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Meikle B, Simons M, Mahoney T, Reddan T, Dai B, Kimble RM, Tyack Z. Ultrasound measurement of traumatic scar and skin thickness: a scoping review of evidence across the translational pipeline of research-to-practice. BMJ Open 2024; 14:e078361. [PMID: 38594186 PMCID: PMC11015304 DOI: 10.1136/bmjopen-2023-078361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/18/2024] [Indexed: 04/11/2024] Open
Abstract
OBJECTIVES To identify the ultrasound methods used in the literature to measure traumatic scar thickness, and map gaps in the translation of these methods using evidence across the research-to-practice pipeline. DESIGN Scoping review. DATA SOURCES Electronic database searches of Ovid MEDLINE, Embase, Cumulative Index of Nursing and Allied Health Literature and Web of Science. Grey literature searches were conducted in Google. Searches were conducted from inception (date last searched 27 May 2022). DATA EXTRACTION Records using brightness mode (B-mode) ultrasound to measure scar and skin thickness across the research-to-practice pipeline of evidence were included. Data were extracted from included records pertaining to: methods used; reliability and measurement error; clinical, health service, implementation and feasibility outcomes; factors influencing measurement methods; strengths and limitations; and use of measurement guidelines and/or frameworks. RESULTS Of the 9309 records identified, 118 were analysed (n=82 articles, n=36 abstracts) encompassing 5213 participants. Reporting of methods used was poor. B-mode, including high-frequency (ie, >20 MHz) ultrasound was the most common type of ultrasound used (n=72 records; 61% of records), and measurement of the combined epidermal and dermal thickness (n=28; 24%) was more commonly measured than the epidermis or dermis alone (n=7, 6%). Reliability of ultrasound measurement was poorly reported (n=14; 12%). The scar characteristics most commonly reported to be measured were epidermal oedema, dermal fibrosis and hair follicle density. Most records analysed (n=115; 97%) pertained to the early stages of the research-to-practice pipeline, as part of research initiatives. CONCLUSIONS The lack of evaluation of measurement initiatives in routine clinical practice was identified as an evidence gap. Diverse methods used in the literature identified the need for greater standardisation of ultrasound thickness measurements. Findings have been used to develop nine methodological considerations for practitioners to guide methods and reporting.
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Affiliation(s)
- Brandon Meikle
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
| | - Megan Simons
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Occupational Therapy, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Tamsin Mahoney
- Surgical, Treatment and Rehabilitation Services (STARS), Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Tristan Reddan
- Medical Imaging and Nuclear Medicine, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bryan Dai
- The University of Queensland, Saint Lucia, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns and Trauma Research, Queensland Children's Hospital, South Brisbane, Queensland, Australia
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Pegg Leditschke Children's Burns Centre, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Saint Lucia, Queensland, Australia
| | - Zephanie Tyack
- Children's Health Research Centre, The University of Queensland Faculty of Medicine, South Brisbane, Queensland, Australia
- Australian Centre for Health Service Innovation (AusHI), Centre for Healthcare Transformation, and School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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Bagheri M, von Kohout M, Fuchs PC, Seyhan H, Stromps JP, Lefering R, Opländer C, Schiefer JL. How to evaluate scar colour after burn injuries - A clinical comparison of the Mexameter® and the subjective scar assessment (POSAS/VSS). Burns 2024; 50:691-701. [PMID: 38097444 DOI: 10.1016/j.burns.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 11/17/2023] [Accepted: 11/24/2023] [Indexed: 04/08/2024]
Abstract
INTRODUCTION Scarring after burn injuries remains one of the major challenges in burn medicine and is the subject of current research. Accurate and high-quality assessment of scars is needed to enable exact outcome evaluation of different treatments. Our aim was to evaluate the most common subjective scar evaluation scores-the POSAS (Patient and Observer Scar Assessment Scale) and VSS (Vancouver Scar Scale)-in comparison with the objective device Mexameter® for colour evaluation. METHODS A prospective monocentre study was performed, which included 120 examined scar areas of 60 patients with third degree burns who had received skin grafts between 1975 and 2018 with a total burned surface area (TBSA) > 2%. Two different scar areas in comparison with one healthy skin area concerning 'colour', 'pigmentation', and 'vascularization' were evaluated by the Mexameter® MX 18, the OSAS, and the VSS by the same examiner, as well as the PSAS by the patient. RESULTS The mean TBSA of the 60 patients was 24.3%. In the OSAS, 61% of the scars were evaluated as 'hyper-', 19% as 'hypo-', and 19% as 'mix-pigmented'. Furthermore, 65% of the scars were estimated as highly vascularized. In the Mexameter®, the melanin index values of the scar areas compared to the healthy skin areas showed a small difference of 12 (p < 0.05). The mean difference of erythema between the scar and the healthy skin areas was 84 (p < 0.001). For the Mexameter®, moderate correlations were found when comparing 'erythema' with the OSAS category 'vascularization' (r = 0.33, p < 0.05) and 'melanin' with the OSAS parameter 'pigmentation' (r = 0.28, p < 0.05). When comparing the Mexameter® measurements to the OSAS questionnaire, 27% of the scars were wrongly evaluated as 'hyperpigmented' by the observer and 21% as 'hypervascularized', while showing low measurements in the device. Additionally, a novel Mexameter® ordinal scare scale was calculated. CONCLUSION In this study, we were able to show on a relatively large patient population that with the Mexameter®, the subjectivity of the scar colour assessment by examiner/patient can be overcome, but precise differentiation can still be ensured with subjective evaluation tools. We further introduced a novel Mexameter® Scar Scale. It is necessary to further investigate the vast range of objective devices and develop scar panels for with an incorporation of objective and subjective devices to further improve reliability with reduced bias in terms of scar assessment.
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Affiliation(s)
- M Bagheri
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany.
| | - M von Kohout
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - P C Fuchs
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - H Seyhan
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - J P Stromps
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, Cologne, Germany
| | - C Opländer
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, Cologne, Germany
| | - J L Schiefer
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
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Bairagi A, Tyack Z, Kimble RM, McPhail SM, McBride CA, Patel B, Vagenas D, Dettrick Z, Griffin B. Effectiveness of a Regenerative Epithelial Suspension (RES), on the pigmentation of split-thickness skin graft donor sites in children: the d RESsing pilot randomised controlled trial protocol. BMJ Open 2024; 14:e077525. [PMID: 38417964 PMCID: PMC10900329 DOI: 10.1136/bmjopen-2023-077525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/04/2024] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Paediatric donor site wounds are often complicated by dyspigmentation following a split-thickness skin graft. These easily identifiable scars can potentially never return to normal pigmentation. A Regenerative Epidermal Suspension (RES) has been shown to improve pigmentation in patients with vitiligo, and in adult patients following a burn injury. Very little is known regarding the efficacy of RES for the management of donor site scars in children. METHODS AND ANALYSIS A pilot randomised controlled trial of 40 children allocated to two groups (RES or no RES) standard dressing applied to donor site wounds will be conducted. All children aged 16 years or younger requiring a split thickness skin graft will be screened for eligibility. The primary outcome is donor site scar pigmentation 12 months after skin grafting. Secondary outcomes include re-epithelialisation time, pain, itch, dressing application ease, treatment satisfaction, scar thickness and health-related quality of life. Commencing 7 days after the skin graft, the dressing will be changed every 3-5 days until the donor site is ≥ 95% re-epithelialised. Data will be collected at each dressing change and 3, 6 and 12 months post skin graft. ETHICS AND DISSEMINATION Ethics approval was confirmed on 11 February 2019 by the study site Human Research Ethics Committee (HREC) (HREC/18/QCHQ/45807). Study findings will be published in peer-reviewed journals and presented at national and international conferences. This study was prospectively registered on the Australian New Zealand Clinical Trials Registry (available at https://anzctr.org.au/ACTRN12620000227998.aspx). TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry [Available at https://anzctr.org.au/ACTRN12620000227998.aspx].
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Affiliation(s)
- Anjana Bairagi
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Burns and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zephanie Tyack
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Roy M Kimble
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Burns and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation (AusHSI), Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
- Digital Health and Informatics, Metro South Health, Brisbane, Queensland, Australia
| | - Craig Antony McBride
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Bhaveshkumar Patel
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Dimitrios Vagenas
- Research Methods Group, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Zoe Dettrick
- Research Methods Group, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Bronwyn Griffin
- Centre for Children's Burns & Trauma Research and Pegg Leditschke Children's Burn Centre, Queensland Children's Hospital, Brisbane, Queensland, Australia
- Burns and Trauma Research, Centre for Children's Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland, Australia
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Raes A, Athanasiou G, Azari-Dolatabad N, Sadeghi H, Gonzalez Andueza S, Arcos JL, Cerquides J, Chaitanya Pavani K, Opsomer G, Bogado Pascottini O, Smits K, Angel-Velez D, Van Soom A. Manual versus deep learning measurements to evaluate cumulus expansion of bovine oocytes and its relationship with embryo development in vitro. Comput Biol Med 2024; 168:107785. [PMID: 38056209 DOI: 10.1016/j.compbiomed.2023.107785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/20/2023] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Cumulus expansion is an important indicator of oocyte maturation and has been suggested to be indicative of greater oocyte developmental capacity. Although multiple methods have been described to assess cumulus expansion, none of them is considered a gold standard. Additionally, these methods are subjective and time-consuming. In this manuscript, the reliability of three cumulus expansion measurement methods was assessed, and a deep learning model was created to automatically perform the measurement. Cumulus expansion of 232 cumulus-oocyte complexes was evaluated by three independent observers using three methods: (1) measurement of the cumulus area, (2) measurement of three distances between the zona pellucida and outer cumulus, and (3) scoring cumulus expansion on a 5-point Likert scale. The reliability of the methods was calculated in terms of intraclass-correlation coefficients (ICC) for both inter- and intra-observer agreements. The area method resulted in the best overall inter-observer agreement with an ICC of 0.89 versus 0.54 and 0.30 for the 3-distance and scoring methods, respectively. Therefore, the area method served as the base to create a deep learning model, AI-xpansion, which reaches a human-level performance in terms of average rank, bias and variance. To evaluate the accuracy of the methods, the results of cumulus expansion calculations were linked to embryonic development. Cumulus expansion had increased significantly in oocytes that achieved successful embryo development when measured by AI-xpansion, the area- or 3-distance method, while this was not the case for the scoring method. Measuring the area is the most reliable method to manually evaluate cumulus expansion, whilst deep learning automatically performs the calculation with human-level precision and high accuracy and could therefore be a valuable prospective tool for embryologists.
