Comparison of Colorado Needle Electrocautery and Traditional Scalpel for Upper Eyelid Blepharoplasty Incision: A Randomized Controlled Trial and Systematic Review.

Upper eyelid blepharoplasty is a popular aesthetic surgery. Electrocautery provides a hemostatic benefit for skin incision; however, its effect on scar cosmesis remains unclear, especially in Asian skin types. We aimed to compare the Colorado needle electrocautery pure cutting mode and the traditional scalpel to determine their efficacy, complications, and cosmetic outcomes. Methods: A systematic review was performed to review the outcome with the conventional method (scalpel) and other methods in upper blepharoplasty procedures. Further, a prospective intraindividual randomized controlled trial was conducted to compare the efficacy of Colorado needle electrocautery and the scalpel in upper blepharoplasty. Study outcomes included scar quality at different times until 1-year postoperation, bleeding during incision, and postoperative ecchymosis. Results: Five articles met the inclusion criteria for this systematic review. The prospective randomized controlled trial study included 30 patients; the average incisional time on the electrocautery side was significantly longer than that on the scalpel side, and the electrocautery side had less blood loss during incision than the scalpel side (2.4 versus 3.27 using average cotton bud sticks, respectively) (P < 0.001). Hypopigmented scarring occurred more frequently on the scalpel side; however, the difference was not statistically significant. Conclusions: Colorado needle electrocautery pure cutting mode can be an alternative to traditional scalpel for upper eyelid blepharoplasty skin incision because of long-term scar quality. Electrocautery use has hemostatic benefits, leading to a decrease in bleeding that can obscure the incision site. However, the incision time on the electrocautery side was significantly longer than the scalpel side, which may be owing to an adaptation of surgical technique.

The Effectiveness of Immediate Triamcinolone Acetonide Injection after Auricular Keloid Surgery: A Prospective Randomized Controlled Trial.

The earlobe and helix are common sites for keloids following ear piercing. First-line therapy involves intra-keloidal excision followed by triamcinolone acetonide (TA) injection. Yet, the optimal timing for TA injection after keloid excision remains debated. The objective of this study was to compare outcomes between immediate and delayed TA injection after auricular keloid excision. METHODS: This was a prospective, controlled trial with patients randomized into immediate or delayed groups. The Vancouver Scar Scale (VSS) and Patient and Observer Scar Assessment Scale (POSAS) were used to evaluate scar quality. The number of recurrent keloid cases was recorded, defined as a VSS height of 3, POSAS thickness greater than 5, or an increase in VSS height or POSAS thickness after keloid excision. Overall complications were recorded. A P value less than 0.05 was considered statistically significant. RESULTS: The immediate group contained 18 patients, and the delayed group had 16 patients. The mean age of patients was 25.52 years, and the mean maximum keloid diameter was 14.49 mm (7-32.5 mm). The immediate group reported a statistically significant lower recurrence rate than did the delayed group at 5 months (P = 0.042). No significant differences were noted between VSS and POSAS scores at 3 months, and no complications were recorded during the study. CONCLUSIONS: Immediate TA injection is an acceptable option for auricular keloid treatment. Here, it was associated with a lower recurrence rate than with delayed injection and resulted in no complications. The immediate and delayed groups had similar outcomes for VSS and POSAS.

Efficacy of Negative-Pressure Wound Therapy with Tetrachlorodecaoxygen-Anion Complex Instillation Compared with Standard Negative-Pressure Wound Therapy for Accelerated Wound Healing: A Prospective, Randomized, Controlled Trial.

