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Kučinskaitė A, Stundys D, Gervickaitė S, Tarutytė G, Grigaitienė J, Tutkuvienė J, Jančorienė L. Aesthetic Evaluation of Facial Scars in Patients Undergoing Surgery for Basal Cell Carcinoma: A Prospective Longitudinal Pilot Study and Validation of POSAS 2.0 in the Lithuanian Language. Cancers (Basel) 2024; 16:2091. [PMID: 38893210 PMCID: PMC11171257 DOI: 10.3390/cancers16112091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Facial basal cell carcinoma (BCC) surgery enhances the quality of life (QoL) but leaves patients with inferior QoL, presumably caused by scarring, emphasizing the need to understand post-surgery aesthetic satisfaction. This study aimed to validate the Lithuanian version of the Patient and Observer Scar Assessment Scale (POSAS) 2.0 and utilise it to identify scar evaluation differences and correlations among POSAS scores and specific aesthetic facial regions, age, gender, surgery types, and short- and long-term QoL. Employing a prospective longitudinal design, 100 patients with facial scars after surgical BCC removal were enrolled. The validation phase confirmed the translated POSAS 2.0 psychometric properties, while the pilot phase used statistical analyses to compare scores among demographic and clinical groups and evaluate correlations between scar assessment and QoL. The findings indicate that the translated Lithuanian version of POSAS 2.0 exhibits good psychometric properties, revealing insights into aesthetic satisfaction with post-surgical facial scars and their impact on QoL. The Lithuanian version of the POSAS 2.0 was established as a valid instrument for measuring post-surgical linear scars. QoL with scar assessment statistically significantly correlates, 6 months after surgery, with worse scores, particularly notable among women, younger patients, and those with tumours in the cheek region.
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Affiliation(s)
| | - Domantas Stundys
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (J.G.); (L.J.)
| | - Simona Gervickaitė
- Department of Anatomy, Histology and Anthropology, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (S.G.); (J.T.)
| | - Gabrielė Tarutytė
- Department of Research and Innovation, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania;
- Institute of Applied Mathematics, Faculty of Mathematics and Informatics, Vilnius University, 03225 Vilnius, Lithuania
- Vilnius University Hospital Santaros Klinikos, 08661 Vilnius, Lithuania
| | - Jūratė Grigaitienė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (J.G.); (L.J.)
| | - Janina Tutkuvienė
- Department of Anatomy, Histology and Anthropology, Faculty of Medicine, Vilnius University, 03101 Vilnius, Lithuania; (S.G.); (J.T.)
| | - Ligita Jančorienė
- Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (J.G.); (L.J.)
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Poddighe D, Ferriero G, Corna S, Bravini E, Sartorio F, Vercelli S. Effects of soft tissue mobilisation on subacute adherent linear scars: a single-group intervention study. J Wound Care 2024; 33:43-50. [PMID: 38197283 DOI: 10.12968/jowc.2024.33.1.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Scar adherence due to a pathological healing process can cause physical and psychological disturbance. Soft tissue mobilisation (STM) techniques are widely used to treat and prevent scar adherence, but little is known on their effects. We aimed to analyse the effect of STM in patients with subacute post-surgical scar adhesions affecting the extremities. METHOD A single-group quasi-experimental study was conducted on consecutive patients undergoing post-surgery limb rehabilitation. Patients with a baseline Adhesion Severity (AS) index of <0.5 at the worst scar point, as measured by the Adheremeter, were eligible. All patients who completed a minimum of five manual treatment sessions were included. The primary outcome was the AS index and the secondary outcome was the Italian version of the Patient and Observer Scar Assessment Scales (POSAS-I). RESULTS A cohort of 19 patients underwent an average of eight STM sessions over a period of one month. The AS index value increased from a median of 0.12 at baseline (interquartile range (IQR): 0.05-0.25) to 0.41 post-treatment (IQR: 0.26-0.63; median change: 0.24; IQR: 0.16-0.40; p<0.001). A large effect size was observed for both AS and Observer Scar Assessment Scale (OSAS-I) (Cohen r=0.6), with a large probability of superiority (PS) (87% and 86%, respectively). A moderate effect was observed for the Patient Scar Assessment Scale (PSAS-I) (Cohen=0.4; PS=71%). Pre-post treatment changes exceeded the minimal detectable changes for the AS and OSAS-I in 68% of subjects, and for PSAS-I in 21% of subjects. CONCLUSION STM manual techniques may produce a large effect on the mobility of adherent subacute post-surgical scars.
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Affiliation(s)
- Diego Poddighe
- KU Leuven, Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, B-3000 Leuven, Belgium
| | - Giorgio Ferriero
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri, Institute of Tradate, IRCCS, Tradate (VA), Italy
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
| | - Stefano Corna
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri, Institute of Veruno, IRCCS, Gattico-Veruno (NO), Italy
| | | | - Francesco Sartorio
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri, Institute of Veruno, IRCCS, Gattico-Veruno (NO), Italy
- Department of Scientific Research, Campus LUdeS Lugano (CH), Off-Campus Semmelweis University of Budapest, Hungary
| | - Stefano Vercelli
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri, Institute of Veruno, IRCCS, Gattico-Veruno (NO), Italy
- Rehabilitation Research Laboratory 2rLab, Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Manno, Switzerland
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Carrière ME, Tyack Z, Westerman MJ, Pleat J, Pijpe A, van Zuijlen PPM, de Vet HCW, Mokkink LB. From qualitative data to a measurement instrument: A clarification and elaboration of choices made in the development of the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0. Burns 2023; 49:1541-1556. [PMID: 36914442 DOI: 10.1016/j.burns.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 02/05/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To clarify and elaborate on the choices that were made in the development of the Patient Scale of the Patient and Observer Scar Assessment Scale 3.0 (POSAS 3.0), based upon the rich information obtained from patients during focus groups and pilot tests. METHODS The discussions described in this paper are a reflection of the focus group study and pilot tests that were conducted in order to develop the Patient Scale of the POSAS3.0. The focus groups took place in the Netherlands and Australia and included 45 participants. Pilot tests were performed with 15 participants in Australia, the Netherlands, and the United Kingdom. RESULTS We discussed the selection, wording and merging of 17 included items. Additionally, the reason for exclusion of 23 characteristics are given. CONCLUSION Based upon the unique and rich material of patient input obtained, two versions of the Patient Scale of the POSAS3.0 were developed: the Generic version, and the Linear scar version. The discussions and decisions taken during the development are informative for a good understanding of the POSAS 3.0 and are indispensable as a background for future translations and cross-cultural adaptations.