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Affiliation(s)
- Annelies Raes
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium.
| | - Georgios Athanasiou
- Artificial Intelligence Research Institute (IIIA-CSIC), 08193, Bellaterra, Spain; Department of Computer Science, Universitat Autonoma de Barcelona, Spain.
| | - Nima Azari-Dolatabad
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Hafez Sadeghi
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Sebastian Gonzalez Andueza
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Josep Lluis Arcos
- Artificial Intelligence Research Institute (IIIA-CSIC), 08193, Bellaterra, Spain
| | - Jesus Cerquides
- Artificial Intelligence Research Institute (IIIA-CSIC), 08193, Bellaterra, Spain.
| | - Krishna Chaitanya Pavani
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Geert Opsomer
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Osvaldo Bogado Pascottini
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Katrien Smits
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Daniel Angel-Velez
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium; Research Group in Animal Sciences-INCA-CES, Universidad CES, Medellin, 050021, Colombia
| | - Ann Van Soom
- Department of Internal Medicine, Reproduction and Population Medicine, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
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Bagheri M, Werres M, Fuchs PC, Seyhan H, Lefering R, Grieb G, Schiefer JL. Which Moisturizer to Use in Scar Therapy after Burn Injuries? A Subjective and Objective Skin and Scar Evaluation after Topical Treatment with Dexpanthenol, Aloe Vera, and Plant Oil. Medicina (Kaunas) 2023; 59:1874. [PMID: 37893592 PMCID: PMC10608183 DOI: 10.3390/medicina59101874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/09/2023] [Accepted: 10/19/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Good scar management in burn care is essential. Nevertheless, there are no consistent recommendations regarding moisturizers for scar management. Our aim was to investigate and compare the effects of commonly used products on normal skin and burn scars. Materials and Methods: A total of 30 skin-healthy (control group) and 12 patients with burn scars were included in this study. For an intraindividual comparison, each participant received creams consisting of dexpanthenol (P), aloe vera (A), and a natural plant oil (O) with instructions to apply them daily to a previously defined area for at least 28 days. Objective scar evaluation was performed with Visioscan®; Tewameter®; Cutometer®, and the Oxygen To See® device. Subjective evaluation was performed with an "application" questionnaire, the Patient and Observer Scar Assessment Scale (POSAS), and with the "best of three" questionnaire. Results: After (A) a high trend of amelioration of +30%, TEWL was detected on the scar area. Blood flow increased slightly on healthy skin areas after (A) application to +104%. The application of (A) on healthy skin demonstrated a positive effect on the parameters of scaliness (+22%, p < 0.001), softness (+14%, p = 0.046), roughness R1 (+16%, p < 0.001) and R2 (+17%, p = 0.000), volume (+22%, p < 0.001), and surface area (+7%, p < 0.001) within the control group. After (P), a significant improvement of the baseline firmness parameter of +14.7% was detected (p = 0.007). (P) also showed a beneficial effect on the parameters of R1 (+7%, p = 0.003), R2 (+6%, p = 0.001), and volume (+17%, p = 0.001). (O) lead to a statistically significant improvement of volume (+15%, p = 0.009). Overall, most study participants stated (A) to be the "best of three". Conclusions: (A) performed statistically best, and is a well-tolerated moisturizing product. However, further quantitative studies are needed to provide statistically significant clarification for uniform recommendations for scar therapy.
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Affiliation(s)
- Mahsa Bagheri
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), 51109 Cologne, Germany
| | - Michelle Werres
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), 51109 Cologne, Germany
| | - Paul C. Fuchs
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), 51109 Cologne, Germany
| | - Harun Seyhan
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), 51109 Cologne, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, Witten/Herdecke University, 51109 Cologne, Germany
| | - Gerrit Grieb
- Department of Plastic and Hand Surgery, Burn Center, Medical Faculty, RWTH Aachen University, 52062 Aachen, Germany
- Department of Plastic and Hand Surgery, Hospital Havelhohe, 14089 Berlin, Germany
| | - Jennifer Lynn Schiefer
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), 51109 Cologne, Germany
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Chen YY, Patel KM, Imran R, Hassouna T, Amirize E, Abdulsalam A, Bishop J, Slade A, Ventura M, Yarrow J, Lord JM, Wilson Y, Moiemen NS. SMOOTH protocol: A pilot randomised prospective intra-patient single-blinded observational study for examining the mechanistic basis of ablative fractional carbon dioxide laser therapy in treating hypertrophic scarring. PLoS One 2023; 18:e0285230. [PMID: 37682920 PMCID: PMC10490849 DOI: 10.1371/journal.pone.0285230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Burn injuries are the fourth most common type of trauma and are associated with substantial morbidity and mortality. The impact of burn injury is clinically significant as burn injuries often give rise to exuberant scarring. Hypertrophic scarring (HTS) is a particular concern as up to 70% of burns patients develop HTS. Laser therapy is used for treating HTS and has shown positive clinical outcomes, although the mechanisms remain unclear limiting approaches to improve its effectiveness. Emerging evidence has shown that fibroblasts and senescent cells are important modifiers of scarring. This study aims to investigate the cellular kinetics in HTS after laser therapy, with a focus on the association of scar reduction with the presence of senescent cells. METHODS We will conduct a multicentre, intra-patient, single-blinded, randomised controlled longitudinal pilot study with parallel assignments to achieve this objective. 60 participants will be recruited to receive 3 interventional ablative fractional CO2 laser treatments over a 12-month period. Each participant will have two scars randomly allocated to receive either laser treatment or standard care. Biopsies will be obtained from laser-treated, scarred-no treatment and non-scarred tissues for immune-histological staining to investigate the longitudinal kinetics of p16INK4A+-senescent cells and fibroblast subpopulations (CD90+/Thy1+ and αSMA+). Combined subjective scar assessments including Modified Vancouver Scar Scale, Patient and Observer Scar Assessment Scale and Brisbane Burn Scar Impact Profile; and objective assessment tools including 3D-Vectra-H1 photography, DermaScan® Cortex, Cutometer® and ColoriMeter®DSMIII will be used to evaluate clinical outcomes. These will then be used to investigate the association between senescent cells and scar reduction after laser therapy. This study will also collect blood samples to explore the systemic biomarkers associated with the response to laser therapy. DISCUSSION This study will provide an improved understanding of mechanisms potentially mediating scar reduction with laser treatment, which will enable better designs of laser treatment regimens for those living with HTS. TRIAL REGISTRATION ClinicalTrials.gov: NCT04736251.
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Affiliation(s)
- Yung-Yi Chen
- The Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Krupali M. Patel
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Rizwana Imran
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Tarek Hassouna
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Ezekwe Amirize
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Abdulrazak Abdulsalam
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Jonathan Bishop
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Anita Slade
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Maximina Ventura
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Jeremy Yarrow
- Welsh Centre for Burns and Plastic Surgery Morriston Hospital, Swansea, United Kingdom
| | - Janet M. Lord
- The Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Yvonne Wilson
- The Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Birmingham Children’s Hospital, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Naiem S. Moiemen
- The Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
- National Institute for Health Research Surgical Reconstruction and Microbiology Research Centre, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
- Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, United Kingdom
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Spyridonos P, Gaitanis G, Likas A, Seretis K, Moschovos V, Feldmeyer L, Heidemeyer K, Zampeta A, Bassukas ID. Image Perceptual Similarity Metrics for the Assessment of Basal Cell Carcinoma. Cancers (Basel) 2023; 15:3539. [PMID: 37509205 PMCID: PMC10377636 DOI: 10.3390/cancers15143539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Efficient management of basal cell carcinomas (BCC) requires reliable assessments of both tumors and post-treatment scars. We aimed to estimate image similarity metrics that account for BCC's perceptual color and texture deviation from perilesional skin. In total, 176 clinical photographs of BCC were assessed by six physicians using a visual deviation scale. Internal consistency and inter-rater agreement were estimated using Cronbach's α, weighted Gwet's AC2, and quadratic Cohen's kappa. The mean visual scores were used to validate a range of similarity metrics employing different color spaces, distances, and image embeddings from a pre-trained VGG16 neural network. The calculated similarities were transformed into discrete values using ordinal logistic regression models. The Bray-Curtis distance in the YIQ color model and rectified embeddings from the 'fc6' layer minimized the mean squared error and demonstrated strong performance in representing perceptual similarities. Box plot analysis and the Wilcoxon rank-sum test were used to visualize and compare the levels of agreement, conducted on a random validation round between the two groups: 'Human-System' and 'Human-Human.' The proposed metrics were comparable in terms of internal consistency and agreement with human raters. The findings suggest that the proposed metrics offer a robust and cost-effective approach to monitoring BCC treatment outcomes in clinical settings.
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Affiliation(s)
- Panagiota Spyridonos
- Department of Medical Physics, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Georgios Gaitanis
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Aristidis Likas
- Department of Computer Science & Engineering, School of Engineering, University of Ioannina, 45110 Ioannina, Greece
| | - Konstantinos Seretis
- Department of Plastic Surgery and Burns, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Vasileios Moschovos
- Department of Plastic Surgery and Burns, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Laurence Feldmeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Kristine Heidemeyer
- Department of Dermatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Athanasia Zampeta
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Ioannis D Bassukas
- Department of Skin and Venereal Diseases, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
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Carney BC, Bailey JK, Powell HM, Supp DM, Travis TE. Scar Management and Dyschromia: A Summary Report from the 2021 American Burn Association State of the Science Meeting. J Burn Care Res 2023; 44:535-545. [PMID: 36752791 DOI: 10.1093/jbcr/irad017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Indexed: 02/09/2023]
Abstract
Burn scars, and in particular, hypertrophic scars, are a challenging yet common outcome for survivors of burn injuries. In 2021, the American Burn Association brought together experts in burn care and research to discuss critical topics related to burns, including burn scars, at its State of the Science conference. Clinicians and researchers with burn scar expertise, as well as burn patients, industry representatives, and other interested stakeholders met to discuss issues related to burn scars and discuss priorities for future burn scar research. The various preventative strategies and treatment modalities currently utilized for burn scars were discussed, including relatively noninvasive therapies such as massage, compression, and silicone sheeting, as well as medical interventions such as corticosteroid injection and laser therapies. A common theme that emerged is that the efficacy of current therapies for specific patient populations is not clear, and further research is needed to improve upon these treatments and develop more effective strategies to suppress scar formation. This will necessitate quantitative analyses of outcomes and would benefit from creation of scar biobanks and shared data resources. In addition, outcomes of importance to patients, such as scar dyschromia, must be given greater attention by clinicians and researchers to improve overall quality of life in burn survivors. Herein we summarize the main topics of discussion from this meeting and offer recommendations for areas where further research and development are needed.