BACKGROUND: Negative-pressure wound therapy (NPWT) with instillation is a novel wound therapy. The optimal solution is still being investigated. Tetrachlorodecaoxygen-anion complex (TCDO) causes increased phagocytosis and oxygenation. The authors' objective was to investigate the efficacy of NPWT with TCDO instillation (NPWTi) and to compare the results with NPWT alone. METHODS: A randomized controlled trial was conducted. Inclusion criteria were wound size greater than 4 cm2 and depth greater than 10 mm. Exclusion criteria were malignancy, immunocompromise, and allergy to TCDO. Patients were randomized into NPWT and NPWTi groups. Outcome measurements consisted of wound surface area, depth, volume, tissue culture, and pathologic evaluation. RESULTS: A total of 24 patients in each group were enrolled. The percentages of wound surface area reduction of NPWTi and NPWT groups were 24.1 ± 6.8 and 28.2 ± 7.6 on day 12, and 19.0 ± 6.6 and 22.7 ± 7.8 on day 15, respectively (p < 0.05). The percentages of wound depth reduction were 16.4 ± 5.3 and 22.5 ± 10.5 on day 12, and 12.0 ± 6.7 and 14.1 ± 8.0 on day 15, respectively (p < 0.05). The percentages of wound volume reduction were 17.9 ± 4.6 and 21.6 ± 5.8 on day 12, and 14.7 ± 6.0 and 17.1 ± 6.6 on day 15, respectively (p < 0.05). No statistically significant difference in microbial reduction was found between the groups. Histopathologic examination showed that more angiogenesis was observed in the NPWTi group than in the NPWT group. CONCLUSIONS: NPWT with TCDO instillation statistically significantly accelerated wound healing, but it did not show significant microbial reduction. The authors' results suggest that TCDO instillation may be an adjunctive treatment in NPWT. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Bronchogenic cyst of the floor of mouth combined with ankyloglossia: an extremely rare presentation of rare anomaly.

Bronchogenic cyst (BC), cyst lined by respiratory epithelium, is uncommon congenital anomaly of bronchial tree. Intraoral BC is extremely rare lesions. Here, we report the unusual presentation of 2-year-old boy with symptomatic cystic lesion at floor of month combined with ankyloglossia. The operation was performed under general anesthesia. Frenotomy was performed. Complete cystic removal was successful with minimal leakage of cyst wall. Sclerosing agent was injected at surgical site to prevent the residual undetected cystic malformation. Pathological examination was demonstrated a unicystic lesion lined by ciliated pseudostratified columnar and cuboidal cells. The final diagnosis was bronchogenic cyst. No postoperative complication was found. The long-term course was uneventful with no signs of recurrence at 1 year. To our best knowledge, a rare example of BC at the floor of mouth combined with ankyloglossia has never been reported.

Characteristics of Marjolin's Ulcers in 21st Century: A Retrospective Study, Systematic Review, and Surgical Guideline Recommendation.

Marjolin's ulcer is rare and aggressive malignancy. The objective was to conduct a review of Marjolin's ulcer cases to gain a better understanding and its management. A retrospective study of patients with Marjolin's ulcers at our hospital between 2010 and 2019 was conducted. For the systematic review, the electronic database of the National Library of Medicine was searched and articles published between 2000 and 2019 were included. A total of 14 patients were included in the retrospective study. Twelve patients were male. The mean age was 59.71 years. The latency period was 27.78 years. The most common malignancy was squamous cell carcinoma, and 71.43% had developed on the lower extremities. Well-differentiated squamous cell carcinomas occurred in 38.46% of the cases Rates of lymphovascular and perineural invasion were 30.77 and 23.08%, respectively. Results from the literature search yielded 80 case reports (91 cases) and 42 retrospective reviews (1216 cases). Most cases were male and the most common location was lower extremities. The latency period for the acute and chronic periods was 2.75 months and 20.75 years, respectively. The most common malignancy was squamous cell carcinoma (92.27% in the retrospective reviews) and 59.98% of the cases exhibited well-differentiation. Rates of regional lymph node involvement and distant metastases were 10.20 and 12.09%, respectively. Marjolin's ulcer in 21st century is not so rare. The most common is well differentiated squamous cell carcinoma. Early flap surgery or skin grafts for chronic ulcers or burn scars are recommended to reduce risk. Guideline for surgical management is established.

