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Jeha GM, Dickerson T, Hargrave L, Bao-Loc-Trung M, Prusisz T, Bucher E, Rougelot RC, LeBlanc K. Does Timolol Solution Improve the Appearance of Acute Surgical Wounds After Mohs Surgery? A Split-Scar Clinical Study. Dermatol Surg 2024; 50:481-483. [PMID: 38261740 DOI: 10.1097/dss.0000000000004094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- George M Jeha
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Taylor Dickerson
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Lyndsey Hargrave
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | | | - Tyler Prusisz
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Elizabeth Bucher
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
- The Skin Surgery Centre, Metairie, Louisiana
| | - R Corey Rougelot
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
- The Skin Surgery Centre, Metairie, Louisiana
| | - Keith LeBlanc
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
- The Skin Surgery Centre, Metairie, Louisiana
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2
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Rose PT. Ethical Considerations in Follicular Unit Excision Surgical Procedures. Facial Plast Surg 2024; 40:245-251. [PMID: 37944997 DOI: 10.1055/a-2207-3413] [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] [Indexed: 11/12/2023] Open
Abstract
Follicular unit excision (FUE) is an increasingly popular hair restoration technique. In many instances, it surpasses linear strip excision (LSE) surgery in terms of number of procedures and clinics dedicated to performing FUE. The rise in popularity relates primarily to a somewhat misguided perception that FUE produces less evidence of a surgical procedure having been performed. This is based on the fact that a linear scar is avoided. The procedure is easier to learn and "less invasive" as compared to LSE harvesting and requires less staff and capital expense. The FUE procedure is aggressively marketed often as "scarless surgery." This false statement, along with the ease of starting an FUE practice, has resulted in various ethical issues related to evaluation, methodology, and business practices. In this chapter, we discuss the ethical issues surrounding FUE hair restoration surgery and the examination of the mathematics of donor management as it relates to the ethical management of the FUE patient.
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Anastassakis K. Paradigm Shift from Linear Strip to Follicular Unit Excision in Hair Restoration Surgery. Facial Plast Surg 2024; 40:129-145. [PMID: 38092043 DOI: 10.1055/s-0043-1777311] [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] [Indexed: 03/20/2024] Open
Abstract
Follicular unit excision (FUE) is a very effective and valuable modality for obtaining donor hair follicles using manual, motorized, or robotic devices to harvest individual donor follicular units in situ without a linear donor scar or visible scarring making it ideal for patients who wish to wear their hair short and hide signs of surgery. Over the past two decades, FUE has become increasingly popular, and the rising demand for FUE has driven the worldwide market size of hair restoration surgery (HRS) to an unprecedented height.FUE has revolutionized the HRS industry and offers excellent cosmesis and high patient satisfaction. Unfortunately, a large part of the favorable appeal of FUE is due to false claims that it is "minimally invasive," "scarless," or "not even surgery." Most patients opt-in for FUE due to these misconceptions, which are advertised by "black-market" clinics offering low-cost FUE surgery performed by amateur, nonprofessional technicians on unsuspected patients. The technique appears deceptively simple, and many neophyte surgeons falsely believe that the learning curve of FUE is short because the barrier of entry is low and no previous surgical skill is required. Nevertheless, injuries on grafts are extremely easy to occur since FUE is a blind technique and can be minimized only with excellent technique, which takes years to master.FUE actually presents unique challenges for the surgeon and carries potential long-term permanent side effects if not performed properly. The surgeon must have a thorough understanding of the nuances of the FUE surgical technique to ensure consistent graft quality and favorable cosmesis of both donor and recipient areas. Efficient FUE requires dexterity, training, dedication, devotion, enthusiasm, cognitive clarity, scientific knowledge, experience, and an extended learning curve.FUE is an invaluable addition to the armamentarium of a hair restoration surgeon but has to be judiciously performed.
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Šuca H, Čoma M, Tomšů J, Sabová J, Zajíček R, Brož A, Doubková M, Novotný T, Bačáková L, Jenčová V, Kuželová Košťáková E, Lukačín Š, Rejman D, Gál P. Current Approaches to Wound Repair in Burns: How far Have we Come From Cover to Close? A Narrative Review. J Surg Res 2024; 296:383-403. [PMID: 38309220 DOI: 10.1016/j.jss.2023.12.043] [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: 08/10/2023] [Revised: 12/06/2023] [Accepted: 12/29/2023] [Indexed: 02/05/2024]
Abstract
Burn injuries are a significant global health concern, with more than 11 million people requiring medical intervention each year and approximately 180,000 deaths annually. Despite progress in health and social care, burn injuries continue to result in socioeconomic burdens for victims and their families. The management of severe burn injuries involves preventing and treating burn shock and promoting skin repair through a two-step procedure of covering and closing the wound. Currently, split-thickness/full-thickness skin autografts are the gold standard for permanent skin substitution. However, deep burns treated with split-thickness skin autografts may contract, leading to functional and appearance issues. Conversely, defects treated with full-thickness skin autografts often result in more satisfactory function and appearance. The development of tissue-engineered dermal templates has further expanded the scope of wound repair, providing scar reductive and regenerative properties that have extended their use to reconstructive surgical interventions. Although their interactions with the wound microenvironment are not fully understood, these templates have shown potential in local infection control. This narrative review discusses the current state of wound repair in burn injuries, focusing on the progress made from wound cover to wound closure and local infection control. Advancements in technology and therapies hold promise for improving the outcomes for burn injury patients. Understanding the underlying mechanisms of wound repair and tissue regeneration may provide new insights for developing more effective treatments in the future.
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Affiliation(s)
- Hubert Šuca
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Matúš Čoma
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic; Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic
| | - Júlia Tomšů
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Jana Sabová
- Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic
| | - Robert Zajíček
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic
| | - Antonín Brož
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Martina Doubková
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Tomáš Novotný
- Department of Orthopaedics, University J.E. Purkině and Masaryk Hospital, Ústí nad Labem, Czech Republic; Department of Histology and Embryology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Orthopaedic Surgery, Faculty of Medicine in Hradec Králové, Charles University, Hradec Králové, Czech Republic
| | - Lucie Bačáková
- Laboratory of Biomaterials and Tissue Engineering, Institute of Physiology of the Czech Academy of Sciences, Prague, Czech Republic
| | - Věra Jenčová
- Department of Chemistry, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic
| | - Eva Kuželová Košťáková
- Department of Chemistry, Faculty of Science, Humanities and Education, Technical University of Liberec, Liberec, Czech Republic
| | - Štefan Lukačín
- Department of Heart Surgery, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic
| | - Dominik Rejman
- Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Prague, Czech Republic
| | - Peter Gál
- Prague Burn Center, Third Faculty of Medicine, Charles University and Královské Vinohrady University Hospital, Prague, Czech Republic; Department of Pharmacology, Faculty of Medicine, Pavol Jozef Šafárik University, Košice, Slovak Republic; Department of Biomedical Research, East-Slovak Institute of Cardiovascular Diseases, Inc, Košice, Slovak Republic; Department of Pharmacognosy and Botany, Faculty of Pharmacy, Comenius University, Bratislava, Slovak Republic; Biomedical Research Center of the Slovak Academy of Sciences, Košice, Slovak Republic.
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5
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Bastos R, Silva SA. Adipose perforator flaps without skin donor site: "in between" single scar approach for reconstruction of small peripheral breast defects after lumpectomy. J Plast Reconstr Aesthet Surg 2024; 91:363-371. [PMID: 38447506 DOI: 10.1016/j.bjps.2024.01.040] [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: 07/30/2023] [Revised: 01/01/2024] [Accepted: 01/29/2024] [Indexed: 03/08/2024]
Abstract
In breast conserving surgery, the reconstruction of defects in small breasts where volume displacement techniques are not feasible can be challenging. In contrast, patients with bigger breasts may not wish to undergo major breast remodeling surgery or breast symmetrization procedures. In such cases, volume replacement techniques can be beneficial, but these leave additional scars and are time consuming. The authors propose an "in between" single scar approach to perform both lumpectomy and reconstruction of small peripheral breast tumors. This approach reduces morbidity and operating time compared with standard volume replacement techniques. The tumors are resected from below, guided by wire, using an incision in the lateral breast crease or inframammary fold, depending on their location. The same incision is used to raise an adipose or adipofascial flap based on perimammary perforators, lateral thoracic artery perforator flap (LTAP), lateral intercostal artery perforator flap (LICAP), or anterior intercostal artery perforator flaps (AICAP) flaps, without skin donor site. Between March and November 2022, eight patients underwent this procedure. In four cases LICAP flap was used; in three-AICAP flap was chosen; and in one-LTAP perforator flap was used. Clear surgical margins were achieved in all cases. The average follow-up time was 9.9 months, during which no local recurrences were detected. All flaps survived. Two patients experienced seromas at the donor site, and an organized hematoma was also reported. This approach represents a viable alternative to volume displacement techniques or no reconstruction for small peripheral lumpectomy defects.
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Affiliation(s)
- R Bastos
- Plastic and Reconstructive Surgery Department, Hospital da Luz Lisboa, Avenida Lusíada, 100, 1500-650 Lisboa, and Breast Unit, Hospital de Beatriz Ângelo, Avenida Carlos Teixeira, 3, 2674-514 Loures, Portugal.
| | - S A Silva
- Breast Unit and Surgery Department, Hospital de Beatriz Ângelo, Hospital da Luz Torres de Lisboa, Rua Tomás da Fonseca, Edifícios B, D, E F, 1600-209 Lisboa, Portugal
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Mayrhofer-Schmid M, Aman M, Panayi AC, Raasveld FV, Kneser U, Eberlin KR, Harhaus L, Böcker A. Fibrin Glue Coating Limits Scar Tissue Formation around Peripheral Nerves. Int J Mol Sci 2024; 25:3687. [PMID: 38612497 PMCID: PMC11011750 DOI: 10.3390/ijms25073687] [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: 02/25/2024] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Scar tissue formation presents a significant barrier to peripheral nerve recovery in clinical practice. While different experimental methods have been described, there is no clinically available gold standard for its prevention. This study aims to determine the potential of fibrin glue (FG) to limit scarring around peripheral nerves. Thirty rats were divided into three groups: glutaraldehyde-induced sciatic nerve injury treated with FG (GA + FG), sciatic nerve injury with no treatment (GA), and no sciatic nerve injury (Sham). Neural regeneration was assessed with weekly measurements of the visual static sciatic index as a parameter for sciatic nerve function across a 12-week period. After 12 weeks, qualitative and quantitative histological analysis of scar tissue formation was performed. Furthermore, histomorphometric analysis and wet muscle weight analysis were performed after the postoperative observation period. The GA + FG group showed a faster functional recovery (6 versus 9 weeks) compared to the GA group. The FG-treated group showed significantly lower perineural scar tissue formation and significantly higher fiber density, myelin thickness, axon thickness, and myelinated fiber thickness than the GA group. A significantly higher wet muscle weight ratio of the tibialis anterior muscle was found in the GA + FG group compared to the GA group. Our results suggest that applying FG to injured nerves is a promising scar tissue prevention strategy associated with improved regeneration both at the microscopic and at the functional level. Our results can serve as a platform for innovation in the field of perineural regeneration with immense clinical potential.
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Affiliation(s)
- Maximilian Mayrhofer-Schmid
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, 69120 Heidelberg, Germany
- Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Martin Aman
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Adriana C. Panayi
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Floris V. Raasveld
- Hand and Arm Center, Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Erasmus University, 3015 GD Rotterdam, The Netherlands
| | - Ulrich Kneser
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, 69120 Heidelberg, Germany
| | - Kyle R. Eberlin
- Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Leila Harhaus
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, 69120 Heidelberg, Germany
- Department of Hand Surgery, Peripheral Nerve Surgery and Rehabilitation, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen, Germany
| | - Arne Böcker
- Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Department of Hand- and Plastic Surgery, University of Heidelberg, 69120 Heidelberg, Germany
- Department of Hand Surgery, Peripheral Nerve Surgery and Rehabilitation, BG Trauma Center Ludwigshafen, 67071 Ludwigshafen, Germany
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Richards E, Brown A, Chottianchaiwat S, Frewen J, Powell R, McGrath E. Timing of suture removal to reduce scarring in skin surgery: a randomized assessor-blinded feasibility trial. Clin Exp Dermatol 2024; 49:394-397. [PMID: 37983174 DOI: 10.1093/ced/llad401] [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: 07/03/2023] [Revised: 11/05/2023] [Accepted: 11/21/2023] [Indexed: 11/22/2023]
Abstract
Timing of suture removal after excision skin surgery varies, with few studies analysing the factors that contribute to poor wound healing and cosmesis. Here, we performed a pilot study to compare suture removal at 7 days or 10 days and its effect on healing and overall appearances of scars including the presence of suture marks.