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Affiliation(s)
- Bonnie C Carney
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- Department of Biochemistry, Georgetown University School of Medicine, Washington, DC, USA
| | - John K Bailey
- Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Heather M Powell
- The Ohio State University, Departments of Materials Science and Engineering and Biomedical Engineering, Columbus, OH, USA
- Scientific Staff, Shriners Children's Ohio, Dayton, OH, USA
| | - Dorothy M Supp
- Scientific Staff, Shriners Children's Ohio, Dayton, OH, USA
- The University of Cincinnati College of Medicine, Department of Surgery, Cincinnati, OH, USA
| | - Taryn E Travis
- Firefighters' Burn and Surgical Research Laboratory, MedStar Health Research Institute, Washington, DC, USA
- The Burn Center, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Surgery, Georgetown University School of Medicine, Washington, DC, USA
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9
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Lee SY, Cho YS, Kim L, Joo SY, Seo CH. The Intra-rater reliability and validity of ultrasonography in the evaluation of hypertrophic scars caused by burns. Burns 2023; 49:344-352. [PMID: 35459576 DOI: 10.1016/j.burns.2022.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE Hypertrophic scars that occur after burns are less flexible and less elastic than normal skin. Objective measurement tools are required to assess hypertrophic scars after thermal injury. Cutometer® MPA 580 has been widely used for evaluating the properties of hypertrophic scars. Ultrasonography can evaluate elasticity, stiffness, and structure of tissues simultaneously using elastography and B-mode. This study aimed to investigate the intra-rater reliability and validity of elastography to visualize hypertrophic scars. METHODS Sixteen participants with a total of 96 scars were evaluated. The measurement sequence was elastography, Cutometer®, and elastography every 10 min. We then analyzed the intra-rater reliability using intraclass correlation coefficients (ICC). The results measured using elastography on the hypertrophic scars and surrounding normal skin were compared. The relationships between the elastographic and Cutometer® measurements using the 2-and 8-mm probes were compared. RESULTS The intra-rater reliability of elastographic measurements was acceptable for clinical use in terms of strain ratio (SR), shear-wave elastography (SWE), shear-wave speed (SWS), and SWE ratio ( ICC = 0.913, ICC=0.933, ICC = 0.842, and ICC = 0.921). The average SWS and SWE in hypertrophic scars were significantly greater than that for normal skin ( p < 0.001 and p < 0.001). SWE showed correlations with the R0 (r = -0.32, p = 0.002) and R8 (r = -0.30, p = 0.003) measured with the 8-mm probe. The SWE ratio was correlated with the R7 (r = -0.34, p = 0.001) measured with the 2-mm probe. The thickness of hypertrophic scars showed correlations with the R5 (r = 0.33, p < 0.001), R6 (r = 0.44, p < 0.001) and R8 (r = -0.35, p < 0.001) measured with the 8-mm probe. R0-R9 measured with 2-mm Cutometer® probes were not correlated with scar thickness ( r < 0.30, P > 0.05). The total scores of mVSS showed correlations with the R0 (r = 0.35, p < 0.001), R1(r = 0.32., p = 0.001), R3 (r = 0.38, p < 0.001), R4 (r = 0.38, p < 0.001), R8 (r = 0.34, p = 0.001), and R9 (r = 0.34, p = 0.001) measured with the 2-mm probe. R0-R9 measured with 8-mm Cutometer® probes were not correlated with mVSS ( r < 0.30, P > 0.05). The thickness of hypertrophic scars showed correlations with the SWE (r = 0.38, p < 0.001) and SWE ratio (r = 0.35, p < 0.001). Elastographic findings were not correlated with mVSS ( r < 0.30, P > 0.05). CONCLUSION In this study, together with the Cutometer®, ultrasound was confirmed as an evaluation tool that can objectively compare and analyze the difference between normal skin and hypertrophic scars.
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Affiliation(s)
- Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, South Korea
| | - Yoon Soo Cho
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, South Korea
| | - Laurie Kim
- Kirk Kerkorian School of Medicine, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - So Young Joo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, South Korea
| | - Cheong Hoon Seo
- Department of Rehabilitation Medicine, Hangang Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, South Korea.
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Dogan S, Elmasry M, El-Serafi A, Sjöberg F, Vuola J, Kankuri E, Grigoriadi MP, Valtonen J, Abdelrahman I, Steinvall I, Karlsson M, Olofsson P, Lindford A. A prospective dual-centre intra-individual controlled study for the treatment of burns comparing dermis graft with split-thickness skin auto-graft. Sci Rep 2022; 12:21666. [PMID: 36522434 PMCID: PMC9755129 DOI: 10.1038/s41598-022-25346-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
To investigate if donor and recipient site morbidity (healing time and cosmesis) could be reduced by a novel, modified split-thickness skin grafting (STSG) technique using a dermal component in the STSG procedure (DG). The STSG technique has been used for 150 years in surgery with limited improvements. Its drawbacks are well known and relate to donor site morbidity and recipient site cosmetic shortcomings (especially mesh patterns, wound contracture, and scarring). The Dermal graft technique (DG) has emerged as an interesting alternative, which reduces donor site morbidity, increases graft yield, and has the potential to avoid the mesh procedure in the STSG procedure due to its elastic properties. A prospective, dual-centre, intra-individual controlled comparison study. Twenty-one patients received both an unmeshed dermis graft and a regular 1:1.5 meshed STSG. Aesthetic and scar assessments were done using The Patient and Observer Scar Assessment Scale (POSAS) and a Cutometer Dual MPA 580 on both donor and recipient sites. These were also examined histologically for remodelling and scar formation. Dermal graft donor sites and the STSG donor sites healed in 8 and 14 days, respectively (p < 0.005). Patient-reported POSAS showed better values for colour for all three measurements, i.e., 3, 6, and 12 months, and the observers rated both vascularity and pigmentation better on these occasions (p < 0.01). At the recipient site, (n = 21) the mesh patterns were avoided as the DG covered the donor site due to its elastic properties and rendered the meshing procedure unnecessary. Scar formation was seen at the dermal donor and recipient sites after 6 months as in the standard scar healing process. The dermis graft technique, besides potentially rendering a larger graft yield, reduced donor site morbidity, as it healed faster than the standard STSG. Due to its elastic properties, the DG procedure eliminated the meshing requirement (when compared to a 1:1.5 meshed STSG). This promising outcome presented for the DG technique needs to be further explored, especially regarding the elasticity of the dermal graft and its ability to reduce mesh patterns.Trial registration: ClinicalTrials.gov Identifier (NCT05189743) 12/01/2022.
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Affiliation(s)
- Sinan Dogan
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden ,grid.411384.b0000 0000 9309 6304Linköping University Hospital, 58185 Linköping, Sweden
| | - Moustafa Elmasry
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ahmed El-Serafi
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jyrki Vuola
- grid.7737.40000 0004 0410 2071Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Esko Kankuri
- grid.7737.40000 0004 0410 2071Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marina Perdiki Grigoriadi
- grid.5640.70000 0001 2162 9922Department of Clinical Pathology, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Jussi Valtonen
- grid.7737.40000 0004 0410 2071Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Islam Abdelrahman
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ingrid Steinvall
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Matilda Karlsson
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Pia Olofsson
- grid.5640.70000 0001 2162 9922Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Andrew Lindford
- grid.7737.40000 0004 0410 2071Department of Plastic Surgery, Helsinki Burn Centre, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Shupp JW, Holmes JH, Moffatt LT, Phelan HA, Sousse L, Romanowski KS, Jeschke M, Kowalske KJ, Badger K, Allely R, Cartotto R, Burmeister DM, Kubasiak JC, Wolf SE, Wallace KF, Gillenwater J, Schneider DM, Hultman CS, Wiechman SA, Bailey JK, Powell HM, Travis TE, Supp DM, Carney BC, Johnson LS, Johnson LS, Chung KK, Chung KK, Kahn SA, Gibson ALF, Christy RJ, Carter JE, Carson JS, Palmieri TL, Kopari NM, Blome-Eberwein SA, Hickerson WL, Parry I, Cancio JM, Suman O, Schulman CI, Lamendella R, Hill DM, Wibbenmeyer LA, Nygaard RM, Wagner AL, Carter ADW, Greenhalgh DG, Lawless MB, Carlson DL, Harrington DT. Proceedings of the 2021 American Burn Association State and Future of Burn Science Meeting. J Burn Care Res 2022; 43:1241-1259. [PMID: 35988021 DOI: 10.1093/jbcr/irac092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Periodically, the American Burn Association (ABA) has convened a State of the Science meeting on various topics representing multiple disciplines within burn care and research. In 2021 at the request of the ABA President, meeting development was guided by the ABA's Burn Science Advisory Panel (BSAP) and a subgroup of meeting chairs. The goal of the meeting was to produce both an evaluation of the current literature and ongoing studies, and to produce a research agenda and/or define subject matter-relevant next steps to advance the field(s). Members of the BSAP defined the topics to be addressed and subsequently solicited for nominations of expert speakers and topic leaders from the ABA's Research Committee. Current background literature for each topic was compiled by the meeting chairs and the library then enhanced by the invited topic and breakout discussion leaders. The meeting was held in New Orleans, LA on November 2nd and 3rd and was formatted to allow for 12 different topics, each with two subtopics, to be addressed. Topic leaders provided a brief overview of each topic to approximately 100 attendees, followed by expert-lead breakout sessions for each topic that allowed for focused discussion among subject matter experts and interested participants. The breakout and topic group leaders worked with the participants to determine research needs and associated next steps including white papers, reviews and in some cases collaborative grant proposals. Here, summaries from each topic area will be presented to highlight the main foci of discussion and associated conclusions.