Efficacy of Silicone Gel versus Silicone Gel Sheet in Hypertrophic Scar Prevention of Deep Hand Burn Patients with Skin Graft: A Prospective Randomized Controlled Trial and Systematic Review.

BACKGROUND: Burn injuries are burdensome to the public health system. Hypertrophic scars are the most common undesirable sequelae associated with burn scar contracture, resulting in reduced hand function. This study compared 2 different forms of silicone combined with pressure garment (PG) to determine the efficacy in hypertrophic scar prevention in hand burns. METHODS: A systematic review was also performed, including only randomized control trials with silicone materials in burned patients. A prospective intraindividual randomized controlled trial was conducted to compare the efficacy of 3 treatment groups: silicone gel and silicone gel sheet combined with PG versus PG alone. RESULTS: There were no significant differences in all Vancouver Scar Scale parameters. Three of 6 Patient and Observer Scar Assessment Score parameters showed significant differences among the 3 groups (P < 0.05). Scar stiffness improved at 8- and 12-weeks follow-up in both silicone gel and silicone gel sheet combined with PG; however, there was no significant difference between silicone groups. Scar thickness significantly improved at 2, 4, and 8 weeks in the silicone gel group compared with PG. Scar irregularity significantly improved at 2, 4, 8, 16, and 20 weeks in both silicone combined PG groups compared with PG alone. CONCLUSIONS: Silicone gel and silicone gel sheet combined with PG were more effective than PG alone in some aspects of the Patient and Observer Scar Assessment Score. However, there was no significant difference between the silicone gel and silicone gel sheet on the Vancouver Scar Scale.

Analysis of Factors Associated with Temporal Hollowing after Pterional Craniotomy.

Background Temporal hollowing is a common complication after pterional craniotomy. Etiologies of hollowing are still in debate and inconclusive. The objective of this study is to determine the etiology and predictive factors of temporal hollowing after pterional craniotomy. Methods A retrospective study of patients who underwent pterional craniotomy was conducted. Inclusion criteria included older than 18 years, having undergone unilateral pterional craniotomy, and with no craniofacial anomaly or temporal defect. Volumes of bone, temporalis muscle, and extratemporalis layer were calculated. Results A total of 51 patients were included. Bone volumes of surgical and nonsurgical sites were 219.12 + 23.02 cm 3 , and 228.39 + 22.76 cm 3 , respectively ( p = 0.04). Difference of bony volume was 9.10 cm 3 (3.99%). Volumes of temporalis muscle in surgical and nonsurgical sites were 12.86 + 3.95 cm 3 , and 18.10 + 6.08 cm 3 , respectively ( p < 0.005). Difference of muscle volume was 5.08 cm 3 (28.32%). Volume of extratemporalis soft tissue in surgical and nonsurgical sites were 11.99 + 5.70 cm 3 , and 17.31 + 7.76 cm 3 , respectively ( p < 0.005). Difference of soft tissue volume was 5.56 cm 3 (31.68%). No statistical significance of the difference of bony, muscle, and soft tissue volumes were found between causes of disease, operative time, and postoperative radiation. Conclusions Hollowing after pterional craniotomy is an unavoidable result. Bone, temporalis muscle, and soft tissues are combined etiologies. No predictive factors including age, sex, causes, operative time, radiation, and surgical technique are demonstrated. Volume of temporal area reduction was 19.74 cm 3 . Immediate reconstruction is recommended and volume of reconstruction is calculated from preoperative imaging.

Anorectal malformation with didelphys uterus: Extremely rare anomaly and successful neoanal sphincter reconstruction with gracilis muscle flap.

