RESUMEN
Wounds are most commonly caused by accidents, surgery and burns, and can be internal or external. Naturally, the wound healing process can take a long time and lead to scarring. In this study we present a technique to shorten wound healing time and prevent or mitigate scarring using D-mannose that is applied directly on the wound. The results showed that the healing time is almost halved compared to treatment with povidone-iodine solution which is an antiseptic widely used in surgery. D-Mannose is neither an antisepsis nor an antibiotic. We propose a posssible mechanism by which D-mannose binds to D-mannose binding lectin and immediately activates the innate immune system that ultimately phagocytizes pathogens and clears the wound of degraded cells and materials, which reduces inflammation and implicitly wound healing time. D-Mannose also intervenes in the coagulation process by binding to fibrinogen, generating a finer and denser fibrin, which visibly reduces collagen scars. Our findings show that applying D-mannose directly on the wound as a powder shortens wound healing time and visibly attenuates scarring. Apart from the unaesthetic appearance, these scars can also cause a certain tissue dysfunction, regardless of the affected organ.
Asunto(s)
Cicatriz , Lectina de Unión a Manosa , Manosa , Cicatrización de Heridas , Cicatrización de Heridas/efectos de los fármacos , Cicatriz/patología , Cicatriz/prevención & control , Lectina de Unión a Manosa/metabolismo , Animales , Humanos , Masculino , Piel/patología , Piel/efectos de los fármacos , Piel/metabolismo , Femenino , Inmunidad Innata/efectos de los fármacosRESUMEN
BACKGROUND: Ureteral stricture (US) is a pathological stenosis in the urinary tract characterized by increased collagen synthesis and inflammation. Autophagy activation has been shown to ameliorate tissue fibrosis and protect against fibrotic diseases. Verapamil has beneficial therapeutic benefits on fibrotic disorders. The pharmacological effects of verapamil on fibroblast autophagy in US and the underlying mechanism need to be investigated further. METHODS: US patients were recruited to isolate scar tissues, hematoxylin-eosin (HE) and Masson trichrome staining were performed to analyze histopathological changes. The US animal model was established and administered with verapamil (0.05 mg/kg) in the drinking water. Transforming growth factor (TGF)-ß1 was adopted to facilitate collagen synthesis in fibroblasts. The mRNA and protein expressions were examined by qRT-PCR, western blot, immunofluorescence and immunohistochemistry. ELISA was adopted to measure interleukin (IL)-1ß and IL-6 levels. Molecular interaction experiments like dual luciferase reporter and chromatin immunoprecipitation (ChIP) assays were performed to analyze the interaction between signal transducers and activators of transcription 3 (STAT3) and RNA polymerase II associated factor 1 (PAF1). RESULTS: Herein, our results revealed that verapamil activated TGF-ß1-treated fibroblast autophagy and inhibited inflammation and fibrosis by repressing Ca2+/calmodulin-dependent protein kinase II (CaMK II) δ-mediated STAT3 activation. Our following tests revealed that STAT3 activated PAF1 transcription. PAF1 upregulation abrogated the regulatory effect of verapamil on fibroblast autophagy and fibrosis during US progression. Finally, verapamil mitigated US in vivo by activating fibroblast autophagy. CONCLUSION: Taken together, verapamil activated TGF-ß1-treated fibroblast autophagy and inhibited fibrosis by repressing the CaMK IIδ/STAT3/PAF1 axis.
