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1.
J Pak Med Assoc ; 74(6): 1104-1108, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38948980

RESUMO

Objective: To assess functional and aesthetic outcomes in patients having undergone dorsal nasal augmentation with costochondral graft in a tertiary care setting. METHODS: The single-centre, retrospective, observational study was conducted at Shifa International Hospital, Islamabad, Pakistan, and comprised data of patients who underwent dorsal nasal augmentation using costochondral graft between January 1, 2018, and December 31, 2022. Aesthetic outcomes in terms of patient satisfaction were assessed using Facial Appearance, Health-related Quality of Life and Adverse Effects scores. Data was analysed using SPSS 26. RESULTS: Of the 46 patients, 28(61%) were males and 18(39%) were females. The overall mean age was 28.39±9.13 years. Dorsal nasal deficiency occurred secondary to congenital causes in 12(26.1%) patients, trauma 19(41.3%) and prior surgery 15(32.6%). Postoperative complication rate was 7(15%); 3(6.5%) had recipient site infection and 2(4.3%) had rib graft resorption. Besides, 1(2.2%) patient reported pain 2 months postoperatively and 1(2.2%) had hypertrophic scarring. Patient satisfaction with the outcome was noted in all the 10 parameters analysed. Most commonly reported problem was that the nose was 'looking thick/swollen' by 12(26.1%) patients, but the issue resolved during 1-year follow-up. Conclusion: Costochondral graft was found to be an ideal material for dorsal nasal augmentation, with high patient satisfaction rate.


Assuntos
Satisfação do Paciente , Rinoplastia , Humanos , Feminino , Masculino , Adulto , Rinoplastia/métodos , Estudos Retrospectivos , Adulto Jovem , Adolescente , Complicações Pós-Operatórias/epidemiologia , Estética , Qualidade de Vida , Nariz/cirurgia , Resultado do Tratamento , Cartilagem Costal/transplante , Cicatriz Hipertrófica/etiologia , Cicatriz Hipertrófica/epidemiologia , Dor Pós-Operatória/epidemiologia
3.
Burns ; 50(6): 1355-1371, 2024 08.
Artigo em Inglês | MEDLINE | ID: mdl-38570250

RESUMO

INTRODUCTION: Ethnic minorities experience disparities in prevention and treatment of burn injury. Research focused on burn injuries in Indigenous populations is limited. This review summarizes literature on burn injuries in Indigenous populations to be considered to inform new research. METHODS: A search was conducted in CINAHL, Ovid MEDLINE, PSYCinfo and SocINDEX. for "burn OR scars OR scald OR deformity OR disfigurement" and "Aboriginal OR Indigenous OR First Nation OR American Indian OR Maori OR Native OR Torres Strait Islander OR Amerindian OR Inuit OR Metis OR Pacific Islander". Inclusion 1) peer reviewed studies of burns in Indigenous persons 2) in English. Exclusion 1) no data specific to Indigenous burns 2) not peer reviewed 3) not in full text 4) protocol publications. RESULTS: The search identified 1091 studies with 51 for review. Sixteen were excluded. The 35 included publications were published between 1987 and 2022. Findings indicated higher incidence of injury and poorer outcomes amongst Indigenous people. Indigenous people suffered more flame and inhalation burns, had longer lengths of stay, and more complications including hypertrophic scarring. Australian Indigenous patients struggle with a lack of culturally safe communication and support for aftercare. CONCLUSION: Racial disparities exist in burn injury incidence and outcome for Indigenous persons. Qualitative research in this area will help providers better understand the experiences of Indigenous burn patients to develop more culturally competent care. We are currently developing a study using qualitative hermeneutic methodology to learn about the experiences of Indigenous burn survivors' injuries, recovery, and social reintegration.


Assuntos
Queimaduras , Humanos , Queimaduras/etnologia , Queimaduras/epidemiologia , Austrália/epidemiologia , Cicatriz Hipertrófica/etnologia , Cicatriz Hipertrófica/epidemiologia , Cicatriz Hipertrófica/etiologia , Povos Indígenas , Havaiano Nativo ou Outro Ilhéu do Pacífico/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Incidência , Tempo de Internação/estatística & dados numéricos , Indígenas Norte-Americanos
4.
Yonsei Med J ; 64(11): 687-691, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37880850

RESUMO

PURPOSE: This study aimed to identify the risk factors associated with the occurrence and prognosis of hypertrophic scarring following thyroidectomy. MATERIALS AND METHODS: A total of 4238 patients who underwent thyroidectomy were included in this study. A multivariable logistic regression model was developed to identify the risk factors for hypertrophic scar development and its prognosis. RESULTS: Our analysis revealed that hypertrophic scar development was associated with younger age [odds ratio (OR)=0.949, p<0.0001], male sex (OR=0.562, p<0.0001), higher body mass index (OR=1.137, p<0.0001), prominent sternocleidomastoid muscles (OR=2.522, p<0.0001), scarring located within 1 cm of the sternal notch (OR=4.345, p<0.0001), and a history of keloid development (OR=2.789, p=0.0031). Additionally, scar location within 1 cm of the sternal notch (beta=4.326, p=0.0429) and a history of keloid development (beta=23.082, p<0.0001) were found to be associated with the prognosis of hypertrophic scarring. CONCLUSION: The findings of this study provide valuable insights into the risk factors associated with hypertrophic scarring following thyroidectomy. Clinicians can use this information to predict the occurrence of hypertrophic scarring and its prognosis, and take preventative measures accordingly.