Anorectal malformation or imperforate anus is a congenital anomaly of rectum and anus. Mullerian duct anomalies are abnormal development of uterus, cervix, and vagina. Imperforate anus with double uterus is extremely rare and cannot explain by normal embryologic development. Moreover, guideline in treatment is inconclusive. We report an extremely rare case of a young adult female who presented with recurrent pelvic inflammatory disease caused by rectovaginal fistula in congenital imperforate anus and didelphys uterus, and successfully neoanal reconstruction with gracilis muscle flap. Aims for treatment are closed rectovaginal fistula, and anal sphincter reconstruction. To our best knowledge, the imperforate anus with double uterus is extremely rare anomaly. Furthermore, successfully anal sphincter reconstruction with functional gracilis muscle in the imperforate anus with double uterus has never been reported in English literature.

Osteoradionecrosis of the Chest Wall.

We present the case of a 48-year-old woman with a chronic ulcer with bony erosion over the right chest wall who had undergone adjuvant chemoradiotherapy for right breast cancer 18 years previously. Preoperative computed tomography revealed a large soft tissue ulcerative lesion with bony destruction of the anterolateral aspect of the right fifth and sixth ribs. Biopsy showed no evidence of recurrent malignancy. En bloc resection including the necrotic ulcer and partial resection of the fourth to sixth ribs was performed, resulting in a chest wall defect that exposed the right diaphragm and the right, middle, and lower lobes of the lung. Synthetic mesh was used to reconstruct the rib defect and prevent paradoxical respiration. A pedicle transverse rectus abdominis musculocutaneous flap was used for soft tissue and skin reconstruction.

Mammary adenoid cystic carcinoma presenting with Ductal carcinoma in situ and axillary lymph node metastasis.

Mammary adenoid cystic carcinoma (ACC) is extremely rare tumors, comprising <0.1% of all breast cancers. Moreover, lymph node metastasis is <2% of mammary ACC. Here, we report a case of 51-year-old female presented with painful mass on her left breast and left axillary lymph node enlargement. Core needle biopsy revealed invasive ductal carcinoma. Left lumpectomy and axillary lymph nodes dissections were performed. The final pathological report showed triple-negative mammary ACC arising with high grade ductal carcinoma in situ (DCIS) and axillary lymph node metastasis. Immunohistochemistry study is useful in confirming a diagnosis. Given the rarity of this cancer, natural history of disease is still not clearly understood. Complete surgical excision is the mainstay of treatment. To our best knowledge, mammary ACC presenting with DCIS and axillary lymph node metastasis has never been reported and should be considered in the differential diagnosis of breast cancers.

A Novel Immediate Nipple Reconstruction Technique in Oncoplastic Breast Surgery: Inverted Lotus Bud Flap.

Oncoplastic surgery is widely popular due to its ability to achieve curative tumor resection and symmetry of both breasts, and as a result of reduced psychological distress after mastectomy. Immediate nipple reconstruction was discussed and the gold standard procedure is inconclusive. Immediate nipple reconstruction with simultaneous breast reconstruction provides satisfactory esthetic results, compared with the delayed procedure. The "inverted lotus bud flap" was demonstrated as a new technique for immediate nipple reconstruction. The advantage of this technique is adequate nipple projection with minimization of scarring. In conclusion, oncoplastic breast surgery with immediate nipple reconstruction was demonstrated to be a safe and esthetically reliable procedure, leading to reduced psychological distress. This single-stage procedure promotes psychosocial well-being after breast cancer surgery. Immediate nipple reconstruction using the "inverted lotus bud flap" technique is versatile, reliable, and offers good esthetic results.

Atypical Lipomatous Tumor/Well-Differentiated Liposarcoma with Intramuscular Lipoma-Like Component of the Thigh.

Atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDLPS) is a locally aggressive mesenchymal neoplasm composed either entirely or partly of an adipocytic proliferation showing at least focal nuclear atypia in both adipocytes and stromal cells. ALT most frequently occurs in deep soft tissue of proximal extremities (thigh and buttock) and usually presents as a deep-seated, painless mass that can slowly attain a very large size, which is one of the most common sarcomas of extremity. In the patients who presented with deep-seated tumor, distinction between intramuscular lipoma and well-differentiated liposarcoma is important due to the differences in treatment and prognosis. However, atypical well-differentiated liposarcoma with intramuscular lipoma-like component of the thigh is extremely rare. Moreover, the infiltrative growth pattern or intramuscular component may lead to a misinterpretation as intramuscular lipoma on a small biopsy. We present an unusual case of a female who presented with symptomatic mass at the thigh which has rarely been reported in English literature as an infiltrative intramuscular lipoma-like growth pattern of well-differentiated liposarcoma. Therefore, preoperative diagnosis is necessary, and correlation with imaging studies is required when one encounters with a large deep-seated mass. Atypical lipomatous tumor or well-differentiated liposarcoma should be kept in mind in the patient who presents with abnormal thigh mass.

Anthropometry Analysis of Beautiful Upper Eyelids in Oriental: New Eyelid Crease Ratio and Clinical Application.

BACKGROUND: Beautiful upper eyelids can make one feel more attractive and confident. However, the definition of a beautiful upper eyelid in Orientals is still not defined. The aim of this study was to define the most beautiful upper eyelids in Orientals. METHODS: Participants, who met the inclusion criteria such as Asian ethnic, ages between 18 and 25 years, and double eyelid fold, were conducted. Double upper eyelids were classified into three groups, group A: most beautiful; group B: average; and group C: less beautiful upper eyelid, by plastic surgeons and beauty contestant winners. Eleven linear measurements and type of epicanthal fold were analyzed. RESULTS: A total of 153 participants were included, 66 were male and 87 were female. The mean ages were 21.45 years in males and 21.41 years in the female group. The vertical distances of the palpebral fissure, height of the double fold, height of the lid crease and height of the closed upper eyelid were found to be significantly different between the most, average and less beautiful upper eyelids in both males and females. The type 1 epicanthal fold was the most common in the most beautiful upper eyelid group. CONCLUSION: The most beautiful double upper eyelids in Orientals demonstrated a higher vertical palpebral fissure, double eyelid fold, and height of eyelid crease than the average and the less beautiful double upper eyelids. The ratio of height of lower margin of eyebrow to eyelid crease: Height of eyelid crease is 1.2:1 to create the beautiful double upper eyelids. However, preoperative consultation with realistic expectations is important. 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.

Perforator Flap Reconstruction for the Distal Third of Lower Extremity Defects: Clinical Application and Guideline Recommendation.

A distal third of lower extremity defect is challenging for plastic surgeons. The standard for treatment is microsurgery. Recently, perforator flap has been reported for small to medium defects. The objective was to analyze the outcomes of perforator flaps for distal third of lower extremity defects and to establish surgical guidelines. A retrospective review of patients with defects in distal third of lower extremities was conducted. Patients with multiple levels of lower extremity defects were excluded. A total of 8 patients with distal third of lower extremity defects were included. Seven patients were male. Overall mean age was 35.3 (18-60) years. Patients had 3 anterior, 3 lateral, and 2 medial defects. Lateral and anterior defects in 6 patients were closed using a peroneal-based propeller perforator flap with an angle of rotation of 90° to 160°. Medial defects in 2 patients were closed using a posterior tibial-based perforator advancement flap. Three patients (37.5%) developed venous congestion. No complications occurred for patients with medial defect closure using an advancement posterior tibial-based perforator flap. No total flap loss was observed. The perforator flap provides a similar texture to the skin at recipient area and a wide range of rotation. Perforator flaps should be the first choice for defects reconstruction in distal third lower extremities. Perforator flaps can be used for small to large defects, and can be moved by propeller or advancement depending on the perforator location. A guideline for perforator flaps reconstruction of the distal third of lower extremity defects was established.

Primary angiosarcoma of the breast presenting with a benign vascular skin-like lesion and expanding hematoma: a case report of an extremely rare tumor.

