Pressure Masks for Facial Scar Treatment after Oncological Reconstruction: Long-Term Patient Satisfaction and Quality of Life.

INTRODUCTION: With increasing incidence of facial skin cancer, more patients undergo facial reconstruction following Mohs micrographic surgery (MMS). Aesthetically unpleasing, thickened facial flaps, and disturbing scars can be treated with a pressure mask with inner silicone lining to help improve functional and aesthetic outcomes. However, data on long-term patient satisfaction and quality of life (QoL) following this treatment are lacking. METHODS: We aimed to assess long-term satisfaction and QoL of patients who underwent local flap reconstruction following MMS. Patients treated between January 2012 and October 2020 were invited to answer FACE-Q and SCAR-Q questionnaires. Demographic data, skin cancer type and location, type of reconstruction, postoperative complications, duration of pressure mask therapy, daily compliance, and additional scar treatment were collected to explore possible predictors. RESULTS: Of 92 eligible patients, 50 responded. Eighteen respondents were male (36%) and 32 were female (64%). Mean duration of pressure mask therapy was 10.20 ± 4.61 months. Patients were 61.14 ± 32.91 months after completion of pressure mask therapy upon participation. Patients whose reconstruction consisted of multiple flaps had significantly worse outcomes in social function (p = 0.012), scar appearance (p = 0.045), and scar symptoms (p = 0.008). A trend of increasing time since therapy completion predicting better outcomes was observed for all scales, and it was a significant predictor for better scar appearance (p = 0.001) and less scar symptoms (p = 0.001). CONCLUSION: Pressure mask treatment for facial flaps and scars following MMS results in good long-term patient satisfaction and QoL. Multiple local flaps, reflecting a larger skin defect postexcision, is a predictor for worse outcomes in social function, scar appearance, and symptoms. Increasing time is associated with increasing satisfaction, which reflects satisfactory and stable long-term effects of treatment, possibly combined with more acceptance of the result over time.

Treatment practice for Dupuytren disease in Belgium before 2020: results from an online survey.

The treatment of Dupuytren disease (DD) continues to evolve. New insights in risk factors for recurrence and new treatment modalities have changed the management strategies for DD over the past decades. However, several differences may remain between these insights and their clinical application. The current tendencies in management of Dupuytren disease, were investigated in a web-based survey. The survey was sent to all members of the Belgian Hand Group, the professional organisation of hand surgeons in Belgium. The participants indicated their preferred treatment for clinical cases and answered questions on the use and timing of splinting, physiotherapy, medication and adapting the management depending on fibrosis diathesis. These findings were compared to recommendations found in the literature. Forty out of 135 surveyed members of the Belgian Hand Group completed the survey and 7 responded incom- pletely, yielding a response rate of 35% for most questions. This is comparable to similar studies. There appeared to be still room for debate on surgical techniques for difficult cases. CCH use increased since reimbursement became available in Belgium, mainly due to satisfying clinical results for patient and surgeon. The survey demonstrated a wide variety in pre- and postoperative splinting protocols, but consensus existed with the literature on postoperative night-time application of orthoses for 7 to 12 weeks.

Can the CutiScan CS 100® measure anisotropy and viscoelasticity in scar tissue after mastectomy? A reliability and validity study.

BACKGROUND: Scars have different biomechanical characteristics, including anisotropy and viscoelasticity compared to healthy skin. To assess these characteristics, the CutiScan CS 100® can be used. The aim of the present study is to investigate reliability and validity of this device in breast cancer patients. MATERIALS AND METHODS: Thirty female patients, with scar adhesions following mastectomy were assessed with the CutiScan CS 100® . Maximal distensibility (pixels) (V1), after-suction return rate (pixels) (V2), and their ratio (%) (V3) at three points on and around the scar were assessed as measures of viscoelasticity. For intra- and interrater reliabilities, the intra-class correlation coefficient (ICC) and its 95% confidence intervals were calculated. The standard error of measurement (SEM) was calculated to interpret reproducibility of these measurements. To investigate criterion validity of the measurement of anisotropy, measurements in the direction of healthy skin were compared with measurements in the direction of the scar, using a paired t-test. RESULTS: V1, V2, and V3 show poor to moderate intrarater reliability (ICC 0.00-0.72) and interrater reliability (ICC 0.00-0.53). The maximum displacement (V1) on the measurement point above the scar shows the best reliability (ICC 0.33-0.72). The SEM is about the same for all parameters at all three points. The paired sample t-test showed a significant difference (p < 0.05) between V1 in the direction towards the scar versus the measurement towards healthy tissue, on the point below the scar. CONCLUSION: These first reliability and validity results of the CutiScan CS 100® for measuring anisotropy and viscoelasticity in scar tissue adhesions after mastectomy seem promising. Further research is needed addressing the limitations of the present study design.

Clinical effects of transparent facial pressure masks: A literature review.