Assuntos
Cicatriz Hipertrófica , Queloide , Humanos , Masculino , Índice de Massa Corporal , Cicatriz Hipertrófica/epidemiologia , Cicatriz Hipertrófica/etiologia , Cicatriz Hipertrófica/patologia , Queloide/complicações , Queloide/patologia , Prognóstico , Fatores de Risco , Feminino
5.
F S Sci ; 4(2): 172-180, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-37028513

RESUMO

OBJECTIVE: To examine the association between keloids, hypertrophic scars, and uterine fibroid incidence as well as growth. Both keloids and fibroids are fibroproliferative conditions that have been reported to be more prevalent among Blacks than Whites, and they share similar fibrotic tissue structures, including extracellular matrix composition, gene expression, and protein profiles. We hypothesized that women with a history of keloids would have greater uterine fibroid development. DESIGN: A prospective community cohort study (enrollment 2010-2012) with 4 study visits over 5 years to conduct standardized ultrasounds to detect and measure fibroids ≥0.5 cm in diameter, assess the history of keloid and hypertrophic scars, and update covariates. SETTING: Detroit, Michigan area. PATIENTS: A total of 1,610 self-identified Black and/or African American women aged 23-35 years at enrollment without a previous clinical diagnosis of fibroids. EXPOSURE(S): Keloids (raised scars that grow beyond the margins of the original injury) and hypertrophic scars (raised scars that stay within the bounds of the original injury). Because of the difficulties in distinguishing keloids and hypertrophic scars, we separately examined the history of keloids and the history of either keloids or hypertrophic scars (any abnormal scarring) and their associations with fibroid incidence and growth. MAIN OUTCOME MEASURE(S): Fibroid incidence (new fibroid after a fibroid-free ultrasound at enrollment) was assessed using Cox proportional-hazards regression. Fibroid growth was assessed using linear mixed models. The estimates for the change in log volume per 18 months were converted to the estimated percentage difference in volume for scarring vs. no-scarring. Both incidence and growth models were adjusted for time-varying demographic, reproductive, and anthropometric factors. RESULT(S): Of the 1,230 fibroid-free participants, 199 (16%) reported ever having keloids, 578 (47%) reported keloids or hypertrophic scars, and 293 (24%) developed incident fibroids. Neither keloids (adjusted hazard ratio = 1.04; 95% confidence interval: 0.77, 1.40) nor any abnormal scarring (adjusted hazard ratio = 1.10; 95% confidence interval: 0.88, 1.38) were associated with fibroid incidence. Fibroid growth differed little by scarring status. CONCLUSION(S): Despite molecular similarities, self-reported keloid and hypertrophic scars did not show an association with fibroid development. Future research may benefit from the examination of dermatologist-confirmed keloids or hypertrophic scars; however, our data suggest little shared susceptibility for these 2 types of fibrotic conditions.


Assuntos
Cicatriz Hipertrófica , Queloide , Leiomioma , Feminino , Humanos , Negro ou Afro-Americano , Cicatriz Hipertrófica/diagnóstico por imagem , Cicatriz Hipertrófica/epidemiologia , Cicatriz Hipertrófica/etiologia , Estudos de Coortes , Queloide/diagnóstico por imagem , Queloide/epidemiologia , Queloide/complicações , Leiomioma/diagnóstico por imagem , Leiomioma/epidemiologia , Estudos Prospectivos , Adulto Jovem , Adulto
6.
JAMA Dermatol ; 159(2): 172-181, 2023 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-36598763