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Affiliation(s)
- Ellen Richards
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | - Alistair Brown
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | | | - John Frewen
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
| | | | - Emily McGrath
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, Devon, UK
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Rauso R, Pascali M, Lizambri D, De Cicco D. Tips and Tricks to Avoid Poor Scarring in Lip Lifting: A Technical Note. Dermatol Surg 2024; 50:312-314. [PMID: 38147463 DOI: 10.1097/dss.0000000000004062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Affiliation(s)
| | | | | | - Davide De Cicco
- Maxillofacial Surgery Unit, Istituto Stomatologico Italiano, Milan, Italy
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Kavitha S, Tejaswini SU, Venkatesh R, Zebardast N. Wound modulation in glaucoma surgery: The role of anti-scarring agents. Indian J Ophthalmol 2024; 72:320-327. [PMID: 38153968 PMCID: PMC11001230 DOI: 10.4103/ijo.ijo_2013_23] [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: 07/29/2023] [Revised: 09/18/2023] [Accepted: 10/16/2023] [Indexed: 12/30/2023] Open
Abstract
Filtration surgery is one of the most frequently performed surgeries in the management of glaucoma, and trabeculectomy is considered the gold standard surgical technique for the same. Though trabeculectomy has been reported to have an excellent initial success rate, about 30% of them fail in 3 years, and nearly 50% of them fail in 5 years. The most significant risk of failure still seems to be wound scarring, especially episcleral fibrosis, leading to bleb failure. As a result, it is essential to explore the role of anti-scarring agents, including mitomycin C, and 5-fluorouracil in wound modulation and improving the bleb survival rate. Since these agents are widely used in trabeculectomy, it is crucial to understand the various modes of application, advantages, and adverse effects of these agents. On an evidence-based approach, all these points have been highlighted in this review article. In addition, the newer agents available for wound modulation and their scope for practical application are discussed.
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Affiliation(s)
| | | | | | - Nazlee Zebardast
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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10
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Fraisse J, Gandolfi S, Berthier C, Gangloff D, Meresse T. The star approach, a surgical approach for skin sparing mastectomy and central lumpectomies. ANN CHIR PLAST ESTH 2024; 69:190-193. [PMID: 37385929 DOI: 10.1016/j.anplas.2023.06.003] [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: 05/05/2023] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 07/01/2023]
Abstract
When preservation of the nipple-areolar complex (NAC) is not possible in oncologic breast surgery, the traditional approaches are either a horizontal incision centered on the NAC resulting in visible scars and breast distortion, or a round block with risk of healing difficulties. To address these concerns, the authors propose a star approach technique for skin sparing mastectomies and lumpectomies of central breast tumors. During the oncologic surgery, the NAC is removed with four cutaneous extensions, which can be closed as a cross-shaped scar. The scarring is similar in size to the original NAC diameter and can easily be covered by the NAC reconstruction. This technique offers good exposure during surgery, a good aesthetic result with limited scarring, no breast deformity, correction of breast sagging, and high-quality healing.
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Affiliation(s)
- J Fraisse
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France.
| | - S Gandolfi
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| | - C Berthier
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| | - D Gangloff
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
| | - T Meresse
- Department of Plastic Reconstructive Surgery and Burns, Rangueil University Hospital, Toulouse, France
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Kwapnoski Z, Doost MS, Vy M, Eisen DB. Aesthetic outcome of intermediate closure versus intermediate closure followed by 2-octyl cyanoacrylate: A randomized evaluator-blinded split-wound comparative effectiveness trial. J Am Acad Dermatol 2024; 90:577-584. [PMID: 37866453 DOI: 10.1016/j.jaad.2023.10.028] [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: 09/13/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Dermatologic surgeons are increasingly using surgical adhesives in their practice. Studies comparing sutured wounds to those that utilize a combination of suturing and skin adhesive have not been previously conducted. OBJECTIVE To compare the cosmetic outcome and patient wound care satisfaction of an intermediate suture closure with an intermediate suture closure followed by the application of 2-octyl cyanoacrylate (2-OCA). METHODS Fifty patients were enrolled in a randomized, evaluator-blinded, split-scar study. Following intermediate sutured closure of a surgical defect, one side of the wound was randomized to receive an additional application of 2-OCA. After 3 months, the scar was assessed using the POSAS tool and patients reported wound care preferences. RESULTS As the primary outcome measure, the mean sum of observer POSAS was 12.80 for sutured closure alone versus 12.40 for sutured closures followed by 2-OCA (P = .49). LIMITATIONS Single-center study of a relatively homogenous population. CONCLUSION Although there were no significant differences in scar cosmesis, both patients and observers tended to prefer the side with an additional application of 2-OCA in most POSAS components, in overall opinion, and in patient wound care satisfaction. Dermatologic surgeons may add this to their practice without sacrificing scar outcomes or patient satisfaction.
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Affiliation(s)
- Zachary Kwapnoski
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California.
| | - Mohammad Saffari Doost
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California
| | - Michelle Vy
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California
| | - Daniel B Eisen
- Department of Dermatology, University of California Davis School of Medicine, Sacramento, California
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12
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Zhou D, Zhang Z, Dou X, Xia F, Li X. Advances in the assessment of cosmetic outcomes, sensory alteration in surgical areas, and health-related quality of life of endoscopic thyroidectomy. World J Surg Oncol 2024; 22:52. [PMID: 38347606 PMCID: PMC10863152 DOI: 10.1186/s12957-024-03307-7] [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: 10/30/2023] [Accepted: 01/13/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Endoscopic thyroidectomy has been preliminarily proven effective and safe for thyroid diseases. The cosmetic outcomes and life quality are critical contents of postoperative assessment. This review will primarily focus on the assessment methods and results related to cosmetic outcomes, sensory alteration of surgical area, and quality of life following endoscopic thyroidectomy. METHODS A comprehensive search of published articles within the last decade was conducted using the terms "endoscopic/robotic thyroidectomy," "patient satisfaction scores," "questionnaire," "quality of life," and "cosmetic" in PubMed. RESULTS Assessment methods for postoperative cosmetic satisfaction and sensory alterations encompassed verbal/visual analog scales, scar evaluations, Semmes-Weinstein monofilament tests, and more. The evaluation of postoperative quality of life in endoscopic thyroidectomy involved tools such as SF-36, SF-12, thyroid-specific questionnaires, thyroid cancer-specific quality of life questionnaires (THYCA-QOL), as well as assessments related to voice and swallow function. The cosmetic results of endoscopic thyroidectomy generally surpassed those of open thyroidectomy, while the quality of life in endoscopic procedures was either superior or equivalent to that in open thyroidectomy, especially with respect to general health, role emotion, and vitality. CONCLUSIONS Assessments of cosmetic outcomes and sensory alterations following endoscopic thyroidectomy predominantly relied on patients' subjective feelings. The objective and subjective perspectives of scar assessments remain underutilized. In addition, postoperative laryngoscopy and voice function assessments in endoscopic thyroidectomy procedures require more attention.
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Affiliation(s)
- Di Zhou
- Division of Thyroid Surgery, Department of General Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Zeyu Zhang
- Division of Thyroid Surgery, Department of General Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Xiaolin Dou
- Division of Thyroid Surgery, Department of General Surgery, Xiangya Hospital of Central South University, Changsha, China
| | - Fada Xia
- Division of Thyroid Surgery, Department of General Surgery, Xiangya Hospital of Central South University, Changsha, China.
| | - Xinying Li
- Division of Thyroid Surgery, Department of General Surgery, Xiangya Hospital of Central South University, Changsha, China
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13
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Uyar I, Aksam E, Kopal C. Nasal Sill Flap for Lip Lifting. Facial Plast Surg 2024; 40:106-111. [PMID: 37402393 DOI: 10.1055/s-0043-1770764] [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] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Over the years, different techniques have been developed to reduce the number of incisions and scars in subnasal lip lifting and to increase the amount of lifting. The aim of this study was to present a new technique to hide the scars at the nasal base in subnasal lip lifting procedures and to review the literature. METHODS The file of patients who underwent subnasal lip lifting between January 2019 and January 2021 were examined. In all patients, the nasal sill flap that was designed was elevated, and the nasal sill flap that was prepared was adapted to its new location when the excision had been completed. Two different plastic surgeons evaluated the patients in the postoperative 12-month follow-ups. The scars were evaluated for vascularity, pigmentation, elasticity, thickness, and height. RESULTS The study included 26 patients. While 21 patients had no histories of lip lifting, five patients had had previous lip lifting history. The mean operation time was 37.11 minutes. Patients' skin types were determined as Type 3 in 18 patients and Type 4 in eight patients according to the Fitzpatrick classification. The mean follow-up period of the patients was 13.11 months. At the end of the 12-month period, the mean scar score of the patients was calculated as 11.15. The mean scar score of primary cases was 11.14, and the mean scar score of secondary cases was 11.20 (p = 0.983). There was no statistically significant difference in terms of complications among smokers (p = 0.356). The mean scar score was calculated as 12.17 in patients who had Type 3 skin and 8.88 in patients with Type 4 skin (p = 0.075). CONCLUSIONS This technique is beneficial for patients because the scars are discrete and easier for patients to accept.
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Affiliation(s)
- Ilker Uyar
- Department of Plastic, Reconstructive and Aesthetic Surgery, Izmir Katip Celebi University Medical Faculty, Izmir, Turkey
| | - Ersin Aksam
- Department of Plastic, Reconstructive and Aesthetic Surgery, Izmir Katip Celebi University Medical Faculty, Izmir, Turkey
| | - Can Kopal
- Private Practice, Kultur Mah. Sair Esref Bul. No:61 Bahar Apartmanı K:2 D:5 Alsancak/Izmir, Turkey
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Santuray R, Schlegel P, Zhang Z, Reddy N, Alhiyari Y, Long JL. Cell-Based Outer Vocal Fold Replacement Both Treats and Prevents Vocal Fold Scarring in Rabbits. Laryngoscope 2024; 134:764-772. [PMID: 37597170 PMCID: PMC10842642 DOI: 10.1002/lary.30952] [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] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 07/10/2023] [Accepted: 07/25/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE Numerous pharmacological and cell-based treatments have shown promise in preventing vocal fold (VF) scarring when applied at the time of injury. A common clinical scenario, however, is the finding of mature scar impeding voicing. Many treatments are less effective in remodeling existing scar tissue. This objective of this study is to determine if a cell-based outer vocal fold replacement (COVR) effectively restores VF function when applied to existing scar. METHODS Eighteen rabbits were allocated to three groups: unilateral COVR implant at the time of cordectomy (acute COVR); unilateral cordectomy followed by COVR implant 2 months later (chronic COVR); and unilateral cordectomy followed by sham implant surgery 2 months later (chronic scar). Larynges were harvested 2 months after implant or sham surgery. RESULTS All larynges in the COVR groups demonstrated human leukocyte antigen labeling on immunohistochemistry (IHC). COVR groups had increased hyaluronic acid content compared with normal. VF stiffness as measured by elastic moduli in acute COVR and chronic COVR were similar to their contralateral unoperated VF. CONCLUSION COVR implantation in both acutely injured and chronically scarred VF demonstrate persistence of implanted cells, restored tissue biomechanics, and increased hyaluronic acid content. LEVEL OF EVIDENCE NA Laryngoscope, 134:764-772, 2024.
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Affiliation(s)
- Rodell Santuray
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Patrick Schlegel
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Zhaoyan Zhang
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Neha Reddy
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Yazeed Alhiyari
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
| | - Jennifer L. Long
- Department of Head and Neck Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA
- Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA
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Barone M, Salzillo R, De Bernardis R, Cogliandro A, Persichetti P. Do Small Scars Lead to Better Results? Analysis of Long-term Outcomes and Satisfaction of Patients Undergoing Anchor-line Abdominoplasty Following Massive Weight Loss. Aesthetic Plast Surg 2024; 48:652-658. [PMID: 37679561 DOI: 10.1007/s00266-023-03641-3] [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: 05/25/2023] [Accepted: 08/23/2023] [Indexed: 09/09/2023]
Abstract
INTRODUCTION Do smaller scars lead to higher patient satisfaction? The aim of this study is to analyze long-term satisfaction of patients who underwent abdominoplasty after massive weight loss. METHODS Patients inclusion criteria: no previous abdominal remodeling procedures, previous bariatric surgery followed by a weight loss of at least 30 kg, weight stability for at least one year, good understanding of the Italian language and standardized pre- and postoperative photographs. We divided the population in 2 groups based on the surgical procedure: group 1, conventional abdominoplasty, and group 2, anchor-line abdominoplasty. All patients presented scars in the epigastric and mesogastric region resulting from previous laparoscopic or laparotomic bariatric surgery and/or other laparoscopic or laparotomic procedures. At least 2 years after surgery, we administered the Italian version of the post-operative BODY-Q module and the SCAR-Q questionnaire. RESULTS We enrolled 20 males and 69 females aged between 25 and 55 years, with a mean follow-up of 2 years. Analyzing the questionnaires, it resulted that patients undergoing anchor-line abdominoplasty were significantly more satisfied in the body perception of the result (p = 0.035) and in the satisfaction with abdomen domain (p = 0.0015) compared to the conventional abdominoplasty group. Scars assessment with the SCAR-Q did not show any significant differences between the groups. CONCLUSION Despite its long scars, the anchor-line pattern shows an overall higher satisfaction, due to the possibility of reducing the abdomen both cranio-caudally and circumferentially. These findings might be an important guide when approaching abdominoplasty in post-bariatric patients, debunking the myth "shorter is better". LEVEL OF EVIDENCE V 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)
- Mauro Barone
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Rosa Salzillo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy.