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12
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Klimitz FJ, Neubauer H, Stolle A, Ripper S, Daeschler SC, Aman M, Boecker A, Thomas B, Kneser U, Harhaus L. Objective Burn Scar Assessment in Clinical Practice Using the Cutometer©: Introduction and Validation of a Standardized Measurement Protocol. J Burn Care Res 2022; 44:95-105. [PMID: 36300728 PMCID: PMC9825325 DOI: 10.1093/jbcr/irac154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Indexed: 01/12/2023]
Abstract
An objective burn scar assessment is essential to informed therapeutic decision-making and to monitor scar development over time. However, widely employed scar rating scales show poor inter-rater reliability. For this study we developed a standardized measurement protocol for the Cutometer© applicable for objective burn scar assessment in everyday clinical practice. We developed a measurement protocol for the Cutometer© MPA 580 including a scar site relocation technique based on anatomical landmarks. The protocol emerged through several steps: Identifying key factors for valid and reliable measurements, preliminary testing, specification of technical details, refining the protocol and final testing. Consecutively, the protocol was validated for inter-rater reliability by assessing 34 burn scars in 17 patients by four clinicians and computing an Intra-class Correlation Coefficient (ICC). Parameter R0, representing scar pliability, was identified as the best suited output parameter yielding excellent inter-rater reliability for average measures (ICC 0.92 [95% CI 0.86; 0.96]) and acceptable reliability for single measures (ICC: 0.74 [0.61; 0.84]). The pressure applied on the measuring probe was identified as an influential confounding factor for reliable measurements. Rater gender did not influence reliability of measurements. The introduced standardized measurement protocol for the Cutometer© MPA 580 enables an objective and reliable burn scar assessment for clinical as well as research purposes.
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Affiliation(s)
- Felix J Klimitz
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Hubert Neubauer
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Annette Stolle
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Sabine Ripper
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Simeon C Daeschler
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Martin Aman
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Arne Boecker
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Benjamin Thomas
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany,Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Ulrich Kneser
- Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany
| | - Leila Harhaus
- Address correspondence to Leila Harhaus, MD, Vice Chair, Department of Hand, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Plastic- and Hand Surgery, University of Heidelberg, Ludwig-Guttmann-Str. 13, 67071, Ludwigshafen, Germany. Presented at: 38th Annual Conference of the German Association of Burn Treatment (DAV) 2020 in Zell am See, Austria, Best Paper Award, IFSSH/IFSHT Triennial Congress 2019 in Berlin, Germany
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13
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Basson R, Bayat A. Skin scarring: Latest update on objective assessment and optimal management. Front Med (Lausanne) 2022; 9:942756. [PMID: 36275799 PMCID: PMC9580067 DOI: 10.3389/fmed.2022.942756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Although skin scarring is considered by some to be a minor, unavoidable consequence in response to skin injury, for many patients, cosmetically unsightly scars may cause uncomfortable symptoms and loss of function plus significant psycho-social distress. Despite their high prevalence and commonality, defining skin scars and their optimal management has proven problematic. Therefore, a literature search to assess the current evidence-base for scarring treatment options was conducted, and only those deemed Levels of Evidence 1 or 2 were included. Understanding the spectrum of skin scarring in the first instance is imperative, and is mainly comprised of four distinct endotypes; Stretched (flat), Contracted, Atrophic, and Raised for which the acronym S.C.A.R. may be used. Traditionally, scar assessment and response to therapy has employed the use of subjective scar scales, although these are now being superseded by non-invasive, objective and quantitative measurement devices. Treatment options will vary depending on the specific scar endotype, but fall under one of 3 main categories: (1) Leave alone, (2) Non-invasive, (3) Invasive management. Non-invasive (mostly topical) management of skin scarring remains the most accessible, as many formulations are over-the-counter, and include silicone-based, onion extract-based, and green tea-based, however out of the 52 studies identified, only 28 had statistically significant positive outcomes. Invasive treatment options includes intralesional injections with steroids, 5-FU, PDT, and laser with surgical scar excision as a last resort especially in keloid scar management unless combined with an appropriate adjuvant therapy. In summary, scar management is a rapidly changing field with an unmet need to date for a structured and validated approach.
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Affiliation(s)
- Rubinder Basson
- Wound Healing Theme, NIHR Manchester Biomedical Research Centre, Centre for Dermatology Research, University of Manchester, Manchester, United Kingdom
| | - Ardeshir Bayat
- Wound Healing Theme, NIHR Manchester Biomedical Research Centre, Centre for Dermatology Research, University of Manchester, Manchester, United Kingdom,Wound Healing Unit, Medical Research Council (South Africa), Division of Dermatology, University of Cape Town, Cape Town, South Africa,*Correspondence: Ardeshir Bayat,
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Abbas DB, Lavin CV, Fahy EJ, Griffin M, Guardino N, King M, Chen K, Lorenz PH, Gurtner GC, Longaker MT, Momeni A, Wan DC. Standardizing Dimensionless Cutometer Parameters to Determine In Vivo Elasticity of Human Skin. Adv Wound Care (New Rochelle) 2022; 11:297-310. [PMID: 34470542 DOI: 10.1089/wound.2021.0082] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Skin fibrosis places an enormous burden on patients and society, but disagreement exists over methods to quantify severity of skin scarring. A suction cutometer measures skin elasticity in vivo, but it has not been widely adopted because of inconsistency in data produced. We investigated variability of several dimensionless parameters generated by the cutometer to improve their precision and accuracy. Approach: Twenty adult human subjects underwent suction cutometer measurement of normal skin (NS) and fibrotic scars (FS). Using Mode 1, each subject underwent five trials with each trial containing four curves. R0/2/5/6/7 and Q1/2/3 data were collected. Analyses were performed on these calculated parameters. Results: R0/2/5/6/7 and Q1/2 parameters from curves 1 to 4 demonstrated significant differences, whereas these same parameters were not significantly different when only using curves 2-4. Individual analysis of all parameters between curve 1 and every subsequent curve was statistically significant for R0, R2, R5, R6, R7, Q1, and Q2. No differences were appreciated for parameter Q3. Comparison between NS and FS were significantly different for parameters R5, Q1, and Q3. Innovation: Our study is the first demonstration of accurate comparison between NS and FS using the dimensionless parameters of a suction cutometer. Conclusions: Measured parameters from the first curve of each trial were significantly different from subsequent curves for both NS and FS. Precision and reproducibility of data from dimensionless parameters can therefore be improved by removing the first curve. R5, Q1, and Q3 parameters differentiated NS as more elastic than FS.
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Affiliation(s)
- Darren B. Abbas
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Christopher V. Lavin
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Evan J. Fahy
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Michelle Griffin
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Nicholas Guardino
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Megan King
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Kellen Chen
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - P. Hermann Lorenz
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Geoffrey C. Gurtner
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Michael T. Longaker
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
- Institute for Stem Cell Biology and Regenerative Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Arash Momeni
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
| | - Derrick C. Wan
- Hagey Laboratory for Pediatric Regenerative Medicine, Department of Surgery, Stanford University School of Medicine, Stanford, California, USA
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15
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Schiefer JL, Andreae J, Fuchs PC, Lefering R, Heidekrueger PI, Schulz A, Bagheri M. Evaluation of Scar Quality after Treatment of Superficial Burns with Dressilk ® and Suprathel ®-In an Intraindividual Clinical Setting. J Clin Med 2022; 11:jcm11102857. [PMID: 35628983 PMCID: PMC9144963 DOI: 10.3390/jcm11102857] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 01/27/2023] Open
Abstract
Background: Various synthetic and biological wound dressings are available for the treatment of superficial burns, and standard care differs among hospitals. Nevertheless, the search for an ideal wound dressing offering a safe healing environment as well as optimal scar quality while being economically attractive is a continuing process. In recent years, Dressilk®, which consists of pure silk, has become the standard of care for the treatment of superficial burns in our hospital. However, no long-term scar-evaluation studies have been performed to compare Dressilk® with the often-used and more expensive Suprathel® in the treatment of superficial burns. Methods: Subjective and objective scar evaluations were performed three, six, and twelve months after treatment in patients who received simultaneous treatment of 20 superficial burn wounds with both Suprathel® and Dressilk®. The evaluations were performed using the Vancouver Scar Scale, the Cutometer®, Mexameter®, Tewameter®, and the O2C®. Results: Both dressings showed mostly equivalent results in subjective scar evaluations. In the objective scar evaluations, the wounds treated with Dressilk® showed a faster return to the qualities of non-injured skin. Wound areas treated with the two dressings showed no significant differences in elasticity and transepidermal water loss after 12 months. Only oxygen saturation was significantly lower in wound areas treated with Suprathel® (p = 0.008). Subjectively, wound areas treated with Dressilk® showed significantly higher pigmentation after six months, which was not apparent after 12 months. Conclusion: Both wound dressings led to esthetically satisfying scar recovery without significant differences from normal uninjured skin after 12 months. Therefore, Dressilk® remains an economically and clinically interesting alternative to Suprathel® for the treatment of superficial burns.
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Affiliation(s)
- Jennifer Lynn Schiefer
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58448 Witten, Germany; (J.A.); (P.C.F.); (A.S.); (M.B.)
- Correspondence: ; Tel.: +49-221-8907-0
| | - Janine Andreae
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58448 Witten, Germany; (J.A.); (P.C.F.); (A.S.); (M.B.)
| | - Paul Christian Fuchs
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58448 Witten, Germany; (J.A.); (P.C.F.); (A.S.); (M.B.)
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten-Herdecke, 50933 Cologne, Germany;
| | - Paul Immanuel Heidekrueger
- Center of Plastic, Aesthetic, Hand and Reconstructive Surgery, University of Regensburg, 93053 Regensburg, Germany;
| | - Alexandra Schulz
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58448 Witten, Germany; (J.A.); (P.C.F.); (A.S.); (M.B.)
| | - Mahsa Bagheri
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, 58448 Witten, Germany; (J.A.); (P.C.F.); (A.S.); (M.B.)