RESUMO

Importance: Keloids and hypertrophic scars (excessive scarring) are relatively understudied disfiguring chronic skin conditions with high treatment resistance. Objective: To evaluate established comorbidities of excessive scarring in European individuals, with comparisons across ethnic groups, and to identify novel comorbidities via a phenome-wide association study (PheWAS). Design, Setting, and Participants: This multicenter cross-sectional population-based cohort study used UK Biobank (UKB) data and fitted logistic regression models for testing associations between excessive scarring and a variety of outcomes, including previously studied comorbidities and 1518 systematically defined disease categories. Additional modeling was performed within subgroups of participants defined by self-reported ethnicity (as defined in UK Biobank). Of 502 701 UKB participants, analyses were restricted to 230078 individuals with linked primary care records. Exposures: Keloid or hypertrophic scar diagnoses. Main Outcomes and Measures: Previously studied disease associations (hypertension, uterine leiomyoma, vitamin D deficiency, atopic eczema) and phenotypes defined in the PheWAS Catalog. Results: Of the 972 people with excessive scarring, there was a higher proportion of female participants compared with the 229 106 controls (65% vs 55%) and a lower proportion of White ethnicity (86% vs 95%); mean (SD) age of the total cohort was 64 (8) years. Associations were identified with hypertension and atopic eczema in models accounting for age, sex, and ethnicity, and the association with atopic eczema (odds ratio [OR], 1.68; 95% CI, 1.36-2.07; P < .001) remained statistically significant after accounting for additional potential confounders. Fully adjusted analyses within ethnic groups revealed associations with hypertension in Black participants (OR, 2.05; 95% CI, 1.13-3.72; P = .02) and with vitamin D deficiency in Asian participants (OR, 2.24; 95% CI, 1.26-3.97; P = .006). The association with uterine leiomyoma was borderline significant in Black women (OR, 1.93; 95% CI, 1.00-3.71; P = .05), whereas the association with atopic eczema was significant in White participants (OR, 1.68; 95% CI, 1.34-2.12; P < .001) and showed a similar trend in Asian (OR, 2.17; 95% CI, 1.01-4.67; P = .048) and Black participants (OR, 1.89; 95% CI, 0.83-4.28; P = .13). The PheWAS identified 110 significant associations across disease systems; of the nondermatological, musculoskeletal disease and pain symptoms were prominent. Conclusions and Relevance: This cross-sectional study validated comorbidities of excessive scarring in UKB with comprehensive coverage of health outcomes. It also documented additional phenome-wide associations that will serve as a reference for future studies to investigate common underlying pathophysiologic mechanisms.


Assuntos
Cicatriz Hipertrófica , Dermatite Atópica , Hipertensão , Queloide , Leiomioma , Humanos , Feminino , Queloide/epidemiologia , Cicatriz Hipertrófica/epidemiologia , Estudos Transversais , Estudos de Coortes , Bancos de Espécimes Biológicos , Hipertensão/epidemiologia , Reino Unido/epidemiologia
7.
Plast Reconstr Surg ; 150(3): 659-669, 2022 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-35787599

RESUMO

BACKGROUND: Surgery is a well-known trigger of keloid and hypertrophic scarring. Sternotomy scars are subject to high skin tension, which is known to promote pathologic scarring. This suggests that sternotomies in adults are associated with high pathologic scarring rates, which aligns with the authors' anecdotal experience. However, this notion has never been examined formally. Therefore, the authors conducted a survey-based cohort study of patients who had undergone a sternotomy. METHODS: All consecutive Japanese adults (18 years of age or older) who underwent cardiovascular surgery with sternotomy in 2014 to 2017 were identified in 2019 by chart review and sent a questionnaire. Respondents formed the study cohort. The questionnaire presented randomly ordered photographs of representative mature, keloid, and hypertrophic scars and asked the patients to choose the image that best resembled their midline scar when it was particularly noticeable. The incidence of self-reported pathologic scarring (keloids and hypertrophic scars were grouped together) and the patient demographic (age and sex) and clinical characteristics (intima-media thickness of the left and right common and internal carotid arteries) that were associated with pathologic scarring were determined. RESULTS: Of the 548 patients who underwent sternotomy, 328 responded for a 60 percent response rate. The mean patient age was 67 years, and 68.0 percent were male. Of these patients, 195 (59.5 percent) reported they had a pathologic scar. Compared with patients who had a mature scar, patients who had a pathologic scar had younger mean age (65 versus 69 years; p = 0.0002) and lower intima-media thickness (0.92 versus 1.05 mm; p = 0.028). CONCLUSIONS: Sternotomy was associated with a high rate of pathologic scarring. Older age and arteriosclerosis were associated with less pathologic scarring. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Arteriosclerose , Cicatriz Hipertrófica , Queloide , Ferida Cirúrgica , Adolescente , Adulto , Idoso , Arteriosclerose/complicações , Espessura Intima-Media Carotídea , Cicatriz Hipertrófica/epidemiologia , Cicatriz Hipertrófica/etiologia , Estudos de Coortes , Feminino , Humanos , Queloide/epidemiologia , Queloide/etiologia , Queloide/cirurgia , Masculino , Ferida Cirúrgica/complicações , Inquéritos e Questionários
8.
Plast Reconstr Surg ; 149(1): 79e-94e, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34813576