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Affiliation(s)
- M E Carrière
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Burn center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, the Netherlands; Association of Dutch Burn centers, Beverwijk, the Netherlands.
| | - Z Tyack
- Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - M J Westerman
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Division of Life Science, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - J Pleat
- Department of Plastic and Reconstructive Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - A Pijpe
- Burn center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, the Netherlands; Association of Dutch Burn centers, Beverwijk, the Netherlands
| | - P P M van Zuijlen
- Burn center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, the Netherlands; Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - H C W de Vet
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - L B Mokkink
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands
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Lassig AAD, Lindgren BR, Wilson AC, Joseph AM, Davison M, Yueh B. InCISE: Instrument for Comprehensive Incisional and Surgical Evaluation. Laryngoscope 2023; 133:2166-2173. [PMID: 36226730 PMCID: PMC10097828 DOI: 10.1002/lary.30439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/22/2022] [Accepted: 09/27/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The evaluation of healing after head and neck surgery is currently qualitative and non-standardized, limiting the quality of surgical healing assessments in clinical and research settings. We sought to develop an objective, standardized wound assessment score, and hypothesize that a reliable instrument can be developed to evaluate head and neck surgical wounds. METHODS A prospective cohort study was conducted in a tertiary-care, academic head and neck surgery practice. Patients undergoing head and neck surgery were enrolled. A digital photograph protocol was developed for evaluating healing surgical wounds. A panel of experts developed and refined a wound healing score and established reliability, reproducibility, internal consistency, and validity of the score. RESULTS InCISE: Instrument for comprehensive incisional and surgical evaluation was created. The utility of our wound healing score was assessed using classical test theory. We performed the major steps of establishing reliability in head and neck surgeons: (1) internal consistency (Cronbach's α = 0.81), (2) inter-observer reliability (intra-class correlation = 0.76), and (3) intra-rater reliability (intra-class correlation = 0.87), and content validity (through focus groups). Our composite measure was found to have strong internal consistency, inter-rater reliability, and intra-rater reliability. Preliminary work suggests criterion validity via associations with physical health related quality of life (SF-12). CONCLUSION A wound healing score for head and neck surgery, InCISE, has been developed and is reliable, reproducible, and consistent. Although content validity is present and criterion validity is suggested, work continues to establish validity in this instrument to allow for expanded clinical and research use. LEVEL OF EVIDENCE NA Laryngoscope, 133:2166-2173, 2023.
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Affiliation(s)
- Amy Anne D. Lassig
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, University of Minnesota, Minneapolis, MN USA
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, Hennepin Healthcare Research Institute / Hennepin County Medical Center, Minneapolis, MN USA
| | - Bruce R. Lindgren
- Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN USA
| | - Anna C. Wilson
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, University of Minnesota, Minneapolis, MN USA
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, Hennepin Healthcare Research Institute / Hennepin County Medical Center, Minneapolis, MN USA
| | - Anne M. Joseph
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN USA
| | - Mark Davison
- Department of Education, University of Minnesota, Minneapolis, MN USA
| | - Bevan Yueh
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, University of Minnesota, Minneapolis, MN USA
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Lewis CJ, Douglas H, Martin L, Deng Z, Melton P, Fear MW, Wood FM, Rea S. Carbon dioxide laser treatment of burn-related scarring: Results of the ELIPSE (Early Laser Intervention Promotes Scar Evolution) prospective randomized controlled trial. J Plast Reconstr Aesthet Surg 2023; 84:368-376. [PMID: 37393760 DOI: 10.1016/j.bjps.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/30/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023]
Abstract
AIM To investigate the impact of ablative fractional carbon dioxide laser (AFCO2L) on patient-reported outcomes measures, subjective scar appearance, dermal architecture, and gene transcription in early burn scars. METHODS Fifteen adult patients with a burn-related scar were recruited. Inclusion criteria were two non-contiguous scar areas of 1% total body surface area, similar baseline Vancouver scar scale (VSS) score and 3months since the time of injury. All participants acted as their own control. Scars were randomized to treatment or control. Treatment scars received three AFCO2L treatments at 6-week intervals. Outcome measures were recorded at baseline, 3, 6, and 12-months post-treatment. Measures included blinded VSS, Patient Observer Scar Assessment Scale (POSAS), Brisbane Burn Scar Impact Profile (BBSIP), blinded scar photo assessment, histological tissue analysis, and RNA sequencing analysis. RESULTS No significant difference was found in VSS, scar erythema, or pigmentation. Patient POSAS improved in scar thickness and texture following AFCO2L. All elements of BBSIP improved in control and laser groups. AFCO2L-treated scars were scored better than control scars by blinded raters. RNA sequencing illustrated that AFCO2L induced sustained changes in fibroblast gene expression. CONCLUSIONS AFCO2L treated scars had significantly altered scar thickness and texture 6 months post-laser and were rated better than controls on blinded photo analysis after 3 treatments. RNASeq results suggest laser treatment alters the transcriptome of treated fibroblasts for at least 3 months after treatment. Expansion of this research to study in more depth fibroblast changes in response to laser, as well as assessing the impact on daily activity and quality of life, will be beneficial.
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Affiliation(s)
- Christopher J Lewis
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia.
| | - Helen Douglas
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia
| | - Lisa Martin
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Zhenjun Deng
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Phillip Melton
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; School of Global and Population Health, University of Western Australia, Crawley, WA, Australia
| | - Mark W Fear
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Fiona M Wood
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia; Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
| | - Suzanne Rea
- Burn Service of Western Australia, Fiona Stanley Hospital, WA Department of Health, Perth, WA, Australia; Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
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Mekeres GM, Buhaș CL, Csep AN, Beiușanu C, Andreescu G, Marian P, Cheregi CD, Fodor R, Manole F. The Importance of Psychometric and Physical Scales for the Evaluation of the Consequences of Scars-A Literature Review. Clin Pract 2023; 13:372-383. [PMID: 36961059 PMCID: PMC10037630 DOI: 10.3390/clinpract13020034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/22/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Scars affect patients after trauma, burns, or surgical procedures and can generate both physical and psychosocial changes. The aesthetic damage represents the modification of a person's physical appearance, in its bodily integrity, causing numerous sufferings and determining social or economic consequences. The aim of this research is to evaluate the advantages and disadvantages offered by the available psychosocial and physical scar scales in assessing the physical, aesthetic, psychosocial, and juridical consequences of scars. This will aid to inform medical examiners about the most valued existing scales to allow them to select the most appropriate instrument to manage their patient. METHODS A broad search of relevant scientific studies on the psychosocial determinants of post-traumatic and surgical scars was conducted by using the following international database tools: PsycINFO, MedLine Social Science Index, Scopus, Web of Science, published from 1960 until 2022. RESULTS We analyzed 63 scientific studies to assess the advantages and limits of several psychometric and physical scar evaluation scales. CONCLUSIONS The researchers analyzed in this review highlight the advantages and limitation of existing instruments, evidencing the demand for future scar evaluation instruments and a scar-assessing algorithm that takes into account the physical, aesthetic, psychosocial, and legal consequences of scars.
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Affiliation(s)
- Gabriel Mihai Mekeres
- Doctoral School of Biomedical Sciences, University of Oradea, Faculty of Medicine and Pharmacy, 410087 Oradea, Romania
| | - Camelia Liana Buhaș
- Morphological Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
- Department of Legal Medicine, County Clinical Emergency Hospital of Oradea, 410169 Oradea, Romania
| | - Andrei Nicolae Csep
- Medical Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Corina Beiușanu
- Morphological Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Gineta Andreescu
- Morphological Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Paula Marian
- Medical Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Cornel Dragoș Cheregi
- Surgical Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
| | - Radu Fodor
- Doctoral School of Biomedical Sciences, University of Oradea, Faculty of Medicine and Pharmacy, 410087 Oradea, Romania
| | - Felicia Manole
- Surgical Disciplines Department, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania
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Carrière ME, Mokkink LB, Tyack Z, Westerman MJ, Pijpe A, Pleat J, van de Kar AL, Brown J, de Vet HCW, van Zuijlen PPM. Development of the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0: a qualitative study. Qual Life Res 2023; 32:583-592. [PMID: 36355319 PMCID: PMC9911488 DOI: 10.1007/s11136-022-03244-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE The Patient and Observer Scar Assessment Scale (POSAS) is widely used for measurements of scar quality. This encompasses visual, tactile and sensory characteristics of the scar. The Patient Scale of previous POSAS versions was lacking input from patients. Therefore, the aim of this study was to develop the POSAS3.0, Patient Scale with involvement of adults patients with all scar types, complying with the highest clinimetric standards. METHODS From February 2018 to April 2019, a series of six focus group interviews were performed in the Netherlands and Australia to identify scar quality characteristics that adults with scars consider to be important. All focus groups were transcribed, anonymized and analysed using a thematic analysis. Relevant characteristics were formulated into items, resulting in a Dutch and English version of the Patient Scale. These drafts were pilot tested in Australia, the Netherlands and the United Kingdom, and refined accordingly. RESULTS A total of 21 relevant scar quality characteristics were identified during the focus groups. Two distinct versions of the POSAS3.0, Patient Scale were developed. The Generic version contains 16 items and can be used for all scar types, except linear scars. The Linear Scar version of the Patient Scale contains the same 16 items, with an extra item referring to the widening of scar margins. All included items are rated on a verbal rating scale with five response options. CONCLUSION Two versions of the POSAS3.0 Patient Scale were developed. Further field tests are being performed to establish the measurement properties and scoring algorithm of the scales.
