decrease of cup size by 1.5. The aesthetic outcome was excellent in 6 patients and good in 5 patients. Patient satisfaction was excellent in 9 patients and good in 2 patients.CONCLUSIONPassot technique is a safe and effective technique of reduction mammoplasty and is especially useful in adolescent macromastia where the absence of visible scar on the breasts is very satisfying for the patients.