| | - Riccardo De Bernardis
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Annalisa Cogliandro
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
| | - Paolo Persichetti
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Roma, Italy
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Tukenmez M, Mollavelioglu B, Kozanoglu E, Emiroglu S, Cabioglu N, Muslumanoglu M. A Novel Surgical Technique for Gynecomastia: Air-Assisted Minimally Invasive Surgery With Single Axillary Incision. Surg Innov 2024; 31:5-10. [PMID: 37995296 PMCID: PMC10773160 DOI: 10.1177/15533506231217621] [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] [Indexed: 11/25/2023]
Abstract
BACKGROUND Gynecomastia is a benign condition that develops due to the proliferation of breast tissue in men. Surgical excision is the most effective treatment method. Minimally invasive techniques can be used to avoid visible scarring. We evaluated the efficacy and safety of air-assisted subcutaneous mastectomy in the treatment of gynecomastia. PATIENT AND METHODS 10 patients with gynecomastia underwent air-assisted subcutaneous mastectomy and liposuction through a single axillary incision, between June 2022 and February 2023. Demographic and clinical data of the patients, duration of surgery, and complications were recorded. The satisfaction levels of the patients regarding physical appearance, mental status, and social environment were measured. The body Q questionnaire was performed preoperatively and in the postoperative third month. RESULTS The median age was 26 (range, 18-54). Surgical excision was measured as a median of 69 gr (range, 41-177), and liposuction volume was measured as a median of 210 ccs (range, 63-400). The median operation time was 50 minutes (range, 21-60) for excision and 21 minutes (range, 20-75) for liposuction. Body, chest, and nipples related appearance satisfaction levels were measured preoperatively as a median of 44 (range, 36.5-52), 31 (range, 27.5-39), and 51.5 (range, 21-69.8) points vs postoperatively as 92 (range, 92-100), 93 (range, 93-94.8) and 90 (range, 90-100) points, respectively. The patients had a median follow-up of 6 months (range, 3-11). No complications were observed during the follow-up period. CONCLUSION Air-assisted subcutaneous mastectomy and liposuction is a feasible technique that may provide good cosmetic outcomes by avoiding anterior chest wall scarring.
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Affiliation(s)
- Mustafa Tukenmez
- Departments of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Baran Mollavelioglu
- Departments of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erol Kozanoglu
- Plastic and Reconstructive Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Selman Emiroglu
- Departments of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Neslihan Cabioglu
- Departments of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mahmut Muslumanoglu
- Departments of General Surgery, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Sharma C, Sharma S, Soni A. Subcuticular skin closure at cesarean delivery with poliglecaprone-25 vs polyglactin-910: a randomized controlled trial. Am J Obstet Gynecol MFM 2024; 6:101256. [PMID: 38109995 DOI: 10.1016/j.ajogmf.2023.101256] [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: 11/30/2023] [Accepted: 12/13/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Cesarean delivery is a commonly performed surgical procedure worldwide. There is limited good-quality evidence regarding subcuticular skin closure with absorbable sutures in transverse incisions after cesarean delivery. OBJECTIVE This study aimed to compare poliglecaprone-25 (3-0) and polyglactin-910 (4-0) sutures for subcuticular skin closure in Pfannenstiel incisions among women undergoing cesarean delivery. STUDY DESIGN In this double-blind, single-center, randomized controlled trial among women undergoing cesarean delivery (elective and emergency), 200 women were randomized (Group 1-subcuticular skin closure with poliglecaprone-25 [3-0] vs Group 2-subcuticular skin closure with polyglactin-910 [4-0]). All women received similar preoperative and postoperative care. A sample size of 200 women was selected with the aim of reducing the composite wound complication rate from 15.8% to 3.6% with a power of 0.80 and a 2-tailed α of 0.05. Thus, 90 women were required in each group, but 100 were selected to account for attrition. RESULTS Composite wound complications (including surgical site infection, hematoma, seroma, need for resuturing or readmission for wound complications) were similar in the 2 groups (Group 1 vs 2: 16 vs 10; P=.293; relative risk, 1.28; 95% confidence interval, 0.91-1.79). Surgical site infection (8 vs 7; P=1.000; relative risk, 1.08; 95% confidence interval, 0.64-1.83), hematoma (1 vs 2; P=.561; relative risk, 0.66; 95% confidence interval, 0.13-3.31), seroma (8 vs 2; P=.052; relative risk, 1.65; 95% confidence interval, 1.17-2.33), need for resuturing (4 vs 3; P=.700; relative risk, 1.15; 95% confidence interval, 0.60-2.22), and need for readmission (4 vs 4; P=1.000) were similar in the 2 groups. Pain score on the visual analog scale at 3 days (3.2±1.0 vs 3.6±1.2) and 6 weeks after operation (1.6±0.8 vs 1.7±0.9;) was significantly lower in Group 1 (P=.023 and P=.033, respectively). There was no difference between observer and patient scar assessment scores measured at 6 weeks after operation (P=.069 and P=.431, respectively). CONCLUSION Poliglecaprone-25 (3-0) and polyglactin-910 (4-0) subcuticular sutures were comparable regarding composite wound complications (surgical site infection, hematoma, seroma, wound separation or re-suturing, need for readmission) and cosmetic appearance (patient scar assessment score & observer scar assessment score) related to skin closure among women undergoing cesarean delivery through a Pfannenstiel incision in nonobese women (average body mass index, 25).
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Affiliation(s)
- Chanderdeep Sharma
- Department of Obstetrics & Gynaecology, All India Institute of Medical Sciences, Bilaspur, India (Dr C Sharma); Department of Obstetrics & Gynaecology, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, India (Drs C Sharma, S Sharma, and Soni).
| | - Shikha Sharma
- Department of Obstetrics & Gynaecology, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, India (Drs C Sharma, S Sharma, and Soni)
| | - Anjali Soni
- Department of Obstetrics & Gynaecology, Dr. Rajendra Prasad Government Medical College, Tanda, Kangra, India (Drs C Sharma, S Sharma, and Soni)
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Rha EY, Jeon HH, Park SH, Lee JY. Defect-Oriented Versus Back Scar-Oriented Flap Design in Breast Reconstruction with Latissimus Dorsi Musculocutaneous Flap: A Patient-Reported Satisfaction Outcome Comparison Using BREAST-Q. Aesthetic Plast Surg 2024; 48:259-265. [PMID: 37202481 DOI: 10.1007/s00266-023-03385-0] [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: 02/07/2023] [Accepted: 04/26/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND The design of the latissimus dorsi musculocutaneous flap in breast reconstruction has several options. To date, there have been no reports on the surgical outcomes with flap designed based on the defect shape of the mastectomy site and flap shape of the donor site. To compare patient satisfaction according to the flap design, we designed and conducted independent three sub-studies targeting fifty-three breast reconstruction patients using BREAST-Q© scale. METHODS In study 1, there was no difference in patient satisfaction between the group with the flap designed according to the shape of mastectomy defect (defect-oriented group) that with the flap designed according to patient's wish regardless of defect shape (back scar-oriented group). In study 2, comparing the results based on the shape of the flap, vertically designed flap showed a statistically significant difference in the psychosocial well-being. In study 3, comparing the results based on the shape of the defect, no significant difference was noted. RESULTS Even though designing a donor flap based on the shape and orientation of the mastectomy defect has no statistical significance in patient satisfaction or quality of life compared with that based on the patient preference in placement of the donor site scar, the group with the vertical donor design showed better psychosocial well-being than the group with other shapes of the donor flap. By considering the advantages and disadvantages of each flap design, enhanced patient satisfaction and durability and natural aesthetic goal can be achieved. This is the first study to compare the differences in results according to the flap design method during breast reconstruction. Patient satisfaction according to the design of the flap was investigated in the form of a questionnaire survey, and the results were displayed. In addition to breast shape, donor scars and complications were also investigated. 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)
- Eun Young Rha
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hui Hyung Jeon
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | | | - Jun Yong Lee
- Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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Lee J, Honjo M, Aihara M. A MEK inhibitor arrests the cell cycle of human conjunctival fibroblasts and improves the outcome of glaucoma filtration surgery. Sci Rep 2024; 14:1871. [PMID: 38253821 PMCID: PMC10803501 DOI: 10.1038/s41598-024-52359-y] [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] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/17/2024] [Indexed: 01/24/2024] Open
Abstract
Better agents are needed to improve glaucoma filtration surgery outcomes compared to current ones. The purpose of this study is to determine whether mitogen-activated protein kinase kinase (MEK) inhibitors can effectively arrest the cell cycle of human conjunctival fibroblasts (HCFs) and inhibit the formation of fibrosis and scarring following glaucoma filtration surgery. A cell counting kit‑8 assay revealed that the MEK inhibitor PD0325901 exhibited concentration-dependent growth inhibition of HCFs. Quantitative PCR, immunocytochemistry, and western blotting demonstrated decreased expression of proliferating cell nuclear antigen (PCNA) and cyclin D1 and increased expression of p27 in HCFs treated with PD0325901. Flow cytometry indicated that PD0325901 arrested the cell cycle of HCFs in the G0/1 phase. The cell-migration assay showed that HCF migration rate was significantly suppressed by PD0325901 exposure. Rabbits were divided into PD0325901-treatment and control groups, and glaucoma filtration surgery was performed. Although intraocular pressure did not differ between PD0325901-treatment and control groups, bleb height was greater in the treatment group. Histopathological evaluation revealed that fibrotic changes were significantly attenuated in the PD0325901-treatment group compared to the control group. In conclusion, the MEK inhibitor impedes HCF proliferation via cell-cycle arrest and may be beneficial for glaucoma filtration surgery by reducing bleb scarring.
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Affiliation(s)
- Jinhee Lee
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Megumi Honjo
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113-8655, Japan
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Yenyuwadee S, Achavanuntakul P, Phisalprapa P, Levin M, Saokaew S, Kanchanasurakit S, Manuskiatti W. Effect of Laser and Energy-based Device Therapies to Minimize Surgical Scar Formation: A Systematic Review and Network Meta-analysis. Acta Derm Venereol 2024; 104:adv18477. [PMID: 38189223 PMCID: PMC10789167 DOI: 10.2340/actadv.v104.18477] [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: 08/24/2023] [Accepted: 11/17/2023] [Indexed: 01/09/2024] Open
Abstract
Utilization of lasers and energy-based devices for surgical scar minimization has been substantially evaluated in placebo-controlled trials. The aim of this study was to compare reported measures of efficacy of lasers and energy-based devices in clinical trials in preventing surgical scar formation in a systematic review and network meta-analyses. Five electronic databases, PubMed, Scopus, Embase, ClinicalTrials.gov, and the Cochrane Library, were searched to retrieve relevant articles. The search was limited to randomized controlled trials that reported on clinical outcomes of surgical scars with treatment initiation no later than 6 months after surgery and a follow-up period of at least 3 months. A total of 18 randomized controlled trials involving 482 participants and 671 postsurgical wounds were included in the network meta-analyses. The results showed that the most efficacious treatments were achieved using low-level laser therapy) (weighted mean difference -3.78; 95% confidence interval (95% CI) -6.32, -1.24) and pulsed dye laser (weighted mean difference -2.46; 95% CI -4.53, -0.38). Nevertheless, low-level laser therapy and pulsed dye laser demonstrated comparable outcomes in surgical scar minimization (weighted mean difference -1.32, 95% CI -3.53, 0.89). The findings of this network meta-analyses suggest that low-level laser therapy and pulsed dye laser are both effective treatments for minimization of scar formation following primary closure of surgical wounds with comparable treatment outcomes.
