Cross-cultural adaptation and psychometric validation of the Patient Scar Assessment Questionnaire to the Spanish language in head and neck surgery.

External appearance is the main aesthetic outcome in patients who undergo surgical procedures. Scars located in exposed areas, such as the neck and face, are important for patients. There are at least eight instruments that are used to evaluate postoperative scars, but few fulfil standard methodological conditions. The Patient Scar Assessment Questionnaire (PSAQ) was designed and validated using psychometric methodology. However, this scale has not been translated or validated in the Spanish language. The aim of this study was to undergo a cross-cultural adaptation and psychometric validation of the PSAQ scale to the Spanish language in patients who underwent head and neck surgery. We followed The Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines for the translation and validation of health-related scales. Forward and back translations were made by independent translators. We included adult patients who underwent thyroidectomy, parathyroidectomy, parotidectomy, and neck dissection. For the psychometric validation, we used a principal axis exploratory factor analysis with oblimin rotation. A reliability test involving Cronbachs alpha and the item-total correlation was performed and for the convergent/concurrent validity, we selected the Spanish version of the Vancouver Scar Scale. A total of 180 patients were recruited. Factor analysis showed a five-factor solution. Cronbachs alpha for the subscales was >0.7. The comparison between the PSAQ appearance subscale and the VSS demonstrated a high correlation (rho = - 0.89). In a sample of 62 patients, the test-retest evaluation showed high correlation (0.74-0.99). Our study supports the Spanish version of the PSAQ as a valid, reliable, and reproducible tool to assess the perception and impact of neck scars in Spanish-speaking patients who undergo head and neck surgery.

Adaptación transcultural del cuestionario POSAS (Patient and Observer Scar Assessment) para valoración de cicatrices / Transcultural adaptation of the POSAS questionnaire (Patient and Observer Scar Assessment) to assess scars

Resumen Introducción: La escala POSAS para evaluación de cicatrices está validada y muestra ventajas sobre otras escalas por integrar parámetros cualitativos y la opinión del paciente. Tiene un uso creciente en la práctica clínica, pero hace falta su adaptación transcultural para su aplicación local. Objetivo: Realizar una adaptación transcultural de la escala POSAS 2.0 original. Materiales y Método: Con técnica de traducción dinámica se efectuó traducción de POSAS en inglés, comparación de traducciones, traducción inversa y prueba piloto en observadores y pacientes. Resultados: Se obtuvo buena correlación de traducciones, los observadores y pacientes lograron comprender el instrumento adaptado en un estudio piloto. Conclusión: Obtuvimos una versión adaptada de la escala POSAS, aplicable a población local para valoración de diferentes tipos de cicatrices. Se puede someter la escala adaptada a procesos de validación.

Introduction: The POSAS scale for the evaluation of scars is validated and shows advantages over other scales by integrating qualitative parameters and the opinion of the patient. It has a growing use in clinical practice, but its transcultural adaptation is needed for its local application. Aim: To carry out a transcultural adaptation of the original POSAS 2.0 scale. Materials and Method: With dynamic translation technique, translation of POSAS in english, comparison of translations, inverse translation and pilot test in observers and patients. Results: Good correlation of translations was obtained, observers and patients were able to understand the instrument adapted in a pilot study. Conclusion: We obtained an adapted version of the POSAS scale, applicable to the local population for assessment of different types of scars. The adapted scale can be submitted to validation processes.

Manejo de cicatrices patológicas excesivas en el Servicio de Rehabilitación / Management of excessive pathological scars in the Rehabilitation Service

The excessive pathological scars are subdivided into hypertrophic, keloid and contracted. They have a complex pathophysiology, not entirely known that only exists in humans. Although the frequency of presentation is not high, excessive pathological scars can affect several areas of human functioning, in the first level of functions and body structures and in the second level of activities of daily life and participation. The evaluation of patients must be complete, including the scar, and any other affected body system, together with psychological, functional and socioeconomic factors. In the treatment of excessive scars there are multiple options that must be combined for a better result. The non-surgical treatments of the most used scars are the pressotherapy, silicone plates, intralesional injections and laser. There are other rehabilitation treatments that although without solid evidence could have a role in patients. The referral to the rehabilitation service is recommended for patients with excessive pathological scars located in areas of folds or special areas and / or, which are accompanied by pain, alterations in the function of the body segment or limitations in activities of daily life, for comprehensive assessment and multidisciplinary management. (AU)

Análise de diagnósticos radiográfico periapicais sugestivos de lesões refratárias / Analysis of periapical radiographic diagnosis that suggest persistent lesion