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16
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Abstract
Significance: The physical and psychological sequalae of burn injuries account for 10 million disability-adjusted life years lost annually. Hypertrophic scarring (HSc) after burn injury results in reduced mobility, contracture, pain, itching, and aesthetic changes for burn survivors. Despite the prevalence of scarring and the number of scar therapies available, none are highly effective at preventing HSc after burn injury. Recent Advances: Recent studies modulating the mechanical environment surrounding incisional and excisional wounds have shown off-loading of tension to be a powerful strategy to prevent scar formation. Preclinical studies applying force perpendicular to the surface of the skin or using a combination of pressure both circumferentially and perpendicularly have shown substantial reductions in scar thickness and contraction after burn injury. Critical Issues: Though pressure therapy is highly effective in preclinical studies, outcomes in clinical studies have been variable and may be a result of differing therapy protocols and garment material fatigue. A recent adult clinical study reported a significant reduction in pressure after 1 month of use and significant reduction between 1 and 2 months of use, resulting in below therapeutic doses of pressure applied after only 1 month of use. Future Directions: To enhance efficacy of pressure garments, new low-fatigue materials must be developed for use in standard garments or garments must be redesigned to allow for adjustment to compensate for the loss of pressure with time. Additionally, measurements of applied pressure should be performed routinely during clinic visits to ensure that therapeutic doses of pressure are being delivered.
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Affiliation(s)
- Heather M. Powell
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio, USA
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio, USA
- Shriners Children's Ohio, Dayton, Ohio, USA
| | - Bernadette Nedelec
- School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CHUM), Montreal, Quebec, Canada
- Hôpital de réadaptation Villa Medica, Montreal, Quebec, Canada
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Gilbert I, Gaudreault N, Gaboury I. Exploring the Effects of Standardized Soft Tissue Mobilization on the Viscoelastic Properties, Pressure Pain Thresholds, and Tactile Pressure Thresholds of the Cesarean Section Scar. J Integr Complement Med 2022; 28:355-362. [PMID: 35426735 PMCID: PMC9051872 DOI: 10.1089/jicm.2021.0178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Objectives of soft tissue mobilization applied to cesarean section (C-section) scars are to decrease stiffness and to reduce pain. Research investigating these effects is lacking. Materials and methods: The authors conducted a descriptive, exploratory, proof-of-concept clinical study. Women aged 18 to 40 years who had undergone at least one C-section were recruited. A trained osteopath performed standardized mobilization of the C-section scar once a week for 2 weeks. Scar quality and pain characteristics, viscoelastic properties, pressure pain thresholds, and tactile pressure thresholds were measured before and after each session. Paired Student's t-tests and Friedman's test with Dunn–Bonferroni adjustment were performed to assess the immediate and short-term effects of mobilizations. Kendall's W and Cohen's d were calculated to determine effect sizes over the short term. Simple bootstrapped bias-corrected and accelerated 95% median confidence intervals were computed. Results: Thirty-two participants completed the study. The Patient and Observer Scar Assessment Scale questionnaire revealed differences with small and moderate effects for stiffness (p = 0.021, d = 0.43), relief (p < 0.001, d = 0.28), surface area (p = 0.040, d = 0.36), flexibility (p = 0.007, d = 0.52), and participant opinion (p = 0.001, d = 0.62). Mobilizations increased elasticity (p < 0.001, W = 0.11), decreased stiffness (p < 0.001, W = 0.30), and improved pressure pain thresholds (p < 0.001, W = 0.10) of the C-section, with small to moderate effects. The results also showed decreased tone and mechanical stress relaxation time, as well as increased tactile pressure thresholds at the different measurement times (p < 0.05), but trivial effect sizes (W < 0.10). Creep showed trivial effect and no significant difference (p = 0.09). Conclusion: This study showed that two sessions of mobilization of C-section scar might have a beneficial effect on some viscoelastic properties of the C-section as well as on pain. Some variables of interest useful for future empirical studies are highlighted. ClinicalTrial. Gov NCT04320355.
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Affiliation(s)
- Isabelle Gilbert
- School of Rehabilitation and Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Nathaly Gaudreault
- School of Rehabilitation and Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
| | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Canada
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18
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Al-Humairi A, Ip RHL, Spuur K, Zheng X, Huang B. Visual grading experiments and optimization in CBCT dental implantology imaging: preliminary application of integrated visual grading regression. Radiat Environ Biophys 2022; 61:133-145. [PMID: 34988606 DOI: 10.1007/s00411-021-00959-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 11/13/2021] [Indexed: 06/14/2023]
Abstract
This study uses a general formulation of integrated visual grading regression (IVGR) and applies it to cone beam computed tomography (CBCT) scan data related to anatomical landmarks for dental implantology. The aim was to assess and predict a minimum acceptable dose for diagnostic imaging and reporting. A skull phantom was imaged with a CBCT unit at various diagnostic exposures. Key anatomical landmarks within the images were independently reviewed by three trained observers. Each provided an overall image quality score. Statistical analysis was carried out to examine the acceptability of the images taken, using an IVGR analysis that was formulized as a three-stage protocol including defining an integrated score, development of an ordinal regression, and investigation of the possibility for dose reduction through estimated parameters. For a unit increase in the logarithm of radiation dose, the odds ratio that the integrated score for an image assessed by observers being rated in a higher category was 3.940 (95% confidence interval: 1.016-15.280). When assessed by the observers, the minimum dose required to achieve a 75% probability for an image to be classified as at least acceptable was 1346.91 mGy·cm2 dose area product (DAP), a 31% reduction compared to the 1962 mGy·cm2 DAP default dosage of the CBCT unit. The kappa values of the intra and inter-observer reliability indicated moderate agreements, while a discrepancy among observers was also identified because each, as expected, perceived visibility differently. The results of this work demonstrate the IVGR's predictive value of dose saving in the effort to reduce dose to patients while maintaining reportable diagnostic image quality.
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Affiliation(s)
- Ahmed Al-Humairi
- School of Dentistry, The University of Queensland, Herston, QLD, Australia.
| | - Ryan H L Ip
- School of Computing, Mathematics and Engineering, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Kelly Spuur
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Xiaoming Zheng
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
| | - Boyen Huang
- Department of Primary Dental Care, University of Minnesota School of Dentistry, Minneapolis, MN, USA
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Aydın H, Kızılgöz V, Ersan Ö, Hekimoğlu B. The Role of Diffusion Weighted MR Imaging in the Diagnosis of Tendon Injuries of the Ankle and Foot. Medicina (B Aires) 2022; 58:321. [PMID: 35208644 PMCID: PMC8879388 DOI: 10.3390/medicina58020321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/27/2022] [Accepted: 02/03/2022] [Indexed: 12/03/2022] Open
Abstract
Background and objectives: Our aim is to determine the diagnostic performance and utility of Diffusion Weighted MR Imaging (DWI) against the routine Magnetic Resonance Imaging (MRI) for the evaluation of patients with tendon injuries of the ankle and foot. Materials and Method: After institutional review board approval and informed consent taken from all the patients, ankle and foot MR imaging and DWI-Apparent Diffusion Coefficient (ADC) mapping were performed on the 81 injured tendons of 50 patients. All tendon injuries were named as Rupture (R), Partial tear (PT), and Tenosynovitis (T). Diagnostic interpretation was based on the MRI-DWI and ADC mapping, verified by either open surgery, diagnostic arthroscopy, or conservative procedures-splint application. Statistical analysis of this research was assessed by Fischer’s exact test, variance analysis test between dependent groups, Receiver Operating Characteristics (ROC) curve, and Pearson chi square statistics. Results: MRI depicted all tendon injuries with 70% sensitivity and 100% specificity, and showed a significant statistical relationship to surgical and arthroscopic references with high agreement (p < 0.05, k: 0.609). DWI had 100% sensitivity and 83–90% specificity for the visualization of tendon injuries with certain agreement and a significant statistical relationship to the gold standard (p < 0.05, k: 0.890–0.899). For all those injured tendons, DWI had 100% sensitivity for the diagnosis of R, and 92–97% sensitivity corresponding to PT and T over routine ankle MR imaging. The specificity of DWI to MRI ranged from 75 to 44% for all the injured tendons. DWI had significant statistical superiority over MRI for the visualization of R, PT, and T of all tendons included in this research (p < 0.05). Conclusions: DWI is a good imaging modality for the visualization of ankles with tendon injuries, possibly further improving the sensitivity of the classical ankle and foot MRI, and supplying more beneficial and diagnostic information than routine MR imaging on the basis of R, PT, and T of tendons at the ankle and foot.
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Goldie K, Kerscher M, Fabi SG, Hirano C, Landau M, Lim TS, Woolery-Lloyd H, Mariwalla K, Park JY, Yutskovskaya Y. Skin Quality - A Holistic 360° View: Consensus Results. Clin Cosmet Investig Dermatol 2021; 14:643-654. [PMID: 34163203 PMCID: PMC8214518 DOI: 10.2147/ccid.s309374] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 05/01/2021] [Indexed: 12/12/2022]
Abstract
Introduction Skin quality is an important component of human attractiveness. To date, there are no standardized criteria for good skin quality. To establish a consensus for good skin quality parameters and measurement and treatment options, a virtual skin quality advisory board consisting of a global panel of highly experienced aesthetic dermatologists/aesthetic physicians was convened. Methods A total of 10 dermatologists/aesthetic physicians served on the advisory board. A modified version of the Delphi method was used to arrive at consensus. Members accessed an online platform to review statements on skin quality criteria from their peers, including treatment and measurement options, and voted to indicate whether they agreed or disagreed. Statements that did not have agreement were modified and the members voted again. Consensus was defined as: strong consensus = greater than 95% agreement; consensus = 75% to 95% agreement; majority consent = 50% to 75% agreement; no consensus = less than 50% agreement. Results There was strong consensus that good skin quality is defined as healthy, youthful in appearance (appearing younger than a person's chronological age), undamaged skin and that skin quality can be described across all ethnicities by four emergent perceptual categories (EPCs): skin tone evenness, skin surface evenness, skin firmness, and skin glow. The EPCs can be affected by multiple tissue layers (ie, skin surface quality can stem from and be impacted by deep structures or tissues). This means that topical approaches may not be sufficient. Instead, improving skin quality EPCs can require a multilayer treatment strategy. Conclusion This global advisory board established strong consensus that skin quality can be described by four EPCs, which can help clinicians determine the appropriate treatment option(s) and the tissue or skin layer(s) to address. Skin quality is important to human health and wellbeing and patients' perception for the need for aesthetic treatment.