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Affiliation(s)
- Sasitorn Yenyuwadee
- Departments of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Petchlada Achavanuntakul
- Department of Medicine, College of Medicine and Public Health, Ubonratchathani University, Ubonratchathani, Thailand
| | - Pochamana Phisalprapa
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | - Surasak Saokaew
- Division of Social and Administration Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Unit of Excellence on Clinical Outcomes Research and Integration (UNICORN), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Unit of Excellence on Herbal Medicine, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Novel Bacteria and Drug Discovery Research Group, Microbiome and Bioresource Research Strength, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bander Sunway, Malaysia; Biofunctional Molecule Exploratory Research Group, Biomedicine Research Advancement Centre, School of Pharmacy, Monash University Malaysia, Bander Sunway, Malaysia
| | - Sukrit Kanchanasurakit
- Center of Health Outcomes Research and Therapeutic Safety (Cohorts), School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Unit of Excellence on Herbal Medicine, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Division of Clinical Pharmacy, Department of Pharmaceutical Care, School of Pharmaceutical Sciences, University of Phayao, Phayao, Thailand; Division of Pharmaceutical care, Department of Pharmacy, Phrae Hospital, Phrae, Thailand.
| | - Woraphong Manuskiatti
- Departments of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Harris IM, Lee KC, Deeks JJ, Moore DJ, Moiemen NS, Dretzke J. Pressure-garment therapy for preventing hypertrophic scarring after burn injury. Cochrane Database Syst Rev 2024; 1:CD013530. [PMID: 38189494 PMCID: PMC10772976 DOI: 10.1002/14651858.cd013530.pub2] [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] [Indexed: 01/09/2024]
Abstract
BACKGROUND Burn damage to skin often results in scarring; however in some individuals the failure of normal wound-healing processes results in excessive scar tissue formation, termed 'hypertrophic scarring'. The most commonly used method for the prevention and treatment of hypertrophic scarring is pressure-garment therapy (PGT). PGT is considered standard care globally; however, there is continued uncertainty around its effectiveness. OBJECTIVES To evaluate the benefits and harms of pressure-garment therapy for the prevention of hypertrophic scarring after burn injury. SEARCH METHODS We used standard, extensive Cochrane search methods. We searched CENTRAL, MEDLINE, Embase, two other databases, and two trials registers on 8 June 2023 with reference checking, citation searching, and contact with study authors to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing PGT (alone or in combination with other scar-management therapies) with scar management therapies not including PGT, or comparing different PGT pressures or different types of PGT. DATA COLLECTION AND ANALYSIS At least two review authors independently selected trials for inclusion using predetermined inclusion criteria, extracted data, and assessed risk of bias using the Cochrane RoB 1 tool. We assessed the certainty of evidence using GRADE. MAIN RESULTS We included 15 studies in this review (1179 participants), 14 of which (1057 participants) presented useable data. The sample size of included studies ranged from 17 to 159 participants. Most studies included both adults and children. Eight studies compared a pressure garment (with or without another scar management therapy) with scar management therapy alone, five studies compared the same pressure garment at a higher pressure versus a lower pressure, and two studies compared two different types of pressure garments. Studies used a variety of pressure garments (e.g. in-house manufactured or a commercial brand). Types of scar management therapies included were lanolin massage, topical silicone gel, silicone sheet/dressing, and heparin sodium ointment. Meta-analysis was not possible as there was significant clinical and methodological heterogeneity between studies. Main outcome measures were scar improvement assessed using the Vancouver Scar Scale (VSS) or the Patient and Observer Scar Assessment Scale (POSAS) (or both), pain, pruritus, quality of life, adverse events, and adherence to therapy. Studies additionally reported a further 14 outcomes, mostly individual scar parameters, some of which contributed to global scores on the VSS or POSAS. The amount of evidence for each individual outcome was limited. Most studies had a short follow-up, which may have affected results as the full effect of any therapy on scar healing may not be seen until around 18 months. PGT versus no treatment/lanolin We included five studies (378 participants). The evidence is very uncertain on whether PGT improves scars as assessed by the VSS compared with no treatment/lanolin. The evidence is also very uncertain for pain, pruritus, adverse events, and adherence. No study used the POSAS or assessed quality of life. One additional study (122 participants) did not report useable data. PGT versus silicone We included three studies (359 participants). The evidence is very uncertain on the effect of PGT compared with silicone, as assessed by the VSS and POSAS. The evidence is also very uncertain for pain, pruritus, quality of life, adverse events, adherence, and other scar parameters. It is possible that silicone may result in fewer adverse events or better adherence compared with PGT but this was also based on very low-certainty evidence. PGT plus silicone versus no treatment/lanolin We included two studies (200 participants). The evidence is very uncertain on whether PGT plus silicone improves scars as assessed by the VSS compared with no treatment/lanolin. The evidence is also very uncertain for pain, pruritus, and adverse events. No study used the POSAS or assessed quality of life or adherence. PGT plus silicone versus silicone We included three studies (359 participants). The evidence is very uncertain on the effect of PGT plus silicone compared with silicone, as assessed by the VSS and POSAS. The evidence is also very uncertain for pain, pruritus, quality of life, adverse events, and adherence. PGT plus scar management therapy including silicone versus scar management therapy including silicone We included one study (88 participants). The evidence is very uncertain on the effect of PGT plus scar management therapy including silicone versus scar management therapy including silicone, as assessed by the VSS and POSAS. The evidence is also very uncertain for pain, pruritus, quality of life, adverse events, and adherence. High-pressure versus low-pressure garments We included five studies (262 participants). The evidence is very uncertain on the effect of high pressure versus low pressure PGT on adverse events and adherence. No study used the VSS or the POSAS or assessed pain, pruritus, or quality of life. Different types of PGT (Caroskin Tricot + an adhesive silicone gel sheet versus Gecko Nanoplast (silicone gel bandage)) We included one study (60 participants). The evidence is very uncertain on the effect of Caroskin Tricot versus Gecko Nanoplast on the POSAS, pain, pruritus, and adverse events. The study did not use the VSS or assess quality of life or adherence. Different types of pressure garments (Jobst versus Tubigrip) We included one study (110 participants). The evidence is very uncertain on the adherence to either Jobst or Tubigrip. This study did not report any other outcomes. AUTHORS' CONCLUSIONS There is insufficient evidence to recommend using either PGT or an alternative for preventing hypertrophic scarring after burn injury. PGT is already commonly used in practice and it is possible that continuing to do so may provide some benefit to some people. However, until more evidence becomes available, it may be appropriate to allow patient preference to guide therapy.
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Affiliation(s)
- Isobel M Harris
- Biostatistics, Evidence Synthesis, Test Evaluation and prediction Models (BESTEAM), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Kwang Chear Lee
- Department of Burns and Plastic Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jonathan J Deeks
- Biostatistics, Evidence Synthesis, Test Evaluation and prediction Models (BESTEAM), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - David J Moore
- Biostatistics, Evidence Synthesis, Test Evaluation and prediction Models (BESTEAM), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Naiem S Moiemen
- Department of Burns and Plastic Surgery, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Janine Dretzke
- Biostatistics, Evidence Synthesis, Test Evaluation and prediction Models (BESTEAM), Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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22
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Mendes FH, Viterbo F, Moragas WR. Finesse in Fleur-de-lis Abdominoplasty. Clin Plast Surg 2024; 51:81-93. [PMID: 37945079 DOI: 10.1016/j.cps.2023.09.001] [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] [Indexed: 11/12/2023]
Abstract
Body contouring for weight loss patients usually requires not only lifting but also some extent of central body tightening to achieve complete tissue readjustment. Fleur-de-lis abdominoplasty provides best vector correction with nice contouring results, especially for central body type patients, with superior waist definition with or without associated circumferential belt lipectomies. Special interest has been addressed on technical refinements to enhance vertical scar with neoumbilicoplasty as well as the mons pubis projection with marking and suturing refinements. Both the inner scar umbilicus and the monsplasty are simple, safe, and reproducible techniques, presenting low complication rates with sustainable and natural results.
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Affiliation(s)
| | - Fausto Viterbo
- Botucatu Medical School, Paulista State University, Sao Paulo, Brazil
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24
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Murray TN, Guo EL, Richmond H, Friedman PM. Single treatment scar resurfacing with a novel ablative fractional 2910 nm erbium-doped fluoride glass fiber laser. Lasers Surg Med 2024; 56:19-22. [PMID: 37846135 DOI: 10.1002/lsm.23729] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/18/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Affiliation(s)
- Taryn N Murray
- Dermatology and Laser Surgery Center, Houston, Texas, USA
| | - Emily L Guo
- Dermatology and Laser Surgery Center, Houston, Texas, USA
| | | | - Paul M Friedman
- Dermatology and Laser Surgery Center, Houston, Texas, USA
- Department of Dermatology, McGovern Medical School, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Dermatology, Weill Cornell Medical College, Houston Methodist Hospital, Houston, Texas, USA
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25
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Kaboodkhani R, Kazemi T, Naderi N, Rabiei N, Babaei A. Comparison of Transalar Suture Technique and External Wedge Resection for Alar Base Narrowing. Plast Reconstr Surg 2024; 153:64e-73e. [PMID: 37166027 DOI: 10.1097/prs.0000000000010624] [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] [Indexed: 05/12/2023]
Abstract
BACKGROUND Alar narrowing is indicated in some rhinoplasty operations. This study compared transalar sutures and external wedge resection for alar narrowing in patients undergoing rhinoplasty. METHODS This study was a single-blind randomized controlled trial with a parallel design. Participants were allocated randomly to the transalar suturing technique group or the external wedge resection group (one-to-one allocation ratio). Primary outcomes were scar formation and satisfaction score (Rhinoplasty Outcome Evaluation questionnaire and patient component of Patient Scar Assessment Questionnaire) after 12 months. Secondary outcomes were the duration of procedure, amount of bleeding, and need for bleeding control. RESULTS In total, 44 and 46 patients completed the study in the transalar suture and external wedge resection groups, respectively. The postoperative assessment showed a significantly lower scar formation rate in the transalar suture group (75.0% versus 37.0%; P < 0.001). The Rhinoplasty Outcome Evaluation questionnaire revealed no statistically significant difference in patient satisfaction between two groups. The Patient Scar Assessment Questionnaire results showed that patients who received transalar sutures had a lower overall score (1; interquartile range, 1 to 1) compared with the external wedge resection group (2; interquartile range, 1 to 4.50) ( P < 0.001). The duration of the procedure ( P < 0.001), amount of bleeding ( P < 0.001), and need for bleeding control ( P = 0.009) were significantly lower in the transalar suture group than in the external wedge resection group. CONCLUSIONS Transalar sutures result in high postoperative patient satisfaction. This approach has a decreased incidence of scarring, operation time, bleeding, and necessity for bleeding control. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, II.
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Affiliation(s)
- Reza Kaboodkhani
- From the Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences
| | - Tayebeh Kazemi
- From the Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences
| | - Noushin Naderi
- From the Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences
| | - Nikta Rabiei
- From the Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences
| | - Amirhossein Babaei
- From the Department of Otolaryngology Head and Neck Surgery, Otolaryngology Research Center, Shiraz University of Medical Sciences
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Stratis C, Haider SA, Oleru O, Seyidova N, Sbitany H, Henderson PW. Paper Tape May Improve Scar Aesthetics and Prevent Wound Closure Complications. Plast Aesthet Nurs (Phila) 2024; 44:59-69. [PMID: 38166309 PMCID: PMC10964990 DOI: 10.1097/psn.0000000000000537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
There is uncertainty whether postoperative application of paper tape (PT) improves scar aesthetics and reduces wound closure complications. This study aimed to review and assess the quality of applicable findings from studies investigating PT's efficacy. We queried PubMed and SCOPUS using the search terms "(("paper tape") AND (wound OR closure OR heal* OR complication OR skin OR prevent* OR scar*))." We excluded articles that were duplicates, basic science, or not clinically relevant. We assessed the level of evidence for each article using the American Society of Plastic Surgeons (ASPS) Rating Levels of Evidence and Grading Recommendations for Therapeutic Studies, ranging from I (highest) to V (lowest). Of 186 publications reviewed, we included eight studies in the literature review. Five of these studies reported statistically significant positive outcomes on scar aesthetics and wound closure associated with using PT. Using the ASPS rating system, we found that two studies were Level I, three studies were Level II, two studies were Level IV, and one study was Level V. Notably, heterogeneity in the study designs limited outcome comparison. The data from the studies included in this literature review support using PT to optimize scar and wound management. The lack of higher levels of evidence, however, suggests the need for additional randomized controlled trials to rigorously evaluate patient outcomes when using PT compared with other forms of adhesive dressings.
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27
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Majumder KR, Shrivastava A, Maitra D, Siddique MI, Rahman MM. Fish-tail Plasty: A Secure Technique to Enhance Cosmesis at the Lateral End of Mastectomy Scar and Prevent Dog Ear. Mymensingh Med J 2024; 33:160-167. [PMID: 38163788] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Mastectomy is very common surgical procedure for breast cancer. The closure of transverse elliptical mastectomy incisions has been represented with numerous modifications since 1915. The technical challenge is to avoid a fold of skin dogging laterally ("dog-ear"). This might lead to off future discomfort and poor cosmetic result. However, various surgical techniques are reported to tackle this lateral dog ear, there is no standardized technique. We therefore conduct a systematic review of the surgical techniques with the aim of comparing the merits and limitations of every technique. The comparative study among 72 patients was performed in Bangabandhu Sheikh Mujib Medical University, Anower Khan Modern Medical College & Hospital and Care Medical College & Hospital, Bangladesh from July 2017 to January 2020. Patients were divided randomly into two groups: Group I underwent fishtail technique group (36 patients), Group II underwent modified suturing technique group (36 patients). The follow up periods were 1 month and 3 months post-operatively for determination of the presence of dog ear and patient's satisfaction regarding cosmetic outcome and comfortability. Incidence of dog ear in fish-tail plasty group patients was less than that for Group II yet the difference is not significant less (p value 0.001). In consideration of patient satisfaction, doctor satisfaction and patient comfortability were significantly higher in Group I than Group II (p value 0.476 and 0.001 respectively). Fish-tail plasty was significantly better in patient satisfaction, comfortability and doctor satisfaction than modified suturing techniques and it might be recommended following mastectomy in obese patients for improving cosmesis and avoiding discomfort due to redundant skin.