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Affiliation(s)
- M. E. Carrière
- grid.16872.3a0000 0004 0435 165XDepartment of Epidemiology and Data Science, Amsterdam UMC (location VUmc), Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.415746.50000 0004 0465 7034Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, The Netherlands ,grid.418147.f0000 0004 9238 8347Association of Dutch Burn Centers, Beverwijk, The Netherlands
| | - L. B. Mokkink
- grid.16872.3a0000 0004 0435 165XDepartment of Epidemiology and Data Science, Amsterdam UMC (location VUmc), Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Z. Tyack
- grid.1003.20000 0000 9320 7537Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - M. J. Westerman
- grid.16872.3a0000 0004 0435 165XDepartment of Epidemiology and Data Science, Amsterdam UMC (location VUmc), Amsterdam Public Health Research Institute, Amsterdam, The Netherlands ,grid.12380.380000 0004 1754 9227Division of Life Science, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - A. Pijpe
- grid.415746.50000 0004 0465 7034Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - J. Pleat
- grid.418484.50000 0004 0380 7221Department of Plastic and Reconstructive Surgery, North Bristol NHS Trust, Bristol, UK
| | - A. L. van de Kar
- grid.440209.b0000 0004 0501 8269Department of Plastic, Reconstructive en Handsurgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - J. Brown
- grid.416100.20000 0001 0688 4634Burn Center, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - H. C. W. de Vet
- grid.16872.3a0000 0004 0435 165XDepartment of Epidemiology and Data Science, Amsterdam UMC (location VUmc), Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - P. P. M. van Zuijlen
- grid.415746.50000 0004 0465 7034Burn Center and Department of Plastic, Reconstructive and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands ,grid.16872.3a0000 0004 0435 165XDepartment of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, The Netherlands ,Pediatric Surgical Centre, Emma Children’s Hospital, Amsterdam UMC, University of Amsterdam, Vrije Universiteit, Amsterdam, The Netherlands
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Sugimoto R, Yamanaka H, Tsuge I, Katayama Y, Katsube M, Sakamoto M, Morimoto N. Two-stage skin grafting using a basic fibroblast growth factor-impregnated artificial dermis. Regen Ther 2022; 21:258-262. [PMID: 36092498 PMCID: PMC9420932 DOI: 10.1016/j.reth.2022.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/17/2022] [Indexed: 11/26/2022] Open
Abstract
For traditional artificial dermises, a waiting period of approximately three weeks is required after the first implantation before they are adequately vascularized. The objective of this retrospective case series was to investigate whether full-thickness skin defects, requiring surgical reconstruction, could be successfully treated by implantation of a basic fibroblast growth factor (bFGF)-impregnated artificial dermis and secondary skin grafting with a shorter waiting period. Between January 2019 and January 2021, 19 skin defects in 14 patients (7 male and 7 female) were treated with two-stage skin grafting using bFGF-impregnated collagen-gelatin sponge (CGS). All of them were included in this case series, and the waiting period for skin grafting, success rate of skin grafting, infection during the waiting period, and scar quality 6–12 months postoperatively were retrospectively investigated. As a result, all skin grafting surgeries were successfully performed with a waiting period of 13.3 ± 4.3 days. Infection during the waiting period was observed in three lesions (15.8%); however, all infections were controllable. Postoperative scar quality was acceptable (Vancouver Scar Scale score range, 1–8). In conclusion, compared to traditional artificial dermises, bFGF-impregnated CGSs have the potential to shorten the waiting period without decreasing the success rate of skin grafting. Further studies are required to confirm this finding. We previously developed a novel artificial dermis which is capable of sustained release of bFGF. Skin defects were successfully treated by two-stage skin grafting using bFGF-impregnated CGS. The use of bFGF-impregnated CGS allowed for a short waiting period for secondary skin grafting.
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Van Praet KM, Kofler M, Akansel S, Montagner M, Meyer A, Sündermann SH, Falk V, Kempfert J. Periareolar endoscopic minimally invasive cardiac surgery: postoperative scar assessment analysis. Interact Cardiovasc Thorac Surg 2022; 35:6648104. [PMID: 35863058 PMCID: PMC9341307 DOI: 10.1093/icvts/ivac200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/17/2022] [Accepted: 07/20/2022] [Indexed: 11/15/2022] Open
Abstract
Abstract
OBJECTIVES
The standard approach for minimally invasive cardiac surgery (MICS) for repair of the atrioventricular valves is a right lateral minithoracotomy. In this study, we report our experience with a periareolar endoscopic approach, which aims at an optimal cosmetic outcome while preserving optimal clinical outcomes.
METHODS
All patients underwent periareolar endoscopic MICS using high-definition three-dimensional endoscopic visualization without additional rib-spreading. Patients presented with degenerative and/or functional mitral regurgitation. Patients undergoing concomitant tricuspid valve surgery, cryo-ablation, patent foramen ovale closure, left atrial appendage occlusion and/or left atrial myxoma extirpation were included. This descriptive article analysed the aesthetic and functional outcome of the periareolar scar using 5 most common and clinimetrically sound scar assessment scales. For statistical analysis of the scar assessment grading scales, box and whisker plots were calculated depicting median, interquartile range and high and low range data points.
RESULTS
Median scar assessment scale scores for n = 100 male patients (response rate 100/109; 91.7%) were 2 [1, 4], 7.5 [6, 9], 11 [8, 14], 3 [2, 3] and 10 [9, 11] for the Vancouver scar scale, Manchester scar scale, patient scar assessment scale, Stony brook scar evaluation scale and Dermatology Quality of Life Index scale, respectively. Ninety-seven patients received mitral valve repair, 7 mitral valve replacement, whereas 5 had left atrial myxoma extirpation. Concomitant tricuspid annuloplasty, cryo-ablation, left atrial appendage occlusion and patent foramen ovale closure surgery were performed in 12, 29, 5 and 8 patients, respectively. Median procedure, cardiopulmonary bypass and cross-clamp times were 169.5 [154.3, 189.3], 111.5 [97, 127], and 68.5 [58.8, 81] min, respectively.
CONCLUSIONS
Periareolar endoscopic MICS is safe and cosmetically appealing. It is feasible and allows for complex mitral valve repair, mitral valve replacement and concomitant surgery. Data from 5 scar assessment scales suggest that this technique delivers patient-satisfying results regarding functional and cosmetic outcomes.