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Affiliation(s)
| | - Martina Kerscher
- Division of Cosmetic Science, Department of Biochemistry and Molecular Biology, University of Hamburg, Hamburg, Germany
| | | | - Cyro Hirano
- Division of Dermatology General Polyclinic of Rio de Janeiro, Private Practice, CD Clinica Dermatologica, Rio de Janeiro, Brazil
| | - Marina Landau
- Dermatology Unit, Wolfson Medical Center, Holon, Israel
| | | | - Heather Woolery-Lloyd
- Department of Ethnic Skin Care, University of Miami Cosmetic Medicine and Research Institute, Miami Beach, FL, USA
| | | | - Je-Young Park
- Apkoo-Jung Department, Oracle Dermatology Center, Seoul, Republic of Korea
| | - Yana Yutskovskaya
- Dermatovenerology and Cosmetology Department, Pacific State Medical University of Health, Moscow, Russia
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21
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Price K, Moiemen N, Nice L, Mathers J. Patient experience of scar assessment and the use of scar assessment tools during burns rehabilitation: a qualitative study. Burns Trauma 2021; 9:tkab005. [PMID: 34212058 PMCID: PMC8240530 DOI: 10.1093/burnst/tkab005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/27/2020] [Indexed: 02/03/2023]
Abstract
Background Scar assessment plays a key role during burns aftercare, to monitor scar remodelling and patients’ psychosocial well-being. To aid assessment, subjective scar assessment scales are available that use health-care professionals’ and patients’ opinions to score scar characteristics. The subjective scales are more widely used in clinical practice over objective scar measures. To date, there is no research that considers patients’ views on scar assessment and the role of subjective and objective assessment tools. Therefore, the aim of this qualitative study was to explore patients’ perspectives on scar assessment and the utility of scar assessment tools during burns rehabilitation. Methods Semi-structured interviews were conducted with 10 adult burn patients who were being reviewed in clinic for scarring. Participants were recruited via their clinical care team and research nurses at the Queen Elizabeth Hospital, Birmingham, UK. Topics covered during interview included patient experience of scar assessment, the use of scar assessment tools and discussion surrounding important factors to be addressed when assessing scars. A thematic analysis using the Framework Method was conducted. Results Participants identified key subthemes that contribute towards the overarching theme of patient-centred scar assessment. These are: patient-led care; continuity in care; learning how to self-manage scarring; and psychological assessment. Links were demonstrated between these subthemes and the remaining themes that describe scar assessment strategies, indicating their potential patient-centred contributions. The subjective opinions of clinicians were found to be valued above the use of subjective or objective scar assessment tools. Scar assessment scales were perceived to be a beneficial method for self-reflection in relation to psychosocial functioning. However, minimal feedback and review of completed assessment scales led to uncertainty regarding their purpose. Patients perceived objective tools to be of primary use for health-care professionals, though the measures may aid patients’ understanding of scar properties. Conclusions Scar assessment tools should be used to support, rather than replace, health-care professionals’ subjective judgements of scarring. Adapting the way in which clinicians introduce and use scar assessment tools, according to patient needs, can support a patient-centred approach to scar assessment.
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Affiliation(s)
- Kate Price
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Naiem Moiemen
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Scar Free Foundation Centre for Conflict Wound Research, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Laura Nice
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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22
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Simas V, Hing W, Rathbone E, Pope R, Climstein M. Auditory exostosis in Australian warm water surfers: a cross-sectional study. BMC Sports Sci Med Rehabil 2021; 13:52. [PMID: 33990216 PMCID: PMC8122542 DOI: 10.1186/s13102-021-00281-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/06/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Surfing is a popular sport in Australia, accounting for nearly 10% of the population. External auditory exostosis (EAE), also referred to as surfer's ear, is recognized as a potentially serious complication of surfing. Cold water (water temperature below 19 °C) is a commonly cited risk factor, with prevalence of EAE in cold water surfers ranging from 61 to 80%. However, there is a paucity of studies reporting the prevalence of EAE in surfers exposed to water temperatures above 19 °C. With mean water temperature ranging from 19 °C to 28 °C, the Gold Coast region of Australia provides the ideal environment to assess the main goal of this study: to assess the prevalence and severity of EAE in warm water surfers. METHODS Eligible participants were surfers living and surfing on the Gold Coast (Queensland, Australia). Currently active surfers over 18 years of age, surfing year-round, with a minimum of five consecutive years of surfing experience were recruited to participate. Included individuals were asked to complete a questionnaire and underwent bilateral otoscopy. RESULTS A total of 85 surfers were included, with mean age 52.1 years (standard deviation [SD] ±12.6 years) and mean surfing experience of 35.5 years (SD ±14.7 years). Nearly two-thirds of participants (65.9%) had regular otological symptoms, most commonly water trapping (66%), hearing loss (48.2%), and cerumen impaction (35.7%). Less than one-fifth of the surfers (17.7%) reported regular use of protective equipment for EAE. The overall prevalence of exostosis was 71.8%, with most of the individuals having bilateral lesions (59%) and a mild grade (grade 1, 47.5%). There was insufficient evidence for any significant associations between the main outcomes (presence and severity of EAE) and factors related to age, surfing experience, winter exposure, surfing ability, symptoms, and use of protective equipment. CONCLUSION To the best of our knowledge, this is the first study assessing EAE in surfers exposed to warm waters (above 19 °C). The prevalence of 71.8% highlights the high prevalence of the condition in the surfing population, regardless of water temperature. Future research should focus on ways to prevent EAE.
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Affiliation(s)
- Vini Simas
- Water Based Research Unit, Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, 2 Promethean Way, Gold Coast, QLD, 4226, Australia.
| | - Wayne Hing
- Water Based Research Unit, Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, 2 Promethean Way, Gold Coast, QLD, 4226, Australia
- Department of Physiotherapy, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Evelyne Rathbone
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD, Australia
| | - Rodney Pope
- School of Community Health, Charles Sturt University, Albury, NSW, Australia
| | - Mike Climstein
- Water Based Research Unit, Bond Institute of Health and Sport, Faculty of Health Sciences and Medicine, Bond University, Robina, 2 Promethean Way, Gold Coast, QLD, 4226, Australia
- School of Health and Human Sciences, Southern Cross University, Gold Coast, QLD, Australia
- Physical Activity, Lifestyle, Ageing and Wellbeing, Faculty Research Group, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
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23
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Schiefer JL, Andreae J, Bagheri M, Fuchs PC, Lefering R, Heitzmann W, Schulz A. A clinical comparison of pure knitted silk and a complex synthetic skin substitute for the treatment of partial thickness burns. Int Wound J 2021; 19:178-187. [PMID: 33973387 PMCID: PMC8684860 DOI: 10.1111/iwj.13613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/24/2021] [Accepted: 04/27/2021] [Indexed: 01/02/2023] Open
Abstract
Currently, many dressings are commercially available for the treatment of burn wounds. Some of these wound dressings remain on the wound, prevent painful dressing changes, and reduce tissue scarring. Nevertheless, still a wound dressing that is cost-effective, produces good wound healing properties, and has a high patient satisfaction is needed. Standard care of superficial burn wounds differs between burn centres. This study aimed to determine a dressing with easy appliance, accurate pain control, favourable outcome, and cost-effectiveness. Therefore, we compared the widely used but expensive Suprathel with the rather new but much cheaper Dressilk in the clinical setting. In a prospective clinical study, the healing of partial thickness burn wounds after simultaneous treatment with Suprathel and Dressilk was examined in 20 patients intra-individually. During wound healing, pain, infection, exudation, and bleeding were evaluated. A subjective scar evaluation was performed using the Patient and Observer Scar Scale. Both dressings were easy to apply, remained on the wound in place, and were gradually cut back as reepithelisation proceeded and showed similar times to wound closure. Dressing changes were not necessary, and neither infections nor bleeding was detected. Overall exudation and pain were highest in the beginning but declined during the wound-healing phase without significant differences. In the follow-up scar evaluation after 12 months, patients reported overall high satisfaction. Overall, the modern dressings Suprathel and Dressilk (solely made out of pure silk) led to safe wound healing without infection and rapidly reduced pain. There was no need for dressing changes, and they had similar clinical outcomes in scar evaluation. Therefore, both dressings seem to be ideal for the treatment of superficial burns. Because acquisition costs remain one of the main factors in the treatment of burns, Dressilk, which is ~20 times cheaper than Suprathel, remains a good option for the treatment of partial thickness burns.
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Affiliation(s)
- Jennifer Lynn Schiefer
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Cologne, Germany
| | - Janine Andreae
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Cologne, Germany
| | - Mahsa Bagheri
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Cologne, Germany
| | - Paul Christian Fuchs
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Cologne, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - Wolfram Heitzmann
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Cologne, Germany
| | - Alexandra Schulz
- Clinic of Plastic, Reconstructive, Hand and Burn Surgery, Hospital Cologne Merheim, University of Witten-Herdecke, Cologne, Germany
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Kemp Bohan PM, Cooper LE, Lu KN, Raper DM, Batchinsky M, Carlsson AH, Cancio LC, Chan RK. Fractionated Ablative Carbon Dioxide Laser Therapy Decreases Ultrasound Thickness of Hypertrophic Burn Scar: A Prospective Process Improvement Initiative. Ann Plast Surg 2021; 86:273-278. [PMID: 32826444 DOI: 10.1097/sap.0000000000002517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Carbon dioxide (CO2) laser treatment is routinely used to treat hypertrophic burn scars (HBS). Although prior research has documented subjective improvement in HBS after treatment, there is little data evaluating objective changes in scar characteristics after therapy. The aim of our process improvement project was to evaluate changes to scar thickness (ST) using high-frequency ultrasound in patients with HBS undergoing CO2 laser therapy. METHODS Ultrasound measurements of ST were obtained from patients with HBS before initial and at each subsequent treatment. ST, reduction in ST per treatment, and percentage reduction in ST from baseline were tabulated. Post hoc analyses examining the effect of initial ST and scar maturity on outcome were performed. First, patients were grouped by baseline ST into thicker (group 1, initial ST ≥ median value) and thinner (group 2, initial ST < median value) scar groups. Second, patients were divided into quartiles based on time from injury to treatment. Outcomes at each time point were compared with either Mann-Whitney U or Kruskal-Wallis tests, with Bonferonni corrections performed for post hoc subgroup analyses. Significance was set at P < 0.05. RESULTS Twenty-one consecutive patients with HBS treated with CO2 laser were included. All patients completed 1 or more treatment, 48% completed 2 or more treatments, and 28% completed 3 treatments. Median initial ST was 0.71 cm (0.44-0.98 cm), and median scar maturity was 7.5 months (4.9-9.8 months). Overall, ST decreased over the treatment course (P < 0.001), with post hoc analysis demonstrating that 2 treatments were required to achieve a significant ST reduction (P < 0.01). On subgroup analysis comparing initial ST, ST decreased significantly in group 1 (thicker scars) overall (P < 0.001) but not in group 2 (P = 0.109). ST reduction was greatest after 1 treatment in group 1 (P = 0.022) and group 2 (P = 0.061). Percent reduction was greater in group 1 relative to group 2 after 1 treatment (P = 0.016). On subgroup analysis of scar maturity, there were no significant differences in either baseline ST or ST at any subsequent visit. CONCLUSIONS Fractionated ablative CO2 laser treatment improved ST after 1 to 2 treatments. Patients with thicker scars demonstrated greater ST reduction than those with thinner scars. Ultrasound adequately assessed treatment response.