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Autofagia , Proteína Quinasa Tipo 2 Dependiente de Calcio Calmodulina , Fibroblastos , Fibrosis , Factor de Transcripción STAT3 , Factor de Crecimiento Transformador beta1 , Obstrucción Ureteral , Verapamilo , Verapamilo/farmacología , Verapamilo/uso terapéutico , Autofagia/efectos de los fármacos , Animales , Proteína Quinasa Tipo 2 Dependiente de Calcio Calmodulina/metabolismo , Obstrucción Ureteral/tratamiento farmacológico , Obstrucción Ureteral/complicaciones , Obstrucción Ureteral/metabolismo , Factor de Transcripción STAT3/metabolismo , Humanos , Fibroblastos/efectos de los fármacos , Fibroblastos/metabolismo , Masculino , Factor de Crecimiento Transformador beta1/metabolismo , Cicatriz/patología , Cicatriz/metabolismo , Cicatriz/tratamiento farmacológico , Cicatriz/etiología , Cicatriz/prevención & control , Modelos Animales de Enfermedad , Inflamación/metabolismo , Transducción de Señal/efectos de los fármacos , Femenino , Persona de Mediana EdadRESUMEN
BACKGROUND: Botulinum toxin A (BoNT-A) treatment has many uses in dermatology. Its mechanism of action and long-term effects for scar formation, rosacea, and antiaging are still being investigated. OBJECTIVE: To conduct a literature review on BoNT-A to further investigate its use in scar formation, rosacea, and antiaging. METHODS: A literature review was conducted using PubMed on botulinum toxin treatment for scar formation, rosacea, and antiaging. Studies discussing the toxin mechanism of action and treatment algorithm were included. The authors also provided their personal experience in BoNT-A use for these 3 conditions. RESULTS: The mechanism of action of Botulinum toxin A in improving scar formation, rosacea, and antiaging is now better understood. While it is effective in the short term, little is still known about how frequently treatment needs to be repeated and if there are any long-term effects. CONCLUSION: While in vitro studies have supporting evidence on the mechanism of action of BoNT-A on scar formation, rosacea, and antiaging, further studies are needed to identify long-term treatment effects.
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Toxinas Botulínicas Tipo A , Cicatriz , Queloide , Rosácea , Envejecimiento de la Piel , Humanos , Rosácea/tratamiento farmacológico , Queloide/tratamiento farmacológico , Queloide/prevención & control , Cicatriz/prevención & control , Cicatriz/tratamiento farmacológico , Cicatriz/etiología , Toxinas Botulínicas Tipo A/administración & dosificación , Envejecimiento de la Piel/efectos de los fármacos , Neurotransmisores/uso terapéutico , Neurotransmisores/farmacologíaRESUMEN
Objective:To explore the safety and aesthetic effect of modified Z-shaped cosmetic incision in parotid benign tumor resection. Methods:A prospective study was conducted. A total of 44 patients with benign parotid tumor resection were randomly divided into experimental groupï¼n=22ï¼ and control groupï¼n=22ï¼. The experimental group underwent modified Z-shaped cosmetic incision, while the control group underwent the traditional S-shaped incision. The surgical duration, hospital stay, complications and maxillofacial aesthetics were compared between the two groups. Results:There was no significant difference in gender, age, surgical method, pathological type between the experimental group and the control groupï¼P>0.05ï¼. The maxillofacial aesthetics and surgical duration of the two groups was statistically significantï¼P<0.05ï¼, while there was no statistically significant difference in terms of hospitalization days, surgical complications and Vancouver scar scale score ï¼P>0.05ï¼. Conclusion:The modified Z-shaped cosmetic incision has a better effect on improving the maxillofacial aesthetics after benign parotid tumor resection, and compared with the traditional S-shaped incision, the safety is consistent, so it is worthy of clinical promotion and application.
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Neoplasias de la Parótida , Humanos , Neoplasias de la Parótida/cirugía , Estudios Prospectivos , Femenino , Masculino , Glándula Parótida/cirugía , Estética , Persona de Mediana Edad , Cicatriz/prevención & control , Complicaciones Posoperatorias , Adulto , Herida Quirúrgica , Procedimientos de Cirugía Plástica/métodos , Tiempo de InternaciónRESUMEN
BACKGROUND: Breast reduction surgery has witnessed significant advancements in recent years; however, it continues to pose challenges for both surgeons and patients when dealing with cases involving excessive breast volume and severe breast ptosis. This study aimed to assess the aesthetic outcomes and the impact on the quality of life, as measured by the BREAST-Q questionnaire, in patients with gigantomastia and severe breast ptosis who underwent reduction mammaplasty using the superomedial-based pedicle technique. METHODS: We present a retrospective series comprising 84 patients who underwent reduction mammoplasty utilizing the superomedial pedicle technique. The surgical resections exceeded 1 kg per breast, with a mean resection weight of 1506.58 g (right breast) and 1500.32 g (left breast). The preoperative mean suprasternal notch to nipple distance measured 40.50 cm (right breast) and 40.38 cm (left breast). Postoperatively, the patients were followed up for a minimum of 6 months. Both preoperative and postoperative BREAST-Q surveys were administered to the participants, and scores were analyzed using descriptive statistics. RESULTS: Complications were observed in 3 patients (3.57%), characterized by partial loss of the areola, which resolved spontaneously over time. Additionally, 2 cases of hematoma and 2 instances of minor delayed wound healing were reported. All patients expressed satisfaction with their aesthetic outcomes, as they achieved a natural breast shape and minimal scarring, along with symptomatic relief. CONCLUSIONS: The superomedial pedicle reduction mammaplasty technique has demonstrated its ability to produce satisfactory aesthetic outcomes and long-term benefits in patients with excessively large breasts. Careful patient selection and postoperative management are vital for achieving optimal results. Further investigations involving larger sample sizes and longer follow-up periods are warranted to validate our findings. LEVEL OF EVIDENCE: IV.