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Affiliation(s)
- K R Majumder
- Dr Krisna Rani Majumder, Associate Professor of Surgical Oncology, Department of Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; E-mail:
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28
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Kromer CM, Jefferson J, Crowe D, Knackstedt T. Outcomes of Upper Lip Mohs Surgery Repairs Using Standardized Scar Scales With Particular Emphasis on Vermillion Border Involvement. Dermatol Surg 2023; 49:1085-1090. [PMID: 37712745 DOI: 10.1097/dss.0000000000003918] [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] [Indexed: 09/16/2023]
Abstract
BACKGROUND The lips are a common location for skin cancer, and thus, a common site for Mohs micrographic surgery (MMS). As an important cosmetic and functional facial unit, MMS defects and reconstruction can affect patient perception on functional and aesthetic outcomes. OBJECTIVE The objective of this study was to compare aesthetic and functional outcomes after upper lip MMS between patients with vermillion sparing repairs (VSR) versus vermillion crossing repairs (VCR). MATERIALS AND METHODS Patients from a single institution from 2018 to 2022 undergoing MMS of the upper lip with linear or select flap repairs were included. Patients were assessed at a minimum of 6-week follow-up for self-assessment of functional and cosmetic outcomes, as well as physician assessment of scar cosmesis using validated Patient and Observed Scar Assessment Scale and Scar Cosmesis Assessment and Rating scale. The results were compared between VSR and VCR groups. RESULTS Forty-five patients were included in this study. No significant difference between patient assessment of functional and cosmetic outcome was identified between VSR and VCR. CONCLUSION Patient satisfaction with lip reconstruction can be high. Crossing the vermillion border does not affect patient assessment of aesthetic and functional results and should be considered if needed to optimize reconstructive outcomes.
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Affiliation(s)
| | | | | | - Thomas Knackstedt
- Mohs Surgery Unit, Pinehurst Dermatology and Mohs Surgery Center, Pinehurst, North Carolina
- School of Medicine, Case Western Reserve University, Cleveland, Ohio
- School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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29
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Ni J, Qi T, He H, Wu Z. tudy on the effect of heart-shaped tension-reducing cosmetic suture on reducing the formation of abdominal scar in cesarean section. Panminerva Med 2023; 65:548-549. [PMID: 34114762 DOI: 10.23736/s0031-0808.21.04414-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Jianzhi Ni
- Department of Obstetrics, Huai'an Maternal and Child Health Care Hospital, Huai'an, China
| | - Tingitng Qi
- Department of Obstetrics, Huai'an Maternal and Child Health Care Hospital, Huai'an, China
| | - Hongli He
- Department of Obstetrics, Huai'an Maternal and Child Health Care Hospital, Huai'an, China
| | - Zhaoqing Wu
- Department of Obstetrics, Huai'an Maternal and Child Health Care Hospital, Huai'an, China -
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30
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Jiang C, Yin X, Chang J, Liu G, Lu P. Topical Administration of Bevacizumab to Facilitate the Functional Filtering Bleb After Trabeculectomy in the Rabbit. J Ocul Pharmacol Ther 2023; 39:716-724. [PMID: 37669059 DOI: 10.1089/jop.2023.0046] [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] [Indexed: 09/06/2023] Open
Abstract
Purpose: To evaluate the effects of bevacizumab in 3 different application methods, subconjunctival injection (SCI), hyaluronic acid retardant (HAR), and eye drop (ED), on attenuating scar formation in the filtering bleb. Methods: Trabeculectomy (TRAB) was performed on New Zealand rabbits. TRAB rabbits were intervened with bevacizumab SCI, HAR, ED, or mitomycin C, respectively. Intraocular pressure (IOP) of 1, 7, 14, and 28 days after TRAB was recorded, and the bleb survival rate was analyzed. Bleb height, area, and vascularization were evaluated using anterior segment optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) at 7, 14 and 28 days after surgery. A histopathology examination of the bleb tissue was performed. The expression levels of vascular endothelial growth factor (VEGF)-A, interleukin (IL)-1α, tumor necrosis factor-alpha (TNF-α), transforming growth factor-β1 (TGF-β1), and α-smooth muscle actin (α-SMA) were measured by Western blot. Results: Bevacizumab significantly reduced postoperative IOP and increased the survival of the filtering bleb, especially in the ED group. Less vascularization was shown in the SCI, HAR, and ED groups. Histopathological results showed the fewest levels of scarring and fibrosis in the ED group. The local VEGF-A, IL-1α, and TNF-α expression levels after bevacizumab ED were decreased, combined with suppression of TGF-β1 and α-SMA. Conclusions: Postoperative use of bevacizumab EDs was an effective application method for improving surgical outcomes after TRAB in rabbits. It might be effective in preventing scarring of the filtering bleb by antivascularization and anti-inflammation.
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Affiliation(s)
- Chun Jiang
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xue Yin
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Jiayu Chang
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Gaoqin Liu
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, China
| | - Peirong Lu
- Department of Ophthalmology, the First Affiliated Hospital of Soochow University, Suzhou, China
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Alam M, Vitarella D, Ahmad W, Abushakra S, Mao C, Brin MF. Botulinum toxin type E associated with reduced itch and pain during wound healing and acute scar formation following excision and linear repair on the forehead: A randomized controlled trial. J Am Acad Dermatol 2023; 89:1317-1319. [PMID: 37666427 DOI: 10.1016/j.jaad.2023.08.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Murad Alam
- Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | | | - Wajdie Ahmad
- Bonti, Inc, AbbVie Company, Newport Beach, California
| | | | | | - Mitchell F Brin
- AbbVie, Irvine, California; University of California, Irvine, California
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32
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Liu H, Lin MH, Jiang LL, Chang SS, Chen W, Nie KY, Huang GT, Qi F, Zhou XF, Chen JD, Deng CL, Wei ZR. A Modified Suture Technique to Improve Scar Appearance in Wounds Under High Tension. Ann Plast Surg 2023; 91:763-770. [PMID: 37962184 DOI: 10.1097/sap.0000000000003693] [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] [Indexed: 11/15/2023]
Abstract
ABSTRACT The purpose of this study was to introduce a modified suture technique and to compare its effects on skin scar formation with 2 traditional suture methods: simple interrupted suture (SIS) and vertical mattress suture (VMS). Three groups of healthy adult female Sprague-Dawley rats were selected (6 replicates in each group), and the full-thickness skin of 5 cm × 0.2 cm was cut off on the back of the rats after anesthesia. The wounds were then sutured using 1 of the 3 methods for each group: SIS, VMS, and a newly introduced modified vertical mattress suture (M-VMS) technique with the needle reinsertion at the exit point. A traction device was installed on the back of the rats to achieve high tension wounds. The tensile distance was increased by 1 mm every day for 20 days. After 20 days of healing, the hematoxylin-eosin staining method was used for observation of scar morphology. The collagen production rate was measured by Masson staining, and the type I collagen and type III collagen were detected by the immunofluorescence method. Immunohistochemical staining was used to detect the expression of myofibroblast marker α-smooth muscle actin, and real-time quantitative polymerase chain reaction and Western blot techniques were used to detect the expressions of transforming growth factors TGFβ1, TGFβ2, and TGFβ3 to understand the mechanisms of scar formation. Results showed that the quantity and density of collagen fibers were both lower in the M-VMS group than in the other 2 groups. Immunofluorescence results showed that type I collagen was significantly lower, whereas type III collagen was significantly higher in the M-VMS group than in the other 2 groups. The expressions of α-smooth muscle actin and TGFβ1 both were lower in the M-VMS group than in the other 2 groups. The expression of TGFβ2 and TGFβ3 had no obvious difference among the 3 groups. For wounds under high tension, compared with SIS and VMS methods, the M-VMS technique we proposed can reduce scar formation due to the reduction of collagen formation, myofibroblast expression, and TGFβ1 expression.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Xiao-Fan Zhou
- Department of Plastic Surgery, The Third People's Hospital of Guizhou, Guizhou, PR China
| | - Jian-Da Chen
- Department of Plastic Surgery, The Third People's Hospital of Guizhou, Guizhou, PR China
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Zoghoul Alsmadi N, Deister C, Agrawal N, Tran L, Zhukauskas R, Neubauer Fischer D, Mercer D. Characterization of Nerve Damage After an Injury to the Adjacent Soft Tissue: A Pilot Animal Study. Tissue Eng Part C Methods 2023; 29:547-557. [PMID: 37742110 PMCID: PMC10714259 DOI: 10.1089/ten.tec.2023.0151] [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: 06/26/2023] [Accepted: 08/22/2023] [Indexed: 09/25/2023] Open
Abstract
Traumatic injuries may result in the formation of soft tissue adhesions between peripheral nerves and surrounding soft tissue. These soft tissue adhesions lead to compression and ischemic stress within fascicles due to nonpliability of adhered scar tissue, and nerve tension due to loss of nerve gliding from scar tethering. These changes in the soft tissue bed surrounding the nerve may result in axon degeneration and neuroma-in-continuity. Preclinical models that simulate clinically relevant levels of scar in the nerve environment may be impactful to the development of surgical techniques and treatments to prevent adhesions. This study presents the results of a rodent model with an induced indirect nerve injury by (1) thermal insult to the soft tissue bed surrounding the nerve and (2) air-drying the surrounding soft tissue bed of the nerve. Our findings suggest that inducing an injury of the soft tissue bed results in increased intraneural scar and extraneural adhesions to the nerve compared to a sham procedure. Thermal induced injuries showed more macrophages and changes in nerve health compared to air-dried induced injuries. The changes in the nerves of the induced injury groups, specifically the thermal injury group, may be meaningful for evaluating treatments for nontransected nerve injuries.