RESUMO

BACKGROUND: In 2010, this Journal published my comprehensive review of the literature on hypertrophic scars and keloids. In that article, I presented evidence-based algorithms for the prevention and treatment of these refractory pathologic scars. In the ensuing decade, substantial progress has been made in the field, including many new randomized controlled trials. To reflect this, I have updated my review. METHODS: All studies were evaluated for methodologic quality. Baseline characteristics of patients were extracted along with the interventions and their outcomes. Systematic reviews, meta-analyses, and comprehensive reviews were included if available. RESULTS: Risk factors that promote hypertrophic scar and keloid growth include local factors (tension on the wound/scar), systemic factors (e.g., hypertension), genetic factors (e.g., single-nucleotide polymorphisms), and lifestyle factors. Treatment of hypertrophic scars depends on scar contracture severity: if severe, surgery is the first choice. If not, conservative therapies are indicated. Keloid treatment depends on whether they are small and single or large and multiple. Small and single keloids can be treated radically by surgery with adjuvant therapy (e.g., radiotherapy) or multimodal conservative therapy. For large and multiple keloids, volume- and number-reducing surgery is a choice. Regardless of the treatment(s), patients should be followed up over the long term. Conservative therapies, including gel sheets, tape fixation, topical and injected external agents, oral agents, and makeup therapy, should be administered on a case-by-case basis. CONCLUSIONS: Randomized controlled trials on pathologic scar management have increased markedly over the past decade. Although these studies suffer from various limitations, they have greatly improved hypertrophic scar and keloid management. Future high-quality trials are likely to improve the current hypertrophic scar and keloid treatment algorithms further.


Assuntos
Cicatriz Hipertrófica/terapia , Procedimentos Clínicos , Queloide/terapia , Complicações Pós-Operatórias/terapia , Ferida Cirúrgica/complicações , Assistência ao Convalescente/métodos , Cicatriz Hipertrófica/diagnóstico , Cicatriz Hipertrófica/epidemiologia , Cicatriz Hipertrófica/etiologia , Terapia Combinada/métodos , Humanos , Queloide/diagnóstico , Queloide/epidemiologia , Queloide/etiologia , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Risco , Índice de Gravidade de Doença , Ferida Cirúrgica/terapia , Cicatrização
9.
Plast Reconstr Surg ; 148(4): 850-860, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34550942

RESUMO

BACKGROUND: In ear reconstruction, the difficulty lies in reestablishing the ear's bionic form with adequate skin coverage and an appropriate framework. Skin expansion and a porous polyethylene (i.e., Medpor) framework are often used for ear reconstruction. However, a long-term review of the combined application of the expanded skin and Medpor framework has not been reported. This article reviews ear reconstruction combining these two factors over the past 20 years in the authors' center to summarize the surgical technique and analyze the postoperative results and complications. METHODS: A retrospective review was performed that included all patients who underwent ear reconstruction with expanded skin and Medpor framework in the authors' center between 1998 and 2018. RESULTS: A total of 68 patients with microtia who were admitted to the authors' center for surgical ear reconstruction were included, and 70 ears were reconstructed. Fifty-seven of the patients (83.82 percent) felt satisfied with their reconstructed ear, five patients (7.35 percent) were not satisfied with the reconstructed ear, and six patients (8.82 percent) had the frameworks removed. Fifteen patients (22.06 percent) developed complications, including framework exposure (13.24 percent), infection (4.41 percent), scar hypertrophy (4.41 percent), and hematoma (2.94 percent). CONCLUSIONS: Framework exposure limits the combined application of expanded skin flap and Medpor framework when reconstructing the ear without additional fascial interposition. Using a temporoparietal fascia or postauricular fascia flap during the operation is effective to decrease the exposure rate; however, this complication cannot be completely avoided. Using postauricular fascia and skin graft may lead to scar hypertrophy; thus, these techniques should be used with caution. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.


Assuntos
Cicatriz Hipertrófica/epidemiologia , Microtia Congênita/cirurgia , Complicações Pós-Operatórias/epidemiologia , Retalhos Cirúrgicos/transplante , Expansão de Tecido/métodos , Adolescente , Criança , Pré-Escolar , Cicatriz Hipertrófica/etiologia , Cicatriz Hipertrófica/prevenção & controle , Pavilhão Auricular/anormalidades , Pavilhão Auricular/cirurgia , Estética , Feminino , Seguimentos , Humanos , Masculino , Polietilenos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Retalhos Cirúrgicos/efeitos adversos , Expansão de Tecido/efeitos adversos , Expansão de Tecido/instrumentação , Dispositivos para Expansão de Tecidos/efeitos adversos , Resultado do Tratamento , Adulto Jovem
10.
Adv Skin Wound Care ; 34(10): 1-6, 2021 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-34546207