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Mama , Hipertrofia , Mamoplastia , Humanos , Mamoplastia/métodos , Femenino , Estudios Retrospectivos , Adulto , Hipertrofia/cirugía , Mama/cirugía , Mama/anomalías , Persona de Mediana Edad , Cicatriz/etiología , Cicatriz/cirugía , Cicatriz/prevención & control , Estética , Colgajos Quirúrgicos , Calidad de Vida , Resultado del Tratamiento , Satisfacción del PacienteRESUMEN
Xkin closure is a newly developed medical suture device for lacerations and surgical wounds that can reduce scarring, pain and the risk of infection compared with conventional sutures or staplers. A randomized controlled study was performed to compare the wound healing effects and complications of Xkin closure with stapler closure. Fifty patients who underwent robot-assisted radical prostatectomy for prostate cancer were randomly assigned. Only the wound above the navel, which was extended to take out the prostate was targeted. The wound was examined at 2, 6 and 12 weeks after surgery, and the modified Vancouver Scar Scale (mVSS), scar height and side effects were assessed with a 3D skin analyser. Forty-six patients (23 Xkin, 23 Stapler) were analysed. The mVSS scores, vascularity and pliability were significantly lower in the Xkin group compared with the stapler group at the 12-week follow-up. No significant differences in the maximum peak and depth of the scars were detected between the two groups using 3D photographs at 12 weeks. Xkin is an effective wound closure method for improving scar outcomes. This method is expected to be widely used for surgical wounds and lacerations caused by trauma in daily life.
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Técnicas de Sutura , Cicatrización de Heridas , Humanos , Masculino , Persona de Mediana Edad , Anciano , Técnicas de Sutura/instrumentación , Cicatriz/prevención & control , Cicatriz/etiología , Cinta Quirúrgica , Prostatectomía/métodos , Prostatectomía/efectos adversos , Suturas , Neoplasias de la Próstata/cirugía , Engrapadoras Quirúrgicas , Herida Quirúrgica , Resultado del TratamientoRESUMEN
AIM: We aimed to confirm the inhibitory effect of nicotinamide on fibrotic scar formation following spinal cord injury in mice using functional metabolomics. METHODS: We proposed a novel functional metabolomics strategy to establish correlations between gene expression changes and metabolic phenotypes using integrated multi-omics analysis. Through the integration of quantitative metabolites analysis and assessments of differential gene expression, we identified nicotinamide as a functional metabolite capable of inhibiting fibrotic scar formation and confirmed the effect in vivo using a mouse model of spinal cord injury. Furthermore, to mimic fibrosis models in vitro, primary mouse embryonic fibroblasts and spinal cord fibroblasts were stimulated by TGFß, and the influence of nicotinamide on TGFß-induced fibrosis-associated genes and its underlying mechanism were examined. RESULTS: Administration of nicotinamide led to a reduction in fibrotic lesion area and promoted functional rehabilitation following spinal cord injury. Nicotinamide effectively downregulated the expression of fibrosis genes, including Col1α1, Vimentin, Col4α1, Col1α2, Fn1, and Acta2, by repressing the TGFß/SMADs pathway. CONCLUSION: Our functional metabolomics strategy identified nicotinamide as a metabolite with the potential to inhibit fibrotic scar formation following SCI by suppressing the TGFß/SMADs signaling. This finding provides new therapeutic strategies and new ideas for clinical treatment.