Cicatrizes fibrosas periapicais podem ter aspecto radiográfico semelhante a lesões periapicais, levando ao plano de tratamento incorreto. Assim, o objetivo deste estudo foi realizar um confronto entre o diagnóstico radiográfico e histopatológico de dentes que foram tratados endodonticamente e apresentaram“lesões periapicais” detectadas radiograficamente após 18 meses do tratamento. Dez pacientes submetidos ao tratamento endodôntico adequado e apresentando imagem radiolúcia persistente 18 meses pós-tratamento, tiveram cirurgia paraendodôntica indicada. Durante a cirurgia, o tecido em volta do ápice foi removido e mergulhado em solução de formalina 10% para processamento histopatológico através de coloração de HE. O ápice removido na apicectomia foi mantido em glutaraldeído 2% e processado para análise por microscopia eletrônica de varredura. Dentre os 10 casos sugestivos de lesão periapical, em apenas um caso foi confirmado diagnóstico de cisto, um caso de granuloma, e os outros oito casos confirmaram cicatriz fibrosa. Em nenhum dos casos foi detectada a presença de bactéria extrarradicular, somente infiltrado inflamatório e presença de células de defesa como linfócitos e neutrófilos, além de hemácias, tecido conjuntivo e colágeno. Pode-se concluir que a radiográfica convencional não constitui ponto conclusivo no diagnóstico de lesões periapicais.

Periapical fibrous scars may have similar radiographic appearance of periapical lesions that canresult in incorrect diagnosis. The aim of this study was a confrontation between the radiographic and histopathologic diagnosis of teeth that were endodontically treated and presented “persistent periapical lesions” detected radiographically after 18 months of treatment. Ten patients under going adequate endodontic treatment and presenting persistent radiolucent image at 18 months post-treatment, had surgery Para endodontic indicated. During surgery, the tissue around the apex was removed and immersedin 10% formalin solution for histological processing by HE staining. The apex oh the tooth was removed and immersed in 2% glutaral dehyde for scanning electron microscopy processing. Among the 10 radiographically suggestive cases of persistent periapical lesion, only 1 case was confirmed diagnosis of cyst, 1 case of granuloma, and the other 8 cases were fibrous scar. In neither case was observed the presence of bacteria, only inflammatory infiltrate and the presence of defense cells such as lymphocytes and neutrophils, red blood cells, connective tissue and collagen. It can be concluded that the conventional radiography is not conclusive point in the diagnosis of periapical lesions.

Surgical treatment of facial acne scars based on morphologic classification: a Brazilian experience.

BACKGROUND: Acne scar treatment remains a challenge in the medical literature. It is very difficult to compare the efficacy of different therapeutic approaches because of the lack of consensus regarding acne scar description and classification. OBJECTIVE: To establish a morphologic classification of acne scars and to assess the efficacy of different therapeutic options based on scar type. METHODS: During an 8-year period, 228 patients were prospectively studied. Their acne scars were morphologically classified and customized, staged rehabilitation programs were established for each patient. The assessment of treatment efficacy was conducted 18 months after the end of treatment and was based on patients' and physicians' opinions ranked on a semiquantitative basis as percentage of improvement from baseline. RESULTS: Among the 168 patients who finished the study, 26 completed three stages of the treatment plan, and 142 were submitted to one or two therapeutic stages, depending on lesion types. Eighty-six percent of the patients considered the results excellent or good compared with 76% by the authors and 78% by three independent dermatologic surgeons. CONCLUSION: The classification and the staged therapeutic plan for acne scarred patients facilitated treatment and improved outcomes and may allow development of protocols by comparing results among different authors.

Complicaciones de la cicatrización de heridas quirúrgicas / Scarring complications of surgical wounds

Se hace referencia a la distinción entre cicatrización y cicatriz y la clasificación según el origen de esta última. Se pasa breve revista a los factores generales y locales que intervienen como complicación de la cicatrización. Se mencionan en forma de cuadro sinóptico las tres fases en que se divide el proceso de cicatrización y su tiempo de duración. Se dividen las cicatrices en viciosas y patológicas. Las primeras se definen como exageración del proceso normal de cicatrización y de las segundas, que son una neopatología, se hace referencia especial al queloide, diferenciándola de la cicatriz hipertrófica, que es una cicatriz viciosa. Breve referencia a un trabajo de investigación personal de 1966 sobre "Primeras etapas de la histogénesis del queloide provocado" y su conclusión. Se pasa revista a factores locales y generales que intervendrían en la formación de un queloide. Para concluir se formulan reglas elementales de la Cirugía dermatológica para lograr una buena cicatriz quirúrgica (AU)

Complicaciones de la cicatrización de heridas quirúrgicas / Scarring complications of surgical wounds

Se hace referencia a la distinción entre cicatrización y cicatriz y la clasificación según el origen de esta última. Se pasa breve revista a los factores generales y locales que intervienen como complicación de la cicatrización. Se mencionan en forma de cuadro sinóptico las tres fases en que se divide el proceso de cicatrización y su tiempo de duración. Se dividen las cicatrices en viciosas y patológicas. Las primeras se definen como exageración del proceso normal de cicatrización y de las segundas, que son una neopatología, se hace referencia especial al queloide, diferenciándola de la cicatriz hipertrófica, que es una cicatriz viciosa. Breve referencia a un trabajo de investigación personal de 1966 sobre "Primeras etapas de la histogénesis del queloide provocado" y su conclusión. Se pasa revista a factores locales y generales que intervendrían en la formación de un queloide. Para concluir se formulan reglas elementales de la Cirugía dermatológica para lograr una buena cicatriz quirúrgica