Primary breast angiosarcoma is an extremely rare tumor type (0.05% of primary breast cancers) for which diagnosis can be difficult. They arise within the breast parenchyma and typically present as a breast mass. Here, we present the case of a 30-year-old female with spontaneous hypervascular skin on her right breast with progressive enlargement presenting as an expanding hematoma. A chest computed tomography revealed a hypervascular mass in the right breast abutting the pectoralis muscle and cystic changes within the mass. A core needle biopsy revealed an angiosarcoma. In this case study, we report a patient who, with no history of any known risk factors, presented with a benign vascular skin lesion as the first sign of angiosarcoma followed by an expanding hematoma, which is an extremely rare manifestation of the disease. Microscopic examination demonstrated a low-grade angiosarcoma on the skin, while a high-grade angiosarcoma was found in the breast parenchyma.

What Is the Most Beautiful Facial Proportion in the 21st Century? Comparative Study among Miss Universe, Miss Universe Thailand, Neoclassical Canons, and Facial Golden Ratios.

BACKGROUND: An ideal facial proportion has been attempted since the ancient times. However, modern facial proportions of the most beautiful women in the 21st century are unavailable and have never been determined. METHODS: A retrospective review of the photographs of Miss Universe Thailand and Miss Universe from 2001 to 2015 was conducted. All photographs were searched from Internet websites. Twenty-six dominant points were identified. Comparisons of the facial proportion among Miss Universe Thailand, Miss Universe, neoclassical canons, and facial golden ratios were performed. RESULTS: Sixteen Miss Universe Thailand and 16 Miss Universe were included. Nine points of facial proportions were found to be statistically significant between Miss Universe Thailand and neoclassical canons. Miss Universe Thailand showed wider nasofrontal angle, thinner lower-upper lip height ratio, and less chin projection. Ten points of facial proportions were found to be statistically significant between Miss Universe and neoclassical canons. Miss Universe showed wider nasofrontal and nasofacial angle, more nasal tip projection, and thinner lower-upper lip height ratio. Seven points of facial analysis were found to be statistically significant between Miss Universe Thailand and Miss Universe groups. Of the 16 facial golden ratios, 12 demonstrated statistical significance in both the Miss Universe Thailand and Miss Universe groups. CONCLUSIONS: Modern facial proportions of beauty are different from the past. Photogrammetic analysis demonstrated longer forehead, thinner lower-upper lip height proportion, wider interala-medial canthus width proportion, and wider nasofrontal angle compared with previous references. Furthermore, facial golden ratios were statistically significantly invalid in modern facial proportions of beauty.

Topical Aloe Vera Gel for Accelerated Wound Healing of Split-Thickness Skin Graft Donor Sites: A Double-Blind, Randomized, Controlled Trial and Systematic Review.

BACKGROUND: Aloe vera has been used to treat wounds since ancient times. However, data regarding the efficacy of aloe vera for burns and split-thickness skin graft donor sites are inconclusive. METHODS: A double-blind, randomized, controlled trial was conducted. Patients who underwent split-thickness skin graft harvesting from the thigh were included. Split-thickness skin graft donor sites were divided into two groups: the aloe vera group and the placebo group. The visual analogue scale score was used to evaluate pain, and complete epithelialization was assessed. The authors searched electronic databases and included only international clinical trials published in the English language. RESULTS: Twelve patients with 24 donor sites participated. Times to complete epithelization for the aloe vera and placebo groups were 11.5 ± 1.45 and 13.67 ± 1.61 days, respectively (p < 0.05). Visual analogue scale scores after wound dressing for the aloe vera and placebo groups were 17.18 ± 13.17 and 18.63 ± 11.20, respectively. No statistical significance was found between groups. Five articles met the inclusion criteria: four involved burns and one involved split-thickness skin graft donor sites. Three studies of burn wounds demonstrated improved epithelization and one did not. The split-thickness skin graft donor-site study indicated that wound healing time for the control group was significantly different from that of the aloe vera and placebo groups. The healing rate was not statistically different between groups. CONCLUSION: Topical aloe vera gel significantly demonstrated accelerated split-thickness skin graft donor-site healing but did not show significant pain relief. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

An Unusual Presentation of Idiopathic Lymphatic Cyst of the Thigh.