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Affiliation(s)
- Karel M Van Praet
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin , Berlin, Germany
| | - Markus Kofler
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin , Berlin, Germany
| | - Serdar Akansel
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin , Berlin, Germany
| | - Matteo Montagner
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin , Berlin, Germany
| | - Alexander Meyer
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin , Berlin, Germany
- Berlin Institute of Health , Berlin, Germany
| | - Simon H Sündermann
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin , Berlin, Germany
- Department of Cardiovascular Surgery, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin , Berlin, Germany
- Department of Cardiovascular Surgery, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin, Germany
- Translational Cardiovascular Technologies, Institute of Translational Medicine, Department of Health Sciences and Technology, Swiss Federal Institute of Technology (ETH) Zurich , Zurich, Switzerland
| | - Jörg Kempfert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin , Berlin, Germany
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10
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Is massage an effective intervention in the management of post-operative scarring? A scoping review. J Hand Ther 2022; 35:186-199. [PMID: 35227556 DOI: 10.1016/j.jht.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 11/21/2021] [Accepted: 01/21/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Scar massage is a widely used treatment modality in hand therapy. This intervention is thoroughly discussed in the literature relating to burns rehabilitation, however, the evidence for its use in treating linear scars following surgery is limited. PURPOSE OF STUDY To collate the empirical literature on scar massage for the treatment of postsurgical cutaneous scars. STUDY DESIGN Scoping review. METHODS Medline, EMBASE, CINAHL, AMED, Scopus, ProQuest Dissertations & Theses Global, and the Joanna Briggs Institute were searched from inception to December 2020. Two researchers used a data extraction tool to record key demographic, intervention and outcome data, and to apply the Oxford Levels of Evidence for each study. RESULTS Twenty-five studies met the inclusion criteria, reporting on a combined sample of 1515 participants. Only two papers addressed hand or wrist scars (92 participants). While all studies reported favorable outcomes for scar massage, there were 45 different outcome measures used and a propensity towards non-standardized assessment. Intervention protocols varied from a single session to three treatments daily for 6 months. The results from 13 studies were confounded by the implementation of additional rehabilitation interventions. CONCLUSIONS The overall findings suggest that while there may be benefits to scar massage in reducing pain, increasing movement and improving scar characteristics; there is a lack of consistent research methods, intervention protocols and outcome measures. This scoping review highlights the heterogenous nature of research into scar massage following surgery and supports the need for further research to substantiate its use in the clinical setting.
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11
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Fu Z, Huang H, Huang J. Efficacy and safety of botulinum toxin type A for postoperative scar prevention and wound healing improvement: A systematic review and meta-analysis. J Cosmet Dermatol 2021; 21:176-190. [PMID: 34859567 DOI: 10.1111/jocd.14617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 11/05/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Botulinum toxin type A (BTXA) has shown underlying effects for wound healing improvement. New small clinical trials keep emerging every year and updated evidence-based information is warranted. This study aimed to evaluate the efficacy and safety of BTXA for preventing scarring. METHODS Four databases were searched to recruit randomized clinical trials (RCTs) which compared the surgical wounds treated with BTXA vs. those treated with placebo or blank control. The outcomes were primarily quantified by measures including the Vancouver Scar Scale (VSS), Visual Analog Scale (VAS), Stony Brook Scar Evaluation Scales (SBSES), modified SBSES (mSBSES), and scar width. Patients' satisfaction and adverse events were also reported. RESULTS In total, 16 RCTs involving 671 cases (510 patients) were included. The outcome showed significant superiority of BTXA in VSS (mean difference [MD] = -1.32, 95% confidence interval [CI]: -2.00 to -0.65, p = 0.0001), VAS (MD = 1.29, 95% CI: 1.05-1.52, p < 0.00001), SBSES or mSBSES (MD = -0.18, 95% CI: -0.27 to -0.10, p < 0.0001), scar width (MD = -0.18, 95% CI: -0.27 to -0.10, p < 0.0001), and patients' satisfaction (risk ratio [RR] = 1.25, 95% CI: 1.06-1.49, p = 0.01). No significant difference of adverse events incidence was observed (RR = 1.46 95% CI: 0.64-3.33, p = 0.36). CONCLUSIONS Botulinum toxin type A is effective and safe for postoperative scar prevention and wound healing improvement, especially for facial wounds of Asians. Further studies should manage to standardize the treatment algorithm, while mSBSES is recommended for scar assessment.
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Affiliation(s)
- Ziyao Fu
- Department of Plastic Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hanzi Huang
- Department of Plastic Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiuzuo Huang
- Department of Plastic Surgery, Peking Union Medical College Hospital (PUMCH), Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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12
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Scafide KN, Bahari G, Kutahyalioglu NS, Mohammadifirouzeh M, Senko SM. Development and Pilot Analysis of the Bruise Visibility Scale. SAGE Open Nurs 2021; 7:23779608211020931. [PMID: 34423127 PMCID: PMC8371286 DOI: 10.1177/23779608211020931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
The accuracy of assessing and documenting injuries is crucial to facilitate
ongoing clinical care and forensic referrals for victims of violence. The
purpose of this cross-sectional, pilot study was to evaluate the inter-rater
reliability and criterion validity of a newly developed Bruise Visibility
Scale (BVS). Methods: The instrument was administered to a
diverse sample (n = 30) with existing bruises. Bruises were assessed under
fluorescent lighting typical of an examination room by three raters who were
randomly selected from a pool of eight experienced clinical nurses.
Colorimetry values of the bruise and surrounding tissue were obtained using
a spectrophotometer. Results: The BVS demonstrated good single
(ICC = 0.71, 95% CI = 0.54 – 0.84) and average agreement (ICC = 0.88, 95%
CI = 0.78 – 0.94) between raters. A significant, positive moderate
correlation was found between mean BVS scores and overall color difference
between the bruise and surrounding skin (Pearson’s r = 0.614,
p < 0.001). Conclusion: With further
research, the BVS has the potential to be a reliable and valid tool for
documenting the degree of clarity in bruise appearance.