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Cicatriz , Fibrosis , Ratones Endogámicos C57BL , Niacinamida , Traumatismos de la Médula Espinal , Animales , Niacinamida/farmacología , Niacinamida/uso terapéutico , Traumatismos de la Médula Espinal/tratamiento farmacológico , Traumatismos de la Médula Espinal/patología , Traumatismos de la Médula Espinal/metabolismo , Traumatismos de la Médula Espinal/complicaciones , Cicatriz/tratamiento farmacológico , Cicatriz/patología , Cicatriz/metabolismo , Cicatriz/prevención & control , Ratones , Fibrosis/tratamiento farmacológico , Factor de Crecimiento Transformador beta/metabolismo , Metabolómica , Fibroblastos/efectos de los fármacos , Fibroblastos/metabolismo , Células Cultivadas , Modelos Animales de Enfermedad , FemeninoRESUMEN
BACKGROUND: Traditional posterolateral thoracotomy (PLT) is a painful and potentially morbid operation associated with an extensive recovery and a long, unsightly scar. In contrast, vertical thoracotomy (VT) is designed to spare muscles, avoid skin flaps, and minimize incision length, thereby limiting postoperative pain, hastening recovery, and improving scar cosmesis. METHODS: We reviewed children aged 1-21 that underwent PLT and VT at our institution from 1/1/2013-12/1/2023. We analyzed demographic data, operative details, and clinical outcomes with special attention paid to total oral morphine equivalents (OME), time to ambulation, and wound complications. RESULTS: We identified 105 patients who underwent PLT and 74 who underwent VT. Both groups were heterogeneous with a greater proportion of oncology patients that received wedge resection in the VT group and congenital lung lesions that received lobectomy in the PLT group. VT patients tended to be older and heavier than PLT patients. Patients who underwent VT demonstrated improved time to ambulation (1.4 ± 0.3 vs 3.0 ± 1.4 days, p = 0.037) and oral morphine equivalent requirements (1.4 ± 0.4mgOME/kg vs 3.5 ± 1.8mgOME/kg, p = 0.035) compared to those who underwent PLT. Additionally, no patients in the VT group required division of the serratus or latissimus, compared to 8 (8%) in the PLT group (p = 0.004). CONCLUSION: Muscle-sparing vertical thoracotomy provides excellent exposure for most intrathoracic pediatric operations, results in a cosmetically acceptable scar that is easily hidden by the upper arm, may reduce the frequency of division of the latissimus and serratus, and does not worsen time to ambulation or post-operative opioid requirements. LEVEL OF EVIDENCE: III.
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Dolor Postoperatorio , Toracotomía , Humanos , Toracotomía/métodos , Niño , Masculino , Femenino , Adolescente , Preescolar , Estudios Retrospectivos , Lactante , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Tratamientos Conservadores del Órgano/métodos , Adulto Joven , Cicatriz/prevención & control , Cicatriz/etiología , Resultado del TratamientoRESUMEN
INTRODUCTION: Fast gut cutaneous sutures have become more prominent due to their low tissue reactivity, rapid absorption, and elimination of suture removal visits. It is not known how fast gut sutures compare to other closure modalities. METHODS: A comprehensive literature review was conducted to identify randomized controlled trials comparing fast gut sutures to alternative closure methods during dermatologic surgery. Data collected included patient and physician assessed cosmetic outcome as well as standardized complication rates. RESULTS: Six studies were included in final analysis and reported on 208 patients. Fast gut sutures were associated with lower physician opinions of final scar when compared to polypropylene sutures (SMD 0.438; 95% CI 0.082 to 0.794). No differences existed between physician opinion of fast gut sutures and cyanoacrylate tissue adhesive (SMD - 0.024; 95% CI - 0.605 to 0.556). Complications with fast gut suture placement were rare, and included infection, dehiscence, and hematomas. Fast gut sutures were less likely to experience wound dehiscence than tissue adhesive (p = 0.01). CONCLUSION: If no contraindications to polypropylene sutures exist, they may provide superior cosmetic outcomes compared to fast gut sutures. Further research is required to better quantify cosmetic outcomes and optimal use of fast gut sutures.