Lymphatic cyst is a collection of lymphatic fluid with an epithelial lining which can either represent lymphatic malformations or may occur after trauma or operation. Idiopathic lymphatic cyst of the thigh in adulthood is extremely rare. We report a case of a 27-year-old Thai female presented with a rapidly growing mass over her right thigh. The magnetic resonance imaging scan demonstrated a well-defined, thin rim, enhancing simple cyst. The cyst disappeared for a few days after aspiration. Completed surgical resection was performed for definitive diagnosis and treatment. Immunohistochemical studies revealed the cell lining was positive for CD34, CD31, and D2-40 and negative for calretinin. To our best knowledge, idiopathic lymphatic cyst of the thigh in young adult has never been reported and should be kept in mind in the patient who presents with abnormal thigh mass.

Efficacy of Botulinum Toxin A in Preventing Recurrence Keloids: Double Blinded Randomized Controlled Trial Study: Intraindividual Subject.

Background: Keloids have been one of the most concerning problems in cosmetic surgery. Current treatments still provide unpredictable outcomes. Interestingly, one molecular study of Botulinum Toxin A (BTXA) has found the inhibitive effect of fibroblast growth factor (TGF-ß), which explain the mechanism of keloid formation. Objective: To study the efficacy of BTXA in preventing keloids formation for clinical use. Material and Method: Prospective randomized controlled trial study was conducted on 25 patients between March 2014 and June 2015. Fifty keloids from 25 patients were equally randomized into two groups, control and toxin group. After the scar excision, the control group was injected with corticotherapy, while the toxin group was injected with BTXA. The outcomes were assessed and evaluated using Vancouver Scar Scale (VSS) by two plastic surgeons. The VSS was compared between pre- and post-operative period. Follow-up protocols were made in both groups at 1-, 3-, and 6-month after surgery. Results: According to the first and third-month follow-up, the outcome in toxin group was more favorable than the control group (6.22±1.72 vs. 5.89±1.83, p = 0.347), whereas the outcome in control group was more favorable than the toxin group in the sixth month follow-up (5.33±1.87 vs. 4.11±1.96, p = 0.010). Conclusion: BTXA is not significantly better in preventing recurrence keloids when compared to corticotherapy after one and three months. However, Corticotherapy provides a significantly better outcome than BTXA at 6-month follow-up.

A Topical Anesthetic and Lidocaine Mixture for Pain Relief During Keloid Treatment: A Double-Blind, Randomized Controlled Trial.

BACKGROUND: Keloids are abnormal overgrowth of collagen fibers, and the first-line treatment includes intralesional injection of triamcinolone acetonide (TA), which is associated with pain. OBJECTIVE: To study the benefit of applying topical anesthetics or a 1:1 mixture of 1% lidocaine and TA at the TA injection site to alleviate pain during keloid treatment. METHODS AND MATERIALS: A double-blind, randomized controlled trial was conducted. Four TA injection methods were tested: control, lidocaine, topical, and combined. A visual analog scale (VAS) was used to assess needle-stick and injection pain. Data on pain duration after injection were also collected. RESULTS: Forty patients were enrolled (mean age, 37.1 years). The VAS scores of needle-stick pain in the control, lidocaine, topical, and combined groups were 4.18 ± 2.12, 3.82 ± 2.48, 2.03 ± 2.02, and 2.20 ± 1.99, respectively. Pain statistically decreased in the topical and combined groups. Intralesional injection pain (VAS) scores in the control, lidocaine, topical, and combined groups were similar as follows: 4.97 ± 2.50, 4.97 ± 2.79, 4.10 ± 2.80, and 4.43 ± 2.68, respectively. CONCLUSION: Application of topical anesthetics significantly relieved needle-stick pain, especially at sternum and auricular keloids; administration of a lidocaine mixture did not alleviate pain during injection.