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Affiliation(s)
| | | | | | - David M Raper
- Department of Oral and Maxillofacial Surgery, Brooke Army Medical Center, Ft. Sam Houston, TX
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25
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Sitohang IBS, Sirait SAP, Suryanegara J. Microneedling in the treatment of atrophic scars: A systematic review of randomised controlled trials. Int Wound J 2021; 18:577-585. [PMID: 33538106 PMCID: PMC8450803 DOI: 10.1111/iwj.13559] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/20/2021] [Accepted: 01/21/2021] [Indexed: 12/04/2022] Open
Abstract
To date, treatment of atrophic acne scars remains a therapeutic challenge for dermatologists, yet there is no standard option on the most effective treatment. Microneedling (MN) is a minimally invasive technology that involves repetitive skin puncture using sterile microneedles to disrupt dermal collagen that connects the scar tissue. Recent studies have demonstrated the potency of MN, such as dermaroller and fractionated microneedle radiofrequency, in the treatment of atrophic scars. The objective of this review is to evaluate systematically the current literature on MN for atrophic acne scars. A systematic search of literature was performed from PubMed, Medline, Cochrane Central, and Google Scholar databases for articles published during the last 20 years. Only randomised controlled trials (RCTs) with full‐text version of the manuscript available were included in our study. Nine RCTs were included in this review. All treatment modalities demonstrated consistent results that MN was efficacious in treating atrophic acne scars as a monotherapy or in combination with other treatments. Moreover, no serious adverse effects were reported in all studies after MN treatment. MN is a well‐tolerated and effective therapeutic modality in treating atrophic acne scars. Further research is required to validate the efficacy of MN with a larger sample size and lengthy follow‐up.
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Affiliation(s)
- Irma Bernadette S Sitohang
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Sondang Aemilia Pandjaitan Sirait
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Jose Suryanegara
- Faculty of Medicine, Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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26
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Mueller B, Elrod J, Distler O, Schiestl C, Mazza E. On the Reliability of Suction Measurements for Skin Characterization. J Biomech Eng 2021; 143:1084899. [PMID: 32601661 DOI: 10.1115/1.4047661] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Indexed: 11/08/2022]
Abstract
in vivo skin characterization methods were shown to be useful in the detection of microstructural alterations of the dermis due to skin diseases. Specifically, the diagnostic potential of skin suction has been widely explored, yet measurement uncertainties prevented so far its application in clinical assessment. In this work, we analyze specific factors influencing the reliability of suction measurements. We recently proposed a novel suction device, called Nimble, addressing the limitations of existing instruments, and applied it in clinical trials quantifying mechanical differences between healthy skin and scars. Measurements were performed with the commercial device Cutometer and with the new device. A set of new suction measurements was carried out on scar tissue and healthy skin, and FE-based inverse analysis was applied to determine corresponding parameters of a hyperelastic-viscoelastic material model. FE simulations were used to rationalize differences between suction protocols and to analyze specific factors influencing the measurement procedure. Tissue stiffness obtained from Cutometer measurements was significantly higher compared to the one from Nimble measurements, which was shown to be associated with the higher deformation levels in the Cutometer and the nonlinear mechanical response of skin. The effect of the contact force exerted on skin during suction measurements was quantified, along with an analysis of the effectiveness of a corresponding correction procedure. Parametric studies demonstrated the inherently higher sensitivity of displacement- over load-controlled suction measurements, thus rationalizing the superior ability of the Nimble to distinguish between tissues.
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Affiliation(s)
- Bettina Mueller
- Institute for Mechanical Systems, ETH Zurich, Leonhardstrasse 21, Zürich 8092, Switzerland
| | - Julia Elrod
- Department of Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, Zürich 8032, Switzerland; Children's Research Center (CRC), University Children's Hospital Zurich, Steinwiesstrasse 75, Zürich 8032, Switzerland
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, Gloriastrasse 25, Zurich 8091, Switzerland
| | - Clemens Schiestl
- Department of Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, Zürich 8032, Switzerland; Children's Research Center (CRC), University Children's Hospital Zurich, Steinwiesstrasse 75, Zürich 8032, Switzerland
| | - Edoardo Mazza
- Institute for Mechanical Systems, ETH Zurich, Leonhardstrasse 21, Zürich 8092, Switzerland; Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf 8600, Switzerland
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Karlsson M, Elmasry M, Steinvall I, Sjöberg F, Olofsson P. Scarring at Donor Sites after Split-Thickness Skin Graft: A Prospective, Longitudinal, Randomized Trial. Adv Skin Wound Care 2020; 33:1-5. [PMID: 33208665 DOI: 10.1097/01.ASW.0000720256.45983.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate if previous findings on the association between dressing treatments and subjective opinion on final donor site scar outcome using the Patient and Observer Scar Assessment Scale (POSAS) can be confirmed objectively. The previous study showed that patients dressed with hydrofiber covered with film were more satisfied with their donor site scars than patients receiving porcine xenograft or polyurethane foam dressings. METHODS Scar outcome measurements were assessed by a blinded observer using POSAS and the Cutometer dual MPA 580 device to measure the viscoelasticity of skin. RESULTS A total of 17 participants were included in this study, five of whom were treated with hydrofiber, six with polyurethane foam, and another six with porcine xenograft. There were no significant differences among groups in any of the POSAS items or in the viscoelasticity measurements made with the Cutometer. CONCLUSIONS The investigators could not confirm previous associations between dressing treatment and long-term donor site scars. No associations between donor sites' healing times and final scarring were found. Hypopigmentation was reported in 15 of 17 donor sites evaluated.
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Lee JH, Seo CE, Song WJ, Kwon MJ, Park YS, Ko JH, Hong JW, Lee MC. Combination treatment utilizing fractional ablative and continuous wave CO 2 lasers for hypertrophic burn scars. Burns 2021; 47:1084-93. [PMID: 33199081 DOI: 10.1016/j.burns.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 10/18/2020] [Accepted: 10/29/2020] [Indexed: 11/20/2022]
Abstract
BACKGROUND Hypertrophic scars are devastating outcomes of severe burn injuries, producing physical and mental burdens. Adequate treatment is of benefit to relieve these burdens. Laser therapy has shown scar reducing effects. In this study, we compared outcomes after combination of two different lasers or single laser treatment to treat severe hypertrophic burn scars. METHODS Forty patients with hypertrophic burn scars were included in one of two therapeutic groups: continuous wave CO2 laser and fractional ablative CO2 laser group (group 1, n = 20) or fractional ablative CO2 laser alone group (group 2, n = 20). Hypertrophic scars were evaluated by the observer-rated Vancouver Scar Scale (VSS) before and after treatment and by patient-completed questionnaires after treatment. Comparative analyses were performed before and after treatment, and time-dependent improvement was also analyzed. RESULTS Forty patients (54 hypertrophic scars) completed the laser treatment protocols. Group 1 exhibited significantly more improvement in VSS vascularity, pliability, and height indices than group 2 (p < 0.05). Time-dependent analysis of total VSS scores suggested that group 1 experienced more improvement during a shorter treatment period (p < 0.05). For patient-reported outcomes, group 1 noted better grades than group 2 in four indices, namely scar appearance, scar thickness, pain, and pruritus (p < 0.05). CONCLUSION Effective scar reduction was achieved using combination laser treatment, with significant improvement in multiple observer- and patient-reported outcomes. The shorter treatment period of the combination method can be a merit, as prolonged hypertrophic scars may increase morbidity. Nonetheless, cautious treatment protocols are necessary to avoid undesirable sequelae related to laser application.
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Yu A, Yick KL, Ng SP, Yip J, Chan YF. A study of using a simple 2D image analysis method to monitor the surface area of hypertrophic scars on hand during pressure therapy. Burns 2020; 46:1548-1555. [DOI: 10.1016/j.burns.2020.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/12/2020] [Accepted: 04/07/2020] [Indexed: 11/22/2022]
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Giorgis AT, Alsoudi AF, Alemu AM, Tadesse T, Gemida J, Taye K, Zeru M, Moe CA, Stamper RL, Keenan JD. The Relationship Between Melanin and Glaucoma: A Case-control Study. J Glaucoma 2020; 29:1143-6. [PMID: 32890103 DOI: 10.1097/IJG.0000000000001652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PRéCIS:: In a case-control study, skin pigmentation was not statistically significantly different when comparing glaucoma patients to those without glaucoma. PURPOSE Darker skin color has been implicated as a risk factor for glaucoma based on previous studies' subjective assessments of skin pigmentation. This study used objective measurements to determine whether cutaneous pigmentation is a risk factor for glaucoma. METHODS This case-control study was conducted at Menelik II Tertiary Referral Hospital in Addis Ababa, Ethiopia. Patients aged 40 years or older from the glaucoma clinic who were being scheduled for trabeculectomy were enrolled as cases and age-matched patients without glaucoma from other clinics at Menelik II Tertiary Referral Hospital were enrolled as controls. A Dermacatch device was used to capture melanin measurements in triplicate from the inner arm of each participant. The exposure variable of interest was the median of the triplicate skin melanin measurements, in arbitrary units. The outcome of interest was presence of glaucoma. RESULTS Agreement between the triplicate inner arm melanin measurements was high, with an intraclass correlation of 0.99 (95% confidence interval, 0.98-0.99). Mean melanin values were 704 units (SD 94) in 76 cases and 694 units (SD 93) in 152 controls. Melanin was not statistically significantly associated with glaucoma after adjusting for sex and season of measurement (ie, dry vs. rainy), with an odds ratio of 1.15 (95% confidence interval, 0.59-2.24) per 100 units of inner arm melanin. CONCLUSION This study failed to find a significant association between skin pigmentation and glaucoma using an objective and reproducible assessment of pigmentation.