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Affiliation(s)
- Katherine N Scafide
- College of Health and Human Services, George Mason University, Fairfax, Virginia, United States
| | - Ghareeb Bahari
- College of Nursing, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Nesibe S Kutahyalioglu
- College of Health and Human Services, George Mason University, Fairfax, Virginia, United States
| | - Mona Mohammadifirouzeh
- College of Health and Human Services, George Mason University, Fairfax, Virginia, United States
| | - Susan M Senko
- College of Health and Human Services, George Mason University, Fairfax, Virginia, United States
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13
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Suh JM, Park SH, Lee JW, Lee SJ, Suh IS, Lee JW, Jeong HS. Clinical Outcomes Following the Early Application of Multimodal Scar Programs for Facial Incisional Wounds. Aesthetic Plast Surg 2021; 45:1772-1782. [PMID: 33973048 DOI: 10.1007/s00266-021-02330-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Even though scars are major issues for patients who undergo facial lacerations, programs for their prevention and early management are not well established. The purpose of this study was to evaluate the clinical outcomes of prophylactic scar assessments and early scar interventions in patients with lacerations. PATIENTS AND METHODS A total of 116 patients underwent suture line and scar prevention treatment in the emergency room from 2014 to 2015. In the retrospective study, 46 patients who met all the criteria were included in the study. They were assigned to one of the following two scar prevention programs: the standard scar program for prevention, which included taping, silicone sheets, and ointments, and the multimodality scar program for treatment, which included triamcinolone, botulinum toxins, or CO2 fractional lasers. The patterns of early scar program were investigated for the standard scar prevention program and the multimodality scar management program, and we evaluated the scar assessment scores of the patients at 3 and 6 months. RESULTS Scar scores for the patients who received multimodality scar management showed statistically significant improvements in Patient Scar Assessment (PSA) scales, Stony Brook Scar Evaluation Scales (SBSES), Vancouver Scar Scale (VSS) scores, and Visual Analog Scar (VAS) scales (the p values were 0.008, 0.007, 0.017, and 0.01, respectively). CONCLUSION The multimodality scar program is more effective for scar prevention than the standard scar program. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Joong Min Suh
- Department of Plastic and Reconstructive Surgery, Kangdong Sacred Heart Hospital, Seoul, Korea
| | - Seong Hoon Park
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jun Won Lee
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Seong Joo Lee
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - In Suck Suh
- Department of Plastic and Reconstructive Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jong Wook Lee
- Department of Plastic and Reconstructive Surgery, Hangang Sacred Heart Hospital, School of Medicine, Hallym University, Seoul, Korea
| | - Hii Sun Jeong
- Department of Plastic and Reconstructive Surgery, Institute for Human Tissue Restoration, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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14
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Deflorin C, Hohenauer E, Stoop R, van Daele U, Clijsen R, Taeymans J. Response to Vercelli et al. re: "Physical Management of Scar Tissue: A Systematic Review and Meta-Analysis". J Altern Complement Med 2021; 27:374-376. [PMID: 33826859 DOI: 10.1089/acm.2020.29089.cde] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Carlina Deflorin
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
| | - Erich Hohenauer
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland.,School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom.,International University of Applied Sciences THIM, Landquart, Switzerland
| | - Rahel Stoop
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland
| | - Ulrike van Daele
- Department of Rehabilitation Sciences and Physiotherapy, University of Antwerp, Antwerp, Belgium.,Oscare, Organization for Burns, Scar After-Care and Research, Antwerp, Belgium
| | - Ron Clijsen
- Rehabilitation Research Laboratory (2rLab), Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Landquart/Manno, Switzerland.,School of Sport, Health and Exercise Science, University of Portsmouth, Portsmouth, United Kingdom.,International University of Applied Sciences THIM, Landquart, Switzerland.,Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Health, Bern University of Applied Sciences, Berne, Switzerland
| | - Jan Taeymans
- Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Health, Bern University of Applied Sciences, Berne, Switzerland
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15
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Vercelli S, Poddighe D, Bravini E, Sartorio F, Ferriero G. Re: "Physical Management of Scar Tissue: A Systematic Review and Meta-Analysis" by Deflorin et al. J Altern Complement Med 2020; 27:373-374. [PMID: 33216616 DOI: 10.1089/acm.2020.0401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Stefano Vercelli
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri, Institute of Veruno, IRCCS, Gattico-Veruno (NO), Italy
| | - Diego Poddighe
- Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | | | - Francesco Sartorio
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri, Institute of Veruno, IRCCS, Gattico-Veruno (NO), Italy
| | - Giorgio Ferriero
- Physical and Rehabilitation Medicine Unit, Istituti Clinici Scientifici Maugeri, Institute of Tradate, IRCCS, Tradate (VA), Italy.,Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
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16
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Hjellestad M, Strand LI, Eide GE, Brekke R, Nesheim A, Gjelsvik BEB. Clinimetric properties of a translated and culturally adapted Norwegian version of the Patient and Observer Scar Assessment Scale for use in clinical practice and research. Burns 2020; 47:953-960. [PMID: 33139075 DOI: 10.1016/j.burns.2020.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 08/26/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To translate and culturally adapt the Patient and Observer Scar Assessment Scale, POSAS, to Norwegian and explore its test-retest, intra- and inter-tester reliability. METHODS POSAS was translated into Norwegian following international guidelines in collaboration with an international translation bureau. Twenty-six adults and 24 children were recruited from a burns outpatient clinic. Three observer-categories: doctor, nurse and physiotherapist, assessed the patients' scars and scored the Observer scale for estimating inter-tester reliability. Photos of the scars were taken and used to score the Observer scale a second time for examining intra-tester reliability. The patients or parents/next of kin rated their scar on the Patient scale at the clinic and after two days at home for examining test-retest reliability. Intraclass correlation (ICC) and Kappa were used for statistical analysis. RESULTS A Norwegian version of POSAS (POSAS-NV) was developed. Inter-tester ICC of the Observer parameters varied between 0.203 and 0.728, and for the total sum score, ICC=0.528 (0.280-0.708). Intra-tester ICC of the Observer scale ranged between 0.575 and 0.858. The Patient scale demonstrated high test-retest reliability. CONCLUSIONS Intra-tester reliability of the Observer scale and test-retest reliability of the Patient scale of POSAS-NV were found satisfactory, but not inter-tester reliability of the Observer scale.
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Affiliation(s)
- Marit Hjellestad
- Department of Physiotherapy, Haukeland University Hospital, Bergen, Norway
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Geir Egil Eide
- Department of Global Public Health and Primary Care, University of Bergen, Norway; Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Ragnvald Brekke
- National Burns Centre, Haukeland University Hospital, Bergen, Norway
| | - Anne Nesheim
- National Burns Centre, Haukeland University Hospital, Bergen, Norway
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17
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Pirri C, Stecco A, Fede C, De Caro R, Stecco C, Özçakar L. Ultrasound imaging of a scar on the knee: Sonopalpation for fascia and subcutaneous tissues. Eur J Transl Myol 2020; 30:8909. [PMID: 32499900 PMCID: PMC7254433 DOI: 10.4081/ejtm.2019.8909] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 02/29/2020] [Indexed: 11/23/2022] Open
Abstract
Persistent scar pain associated with healed surgical incisions after a trauma is a common and potentially debilitating type of fascial pain. At present, there is no universally effective treatment for persistent surgical or post-trauma scar pain. Herein we describe the successful objective diagnosis of debilitating scar pain by Ultrasound (US) imaging. The sonopalpation of the fasciae and subcutaneous tissues seems to be relevant to diagnose the real cause of the pain and why not to monitor the treatment.
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Affiliation(s)
- Carmelo Pirri
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Italy
| | - Antonio Stecco
- RUSK Rehabilitation, New York University School of Medicine, New York, New York, USA
| | - Caterina Fede
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Italy
| | - Raffaele De Caro
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Italy
| | - Carla Stecco
- Department of Neurosciences, Institute of Human Anatomy, University of Padova, Italy
| | - Levent Özçakar
- Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine Ankara, Turkey
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18
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Franchignoni F, Giordano A, Vercelli S, Bravini E, Stissi V, Ferriero G. Rasch Analysis of the Patient and Observer Scar Assessment Scale in Linear Scars. Plast Reconstr Surg 2019; 144:1073e-1079e. [DOI: 10.1097/prs.0000000000006265] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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19
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Behrouz-Pirnia A, Liu H, Peternel S, Dervishi G, Labeit A, Peinemann F. Early laser intervention to reduce scar formation in wound healing by primary intention: A systematic review. J Plast Reconstr Aesthet Surg 2019; 73:528-536. [PMID: 31757687 DOI: 10.1016/j.bjps.2019.09.050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/24/2019] [Accepted: 09/28/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Hypertrophic scars frequently follow primary closure of surgical wounds. Laser application at or shortly after suture may be associated with a reduction in scar formation, although the respective study results vary. AIM The objective was to evaluate the efficacy of early laser applied within the first six months after surgery to reduce scar formation compared to no treatment. METHODS We searched the databases MEDLINE and CENTRAL on 14 January 2019 and included randomized controlled trials (RCTs). Primary outcome was the Vancouver Scar Scale (VSS). Measure of treatment effect was the mean difference from baseline. RESULTS Seventeen relevant RCTs randomized 430 scars (413 assessed) and compared laser versus no treatment. Fourteen studies applied a split-scar and three applied a simple parallel design. Three studies with a split-scar design favored the laser group on VSS, and one study had indifferent findings. Considerable heterogeneity I2 = 86% did not justify a meta-analysis. The remaining 13 studies did not report appropriate data. CONCLUSION On the basis of the currently available evidence, we are uncertain whether early laser can reduce scar formation, and more high-quality research is needed for a definitive conclusion.