RESUMO

OBJECTIVE: To identify the risk factors of hypertrophic scarring (HS) after thyroidectomy and construct a risk prediction model. METHODS: From November 2018 to March 2019, the clinical data of patients undergoing thyroidectomy were collected for retrospective analysis. According to the occurrence of HS, the patients were divided into an HS group and a non-HS group. Univariate analysis and binary logistic regression analysis were conducted to explore the independent risk factors for HS. Receiver operating characteristic analysis was also carried out. RESULTS: In this sample, 121 of 385 patients developed HS, an incidence of 31.4%. Univariate analysis showed significant differences in sex, age, postoperative infection, history of abnormal wound healing, history of pathologic scar, family history of pathologic scar, and scar prevention measures between the two groups (P < .05). Binary logistic regression analysis indicated that age 45 years or younger (odds ratio [OR], 1.815), history of abnormal wound healing (OR, 4.247), history of pathologic scarring (OR, 9.840), family history of pathologic scarring (OR, 5.708), and absence of preventive scar measures (OR, 5.566) were independent factors for HS after thyroidectomy. The area under the receiver operating characteristic curve was 0.837. When the optimal diagnostic cutoff value was 0.206, the sensitivity was 0.661, and the specificity was 0.932. CONCLUSIONS: The development of HS after thyroidectomy is related to many factors, and the proposed risk prediction model based on the combined risk factors shows a good predictive value for postoperative HS. When researchers consider the prevention and treatment of scarring in patients at risk, the incidence of HS in different populations can provide theoretical support for clinical decision-making.


Assuntos
Cicatriz Hipertrófica/etiologia , Tireoidectomia/efeitos adversos , Adolescente , Adulto , Idoso , Área Sob a Curva , China/epidemiologia , Cicatriz Hipertrófica/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Estudos Retrospectivos , Fatores de Risco , Tireoidectomia/normas , Tireoidectomia/estatística & dados numéricos
11.
Dermatol Surg ; 47(10): 1347-1351, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34334617

RESUMO

BACKGROUND: Acne scarring can be divided into 2 types: atrophic and hypertrophic scars. Papular acne scars are commonly encountered, skin-colored papules on the chin and back. OBJECTIVE: This study aimed to estimate the prevalence of each acne scar type and to investigate the clinical manifestations of papular acne scars. METHODS: This retrospective study included 416 patients with acne scars. Dermatologists classified the scars into 3 types (atrophic, papular, and keloid type) based on clinical photographs and analyzed the clinical and histologic features of papular acne scars. RESULTS: Among 416 patients with acne scars, 410 patients (98.56%) had atrophic scars, 53 patients (12.74%) had keloid scars, and 46 patients (11.06%) had papular acne scars. Twenty patients (4.81%) had both papular and keloid acne scars. Histologic analysis showed fibrotic tissue in both keloid and papular acne scars. Fibrosis of the papular scar was limited to the upper dermis. CONCLUSION: Papular acne scars were significantly more prevalent in patients with keloid scars than in those without keloid scars. These results provide a basis for understanding papular acne scars, which have been under-recognized. The association between papular and keloid acne scars can suggest the decision for scar treatment.


Assuntos
Acne Queloide/epidemiologia , Acne Vulgar/complicações , Cicatriz Hipertrófica/epidemiologia , Acne Queloide/diagnóstico , Acne Queloide/patologia , Acne Vulgar/patologia , Adolescente , Adulto , Cicatriz Hipertrófica/diagnóstico , Cicatriz Hipertrófica/etiologia , Cicatriz Hipertrófica/patologia , Feminino , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Pele/diagnóstico por imagem , Pele/patologia , Adulto Jovem
12.
J Obstet Gynaecol ; 41(3): 380-384, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33632049

RESUMO

This study aimed to investigate the side effects of silicone gel sheet (Lady Care®) and evaluate its prophylactic efficacy in preventing abnormal scarring. Sixty women who underwent caesarean section were recruited from September 2016 to September 2017 in this prospective study. Lady Care® was applied from the 2nd to the 6th postoperative months. Side effects of Lady Care® were evaluated through medical examinations and questionnaires. A plastic surgeon diagnosed abnormal scarring. Pruritus was diagnosed in 25 (47.2%) patients; folliculitis, four (7.5%); dry skin, four (7.5%); contact dermatitis, three (5.7%); wound infection, two (3.8%); and epidermolysis, one (1.9%), albeit with mild severity. Following Lady Care® application, no abnormal scarring and mild hypertrophic scarring was observed in 32 (64.0%) and 18 (36.0%) patients respectively. Of seven patients with pre-existing hypertrophic scars, only two showed hypertrophic scarring after Lady Care® application. Our findings support the safety and prophylactic efficacy of Lady Care®.Impact StatementWhat is already known on this subject? The incidence of abnormal scarring, i.e. keloid or hypertrophic scar formation after caesarean section (CS) is reported to be ∼41%. Abnormal or excessive scar formation can lead to functional limitations, pruritus, pain and cosmetic issues. Studies have also shown a prophylactic effect of the application of silicone materials against the development of hypertrophic and keloid scars, though prohibitive cost and lack of adhesiveness of such gel sheets are known factors limiting their usage.What the results of this study add? The new silicone gel sheet 'Lady Care®' has strong adhesive properties and is consequently not easily peeled off. Furthermore, it is easy to use and economically efficient.What the implications are of these findings for clinical practice and/or further research? This is the first clinical trial on the application of Lady Care® silicone gel sheet for the prevention of CS scarring. Our findings support the safety and prophylactic efficacy of Lady Care®.