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Affiliation(s)
| | - Curt Deister
- Department of Research & Development, Axogen Corporation, Tampa, Florida, USA
| | - Nik Agrawal
- Department of Research & Development, Axogen Corporation, Tampa, Florida, USA
| | - Lan Tran
- Department of Research & Development, Axogen Corporation, Tampa, Florida, USA
| | - Rasa Zhukauskas
- Department of Research & Development, Axogen Corporation, Tampa, Florida, USA
| | | | - Deana Mercer
- Department of Orthopedics & Rehabilitation, University of New Mexico, Albuquerque, New Mexico, USA
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Gkiourtzis N, Glava A, Moutafi M, Vasileiadou T, Delaporta T, Michou P, Printza N, Makedou K, Tramma D. The efficacy and safety of corticosteroids in pediatric kidney scar prevention after urinary tract infection: a systematic review and meta-analysis of randomized clinical trials. Pediatr Nephrol 2023; 38:3937-3945. [PMID: 36943468 PMCID: PMC10584697 DOI: 10.1007/s00467-023-05922-0] [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: 12/02/2022] [Revised: 02/07/2023] [Accepted: 02/13/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Acute pyelonephritis (APN) in pediatric patients may lead to kidney scarring and is one of the main causes of permanent kidney damage. The incidence of kidney scarring after one febrile urinary tract infection (UTI) is reported to range from 2.8 to 15%, with the percentage rising to 28.6% after ≥ 3 febrile UTIs. Corticosteroids may have a role in the reduction of kidney scar formation and urine cytokine levels. The possible benefit of adjuvant corticosteroid administration in the reduction of kidney scar formation in children with APN has been recently examined in randomized controlled trials (RCTs). OBJECTIVES The aim of this meta-analysis was to provide a summary of the current literature about the efficacy and safety of adjuvant corticosteroid administration in the reduction of kidney scar formation in children with APN. DATA SOURCES An extensive literature search through major databases (PubMed/MEDLINE and Scopus) was carried out for RCTs from inception until October 12, 2022, investigating the efficacy and safety of adjuvant corticosteroids in preventing kidney scarring in children with APN. A risk ratio with 95% CI was used for dichotomous outcomes. RESULTS In total, 5 RCTs with 918 pediatric patients with APN were included in the study. Adjuvant corticosteroid treatment revealed a statistically significant reduction in kidney scarring (95% CI 0.42-0.95, p = 0.03), without increasing the risk of adverse events like bacteremia, prolonged hospitalization, or recurrence of UTI. LIMITATIONS There were limitations regarding sample size (n = 498 children), different classes of corticosteroids (methylprednisolone or dexamethasone), different routes of corticosteroid administration (intravenous or oral), and different day courses (3-day or 4-day course). CONCLUSIONS Adjuvant corticosteroid administration seems to have a beneficial effect on kidney scar reduction in children with APN. Future studies should focus on the evaluation of the efficacy and safety of corticosteroids in kidney scarring reduction after APN to strengthen the results of our study. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Nikolaos Gkiourtzis
- 4th Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Agni Glava
- 4th Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Moutafi
- 4th Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theopisti Vasileiadou
- 4th Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Theodora Delaporta
- 4th Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiota Michou
- Pediatric Department, G. Gennimatas General Hospital, Thessaloniki, Greece
| | - Nikoleta Printza
- 1st Department of Pediatrics, Ippokrateio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kali Makedou
- Laboratory of Biochemistry, School of Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Despoina Tramma
- 4th Department of Pediatrics, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Panton J, Vingan N, Barillas J, Akgul Y, Lazzarini A, Coroneos CJ, Amirlak B, Kenkel J, Culver A. Postoperative Mechanomodulation Decreases T-Junction Dehiscence After Reduction Mammaplasty: Early Scar Analysis From a Randomized Controlled Trial. Aesthet Surg J 2023; 43:NP1033-NP1048. [PMID: 37606245 PMCID: PMC10902896 DOI: 10.1093/asj/sjad269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/09/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Soft tissue and cutaneous tension is an important contributor to complicated wound healing and poor scar cosmesis after surgery and its mitigation is a key consideration in aesthetic and reconstructive procedures. OBJECTIVES The study objective was to assess the efficacy of the force modulating tissue bridge (FMTB) ("Brijjit", Brijjit Medical Inc., Atlanta, GA) in reducing mechanical tension on postoperative wounds. METHODS A prospective, single-center, randomized, within-subject clinical trial was conducted to evaluate wound healing and nascent scar formation after 8 weeks of postoperative wound support with the FMTB. Patients received standard of care (SOC) subcuticular closure on the vertical incision of 1 breast and experimental closure with the FMTB on the contralateral incision after Wise-pattern reduction mammaplasty. Three-dimensional wound analysis and rates of T-junction dehiscence were evaluated by clinical assessment at 2, 4, 6, and 8 weeks postsurgery. RESULTS Thirty-four patients (n = 68 breasts) completed 8 weeks of postoperative FMTB application. There was a reduced rate of T-junction wound dehiscence in FMTB breasts (n = 1) vs SOC breasts (n = 11) (P < .01). The mean vertical incision wound area during the intervention period was significantly decreased in the FMTB breast (1.5 cm2) vs the SOC breast (2.1 cm2) (P < .01) and was significantly lower at 2-, 4-, and 8-week follow-up (P < .01). Only the closure method was significantly associated with variations in Week 8 wound area (P < .01) after linear regression modeling. CONCLUSIONS FMTBs decrease nascent scar dimensions and reduce the occurrence of wound dehiscence. This study provides evidence that the use of continuous mechanomodulation significantly reduces postoperative wound complications after skin closure. LEVEL OF EVIDENCE: 2
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Berry CE, Longaker MT, Wan DC. Commentary on: Postoperative Mechanomodulation Decreases T-Junction Dehiscence After Reduction Mammaplasty: Early Scar Analysis From a Randomized Controlled Trial. Aesthet Surg J 2023; 43:NP1049-NP1051. [PMID: 37625787 DOI: 10.1093/asj/sjad281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 08/27/2023] Open
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Wall HC, Halani SH, Mosieri C, Daniel C, Gallo L, Eaves FF, Coroneos CJ. Tension Reduction With Force Modulating Tissue Bridges Reduces Wounds in Breast Surgery. Aesthet Surg J 2023; 43:1471-1480. [PMID: 37652052 PMCID: PMC10902893 DOI: 10.1093/asj/sjad285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Tension on healing wounds increases the risk of dehiscence and poor or pathologic scar formation. Force modulating tissue bridges (FMTBs) represent a new class of wound closure and support devices designed to offload tension on healing wounds to improve wound healing and scar outcomes. OBJECTIVES The study was undertaken to assess the efficacy of FMTBs to reduce the risk of wound healing complications in elective breast surgery. METHODS One hundred twenty-two consecutive patients undergoing bilateral aesthetic breast surgery underwent intraoperative placement of FMTBs on the vertical limb closure site. A matched case-control cohort of 121 consecutive patients was established for comparison. Wounds were considered significant if larger than 3 mm in diameter. The primary outcome of breast wounds >3 mm was reported with a relative risk, and all outcomes were framed with number needed to treat. RESULTS The control and intervention cohorts had similar demographics, comorbidities, type of operation, and incision pattern utilized. Within the FMTB group, 96.7% (n = 118) patients completed treatment per protocol. Significant wounds occurred in 1.7% (n = 2) of patients in the tissue bridge vs 15.2% (n = 19) in controls on a per patient/per protocol basis (89% reduction, P < .001). Statistically significant improvements were maintained on sensitivity analyses with intention to treat, even when minor wounds were included. There were no complications noted related to FMTBs. CONCLUSIONS FMTBs are safe and highly effective at reducing the risk of wound formation in elective breast surgery. Results are consistent with sensitivity analyses based on clinical and methodological factors. Further research will assess long-term scar outcomes. LEVEL OF EVIDENCE: 4
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Lai Y, Chuanqing M, Zhiyu C, Chengyong W, Meng L, Jing L, Chen WH. Comparison of two preserved cartilage iliac crest cortical-cancellous bone blocks graft harvesting techniques in children: A prospective, double-blind, randomized clinical trial. J Craniomaxillofac Surg 2023; 51:716-722. [PMID: 37821308 DOI: 10.1016/j.jcms.2023.09.017] [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: 08/02/2022] [Revised: 09/06/2023] [Accepted: 09/30/2023] [Indexed: 10/13/2023] Open
Abstract
PURPOSE To compare donor-site morbidity for alveolar bone grafting results following cartilage-preserving outer and inner cortico-cancellous iliac crest (OCIC and ICIC) bone block grafting in children. MATERIALS AND METHODS Patients were randomly divided into two groups and prospectively reviewed. In the OCIC and ICIC groups, cortico-cancellous bone blocks were harvested at outer and inner iliac crest respectively. Patient characteristics and surgical parameters were compared; pain intensity and duration, lateral femoral cutaneous nerve (LFCN) injury, gait disturbance, scar and contour satisfaction were analysed postoperatively. RESULTS Forty-nine consecutive patients (OCIC, 24; ICIC, 25) were included. There were no significant differences in patient characteristics or donor-site surgical parameters. The mean pain score on the first post-operative day was significantly lower in the OCIC group (3.75±1.70) than in the ICIC group (5.20±2.08) (p=0.012). The pain duration was similar in the two groups (median: 5 days). Temporary LFCN injury only occurred in 3 patients in the ICIC group. Postoperatively, the duck and circle gaits were observed in the OCIC and ICIC groups, respectively. There were no significant differences in the claudication duration, scar and contour satisfaction between the groups. CONCLUSION OCIC bone graft harvesting is marginally advantageous in children due to less early postoperative donor-site pain and a lower risk of nerve damage.
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Affiliation(s)
- Yongzhen Lai
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China; Stomatological Key Laboratory of Fujian College and University, Fuzhou, China
| | - Mao Chuanqing
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Cai Zhiyu
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Wang Chengyong
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Lu Meng
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China
| | - Liu Jing
- Department of Stomatology, Fujian Maternal and Child Health Hospital, No 18 Dao Shan Road, Fuzhou City, 350001, Fujian Province, China
| | - Wei Hui Chen
- Department of Oral and Cranio-maxillofacial Science, Fujian Medical University Union Hospital, No. 28, Xinquan Road, Fuzhou City, 350001, Fujian Province, China.
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Sheibani N, Song YS, Farnoodian M, Inampudi S, Wang S, Darjatmoko SR, Sorenson CM. Artesunate mitigates choroidal neovascularization and scar formation. Exp Eye Res 2023; 236:109666. [PMID: 37783334 DOI: 10.1016/j.exer.2023.109666] [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: 07/10/2023] [Revised: 09/08/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
Angiogenesis, although required during eye development, has a causative effect in many ocular diseases. Aberrant neovascularization contributes to the progression of neovascular age-related macular degeneration (nAMD), a vision-threaten disease in aging Americans. Since increased amounts of vascular endothelial growth factor (VEGF) drives neovascularization during the pathogenesis of nAMD the standard of care are anti-VEGF therapies attempt to disrupt this vicious cycle. These current anti-VEGF therapies try to maintain vascular homeostasis while abating aberrant neovascularization but regrettably don't prevent fibrosis or scar formation. In addition, some patients demonstrate an incomplete response to anti-VEGF therapy as demonstrated by progressive vision loss. Here, we show choroidal endothelial cells (ChEC) incubated with artesunate demonstrated decreased migration and inflammatory and fibrotic factor expression, which corresponded with decreased sprouting in a choroid/retinal pigment epithelium (RPE) explant sprouting angiogenesis assay. To assess the efficacy of artesunate to curtail neovascularization in vivo, we utilized laser photocoagulation-induced rupture of the Bruch's membrane to induce choroidal neovascularization (CNV). Artesunate significantly inhibited CNV and the accompanying fibrotic scar, perhaps due in part to its ability to inhibit mononuclear phagocyte (MP) recruitment. Thus, artesunate shows promise in inhibiting both CNV and fibrosis.
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Affiliation(s)
- Nader Sheibani
- McPherson Eye Research Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Cell and Regenerative Biology, University of Wisconsin School of Medicine and Public Health, USA
| | - Yong-Seok Song
- McPherson Eye Research Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mitra Farnoodian
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Samay Inampudi
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Shoujian Wang
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Soesiawati R Darjatmoko
- Department of Ophthalmology and Visual Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Christine M Sorenson
- McPherson Eye Research Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA; Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Chameettachal S, Venuganti A, Parekh Y, Prasad D, Joshi VP, Vashishtha A, Basu S, Singh V, Bokara KK, Pati F. Human cornea-derived extracellular matrix hydrogel for prevention of post-traumatic corneal scarring: A translational approach. Acta Biomater 2023; 171:289-307. [PMID: 37683964 DOI: 10.1016/j.actbio.2023.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/24/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 09/10/2023]
Abstract
Corneal scarring and opacification are a significant cause of blindness affecting millions worldwide. The current standard of care for corneal blindness is corneal transplantation, which suffers from several drawbacks. One alternative approach that has shown promise is the use of xenogeneic corneal extracellular matrix (ECM), but its clinical applicability is challenging due to safety concerns. This study reports the innovative use of human cornea-derived ECM to prevent post-traumatic corneal scarring. About 30 - 40% of corneas donated to the eye banks do not meet the standards defined for clinical use and are generally discarded, although they are completely screened for their safety. In this study, human cornea-derived decellularized ECM hydrogel was prepared from the non-transplantation grade human cadaveric corneas obtained from an accredited eye-bank. The prepared hydrogel was screened for its efficacy against corneal opacification following an injury in an animal model. Our in vivo study revealed that, the control collagen-treated group developed corneal opacification, while the prophylactic application of human cornea-derived hydrogel effectively prevented corneal scarring and opacification. The human hydrogel-treated corneas were indistinguishable from healthy corneas and comparable to those treated with the xenogeneic bovine corneal hydrogel. We also demonstrated that the application of the hydrogel retained the biological milieu including cell behavior, protein components, optical properties, curvature, and nerve regeneration by remodeling the corneal wound after injury. The hydrogel application is also sutureless, resulting in faster corneal healing. We envision that this human cornea-derived ECM-based hydrogel has potential clinical application in preventing scarring from corneal wounding. STATEMENT OF SIGNIFICANCE: There are significant challenges surrounding corneal regeneration after injury due to extensive scarring. Although there is substantial research on corneal regeneration, much of it uses synthetic materials with chemical cross-linking methods or xenogeneic tissue-based material devices which have to undergo exhaustive safety analysis before clinical trials. Herein, we demonstrate the potential application of a human corneal extracellular matrix hydrogel without any additional materials for scarless corneal tissue regeneration, and a method to reduce the wasting of donated allogenic corneal tissue from eye banks. We found no difference in efficacy between the usage of human tissues compared to xenogeneic sources. This may help ease clinical translation and can be used topically without sutures as an outpatient procedure.
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Affiliation(s)
- Shibu Chameettachal
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Sangareddy 502285, Telangana, India
| | - Animith Venuganti
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Yash Parekh
- CSIR-Center for Cellular and Molecular Biology, ANNEXE II, Medical Biotechnology Complex, Uppal Road, Hyderabad, Telangana, India
| | - Deeksha Prasad
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Vineet P Joshi
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Sangareddy 502285, Telangana, India; Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
| | - Anviti Vashishtha
- CSIR-Center for Cellular and Molecular Biology, ANNEXE II, Medical Biotechnology Complex, Uppal Road, Hyderabad, Telangana, India
| | - Sayan Basu
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India.
| | - Vivek Singh
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India.
| | - Kiran Kumar Bokara
- CSIR-Center for Cellular and Molecular Biology, ANNEXE II, Medical Biotechnology Complex, Uppal Road, Hyderabad, Telangana, India.
| | - Falguni Pati
- Department of Biomedical Engineering, Indian Institute of Technology Hyderabad, Kandi, Sangareddy 502285, Telangana, India.