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Affiliation(s)
- Armin Behrouz-Pirnia
- Children's Hospital, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Haibo Liu
- Department of Dermatology, Jinling Hospital, Nanjing University School of Medicine, 305 East Zhongshan Rd, Xuanwu District, 210002 Nanjing, Jiangsu, China.
| | - Sandra Peternel
- Department of Dermatovenereology, Clinical Hospital Centre Rijeka, Krešimirova ul. 42, 51000 Rijeka, Croatia; Faculty of Medicine, University of Rijeka, Ul. Braće Branchetta 20/1, 51000, Rijeka, Croatia.
| | - Gezim Dervishi
- Children's Hospital, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany.
| | - Alexander Labeit
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549 Singapore.
| | - Frank Peinemann
- Children's Hospital, University Hospital of Cologne, Kerpener Str. 62, 50937 Cologne, Germany; FOM University of Applied Science for Economics & Management, Leimkugelstraße 6, 45141 Essen, Germany.
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20
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Restrepo S, Rojas S, Sanabria A. Cross-cultural adaptation and psychometric validation of the Patient Scar Assessment Questionnaire to the Spanish language in head and neck surgery. Int Wound J 2019; 17:21-31. [PMID: 31680458 DOI: 10.1111/iwj.13218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/18/2019] [Indexed: 11/27/2022] Open
Abstract
External appearance is the main aesthetic outcome in patients who undergo surgical procedures. Scars located in exposed areas, such as the neck and face, are important for patients. There are at least eight instruments that are used to evaluate postoperative scars, but few fulfil standard methodological conditions. The Patient Scar Assessment Questionnaire (PSAQ) was designed and validated using psychometric methodology. However, this scale has not been translated or validated in the Spanish language. The aim of this study was to undergo a cross-cultural adaptation and psychometric validation of the PSAQ scale to the Spanish language in patients who underwent head and neck surgery. We followed The Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines for the translation and validation of health-related scales. Forward and back translations were made by independent translators. We included adult patients who underwent thyroidectomy, parathyroidectomy, parotidectomy, and neck dissection. For the psychometric validation, we used a principal axis exploratory factor analysis with oblimin rotation. A reliability test involving Cronbachs alpha and the item-total correlation was performed and for the convergent/concurrent validity, we selected the Spanish version of the Vancouver Scar Scale. A total of 180 patients were recruited. Factor analysis showed a five-factor solution. Cronbachs alpha for the subscales was >0.7. The comparison between the PSAQ appearance subscale and the VSS demonstrated a high correlation (rho = - 0.89). In a sample of 62 patients, the test-retest evaluation showed high correlation (0.74-0.99). Our study supports the Spanish version of the PSAQ as a valid, reliable, and reproducible tool to assess the perception and impact of neck scars in Spanish-speaking patients who undergo head and neck surgery.
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Affiliation(s)
- Santiago Restrepo
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Santiago Rojas
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia.,Head and Neck Service, Fundación Colombiana de Cancerología-Clínica Vida, Medellín, Colombia.,Centro de Excelencia en Cirugía de Cabeza y Cuello, CEXCA, Medellín, Colombia
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21
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Wang Y, Wang J, Zhang J, Hu C, Zhu F. Effectiveness and Safety of Botulinum Toxin Type A Injection for Scar Prevention: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2019; 43:1241-1249. [PMID: 30903249 DOI: 10.1007/s00266-019-01358-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 03/10/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND The role of active scar prevention in postoperative scar management is important. Botulinum toxin type A (BTXA) has been shown to improve postoperative scars in the past decades. The aim of this systematic review and meta-analysis was to evaluate the effectiveness and safety of BTXA injection for scar prevention. METHODS The authors searched the databases of Medicine, Embase, the Cochrane Library, Web of Science, and CINAHL from inception through November 2018 for randomized controlled trials (RCTs) reporting the use of BTXA in scar prevention. The outcomes were the visual analogue scale (VAS) score, Vancouver Scar Scale score, scar width, patient satisfaction and adverse events. RESULTS A total of nine RCTs were identified in this systematic review and meta-analysis. The VAS score was significantly higher in the BTXA group than in the control group (weighted mean difference (WMD) = 1.32, 95% confidence interval (CI) = 1.06-1.58, P < 0.00001). The Vancouver Scar Scale score was significantly lower in the BTXA group (WMD = - 1.25, 95% CI = - 2.23 to - 0.26, P = 0.01). The scar width was also significantly smaller in the BTXA group (WMD = - 0.18, 95% CI = - 0.24 to - 0.12, P < 0.00001). There was a significant difference in terms of patient satisfaction between the BTXA group and the control group (relative risk (RR) = 1.38, 95% CI = 1.09-1.74, P = 0.007). Only two studies reported complications, and other studies reported no complications during the follow-up period. CONCLUSIONS This systematic review and meta-analysis demonstrates that BTXA injection can reduce scar width in wounds and improve the overall appearance of postoperative scars and suggests that BTXA may be a safety therapy for scar prevention. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Systematic Review on the Content of Outcome Measurement Instruments on Scar Quality. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2424. [PMID: 31741815 PMCID: PMC6799398 DOI: 10.1097/gox.0000000000002424] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/09/2019] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is available in the text. Measurements of scar quality are essential to evaluate the effectiveness of scar treatments and to monitor scars. A large number of scar scales and measurement devices have been developed, which makes instrument selection challenging. The aim of this study was to provide an overview of the content (ie, included items) of all outcome measurement instruments that measure scar quality in different types of scars (burn, surgical, keloid, and necrotizing fasciitis), and the frequency at which the instruments and included items are used.
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23
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Al-Drees T, Albosaily A, Alanazi L, Alharethy S, AlHindi G, Altuwaijri A, Aldhahri S. Translation and cultural adaptation of an Arabic version of the patient scar assessment scale for thyroidectomy patients. Saudi Med J 2019; 40:590-594. [PMID: 31219493 PMCID: PMC6778767 DOI: 10.15537/smj.2019.6.24197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives: To translate and validate an Arabic version of the patient scar assessment scale (PSAS). The cosmetic appearance of a thyroidectomy scar can critically influence a patient’s self-esteem. Moreover, scar evaluation tools are necessary for an evidence-based approach to scar management. Methods: This quantitative, observational, cross-sectional study was conducted by administering an Arabic-translated version of the PSAS. The translation process included a forward translation into Arabic by 3 fluently bilingual otolaryngologists, a back-translation into English, and a comparison with the original items. The questionnaires were distributed to patients who underwent thyroidectomies. We included patients who underwent surgery at least 2 months previously. Results: A total of 50 patients were included in this research. The internal consistency was 0.89, with a 95% confidence interval (CI) of 0.88-0.90. The score distributions showed high correlations for all items. The Arabic-translated PSAS showed good test-retest reliability, and the Pearson correlation coefficient between the test and retest administrations was 0.84 (p<0.001). With a possible range of 6-60 points, the standard error of the mean was 5.14, and the minimal detectable change was 14.2. Conclusion: This Arabic version of the PSAS was reliable for use in Arabic-speaking communities. It will allow for comparisons between the results of investigations conducted in different countries, which aids in the exchange of information within the international scientific community.
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Affiliation(s)
- Turki Al-Drees
- Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Al-Kharj, Kingdom of Saudi Arabia. E-mail.