Assuntos
Cesárea/efeitos adversos , Cicatriz Hipertrófica/prevenção & controle , Queloide/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Géis de Silicone/administração & dosagem , Adulto , Cicatriz Hipertrófica/epidemiologia , Cicatriz Hipertrófica/etiologia , Feminino , Humanos , Incidência , Queloide/epidemiologia , Queloide/etiologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Gravidez , Resultado do Tratamento
13.
Asian J Surg ; 44(1): 169-173, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32513633

RESUMO

OBJECTIVE: In the conventional Charles' procedure for lower-limb lymphedema, full-thickness skin grafts (FTSGs) or flaps are the preferred treatment for areas around the knee and ankle because of the belief that FTSGs or flaps result in slighter contracture relative to split-thickness skin grafts (STSGs). However, the use of FTSGs or flaps prolongs operation and increases the risk of partial graft loss; should partial graft loss occur, additional grafting is required for remnant defects to avoid significant scarring after secondary healing. The senior author (HCC) thus modified the Charles' procedure and used STSGs around the knee and ankle. The aim of this study was to elucidate the long-term outcomes of STSGs in HCC-modified Charles' procedure, including its attendant complications, such as joint contracture, range-of-motion limitations, and the presence of hypertrophic scars. METHODS: Participants were patients (n = 142) who underwent HCC-modified Charles' procedure and STSGs between 1990 and 2016 for advanced lymphedema; the follow-up was at least 3 years. We detail our modification for improving the take of STSGs in the first operation and the rehabilitation protocol. RESULTS: The active flexion of knee was >90° in 89.4% and 70°-90° in 10.6% of patients. The active plantar flexion of ankle was 30° in 90.8% and 20°-30° in 9.2% of patients. In Stiefel Grading System, 85.9% were "Excellent," 12.0% were "Good," 2.1% were "Fair," and 0 were "Poor." CONCLUSION: STSGs in HCC-modified Charles' procedure yield satisfactory outcomes without joint contracture. Early physiotherapy and the primary take of STSGs are crucial to good functional outcomes.


Assuntos
Articulação do Tornozelo/cirurgia , Articulação do Joelho/cirurgia , Linfedema/cirurgia , Transplante de Pele/métodos , Adolescente , Adulto , Idoso , Cicatriz Hipertrófica/epidemiologia , Cicatriz Hipertrófica/etiologia , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Linfedema/fisiopatologia , Linfedema/reabilitação , Masculino , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Transplante de Pele/efeitos adversos , Retalhos Cirúrgicos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
15.
Burns ; 46(5): 993-1004, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31813620

RESUMO

In low- and lower middle-income countries (LMICs), timely access to primary care following thermal injury is challenging. Children with deep burns often fail to receive specialized burn care until months or years post-injury, thus suffering impairments from hypertrophic scarring or joint and soft tissue contractures. We aimed to examine the correlation between limited access to care following burn injury and long-term disability in children in LMICs and to identify specific factors affecting the occurrence of late burn complications. A systematic literature search was conducted to retrieve articles on pediatric burns in LMICs using Medline, Embase, the Cochrane Library, LILACS, Global Health, African Index Medicus, and others. Articles were assessed by two reviewers and reported in accordance with PRISMA guidelines. Of 2896 articles initially identified, 103 underwent full-text review and 14 met inclusion criteria. A total of 991 children who developed long-term burn sequelae were included. Time from injury to consultation ranged from a few months to 17 years. Factors associated with late complications included total body surface area burned, burn depth, low socio-economic status, limited infrastructure, perceived inability to pay, lack of awareness of surgical treatment, low level of maternal education, and time elapsed between burn injury and reconstructive surgery.


Assuntos
Queimaduras/cirurgia , Contratura/epidemiologia , Escolaridade , Acessibilidade aos Serviços de Saúde , Procedimentos de Cirurgia Plástica/estatística & dados numéricos , Classe Social , Tempo para o Tratamento/estatística & dados numéricos , Superfície Corporal , Queimaduras/complicações , Queimaduras/patologia , Criança , Cicatriz Hipertrófica/epidemiologia , Cicatriz Hipertrófica/etiologia , Contratura/etiologia , Países em Desenvolvimento , Custos de Cuidados de Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Fatores de Risco , Índices de Gravidade do Trauma
16.
Mol Biol Rep ; 47(1): 201-209, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31612410