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Procedimientos Quirúrgicos Dermatologicos , Técnicas de Sutura , Suturas , Humanos , Procedimientos Quirúrgicos Dermatologicos/efectos adversos , Técnicas de Sutura/efectos adversos , Adhesivos Tisulares/efectos adversos , Polipropilenos , Cicatriz/etiología , Cicatriz/prevención & control , Ensayos Clínicos Controlados Aleatorios como Asunto , Cianoacrilatos/administración & dosificación , Cicatrización de HeridasRESUMEN
OBJECTIVE: To evaluate the surgical outcomes of a modified technique for treating congenital cilial entropion in children, which involves reducing tension step by step in the epicanthus and lower eyelid incision. METHODS: The observational group consisted of 153 pediatric patients (81 males and 72 females) who were treated using the modified technique, whereas the control group included 124 patients (68 males and 56 females) who were treated using the rotating suture surgery. All the participants were bilateral. Surgical outcomes were classified as good, fair, or poor, and the recurrence rate, scar condition, inferior eyelid position, and patient satisfaction were also assessed. RESULTS: The mean follow-up period was 9.13 ± 3.50 months (range: 3-14 months) for the observational group and 6.93 ± 4.51 months (range: 3-14 months) for the control group. In the observational group, surgical success with "good" outcomes was achieved in 300 eyes (98.04%), compared to 224 eyes (90.32%) in the control group. No recurrence occurred in the observational group, whereas the recurrence rate in the control group was 4.43%. Postoperative scar formation was mild in the observational group. The average scar score was 1.27 ± 0.96 in the observational group and 2.70 ± 0.99 in the control group, with a statistically significant difference (P < 0.001). Neither overcorrection nor postoperative ectropion was observed in both groups. CONCLUSION: The modified technique effectively corrected medial entropion and trichiasis in the lower eyelid, resulting in stable postoperative outcomes, mild scar formation, quick recovery, flexible eyelid motility, and stable ocular surface. Therefore, it can be widely applied to children with congenital entropion and trichiasis.
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Entropión , Párpados , Técnicas de Sutura , Humanos , Entropión/cirugía , Femenino , Masculino , Preescolar , Niño , Párpados/cirugía , Resultado del Tratamiento , Blefaroplastia/métodos , Satisfacción del Paciente , Lactante , Estudios de Seguimiento , Recurrencia , Cicatriz/prevención & control , Cicatriz/cirugía , Cicatriz/etiología , Estudios RetrospectivosRESUMEN
BACKGROUND: Skin incision scars are cosmetically displeasing; the effects of current treatments are limited, and new methods to reduce scar formation need to be found. OBJECTIVE: We sought to determine whether immediate postoperative injection of stromal vascular fraction gel (SVF-gel) could reduce scar formation at skin incision sites. METHODS: A prospective, randomized, double-blind, self-controlled trial was conducted in patients who underwent breast reduction. SVF-gel was intradermally injected into the surgical incision on one randomly selected side, with the other side receiving saline as a control. At the 6-month follow-up, the incision scars were evaluated using the Vancouver scar scale (VSS) and visual analog scale (VAS). Antera 3D camera was used for objective evaluation. RESULTS: The VSS score and VAS score were significantly different between the SVF-gel-treated side (3.80 ± 1.37, 3.37±1.25) and the control side (5.25 ± 1.18, 4.94 ± 1.28). Moreover, the SVF-gel-treated side showed statistically significant improvements in scar appearance, based on evidences from Antera 3D camera. LIMITATIONS: This was a single-center, single-race, and single-gender study. Furthermore, the results were available only for the 6-month interim follow-up period. CONCLUSION: Postoperative immediate SVF-gel injection in surgical incisions can reduce scar formation, and exert a preventive effect on scars. LEVEL OF EVIDENCE I: Evidence obtained from at least one properly designed randomized controlled trial. 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 .
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Cicatriz , Geles , Mamoplastia , Humanos , Método Doble Ciego , Cicatriz/prevención & control , Cicatriz/etiología , Femenino , Estudios Prospectivos , Adulto , Mamoplastia/métodos , Resultado del Tratamiento , Persona de Mediana Edad , Inyecciones Intradérmicas , Factores de Tiempo , Estudios de Seguimiento , Estética , Cicatrización de Heridas/fisiologíaRESUMEN
While surgical resection is the predominant clinical strategy in the treatment of melanoma, postoperative recurrence and undetectable metastasis are both pernicious drawbacks to this otherwise highly successful approach. Furthermore, the deep cavities result from tumor excision can leave long lasting wounds which are slow to heal and often leave visible scars. These unmet needs are addressed in the present work through the use of a multidimensional strategy, and also promotes wound healing and scar reduction. In the first phase, cell membrane-derived nanovesicles (NVs) are engineered to show PD-1 and dibenzocyclooctyne (DBCO). These are capable of reactivating T cells by blocking the PD-1/PD-L1 pathway. In the second phase, azido (N3) labeled mesenchymal stem cells (MSCs) are cultured into cell sheets using tissue engineering, then apply directly to surgical wounds to enhance tissue repair. Owing to the complementary association between DBCO and N3 groups, PD-1 NVs were accumulated at the site of excision. This strategy can inhibit postoperative tumor recurrence and metastasis, whilst also promoting wound healing and reducing scar formation. The results of this study set a precedent for a new and innovative multidimensional therapeutic strategy in the postoperative treatment of melanoma.