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Kern JN, Weidemann F, O'Loughlin PF, Krettek C, Gaulke R. Mid- to Long-term Outcomes After Split-thickness Skin Graft vs. Skin Extension by Multiple Incisions. In Vivo 2019; 33:453-464. [PMID: 30804125 DOI: 10.21873/invivo.11494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Revised: 12/16/2018] [Accepted: 12/17/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Skin extension by multiple incisions (SEMI) may be superior to split-thickness skin graft (STSG) for closure of large soft tissue defects. MATERIALS AND METHODS Twenty-six patients who had undergone STSG were compared to 29 patients who had undergone SEMI on the extremities. Patient and Observer Scar Assessment Scale (POSAS), Dermatology Life Quality Index, Wound QoL (Quality of Life) and Short Form Health Survey 36 were used. Elasticity, thickness and skin sensation were compared between the treated and contralateral extremity. Range of motion in adjacent joints was measured. Complication rates were compared. RESULTS A total of 55 patients with a mean follow-up of 5.5 years (range=2-9 years) were examined. Patients with STSG had significantly worse scores in POSAS. The scar was thinner, less elastic and did not provide intact sensibility. Other scores, ROM and complication rates did not differ significantly. CONCLUSION SEMI was superior to STSG regarding patient satisfaction and scar quality.
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Affiliation(s)
- Jette Nicoline Kern
- Section Upper Extremity, Foot- and Rheuma Surgery, Trauma Department, Medical School Hanover (MHH), Hanover, Germany.,Trauma Department, Medical School Hanover (MHH), Hanover, Germany
| | | | | | | | - Ralph Gaulke
- Section Upper Extremity, Foot- and Rheuma Surgery, Trauma Department, Medical School Hanover (MHH), Hanover, Germany .,Trauma Department, Medical School Hanover (MHH), Hanover, Germany
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Spens K, Bird L, Bright P. Transabdominal ultrasound: Can it be used to detect and quantify adhesions/reported pain, following Caesarean section? J Bodyw Mov Ther 2018; 22:733-740. [PMID: 30100305 DOI: 10.1016/j.jbmt.2017.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 07/30/2017] [Accepted: 09/06/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Caesarean section is common in the UK with post-procedural adhesions causing life-long clinical symptoms and impacting future pregnancies. This study's aim was to explore associations between these surgical adhesions, via transabdominal ultrasound findings, and perceived symptoms. METHOD Females demonstrating 1-3 transverse, lower-segment Caesareans were included. Visceral slide transabdominal ultrasound elicited positive adhesions (<1 cm movement) and negative adhesions (>1 cm movement). Scar tissue quality was assessed by the Patient and Observer Scar Assessment Scale (POSAS) and Numerical rating scales (NRS) described pain symptoms. The relationship between adhesions was explored using Fisher's exact test and multiple regression analysis. RESULTS Twenty-two subjects (mean-age 35) were recruited; twenty participants (91%) had undergone 1 Caesarean, one each of the remainder had undergone 2 and 3 Caesareans respectively. Increased Visceral slide (>1 cm) was seen as predictive of increased scar pain (R2 = 0.76 (95% CI 0.12-0.28), P < 0.001). CONCLUSION Caesarean adhesion scans showed significant associations with pain symptomology. Comprehensive adhesion assessment needs to be developed to improve long term outcomes of adhesions. Transabdominal Ultrasound can be considered a useful, quick and non-deleterious alternative diagnostic tool to Laparoscopy, therefore preventing further adhesion formation.
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Affiliation(s)
- Katharine Spens
- European School of Osteopathy, Boxley House, The Street, Boxley, Maidstone, Kent, ME14 3DZ, UK(1).
| | - Lance Bird
- European School of Osteopathy, Boxley House, The Street, Boxley, Maidstone, Kent, ME14 3DZ, UK(1)
| | - Philip Bright
- European School of Osteopathy, Boxley House, The Street, Boxley, Maidstone, Kent, ME14 3DZ, UK(1)
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Svensson-Björk R, Hasselmann J, Acosta S. Evaluation of inguinal vascular surgical scars treated with closed incisional negative pressure wound therapy using three-dimensional digital imaging-A randomized controlled trial on bilateral incisions. Wound Repair Regen 2018; 26:77-86. [PMID: 29381241 DOI: 10.1111/wrr.12615] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 01/23/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE OF THE INVESTIGATION Scar formation is an important, permanent surrogate marker for wound healing. The main aim of this randomized trial was to evaluate the effects of incisional negative pressure wound therapy (iNPWT) on scar formation in uncomplicated wound healing with 3-dimensional (3D) digital imaging. BASIC PROCEDURES Patients undergoing bilateral inguinal incisions after vascular surgery were randomized to receive iNPWT and standard dressing on separate sides. The incisional scars were documented at a median time of 808 days (range 394-1194) after surgery with 3D photography, which were objectively evaluated by two plastic surgeons using the Stony Brook scar evaluation scale (SBSES) and a 10-point graded numeric ranking scale (NRS10). Subjective evaluation was performed with the patient observer scar assessment scale (POSAS). Patients with surgical site infection or other wound complications were excluded to minimize bias. The p-values were calculated using McNemar's and Wilcoxon signed-rank test for paired nominal and paired continuous data, respectively. MAIN FINDINGS Among 33 patients, 32 patients had undergone endovascular aortic repair (EVAR) and 31 patients had transverse inguinal incisions. Objective and subjective scar evaluation showed no difference between iNPWT and standard dressing. In objective scorings, 18.8 and 21.9% received the highest possible SBSES total score in the iNPWT and standard dressing groups, while 43.8 and 37.5% received the highest possible NRS10 score, respectively. The inter-rater reliability between the two assessors for SBSES total score and NRS10 showed an intra-class correlation (ICC) of 0.78 and 0.68 for NPWT and 0.70 and 0.77 for traditional dressing, respectively. PRINCIPAL CONCLUSION The present randomized trial showed that iNPWT and standard dressings on closed transverse inguinal incisions after EVAR resulted in equal subtle scar formation. Objective scar evaluation with 3D images showed good inter-rater agreement.
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Affiliation(s)
- Robert Svensson-Björk
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Julien Hasselmann
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
| | - Stefan Acosta
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Vascular Center, Department of Cardiothoracic and Vascular Surgery, Skåne University Hospital, Malmö, Sweden
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Optimizing Postsurgical Scars: A Systematic Review on Best Practices in Preventative Scar Management. Plast Reconstr Surg 2017; 140:782e-793e. [PMID: 28806293 DOI: 10.1097/prs.0000000000003894] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Scar management is critical for every plastic surgeon's practice and, ultimately, the patient's satisfaction with his or her aesthetic result. Despite the critical nature of this component of routine postoperative care, there has yet to be a comprehensive analysis of the available literature over the past decade to assess the best algorithmic approach to scar care. To this end, a systematic review of best practices in preventative scar management was conducted to elucidate the highest level of evidence available on this subject to date. METHODS A computerized MEDLINE search was performed for clinical studies addressing scar management. The resulting publications were screened randomized clinical trials that met the authors' specified inclusion/exclusion criteria. RESULTS This systematic review was performed in May of 2016. The initial search for the Medical Subject Headings term "cicatrix" and modifiers "therapy, radiotherapy, surgery, drug therapy, prevention, and control" yielded 13,101 initial articles. Applying the authors' inclusion/exclusion criteria resulted in 12 relevant articles. All included articles are randomized, controlled, clinical trials. CONCLUSIONS Optimal scar care requires taking into account factors such as incisional tension, anatomical location, and Fitzpatrick skin type. The authors present a streamlined algorithm for scar prophylaxis based on contemporary level I and II evidence to guide clinical practice.