RESUMO

Circular RNA (circRNA), a novel type of non-coding RNA that consists of a circular loop, has been demonstrated to act as a "sponge" for microRNAs (miRNAs). However, the role of circRNAs in keloid remains unknown. In this study, we investigated circRNA expression profiles in keloid to identify potential diagnostic and therapeutic circRNAs. We performed a circRNA microarray assay to determine circRNA expression in keloid and paired normal skin tissues. Quantitative reverse transcription polymerase chain reaction was used to evaluate the expression levels of candidate circRNAs. The most significantly over-expressed circRNA was used to predict putative miRNA targets and the binding sites of miRNAs with this circRNA. Finally, we constructed a circRNA-miRNA interaction network and carried out gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. We found 52 significantly upregulated and 24 downregulated circRNAs in keloid compared with normal skin tissue. We confirmed that hsa_circ_0057452, hsa_circ_0007482, hsa_circ_0020792, hsa_circ_0057342, and hsa_circ_0043688 were significantly upregulated in keloid tissues. Analysis of the circRNA-miRNA interaction network revealed that circRNAs could interact with miRNAs, including miRNA-29a, miRNA-23a-5p and miRNA-1976. GO and KEGG analyses indicated that these target genes were involved in biological functions and signaling pathways that may play vital roles in the pathogenesis of keloid. This study revealed that circRNAs are potentially implicated in the development of keloid and could serve as novel diagnostic and therapeutic targets.


Assuntos
Redes Reguladoras de Genes/genética , Queloide/genética , MicroRNAs/genética , RNA Circular/genética , Adulto , Sítios de Ligação/genética , Estudos de Casos e Controles , Cicatriz Hipertrófica/epidemiologia , Cicatriz Hipertrófica/genética , Biologia Computacional/métodos , Perfilação da Expressão Gênica , Regulação da Expressão Gênica , Humanos , Queloide/epidemiologia , Queloide/patologia , Análise em Microsséries , Pele/metabolismo , Pele/patologia , Adulto Jovem
17.
Burns ; 46(1): 225-233, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31787474

RESUMO

BACKGROUND: Distally based peroneal artery perforator-plus fasciocutaneous (DPAPF) flaps and distally based posterior tibial artery perforator-plus fasciocutaneous (DPTAPF) flaps are widely used to reconstruct soft-tissue defects of the distal lower leg, ankle, and foot. However, a comparative study of both flaps in a considerable sample size is lacking. This retrospective study aimed to compare the efficacy of the flaps and provide referential evidence for selection of flaps. METHODS: Between April 2001 and October 2016, 227 patients underwent reconstruction with DPAPF flaps (peroneal group; n = 150) or DPTAPF flaps (posterior tibial group; n = 82). The distal lower leg, ankle, and foot were divided into Zones I and II. Flap viability-related complications and their risk factors, reconstruction outcomes, and donor-site morbidities were compared. RESULTS: In Zone I, the partial necrosis rate was lower in the peroneal group than in the posterior tibial group (p > 0.05). In Zone II, the partial necrosis rate was significantly lower in the peroneal group (p < 0.05). Significantly lower incidences of donor-site morbidities in terms of hypertrophic scarring, itching, and pigmentation were observed in the peroneal group (p < 0.05). CONCLUSIONS: The DPAPF flap was superior to the DPTAPF flap with respect to reliability and decreased donor-site morbidities. The former is the recommended preferential choice between the two.


Assuntos
Traumatismos do Tornozelo/cirurgia , Traumatismos do Pé/cirurgia , Úlcera do Pé/cirurgia , Osteomielite/cirurgia , Retalho Perfurante , Procedimentos de Cirurgia Plástica/métodos , Complicações Pós-Operatórias/epidemiologia , Tornozelo/cirurgia , Doença Crônica , Cicatriz Hipertrófica/epidemiologia , Feminino , Pé/cirurgia , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Necrose , Transtornos da Pigmentação/epidemiologia , Prurido/epidemiologia , Estudos Retrospectivos , Neoplasias de Tecidos Moles/cirurgia , Artérias da Tíbia , Sítio Doador de Transplante
18.
Saudi Med J ; 40(7): 701-706, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31287131

RESUMO

OBJECTIVES: To investigate the correlation between the characteristics of urethral stricture and incision scars in patients with urethral stricture and median sternotomy incision. Methods: We identified 368 patients who had undergone internal urethrotomy between January 2014 and December 2017. A total of 49 male patients with a median sternotomy scar and diagnosed with  urethral stricture were retrospectively evaluated. The median sternotomy incision scars were assessed using the Vancouver Scar Scale (VSS) and the patients were divided into 2 groups. Group I consisted of patients with a VSS score of less than 4 points, and those with ≥4 points constituted group II. The groups were compared in terms of age, smoking habit, body mass index, diabetes mellitus, hypertension, urethral stricture etiology, length and localization, and stricture relapse after intervention. RESULTS: The mean total VSS score was 2.0 points in group I and 7.46 points in group II. There was a significant correlation between the VSS total score and the urethral stricture length among the whole study population (correlation coefficient value=0.481; p less than 0.001). The urethral stricture was longer as the VSS score increased. Conclusion: A poorly healed median sternotomy incision scar can predict a poor wound healing in the urethra tissue. Further large scale, multi-center and prospective studies are needed to clarify this relationship.