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Trinh A, Hashmi SS, Massoud TF. Imaging anatomy of the vertebral canal for trans-sacral hiatus puncture of the lumbar cistern. Clin Anat 2020; 34:348-356. [PMID: 32323367 DOI: 10.1002/ca.23612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/16/2020] [Accepted: 04/18/2020] [Indexed: 12/18/2022]
Abstract
A standard lumbar puncture may be impossible for many anatomic or technical reasons. Previous accounts of caudal epidural anesthesia and other procedures via the sacral hiatus prompted us to test if image-guided percutaneous trans-sacral hiatus access to the lumbosacral subarachnoid cistern would be anatomically feasible. To study vertebral canal morphometry and curvature, we analyzed midsagittal computed tomography-myelogram images of 40 normal subjects and digitally measured sacral curvatures between S1 to S5 and S2 to S4 using two methods whereby a lower angle signifies a straighter sacrum. We measured midsagittal vertebral canal area, hiatus width, dural sac termination levels, and distance from sacral hiatus to the dural sac tip (needle distance). Subjects were F:M = 25:15, with a mean age of 44.9 years. The two S1-S5 full sacral curvature mean angles were 57.3° and 60.4°. Almost all sacral hiatuses were at S4, and dural sac terminations were at S1-S2. The mean S2-S4 sacral curvature was 25.1°, and the mean needle distance was 57.7 mm. Using two-way analysis of variance, there were significant sex differences for needle distances (p = .001), and full and limited sacral curvatures (p = .02, and p = .046, respectively). There were no significant linear regression correlations between age and sacral curvature, needle distance, canal area, or hiatus width. Therefore, despite a frequently prominent full sacral curvature, the combination of S1-S2 dural sac termination plus a relatively straight trajectory of the lower vertebral canal between S2 and S4 support the theoretical feasibility of percutaneous trans-sacral hiatus and vertebral canal access to the lumbosacral cistern using a standard spinal needle.
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Affiliation(s)
- Austin Trinh
- Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality Neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Syed S Hashmi
- Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality Neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Tarik F Massoud
- Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality Neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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Phillips J, Reynolds KJ, Gordon SJ. Dermal thickness and echogenicity using DermaScan C high frequency ultrasound: Methodology and reliability testing in people with and without primary lymphoedema. Skin Res Technol 2020; 26:813-823. [PMID: 32579302 DOI: 10.1111/srt.12880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND DermaScan C high frequency ultrasound was investigated for image capture and analysis of dermal measures in people with and without primary lymphoedema. METHOD Three repeated images were taken at six sites in people without lymphoedema (NLO). Intra-rater reliability was assessed by taking three sets of measures on images from 10 people and inter-session reliability by capturing three images, lifting the probe from the skin in between. Methods were adjusted, and repeated images from four sites were taken in people with primary lymphoedema (PLO) and reliability re-assessed. RESULTS Intra-rater reliability in NLO and PLO for echogenicity measures were excellent (NLO ICC(3,1) : .989; PLO .997) across all sites and specific to each site (calf: ICC(3,1) : .989; and foot: ICC(3,1) : .999, respectively). Inter-session reliability was moderate for NLO (ICC(3,1) : .727), improving after method modifications for PLO (ICC(3,1) : .916). When investigated by site, inter-session reliability was good in the foot (ICC(3,1) : .811) and moderate in the calf (ICC(3,1) : .616). Mean thickness analysed by site resulted in good inter-session reliability only in the foot (ICC(3,1) .838). CONCLUSION Intra-rater reliability was excellent using the DermaScan C for dermal measures in people with primary lymphoedema. Inter-session reliability required particular attention to method and gain settings.
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Affiliation(s)
- Jane Phillips
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia.,Murdoch Children's Research Institute, Parkville, Vic., Australia
| | - Karen J Reynolds
- College of Science & Engineering, Medical Device Research Institute, Flinders University, Adelaide, SA, Australia
| | - Susan J Gordon
- College of Nursing & Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
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Ghaderi Niri S, Khalaf AM, Massoud TF. The mammillothalamic tracts: Age-related conspicuity and normative morphometry on brain magnetic resonance imaging. Clin Anat 2020; 33:911-919. [PMID: 32239548 DOI: 10.1002/ca.23595] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/21/2020] [Accepted: 03/25/2020] [Indexed: 01/24/2023]
Abstract
The mammillothalamic tract (MTT, bundle of Vicq d'Azyr) is a white-matter projection from each mammillary body to the anterior nucleus of the thalamus (ANT). Deep brain stimulation of the MTTs or ANTs is a treatment option for medically refractory focal epilepsy. Since the ANTs may be atrophied in epilepsy, targeting of the MTT terminations could be used as a proxy for ANT locations. However, MTT conspicuity and morphometry on MRI have not been evaluated to date. We investigated normative age- and sex-related MRI morphometrics of the MTTs in healthy individuals. We retrospectively analyzed magnified axial T2-weighted images of 80 subjects for bilateral MTT conspicuity, diameters, areas, shapes, precise locations, and symmetry. We statistically tested the effects of independent variables (sex and MTT side) on measured dependent variables using two-way ANOVA; and performed linear regressions with age as the independent variable for each of the dependent variables. Subjects were F:M = 44:36, with mean age 45.3 years. Only one (0.63%) MTT was inconspicuous. Mean MTT diameter was 1.8 mm, area was 2.0 mm2 , and distance from third ventricle was 3.1 mm. MTTs were mostly bilaterally symmetrical in shape, equally round, or ovoid. The right MTT diameter was larger than the left, and males had larger MTT areas than females. We found no statistical difference between MTT diameters and areas in young, middle-aged, and older adults. We report normative axial MRI morphometrics of the MTTs to guide neuromodulation treatments. Future detailed analyses will determine if the MTTs atrophy in proportion to the ANTs in refractory epilepsy.
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Affiliation(s)
- Sanaz Ghaderi Niri
- Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Alexander M Khalaf
- Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
| | - Tarik F Massoud
- Division of Neuroimaging and Neurointervention, and Stanford Initiative for Multimodality neuro-Imaging in Translational Anatomy Research (SIMITAR), Department of Radiology, Stanford University School of Medicine, Stanford, California, USA
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Karlsson M, Steinvall I, Sjöberg F, Olofsson P, Elmasry M. Burn scar outcome at six and 12 months after injury in children with partial thickness scalds: Effects of dressing treatment. Burns 2020; 46:546-551. [PMID: 32165027 DOI: 10.1016/j.burns.2020.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/29/2020] [Accepted: 02/15/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In line with other researchers in the field of burns' care, we think that research investigating the long-term outcome of scars is largely lacking. As scarring is of the utmost importance to the patient, clinicians who treat burns must aim to find treatments that lead to a good end result. The aim of this study was to study scar outcomes at six and 12 months after injury. It is an extension of a previous randomised controlled trial (RCT) in which two dressings (porcine xenograft and silver foam dressing) were examined with respect to their ability to help heal partial thickness scalds. METHOD Children aged six months - six years with acute partial thickness scalds, on the trunk, or extremities, or both, were included. In the previous study, the silver foam was found to have significantly shorter healing times than the xenograft. Children were assessed at six and 12 months after injury for this study, and photographs were taken of the burn site, and both the patient and observer scar assessment scale (POSAS) and the Vancouver scar scale (VSS) were completed and evaluated by blinded observers. RESULTS Of the 58 children from the original RCT, 39 returned to the clinic for evaluation of their scars at six months, and 34 at 12 months after injury. There were no differences in POSAS, VSS total scores, or incidence of hypertrophic scarring between the different dressings. Fifteen children were assessed as having hypertrophic scarring, all of whom had healing times that had extended beyond 14 days. CONCLUSIONS This study compared burn scarring after two different treatments for burns in children with partial-thickness scalds and the data suggested that neither dressing had a more favourable impact on scar outcome. The conclusion is, however, tempered by the non-return of all the patients to the follow up. However, as anticipated, regardless of the dressing used, longer healing times were associated with higher scar scores (more scarring) and hypertrophic scarring.
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Affiliation(s)
- Matilda Karlsson
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
| | - Ingrid Steinvall
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Department of Anesthesiology and Intensive Care, Linköping University, Linköping, Sweden
| | - Pia Olofsson
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Moustafa Elmasry
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University, Linköping, Sweden; Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Wang F, Li X, Wang X, Jiang X. Efficacy of topical silicone gel in scar management: A systematic review and meta-analysis of randomised controlled trials. Int Wound J 2020; 17:765-773. [PMID: 32119763 DOI: 10.1111/iwj.13337] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/19/2020] [Accepted: 02/19/2020] [Indexed: 02/05/2023] Open
Abstract
To assess the efficacy of topical silicone gel in the management of scars, we conducted this meta-analysis. The systematic search was performed on PubMed, Web of Science and Embase, and six randomised controlled trials with a total of 375 patients were involved. The outcome data of Vancouver Scar Scale were extracted from the studies and their effect sizes were calculated using Review Manager 5.3. As a result, topical silicone gel significantly reduced pigmentation, height, and pliability scores postoperatively compared with placebos or no treatment (Pigmentation: standard mean difference [SMD] = -0.55 [-0.83 to -0.26], P = .0002; Height: SMD = -0.73 [-1.02 to -0.44], P < .00001; Pliability: SMD = -0.49 [-0.95 to -0.03], P = .04). Topical silicone gel and silicone gel sheet were comparably effective (P > .05). The performance of topical silicone gel and other non-silicone topical treatment was also similar (P > .05). In summary, topical silicone gel was effective in post-operative scar prevention.
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Affiliation(s)
- Fan Wang
- Department of Dermatology and Venerology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaoxue Li
- Department of Dermatology and Venerology, West China Hospital of Sichuan University, Chengdu, China
| | - Xiuyun Wang
- Department of Abdominal Cancer, West China Hospital of Sichuan University, Chengdu, China
| | - Xian Jiang
- Department of Dermatology and Venerology, West China Hospital of Sichuan University, Chengdu, China
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Lee K, Bamford A, Gardiner F, Agovino A, ter Horst B, Bishop J, Grover L, Logan A, Moiemen N. Burns objective scar scale (BOSS): Validation of an objective measurement devices based burn scar scale panel. Burns 2020; 46:110-120. [DOI: 10.1016/j.burns.2019.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 05/04/2019] [Accepted: 05/15/2019] [Indexed: 01/04/2023]
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