BACKGROUND: Severe facial hypertrophic scars are known to severely impact emotional well-being. Pressure therapy by means of transparent face masks has been used for almost 40 years, but evidence about the clinical effects remains sparse. OBJECTIVES: To provide a summary on the efficacy of transparent face masks in the treatment of facial hypertrophic scars. METHODS: A literature search was conducted in PubMed, MEDLINE, and Cochrane databases through 1 January 2018. Articles describing the clinical effects of facial pressure therapy for remodeling the face after trauma or surgery with a validated tool were included. This review included studies of participants treated with facial hypertrophic scars, both minors and adults. RESULTS: Three articles involving 33 patients were selected for inclusion. Two studies described statistically significant improvement in facial scars measured by durometer, ultrasound, and the Patient and Observer Scar Assessment Scale (POSAS). CONCLUSIONS: Facial pressure masks have been shown to deliver significant improvement in facial scars, measured by both subjective and objective tools. However, only three studies could be included in this literature review. Also, because of considerable limitations of the studies, it remains difficult to draw substantial conclusions about the efficacy of transparent face masks. CLINICAL RELEVANCE: This literature review provides a summary of the current evidence on the subjectively and objectively measured clinical effects of transparent face masks in the treatment of facial scars, highlighting the need for further research on this topic.

An evaluation tool for Myofascial Adhesions in Patients after Breast Cancer (MAP-BC evaluation tool): Concurrent, face and content validity.

PURPOSE: To investigate the concurrent, face and content validity of an evaluation tool for Myofascial Adhesions in Patients after Breast Cancer (MAP-BC evaluation tool). METHODS: 1) Concurrent validity of the MAP-BC evaluation tool was investigated by exploring correlations (Spearman's rank Correlation Coefficient) between the subjective scores (0 -no adhesions to 3 -very strong adhesions) of the skin level using the MAP-BC evaluation tool and objective elasticity parameters (maximal skin extension and gross elasticity) generated by the Cutometer Dual MPA 580. Nine different examination points on and around the mastectomy scar were evaluated. 2) Face and content validity were explored by questioning therapists experienced with myofascial therapy in breast cancer patients about the comprehensibility and comprehensiveness of the MAP-BC evaluation tool. RESULTS: 1) Only three meaningful correlations were found on the mastectomy scar. For the most lateral examination point on the mastectomy scar a moderate negative correlation (-0.44, p = 0.01) with the maximal skin extension and a moderate positive correlation with the resistance versus ability of returning or 'gross elasticity' (0.42, p = 0.02) were found. For the middle point on the mastectomy scar an almost moderate positive correlation with gross elasticity was found as well (0.38, p = 0.04) 2) Content and face validity have been found to be good. Eighty-nine percent of the respondent found the instructions understandable and 98% found the scoring system obvious. Thirty-seven percent of the therapists suggested to add the possibility to evaluate additional anatomical locations in case of reconstructive and/or bilateral surgery. CONCLUSIONS: The MAP-BC evaluation tool for myofascial adhesions in breast cancer patients has good face and content validity. Evidence for good concurrent validity of the skin level was found only on the mastectomy scar itself.

Minimizing limb amputations in meningococcal sepsis by early microsurgical arteriolysis.

PURPOSE: Surgical treatment of children with meningococcal sepsis has mainly involved debridement of necrotic skin and amputation of limbs. This resulted in major functional impairment. On the contrary, when early microsurgical arteriolysis was performed, freeing up the blood vessels, the impaired blood flow could be restored, thereby significantly reducing the amputation levels. METHODS: We prospectively evaluated 14 patients affected by meningococcal sepsis. In 7 patients, microsurgical arteriolysis was performed; standard sepsis treatment was performed on the remaining 7. Ischemia levels on admission were compared with permanent amputation levels after 1 year. RESULTS: Statistically significant decreases (P = .005) in ischemia values were achieved by the arteriolysis, in comparison with final amputation percentages. The functional impairment of the affected limbs was highly reduced compared with the probable loss of function observed on admission. CONCLUSIONS: Our findings show that early microsurgical arteriolysis is a reliable method to reduce the devastating amputations normally found in patients with meningococcal sepsis. This significantly improves the functional outcome in severely ischemic limbs in meningococcal induced septic children.

The effect of triclosan-coated sutures in wound healing. A double blind randomised prospective pilot study.

BACKGROUND: Wound infection and dehiscence are both major contributors to postoperative morbidity. One potential cause or co-factor is the use of suture material. A recently introduced subcutaneous suture is coated with triclosan (TC), an antiseptic drug. It is suggested to reduce wound complications. METHODS: To investigate the effect of TC on wound healing a double blind prospective pilot study in women undergoing a breast reduction was performed. Each patient was her own control. After randomisation the TC-coated sutures were used either on the left or right side. The contralateral side was used as the control. The incidence of dehiscence was studied. RESULTS: Twenty-six patients were included. In the TC breasts there was a wound dehiscence in 16 cases, whereas in the control breasts in seven cases a dehiscence was observed (P=0.023). CONCLUSION: These results suggest that TC-coated sutures should be used with caution. These sutures have already been introduced on to the market without good clinical studies and might have potential adverse effects as shown by these data.

Initial reconstruction of sustained neck and facial burns.

Approximately 50% of burn injuries involve the neck and head region. Because both appearance and function must be taken into account with burns of this area, several consecutive reconstructions will be performed. With a focus on improving outcome after burn injury, we underline the method of grafting as a very important element in primary surgery. With our special excision and grafting technique, we aim to achieve a reconstruction that deals with mobility and aesthetics. Consequently, necessary reconstructive procedures may be fewer and of less magnitude. We describe this surgical technique in detail. In this study we surgically treated 39 patients with sustained facial and neck burns. For 22 patients this surgical treatment circumvented the need to perform any secondary reconstructions. The proposed treatment involves a special grafting technique after pretreatment with a topical agent in combination with early pressure therapy.