Comparison of Enalapril, Candesartan and Intralesional Triamcinolone in Reducing Hypertrophic Scar Development: An Experimental Study.

BACKGROUND: The purpose of this study was to compare the effects of oral enalapril, an angiotensin-converting enzyme inhibitor (ACE-I), oral candesartan, an angiotensin receptor blocker (ARB), and intralesional corticosteroid treatments in reducing scar formation. METHODS: Twenty male rabbits were divided into five study groups: A (sham), B (control), C (ACE-I), D (ARB) and E (intralesional corticosteroid). The rabbit ear hypertrophic scar model was used. The hypertrophic scars were photographed and analyzed with the program ImageJ quantitatively to determine the degree of collagen fibers. The scar elevation index (SEI) was calculated at the end of the 40th day. Tissue samples were stained with hematoxylin and eosin and Masson's trichrome and examined under light microscopy for the determination of fibroblast number, epithelization, vascularization, inflammation and fibrosis. RESULTS: The SEI was the highest in the control group with the highest number of fibroblasts under the epithelium. In the steroid group, the SEI was significantly lower than both the ACE-I (p: 0.02) and ARB (p: 0.001) groups. The density of type 1 collagen fibers was the lowest in the control group, whereas type 3 collagen fibers were highest in that group. The ACE-I and ARB groups were similar regarding densities of type 1 and type 3 collagen fibers. The density of type 1 collagen fibers was the highest in the steroid group, whereas the density of type 3 collagen fibers was the lowest in that group. CONCLUSIONS: Enalapril, candesartan and intralesional steroid therapies were all effective in reducing scar tissue development; however, enalapril and steroid groups revealed better results. NO LEVEL ASSIGNED: 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 .

Inferior Pedicle Reduction Mammoplasty with or without Tourniquet: A Comparative Study.

OBJECTIVE: To compare the perioperative findings of inferior pedicle reduction mammoplasty (IPRM) performed with or without a tourniquet. METHODS: This study was carried out in the plastic and reconstructive surgery department at a tertiary care center on a total of 42 consecutive women scheduled for IPRM. Patients in Group I (n = 21) underwent surgery using a tourniquet, whereas patients in Group II (n = 21) were operated on without a tourniquet. Levels of hemoglobin (Hb), hematocrit (Hct), Hct/Hb ratio, and platelet counts were noted preoperatively and on postoperative 24th and 48th h. Numbers of surgical pads and gauze sponges completely used and dripping with blood were recorded. Duration of operation, the amount of breast tissue excised on both sides, and fluid collected in hemovac drains on 48th h after operation were documented. RESULTS: In Group I, the operative time was significantly shorter (p < 0.001), and numbers of gauze sponges and surgical pads were fewer (p < 0.001 for both). Hemoglobin levels were significantly higher in Group I on postoperative 24th (p = 0.002) and 48th h (p = 0.007). Similarly, hematocrit levels in Group I were higher than those of Group II on postoperative 24th (p = 0.004) and 48th h (p = 0.009). CONCLUSION: We determined that use of a tourniquet significantly reduced the operative time and blood loss during IPRM. Therefore, our preliminary results support that tourniquet usage is practical and safe, and it may also improve the cost-effectiveness of the procedure. LEVEL OF EVIDENCE III: 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 .