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Vercelli S, Ferriero G, Bravini E, Stissi V, Ciceri M, Rossetti S, Bianchi S, Sartorio F. Cross-cultural adaptation, reproducibility and validation of the Italian version of the Patient and Observer Scar Assessment Scale (POSAS). Int Wound J 2017; 14:1262-1268. [PMID: 28782201 DOI: 10.1111/iwj.12795] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 07/02/2017] [Indexed: 11/30/2022] Open
Abstract
The Patient and Observer Scar Assessment Scale (POSAS) is one of the most robust instruments to assess scar quality, but there is no Italian version, and no other competing instruments are available in Italian. The aim of this study was to translate and validate an Italian version of POSAS (POSAS-I). POSASv2.0 was culturally adapted in accordance with international standards. The psychometric assessment included acceptability/feasibility, internal consistency, reproducibility, construct validity and sensitivity to change. Cultural equivalence of POSAS-I with the English version was confirmed. The validation study included 102 subjects with surgical scars. Both subscales demonstrated acceptable internal consistency (Cronbach's α = 0·72-0·80). Reproducibility of the OSAS-I (ICCs = 0·93-0·94; SEM = 1·8 points; MDC95 = 5·1 points) was superior to that of PSAS-I (ICC = 0·65; SEM = 5·7 points; MDC95 = 15·7 points). OSAS-I showed moderate to good correlations with the Vancouver Scar Scale (VSS), Global Rating of Change Scale (GRCS) and PSAS-I. Sensitivity to change was large for PSAS-I (effect size = 1·08; standardised response mean = 0·96) and moderate to large for OSAS-I (ES = 0·69; SRM = 0·92). This study confirmed that POSAS-I can be used to assess patients with surgical scars in the Italian population. OSAS-I is useful for clinical and research purposes, while PSAS-I should be better used to capture patients' own opinions and symptoms in clinical settings.
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Affiliation(s)
- Stefano Vercelli
- Laboratory of Ergonomics and Musculoskeletal Disorders Assessment, Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri SpA-SB, Scientific Institute of Veruno, IRCCS, Novara, Italy
| | - Giorgio Ferriero
- Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri SpA-SB, Scientific Institute of Lissone, IRCCS, Lissone, Italy
| | | | | | | | - Sara Rossetti
- Clinica La Vialarda - Presidio di Policlinico di Monza SpA, Biella, Italy
| | | | - Francesco Sartorio
- Laboratory of Ergonomics and Musculoskeletal Disorders Assessment, Division of Physical Medicine and Rehabilitation, Istituti Clinici Scientifici Maugeri SpA-SB, Scientific Institute of Veruno, IRCCS, Novara, Italy
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Casanova D, Alliez A, Baptista C, Gonelli D, Lemdjadi Z, Bohbot S. A 1-Year Follow-Up of Post-operative Scars After the Use of a 1210-nm Laser-Assisted Skin Healing (LASH) Technology: A Randomized Controlled Trial. Aesthetic Plast Surg 2017; 41:938-948. [PMID: 28233128 DOI: 10.1007/s00266-017-0820-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/06/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Laser therapies are used prophylactically for excessive scar formation. The Laser-Assisted Skin Healing treatment induces a controlled heat stress that promotes tissue regeneration. This comparative trial is the first to evaluate the performance of a new automated 1210-nm laser system, compatible with all Fitzpatrick scale phototypes. METHODS Forty women undergoing bilateral breast reduction were enrolled in this double-blinded randomized controlled trial. The horizontal sutured incision of one breast was treated with the portable 1210-nm laser while in the operating theatre. The other breast was used as the study control. Objective measurements, subjective clinical assessments and safety evaluation were carried out over 1 year by both clinicians and patients. RESULTS Six weeks following surgery, better overall appearance and modified OSAS scores were reported for the laser-treated scars when compared to the control group (p = 0.024 and p = 0.079). This supports an early effect of the laser treatment during the inflammatory stage of the healing process. After a post-treatment period of 6 months, there continued to be a strong tendency in favour of the laser treatment based on the subjective scores and corroborated by the objective improvement of the treated scar volume (p = 0.038). At 1 year, the laser-treated scars continued to improve compared to the control ones in terms of volume (p = 0.004), surface (p = 0.017) and roughness (p = 0.002), and these comparatively better results were strengthened with the blind expression of patients' preference for their laser-treated scar (p = 0.025). CONCLUSIONS This new 1210-nm laser treatment, used as a single session performed immediately after surgery, provides significant objective and subjective improvements in scar appearance. These data can be useful when preparing patients to undergo their surgical procedure. LEVEL OF EVIDENCE I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Goei H, van der Vlies C, Tuinebreijer W, van Zuijlen P, Middelkoop E, van Baar M. Predictive validity of short term scar quality on final burn scar outcome using the Patient and Observer Scar Assessment Scale in patients with minor to moderate burn severity. Burns 2017; 43:715-723. [DOI: 10.1016/j.burns.2016.10.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 10/12/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
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Kantor J. The SCAR (Scar Cosmesis Assessment and Rating) scale: development and validation of a new outcome measure for postoperative scar assessment. Br J Dermatol 2016; 175:1394-1396. [PMID: 27292082 DOI: 10.1111/bjd.14812] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Kantor
- Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, U.S.A.,Florida Center for Dermatology, P.A., PO Box 3044, Saint Augustine, FL, 32085, U.S.A
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Vidal A, Mendieta Zerón H, Giacaman I, Camarillo Romero MDS, López SP, Meza Trillo LE, Pérez Pérez DA, Concha M, Torres-Gallegos C, Orellana SL, Oyarzun-Ampuero F, Moreno-Villoslada I. A Simple Mathematical Model for Wound Closure Evaluation. J Am Coll Clin Wound Spec 2016; 7:40-49. [PMID: 28053868 DOI: 10.1016/j.jccw.2016.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The incidence of ulcers associated to type 2 diabetes mellitus (T2DM) increases every year. We introduce and explore a new mathematical algorithm to evaluate wound-healing in foot ulcers associated to T2DM. Fifteen patients (nine women and six men), mean age of 70 ± 16 years were included. The evolution of their wounds followed-up for a period of 18-45 days. According to the Wagner grading system the ulcers were grade I (5 patients), grade II (9 patients), and grade III (1 patient). Clinically, the type of the ulcers was neuroischemic (12 patients) and neuropathic (3 patients). A new parameter is introduced, the "continuous linear healing rate" Dc that was more accurate with higher values and requires less quantifications than usual formulas to make a wound-healing projection.
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Affiliation(s)
- Alejandra Vidal
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Hugo Mendieta Zerón
- Facultad de Medicina, Universidad Autónoma del Estado de México, Toluca, Estado de México, Mexico
| | - Israel Giacaman
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | | | - Sandra Parra López
- Facultad de Medicina, Universidad Autónoma del Estado de México, Toluca, Estado de México, Mexico
| | - Laura E Meza Trillo
- Facultad de Ciencias de la Salud, Universidad de Anáhuac, Huixquilucan, Estado de México, Mexico
| | | | - Miguel Concha
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - César Torres-Gallegos
- Instituto de Ciencias Químicas, Facultad de Ciencias, Universidad Austral de Chile, Valdivia, Chile
| | - Sandra L Orellana
- Instituto de Ciencias Químicas, Facultad de Ciencias, Universidad Austral de Chile, Valdivia, Chile
| | - Felipe Oyarzun-Ampuero
- Departamento de Ciencias & Tecnologías Farmacéuticas, Universidad de Chile, Santiago, Chile
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