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Winayanuwattikun W, Vachiramon V, Rattananukrom T, Palakornkitti P, Sitpahul N. Efficacy of Botulinum Toxin Type A for Prevention of Post-Mastectomy Scar in Transmen: A Prospective, Randomized Study. Toxins (Basel) 2023; 15:636. [PMID: 37999499 PMCID: PMC10680993 DOI: 10.3390/toxins15110636] [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: 09/25/2023] [Revised: 10/21/2023] [Accepted: 10/28/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Subcutaneous mastectomies in transmen have been gaining popularity. However, post-operative scars are an inevitable consequence. Recently, Botulinum neurotoxin A (BoNT-A) has shown positive effects in scar prevention. The objective of this study is to investigate the effectiveness of BoNT-A in scar prevention. METHODS Fifteen patients who had undergone subcutaneous mastectomy were included. At 14 days post-surgery, either incoBoNT-A or a placebo was injected into the scar on each side. The primary outcome assessment measured the scar's severity using the Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS). The secondary outcome assessment evaluated the scar's color using a standard measurement device. Outcome assessments were conducted until 6 months post-surgery. RESULTS There were significantly lower VSS scores in the BoNT-A group compared to the placebo at the end of the study (7.43 ± 0.26 vs. 8.82 ± 0.26, p < 0.001). The objective assessment revealed a statistically significant decrease in redness values in the BoNT-A group compared to the placebo at 3 and 6 months. CONCLUSION BoNT-A has demonstrated effectiveness in scar prevention by reducing the severity of postoperative scar formation and improving overall scar appearance.
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Affiliation(s)
- Waranaree Winayanuwattikun
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (W.W.); (T.R.); (P.P.)
| | - Vasanop Vachiramon
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (W.W.); (T.R.); (P.P.)
| | - Teerapong Rattananukrom
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (W.W.); (T.R.); (P.P.)
| | - Pasita Palakornkitti
- Division of Dermatology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; (W.W.); (T.R.); (P.P.)
| | - Ngamcherd Sitpahul
- Department of Plastic and Maxillofacial Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
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Sağır M, Güven E, Ozkan AC, Kozanoğlu E. Reduction of the scar burden at the donor area of the radial forearm flap with the aid of an endoscopic pedicle preparation. ULUS TRAVMA ACIL CER 2023; 29:1296-1302. [PMID: 37889031 PMCID: PMC10771239 DOI: 10.14744/tjtes.2023.62186] [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: 07/25/2023] [Revised: 09/30/2023] [Accepted: 10/07/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND The radial forearm flap is one of the most commonly used flaps of reconstructive microsurgery with its long pedicle and thin structure. The donor site at the forearm is a visible anatomic region that has high mobility and functional importance. In this study, a longitudinal and large scar was avoided on the forearm during pedicle dissection of the conventional radial forearm flap with the utilization of an endoscope. Furthermore, arterial, venous, and nervous injuries were avoided by performing a separate inci-sion of 2-3 cm at the cubital fossa to reduce flap failure and donor site morbidity. METHODS The patients who underwent pedicle dissection of the radial forearm flap with the aid of an endoscope for head-neck reconstruction between 2014 and 2021 were included in this study. The flap was harvested from the subfascial plane. The cephalic vein was used in all of the patients. When the pedicle dissection reached the antecubital region, an incision of 2-3 cm was performed from the skin. Two vein anastomoses were performed for each patient. RESULTS This retrospective study consists of 51 patients. While 45 of the patients were the result of head and neck cancer, six of them had a defect caused by trauma. The average area of skin islands was 40.3 cm2, while the full-thickness skin graft size was 24.2 cm2. An average of 2.6 cm of scar tissue was formed at the antecubital region. No venous or arterial compromise was observed in the post-operative period. There was no partial or total flap loss in any patient. Localized numbness persisted in the skin area where the superficial sensory branch of the radial nerve is located in 6 (11.7%) patients. CONCLUSION With endoscopic radial forearm flap harvesting, the longitudinal incision in the forearm and wound healing prob-lems are avoided. The absence of partial or total flap loss has shown that endoscopic harvesting of the radial forearm flap is a safe and reliable method.
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Affiliation(s)
- Mehmet Sağır
- Department of Plastic Reconstructive and Aesthetic Surgery, Privete Maslak Acıbadem Hospital, İstanbul-Türkiye
| | - Erdem Güven
- Department of Plastic Reconstructive and Aesthetic Surgery, Privete Maslak Acıbadem Hospital, İstanbul-Türkiye
| | - Aret Cerci Ozkan
- Specialist of Plastic Reconstructive and Aesthetic Surgery, Private Practice, İstanbul-Türkiye
| | - Erol Kozanoğlu
- Department of Plastic Surgery, İstanbul University, Istanbul Faculty of Medicine, İstanbul-Türkiye
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Wu J, Guo R, Li L, Chu D, Wang X. Effectiveness and safety of prophylactic abdominal aortic balloon occlusion for patients with type III caesarean scar pregnancy: a prospective cohort study. BMC Pregnancy Childbirth 2023; 23:754. [PMID: 37880627 PMCID: PMC10601196 DOI: 10.1186/s12884-023-06065-8] [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] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 10/13/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Caesarean scar pregnancy (CSP) is a special type of ectopic pregnancy with a high risk of massive haemorrhage. Few studies have focused on the efficacy of prophylactic abdominal aortic balloon occlusion as a minimally invasive method in caesarean section. This study aimed to evaluate the effectiveness and safety of prophylactic abdominal aortic balloon occlusion for patients with type III CSP. METHODS This was a prospective cohort study. Patients with type III CSP in the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2022 were enrolled. Eligible patients received prophylactic abdominal aortic balloon occlusion (defined as the AABO group) or uterine artery embolization (defined as the UAE group) before laparoscopic surgery. Clinical outcomes included intraoperative blood loss, body surface radiation dose, hospitalization expenses, and time to serum β-hCG normalization, and safety were also assessed. RESULTS A total of 68 patients met the criteria for the study, of whom 34 patients were in the AABO group and 34 patients were in the UAE group. The median intraoperative blood loss in the AABO and UAE groups was 17.5 (interquartile ranges [IQR]: 10, 45) and 10 (IQR: 6.25, 20) mL, respectively (P = 0.264). The body surface radiation dose of the AABO group was much lower than that of the UAE group (5.22 ± 0.44 vs. 1441.85 ± 11.59 mGy, P < 0.001). The AABO group also had lower hospitalization expenses than the UAE group (2.42 ± 0.51 vs. 3.42 ± 0.85 *10^5 yuan, P < 0.001). The average time to serum β-hCG normalization in the AABO group was 28.9 ± 3.21 d, which was similar to that in the UAE group (30.3 ± 3.72 d, P = 0.099). In addition, the incidence of adverse events in the AABO group was lower than that in the UAE group (5.9% vs. 58.8%, P < 0.001). CONCLUSION Prophylactic AABO was equally as effective as UAE in patients with type III CSP but was safer than UAE during and after the operation.
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Affiliation(s)
- Jie Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 East Construction Rd, Zhengzhou, 450052, Henan, China
| | - Ruixia Guo
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 East Construction Rd, Zhengzhou, 450052, Henan, China.
| | - Lixin Li
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 East Construction Rd, Zhengzhou, 450052, Henan, China
| | - Danxia Chu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 East Construction Rd, Zhengzhou, 450052, Henan, China
| | - Xinyan Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital of Zhengzhou University, No. 1 East Construction Rd, Zhengzhou, 450052, Henan, China
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Samie A, Alavian H, Vafaei-Pour Z, Mohammadpour AH, Jafarian AH, Danesh NM, Abnous K, Taghdisi SM. Accelerated Wound Healing with a Diminutive Scar through Cocrystal Engineered Curcumin. Mol Pharm 2023; 20:5090-5107. [PMID: 37624646 DOI: 10.1021/acs.molpharmaceut.3c00398] [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] [Indexed: 08/27/2023]
Abstract
Pharmaceutical cocrystals ( Regulatory Classification of Pharmaceutical Co-Crystals Guidance for Industry; Food and Drug Administration, 2018) are crystalline solids produced through supramolecular chemistry to modulate the physicochemical properties of active pharmaceutical ingredients (APIs). Despite their extensive development in interdisciplinary sciences, this is a pioneering study on the efficacy of pharmaceutical cocrystals in wound healing and scar reducing. Curcumin-pyrogallol cocrystal (CUR-PYR) was accordingly cherry-picked since its superior physicochemical properties adequately compensate for limitative drawbacks of curcumin (CUR). CUR-PYR has been synthesized by a liquid-assisted grinding (LAG) method and characterized via FT-IR, DSC, and PXRD analyses. In vitro antibacterial study indicated that CUR-PYR cocrystal, CUR+PYR physical mixture (PM), and PYR are more effective against both Gram-negative (Pseudomonas aeruginosa and Escherichia coli) and Gram-positive (Staphylococcus aureus and Bacillus subtilis) bacteria in comparison with CUR. In vitro results also demonstrated that the viability of HDF and NIH-3T3 cells treated with CUR-PYR were improved more than those received CUR which is attributed to the effect of PYR in the form of cocrystal. The wound healing process has been monitored through a 15 day in vivo experiment on 75 male rats stratified into six groups: five groups treated by CUR-PYR+Vaseline (CUR-PYR.ung), CUR+PYR+Vaseline (CUR+PYR.ung), CUR+Vaseline (CUR.ung), PYR+Vaseline (PYR.ung), and Vaseline (VAS) ointments and a negative control group of 0.9% sodium chloride solution (NS). It was revealed that the wounds under CUR-PYR.ung treatment closed by day 12 postsurgery, while the wounds in other groups failed to reach the complete closure end point until the end of the experiment. Surprisingly, a diminutive scar (3.89 ± 0.97% of initial wound size) was observed in the CUR-PYR.ung treated wounds by day 15 after injury, followed by corresponding values for PYR.ung (12.08 ± 2.75%), CUR+PYR.ung (13.89 ± 5.02%), CUR.ung (16.24 ± 6.39%), VAS (18.97 ± 6.89%), and NS (20.33 ± 5.77%). Besides, investigating histopathological parameters including inflammation, granulation tissue, re-epithelialization, and collagen deposition signified outstandingly higher ability of CUR-PYR cocrystal in wound healing than either of its two constituents separately or their simple PM. It was concluded that desired solubility of the prepared cocrystal was essentially responsible for accelerating wound closure and promoting tissue regeneration which yielded minimal scarring. This prototype research suggests a promising application of pharmaceutical cocrystals for the purpose of wound healing.
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Affiliation(s)
- Ali Samie
- Department of Medicinal Chemistry, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
| | - Hoda Alavian
- Department of Medicinal Chemistry, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
| | - Zeinab Vafaei-Pour
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
- Department of Pharmacodynamics and Toxicology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Science, Mashhad 9177948954, Iran
| | - Amir Hossein Jafarian
- Cancer and Molecular Research Center, Department of Pathology, School of Medicine, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
| | - Noor Mohammad Danesh
- Department of Medicinal Chemistry, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
| | - Khalil Abnous
- Department of Medicinal Chemistry, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
- Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
| | - Seyed Mohammad Taghdisi
- Targeted Drug Delivery Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
- Department of Pharmaceutical Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
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45
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Balevi M, Balevi A. The effect of Centella Asiatica cream on scar development in patients who underwent open carpal tunnel release surgery. J Hand Ther 2023; 36:962-966. [PMID: 36918311 DOI: 10.1016/j.jht.2022.11.001] [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: 04/14/2021] [Revised: 10/31/2022] [Accepted: 11/01/2022] [Indexed: 03/16/2023]
Abstract
AIM To evaluate the efficacy of the Centella asiatica extract in a cream preparation for the prevention of scar tenderness formation in patients who underwent conventional open carpal tunnel release (CTR) surgery. MATERIAL AND METHODS A total of 280 patients with carpal tunnel syndrome who underwent CTR surgery were individually randomized into the intervention (n = 140) and control (n = 140) groups. In the intervention group, a petroleum cream mixture consisting of 1% Centella asiatica extract was applied to the patients' wrist for 6 months after the sutures were removed. In the control group, no intervention was applied. The Vancouver Scar Scale (VSS), Quick Disabilities of Arm, Shoulder and Hand (QuickDASH) functional score, and Visual Analog Scale (VAS) satisfaction scores were assessed preoperatively and postoperatively. Follow-up evaluations were scheduled at 1, 3 and 6 months after CTR surgery. RESULTS The overall VSS score of the intervention group significantly improved at 3-6 months (-1.260, p = .040). At 6 months after surgery, the mean QuickDASH functional score was 18.54 (range 0.00-63.64, SD 17.4) in the intervention group and 28.70 ± 12 (range: 2.27-40.91) in the control group (p < .04). At 6 months after surgery, the mean VAS satisfaction score was 1.46 ± 1.95 (range: 0-4) in the intervention group and 2.48 ± 1.02 (range: 0-4) in the control group (p < .03). CONCLUSION The Centella asiatica cream applied to the wrist after CTR surgery was found to be beneficial in preventing scar tenderness in the thenar and hypothenar regions of the hand.