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Cicatriz , Melanoma , Células Madre Mesenquimatosas , Recurrencia Local de Neoplasia , Animales , Cicatriz/prevención & control , Recurrencia Local de Neoplasia/prevención & control , Melanoma/patología , Cicatrización de Heridas , Ratones Endogámicos C57BL , Línea Celular Tumoral , Membrana Celular/metabolismo , Humanos , Ratones , Receptor de Muerte Celular Programada 1/antagonistas & inhibidores , Femenino , Neoplasias Cutáneas/patología , Melanoma Experimental/patología , MasculinoRESUMEN
BACKGROUND: A congenital constriction band (CCB) is a relatively common anomaly among limb malformations. However, the number of cases treated at a given center is limited and differences in techniques used by surgeons at each facility have a significant impact on the treatment outcomes. Several surgical methods have been reported, but a standard technique that yields consistent satisfactory results is still needed. Here, we introduce a novel technique for the treatment of CCB syndrome that uses a combination of wave-like skin incision and Z-axis Z-plasty. PATIENTS AND METHODS: A wave-like incision was used for skin incision with the goals of achieving an accordion effect and a less noticeable post-operative scar. After the fibrous constriction band was completely excised, a Z-plasty of sufficient size in the Z-axis direction was performed on the dermis-inclusive adipose tissue. For over 10 years, this technique was applied to 11 sites in 6 patients. A retrospective study of the characteristics of these cases was performed, including age at surgery, gender, type of deformity, degree of constriction, types of examination, number of surgeries, and post-operative outcomes. RESULTS: In all patients, a normal contour of the limbs was achieved and the hourglass-like deformity caused by the constriction band was satisfactorily improved. No additional corrective surgeries were needed, there was no abnormal growth of the treated limbs, and scarring was aesthetically acceptable in all cases. CONCLUSION: The novel technique described here uses deep subcutaneous fat to correct the hourglass-like deformity and restores a normal limb contour, while the wave-like skin incision minimizes post-operative scarring.
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Procedimientos de Cirugía Plástica , Humanos , Femenino , Masculino , Estudios Retrospectivos , Lactante , Procedimientos de Cirugía Plástica/métodos , Síndrome de Bandas Amnióticas/cirugía , Recién Nacido , Resultado del Tratamiento , Cicatriz/prevención & control , Cicatriz/cirugía , PreescolarRESUMEN
INTRODUCTION: The columellar incision and dissection which were integral steps in open rhinoplasty play a crucial role in achieving optimal results. However, scarring in the supratip region may pose challenges to skin circulation, potentially leading to complications such as flap loss. OBJECTIVES: This study aims to establish the safety and efficacy of the open rhinoplasty technique as a viable alternative for patients with substantial scars in the supratip region typically addressed using the closed rhinoplasty technique. PATIENTS AND METHODS: Patients with scars on the tip or supratip region were operated clinic between February 2010 and March 2023. To mitigate the risk of tip necrosis, a meticulous two-step delay approach was employed. In the initial outpatient procedure, performed under local anesthesia, we opted for a columellar incision. Subsequently, the columellar arteries were identified and cauterized to facilitate the delay procedure. Following a ten-day interval, all patients underwent standard open rhinoplasty. RESULTS: The columellar artery delay procedure proved instrumental in executing successful open rhinoplasty without compromising skin circulation between the scarred supratip and columellar incision line. CONCLUSION: Our findings suggest that the columellar delay procedure effectively prevents flap loss in open rhinoplasty patients with scars in the supratip and columellar regions. This brief outpatient intervention, lasting approximately ten minutes, provides a reliable method for adopting the open approach in primary rhinoplasty cases, irrespective of prior scarring. LEVEL OF EVIDENCE: Level IV, therapeutic study.
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Cicatriz , Rinoplastia , Humanos , Rinoplastia/métodos , Cicatriz/prevención & control , Femenino , Adulto , Masculino , Persona de Mediana Edad , Adulto Joven , Tiempo de TratamientoRESUMEN
In this article, an array of new developments in burn care, from diagnosis to post-burn reconstruction and re-integration, will be discussed. Multidisciplinary advances have allowed the implementation of technologies that provide more accurate assessments of burn depth, improved outcomes when treating full-thickness burns, and enhanced scar tissue management. Incorporating these new treatment modalities into current practice is essential to improving the standard of burn care and developing the next generation of burn wound management methodologies.