Assuntos
Cicatriz Hipertrófica/epidemiologia , Esternotomia , Estreitamento Uretral/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Turquia/epidemiologia , Estreitamento Uretral/diagnóstico por imagem , Cicatrização
19.
Burns ; 45(5): 1066-1074, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30824160

RESUMO

TITLE: Prevalence and Risk Factors for Hypertrophic Scarring of Split Thickness Autograft Donor Sites in a Pediatric Burn Population. OBJECTIVE: The split-thickness autograft remains a fundamental treatment for burn injuries; however, donor sites may remain hypersensitive, hyperemic, less pliable, and develop hypertrophic scarring. This study sought to assess the long-term scarring of donor sites after pediatric burns. METHODS: A retrospective review of pediatric burn patients treated at a single institution (2010-2016) was performed. Primary outcomes were prevalence of donor site hypertrophic scarring, scarring time course, and risk factor assessment. RESULTS: 237 pediatric burn patients were identified. Mean age at burn was 7 yrs., mean %TBSA was 26% with 17% being Full Thickness. Mean follow-up was 2.4 yrs. Hypertrophic scarring was observed in 152 (64%) patients with 81 (34%) patients having persistent hypertrophic scarring through long-term follow-up. Patient-specific risk factors for hypertrophic scarring were Hispanic ethnicity (P=0.03), increased %TBSA (P=0.03), %Full Thickness burn (P=0.02) and total autograft amount (P=0.03). Donor site factors for hypertrophic scarring were longer time to epithelialization (P<0.0001), increased donor site harvest depth (P<0.0001), autografts harvested in the acute burn setting (P=0.008), and thigh donor site location (vs. all other sites; P<0.0001). The scalp, arm, foot, and lower leg donor sites (vs. all other sites) were less likely to develop HTS (P<0.0001, 0.02, 0.005, 0.002, respectively), along with a history of previous donor site harvest (P=0.04). CONCLUSIONS: Hypertrophic scarring is a prominent burden in donor site wounds of pediatric burn patients. Knowledge of pertinent risk factors can assist with guiding management and expectations.


Assuntos
Queimaduras/cirurgia , Cicatriz Hipertrófica/epidemiologia , Transplante de Pele , Pele/patologia , Sítio Doador de Transplante/patologia , Negro ou Afro-Americano , Superfície Corporal , Queimaduras/patologia , Criança , Pré-Escolar , Cicatriz Hipertrófica/etnologia , Cicatriz Hipertrófica/patologia , Feminino , Hispânico ou Latino , Humanos , Masculino , Prevalência , Reepitelização , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Coleta de Tecidos e Órgãos/métodos , Transplante Autólogo , População Branca
20.
J Burn Care Res ; 40(3): 274-280, 2019 04 26.
Artigo em Inglês | MEDLINE | ID: mdl-30806461

RESUMO

Fibroblasts, keratinocytes, mast cells, and other cells participate in hypertrophic scar formation and express the vitamin D receptor. We investigated the association between vitamin D deficiency and the biomechanical properties of hypertrophic burn scars. This cross-sectional study analyzed 486 participants enrolled from May 1, 2013 to April 30, 2017. When complete wound healing was agreed with by the two opinions, blood sampling and scar evaluation were performed. The values of melanin and erythema, trans-epidermal water loss (TEWL), and scar distensibility and elasticity were measured using pigment- and TEWL-measuring devices and a suction skin elasticity meter. 25(OH) vitamin D deficiency was defined as plasma level of <20 ng/ml. The vitamin D-deficient patients had significantly higher mean values of scar melanin and TEWL (P = .032, P = .007), whereas scar erythema level was similar. They also showed significantly lower values of Uf (final distensibility; P < .001), Ua/Uf (gross elasticity; P < .001) and Ur/Uf (biological elasticity; P = .014), and higher value of Uv/Ue (viscoelasticity or potency against interstitial fluid shift; P = .016). In multiple linear regression analysis, Uf, Ua/Uf, Uv/Ue, and Ur/Uf were significantly affected by 25(OH)-vitamin D level in deficient patients (Uf, P = .017; Ua/Uf, P = .045; Uv/Ue, P = .024; Ur/Uf, P = .021). Our results demonstrated that vitamin D deficiency was significantly related to increased pigmentation, decreased skin barrier function, low scar distensibility and elasticity, and slow interstitial fluid movement in burn patients.


Assuntos
Queimaduras/epidemiologia , Queimaduras/patologia , Cicatriz Hipertrófica/epidemiologia , Cicatriz Hipertrófica/patologia , Deficiência de Vitamina D/epidemiologia , Adulto , Fatores Etários , Análise de Variância , Fenômenos Biomecânicos/fisiologia , Biópsia por Agulha , Queimaduras/diagnóstico , Queimaduras/terapia , Cicatriz Hipertrófica/sangue , Estudos Transversais , Bases de Dados Factuais , Feminino , Fibroblastos/patologia , Seguimentos , Humanos , Imuno-Histoquímica , Incidência , Escala de Gravidade do Ferimento , Queratinócitos/patologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/tratamento farmacológico
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