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Affiliation(s)
- Mustafa Balevi
- Neurosurgery expert. Department of Neurosurgery, Konya Numune State Hospital, Konya, Turkey.
| | - Ali Balevi
- Department of Dermatology, Istanbul Medipol University, School of Medicine, Turkey
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46
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Gentile P. Lipofilling Enriched with Adipose-Derived Mesenchymal Stem Cells Improves Soft Tissue Deformities and Reduces Scar Pigmentation: Clinical and Instrumental Evaluation in Plastic Surgery. Aesthetic Plast Surg 2023; 47:2063-2073. [PMID: 37012499 DOI: 10.1007/s00266-023-03325-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/08/2022] [Accepted: 03/12/2023] [Indexed: 04/05/2023]
Abstract
BACKGROUND Scars and soft tissue deformities (S-STDs), often resulting from hemifacial atrophy, trauma, and outcomes of burns, were usually associated with hyperpigmentation of overlying skin. OBJECTIVES This study aimed to evaluate the long-term effects of fat grafting commonly called "Lipofilling" enhanced with adipose-derived mesenchymal stem cells (Lipofilling-AD-MSCs) for treating S-STDs with pigmentary changes. METHODS A cohort study has been performed. 50 patients affected by S-STDs with hyperpigmentation treated with Lipofilling-AD-MSCs and 50 patients treated with Lipofilling not enhanced (Lipofilling-NE) were prospectively assessed. The pre-op evaluation included a clinical evaluation, a photographic assessment, magnetic resonance imaging, and ultrasound. Post-op follow-up was performed at 1, 3, 7, 12, 24, 48, weeks, and then annually. RESULTS Improvement in volume contours and pigmentation was clinically assessed. All people who underwent the treatments (Lipofilling-AD-MSCs and Lipofilling-NE) were satisfied with the improving pigmentation, texture, and volume contours with some differences. However, the results reported displaying a better trend in patients treated with Lipofilling-AD-MSCs to be more satisfied than patients treated with Lipofilling-NE (p < 0.0001). CONCLUSIONS In conclusion, Lipofilling-AD-MSCs was the preferred option for improving the contour deformities related to increased pigmentation of scars. LEVEL OF EVIDENCE IV Evidence obtained from cohort studies.
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Affiliation(s)
- Pietro Gentile
- Associate Professor of Plastic and Reconstructive Surgery, Department of Surgical Science, "Tor Vergata" University, 00173, Via Montpellier 1, 00133, Rome, Italy.
- Scientific Director of Academy of International Regenerative Medicine and Surgery Societies (AIRMESS), 1201, Geneva, Switzerland.
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47
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Jin Y, Jin W, Sun Q, Li N, Jiang M, Liu Y, Sun L. Role of the chloride channel blocker in the formation of filtering tract scars after glaucoma surgery in rats. Clin Exp Pharmacol Physiol 2023; 50:806-814. [PMID: 37452725 DOI: 10.1111/1440-1681.13803] [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: 11/19/2022] [Revised: 05/09/2023] [Accepted: 06/05/2023] [Indexed: 07/18/2023]
Abstract
Filtration surgery is commonly performed for glaucoma treatment to reduce intraocular pressure (IOP); however, scarring of the filtering bleb is the main cause of failure. In this study, we evaluated the effects of the chloride channel blocker 5-nitro-2-(3-phenylpropylamino)benzoic acid (NPPB) on scar formation in filtering blebs. A glaucoma filtering surgery model was generated using Sprague-Dawley rats, divided into the control and NPPB groups receiving injections of different NPPB concentrations. The IOP of all rats decreased 1-day post-surgery and gradually increased afterward. However, IOP in rats from the NPPB groups recovered more slowly than that of the control group rats. In addition, the area and survival times of filtering blebs in rats from the NPPB groups were substantially larger and longer than those in the control group. Twenty-eight days after surgery, the protein and mRNA expression of collagen I, fibronectin and α-smooth muscle actin in the filtering area of rats from the NPPB groups were significantly lower than that in the control group rats. Collectively, our study demonstrates that NPPB inhibits filtering bleb scar formation, maintains filtering bleb morphology and prolongs filtering bleb survival time by inhibiting the differentiation of conjunctival fibroblasts and extracellular matrix synthesis.
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Affiliation(s)
- Yujiao Jin
- Department of Ophthalmology, The Affiliated Hospital of Yanbian University, Yanji, China
| | - Weiyi Jin
- Department of Ophthalmology, The Affiliated Hospital of Yanbian University, Yanji, China
| | - Qiushuang Sun
- Department of Ophthalmology, The Affiliated Hospital of Yanbian University, Yanji, China
| | - Nan Li
- Department of Ophthalmology, The Affiliated Hospital of Yanbian University, Yanji, China
| | - Meiling Jiang
- Department of Ophthalmology, The Affiliated Hospital of Yanbian University, Yanji, China
| | - Yinfeng Liu
- Department of Ophthalmology, The Affiliated Hospital of Yanbian University, Yanji, China
| | - Lixia Sun
- Department of Ophthalmology, The Affiliated Hospital of Yanbian University, Yanji, China
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48
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Tondu T, Jacobs C, Vandevivere Y, Verhoeven V, Tjalma W, Hubens G, Blondeel P, De Greef K, Ysebaert D. Dermal Nipple-Areola Complex Perfusion through Circumareolar Scars: A Delay Model in Two-Stage Nipple-Sparing Mastectomy. Plast Reconstr Surg 2023; 152:797-805. [PMID: 36877763 DOI: 10.1097/prs.0000000000010386] [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] [Indexed: 03/07/2023]
Abstract
BACKGROUND Nipple-sparing mastectomy (NSM) has evolved as a standard surgical option. The NSM complication rate remains high in large breasts. To reduce the risk of necrosis, several authors have proposed delayed procedures to enhance blood supply to the nipple-areola complex (NAC). The purpose of this study in a porcine model was to show adequate redirection of NAC perfusion by neoangiogenesis through circumareolar scars. METHODS Delayed two-staged NSM was simulated in 52 nipples (six pigs) with a 60-day interval. The nipples underwent a full-thickness, circumareolar incision onto the muscular fascia, with preservation of underlying glandular perforators. After 60 days, NSM was performed through a radial incision. A silicone sheet was introduced in the mastectomy plane to prevent NAC revascularization by wound bed imbibition. Digital color imaging was used to assess necrosis. Near-infrared fluorescence with indocyanine green was used to assess perfusion patterns and perfusion in real time. RESULTS No NAC necrosis was seen after 60 days' delay in any nipples. In all nipples, indocyanine green angiography showed complete alteration of the NAC vascular perfusion pattern from subjacent gland to a capillary fill following devascularization, exhibiting a predominant arteriolar capillary blush without distinct larger vessels. CONCLUSIONS NAC delay reverses glandular perfusion to adequate dermal neovascularization. Neovascularization through full-thickness scars provides sufficient dermal perfusion after 60 days' delay. Identical staged delay in humans may be a surgically safe NSM option and could broaden therapeutic NSM indications in difficult breasts. Large clinical trials are necessary to provide identical results in human breasts. CLINICAL RELEVANCE STATEMENT NAC delay reverses glandular perfusion to adequate dermal neovascularization. Neovascularization through full-thickness scars provides sufficient dermal perfusion after 60 days of delay. Identical staged delay in humans may be a surgically safe NSM option.
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Affiliation(s)
- Thierry Tondu
- From the Department of Abdominal, Pediatric, and Reconstructive Surgery, Plastic Surgery Unit
- Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp
| | | | | | | | - Wiebren Tjalma
- Multidisciplinary Breast Clinic, Unit of Gynecologic Oncology
- Department of Obstetrics and Gynecology
| | - Guy Hubens
- From the Department of Abdominal, Pediatric, and Reconstructive Surgery, Plastic Surgery Unit
- Animal Research Facility
| | | | - Kathleen De Greef
- Department of Hepatobiliary and Transplant Surgery, Antwerp University Hospital
| | - Dirk Ysebaert
- Department of Hepatobiliary and Transplant Surgery, Antwerp University Hospital
- Animal Research Facility
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Chen L, He Q, Tian H, Zhu Q, Shen Y, Fang Y, Zhu F, Zhu L, Chen L, Pan J, Du Y, Yan X, Zhang Q, Zhou X, Tian W, Wu Y. Sternomastoid intermuscular approach has better postoperative cosmesis and less neck discomfort than linea alba cervicalis approach in hemithyroidectomy: a randomized clinical trial. Int J Surg 2023; 109:2672-2679. [PMID: 37379168 PMCID: PMC10498877 DOI: 10.1097/js9.0000000000000505] [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: 08/29/2022] [Accepted: 05/11/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Surgery is still the most important treatment method for thyroid cancer. The classic linea alba cervicalis approach caused obvious neck scarring. This study explored an alternative open operative approach with concealed incision for hemithyroidectomy, and demonstrated whether it was non-inferior to traditional approach in postoperative complications and operation efficiency. METHODS Patients ( n =220) from November 2019 to November 2020 willing to undergo hemithyroidectomy because of differentiated thyroid cancer were randomly divided into the sternocleidomastoid intermuscular approach (SMIA) group ( n =110), and the linea alba cervicalis approach (LACA) group ( n =110). The incidence of postoperative complications within 3 months and operation efficiency indicator R0 resection rate were recorded as primary endpoint, while scar apperance was assessed as secondary endpoint. The data were statistically analyzed. RESULTS The baseline data of these two groups were comparable, with no significant difference ( P >0.05). As primary endpoint, R0 resection rate was 100% in both groups. In the 1-month follow-up period, the SMIA group had a lower score for neck discomfort compared with that of the LACA group (1.01±0.1648 vs. 0.5657±0.0976, P =0.0217). The SMIA group's scar had better results from the observer scar assessment compared to that of the LACA group as secondary endpoint. Within the 3-month follow-up, the total complications were calculated, and it was demonstrated that SMIA was non-inferior to traditional LACA operation ( P of non-inferiority=0.0048). CONCLUSIONS Compared with LACA group, surgery through the SMIA is safe, effective, and has non-inferior postoperative complications. SMIA can be considered an alternative approach to classic LACA in hemithyroidectomy.
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Affiliation(s)
- Linghui Chen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qiwen He
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Hedi Tian
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qinsheng Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yibin Shen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yun Fang
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Feng Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Lixian Zhu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Liang Chen
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Jun Pan
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Yehui Du
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xiaochuan Yan
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Qijun Zhang
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Xueyu Zhou
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
| | - Wen Tian
- Department of General Surgery, Chinese PLA General Hospital, Beijing, P.R. China
| | - Yijun Wu
- Department of Thyroid Surgery, The First Affifiliated Hospital, School of Medicine, Zhejiang University, Hangzhou
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50
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Ko JA, Komatsu K, Minamoto A, Kondo S, Okumichi H, Hirooka K, Kiuchi Y. Effects of Ripasudil, a Rho-Kinase Inhibitor, on Scar Formation in a Mouse Model of Filtration Surgery. Curr Eye Res 2023; 48:826-835. [PMID: 37216470 DOI: 10.1080/02713683.2023.2217367] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 01/30/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 05/24/2023]
Abstract
PURPOSE Glaucoma is a leading cause of blindness worldwide. Characteristic changes occur in the optic nerve and visual field of patients with glaucoma; optic nerve damage can be mitigated by lowering intraocular pressure. Treatment modalities include drugs and lasers; filtration surgery is necessary for patients with insufficient intraocular pressure reduction. Scar formation often contributes to glaucoma filtration surgery failure by increasing fibroblast proliferation and activation. Here, we examined the effects of ripasudil, a Rho-associated protein kinase (ROCK) inhibitor, on postoperative scar formation in human Tenon's fibroblasts. METHODS Collagen gel contraction assays were used to compare contractility activity among ripasudil and other anti-glaucoma drugs. The effect of Ripasudil in combination with other anti-glaucoma drugs and transforming growth factor-β (TGF-β), latanoprost and timolol-induce contractions were also tested in this study. Immunofluorescence and Western blotting were used to study the expression of factors relating scarring formation. RESULTS Ripasudil inhibited contraction in collagen gel assay and reduced α-smooth muscle actin (SMA) and vimentin (scar formation-related factors) expression, which was inversely promoted by latanoprost, timolol or TGF-β. Ripasudil also inhibited contraction on TGF-β, latanoprost and timolol-induced contraction. Furthermore, we investigated the effects of ripasudil on postoperative scarring in a mouse model; ripasudil suppressed postoperative scar formation by altering the expression of α-SMA and vimentin. CONCLUSIONS These results suggest that ripasudil, ROCK inhibitor may inhibit excessive fibrosis after glaucoma filtering surgery vis inhibition the transdifferentiation of tenon fibroblast into myofibroblast and may have a potential effect as anti-scarring for glaucoma filtration surgery.
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Affiliation(s)
- Ji-Ae Ko
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | - Kaori Komatsu
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | - Akira Minamoto
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | - Satomi Kondo
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | - Hideaki Okumichi
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | - Kazuyuki Hirooka
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
| | - Yoshiaki Kiuchi
- Department of Ophthalmology and Visual Science, Hiroshima University, Hiroshima, Japan
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