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Quemaduras , Humanos , Quemaduras/diagnóstico , Quemaduras/cirugía , Quemaduras/terapia , Cicatriz/prevención & control , Cicatriz/terapia , Procedimientos de Cirugía Plástica/métodos , Cicatrización de HeridasRESUMEN
BACKGROUND: Skin closure techniques in otolaryngology vary based on surgeon preference and wound site. Octyl-2-Cyanoacrylate may be a safe, rapid, and cost-effective option for post-site closure. AIM: This randomized controlled trial study aimed to compare Octyl-2-Cyanoacrylate and conventional subcuticular sutures in ear surgeries, assessing wound closure results in both case and control groups. METHODS: This prospective, randomized, controlled, single-blind study was conducted at Ohud Hospital from May 2021 to May 2022. Ear surgery and cochlear implantation in patients were examined, and each group was randomly assigned to receive Dermabond TM and deep layer subcuticular sutures closure. Incisions were assessed at various time points, including 3 weeks, 6 weeks, 6 months, and 1 year post-surgery. The patient and observer Scar Assessment Scale was used, and two independent ear surgeons used the Stony Brook Scar Evaluation Scale for initial scar assessment. RESULTS: This study involved 126 ear surgery and cochlear implantation patients randomized to use cyanoacrylate tissue adhesive or subcuticular suture for port site closure. The study found that tissue adhesive (OCA) was faster and more efficient than standard sutures, saving an average of 12 min per incision in each ear. Incision cosmesis showed immediate results and significant differences, and patient satisfaction with OCA wound closure was higher than standard sutures. CONCLUSION: The findings confirmed that cyanoacrylate tissue adhesive significantly reduced the time needed for skin closure during ear surgery and showed immediate cosmetic improvements without any documented instances of bleeding, hematoma, infection, or wound separation. LEVEL OF EVIDENCE: This is a randomized controlled trial, it follows Level 2 of evidence. Randomized trial or observational study with dramatic effects Laryngoscope, 134:4036-4041, 2024.
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Cianoacrilatos , Técnicas de Sutura , Suturas , Adhesivos Tisulares , Humanos , Método Simple Ciego , Estudios Prospectivos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Técnicas de Cierre de Heridas , Procedimientos Quirúrgicos Otológicos/métodos , Cicatrización de Heridas/efectos de los fármacos , Anciano , Cicatriz/prevención & control , Cicatriz/etiología , Adulto Joven , Resultado del TratamientoRESUMEN
Syndactyly release aims to address skin deficits by resurfacing web spaces and sides of digits to allow independent digital motion while minimizing the risk of web creep and scar contractures. Conventional methods include the use of a dorsal and interdigitating flaps with full-thickness skin grafts. More recently, there have been several descriptions of "graftless" syndactyly release without skin grafts, thus avoiding a further (usually distant) donor site. However, the indications of when and when not to use these techniques remain unclear. In addition, the inevitable scarring from extra recruitment of local adjacent skin is perhaps underemphasized. In this article, we revisit the trilobed flap technique which serves to balance the amount of skin needed for resurfacing digits while minimizing local donor site scarring. The geometry and nuances of the flap inset are illustrated in detail to guide those embarking on this technique. The trilobed syndactyly release technique is a reproducible, safe, and reliable method for the release of simple syndactyly.
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Colgajos Quirúrgicos , Sindactilia , Humanos , Sindactilia/cirugía , Cicatriz/prevención & controlRESUMEN
Here we describe a template of DIEP flap inset that prioritises projection, lateral flow and natural ptosis; key elements of an aesthetically successful delayed breast reconstruction. By not excising the full length of the mastectomy scar, and preserving the scar laterally, we increase the 3-dimensional aesthetic of the breast, moving the final reconstructed breast aesthetic further away from an unintentional 2-dimensional resurfacing. Through controlling the initial take-off around the whole circumference of the breast footprint, a favourable and durable breast conus is consistently achieved. This technique employs designated segments of comparatively more rigid irradiated mastectomy skin flaps, to positively influence reconstructed breast aesthetics at the time of flap inset. Conceptually, this reminds the authors of how the green sepals of a rose shape the bud of petals.