Microneedling in Abdominal Scarring after DIEP-flap Breast Reconstruction to Improve Scar Quality: A Randomized Controlled Split Scar Trial.

Background: Deep inferior epigastric perforator (DIEP) flap breast reconstruction leads to large scars in the breast and abdominal region. Common symptoms related to abdominal scarring include changes in color, stiffness, thickness, and irregularity of the skin. The aim of this study was to examine whether microneedling improves the abdominal scar quality after DIEP-flap breast reconstruction. Methods: A prospective randomized controlled within subject comparison design (N = 30) was used to study the effect of microneedling treatments on the abdominal scar, versus no treatment. Three electrically powered microneedling sessions were performed every 4 weeks on one side of the abdominal scar. Abdominal scar assessment was performed at baseline and 3-, 6-, and 9-month follow-up using the Patient and Observer Scar Assessment Scale (POSAS). Treated and untreated sides were compared using a t test or Wilcoxon signed-rank test in case the data were not normally distributed. Results: Twenty-seven women completed the study. Microneedling treatment led to lower POSAS scores compared with the untreated scar side after the 3- and 9-month follow-up. At the 9-month follow-up, the POSAS total score (Mdn = 17, interquartile range = 18.3 versus Mdn = 21.4, interquartile range = 17.5) was statistically lower for the treated side compared with the untreated side, implying a better-appraised scar quality. The observer POSAS total score was statistically lower for the treated side compared with the untreated side. Conclusions: Based on patient and observer ratings, overall abdominal scars after DIEP-flap surgery improve significantly after microneedling treatment. Scar symptoms reduce faster under the influence of microneedling treatment compared with no treatment.

Breast and abdominal scarring after DIEP flap breast reconstruction: An exploration of patient-reported scar quality.

PURPOSE: This research aimed to explore factors associated with patient-reported breast and abdominal scar quality after deep inferior epigastric perforator (DIEP) flap breast reconstruction (BR). MATERIAL AND METHODS: This study was designed as a descriptive cross-sectional survey in which women after DIEP flap BR were invited to complete an online survey on breast and abdominal scarring. The online survey was distributed in the Netherlands in several ways in order to reach a diverse population of women. Outcomes were assessed with the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS). Additional items were assessed with a numeric rating scale (NRS). RESULTS: A total of 248 women completed the survey. There was a statistically significant worse POSAS scar appraisal for the abdominal scar compared with the breast scar. The vast majority of women reported high scores on at least one scar characteristic of their breast scar or abdominal scar. Overall, color, stiffness, thickness, and irregularity scored higher than pain and itching. Women were only moderately positive about the size, noticeability, location, and the information provided regarding scarring. CONCLUSION: It is crucial to address the inevitability of scars in patient education before a DIEP flap BR, with a particular focus on the abdominal scar, as women experience abdominal scars significantly worse than their breast scars. Providing more information on the experience of other women and the expected appearance will contribute to having realistic expectations while allowing them to make well-informed decisions.

The impact of scars on health-related quality of life after breast surgery: a qualitative exploration.

PURPOSE: The purpose of this research was to explore women's experiences after breast surgery with scar characteristics and symptoms, and its impact on their health-related quality of life (HRQOL). MATERIAL AND METHODS: A qualitative study using semi-structured face-to-face interviews was conducted among women following prophylactic, oncologic, or reconstructive breast surgery in the Netherlands. A directed content analysis was performed using guiding themes. Themes were "physical and sensory symptoms," "impact of scar symptoms," "personal factors," "impact of scar interventions," and "change over time." RESULTS: The study population consisted of 26 women after breast surgery. Women experienced a wide range of symptoms like adherence, stiffness, pain, and uncomfortable sensations. Scar characteristics as visibility, location, texture, and size, influenced satisfaction with their appearance. The impact of scar symptoms is reflected in physical, social, emotional, and cognitive functioning, thereby affecting HRQOL. The experienced impact on HRQOL depended on several factors, like personal factors as the degree of acceptance and environmental factors like social support. CONCLUSION: Women can experience a diversity of scar characteristics and symptoms, which play a central role in the perceived impact on HRQOL. Since scarring can have a considerable impact on HRQOL, scarring after prophylactic, oncologic and reconstructive breast surgery should be given more attention in clinical practice and research. IMPLICATIONS FOR CANCER SURVIVORS: Considering scarring as a common late effect after breast surgery and understanding the variety of experiences, which could impact HRQOL of women, can be beneficial in sufficient information provision, expectation management, and informed decision making.

Faster wound healing with topical negative pressure therapy in difficult-to-heal wounds: a prospective randomized controlled trial.

OBJECTIVE: A randomized clinical trial was conducted to determine the effectiveness and safety of topical negative pressure therapy in patients with difficult-to-heal wounds. METHODS: A total of 24 patients were randomly assigned to either treatment with topical negative pressure therapy or treatment with conventional dressing therapy with sodium hypochlorite. The study end point was 50% reduction in wound volume. The maximum follow-up time was 6 weeks. RESULTS: The median treatment time to 50% reduction of wound volume in the topical negative pressure group was 2.0 weeks (interquartile range = 1) versus 3.5 weeks (interquartile range = 1.5) in the sodium hypochlorite group (P < 0.001). The unadjusted hazard rate ratio for the time until 50% wound volume reduction was 0.123 (P < 0.001). After adjustment for relevant baseline characteristics in a Cox proportional hazards model treatment group, membership was found as the only and statistically significant indicator for the time to 50% wound volume reduction (hazard rate ratio of 0.117 [P < 0.001]). Subgroup analysis of spinal cord injured patients with severe pressure ulcers showed similar statistically significant results as in the total wound group. CONCLUSION: Topical negative pressure resulted in almost 2 times faster wound healing than treatment with sodium hypochlorite, and is safe to use in patients with difficult-to-heal wounds.